News Scan for Nov 25, 2019

News brief

CDC announces E coli outbreak tied to Salinas, California, romaine lettuce

The Centers for Disease Control and Prevention (CDC) said a multistate outbreak of Escherichia coli is connected to romaine lettuce grown in the Salinas, California growing region and is advising people not to eat romaine from that area.

As of Nov 21, 40 people infected with the outbreak strain of E coli O157:H7 have been reported from 16 states, up from 17 illnesses in 8 states reported just 2 days earlier.

"Based on new information, CDC is advising that consumers not eat and retailers not sell any romaine lettuce harvested from the Salinas, California, growing region," the CDC said. "This advice includes all types of romaine lettuce harvested from Salinas, California such as whole heads of romaine, hearts of romaine, and packages of precut lettuce and salad mixes which contain romaine, including baby romaine, spring mix, and Caesar salad."

Eighty percent of interviewed case-patients reported eating romaine lettuce in the week preceding illness. Twenty-eight people have been hospitalized, including five who have been diagnosed as having hemolytic uremic syndrome, a type of kidney failure. There have been no deaths.

The Food and Drug Administration (FDA) also issued a statement on the outbreak, urging consumers to toss any romaine lettuce labeled with "Salinas."

"The FDA and state partners are conducting a traceback investigation to trace romaine exposures to the source. Preliminary information indicates that ill people in Maryland were exposed to romaine lettuce harvested in Salinas, California," the FDA said. "FDA is deploying investigators to the farms in question to try to determine the source and extent of the contamination. More information will be forthcoming as the investigation proceeds."
Nov 22 CDC update
Nov 22 FDA update

Chronic wasting disease detected in another Tennessee county

Animal health officials in Tennessee on Nov 21 announced that chronic wasting disease (CWD) has been detected for the first time in a deer harvested in Shelby County in the far southwestern part of the state near Memphis.

Chuck Yoest, CWD coordinator for the Tennessee Wildlife Resources Agency (TWRA) said in a news relese that the deer was a 2½-year-old buck that was harvested in the Shelby County part of the Wolf River Wildlife Management area, and that the new detection isn't surprising, given that CWD had already been detected in neighboring Fayette County.

Shelby County is already part of a Unit CWD, and hunting regulations specific to the disease already apply there, along with carcass exportation and wildlife feeding restrictions. The TWRA said the only change is that Shelby County will be reclassified as CWD-positive, which will trigger slight modification of carcass export restrictions.

In May, the Tennessee Fish and Wildlife Commission changed deer hunting regulations after CWD was found in three southwestern counties—Fayette, Hardeman, and Madison—last winter. The commission approved the TWRA's recommendation to establish a new CWD deer hunting unit for the three affected counties, plus counties within a 10-mile radius of a positive CWD deer location: Chester, Haywood, McNairy, Shelby, and Tipton.
Nov 21 TWRA press release
May 24 TWRA press release

Dutch nationals contract Lassa fever in Sierra Leone

Two Dutch nationals working in Sierra Leone have contracted Lassa fever and one has died from the virus, while three UK citizens who had close contact with them have been brought back to the country for medical assessment, the UK newspaper The Guardian reports.

Public Health England's head of emerging infections and zoonosis, Jake Dunning, MBE BSc, MBBS, PhD, said, "It is important to emphasise that Lassa fever does not spread easily between people and the overall risk to the public is very low. There are no confirmed cases of Lassa fever in the UK."

Lassa fever is a type of viral hemorrhagic fever that can cause headache, fever, bleeding, and diarrhea. In severe cases, infection can be deadly. There is no vaccine for Lassa fever.

The virus usually spreads to humans after contact with the urine or feces of infected rodents. In recent years Nigeria and other West Africa nations have seen outbreaks of the disease.
Nov 24 Guardian article

Work partially resumes at shuttered USAMRIID lab

After a 4-month hiatus due to safety protocol problems, research will resume on a limited basis at the US Army Medical Research Institute of Infectious Disease (USAMRIID) at Fort Detrick in Frederick, Maryland, the Frederick News-Post reported on Nov 22.

In July, work on high-level pathogens was stopped after a Centers for Disease Control and Prevention (CDC) inspection in June identified several concerns about standard operating procedures.

No pathogens were found outside authorized areas, but the review found issues such as a failure to follow local procedures, a lack of periodic recertification training for biocontainment lab workers, and a wastewater decontamination system that didn't meet Federal Select Agent program standards. The lab said at the time that it had been working on modified biosafety level 3 procedures and a new decontamination system in the wake of flooding that occurred in May, which created complexities for research activities at the lab.

According to a Nov 22 USAMRIID press release, work will resume in a stepwise fashion. The CDC inspected the lab in early November and provided additional conditions for research to gradually resume, which includes allowing a limited number of studies to be done in specific labs by personnel who have undergone extensive training.

According to the News-Post story, scientists will resume work on five studies, and USAMRIID can also resume its participation in the Laboratory Response Network, as part of a three-lab network that can identify unknown materials.
Nov 22 News-Post story
Nov 22 USAMRIID news release
Aug 5 CIDRAP News scan "Inspection findings suspend work at USAMRIID lab at Fort Detrick"

Stewardship / Resistance Scan for Nov 25, 2019

News brief

Educational stewardship program tied to better antibiotic prescribing

A comprehensive educational antimicrobial stewardship program (ASP) implemented in 214 Spanish primary care clinics was tied to improved use of antibiotics and a sustained reduction of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli, according to a new study in The Lancet Infectious Diseases.

In total, 1,387 physicians participated in the ASP from 2014 to 2017 in outpatient primary care clinics serving more than 1.9 million patients across a wide area of Spain. The ASP combined educational presentations on correct prescribing; practice-based diagnostic and treatment guidelines; case-based, in-person discussions with clinicians about their prescribing practices; and audit and feedback reports. Researchers analyzed data from January 2012 (before implementation) through December 2017.

The investigators noted a 36.5% rate of inappropriate antibiotic prescribing in 2014, compared with a 26.9% rate in 2017. Ciprofloxacin use dropped 15.9% and cephalosporin use 22.6% after ASP implementation, and both reductions were sustained. The use of antibiotics recommended in guidelines, meanwhile, increased: Amoxicillin use climbed 22.2%, while fosfomycin use rose 6.1%.

The incidence of ESBL-producing E coli in urine samples declined 65.6%, down 0.028 cases per 1,000 inhabitants. Before the ASP was begun, the rate of that resistant pathogen had been increasing.

The study was funded by the Instituto de Salud Carlos III and the Spanish government.

In a related commentary in the same journal, two Johns Hopkins experts who were not involved in the study wrote, "Understanding whether the intervention can persist in the long-term and which of its components must be hardwired into the clinic workflow to achieve sustainability are important next steps. Elements of the investigators' work, such as education via a massive open online course and tools developed for audit, feedback, and peer review, can and should be disseminated and implemented in other ambulatory practices, such that optimal antibiotic prescribing in the outpatient setting becomes the norm, not the exception."
Nov 22 Lancet Infect Dis study
Nov 22 Lancet Infect Dis commentary

Studies note high rates of improper antibiotic use in Saudi Arabia, Pakistan

A two-hospital study in Saudi Arabia highlights inappropriate antibiotic use in patients both with and without sepsis, while a second study in the same journal—Antimicrobial Resistance & Infection Control—notes antibiotic overprescribing in hospitals in Lahore, Pakistan.

The case-control study in Riyadh, Saudi Arabia, involved 157 patients with sepsis and 158 without. All patients with sepsis received antibiotics, while 87.3% of controls received the drugs. The researchers compared antibiotic use before and after management by critical care response teams (CCRTs).

Overall appropriateness was 59.6% in sepsis patients and 50.7% in controls. In addition, only 48.5% of antimicrobials prescribed by CCRTs were de-escalated by a primary team within 4 days across both study groups. Individual appropriateness was highest with piperacillin/tazobactam (87.1%) and colistin (78.3%) and lowest with meropenem (16.7%) and imipenem (25.0%).

The authors concluded, "Empiric use and inadequate de-escalation of broad-spectrum antimicrobials were major causes for inappropriate antimicrobial use in CCRT patients."
Nov 21 Antimicrob Resist Infect Control Saudi Arabia study

In the second study, Pakistani scientists analyzed data on 1,185 patients who, over a 2-month period in 2017, were prescribed antibiotics in one of four acute-care hospitals in the capital city, two public and two private. Among those patients, 70.3% received at least one antibiotic that was deemed inappropriate based on guidelines. Of the 27.2% of patients who had respiratory tract infections, 62.8% received inappropriate antibiotic therapy.

Macrolides were tied to the highest rate of inappropriate prescribing—74.6%—followed by penicillins (71.0%), carbapenems (70.9%), cephalosporins (67.2%), and fluoroquinolones (64.2%). The inappropriate rate for aminoglycosides, in contrast, was 35.8%.
Nov 21 Antimicrob Resist Infect Control Pakistan study

CARB-X announces funding for drug targeting resistant gonorrhea

CARB-X today announced funding of up to $4.1 million for VenatoRx Pharmaceuticals, Inc to develop a new class of oral antibiotics to treat multi-drug-resistant (MDR) Neisseria gonorrhoeae.

"Neisseria gonorrhoeae are highly adept at avoiding the action of antibiotics that are meant to kill them. Some strains resist even last-resort antibiotics and these superbugs continue to build resistance at an alarming rate," said Kevin Outterson, JD, executive director of CARB-X, in a press release. VenatoRx could receive an additional $8.9 million if it meets certain project milestones.

Each year, 78 million people worldwide are infected with the gonorrhea, and half of all infections are resistant to at least one antibiotic, CARB-X said. VenatoRx's product is a novel non-beta-lactam penicillin-binding protein inhibitor that has acts against select gram-negative bacteria, including N gonorrhoeae.

The award is CARB-X's second for VenatoRX, and the 51st the organization has made since its inception in 2016. The awards together exceed $154 million.

CARB-X stands for the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, and the organization has pledged to invest up to $500 million between 2016-2021 to support the development of new antibiotics, rapid diagnostics, vaccines and other life-saving products.
Nov 25 CARB-X press release