Angola, Ethiopia, Pakistan report new polio cases

Two countries in Africa and Pakistan have recorded new polio cases in the past week, according to an update today from the Global Polio Eradication Initiative (GPEI).

Pakistan has reported two wild poliovirus type 1 (WPV1) cases in Shangla and Bannu districts in Khyber Pakhtunkhwa province, with onset of paralysis on May 18 and 24. The cases raise Pakistan's total in 2019 to 24.

A circulating vaccine-derived poliovirus type 2 (cVDPV2) was confirmed in Angola, in a patient with acute flaccid paralysis (AFP) who experienced onset of paralysis on Apr 5. The case-patient lives in Lunda Norte province, which borders the Democratic Republic of the Congo (DRC). GPEI said DRC has been monitoring cVDPV2 outbreaks since 2017.

An AFP patient in Somali province, Ethiopia, also tested positive for cVDPV2. The patient reported an onset of paralysis on May 20.

"Genetic sequencing confirms that the isolated virus is linked to an ongoing cVDPV2 outbreak detected in the Horn of Africa in 2018, with cases reported in Somalia as well as from an environmental sample in Kenya," the GPEI said.
Jun 20 GPEI update

CDC ends investigation into 209-case E coli outbreak tied to ground beef

The Centers for Disease Control and Prevention (CDC) announced an end to its investigation  of an Escherichia coli O103 outbreak linked to contaminated ground beef.

The outbreak resulted in 209 illnesses reported in 10 states—13 more cases than in the agency's last update on May 13. No deaths were recorded, but 29 people were hospitalized for their infections. Two cases of hemolytic uremic syndrome, a type of kidney failure, were reported.

"This outbreak appears to be over. Ill people in this outbreak ate ground beef from many sources. No single supplier, distributor, or brand of ground beef was identified," the CDC said.

On Apr 24, Grant Park Packing of Franklin Park, Illinois, recalled approximately 53,200 pounds of raw ground beef products distributed to restaurants. The day before, K2D Foods, doing business as Colorado Premium Foods in Carrolton, Georgia, recalled 113,424 pounds of ground beef.

Patients reported symptom onset from Mar 1 to May 1. Of 159 people interviewed, 125 (79%) reported eating ground beef in the week prior to illness.

Kentucky and Tennessee recorded the most cases, with 76 and 59 cases respectively. Georgia reported 51.
Jun 19 CDC update

More H5 avian flu confirmed in Namibian penguins, Taiwanese poultry

In the latest highly pathogenic avian flu developments with wild birds and poultry, Namibia reported three more detections in penguins and Taiwan reported three more poultry events involving H5N2, according to notifications from the World Organization for Animal Health (OIE).

Namibia reported its first H5N8 outbreak in February at a penguin breeding site on Halifax Island. Yesterday it reported two others that occurred in February, one on Halifax Island and the other on Ichaboe Island. The third outbreak began on Jun 20 on Mercury Island, another coastal seabird conservation area. Taken together, the outbreaks killed 238 jackass penguins. Officials said the source of the virus is migratory waterfowl.

Taiwan's latest H5N2 events are part of outbreaks in poultry that have been under way since 2015. The three outbreaks began between May 27 and Jun 8. One involved discarded dead geese in Yunlin County, a second occurred in native chickens at a slaughterhouse in Taipei City, and the third involved native chickens at a farm in Yunlin County.

Among the three outbreaks, the virus killed 594 of 12,505 susceptible birds.
Jun 20 OIE report on H5N8 in Namibia
Jun 20 OIE report on H5N2 in Taiwan

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Joint Commission announces stewardship measures for ambulatory care

The Illinois-based Joint Commission, which accredits healthcare facilities for receipt of Medicaid and Medicare reimbursements, has created five new performance measures for antimicrobial stewardship requirements in ambulatory care centers, the commission announced yesterday.

The requirements will become effective on Jan 1, 2020. The new elements of performance align with current recommendations from scientific and professional organizations, the Joint Commission said in a news release, and address the following concepts:

• Identifying an antimicrobial stewardship leader
• Establishing an annual antimicrobial stewardship goal
• Implementing evidence-based practice guidelines related to the stewardship goal
• Providing clinical staff with educational resources related to the goal
• Collecting, analyzing, and reporting related data

The commission developed the new standards after literature and public field reviews and input from two expert panels.

"With improving patient safety as its goal, The Joint Commission developed new requirements to help decrease misuse of antimicrobial medications, which contributes to antibiotic resistance and adverse drug events," the commission said. "This project is a continuation of The Joint Commission’s ongoing initiative to promote the appropriate use of antimicrobial medications in the hospital, critical access hospital and nursing care center programs."
Jun 20 Joint Commission news release

Special point-of-care test tied to fewer antibiotics with respiratory infection

A single-center randomized clinical trial in Beijing has found that a molecular point-of-care test (POCT) for viral and atypical pathogens added to routine real-time polymerase chain reaction (rt-PCR) testing might help reduce intravenous (IV) antibiotics in hospitalized patients who have lower respiratory tract infections, according to findings yesterday in Clinical Microbiology and Infection.

The study compared the POCT FilmArray Panel, which tests for 20 viral and atypical pathogens, plus rt-PCR with a control group that received only routine rt-PCR for 10 pathogens. The researchers enrolled 398 patients in the intervention group and 402 in the control group.

The found that duration of IV antibiotics in the intervention group was shorter than in the control (7.0 vs 8.0 days). In addition, length of hospital stay was 8.0 days compared with 9.0 days, and the cost of hospitalization in the intervention group was $1,805, compared with $2,043. Also, de-escalation was achieved within 72 hours in 7.9% of patients in the intervention group and 3.2% in the control group, with de-escalation in 29.7% and 22.0%, respectively, within 3 to 7 days.
Jun 20 Clin Microbiol Infect abstract

Study finds physician education tied to fewer urgent antibiotics

Originally published by CIDRAP News Jun 20

A study involving nine emergency departments and acute care centers in California and Colorado found that educating physicians and patients about safe antibiotic use was tied to a 34% drop in inappropriate antibiotic prescribing, but the absolute reduction was fairly small because levels were already low to begin with.

Writing in Academic Emergency Medicine yesterday, researchers in the two states describe two approaches designed to help physicians make better choices about prescribing antibiotics for acute respiratory infections. One approach offered educational materials from the "Be Antibiotics Aware" campaign from the US Centers for Disease Control and Prevention for patients and providers, plus an on-site physician stewardship "champion." The other more intensive approach provided education and behavioral "nudges," which gave each physician feedback on prescribing rates and other information.

The investigators then tracked 44,820 visits for respiratory infections caused by viruses—which don't require antibiotics—among 292 providers at five emergency departments and four urgent care centers. They found that, after adjusting for health‐system and provider‐level effects, inappropriate antibiotic prescribing fell from 2.2% (95% confidence interval [CI], 1.0%-3.4%) before the interventions to 1.5% (95% CI, 0.7%-2.3%) with an odds ratio of 0.67 (95% CI, 0.54 to 0.82). Both interventions yielded similar results.

"Our study shows that this relatively simple approach can get us to near-zero inappropriate antibiotic use for acute respiratory infections," said senior author Larissa May, MD, MSPH, MSHS, of the University of California-Davis, in a UC-Davis new release. 
Jun 19 Acad Emerg Med abstract
Jun 19 UC-Davis news release

Dutch researchers report increased resistance in E coli in livestock, poultry

Originally published by CIDRAP News Jun 20

A longitudinal analysis of Escherichia coli isolated from fecal samples from chickens, pigs, and calves in the Netherlands found generally increasing levels of antimicrobial resistance, according to a report today in Eurosurveillance.

Dutch researchers collected fecal samples at slaughter from broilers, pigs, and veal calves from 1998 to 2016—about 300 samples from each animal type per year. They observed a statistically significant increasing resistance trend for all antimicrobials tested except tetracycline among broilers from 1998 to 2009, then a decreasing trend in all antibiotics from 2009 to 2016.

In pigs, resistant counts were generally lower than in broilers except for tetracyclines, where they were a bit higher. Resistance also increased in veal calves, but, because of a sampling change in 2012, results could not be compared directly with the other animal species. The authors also reported sporadic detection of colistin-resistant isolates since 2010, which increased in poultry.
Jun 20 Eurosurveill report

T2Bacteria panel shown to accurately detect ESKAPE bacteria in BSIs

Originally published by CIDRAP News Jun 18

A diagnostic accuracy study has determined that the T2Bacteria Panel rapidly and accurately diagnoses bloodstream infections (BSIs) caused by five common pathogenic bacteria, according to a study today in the Annals of Internal Medicine.

Researchers from several US universities compared results from the panel with those of blood culture for suspected BSI in 1,427 adults at 11 US hospitals from Dec 8, 2015, through Aug 4, 2017.

The T2Bacteria Panel is made by T2 Biosystems of Lexington, Massachusetts. It is designed to identify the most common ESKAPE bacteria (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli).

The investigators found that blood culture and T2Bacteria results were positive for targeted bacteria in 39 (3%) and 181 (13%) of patients, respectively. Per-patient sensitivity and specificity of T2Bacteria for proven BSIs were both 90%, and its negative predictive value was 99.7%. If probable BSIs and both probable and possible BSIs were assumed to be true positives missed by blood culture, per-patient specificity of T2Bacteria was 94% and 96%, respectively.
Jun 18 Ann Intern Med abstract

CARB-X announces funding for new antibiotic class

Originally published by CIDRAP News Jun 18

CARB-X announced yesterday that is awarding United Kingdom–based Oxford Drug Design up to $2.55 million with the possibility of $4.24 million more to develop a new class of antibiotics to treat gram-negative bacterial infections using an approach designed to reduce the likelihood of emerging resistance.

The company is working on drugs that inhibit aminoacyl-tRNA synthetases (aaRSs), enzymes that are essential for bacteria survival. Though aaRSs are a clinically validated target family, no inhibitors with systemic activity have reached the market. Also, the company has developed a new class of small-molecule aaRSs inhibitors that are active against gram-negative ESKAPE pathogens. The compounds target more than one synthetase site to decrease the probability of resistance development.

Oxford Drug Design also received £2 million ($2.5 million) from Innovate UK, on behalf of the country's Department for Health and Social Care, to support other aspects of the company's tRNA synthetase inhibitor research portfolio.

Kevin Outterson, JD, executive director of CARB-X, said in a press release from the group that CARB-X partners are making steady supporting innovative antibacterial research and development like the Oxford Drug Design project to treat drug-resistant bacterial infections. "But we know that much more is needed—more investment and global leadership to establish incentives that will ensure that life-saving products reach the market and patients who need them," he added.

Since its inception in 2016, CARB-X, a public-private partnership, has announced awards for 44 projects in 44 countries exceeding $216 million. Its goal is to invest more than $500 million by 2021 in innovative research and development to combat antimicrobial resistance.
Jun 17 CARB-X press release

Researchers detect multidrug-resistant E coli in Alaskan gulls

Originally published by CIDRAP News Jun 18

A study led by US Geological Survey scientists yesterday in Antimicrobial Agents and Chemotherapy highlights the repeated detection of carbapenemase-producing E coli in gulls in Alaska, the first such report in US wildlife.

The researchers collected 939 gull feces samples from seven locations in late spring and summer of 2016. Seven samples, four from the Kenai Peninsula sampled in June and August and three from Anchorage sampled in August, yielded E coli isolates exhibiting non-wild-type susceptibility to meropenem. All three of the Anchorage isolates harbored the bla_KPC-2 carbapenemase gene. They also harbored genes associated with resistance to as many as eight antibiotic classes.

The four Kenai E coli isolates harbored the bla_OXA-48 carbapenemase gene, and they also harbored genes demonstrating resistance to five antibiotic classes.

The authors conclude, "The isolation of CPE [carbapenemase-producing Enterobacteriaceae] from environmental samples collected in Alaska is both unprecedented and potentially relevant to local public health."

In an accompanying commentary, two experts from the Czech Republic write, "Wild animals are not only useful sentinels mirroring the presence of the AMR [antimicrobial resistance] in the contaminated environment in a particular area, but they also have been recognized as possible reservoirs, melting-pots, vectors and secondary sources of multi-drug resistant bacteria for humans and animals. Wild birds are ubiquitous and their faeces are freely dispersed into the environment, possibly contaminating surface waters and soils where crops are grown.

"However, at this stage it is difficult to assess human health risks of the AMR in wildlife as it requires active surveillance of clinically relevant resistant bacteria in the environment including wildlife which is currently very limited. The use of antibiotics and human to human transmission is clearly the driving force in CPE dissemination."
Jun 17 Antimicrob Agent Chemother study
Jun 17 Antimicrob Agent Chemother commentary