Stewardship / Resistance Scan for Jan 08, 2020

News brief

English health officials unveil strategy to contain CPE in hospitals

Public Health England (PHE) yesterday published a draft framework for healthcare providers on how to contain the spread of carbapenemase-producing Enterobacteriaceae (CPE) in hospitals.

Among the measures recommended is active screening for CPE among risk groups to minimize transmission from CPE-positive patients and reduce the risk that colonized patients will develop clinical infections. The document says that hospitals will need to develop their own risk assessment based on regional prevalence, patient mix, and connections to other healthcare providers. But it encourages screening for patients who have been previously identified as CPE-positive, been an inpatient in any hospital (both in the United Kingdom and abroad), had multiple hospital treatments, had known epidemiologic links to a CPE carrier, or been admitted to high-risk hospital units.

The framework also calls for appropriate surveillance systems to rapidly detect and monitor patients infected or colonized with CPE and hospital outbreaks, implementation of infection prevention and control practices, thorough environmental cleaning and decontamination processes to reduce CPE reservoirs, antimicrobial stewardship programs to reduce use of broad-spectrum antibiotics, optimized laboratory methods to detect carbapenemase-producing organisms, and support from hospital leadership.

"Unless action is taken, learning from experiences elsewhere in the world, rapid spread of CPE will pose an ever-increasing threat to public health and medical treatment pathways in the UK," the document states.

PHE says the framework is based on new evidence from the past 5 years, but it notes that the evidence base for some of the recommendations is limited. The comment period for the draft framework is open until Feb 14.
Jan 7 PHE draft framework

New strain of hypervirulent, carbapenem-resistant Klebsiella in China

An analysis of bloodstream infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) in China has identified the emergence of a high-risk subclone of the most dominant CRKP clone in Asia, an international teams of researchers reported yesterday in Emerging Infectious Diseases.

The analysis of 203 CRKP isolates collected from patients with bloodstream infections at a Chinese hospital from January 2013 through June 2017 found that 174 (85.7%) belonged to sequence type (ST11), a clone that accounts for 60% of CRKP infections in Asia.

Whole-genome sequencing (WGS) further revealed the prevalence of two capsular types (KLs) among the ST11 isolates—KL47 and KL46—and showed that the ratio of KL47 to KL46 had decreased substantially during the study period, with KL46 becoming more prevalent over the 4 years. Analysis of 162 infected patients showed that patients with ST11-KL46 had significantly higher mortality rates than those with ST11-KL47 (62.2% vs 52.8%) and those with non-ST11 CRKP (62.2% vs 48.8%). The researchers suggest capsular switching in the ST11 population might contribute to the increased mortality.

WGS also revealed the presence of the virulence genes rmpA and rmpA2 in the ST11-KL46 isolates, and phenotypic tests demonstrated enhanced virulence. Phylogenetic reconstruction showed that ST11-KL46 may have emerged from an ST11-K47–like ancestor in 2011 through recombination events.

"In summary, our study identified the emergence of a high-risk subclone of CRKP-ST11, resulting in enhanced virulence and transmissibility," the authors write. "The newly emerging descendant obtained enhanced environmental survival and poses a substantial threat to healthcare networks, suggesting the urgent need for tailor-made surveillance and stricter infection-control measures to prevent further dissemination in nosocomial settings."
Jan 7 Emerg Infect Dis study

CARB-X funds research on new drug class targeting resistant bacteria

CARB-X today said it has awarded TAXIS Pharmaceuticals of Mammoth Junction, New Jersey, up to $3.2 million to develop efflux pump inhibitors (EPIs), a new drug class designed to destroy a major mechanism of multidrug-resistant (MDR) Pseudomonas aeruginosa bacteria.

"Pseudomonas aeruginosa is an intrinsically resistant pathogen, with a nearly impermeable outer membrane and with the ability to turn on many efflux pumps to eject antibiotics that make it through," Erin Duffy, PhD, chief of research and development at CARB-X, which is based at Boston University, said in a CARB-X news release. "The TAXIS project is in the early stages of development but if successful, it would potentially be a leap forward in combating drug-resistance mechanisms and restoring the utility of many existing antibiotics."

TAXIS is eligible for up to $11.4 million in addition funding if the company achieves certain milestones. The EPIs it is developing are designed to disable P aeruginosa efflux pumps, which flush out antibiotics from the cell to protect the MDR bacteria from the drugs. TAXIS researchers are focusing on hospital-acquired and ventilator-related infections.

Greg Mario, MBA, CEO of TAXIS Pharmaceuticals, said, "This new drug class is designed to enable the reuse of existing generic antibiotics by addressing an elemental form of drug resistance."

Since it began in 2016, CARB-X (the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator), a public-private partnership, has announced 54 awards of more than $179 million total. It plans to invest $500 million for promising approaches to combat antibiotic resistance by the end of next year.
Jan 8 CARB-X news release

News Scan for Jan 08, 2020

News brief

New Ebola case confirmed in DRC amid unknown transmission chains

The World Health Organization's (WHO's) online Ebola dashboard shows a case count of 3,392 today, with a single newly confirmed case since yesterday. No new fatalities were recorded, so the death toll remains 2,234.

The WHO said 568 suspected cases are currently under investigation, the same number reported yesterday for the ongoing outbreak in the Democratic Republic of the Congo (DRC). The DRC's Ebola technical committee (CMRE) said the newly confirmed case yesterday was in Mabalako.

All cases in the past 2 weeks have come from Butembo, Katwa, Kalunguta, Mabalako, and Mambasa, the WHO said in its latest situation report on the outbreak yesterday.

"Two of these three chains have an unknown origin to date and are still under investigation, including through the use of the genetic sequencing techniques," the WHO said. "The new confirmed cases in Mambasa are of particular concern, since there had been no new confirmed cases in Ituri Province for 66 days."

The transmission chain in Kalunguta is also unknown.
WHO Ebola dashboard
Jan 7 CMRE report
Jan 7 WHO situation report

WHO confirms MERS case in United Arab Emirates

The World Health Organization (WHO) today confirmed a new MERS-CoV case in the United Arab Emirates (UAE), only the country's second case since 2018.

The MERS-CoV (Middle East respiratory syndrome coronavirus) infection involves a 74-year-old man in Al Ain, a city of more than 750,000 people in Abu Dhabi region, according to a WHO statement. He developed a fever, cough, and sore throat 1 month ago and was hospitalized on Dec 10. He was transferred on Dec 16 to intensive care, where he is now in stable condition.

The man has multiple underlying medical conditions, including diabetes, heart disease, and asthma. He also had recent contact with camels, a known MERS risk factor, on his farm. He had not traveled recently.

The most recent UAE MERS case also involved a farmer in Al Ain and was reported by the WHO on Oct 31, 2019. Before that, the country hadn't confirmed a case since May 2018. All told, the country has reported 89 MERS cases, including 12 deaths, since 2012.

Globally, the WHO has tallied 2,494 MERS cases in that span, including 858 deaths. The vast majority of cases have been in Saudi Arabia.
Jan 8 WHO statement
Oct 31, 2019, CIDRAP News scan on previous case

After 8 German deaths, researchers suggest more testing for Borna virus

Yesterday in the Lancet Infectious Diseases, researchers describe eight human fatalities in Germany caused by Borna disease virus 1 (BoDV-1), and suggest that wider testing for the disease may be useful in regions where the virus occurs in the wild.

The study was based on data collected from the brain tissue of 56 patients who died of an unidentified virus and presented with encephalitis. Six of those patients had BoDV-1, and two were likely infected, the authors said. All patients lived in southern Germany at their time of death. The newly confirmed cases raise the number of published human BoDV-1 infections in the endemic area to 14.

Southern Germany, as well as Austria, Switzerland, and Liechtenstein, is home to the white-toothed shrew, which is the natural reservoir for Borna.

The authors say testing should occur in all patients with unknown and rapidly evolving central or peripheral nervous system disorders, and when patients may have come into contact with the infected reservoir host, the white-toothed shrew. Testing would help gain a more accurate picture of the spread of BoDv-1, they said.

Writing in an accompanying commentary, Tomoyuki Honda, PhD from Osaka University, Japan, said the study "has several implications for the pathology and epidemiology of bornavirus infection…. It is time to relaunch human bornavirus research based on a theoretical framework that integrates the knowledge from these confirmed human bornavirus cases."
Jan 7 Lancet Infect Dis study
Jan 7 Lancet Infect Dis commentary

High-path avian flu outbreaks strike birds in China, Poland, and India

In the latest highly pathogenic avian flu developments, three countries reported new outbreaks, all involving different strains.

In China, the agriculture ministry reported two H5N6 outbreaks involving wild swans in Xinjiang province, located in the west of the country, according to an official statement translated and posted by Avian Flu Diary (AFD), an infectious disease news blog. H5N6 has sickened poultry in several mostly Asian countries, but so far, human illnesses involving the strain have only been reported in China.

Meanwhile, Poland reported eight more H5N8 outbreaks on poultry farms, which come in the wake of new detections announced on Jan 2, according to notifications from the World Organization for Animal Health (OIE). Of the eight new events, seven occurred in Lubelski province, located in the east where the virus was detected earlier this month. One of the farms is in Wielkopolski province in western Poland. The events began between Dec 31 and Jan 4, killing 22,359 of 116,394 susceptible birds. The surviving ones were culled to curb the spread of the virus.

And animal health officials in India reported a H5N1 outbreak at poultry farm in Chhattisgarh state, located in the east central part of the country, according to notification from the OIE. The event began on Dec 7, killing 5,634 of 21,060 birds at the facility. The remaining birds were slaughtered as part of the outbreak response. India's last H5N1 outbreak occurred in September 2019.
Jan 8 AFD post
Jan 7 OIE report on H5N8 in Poland
Jan 8 OIE report on H5N1 in India