Stewardship / Resistance Scan for Oct 31, 2019

News brief

ICU stewardship program tied to drop in antibiotics, bloodstream infection

An interrupted time series analysis conducted in two Italian intensive care units (ICUs) demonstrated a substantial reduction in antibiotic consumption and bloodstream infections (BSIs) caused by multidrug-resistant (MDR) gram-negative bacteria after the teaching hospital instituted an antimicrobial stewardship (AMS) program, with no change in mortality or length of stay, according to a study yesterday in Clinical Microbiology and Infection.

The analysis spanned January 2017 through 2018 to assess the effects of prospective audit and feedback in the ICUs. Primary outcomes were differences in antibiotic consumption and the incidence of BSIs caused by MDR organisms, while secondary outcomes included mortality rate, mean length of stay, and antibiotic expense.

During the study, hospital staff performed 231 audits that evaluated 693 antibiotic prescriptions. The AMS program was tied to a global reduction in antibiotic consumption, with an overall drop of 324.8 daily defined doses (DDD) per 100 patient-days (PD; P = 0.04), particularly in the use of fluoroquinolone (-63.5 DDD/100 PD, P < 0.001). The authors noted non-significant declines of carbapenems and third- and fourth-generation cephalosporins.

In addition, they noted a drop of 5.8 events of BSI/100 PD (P = 0.026) and in BSI caused by gram-negative MDR bacteria (-2.96 events/100 PD, P = 0.043). The researchers observed no change in hospital mortality or length of stay.
Oct 30 Clin Microbiol Infect abstract

BARDA funds development of rapid sepsis test, digital diagnostic tool

The Biomedical Advanced Research and Development Authority (BARDA) announced that it will provide Cytovale of San Francisco an initial $3.4 million, with an option for an additional $4.17 million, to advance development of the company's sepsis test, which may be able to diagnose the blood infection in less than 10 minutes.

"We need faster diagnostics to reduce the health burden of sepsis in our country and save lives," said BARDA Director Rick Bright, PhD. "Like so many threats, speed of diagnosis is critical to improving outcomes for sepsis patients. Through this and other projects, our Solving Sepsis program continues to focus on catalyzing technology to address sepsis."

According to the Centers for Disease Control and Prevention, sepsis kills about 270,000 Americans annually. Sepsis occurs during a faulty immune response to an infection, and can cause tissue damage, organ failure, and even death.

Earlier this week, BARDA also announced it will provide Beckman Coulter Diagnostics, of Brea, California, with an initial $1.25 million, with an option for an additional $6.5 million, to develop a machine-learning algorithm-based diagnostic for sepsis.

According to Beckman Coulter, the digital diagnostic tool combines clinical data from laboratory tests and patient data from electronic health records to create a predictive machine-learning algorithm expected to more accurately detect sepsis in clinical settings.

Both Cytovale's and Beckman Coulter's projects are part of BARDA DRIVe's Solving Sepsis program, which aims to reduce the incidence, morbidity, mortality, and cost associated with sepsis. BARDA operates under the US Department of Health and Human Services's Office of the Assistant Secretary for Preparedness and Response.
Oct 29 BARDA press releases

Study notes UTI antibiotic prescribing problems in Aussie nursing homes

An antimicrobial prescribing survey of Australian nursing homes found that antibiotics for urinary tract infection (UTIs) often didn't follow guidelines, researchers reported yesterday in the American Journal of Infection Control.

The analysis is based on data from the country's Aged Care National Antimicrobial Prescribing Survey, which has been collecting data since 2015. For the study, the team looked at 2016 and 2017 survey data, comparing antibiotic prescribing for UTIs with national guidelines. The study included 662 antibiotic prescriptions from 247 nursing homes.

For all prophylactic antibiotics for UTIs, 51.8% were prescribed for longer than 6 months, which doesn't follow guidelines.

Most (71.6%) of the antibiotics that doctors prescribed were for cystitis. Cefalexin was most frequently prescribed for the condition, but only 10.4% aligned with recommendations. Prescribing extra daily doses of the drug occurred in 63.2% of the prescriptions.

Researchers said the longer duration findings suggest that many nursing home residents aren't reviewed and tested without antibiotic prophylaxis as often as they should be; however, they note that the study couldn't assess the clinical appropriateness of starting prophylactic therapy, a topic that would be worthy of more detailed study.

They said the reasons for prescribing extra doses of cefalexin for cystitis is unclear, but factors may include that clinicians often prescribe it for other indications, including skin and soft-tissue infections, they may be confused about the higher number of doses recommended for pyelonephritis and lower number recommended for cystitis, or they may believe extra doses are needed for nursing home residents.

Researchers concluded that antimicrobial stewardship activities that target UTI prophylaxis for longer than 6 months and excessive use of cefalexin for cystitis could significantly reduce unnecessary antibiotic prescribing in Australian nursing home residents.
Oct 30 Am J Infect Control abstract

News Scan for Oct 31, 2019

News brief

UAE, Saudi Arabia report MERS cases

The United Arab Emirates (UAE) has reported its first MERS-CoV case since 2018, and Saudi Arabia today reported two new illnesses, according to official reports.

In the UAE, the patient is a 44-year-old farmer who is not a citizen of the country but lives in the city of Al Ain in Abu Dhabi region, according to a statement today from the World Health Organization (WHO), which was notified by the UAE of the case on Oct 7.

The man's symptoms began on Sep 25, and as of Oct 14 he was in stable condition in an intensive care unit. An investigation revealed he had a history of close contact with dromedary camels and sheep at nearby farms in the 2 weeks before his Middle East respiratory syndrome coronavirus (MERS-CoV) symptoms started. He has no history of recent travel, but he has underlying medical conditions, including diabetes, hypertension, and hyperlipidemia. So far, 61 of the man's contacts have been identified and are under monitoring, which include 57 healthcare workers and 4 farmworkers. Five health workers who developed respiratory symptoms tested negative for the virus.

The illness marks the UAE's first since May 2018. The case lifts the UAE's MERS-CoV total to 88 cases, 12 of them fatal.

Elsewhere, Saudi Arabia today reported two more cases, part of an uptick in cases for October. According to a ministry of health (MOH) statement, the patients include a 32-year-old man from Wadi Aldawasir in the central part of the country and a 55-year-old man from Khamis Mushait in the southwest. So far this month, four MERS-CoV cases have been reported from Khamis Mushait. Both men were thought to have had primary exposure, meaning they likely didn't contract the virus from another patient. Contact with camels is listed as unknown for both men. Saudi Arabia has reported 14 MERS-CoV cases in October, up sharply from 4 reported in September.

The WHO said as of Oct 8, it has received reports of 2,470 MERS-CoV cases since 2012, at least 851 of them fatal.
Oct 31 WHO statement
Oct 31 Saudi MOH statement

Probe ends of Salmonella outbreak tied to pig ear dog treats

The investigation into a multistate outbreak of multidrug-resistant Salmonella linked to pig ears meant for dogs is over, the Centers for Disease Control and Prevention (CDC) said yesterday in a notice.

"As of October 30, 2019, CDC and FDA have dropped their warning to avoid buying or feeding any pig ear pet treats, except for treats that have already been recalled," the CDC said. "Always wash your hands right after feeding any pig ears treats to your dogs."

A total of 154 people in 34 states were sickened during this outbreak, representing 11 new cases and 1 new state since the CDC's previous update on Aug 27. Thirty-five people were hospitalized, but there were no deaths. Twenty-seven illnesses (19%) were among children younger than 5 years. Illness-onsets were reported from Jun 10, 2015, to Sep 13, 2019.

Iowa had the most cases, with 24, followed by Michigan (17) and New York (16). Ohio had 12 cases, and Illinois had 10.

The CDC said the identified Salmonella strains were Cerro, Derby, London, Infantis, Newport, Rissen, and I 4,[5],12:i:-. Whole-genome sequencing on isolates from ill people and pig ear samples showed drugs resistance to a number of antibiotics, including ampicillin, tetracycline, and trimethoprim-sulfamethoxazole.

No single brand of pig ears was identified as being the cause of the outbreak, and several companies recalled products.
Oct 30 CDC update

France reports third local Zika case

Active investigation of local Zika virus cases in France has turned up a third case, according to an update today from the European Centre for Disease Prevention and Control (ECDC).

The patient, who had no history of travel to Zika-endemic countries, lives near the first two case-patients in from the city of Hyeres in Var department in the country's southeast.

All three patients were sick in early to mid-August and have recovered.

Identification of a third case reinforces the hypothesis that the virus was spread locally by mosquitoes in August. The patients' symptoms began only a few days apart, suggesting that the cases are part of the same transmission cycle.

The cases are Europe's first known instance of vectorborne spread of Zika virus by Aedes albopictus.

Health officials have stepped up surveillance and vector control activities in the affected area, and health providers in an around Hyeres have been given instructions on managing pregnant patients who lived in or visited the area between July and September.

In an earlier report, the ECDC said the cases pose a low transmission risk. The mosquito that can spread the disease is established in southern Europe, but declining temperatures in autumn aren't favorable for sustained transmission.
Oct 31 ECDC statement
Oct 22 CIDRAP News scan "France reports second local Zika case"