Romanian authorities identify 4 cases of XDR TB

Cases of extensively drug-resistant tuberculosis (XDR-TB) have been identified in three students at a university in Romania and in a family contact, according to a report yesterday from the European Centre for Disease Prevention and Control (ECDC).

The cluster of cases involves three students attending the University of Medicine and Pharmacy in Oradea Municipality, Bihor County, Romania, and a family member of one of the students. The presumed index case is a student from Israel who was diagnosed in 2015, and the other two students are UK citizens. All three students were in contact with each other at the university. The family contact is a brother of one of the UK students.

Romanian authorities have identified 87 contacts who were exposed to the students and are following up to test for XDR-TB as well as latent TB infection. More cases in association with this cluster are expected.

XDR-TB is a rare type of TB that is resistant to first-line antibiotics (isoniazid and rifampicin), any fluoroquinolone, and at least one of three second-line drugs (amikacin, kanamycin, or capreomycin). While it is possible to treat patients diagnosed with XDR-TB, the remaining treatment options are less effective and have more side effects.
Oct 19 ECDC Rapid Risk Assessment

Dutch study finds incidence of pediatric C diff stable

A study by Dutch researchers yesterday finds that the incidence of pediatric Clostridium difficile infection (CDI) has been stable over the previous 6 years.

The surveillance study, published in Clinical Infectious Diseases, included all CDIs reported from May 2009 to May 2015 by 26 Dutch hospitals participating in a national sentinel surveillance study. Infected children were 2 and older. Investigators distinguished between healthcare-onset CDI (in which symptoms began in a hospital or long-term care facility) and community-onset CDI (when symptoms began at home).

Overall, 4,691 CDIs were included in the study, with a total of 135 pediatric CDIs (3%) being reported at 17 hospitals. The investigators did not observe an increase in the monthly number of reported pediatric CDIs during the study period. The median age of the children with CDI was 10 years.

Of the 135 pediatric CDI cases, 55% were community-onset, and 31% met the criteria for severe CDI. Although severe CDI was more likely to occur in children, it resulted in fewer complications than adult CDI. In contrast to adults, there was no CDI-related mortality. Pediatric CDI cases were more likely to occur in university hospitals than non-university hospitals.

The investigators also found that, of the 36 C difficile PCR ribotypes identified, ribotype 265 was most prevalent in children (15%) but rarely found in adults.

The authors note that the findings are in contrast to several studies in recent years that have shown an increase in the incidence of pediatric CDI in community settings and hospitals in the United States.
Oct 19 Clin Infect Dis abstract

Significant overtreatment, undertreatment found in young people's STIs

A study yesterday suggests a significant number of adolescents and young adults are overtreated, and even more are undertreated, for chlamydia and gonorrhea.

The retrospective study, published in the International Journal of Infectious Diseases, looked at 797 patients aged 13 to 24 who were screened for Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) in the pediatric emergency department of an urban safety-net hospital in Chicago from July 2014 to June 2015. Cook County, where the hospital is located, has the second highest rate of CT and GC infections in the United States, after Los Angeles County.

Overall, the investigators found that 21.6% of the patients tested positive for a sexually transmitted infection (STI), with 19.1% testing positive for CT, 5.5% for GC, and 3.1% testing positive for both. Most of the infected were black and female. Of the 171 patients with an STI, 21.6% were overtreated and 43.4% were undertreated.

When the investigators looked at the factors involved in overtreatment and undertreatment, they found that male and female patients who were overtreated were more likely to present with STI exposure or genitourinary (GU) symptoms. In addition, female patients who were overtreated were likely to be 18 to 19 years old and have a history of STIs. Patients were more likely to be undertreated if they were female and less likely to be undertreated if they presented with STI exposure, had a history of STIs, and had GU symptoms.

Both overtreatment and undertreatment of STIs are problematic. Overtreatment can cause unnecessary emotional trauma, the authors write, and potentially increase the risk of antibiotic resistance, particularly in gonorrhea. Undertreatment, meanwhile, can lead to other conditions and create a pool of young adults and adolescents who are at risk of spreading their infections. The authors suggest that point-of-care testing for CT and GC, as well as use of more modern methods of patient communication to ensure follow-up, could substantially reduce over- and undertreatment.
Oct 19 Int J Infect Dis study