Stewardship / Resistance Scan for Sep 26, 2019

News brief

Study finds ceftolozane-tazobactam non-inferior for serious pneumonia

An international group of researchers, in a phase 3 trial, have demonstrated that ceftolozane-tazobactam—an antibiotic approved in 2014 for complicated urinary tract and intra-abdominal infections—is non-inferior to meropenem for serious cases of nosocomial (hospital-acquired) pneumonia, paving the way for a potential new tool for the disease.

Writing in The Lancet Infectious Diseases yesterday, the team detailed the randomized, controlled trial conducted at 263 hospitals in 34 countries. The scientists included 726 patients with severe nosocomial pneumonia: 71% had ventilator-associated pneumonia, and 92% required intensive care. They placed 362 in the ceftolozane–tazobactam group and 364 in the meropenem group. The former received 3 grams of the drug, while the latter received 1 gram; both antibiotics were administered every 8 hours for 8 to 14 days.

At 28 days, 87 patients (24.0%) in the ceftolozane–tazobactam group and 92 (25.3%) in the meropenem group had died. At the test-of-cure visit, 197 patients (54%) in the ceftolozane–tazobactam group and 194 (53%) in the meropenem group were clinically cured. "Ceftolozane–tazobactam was thus non-inferior to meropenem in terms of both 28-day all-cause mortality and clinical cure at test of cure," the authors conclude.

Citing the most common causes of nosocomial pneumonia, they add, "High-dose ceftolozane-tazobactam can be used to treat nosocomial pneumonia caused by P aeruginosa (including multidrug-resistant strains), Enterobacteriaceae (including producers of extended-spectrum β-lactamases), and other Gram-negative pathogens."

In an accompanying commentary, experts from the United States and Brazil point out that using a higher meropenem dose might have afforded a better comparison. But they write, "Ceftolozane-tazobactam is a welcome addition to the antibiotic armamentarium for nosocomial pneumonia. Still, in view of the high dose used in this trial and the limited safety data available, close monitoring and surveillance of clinical practice and phase 4 safety registries will be necessary to better define the risk-benefit profile of this new antimicrobial."
Sep 25 Lancet Infect Dis study
Sep 24 Lancet Infect Dis commentary

 

XDR typhoid case reported in Taiwan

Health officials in Taiwan have announced their first imported case of extensively drug-resistant (XDR) typhoid, according to a government statement posted and translated by Avian Flu Diary, an infectious disease news blog.

The statement from Taiwan's Department of Disease Control says the case involves a 30-year-old man who began developing symptoms (diarrhea, fever, and rash) on Aug 4, after traveling to Morocco, India, Indonesia, and Pakistan. Subsequent blood tests confirmed typhoid fever, a highly infectious illness caused by Salmonella enterica serotype Typhi. Genetic sequencing identified the strain, which is resistant to five classes of antibiotics, as originating from Pakistan.

Pakistan is currently the center of an outbreak of XDR Salmonella Typhi that originated in Sindh province in 2016. In December 2018, the World Health Organization reported that the outbreak had affected more than 5,200 people in the country, mainly in Karachi and Hyderabad.
Sep 24 Avian Flu Diary post

 

UK announces funding to boost AMR surveillance in Africa, Asia

The United Kingdom's outgoing chief medical officer yesterday announced £6.2 million ($7.6 million US) in funding to strengthen antimicrobial resistance (AMR) surveillance systems in Africa and Asia.

Professor Dame Sally Davies announced the funding at the United Nations General Assembly (UNGA) in New York, along with £12 million ($14.8 million US) to improve collaborations on health systems research between the UK and low- and middle-income countries. Davies is representing the UK in UNGA high-level discussions on universal health coverage.

UN member states yesterday adopted a declaration recognizing that addressing AMR and investing in innovative health research are critical strategies for achieving universal health coverage. The AMR funding, which will come from the Fleming Fund, will help improve AMR data quality, collection, and sharing in African and Asian nations, with the goal of developing policy and action from that data.

"I am delighted to announce this funding, which will catalyse regional collaboration to help strengthen AMR surveillance systems across Africa and Asia and support the next generation of health policy and systems research," Davies said in a news release from the UK government's Department of Health and Social Care (DHSC).
Sep 25 DHSC news release

News Scan for Sep 26, 2019

News brief

Three new Ebola cases confirmed today, raising total to 3,178

The steady trickle of new Ebola cases in the Democratic Republic of the Congo (DRC) continued today, with the World Health Organization (WHO) dashboard showing three new cases and three new fatalities.

The outbreak total now stands at 3,178 cases, with 2,122 deaths, and 520 suspected cases under investigation.

In the latest daily update from the DRC's multisector Ebola committee (CMRE), the group said the four new cases confirmed yesterday were from Kalunguta, Komanda (two cases), and Mambasa. Those areas have been identified as hot spots of the outbreak in August and September.
WHO Ebola dashboard
Sep 25 CMRE update

 

NFID notes increased flu vaccine uptake in kids, gaps in adult coverage

At an annual event to encourage vaccination ahead of flu season, health officials at a National Foundation for Infectious Diseases (NFID) media briefing today released new poll findings suggesting that only 52% of US adults plan to be immunized this season.

In reviewing vaccine coverage from the 2018-19 season, they said uptake in children increased after a several-year plateau, especially in teens ages 13 to 17, which jumped nearly 20 percentage points. Coverage for adults remains at about 45%.

The NFID poll on attitudes about flu and pneumonia prevention found that most US adults believe vaccination is the best way to protect against flu, but the top reasons for not getting vaccination were beliefs that the vaccine doesn't work, concerns about side effects, and misconceptions about getting flu from the flu vaccine.

Health professionals were the most trusted information source, and 70% said they don't trust social media as an information source. And of those who have been vaccinated against flu, most got it in a health setting, even when flu vaccine was offered in the workplace. The poll also found gaps in understanding of pneumococcal disease among adults age 65 and older with underlying health conditions, a group at increased risk.

The poll was conducted by NORC at the University of Chicago from Aug 15 to Aug 18 of people randomly selected from AmeriSpeak, a survey panel of American households. It included 1,002 complete responses among adults by web and telephone.

At the media briefing, Alex Azar, secretary of the US Department of Health and Human Services, emphasized three steps in preventing flu: vaccination, everyday actions such as staying home when sick and covering coughs, and taking antiviral drugs when prescribed as soon as possible. He compared getting vaccinated against flu to wearing a seatbelt: Though protection isn't invincible, it is significant for very little effort.

As part of the media briefing, Azar received his flu shot, as did Mark May, former offensive guard for the Washington Redskins and NFID flu ambassador.
Sep 26 NFID press release
NFID national poll on flu and pneumococcal disease

 

More yellow fever recorded in Nigerian outbreak

According to a WHO update today, Nigeria has now seen at least 84 suspected yellow fever cases and 26 deaths in an ongoing outbreak in Ebonyi state, for a case-fatality rate of 31%.

This is 29 more cases than were reported on Sep 7, when the WHO said Nigeria had tracked 55 suspected cases in an outbreak that began in May.

"Seventy-nine per cent of suspected cases (66/84), including seven confirmed cases positive by real-time polymerase chain reaction (RT-PCR) are reported from Izzi LGA which is located in the north-eastern part of the State, bordered with Cross River State in the east, and Benue State in the north," the WHO said.

A third of the suspected cases are in children under the age of 9, and 55% of case-patients are male, the WHO said. In 2014, Nigeria introduced the yellow fever vaccine into the immunization schedule, but coverage is low across the country, with coverage estimates at 64% for children aged less than 5 years, and 48% for those older than 5 years of age.

Earlier this month, the WHO and Gavi, the Vaccine Alliance, launched a 10-day yellow fever vaccination campaign targeting 1.6 million people in Ebonyi and two bordering states, Benue and Cross River. The WHO recommends that anyone traveling to Nigeria be vaccinated against yellow fever.
Sep 26 WHO update

 

PAHO: Brazil and United States have most measles cases in 2019

The Pan American Health Organization (PAHO) said most measles cases in the Americas in 2019 have been in Brazil (68%) and the United States (19%), according to an update yesterday.

In 2018, Venezuela and Brazil had the most cases, PAHO said.

A total of 14 countries in the Americas have reported measles cases this year, with 8 confirming cases in the past month. Since Jan 1, the region of the Americas has seen 6,541 confirmed measles cases, including 5 deaths.

Affected countries are Argentina (12 cases), the Bahamas (1), Brazil (4,476), Canada (111), Chile (8), Colombia (203), Costa Rica (10), Cuba (1), Curacao (1), Mexico (17), Peru (2), the United States (1,241), Uruguay (9), and Venezuela (449).

Sao Paulo is the epicenter of the measles outbreak in Brazil, with 4,300 cases and 3 deaths recorded so far this year. The most recent patient in that state had symptom onset on Sep 9. The cumulative incidence rate of measles in Sao Paulo is 10.2 cases per 100,000 population.

As reported yesterday, local officials announced an end to an ongoing measles outbreak in Rockland County, New York. The outbreak, which began in 2018, sickened 312 people. With that outbreak over, the United States is likely to keep its "measles free" status, which has been in jeopardy during this record-breaking year.
Sep 25 PAHO report
Sep 25 CIDRAP news scan

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