Stewardship / Resistance Scan for Mar 28, 2018

News brief

Urine culture on hospital admission tied to longer antibiotic therapy

Texas researchers who analyzed data from 230 US hospitals discovered that patients with a urine culture taken on the day of hospital admission receive more days of antibiotics and have a longer hospital stay than do patients who do not have a urine culture, according to their study yesterday in Infection Control and Hospital Epidemiology (ICHE).

The team looked at data on 88,481 adults hospitalized from 2009 through 2014. Of those, 41,070 had a culture taken on day 1 of hospitalization and 47,411 did not. Guidelines recommend generally avoiding antibiotic therapy for a positive urine culture if the patient has no symptoms.

Patients who had the early urine culture received an additional 36,607 aggregate days of inpatient antibiotic treatment, or 0.9 extra days per patient. They also had a 2.1% increase in their length of hospital stay, resulting in an additional 6,071 days of hospital care.

The authors conclude, "Targeted interventions may reduce the potential harms associated with low-yield urine cultures on day 1."
Mar 27 ICHE abstract on urine culture

Stopping MRSA, VRE contact precautions shown effective

Discontinuing contact precautions for patients infected by or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant Enterococcus (VRE), when combined with other infection prevention steps, was not associated with an increased incidence of device-associated MRSA and VRE infections, and the approach may represent a safe and cost-effective strategy, according to a separate ICHE study yesterday.

Virginia Commonwealth University scientists used an interrupted time series design to evaluate the effect of seven horizontal infection prevention interventions across intensive care units (ICUs) and hospital wards at their 865-bed medical center.

They noted that the rate of healthcare-associated infections (HAIs) declined (albeit not significantly) during the study period, from 2011 to 2016. Infection rates for MRSA and VRE decreased by 1.31 (P = .76) and 6.25 (P = .21) per 100,000 patient-days, respectively. In addition, the infection rate for either pathogen decreased by 2.44 per 10,000 patient-days (P = .23) for device-associated HAIs following discontinuation of contact precautions.

"This approach," the authors conclude, "may represent a safe and cost-effective strategy for managing these patients."
Mar 27 ICHE abstract on contact precautions

Review finds high prevalence of drug-resistant Acinetobacter in SE Asia

A new meta-analysis of studies that focused on multidrug-resistant (MDR) HAIs in ICUs in Southeast Asia found a high prevalence of MDR Acinetobacter baumannii, researchers report in a third ICHE study.

The investigators identified 41 studies that among them included data on 22,876 ICU patients in seven Southeast Asian countries. They report up to a 64.9% cumulative incidence of carbapenem-resistant A baumannii and up to a 58.5% incidence of MDR A baumannii among all A baumannii infections, rates that are much higher than reported in other regions. The experts also found a 23% higher death rate in MDR A baumannii, a 72% higher rate for extensively drug-resistant A baumannii, and an 82% higher rate among those with the pan-drug–resistant form of the pathogen.

They note, however, "a paucity of published data on additional length of stay and costs attributable to MDROs [MDR organisms]."

The authors conclude, "This review highlights the challenges in addressing MDROs in Southeast Asia, where HAIs caused by MDR gram-negative bacteria are abundant and have a strong impact on society."
Mar 27 ICHE Southeast Asia abstract

News Scan for Mar 28, 2018

News brief

South Africa reports more H5N8 outbreaks; H5N1 strikes Cambodian farm

South Africa has reported more highly pathogenic H5N8 detections in ostriches, other captive birds, and a wild bird, and Cambodia reported another H5N1 outbreak in poultry, according to the latest avian flu reports from the World Organization for Animal Health (OIE).

In South Africa, H5N8 turned up at another commercial ostrich farm in hard-hit Western Cape province. The outbreak began on Feb 15 in a flock of 384 birds, with 1 death and 23 illnesses reported. The surviving birds were slated for culling as part of the outbreak response.

South African officials also reported an outbreak in October that involved backyard hobby geese and ducks at a location in Western Cape province and an outbreak that began on Mar 11 in backyard hobby swans in North West province. Between those two locations, the virus killed 94 of 2,429 birds.

In wild bird H5N8 developments, the virus was detected in two swift terns found dead on Feb 21 in Eastern Cape province.

In earlier outbreaks, the H5N8 virus struck African penguins and other wild birds off the coast of Western Cape province. As a result, South Africa's Department of Environmental Affairs on Mar 23 announced a ban on scientists handling seabirds during research activities in the coastal area to prevent the virus from unintentionally spreading to other bird colonies, Nature News reported today.
Mar 27 OIE report on H5N8 in South African ostriches
Mar 27 OIE report on H5N8 in other South African birds
Mar 28 Nature News report

Elsewhere, Cambodia—where H5N1 reemerged in poultry in December—reported another poultry outbreak. The event began on Mar 15 at a farm in Siem Reap province in the western part of the country, killing 23 of 200 birds. The remaining ones were destroyed to curb the spread of the virus.
Mar 28 OIE report on H5N1 in Cambodia

Animal study suggests high-dose favipiravir might be useful for Ebola

In trials involving nonhuman primates, high doses of the antiviral drug favipiravir helped the animals survive Ebola infection, a research team based in France reported yesterday in PLoS Medicine.

Favipiravir is a small-molecule antiviral and was one of the experimental treatments used for patients sickened in West Africa's 2014-16 Ebola virus outbreak. Studies based on those experiences, in which lower doses were given, suggested that the drug was well tolerated but didn't seem to have strong antiviral activity.

In the new study, the scientists infected 26 monkeys with the 2001 Gabon strain of Ebola and monitored them for 21 days. Thirteen received treatment starting 2 days before infection, with twice-daily favipiravir at three different doses: 100, 150, or 180 milligram per kilogram (mg/kg).

All animals that were untreated and those receiving the lowest dose died within 10 days of infection. However, 2 of 5 animals treated with the 150-mg/kg dose were still alive at day 21 and 3 of 5 that received the 180-mg/kg dose survived to day 21. Investigators also found that the treatment inhibited viral replication in a drug concentration-dependent manner.

Applicability to humans, however, is limited by the fact that the model is fully lethal and that treatment for people typically begins several days after infection when symptoms and high viremia levels are already occurring.

The authors concluded that their results, combined with earlier data on animals and humans, support further evaluation of high doses of favipiravir for future use in humans, especially for contacts of infected patients.
Mar 27 PLoS Med abstract
Mar 27 PLoS press release