Stewardship / Resistance Scan for Jun 07, 2018

News brief

CDC: Injecting drug users 16 times more likely to contract MRSA

People who inject recreational drugs are 16.3 times more likely to develop invasive methicillin-resistant Staphylococcus aureus (MRSA) infections than people who do not inject drugs, according to data published today in the Centers for Disease Control and Prevention's (CDC's) Morbidity and Mortality Weekly Reports (MMWR).

CDC scientists looked at MRSA in drug users from 2005 to 2016 to assess how and if the opioid epidemic has affected MRSA case counts. Using six surveillance sites across the country, the researchers calculated the risk ratio of MRSA among drug users.

During the study period, 39,050 invasive MRSA cases were reported from six sites, with 2,093 (5.4%) occurring in persons who injected drugs. The estimated rate of invasive MRSA among injected drug users older than 13 years was 472.2 per 100,000 in 2011, and the estimated rate among those who did not inject drugs in the previous year was 29.0 per 100,000.

In addition, the researchers found that invasive MRSA in injected drug users rose from 3.5% to 9.2% from 2010 to 2016.

"Although much attention has focused on the transmission of blood-borne pathogens such as HIV and hepatitis B and C viruses related to injection drug use, infections from skin flora such as Staphylococcus aureus are also important and might not be prevented solely by programs focused on preventing blood-borne pathogen transmission," the CDC authors said. "Increases in nonsterile injection drug use are likely to result in increases in the occurrence of invasive MRSA infections among persons who inject drugs, underscoring the importance of public health measures to curb the opioid epidemic."
Jun 8 MMWR study

UK poultry industry has cut antibiotics 82% in 6 years, report says

The UK poultry sector has cut antibiotic use 39% from 2016 to 2017 and 82% over the past 6 years, according to a report this week from the British Poultry Council (BPC).

In addition to the overall reduction, the British poultry industry has slashed the use of fluoroquinolones (deemed critically important antibiotics [CIAs] in humans by the World Health Organization) by 91%, CIA macrolides by 76%, amoxicillin by 60%, and tetracyclines by 93%. In 2012, the poultry sector accounted for 21% of total antibiotic use for food-producing animals in Great Britain, but by 2016 the percentage had dropped to 9.7%.

The BPC also noted that the industry has stopped using antibiotics for growth promotion, as well as ceased using third- and fourth-generation cephalosporins and polymyxins (colistin).

BPC Chairman John Reed said in a news release, "Through BPC Antibiotic Stewardship, the British poultry meat sector is delivering excellence in bird health and welfare by monitoring and reviewing on-farm management practices and ensuring responsible use of antibiotics throughout our supply chain. Our farmers and veterinarians need antibiotics in their toolbox to preserve the health and welfare of our birds. Responsible use of antibiotics is about so much more than reduction targets. Zero use is neither ethical nor sustainable."

UK Chief Veterinary Officer Christine Middlemiss, BVMS, MBA, said, "The achievements made by members of the BPC are remarkable. Continuously reviewing on-farm biosecurity and disease management practices whilst ensuring prudent use of antibiotics is integral to the sustainability of British agriculture."
Jun 4 BPC news release

Study reveals docs' openness, barriers to feedback on antibiotic use

A survey conducted by Vanderbilt researchers found that physicians treating inpatients are open to receiving information on their antibiotic prescribing patterns but are concerned about barriers to that reporting, according to a study today in Infection Control and Hospital Epidemiology.

The investigators surveyed 211 physicians in various specialties who provided inpatient care at Vanderbilt University Hospital. They found that 89% preferred that their own institutions determine provider use attribution as opposed to external personnel, 64% wanted to be compared with other providers within their service, 64% preferred quarterly feedback, and 73% wanted the feedback via email.

The study also found that providers agreed upon attribution of antimicrobial use early on in a hospital stay scenario but disagreed once care became more complex, with some deferring and others accepting responsibility. In general, they expressed concern that quantitative feedback would not account for the complexity of clinical care and severity of illness.

Overall, 51% of providers anticipated changing practice based on antibiotic use feedback.

"Data can help drive change, however in order to implement meaningful change, we must overcome barriers and use this data to improve the use of antibiotics," said lead author Tara Lines, PharmD, in a news release from the Society for Healthcare Epidemiology of America (SHEA), which publishes the journal.
Jun 7 Infect Control Hosp Epidemiol abstract
Jun 7 SHEA news release

BARDA initiative to address systemic health concerns, including sepsis

The Department of Health and Human Services' Biomedical Advanced Research and Development Authority (BARDA) has launched DRIVe (Division of Research, Innovation and Ventures) to accelerate innovations for addressing systemic health concerns through an approach similar to that being taken for addressing man-made health threats, and one of its first focuses is sepsis, FierceHealthcare reports.

DRIVe will take advantage of powers granted to BARDA under the 21st Century Cures Act to fund innovation through grants and venture capital investment. It will also unite a network of accelerators to identify promising interventions, according to the story.

"It's now time to address those systemic problems, the ones common to most illnesses and injuries," said BARDA Director Rick Bright, PhD."Those need to be resolved to save even more lives. With DRIVe, we're focusing on solving sepsis in our lifetime. Too many lives are lost because of sepsis, and if a national health emergency arises, sepsis will surely take more."

DRIVe has already established eight partnerships with institutions across the United States.
Jun 5 FierceHealthcare story
DRIVe website
BARDA news releases page, which includes the 8 partnerships

News Scan for Jun 07, 2018

News brief

Experts say focus on surveillance, not genomes for pandemic readiness

Spending public health money on surveillance rather than on broad, expensive genomic surveys of animal diseases is a sounder investment and better way to prepare for the next pandemic or other global health emergency, three infectious disease experts wrote today in Nature.

"The resurgence of Ebola virus in the Democratic Republic of the Congo this May is a stark reminder that no amount of DNA sequencing can tell us when or where the next virus outbreak will appear," they write, noting that more genome sequence data were obtained in the 2014-16 Ebola outbreak in West Africa than for any single epidemic.

The experts—Edward C. Holmes, PhD, of the University of Sydney, Andrew Rambaut, PhD, of the University of Edinburgh, and Kristian G. Andersen, PhD, at The Scripps Research Institute—also maintain that overselling the potential of genome sequencing to predict future outbreaks undermines trust in public health.

They highlight the recently announced Global Virome Project and its $1.2 billion price tag, which is about a fourth of the annual infectious disease research budget of the US National Institute of Allergy and Infectious Diseases. "Broad genomic surveys of animal viruses will almost certainly advance our understanding of virus diversity and evolution," they write. "[But] in our view, they will be of little practical value when it comes to understanding and mitigating the emergence of disease.

"We urge those working on infectious disease to focus funds and efforts on a much simpler and more cost-effective way to mitigate outbreaks—proactive, real-time surveillance of human populations." They add that emerging diseases are often tied to factors like human encroachment on animal habitat, environmental disturbances, and climate change.
Jun 7 Nature commentary

Study: Influenza remains infective regardless of humid levels

A study today in the Journal of Infectious Diseases challenges the long-held notion that the influenza virus loses infectivity as humidity levels increase.

The study used humidity-controlled chambers to measure the stability of the 2009 pandemic influenza A(H1N1) virus in suspended aerosols and stationary droplets during a 1-hour challenge.

Using a rotating drum that suspended aerosols, the team combined samples of human airway secretions with the 2009 pandemic H1N1 flu strain. When sprayed into a drum, this mixture mimicked the mucosal spray of a sick person's cough.

The drum was tested at seven different humidity levels, ranging from arid to tropical. In all levels, infectivity remained stable.

"The result was surprising," said Linsey C. Marr, PhD, of Virginia Tech's Department of Civil and Environmental Engineering, in a University of Pittsburgh press release. "Because our previous work suggested that the flu virus survived better at low humidity. We thought this might help explain why flu season occurs in the winter, when humidity is low indoors, but we now have to rethink what's happening with the virus when it's in droplets and aerosols."
Jun 7 Journal of Infect Dis study
Jun 7 University of Pittsburgh press release

Officials adjust Nipah totals, say outbreak contained

After testing 244 samples, health officials confirmed 18 cases of Nipah virus, 16 of them fatal, in India's Kerala state, NDTV reported today. The health ministry said the totals were adjusted after two samples from suspected cases that initially tested positive, now tested negative for Nipah.

Earlier this week the chief minister of Kerala Pinarayi Vijayan said the outbreak was contained, telling NDTV, "There is no alarming situation now. The spread of the virus has been controlled. But people should remain alert."

The Nipah outbreak began in early May, when two brothers died from the rare virus. A nurse at a Kerala hospital also died after treating patients who were infected with the virus.

Officials said bats are not ruled out as the primary source of the outbreak, despite samples from seven bat species testing negative for the virus, WION reported today. Local pigs and cattle have also tested negative.

New samples from 55 fruit bats are currently being tested, and officials explained that these animals could likely be the reservoir of the deadly virus. Fruit bats harbor Nipah infections only for a short time, which makes testing difficult, officials said.
Jun 7 NDTV story
Jun 4 NDTV story
Jun 7 WION story

Study: When measles vaccine fails to protect, symptoms milder

A study of measles cases in California over 16 years has revealed that 80% of patients were unvaccinated, 9% had had one dose of measles vaccine, and 11% had had two or more doses of measles vaccine, with this final group experiencing less severe illness. The study was published today in Clinical Infectious Diseases.

Two doses of the measles, mumps, and rubella vaccine are designed to provide protection against measles, so a case in a patient receiving that regimen is considered vaccine failure.

The study authors reviewed all 232 measles cases reported to the California Department of Public Health from 2000 through 2015. They found that individuals who had received two or more vaccine doses had lower rates of hospitalization, cough, coryza (cold-like symptoms), conjunctivitis, and fever than patients who had one vaccine dose or were unimmunized.

The authors conclude, "Vaccine failure measles cases were less ill than cases that occurred in unvaccinated patients. Nevertheless, these cases still required the same amount of public health effort in tracing contacts as in cases who were unvaccinated."
Jun 7 Clin Infect Dis abstract