News Scan for Oct 31, 2016

News brief

Saudi MOH: New case of MERS

Over the weekend, Saudi Arabia's Ministry of Health (MOH) reported one new case of MERS-CoV. The patient is in critical condition.

A 41-year-old Saudi man from Buraydah was diagnosed as having MERS-CoV (Middle East respiratory syndrome coronavirus) on Oct 29. The man is listed as having primary exposure, which means he did not contract the virus from another patient.

Confirmation of the latest case lifts Saudi Arabia's MERS-CoV total to 1,470 cases, 615 of them fatal. Seven people are still being treated for their infections.
Oct 29 Saudi MOH update

Ebola transmission chain analysis highlights viral longevity in semen

A study from the World Health Organization (WHO) tracked an 11-month transmission chain that ended with a case of Ebola virus in Guinea, suggesting the disease should be considered transmissible in semen for at least 12 months.

In a new report published in Emerging Infectious Diseases, researchers detailed the unusual transmission route for a case-patient who presented with Ebola in October of 2015. Eleven months earlier, the patient's brother-in-law tested positive for Ebola. The man recovered and refrained from intercourse with his wife for 6 months, resuming sex about 9 months post-infection. In September of 2015, the woman had a mild illness that was likely undiagnosed Ebola, and through close household contact spread it to her brother. The woman's serologic tests were positive for Ebola, but no genomic data were available.

The interval between the case-patient’s onset of symptoms and that of the woman's mild and missed Ebola illness was about 30 days, longer than the usual maximum incubation period of 21 days.

Epidemiologic and molecular evidence support this unusual chain of Ebola transmission. The authors of the study said this case supports the WHO's updated January 2016 recommendation that safe sex should be practiced between couples for 12 month post–Ebola exposure. Alternatively, semen can be tested every 3 months post-illness, and sex can be resumed after two negative tests.
Oct 28 Emerg Infect Dis study

Study details 18 outbreaks tied to organic food

A study today in the Journal of Food Protection said it was not possible to tell if organic food was more likely to be implicated in foodborne illness outbreaks than conventional food, despite public perception that organic food is healthier, but it has been involved in at least 18 outbreaks since 1992.

Researchers used the Centers for Disease Control and Prevention's Foodborne Disease Outbreak Surveillance System to look at 18 organic food–linked illness outbreaks in the United States from 1992 to 2014, which caused 779 illnesses, 258 hospitalizations, and 3 deaths.

Of those, 56% occurred from 2010 to 2014, which shows the increasing demand for organic food, the authors said. Salmonella caused 44% of outbreaks, and Escherichia coli caused 33%. Campylobacter, Clostridium botulinum, and hepatitis A virus caused one outbreak each (6%). Eight of the outbreaks were attributed to produce items, four to unpasteurized dairy products, two to eggs, two to nut and seed products, and two to multi-ingredient foods. Foods that were certainly or likely certified by the US Department of Agriculture were implicated in 15 of the 18 outbreaks (83%).

As organic food has risen in consumer popularity, it's been more frequently tied to foodborne illnesses. Though there's not enough to data to determine whether or not organic food was more likely to cause illness than conventional food, the authors said the study is the first step in understanding organic food risk.

"Consumers should not assume organic foods to be more or less safe than foods produced by conventional methods. Proper handling, preparation, and storage of foods, regardless of production method, are necessary to prevent foodborne illness," the authors conclude.
Oct 31 J Food Prot study

PAHO reports 452 new chikungunya cases

The Pan American Health Organization (PAHO) late last week reported 452 new chikungunya cases in the Americas, bringing the 2016 total to 303,107 confirmed, suspected, and imported cases.

The report comes a week after PAHO adjusted its numbers downward by 1,667 cases after Panama ruled out 1,788 previously suspected infections.

The Oct 28 report includes 216 new cases in Peru, 141 new cases in Cost Rica, and 52 in Colombia—as well as smaller increases elsewhere. Those three countries now have 233, 3,023, and 19,159 cases this year, respectively.

Many countries, however, have not reported on chikungunya for several weeks, including Brazil, which has reported more than 216,000 cases in 2016, by far the most of any country. PAHO reported no new chikungunya-related deaths, leaving that number at 106 for the year.

The region's chikungunya outbreak started in December 2013 in St. Martin in the Caribbean and so far has sickened 2,181,547 people.
Oct 28 PAHO update

Antimicrobial Resistance Scan for Oct 31, 2016

News brief

New AHRQ guide to help nursing homes implement stewardship programs

The Agency for Healthcare Research and Quality has released a new online guide to help nursing homes address the challenge of creating and implementing an antimicrobial stewardship program (ASP).

The AHRQ Antimicrobial Stewardship Guide comes on the heels of a new rule finalized by the Centers for Medicare and Medicaid Services (CMS) in early October that requires nursing homes and other long-term care facilities to have an antibiotic stewardship program that includes antibiotic use protocols and a system to monitor antibiotic use. According to the Centers for Disease Control and Prevention (CDC), an estimated 70% of nursing home residents receive one or more courses of antibiotics during a year, and studies have indicated that anywhere from 40% to 70% of those antibiotics prescriptions are inappropriate.

Among the challenges facing nursing homes in creating and implementing an ASP are a lack of financial resources, antibiotic stewardship expertise, and diagnostic and support services. In addition, medical care at nursing homes is often poorly coordinated.

The guide, which was pilot-tested in nine nursing homes, provides several toolkits to help nursing homes optimize their use of antibiotics. The toolkits offer guidance on how to implement and sustain an ASP, how to determine when antibiotics are necessary, how to choose the right antibiotic for treating an infection, and how to educate residents and family members about antibiotics.

"We're committed to ASPs because they're essential to our broad national effort to maintain the effectiveness and safety of the nation's antibiotics," writes James Cleeman, MD, director of AHRQ's division of healthcare-associated infections, in a blog post.
AHRQ Nursing Home Antimicrobial Stewardship Guide
Oct 27 AHRQ Views blog post

Study examines types of stewardship at small community hospitals

A study presented at IDWeek 2016 found that higher-level antibiotic stewardship programs (ASPs) resulted in greater reduction in antibiotic use in small community hospitals.

The purpose of the study, which was the featured oral abstract of the Society for Healthcare Epidemiology of America, was to compare the impact of three different types of ASP in a network of small community hospitals operated by Utah-based Intermountain Healthcare. Small community hospitals account for nearly 75% of all US hospitals, but only about 22% have an ASP.

In the cluster-randomized control trial, investigators randomly assigned the 15 small community hospitals to one of the three ASP models: Five hospitals were assigned to program 1, a reference group that had a minimal ASP program; five hospitals were assigned to program 2, which featured stewardship education, a limited prospective audit and feedback program, and antibiotic restrictions that were controlled by local pharmacy staff; and five hospitals were in program 3, which featured an expanded prospective audit and feedback program, antibiotic restrictions overseen by both a pharmacist and an infectious disease (ID) physician, and ID physician review of all culture results.

The primary outcomes were total antibiotic use and broad-spectrum antibiotic use. Secondary outcomes included mortality rates, readmission rates, and incidence of Clostridium difficile.

In the final analysis, the investigators found that the small community hospitals in program 3 reduced total antibiotic use by 17% compared to program 1, but the hospitals in program 2 showed no statistically significant reduction compared to those in program 1. Both program 2 and 3 hospitals reduced broad spectrum use by 31% and 27%, respectively, compared to hospitals in program 1. An analysis of secondary outcomes showed no difference in mortality or patient readmission rates among the different programs, but programs 2 and 3 saw 45% fewer cases of C difficile compared to program 1.

"Stewardship programs are now known to be feasible in small community hospitals, and they can reduce antibiotic use if the appropriate resources are out there," lead author Edward Stenehjem, MD, MSc, told the audience.
Oct 28 Stewardship in community hospitals abstract

ID consultations can save lives, single-center study finds

Consulting an infectious diseases (ID) specialist can reduce mortality in patients with multi-drug resistant Gram-negative infections, according to a study presented at IDWeek 2016.

The single-center, retrospective, case-cohort study included 205 patients at SUNY Downstate Medical Center in Brooklyn, N.Y., who were being treated for bacteremias and urinary tract infections. Of the 205 patients, 40 patients received early ID consultation (within 48 hours), 25 received late ID consultation (after 48 hours), and 140 received no consultation. The two most common organisms isolated were extended-spectrum beta-lactamase producing Escherichia coli and Klebsiella pneumoniae.

Overall, 60 patients died during the study. Forty-five of the deaths occurred in patients who received no ID consult, and 15 occurred among those patients who received late ID consultation. None of the patients who received early ID consultation died. In addition, mean time to defervescence (fever reduction) was estimated at 1.8 days for early consult, 5.3 days for late consult, and 4.9 days for no consult.

The study adds to research showing that when an ID specialist is involved in a patient's care, patients are correctly diagnosed more often, have fewer complications, and have better outcomes.
Oct 29 ID consultations abstract