News Scan for Nov 16, 2016

News brief

Vitamin D tied to lower respiratory illness rate in older patients

High doses of vitamin D were associated with a reduced incidence of acute respiratory illness (ARI) by 40% in elderly, long-term–care residents, according to a study today in the Journal of the American Geriatrics Society.

In the first clinical trial to study vitamin D's impact in a nursing home population, researchers looked at 107 residents in Colorado long-term care facilities over the course of 1 year. The patients were all 60 years and older, with an average age of 84. Although ARI was the primary outcome measured, the scientists also tracked falls and fractures, hypercalcemia, and kidney stones as secondary outcomes.

Fifty-five residents received high doses of vitamin D—100,000 units monthly (3,300 to 4,300 units daily)—and 52 received standard doses (400 to 1,000 units per day). Those with higher doses saw ARIs cut 40%, but those patients also fell more compared with the residents who received lower doses of vitamin D. The other secondary outcomes did not vary between the two groups.

The authors of the study said the next step would be reproducing the results in a confirmatory trial and further exploring the risk of falls. But the study results are encouraging for clinicians who have little recourse over viral ARI, especially influenza and bronchitis, which are some of the leading causes of morbidity among older adult populations who live in nursing homes, they added.
Nov 16 Jour Am Ger Soc study
Nov 16 University of Colorado press release

Burkholderia cepacia outbreak from saline syringes sickens 149 in 5 states

A multistate Burkholderia cepacia bloodstream infection outbreak linked to contaminated prefilled saline flushes has now sickened 149 people in five states, according to a Nov 9 update from the US Centers for Disease Control and Prevention (CDC).

Most of the infections have occurred in patients in 58 nursing home or rehabilitation facilities. Six deaths have been reported among the patients, though it's not clear if they were cause by B cepacia infection or other underlying health condition.

The saline flush syringes, used for patients receiving intravenous fluids or antibiotics through central venous catheters, investigated as the source of the bacteria, were made by Nurse Assist, based in Haltom City, Tex. On Oct 4 the company recalled its products.

Affected states are Delaware, Maryland, New Jersey, New York, and Pennsylvania. The CDC has urged local and state health authorities to report any B cepacia bloodstream infections in patients treated in facilities that used the products and whose symptoms began after Aug 1.

B cepacia is resistant to many common antibiotics, and the same bacterium was implicated in a healthcare-related outbreak over the summer linked to the liquid stool softener docusate.
Nov 9 CDC outbreak update

Antimicrobial Resistance Scan for Nov 16, 2016

News brief

Study: Discontinuing contact precautions did not lead to CDI outbreaks

A study yesterday in Clinical Infectious Diseases suggests that contact isolation may not be necessary to prevent outbreaks of Clostridium difficile infection (CDI) in hospitals.

The single-center study was conducted at the University Hospital Basel, Switzerland, a 735-bed tertiary care center that, in contrast to American and European guidelines, has discontinued contact precautions for CDI patients as a standard of care—except in cases where patients have hypervirulent strains of CDI such as PCR ribotype 027 or 078 or are suffering from incontinence. Contact precautions generally include assignment to a single room and the use of gloves and gowns at entrance. Instead, CDI patients at the hospital share rooms with other patients, are treated with adherence to standard precautions, and use dedicated toilets.

For the study, investigators screened the contacts of all index CDI cases recorded at the hospital between January 2004 and December 2013 by culturing rectal swabs. CDI transmission from an index to a contact patient was defined as possible if toxigenic C difficile was detected in contacts, as probable if the identical PCR-ribotype was identified in index-contact pairs, and as confirmed in next-generation sequencing revealed clonality of strains.

Overall, the investigators found that 451 contacts were exposed to 279 CDI index patients, with toxigenic C difficile being detected in 27 (6%) of those contact patients after a median contact time of 5 days. But probable transmission was only detected in six index-contact pairs, and next-generation sequencing performed on four of six pairs with identical PCR-ribotype strains confirmed transmission in only 2 contact patients.

"In conclusion, discontinuing contact precautions did not lead to CDI-outbreaks over a 10-year study period," the authors write. "The rate of transmission was low, challenging current guidelines for management of CDI. Contact isolation may lead to lower levels of care and additional costs."
Nov 15 Clin Infect Dis abstract

Hog workers may be at risk for Staph aureus skin infections, study finds

A study today in PLoS One provides new evidence of the potential risk posed by livestock-associated, drug-resistant Staphylococcus aureus to hog workers and their families.

The study, led by a team of investigators from the Johns Hopkins University Bloomberg School of Public Health, builds on their previous research into the emergence of livestock-associated S aureus in hog workers, which is believed to be linked to the widespread use of antibiotics in hog production. Their previous study found that employees of industrial hog farms, and their family members, may be more vulnerable to nasal carriage of S aureus, methicillin-resistant S aureus (MRSA), and multidrug-resistant S aureus (MDRSA). What they were unable to determine from that research was whether the nasal carriage prevalence of drug-resistant S aureus they found represented a risk for infection. That's what they wanted to find out in the current study.

To determine the risk for infection, the researchers enrolled 103 workers from an industrial hog operation in North Carolina, along with 26 adult household members and 54 minor children. All participants provided a baseline nasal swab and completed a questionnaire. They were also asked whether they had seen symptoms, or been diagnosed with, a soft-tissue skin infection (SSTI) in the 3 months prior to enrollment in the study.

Analysis of the nasal swabs found that 45 of the 103 hog workers (44%) and 31 of 80 household members (39%) carried S aureus in their noses. Nearly half of the strains carried by the hog workers, and nearly a third of those carried by the household members, were drug-resistant. But the researchers also found that 6% of the hog workers and 11% of the children who lived with them had reported a recent SSTI. Furthermore, hog workers who carried S aureus were five times as likely to have an SSTI as those who didn't carry the bacteria, and those who carried MDRSA were nearly nine times as likely to have an SSTI.

While the study was small and the overall number of SSTIs was low among the study participants, the researchers say their findings are the first to show a relation between nasal carriage of livestock-associated S aureus and SSTIs among workers with frequent and intense exposure to hog production.

"Before this study, we knew that many hog workers were carrying livestock-associated and multidrug-resistant Staphylococcus aureus strains in their noses, but we didn't know what that meant in terms of worker health," study leader Christopher D. Heaney, PhD, MS, said in a Johns Hopkins news release. "This study suggests that carrying these bacteria may not always be harmless to humans."
Nov 16 PLoS One study
Nov 16 Johns Hopkins news release

Experts call for surgeons to have a greater role in ASPs

An international collection of experts is calling on surgeons to play a greater role in antimicrobial stewardship programs (ASPs).

In an article published in the journal Surgical Infections, the authors wrote that surgeons, in their role as providers who actively engage in antimicrobial prescribing, must be aware that judicious use of antimicrobials is an integral part of any ASP and is necessary to minimize the emergence of antimicrobial resistance. Moreover, they argue that the direct involvement of surgeons in ASPs, in collaboration with other healthcare specialists, can be highly impactful.

One area where surgeons can play a greater role in ASPs is in enforcing compliance with standards for pre-operative antibiotic prophylaxis (AP), which accounts for 15% of all antibiotic agents prescribed in hospitals. The authors write that surgeons should follow joint guidelines that call for narrow-spectrum antibiotics to be used in procedures that have high rates of surgical site infection (SSI) and administered not more than 30 to 60 minutes before surgery. Those guidelines also discourage the use of prolonged post-operative antibiotic therapy.

And because they commonly have to initiate antimicrobial therapy in their patients if a SSI is suspected, the authors argue that surgeons need to be aware that inappropriate prescribing, improper dosing, and incorrect duration can fuel drug-resistant pathogens and cause collateral damage (such as CDIs) in their patients.

"If surgeons around the world participate in this global fight and demonstrate awareness of the major problem of antimicrobial resistance, they will be pivotal leaders," the authors write. "If surgeons fail to actively engage and use antibiotics judiciously, they will find themselves deprived of the autonomy to treat their patients."
Nov 9 Surg Infect article