Stewardship / Resistance Scan for Jun 02, 2022

News brief

Review finds increased intestinal carriage of multidrug-resistant E coli

An analysis of studies published over the past two decades shows that human intestinal carriage of multidrug-resistant (MDR) Escherichia coli has risen substantially in healthcare and community settings around the world, researchers reported today in JAC-Antimicrobial Resistance.

The review and meta-analysis of 133 studies published from January 2000 through Apr 22, 2021, which included 73,318 patient samples, found that 21.1% of inpatients in healthcare settings and 17.6% of healthy individuals worldwide carried extended-spectrum beta-lactamase (ESBL)-producing E coli in their intestines, which can cause MDR infections that are difficult to treat.

In healthcare settings, the highest carriage rate by World Health Organization region was found in the Eastern Mediterranean (45.6%), followed by Southeast Asia (32.9%), Africa (32.4%), and the Western Pacific (24.1%). In community settings, the highest carriage rates were observed in Southeast Asia (35.1%), the Western Pacific (25.3%), Africa (21.4%), and Eastern Mediterranean (20.6%).

Based on an estimation from linear regression analysis, the researchers found that the prevalence of human intestinal ESBL E coli carriage in the healthcare setting more than tripled over the study period, from 7% in 2001 to 2005 to 25.7% in 2016 to 2020, with a 10-fold increase seen in community settings (2.6% to 26.4% during the same period). The researchers also found, based on data from Europe, that fecal ESBL E coli colonization increased with duration of contact/stay in healthcare settings. For example, the prevalence of fecal ESBL E coli colonization in patients who spent more than 48 hours in the hospital was twice that of healthy people who had no contact with a healthcare setting.

"Key relevant health organizations should perform surveillance and implement preventive measures to address the spread of ESBL E. coli in both settings," the study authors concluded.
Jun 2 JAC-Antimicrob Resist study

Testing for carbapenemase production rises at VA hospitals

A study of Veterans Affairs medical centers (VAMCs) found an increase in carbapenemase detection and testing following the release of new guidelines, a team of VA researchers reported today in Antimicrobial Stewardship & Healthcare Epidemiology.

In late 2016, the VA released guidelines that prioritized the identification of carbapenenemase-producing carbapenem-resistant Enterobacterales (CP-CRE). The new guidelines simplified antimicrobial susceptibility testing and recommended polymerase chain reaction (PCR) to identify carbapenemase production in CRE cultures. Knowing whether and what type of carbapenemase enzyme or gene is being produced can provide critical information for clinical care and empiric antibiotic treatment, help guide real-time infection control response, and inform epidemiologic surveillance.

To analyze trends in carbapenemase testing and detection following the release of the guidelines, the researchers analyzed microbiologic and clinical data on VA patients who had CRE-positive cultures from 2013 through 2018.

Overall, the researchers identified 5,778 standard cultures from 3,096 patients at 132 VAMCs that grew CRE. Of these, 1,905 (33.0%) had evidence of molecular or phenotypic carbapenemase testing, and 1,603 (84.1%) of these had carbapenemases detected.

Among the cultures confirmed as CP-CRE, 1,053 (65.7%) had molecular testing for one or more mechanism of carbapenemase production. Almost all testing included the KPC enzyme (1,047; 99.4%), with KPC detected in 914 (87.3%) of 1,047 cultures. The NDM enzyme was found in 585 cultures (55.6%), and OXA-48 was found in 507 (48.1%).

Carbapenemase testing increased over the study period, from 23.5% of CRE cultures in 2013 to 58.9% in 2018, with significant increases in testing observed after the release of the new guidelines. The study authors note, however, that despite the encouraging increase in testing, as of 2018, more than 40% of cultures that grew CRE in all VAMCs and more than 75% of cultures in low-complexity or rural facilities did not have evidence of carbapenemase testing.

"Our study indicates a need to expand carbapenemase testing, to standardize test reporting in microbiology reports, and to support all laboratories in fully implementing national recommendations," they wrote. "Further research in this area could help delineate the most cost-effective strategies to enhance implementation of carbapenemase testing for both VA and private-sector healthcare systems."
Jun 2 Antimicrob Steward Healthc Epidemiol abstract

News Scan for Jun 02, 2022

News brief

Study says dogs 97% sensitive at detecting COVID-19 in patients

Compared with reverse-transcription polymerase chain reaction (RT-PCR) testing, dogs can detect COVID-19 infections via scent with high sensitivity (97%)—though lower specificity (91%)—even when patients are asymptomatic, according to a study in PLOS One yesterday.

Scientists in Paris collected nasopharyngeal, saliva, and sweat samples (from participants' armpits) from 335 outpatients, 143 of whom had COVID-like symptoms and 192 of whom did not. Of the 335, 109 patients tested positive for COVID-19 via RT-PCR and 226 tested negative. Of the 109 volunteers with lab-confirmed COVID-19, 78 had symptoms and 31 did not.

Trained dogs correctly identified 106 of the 109 COVID-positive patients and 206 of the 226 COVID-negative patients. That translates to an overall sensitivity of 97% (95% confidence interval [CI], 92% to 99%), which reached 100% (95% CI, 89% to 100%) in asymptomatic patients compared with RT-PCR from nasopharyngeal swabs. The dogs' specificity was 91% (95% CI, 72% to 91%), reaching 94% (95% CI, 90% to 97%) in asymptomatic patients. That compares with 84% sensitivity and 97% specificity for nasopharyngeal antigen testing.

The study authors conclude, "Our results show the excellent sensitivity of SARS-CoV-2 detection by dogs using nasopharyngeal RT-PCR as the reference for comparison. These results are consistent with the results obtained previously in proof of concepts studies using sweat in hospitalized patients."

The authors cite four studies conducted in 2020 and 2021, but an additional study published just last month demonstrated how trained dogs can detect COVID-19 in airline travelers.
Jun 1 PLOS One study

CDC reports 30 more kids' unexplained hepatitis cases

In its weekly update yesterday, the US Centers for Disease Control and Prevention (CDC) reported that investigations are under way into 30 more unexplained hepatitis cases in children, raising the nation's total to 246. The number of affected states and jurisdictions remained the same, at 38.

The CDC has said that many of the recently reported cases are retrospective, with the probe covering illnesses experienced since October 2021.

More than 650 potential cases have been reported in 33 countries, the World Health Organization (WHO) said last week in its latest update. So far, a definitive cause hasn't been established, but a possible role for adenovirus is a strong lead. The CDC and other groups are also examining other infections, such as COVID-19, as well as other types of exposures, including toxins.
Jun 1 CDC update

Avian flu strikes poultry for first time in Georgia

The US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) today reported the first highly pathogenic avian flu outbreak in Georgia of the year, which affected a backyard flock and brought the number of states reporting the virus in poultry to 36.

Georgia's outbreak occurred at a location housing 409 birds in Toombs County, about 90 miles west of Savannah. The state had previously reported the virus in wild birds, but not since the end of March.

In other avian flu developments, the APHIS reported two more outbreaks, both in backyard birds. One occurred in Minnesota's Becker County and the other struck a flock in Washington's Snohomish County.
Jun 2 USDA APHIS announcement
USDA APHIS poultry avian flu outbreak page

H9N2 avian flu infects 2 more in China

China reported two more H9N2 avian flu cases, both in people who had been exposed to live-poultry markets, according to a statement from Macao's Health Service that was translated and posted by Avian Flu Diary (AFD), an infectious disease news blog.

Both patients are children who had mild infections. One is a 5-year-old boy from Hunan province whose symptoms began on Apr 26, and the other is a 2-year-old boy from Guizhou province who got sick on May 8.

H9N2 is known to circulate in poultry in some Asian countries. Most of the human cases have been reported from China. The infections are most common in children, who typically experience mild illnesses. The country had reported four H9N2 cases earlier this year.
Jun 2 AFD post

Iraq reports surge in Crimean Congo hemorrhagic fever

Iraq is experiencing a spike in Crimean Congo hemorrhagic fever (CCHF) activity this year, with cases reported across several governorates, the WHO said yesterday.

Though CCHF, a viral disease usually passed by ticks, is endemic in Iraq, the number of cases reported in the first 5 months of the year is much higher than reported in 2021. So far, 212 cases have been reported, 97 of them lab-confirmed. There have been 27 deaths, 13 of them among patients with lab-confirmed infections.

For comparison, the country reported 33 lab-confirmed cases in 2021.

Most of the patients had contact with animals and were livestock breeders or butchers. Half of the cases were in Thiquar governorate in the southeast. Besides transmission from ticks, the virus can be transmitted through contact with blood or tissues from infected people or livestock.

The WHO said there is a risk of further spread in Iraq because of an upcoming religious holiday, when more animals will be slaughtered. It added that the situation poses a cross-border risk due to holiday travel. Iraq's cases increased in March and April in connection with Ramadan observances.
Jun 1 WHO announcement