Stewardship / Resistance Scan for Oct 15, 2020

News brief

Study will examine risk factors for multidrug-resistant infections

The University of Texas Health Science Center at Houston (UTHealth) announced yesterday that it has received an $11 million grant from the National Institute of Allergy and Infectious Diseases to conduct a 5-year study to better understand why some critically ill patients develop multidrug-resistant infections.

Using state-of-the-art genomic analysis and microbiome analysis, researchers at UTHealth will seek to identify the microbial and clinical factors involved in infections caused by vancomycin-resistant enterococci, extended-spectrum beta-lactamase– and carbapenemase–producing Enterobacterales, and Clostridioides difficile. They'll follow study participants hospitalized in intensive care units at Memorial Hermann Hospital-Texas Medical Center, as well as those in the bone marrow transplant unit at the University of Texas MD Anderson Cancer Center, to understand why some patients colonized with these pathogens develop infections and others don't.

"We want to learn more about how these three classes of organisms colonize the gastrointestinal tract of critically ill patients and, eventually, cause infections in these patient populations," Cesar Arias, MD, MSc, PhD, the study's principal investigator and professor of infectious disease at McGovern Medical School at UTHealth, said in a press release.

Arias says the goals of the study will be to create an algorithm to determine whether patients have a low, medium, or high risk for these infections, and to develop future interventions based on that knowledge.
Oct 14 UTHealth press release

German researchers report C difficile pacemaker infection

In a case study yesterday in Open Forum Infectious Diseases, German researchers reported what they say is the first documented case of a pacemaker infection caused by Clostridioides difficile, a pathogen typically associated with intestinal infections.

The case involved a 75-year-old man who underwent pacemaker implantation at a hospital in Munich following an acute ischemic stroke and treatment for aspiration pneumonia. No specific antibiotic prophylaxis was used for the procedure because the patient was still on antibiotics (piperacillin/tazobactam) for pneumonia. The patient was discharged to a rehabilitation facility 4 days after the procedure, then readmitted to the hospital 7 days later with fever and a reddened pacemaker incision site.

Blood cultures and swab samples from the pacemaker, the leads connected to the device, and the pocket where the leads were implanted all came back positive for C difficile, as did stool samples tested to detect intestinal colonization. One toxigenic strain, RT014, was found in both the stool and the blood samples, but the patient showed no signs of gastrointestinal problems or diarrhea. Antibiotic treatment was switched to intravenous (IV) vancomycin and oral metronidazole, with oral antibiotic therapy switched to vancomycin after 3 days. After 42 days of IV and oral vancomycin, the pacemaker was reimplanted.

Although the route of infection is unclear, the authors of the study suggest the C difficile bacteria could have been on the patient's skin or in the hospital environment. Given the high numbers of asymptomatic C difficile carriers and the growing use of implantable cardiac devices, they say they're surprised there haven't been more reports of extra-intestinal C difficile infections.

"With rising numbers of implanted cardiac electronic devices and the high incidence of C. difficile infections and colonisations, bloodstream and device infections with C. difficile might be a potentially growing issue," they wrote. "Recommendations for management of extra-intestinal C. difficile infection risk and treatment are needed."

C difficile is the leading cause of hospital-acquired diarrhea in the United States and Europe.
Oct 14 Open Forum Infect Dis abstract

News Scan for Oct 15, 2020

News brief

Poor, non-white districts less likely to reopen, study finds

A study yesterday in Journal of School Choice found that US schools in poor districts with large non-white student populations are less likely to reopen fully for the 2020 to 2021 academic year.

Researchers analyzed back-to-the-classroom plans for schools between Aug 5 and Aug 21 in all 50 states, including 120 of the largest school districts. They found that only 6.7% of schools serving a high number of non-white students and 13.3% of high-poverty districts planned to offer face-to-face lessons in the fall. Of the nation's largest school districts, 69% intended to restrict lessons to remote learning.

Nearly all states provided reopening guidance that included strong recommendations or mandates for mask-wearing, provisions for student mask breaks when outdoors or distanced, learning alternatives offered for at-risk students (and staff, in some states), district-level latitude for decision-making, and family choice to begin the year with remote instruction.

"One of the biggest takeaways from this work is that despite the lack of a national blueprint for reopening, states made many similar decisions," the researchers noted.

The authors anticipated that high-poverty districts might be more likely to reopen because of low-income families' child-care and food needs, but found the opposite. "Only four of the 30 poorest districts are opening the school year with in-person instruction," and "Only two of the 31 districts that serve student bodies that are 85% or more nonwhite are opening their campuses this fall," the authors found, perhaps reflecting the disproportionate impact of COVID-19 on people of color and a low level of trust in government response to the pandemic among racial and ethnic minority groups.

"The disruption caused by the pandemic represents a crossroads for public education in the United States," lead author David Marshall, PhD, of Auburn University said in a news release yesterday, noting that more learning choices for families during the pandemic could shift future educational policy. "Parents may emerge from this moment more empowered than before and be ready to take greater responsibility over their children's education. Or they may find themselves weary of the stress caused by the pandemic and ready for a return to what they were accustomed to prior to this disruption," Marshall commented.
Oct 14 J Sch Choice study
Oct 14 Taylor & Francis Group news release

More evidence of COVID-19 protection for people with type O blood

Two retrospective studies in Blood Advances yesterday add evidence for an association between blood type and COVID-19 vulnerability, indicating that people with blood type O may be less susceptible to infection and experience milder disease.

A Danish study compared data from around 473,000 COVID-19–positive individuals with a control group of 2.2 million people in the general population, finding fewer infected people with blood type O (risk ratio [RR], 0.87, 95% confidence interval [CI], 0.82 to 0.91, P < 0.001) and more people with A, B, and AB types. No associations were found between non-O blood groups and comorbidities that might explain infection rate differences.

The authors hypothesize that the presence of virus-neutralizing anti-A and anti-B antibodies on mucosal surfaces of some type O individuals may explain the relative protection for this blood type.

A second study of 95 critically ill COVID-19 patients in a Vancouver, Canada, hospital found that—after adjusting for sex, age, and comorbidities—patients with blood types A or AB were more likely to require mechanical ventilation than patients with types O or B (84% vs 61%, P = 0.02), indicating higher rates of lung damage.

Patients with blood types A and AB also had higher rates of dialysis for kidney failure, suggesting increased organ dysfunction or failure due to COVID-19 (32% vs 95%, P = 0.004). Patients with blood types A and AB did not have longer hospital stays than those with types O or B, but they did experience longer intensive care unit stays, which may signal greater COVID-19 severity.

"The unique part of our study is our focus on the severity effect of blood type on COVID-19. We observed this lung and kidney damage, and in future studies, we will want to tease out the effect of blood group and COVID-19 on other vital organs," said study author Mypinder S. Sekhon, MD, of the University of British Columbia in a news release yesterday. "Of particular importance as we continue to traverse the pandemic, we now have a wide range of survivors who are exiting the acute part of COVID-19, but we need to explore mechanisms by which to risk stratify those with longer-term effects," he added.
Oct 14 Blood Adv study on COVID-19 prevalence
Oct 14 Blood Adv study on COVID-19 severity
Oct 14 American Society of Hematology news release

Avian flu strikes birds in Israel, Russia, and South Africa

In the latest avian flu outbreak developments, Israel and Russia reported more highly pathogenic H5N8 outbreaks, and South Africa reported more low-pathogenic H7 detections at commercial ostrich farms, according to the latest notifications from the World Organization for Animal Health (OIE).

In Israel, animal health officials reported an outbreak at a poultry breeding farm in the Maanit kibbutz in the country's north, which began on Oct 12 and killed 800 of 35,000 susceptible birds. The survivors were culled as part of the outbreak response. The investigation suggests that the source of the virus is probably migratory birds at a pond near the farm.

In a separate report, officials reported an H5N8 outbreak at a zoo in Jerusalem. It began on Oct 12, affecting 6 of 26 black swans, of which 4 were found dead. Officials said the source of the virus is likely contact with wild species, given that birds from Europe are currently migrating over Israel.

Elsewhere, Russia reported two more H5N8 outbreaks in backyard birds from earlier affected Omsk oblast in the country's southwest. The events began on Sep 30 and killed 62 of 1,776 susceptible birds. The rest were slated for culling.

In low-pathogenic developments, South Africa reported two more H7 detections at commercial ostrich farms, all in Western Cape province in the south. The outbreaks occurred in the last half of August, sickening 83 of 2,492 susceptible birds.
Oct 13 OIE report on H5N8 at Israeli poultry breeder
Oct 14 OIE report on H5N8 at a Jerusalem zoo
Oct 14 OIE report on H5N8 in Russia
Oct 14 OIE report on H7 in South Africa
Oct 13 OIE report on H7 in South Africa