Stewardship / Resistance Scan for Oct 05, 2016

News brief

UK researchers note worrisome antibiotic-resistant Shigella cluster

A UK study this week notes highly resistant Shigella sonnei isolates from men who have sex with men (MSM) who had engaged in high-risk activities, while Canadian scientists report a different antibiotic-resistant Shigella strain in a man with HIV, according to separate reports in Emerging Infectious Diseases.

In the first study, researchers from Public Health England report identifying a cluster of S sonnei in November 2015 that showed high levels of resistance to amoxicillin, ceftriaxone, tetracycline, sulphonamides, trimethoprim, and azithromycin and produced extended-spectrum beta-lactamase (ESBL). Those findings led the agency to sequence about 70% of S sonnei isolates obtained from hospital labs since August 2015.

Their investigation revealed nine patients whose fecal specimens tested positive for resistant S sonnei. Their gastrointestinal symptoms began from September to late December 2015. All seven patients who answered detailed questions about sexual history reported having male partners. Six reported sexual activities considered to be high risk for Shigella transmission, such as oral-anal contact and attendance at sex parties.

Isolates from all nine men produced ESBL and exhibited macrolide resistance. Whole-genome sequencing showed a close relationship among the isolates, which harbored a previously identified plasmid that has since acquired a mobile element, making it more easily transferred to another pathogen, the authors reported. No epidemiologic links were found among the patients, and no point sources were identified, making foodborne acquisition less likely.

In Canada, the researchers reported S flexneri in a 53-year-old HIV-positive MSM that was resistant to ampicillin, trimethoprim/sulfamethoxazole, nalidixic acid, ciprofloxacin, tetracycline, and chloramphenicol. It was susceptible to ceftriaxone, cefixime, ertapenem, and gentamicin and was also isolated last year.
Oct 3 Emerg Infect Dis UK report
Oct 3 Emerg Infect Dis Canadian case report

Study links nations' poverty to higher antimicrobial resistance levels

Researchers from India reported yesterday that countries with lower per-capita income have higher levels of antimicrobial resistance (AMR).

Writing in the International Journal of Infectious Diseases, a trio of scientists compared 2013-2014 gross national income per capita (GNIPC) with the prevalence of three common resistant bacteria: third-generation cephalosporin (3GC)-resistant Escherichia coli, methicillin-resistant Staphylococcus aureus (MRSA), and 3GC-resistant Klebsiella. Their analysis included 43 countries.

The researchers found that, for each log increase in GNIPC, levels of 3GC-resistant E coli, 3GC-resistant Klebsiella, and MRSA dropped 11.3%, 18.2%, and 12.3%, respectively. The association was stronger, however, for E coli and Klebsiella than for MRSA.

The authors concluded, "Our results underscore the urgent necessity of new policies aiming at reducing AMR in resource-poor settings."
Oct 4 Int J Infect Dis study

News Scan for Oct 05, 2016

News brief

H5N1 outbreaks reported in UAE and Nigeria

Health officials in Abu Dhabi yesterday announced the detection of highly pathogenic H5N1 avian flu in quails in the western part of the United Arab Emirates (UAE), according to a report from Xinhua that cited the UAE's state news agency.

The infected birds were found in Al Gharbia, and emergency management teams have taken response steps, including increasing surveillance and alerting farmers in the area, according to the report.

The United Nations Food and Agriculture Organization (FAO) last week warned about H5N1 risk to countries in the Middle East because of a host of factors, including recent outbreaks in Iraq and Lebanon, bird migration and wintering patterns, and political instability.
Oct 5 Xinhua story
Sep 26 CIDRAP News story "FAO warns of H5N1 threat to Middle East"

Elsewhere, Nigeria's agriculture ministry yesterday reported that H5N1 struck a commercial farm housing 32-week-old layers in Rivers state in the south-central part of the country, according to a report from the World Organization for Animal Health (OIE).

The outbreak began Aug 30, killing 1,300 of 2,000 susceptible birds. The remaining 700 were culled to control the spread of the virus. The source of the virus isn't definitive, but officials said poor farm biosecurity may have played a role.

Nigeria is one of a handful of African countries that has reported a resurgence of H5N1 in poultry over the past year.
Oct 4 OIE report on Nigerian outbreak

Korean whistleblower: Scientist carried MERS-CoV samples to France

A scientist working for the South Korean branch of the Pasteur Institute took MERS-CoV samples on a commercial flight from Seoul to Paris without proper clearance and in violation of United Nations rules and French laws, according to a former Pasteur Institute official in South Korea who provided information surrounding the incident, including lab e-mails, to the Korea Times today.

According to the Times, the whistleblower reported the scientist's actions to South Korea's health ministry, which sent a team to the lab to investigate but didn't take any action. An official from the Korea Centers for Disease Control and Prevention told the Times that transporting MERS-CoV samples to another county doesn't violate Korean law but may breach international air transport rules.

The story said that the lab in South Korea conducted an internal investigation and found that all procedures involving the MERS-CoV (Middle East respiratory syndrome coronavirus) samples were done properly.

According to the Times, the whistleblower said that if the containers carrying the virus had ruptured they could have spread quickly in an aircraft cabin and infected many passengers. A top Pasteur Institute official and the Korean virologist involved in the incident did not respond to the Times' request for comment.
Oct 5 Korea Times story

Officials probe Burkholderia cepacia clusters linked to prefilled saline flushes

Health officials in New Jersey and their federal partners are investigating a multistate Burkholderia cepacia bloodstream infection outbreak that appears to be linked to prefilled saline flushes, which the company recalled yesterday.

According to a statement from the New Jersey Department of Health (NJ Health), it received notice last week of clusters of B cepacia bloodstream infections in Pennsylvania and Maryland, adding that its investigation so far has identified two related cases in New Jersey.

The Pennsylvania and Maryland clusters occurred at long-term care facilities in patients who have a history of receiving medications through central lines. The outbreak appears to be linked to prefilled saline flushes made by Nurse Assist, based in Haltom City, Tex.

NJ Health is asking health facilities to immediately stop using the flushes and to report any suspected illnesses.

Meanwhile, the company yesterday announced that it is voluntarily recalling all unexpired lots of its intravenous flush syringes because of possible links to B cepacia bloodstream infections. Nurse Assist said it is actively investigating with federal and state health officials potential contamination.

The event is the second recent B cepacia outbreak in a heathcare setting, where the bacteria are known to spread rapidly. In early July the Centers for Disease Control and Prevention (CDC) announced an outbreak in five states, sickening 47 people, that was linked to the liquid stool softener docusate, produced by PharmTech, which voluntarily recalled its product. The active ingredient in the stool softener is imported from Laxachem Organics, an Indian company that has refused to allow the Food and Drug Administration (FDA) to investigate its facility. The FDA on Aug 18 barred all of the company's products from entering the United States.

In an Aug 10 update the CDC said 60 illnesses had been reported from eight states in the earlier outbreak, which involved two strains. The bacteria can cause severe lung infections and death, especially in people who have immune system compromise or chronic lung conditions.
Oct 4 NJ Health press release
Oct 4 FDA recall notice
Aug 10 CDC information on earlier multistate B cepacia outbreak
Jul 11 CIDRAP News scan "Stool softener ties to Burkholderia cepacia infections in 5 states"

More than half of NICU viral infections require respiratory support

In a case-control study published today in Pediatrics, researchers found that 51% of infants with hospital-acquired respiratory illness require respiratory support, and they average much longer hospital stays than those without such infections.

The researchers based their study on hospital data from 6 years of neonatal intensive care unit (NICU) admissions in Nottingham, United Kingdom. They assessed the relationship between nosocomially acquired viral respiratory tract infections (VRTIs), neonatal respiratory distress, and hospital costs, matching 92 cases with 183 controls from two tertiary NICU units. The median age of gestation was 29 weeks.

Rhinovirus, the virus behind the common cold, was found in 74% of VRTIs. Fifty-one percent of infants with VRTIs needed escalation of respiratory support, and case-patients required respiratory support for an average of 25 days, versus 7 days for controls. Case subjects also spent more time in the hospital (76 days, compared with 41), and 37% required home oxygen. Finally in-hospital costs were much higher for infants with VRTIs ($71,861 compared with $32,057).

Because neonatal respiratory disease remains the leading cause of infant morbidity and mortality, the authors suggest that prevention efforts must be explored to limit the burden of disease.
Oct 5 Pediatrics study