ECDC warns that Italian Candida auris outbreak could spread
The European Centre for Disease Prevention and Control (ECDC) yesterday issued a warning about an ongoing outbreak of the multidrug-resistant yeast Candida auris in Italy.
The outbreak began with a single case detected in a hospital in Liguria in July 2019. In February 2020, a case was detected in the same hospital's intensive care unit for COVID-19 patients, and C auris case numbers continued to increase at the facility through 2020 and 2021. Whole-genome sequencing of isolates from 10 of the early cases showed that the isolates belonged to the South Asian clade and that all except one were part of the same cluster originating from the index case.
To date at least 277 cases have been detected at eight hospitals in Liguria, 210 of them at the initial hospital. An additional 11 cases have been detected in facilities in the neighboring region of Emilia-Romagna.
C auris was first identified in Japan in 2009 and since then has been detected in 40 countries on six continents. It can cause severe invasive infections in patients who have underlying disease or immunosuppression, and clinicians have limited treatment options. Nearly all C auris isolates described worldwide have been reported as resistant to fluconazole, with varying levels of resistance to other azoles, echinocandins, and amphotericin B.
The ECDC says that, given the high number of cases and the inter-regional spread, the risk of further spread within Italy is considered high.
Feb 21 ECDC rapid risk assessment
VA study finds most dental antibiotic prophylaxis prescriptions improper
Another study of antibiotic prescribing by Veterans' Affairs (VA) dentists found that five of every six prescriptions for antibiotic prophylaxis were inconsistent with guidelines, researchers reported today in Infection Control & Hospital Epidemiology.
The cross-sectional study of visits to VA dentists from 2015 through 2019 examined all antibiotics prescribed within 7 days of a visit in the absence of an oral infection. In the primary analysis, antibiotic prophylaxis was considered appropriate only if it was associated with a visit that involved manipulation of gingival tissue and if the patient had a cardiac condition at the highest risk of an adverse outcome from infective endocarditis according to guidelines.
In the secondary analysis, antibiotic prophylaxis was considered appropriate if it was associated with tooth extractions or implants and the patients had a cardiac condition or was immunocompromised.
The investigators analyzed data on 369,102 prophylaxis prescriptions for 358,078 visits. Over 90% of the visits were categorized as gingival manipulation. The median prescription duration was 7 days; only 6.5% were prescribed for 1 day.
In the primary analysis, using a narrow definition of appropriate, 15% of prophylaxis prescriptions were considered appropriate. In the secondary analysis, with a broader definition, 72% of prophylaxis prescriptions were considered appropriate. Prophylaxis inconsistent with guidelines increased over time.
For the narrow definition, multivariable analysis found that Black (vs White) race, Latino (vs non-Latino) ethnicity, and visits located in the West census region were associated with unnecessary prophylaxis. Variables associated with a lower risk for inappropriate prophylaxis were older age, prosthetic joints, immunocompromising condition, and rural location. Similar predictors were identified on multivariable analysis for the broad definition, although Latino ethnicity was less likely to be associated with inappropriate prophylaxis and dental visits in the Northeast more likely.
The study authors say pressure for dentists to prescribe antibiotics by medical clinicians may play a role in the lack of guideline concordance.
"Other factors that may be associated with potentially unnecessary prescribing by dentists include time constraints, an aging population, dental implant placements, underinsurance, and procedural skills during emergencies," they write.
Feb 22 Infect Control Hosp Epidemiol abstract
WHO survey finds gaps in global infection prevention and control
A World Health Organization (WHO) survey of infection prevention and control (IPC) professionals found significant gaps in IPC implementation, WHO researchers reported yesterday in The Lancet Infectious Diseases.
From Jan 16 to Dec 31, 2019, 4,440 IPC professionals from 81 countries completed the WHO online IPC assessment framework (IPCAF), a questionnaire that scores responses to questions about eight WHO IPC core components: (1) IPC program; (2) IPC guidelines; (3) IPC education and training; (4) healthcare-associated infection (HAI) surveillance; (5) multimodal strategies; (6) monitoring and audit of IPC practices and feedback; (7) workload, staffing, and bed occupancy; and (8) materials and equipment for IPC. Each section generates a score from 0 to 100.
The overall weighted IPCAF median score indicated an advanced level of IPC implementation (605), but significantly lower scores were found in low-income (385) and lower-middle-income (500) countries, as well as in public healthcare facilities (515). Core component 8 (90) and core component 2 (87.5) scored the highest, and core component 7 (70) and core component 3 (70) scored the lowest.
Overall, only 15.2% (588 of 3,873) of facilities met all IPCAF minimum requirements, ranging from 0% (0 of 417) in low-income countries to 25.6% (278 of 1,087) in primary facilities, 9% (24 of 268) in secondary facilities, and 19% (18 of 95) in tertiary facilities in high-income countries.
The authors of the paper say the findings identify key opportunities to inform ongoing global IPC improvement efforts, particularly in low-income and lower-middle-income countries, and note that improvements will be needed to reduce the global burden of HAIs and antimicrobial resistance (AMR).
"The endemic burden of HAIs and AMR continues to affect patient safety, hamper high standards of quality of care, and impede the achievement of universal health coverage," they wrote.
"To address these challenges and make substantial durable progress in IPC, a greater emphasis must be placed on developing and enforcing stronger policies and regulations, supported by leadership and accountability mechanisms at the highest levels, as well as by an appropriately trained IPC workforce at the facility level."
Feb 21 Lancet Infect Dis study
WHO adds details to deadly UK Lassa cluster reports
The WHO yesterday fleshed out more details on the family cluster of imported Lassa fever cases—one of them fatal—recently reported from the United Kingdom.
The first patient got sick after returning from a trip in late 2021 to Mali, where Lassa fever is endemic. He or she was hospitalized and has recovered. The second and third case involved family members who did not travel.
The WHO notes that the cases mark the second known instance of secondary Lassa transmission in Europe. The last secondary Lassa cases in Europe were reported in 2016 in Germany in an individual who performed postmortem care of a person who died from Lassa virus infection.
In the UK cluster, the other two family members were hospitalized, and one died. British media reports said the patient who died was a newborn.
Contact tracers have identified people who were exposed and are being monitored for 21 days. Those with high-risk exposure have been offered postexposure prophylaxis.
Lassa fever is endemic in a number of West African countries where Mastomys rats spread the virus, which can cause a hemorrhagic illness in humans who consume food or water contaminated with feces or urine from infected animals. Human-to-human infections can occur through contact with an infected patient's body fluids.
Feb 21 WHO statement
Feb 16 BBC story