Stewardship / Resistance Scan for Jan 16, 2019

News brief

Clinical pathway linked to improved antibiotic prophylaxis in peds surgery

Italian researchers report that an antimicrobial stewardship program based on a clinical pathway (CP) was associated with both an improved choice of antibiotic and duration of perioperative antibiotic prophylaxis (PAP) in pediatric surgical patients. The findings appeared yesterday in Antimicrobial Resistance and Infection Control.

The pre-post quasi-experimental study, conducted in the pediatric surgical unit of Padua University Hospital, assessed the changes in PAP appropriateness and the effect on surgical-site infections (SSIs) in the 6 months preceding CP implementation and the 6 months after implementation. The CP, which details all the steps needed to administer correct PAP to pediatric surgical patients, was developed by a multidisciplinary group of pediatric infectious disease, microbiology, and pediatric surgery specialists and based on the main guidelines for PAP in adult surgical patients.

The study included 766 children from 1 month to 15 years of age, with 394 in the pre-intervention group and 372 in the post-intervention group. After CP implementation, there was an increase in appropriate PAP administration, as well as in the selection of the appropriate antibiotic for prophylaxis, both for monotherapy (from 81% to 91.9%, P = 0.02) and combination therapy (from 65.9% to 100%, P = 0.004).

The duration of prophylaxis also decreased after CP implementation, with an increase in correct PAP discontinuation from 45.1% in the pre-intervention period to 66.7% post-intervention (P < 0.001). Despite the greater use of narrow-spectrum antibiotic for fewer days, there was no increase in SSIs (10/394 (2.5%) pre-intervention vs. 7/372 (1.9%) post-intervention, P = 0.54).

The authors of the study conclude, "CPs with a proper educational intervention can be a useful tool to improve the choice of first-line antibiotic and the duration of PAP in pediatric patients."
Jan 15 Antimicrob Resist Infect Control study

Study: Healthcare-related MRSA rates drop almost in half in Germany

From 2007 to 2016, nonsocomial transmission of methicillin-resistant Staphylococcus aureus (MRSA) dropped significantly in German intensive care units (ICUs) and surgical departments, according to a study published in Journal of Infection.

The study was based on data collected from the voluntary German National Nosocomial Infection Surveillance System and included information from 1,218 intensive care units (ICUs) and 1,556 surgical departments. A total of 14,408 nosocomial MRSA infections were documented during the study period.

The overall decrease in the proportion of MRSA among all healthcare-associated S aureus infections dropped from 37.1% to 20.0% during the 10-year period, a 46.1% decline. In both ICUs and surgical wards, MRSA rates decreased from 37.1% to 21.8% (a 42.4% reduction) in bloodstream infections and 38.7% to 19.2% (50.4% drop) in lower respiratory tract infections. Surgical-site infections caused by MRSA decreased from 21.1% to 7.4%, a 64.9% reduction.

An especially impressive decrease was seen in surgical departments, where overall MRSA proportions fell from 20.4% to 9.4%, a 53.9% drop.

"MRSA still remain[s] a relevant part of healthcare associated infections due to Staphylococcus aureus in Germany. Nonetheless, a significant decrease of its proportion occurred over the course of the past 10 years," the authors concluded.
Jan 15 J Infect study

News Scan for Jan 16, 2019

News brief

Ebola infects 5 more in DRC outbreak, 663 total

The Democratic Republic of the Congo (DRC) Ebola outbreak grew by five cases today, with illnesses reported in four different location, according to the health ministry's daily update.

Of the latest confirmed cases, two are from Katwa, with one each reported in Butembo, Kyondo, and Oicha. The illnesses bring the outbreak number to 663, which includes 614 confirmed and 49 probable cases. Health officials are still investigating 123 suspected Ebola cases, down from 200 noted yesterday.

Five new deaths were reported, including three that occurred in community settings in Katwa, Butembo, and Kyondo. Community deaths raise the risk of further transmission, because the patients weren't isolated and caregivers likely weren't protected at a point during illnesses when viral levels are highest. The two other deaths were reported from the Butembo Ebola treatment center.

Vaccination with Merck's unlicensed VSV-EBOV continues, and today's report said 60,715 people have received it.
Jan 16 DRC statement

CEPI funds Australia-based rapid vaccine response pipeline

The Coalition for Epidemic Preparedness and Innovations (CEPI) has provided $14.7 million in funding for a partnership led by scientists at the University of Queensland to develop a rapid response pipeline to develop and test new vaccines against novel and existing infectious disease threats in as little as 16 weeks, according to a press release today from the university.

Keith Chappell, PhD, one of the leaders of the project, said the goal is to make 200,000 doses of a new vaccine, demonstrate safety and the likelihood of efficacy, and have it ready for field deployment in as little as 6 months. The research group has patented a "molecular clamp" technology designed to stabilize viral proteins that are the main target of the immune system. The technology is part of a platform to make vaccines against a range of human and animal viruses, with promising results for influenza, Ebola, and Nipah viruses, as well as Middle East respiratory syndrome coronavirus (MERS-CoV).

The funding will be spread over 3 years, with a clinical trial of a synthesized influenza vaccine slated to begin later this year, the Sydney Morning Herald reported today.

Collaborators also include Australia's Commonwealth Scientific and Industrial Research Organization (CSIRO), the World Health Organization Collaborating Center for Reference and Research on Influenza, Australian national University, Hong Kong University, and Q-Pharm.

CEPI was founded in 2017 as a way to streamline and fund research for new vaccine candidates against three priority diseases: MERS-CoV, Lassa, and Nipah viruses. It is supported by the governments of Norway, Germany, India, Japan, Belgium, Canada, and Australia, plus groups including the Bill & Melinda Gates Foundation, Wellcome Trust, World Economic Forum, Medical Research Future Fund, and European Commission.
Jan 16 University of Queensland press release
Jan 16 Sydney Morning Herald story

Ethiopia detects malaria-carrying mosquito for first time

For the first time, researchers have detected Anopheles stephensi—a mosquito capable of transmitting malaria and normally found in the Middle East, Indian subcontinent, and China—in Ethiopia.

"If these mosquitoes carry malaria, we may see an emergence of malaria in new regions," said lead study author Tamar Carter, PhD, assistant professor of tropical disease biology at Baylor University, in a Baylor news release. Carter and her team conducted the genetic analysis on the mosquito, and their work is published in the journal Acta Tropica.

The mosquitoes were collected in breeding sites in late 2016 in Kebri Dehar, a city in Ethiopia's semi-arid eastern region. In a phylogenetic analysis, the researchers found the insects to be part of a distinct clade with a sister isolate from Pakistan, possibly suggesting a novel introduction of the species into the Horn of Africa.

"To gain better insight into the geographic range of An. stephensi, the next step is to conduct mosquito surveys in multiple locations throughout Ethiopia," the authors wrote.

According to the World Malaria Report of 2017, more than 68 % of Ethiopia's population is at risk for malaria, with an average of 2.5 million cases reported annually. The dominant mosquito strain that carries the disease in Ethiopia is Anopheles arabiensis.
Jan 16 Baylor University press release
December 2018 Acta Tropica study