Stewardship / Resistance Scan for Jul 28, 2022

News brief

High levels of antibiotic-resistant urinary bacteria found in German men

An analysis of urine specimens from male patients in Germany found high levels of antibiotic resistance in the most frequent causes of urinary tract infections (UTIs), researchers reported today in Eurosurveillance.

The retrospective observational study analyzed routinely collected urine specimens from 102,736 adult men treated at outpatient practices across Germany from 2015 through 2020. Researchers focused on the distribution of bacteria and the resistance of the three most common bacteria to frequently used oral antibiotics for UTIs. A secondary aim was to identify risk factors for the occurrence UTIs caused by antibiotic-resistant Escherichia coli.

The three most frequent bacteria were E coli (38.4%), Enterococcus faecalis (16.5%), and Proteus mirabilis (9.3%). While E coli resistance to first-line, recommended antibiotics for uncomplicated UTIs (fosfomycin and nitrofurantoin) was low, resistance to amoxicillin (45.7%), TMP (26.6%), and ciprofloxacin (19.8%) was common, and multidrug resistance was high (22.9%). Resistance of E faecalis to ciproflxacin was also high (29.3%), as was P mirabilis resistance to TMP (41.3%) and ciprofloxacin (16.6%). Resistance to TMP and ciprofloxacin was significantly higher among bacteria derived from recurrent UTIs.

Multivariable logistic regression identified age (90 years or older) and recurrent UTI as independent risk factors for E coli UTIs with resistance to TMP and ciprofloxacin.

The study authors say the findings suggest urine culture should always be performed before therapy in men with suspected UTIs, and that the use of TMP and ciprofloxacin should be limited.
Jul 28 Eurosurveill study


New candidemia treatment could be on the horizon

San Diego-based biotechnology company Cidara Therapeutics announced yesterday that it has submitted a New Drug Application (NDA) to the US Food and Drug Administration (FDA) for its novel antifungal candidate rezafungin.

The company submitted the NDA for rezafungin—an echinocandin antifungal—for the treatment of candidemia and invasive candidiasis based on positive results from the phase 3 ReSTORE and phase 2 STRIVE trial. In both trials, a once-weekly dose of rezafungin demonstrated statistical non-inferiority to once-daily caspafungin, meeting the primary endpoints for the FDA and the European Medicines Agency.

The FDA has granted rezafungin Qualified Infectious Disease Product designation, which confers priority review of the NDA.  If the NDA is accepted, Cidara expects an FDA decision on approval of the drug could come in early 2023. No new therapies for candidemia and invasive candidiasis, which are caused by a yeast called Candida and are associated with high rates of morbidity and mortality, have been approved by the FDA in over a decade.

“If approved, rezafungin would represent an important new treatment option for patients at risk of these potentially deadly diseases," Cidara President and CEO Jeffrey Stein, PhD, said in a company press release.

Cidara also announced that it has entered into a license agreement with Melinta Therapeutics, of Morristown, New Jersey, under which Melinta will acquire an exclusive license to commercialize rezafungin in the United States.
Jul 27 Cidara Therapeutics press release

News Scan for Jul 28, 2022

News brief

Smell and taste loss persists in 5.6% of COVID-19 patients

A systematic review and meta-analysis published yesterday in BMJ estimates that 5.6% of COVID-19 survivors may face long-lasting changes to their sense of smell or taste, adding to concerns about the overall burden of long COVID.

National University of Singapore researchers led the analysis of 18 observational studies of 3,699 adults with 4,180 medical records reporting impaired taste or smell after COVID-19 infection up to Oct 3, 2021. Nine studies were conducted in Europe, five in Asia, and four in North America. Average participant age range was 30.0 to 55.8 years, and the proportion of men ranged from 29.0% to 79.4%.

Models of time-to-event data showed that lingering self-reported smell and taste impairments could affect about 5.6% of COVID-19 patients, but sensitivity analyses suggested that this figure may be an underestimate.

Among all patients, 74.1%, 85.8%, 90.0%, and 95.7% regained their sense of smell by 30, 60, 90, and 180 days, respectively, and 78.8%, 87.7%, 90.3%, and 98.0% recovered their sense of taste by 30, 60, 90, and 180 days, respectively.

Relative to men, women had lower probability of regaining their sense of smell (odds ratio [OR], 0.52; seven studies) and taste (OR, 0.31; seven studies), and patients with more severe initial impairment (OR, 0.48; five studies) and those with nasal congestion (OR, 0.42; three studies) were less likely to recover their sense of smell.

The study authors said that clinicians often overlooked smell and taste dysfunction before the COVID-19 pandemic, perhaps because these senses were considered less important than vision and hearing. "As a result of the COVID-19 pandemic, patients and doctors may now be aware that these are major problems that could adversely impact quality of life, personal-social functioning, mental health, general health, and safety, long after patients recover from COVID-19," they wrote.

It's crucial, the researchers said, to identify affected patients and provide personalized treatment and long-term follow-up. "Our findings are likely to be of substantial relevance to general doctors and otolaryngologists in the counselling of patients with smell and taste disorders post–COVID-19," they concluded.
Jul 27 BMJ study


Global flu levels decline overall, with rises in some regions

Global flu activity has been declining since March, and has dropped some in Southern Hemisphere temperate countries, the World Health Organization (WHO) said this week in its latest update, which roughly covers the first part of July.

Flu appears to have peaked in some parts of Australia, a country that has experienced and early and brisk season. Levels also declined in some temperate South American countries, with southern Africa showing a slight drop.

However, other regions are experiencing upticks, such as in South Asian countries including Bangladesh and Nepal and Southeast Asian countries including Malaysia, Singapore, and Thailand. In East Asia, flu activity continues to rise in southern China.

If recent flu samples tested at national flu labs, 98.6% were influenza A. Of subtyped samples, H3N2 continues to dominant, with H1N1 making up only 2.2% of samples. If subtyped influenza B samples, all belonged to the Victoria lineage.
Jul 25 WHO global flu update


Peanut butter Salmo outbreak winds down, 5 more cases reported

The investigation into a multistate Salmonella Seftenberg outbreak linked to peanut butter is over, with five more cases reported, bringing the total to 21 from 17 states, the Centers for Disease Control and Prevention (CDC) said yesterday.

The latest illness onset was May 24. Of 13 people with available information, 4 were hospitalized. No deaths were reported.

Based on interviews with sick patients, the outbreak had been linked to Jif brand peanut butter, which prompted a recall by its maker J.M. Smucker.

In an update on the investigation, the CDC said the Food and Drug Administration (FDA) sequenced environmental samples collected at the company's Lexington, Ky., facility in 2010, finding that the environmental sample closely matched the outbreak strain.

In a tweet, the CDC warned consumers that though the peanut butter and foods made with it should no longer be on store shelves, it could still be in people's homes. It urged people to check their supplies and throw out or return any of the recalled peanut butter.
Jul 27 CDC outbreak announcement
Jul 27 CDC tweet


Avian flu strikes more poultry in 3 western states

Sporadic highly pathogenic avian influenza outbreaks continue to be reported in the United States, with three more reported from three western states, including another at a commercial turkey farm in Utah, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said in its latest updates.

The turkey farm in Utah is in Sanpete County and houses 12,700 birds. The outbreak is the third to hit a turkey farm in Sanpete County, located in the central part of the state, south of Provo.

The other two outbreaks affected backyard flocks, one in Montana's Flathead County and the other in Washington's Jefferson County.

The outbreaks in US poultry, which involve the Eurasian H5N1 strain, began in early February and have now led to the loss of 41.1 million birds across 38 states. Numerous H5N1 detections are still occurring in wild birds from many states.
USDA APHIS poultry avian influenza updates


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