In a new update on a multistate Salmonella outbreak linked to backyard poultry—first announced in May—the Centers for Disease Control and Prevention (CDC) reported 86 more illnesses and 9 more affected states, raising the national total to 195 cases from 38 states.

Initially, outbreak involved five Salmonella serotypes: Altona, Indiana, Infantis, Mbandaka, and Typhimurium. The CDC said two more have been implicated in the illnesses—Cerro and Johannesburg. 

Of information based on 136 patients, 50 were hospitalized. No deaths have been reported. Just over 40% of patients are younger than 5 years old. The latest illness onset is May 30. The CDC warned that the outbreak total is likely much higher and that illnesses probably aren't limited to the states with known cases, given that most people aren't tested and recover without medical care.

Of 45 people with information available, 36 had bought or obtained poultry before they became ill. People got the birds from multiple retail stores and directly from hatcheries.

Samples from shipping boxes matched patient strains

Investigators from Minnesota, Ohio, and Utah collected samples from inside boxes used to ship the poultry from hatcheries to retail stores, which included box liner and bedding. Whole-genome sequencing (WGS) found that Salmonella Altona, Cerro, and Mbandaka in the samples matched strains from some of the sick patients.

WGS analysis of 176 patient samples and 13 environmental samples found no predicted resistance, but 14 patient samples had predicted resistance to one or more antibiotics: amoxicillin-clavulanic acid, ampicillin, cefoxitin, ceftiofur, ceftriaxone, chloramphenicol, ciprofloxacin, gentamicin, kanamycin, streptomycin, sulfisoxazole, and tetracycline.

Backyard poultry have been tied to several other Salmonella outbreaks over the past several years. The CDC urged poultry owners to take precautions, such as washing hands with soap and water after touching backyard poultry and supervising children around backyard poultry, especially young ones who are more likely to get sick.

The World Health Organization (WHO) last week launched an effort to strengthen global diagnostic capacity and support access to safe, affordable, and quality-assured diagnostics.

In a policy brief, the WHO said the Antimicrobial Resistance (AMR) Diagnostic Initiative aims to "bring diagnostics to the forefront" of the global response to antimicrobial resistance, help countries strengthen microbiology laboratory capacity, support antimicrobial stewardship and infection prevention and control, enhance routine surveillance, and achieve equitable access to quality testing for common bacterial and fungal pathogens and associated AMR.

The initiative was developed by the WHO to help World Health Assembly member states address commitments made in 2023 to strengthen diagnostic capacity. The agency notes that for nearly half the global population, access to reliable and timely laboratory test results is severely limited, with only 1% to 2% of clinical laboratories in sub-Saharan countries undertaking bacteriology testing. Mycology testing is even more limited. 

"Appropriate and rapid diagnosis of bacterial and fungal infections and associated resistance is of paramount importance for guiding appropriate clinical management and rational selection of antimicrobial therapy, monitoring infections and treatment response, and carrying out antimicrobial stewardship initiatives, infection prevention and control measures, investigating outbreaks and emerging threats, and monitoring the burden of antimicrobial resistance," the WHO said. 

"Without equitable access to quality-assured diagnostics and laboratory services, antimicrobial resistance will be allowed to spread silently within and across countries," it added.

Building blocks

The ability to provide essential bacteriology and mycology laboratory services is hindered by a shortage of clinical microbiologists and lab technicians, the high cost of supplies and equipment, and inadequate infrastructure, the agency said.

To overcome these challenges and strengthen global diagnostic and laboratory capacity, the policy brief lays out four "building blocks" for the initiative. These include a strategic and operational framework to set standards and provide implementation guidance; standardized assessment tools for monitoring and reporting bacteriology and mycology laboratory services capacity at national and global levels; a global AMR laboratory network that includes laboratories designated by the WHO for bacteriology, mycology, and susceptibility testing at national, supranational, and specialized levels; and research and innovation in AMR diagnostics.

Implementation of a prospective, multidisciplinary antimicrobial stewardship (AMS) program in neonatal units in South Africa significantly reduced neonatal antibiotic use, particularly in newborns with sepsis, researchers reported last week in the International Journal of Infectious Diseases.

The 20-week national neonatal AMS (NeoAMS) intervention was implemented in 14 South African neonatal units (seven public, seven private) from February to July 2022. The intervention involved multidisciplinary teams of neonatologists, microbiologists, pharmacists, and nurses attending online training sessions, participating in weekly meetings, and conducting prospective audit and feedback of neonatal antibiotic prescriptions. 

To evaluate the intervention, researchers collected data on the number and type of interventions recommended by pharmacists, the acceptance rate of AMS recommendations, and changes in antibiotic length of therapy (LOT).

24% reduction in mean antibiotic LOT

The 565 neonates enrolled in the study received antibiotic therapy for 753 infection episodes. Pharmacists evaluated 700 antibiotic prescriptions. The most frequent indication for empiric antibiotic therapy was to rule out early-onset sepsis (41.4%), followed by therapy for suspected hospital-acquired sepsis (26.1%). 

Pharmacists recommended 437 NeoAMS interventions (0.6 per antibiotic prescription episode) during the 20-week study period, with antibiotic discontinuation (42%), therapeutic drug monitoring (17%), and dosing (15%) recommendations the most frequent. Neonatal clinicians’ acceptance rates for AMS recommendations were high (77%). Overall, mean antibiotic LOT decreased 24%, from 9.1 to 6.9 days, with the greatest decline in LOT observed for culture-negative sepsis (8.2 to 5.9 days).

The study authors say the findings are significant because almost all previously published neonatal AMS intervention data were generated in high-income settings. They note that NeoAMS is the first multisite, multidisciplinary neonatal stewardship study conducted on the African continent.

"This study adds to the limited evidence base for neonatal AMS in Africa and demonstrates the positive impact of multidisciplinary team-led AMS," they wrote. "These findings confirm that successful AMS initiatives are possible in resource-limited neonatal settings."

A 2-year-old white-tailed doe in a second Sutton County, Texas, deer-breeding facility has tested positive for chronic wasting disease (CWD), the Texas Parks and Wildlife Department (TPWD) announced late last week.

The infection was found during mandatory postmortem CWD surveillance testing. Sutton County is located in west central Texas.

The first Sutton County case was discovered in a deer-breeding facility in May 2023. That case was detected in a 4-year-old white-tailed buck tested for CWD before transfer to a registered release site.

A continuing threat to cervids

Since the first Texas CWD detection in 2012, the fatal neurologic disease has been found in captive and free-ranging cervids such as deer, mule deer, red deer, and elk, the TPWD said.

CWD, which is caused by misfolded proteins called prions, poses an ongoing threat to cervids because it can spread from animal to animal and through environmental contamination. The disease isn't known to infect humans, but officials recommend not eating meat from a sick animal and using precautions when field-dressing or butchering cervids.