News Scan for Apr 01, 2022

News brief

Molnupiravir reduces COVID-19 symptoms, virus by day 3, data show

Three new studies to be presented at the upcoming European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) conference at the end of the month demonstrate benefits of the antiviral molnupiravir against COVID-19 infections, including evidence that Merck's pill reduces symptoms of the SARS-CoV-2 virus by day 3 of administration.

All three studies are based on results seen in the MOVe-OUT study, which was conducted throughout 2021 to determine the drug's efficacy against COVID-19 infections.

In the first study, participants were randomized and given molnupiravir or placebo within 5 days of symptom onset. Participants in the study kept a daily record of COVID-19 symptoms for 1 month. Those who took molnupiravir saw significant reduction of symptoms by day 3 and 5, including shortness of breath or difficulty breathing, cough, fatigue, loss of smell, and loss of taste.

In a second study, the antiviral pill was able to clear active SARS-CoV-2 virus equally well in immunocompromised patients, as well as those who were deemed immunocompetent. Of the 1,433 participants in MOVe-OUT, 57 (4%) were identified as immunocompromised. Of those participants, only 2 of 25 (8%) given molnupiravir were hospitalized or died from COVID-19, compared to 8 of 32 (25%) of immunocompromised patients given a placebo.

In a final study, PCR testing was used to determine viral loads from nasopharyngeal swabs collected on days 1 (baseline), 3, 5 (end-of-treatment visit), 10, 15, and 29. By day 3 of treatment, among patients with infectious virus at baseline, infectious SARS-CoV-2 was detected in none of the 92 patients who received molnupiravir, compared with 20 (20.8%) of 96 patients who received a placebo. By day 5, virus was detected in 0.0% in the molnupiravir arm of the study compared with 2.2% in the placebo arm.

"This study provides additional evidence that molnupiravir helps those infected clear SARS-CoV-2 faster than placebo, and supports MOVe-OUT's primary finding that molnupiravir can lower the risk of progression to serious illness in this high-risk cohort," said Julie Strizki, PhD, a researcher at Merck.
Mar 31 ECCMID symptoms press release
Mar 31 ECCMID immunocompromised press release
Mar 31 ECCMID infectiousness press release

 

CWD confirmed in North Carolina for first time

Chronic wasting disease (CWD) has been detected in North Carolina for the first time, in a white-tailed deer, the North Carolina Wildlife Resources Commission (NCWRC) said yesterday in a news release, bringing the number of CWD-affected US states to 30.

The deer was harvested by a hunter in Yadkin County in north central North Carolina in December 2021, and the sample was sent in by a taxidermist through a program established by the NCWRC. It is 1 of 7,200 samples collected by the agency after the discovery of a CWD-positive deer 33 miles away from the North Carolina border last year in Montgomery County, Virginia.

The NCWRC has received test results from 4,287 samples submitted, including 626 from a focal area that includes Alleghany, Surry, Stokes, and Rockingham counties. CWD is a prion disease that is always fatal to the members of the deer family (cervids) that it infects. A human case has yet to be detected, but the Centers for Disease Control and Preventions warns people not to eat meat from CWD-infected animals.

"We are appreciative of all the cooperating taxidermists, meat processors and hunters that have helped us with our CWD surveillance," said Brad Howard, chief of the NCWRC's Wildlife Management Division. "Now that we know the disease is in North Carolina, we will implement our CWD Response Plan to help slow the spread of CWD while preserving our deer herd and deer hunting tradition."

He added, "We've been in contact with wildlife professionals in other states that are already CWD-positive to learn from their experiences."

The disease is spread among cervids through direct contact and from infected saliva, urine, and feces of live animals or carcasses and body parts.
Mar 31 NCWRC news release

 

Study finds high rates of resistant E coli in young Kenyan children

A study of Escherichia coli isolates from young hospitalized children in western Kenya found high levels of antimicrobial resistance (AMR), researchers reported yesterday in PLOS Neglected Tropical Diseases.

For the cross-sectional study, researchers with the Kenya Medical Research Institute and the University of Washington cultured and analyzed E coli fecal samples collected at the time of hospital discharge from 406 children ages 1 to 59 months. Most of the children (87.2%) had received antibiotics in the hospital, and the most frequent diagnoses at admission and discharge were pneumonia, diarrhea, anemia, and malaria.

The researchers performed antimicrobial susceptibility testing on the isolates and tested for extended-spectrum beta-lactamase (ESBL) production, and they used multivariate regression models to identify risk factors for the presence of ESBL-producing E coli.

All 406 children had reduced susceptibility to at least 1 of the 12 antibiotics tested; 92.6% had E coli that lacked susceptibility to ampicillin, 46.1% harbored isolates that were non-susceptible to ceftriaxone, and 43.8% had isolates resistant to gentamicin. ESBL-producing E coli was found in 44.3% of children.

Multivariate analysis showed that receipt of antibiotics during the hospitalization was associated with the presence of ESBL-producing E coli (adjusted prevalence ratio [aPR], 2.23; 95% confidence interval [CI], 1.29 to 3.83), as was being hospitalized within the prior year (aPR, 1.32; 95% CI, 1.07 to 1.69). Defecating in the open (aPR, 2.02; 95% CI, 1.39 to 2.94), having a toilet shared with other households (aPR, 1.49; 95% CI, 1.17 to 1.89), and being female (aPR, 1.42; 95% CI, 1.15 to 1.76) were also associated with carriage of ESBL E coli.

The authors say the high rates of AMR carriage observed in the study may be particularly problematic during the post-discharge period, when children are at high risk of subsequent illness, and has potential implications for the broader population, given that resistant organisms and genetic elements can be spread to others in households and communities.

"AMR is increasing globally, and the public health relevance of these findings is likely significant, both for individual children and for communities," they wrote. "Health care exposure appears to be a major driver of AMR, and interventions to prevent and reduce AMR transmission and acquisition in the health care setting are urgently needed."
Mar 31 PLOS Negl Trop Dis study

 

Four countries report more vaccine-derived polio detections

The Democratic Republic of the Congo (DRC), Nigeria, and Yemen reported more circulating vaccine-derived poliovirus type 2 (cVDPV2) cases this week, and Israel reported more detections of cVDPV3, according to the latest official reports.

The Global Polio Eradication Initiative detailed the cVDPV2 cases in its latest weekly update. In Africa, the DRC reported six cases, all in Maniema province, bringing its number this year to nine. Nigeria reported three more cases, two in Bauchi state and one in Gombe state, raising its 2022 total to eight.

In the Middle East, Yemen reported 16 more cVDPV2 cases from 8 different governorates, which are added to its 2021 total, which now stands at 32.

In another polio development, Israeli officials reported four more cVDPV3 positives in asymptomatic children, raising the total in asymptomatic kids to six, the European Centre for Disease Prevention and Control (ECDC) said in its weekly communicable disease update.

Testing is under way as part of the investigation into a case of acute flaccid myelitis that was diagnosed in a child on Mar 6. All children who have tested positive so far are unvaccinated.
Mar 31 GPEI update
Apr 1 ECDC weekly communicable disease threat report

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Flu Scan for Apr 01, 2022

News brief

Avian flu strikes more poultry in 3 states; first wild bird detections in WI

Three already-affected states—Maine, South Dakota, and Wyoming—reported more highly pathogenic avian flu outbreaks in poultry flocks, and Wisconsin reported its first detections in wild birds, according to updates from federal and state agriculture officials.

South Dakota's latest outbreak occurred at a commercial turkey farm in Brule County housing 55,219 birds, the US Department of Agriculture (USDA) Animal and Plant Health Inspection Service (APHIS) said on its update page. Brule County is in south central South Dakota, and the latest outbreak is state's 21st.

The outbreaks in Maine and Wyoming both involve backyard mixed-species flocks. Maine's event, its 11th, occurred in Lincoln County on the state's Atlantic coast. Wyoming's outbreak marks its second and struck a location in the far northwest.

And the Wisconsin Department of Agriculture, Trade, and Consumer Protection (DATCP) yesterday reported that highly pathogenic avian flu, based on preliminary positives from testing, has been found in wild birds in five counties: Dane, Columbia, Grant, Milwaukee, and Polk. Earlier this month, Wisconsin reported its first outbreak in poultry, on a large layer farm in Jefferson County.

The outbreaks and detections are part of expanding Eurasian H5N1 activity that began in January and has now spread to wild birds or poultry in 31 states.
USDA APHIS poultry outbreak update
Mar 31 Wisconsin DATCP statement

 

Flu activity shifting to northern corners of US

Flu levels in the Northeast and Northwest rose last week, and although activity is still highest in central and southeast regions, markers there showed signs of decline, the US Centers for Disease Control and Prevention (CDC) said today in its latest weekly update.

The percentage of outpatient visits for flulike illness held steady, at 1.8%, and is still below baseline. At public health labs, all respiratory samples that were positive for flu were influenza A, and, of subtyped influenza A samples, all were H3N2.

In another measure of clinic visits for flu, New Mexico reported high activity. Four states reported moderate activity: Kansas, Oklahoma, New Hampshire, and Utah.

Hospitalizations rose for the eighth straight week. The cumulative hospitalization rate for flu this season, however, is still below the average of the past four prepandemic flu seasons. One more pediatric flu death was reported, raising the season's total to 14. The death occurred during the week ending Mar 5 and involved the H3N2 strain.
Apr 1 CDC FluView report

ASP Scan (Weekly) for Apr 01, 2022

News brief

Our weekly wrap-up of antimicrobial stewardship & antimicrobial resistance scans

Study finds high rates of resistant E coli in young Kenyan children

A study of Escherichia coli isolates from young hospitalized children in western Kenya found high levels of antimicrobial resistance (AMR), researchers reported yesterday in PLOS Neglected Tropical Diseases.

For the cross-sectional study, researchers with the Kenya Medical Research Institute and the University of Washington cultured and analyzed E coli fecal samples collected at the time of hospital discharge from 406 children ages 1 to 59 months. Most of the children (87.2%) had received antibiotics in the hospital, and the most frequent diagnoses at admission and discharge were pneumonia, diarrhea, anemia, and malaria.

The researchers performed antimicrobial susceptibility testing on the isolates and tested for extended-spectrum beta-lactamase (ESBL) production, and they used multivariate regression models to identify risk factors for the presence of ESBL-producing E coli.

All 406 children had reduced susceptibility to at least 1 of the 12 antibiotics tested; 92.6% had E colithat lacked susceptibility to ampicillin, 46.1% harbored isolates that were non-susceptible to ceftriaxone, and 43.8% had isolates resistant to gentamicin. ESBL-producing E coli was found in 44.3% of children.

Multivariate analysis showed that receipt of antibiotics during the hospitalization was associated with the presence of ESBL-producing E coli (adjusted prevalence ratio [aPR], 2.23; 95% confidence interval [CI], 1.29 to 3.83), as was being hospitalized within the prior year (aPR, 1.32; 95% CI, 1.07 to 1.69). Defecating in the open (aPR, 2.02; 95% CI, 1.39 to 2.94), having a toilet shared with other households (aPR, 1.49; 95% CI, 1.17 to 1.89), and being female (aPR, 1.42; 95% CI, 1.15 to 1.76) were also associated with carriage of ESBL E coli.

The authors say the high rates of AMR carriage observed in the study may be particularly problematic during the post-discharge period, when children are at high risk of subsequent illness, and has potential implications for the broader population, given that resistant organisms and genetic elements can be spread to others in households and communities.

"AMR is increasing globally, and the public health relevance of these findings is likely significant, both for individual children and for communities," they wrote. "Health care exposure appears to be a major driver of AMR, and interventions to prevent and reduce AMR transmission and acquisition in the health care setting are urgently needed."
Mar 31 PLOS Negl Trop Dis study

 

GARDP announces new North American branch

Originally published by CIDRAP News Mar 30

The Global Antibiotic Research and Development Partnership (GARDP), based in Geneva, Switzerland, this week announced the formation of a new sister organization in the United States.

GARDP and GARDP North America will work together on a common portfolio of projects that aim to accelerate the development and delivery of treatments for antibiotic-resistant infections caused by the priority pathogens identified by the World Health Organization (WHO) and the Centers for Disease Control and Prevention, according to a GARDP news release.

Created by the WHO and the Drugs for Neglected Diseases Initiative, GARDP works with partners in government, the private sector, academia, and civil society to develop and ensure sustainable access to new antibiotics. Likewise, GARDP North America will champion new drug development and global access and promote policies aimed at incentivizing antibiotic development, while focusing on strengthening ties with current and future partners in the United States.

"It will tap into the U.S.'s strong tradition of partnerships between the public, non-profit, and private sectors to realize global and public health objectives," GARDP says.
Mar 28 GARDP North America news release

 

Study finds high levels of resistance in US urine isolates

Originally published by CIDRAP News Mar 30

A study of Enterobacterales urine isolates from more than 650 US healthcare facilities found high levels of AMR, with clear geographic variations, US researchers reported yesterday in the International Journal of Infectious Diseases.

For the retrospective study, researchers examined more than 1.3 million non-duplicate, non-contaminant Enterobacterales urine isolates collected from ambulatory and hospitalized adult patients at 321 inpatient and 338 ambulatory care facilities from 2018 through 2020. They evaluated the percentage of non-susceptible isolates overall, by geographic region, and by inpatient and ambulatory populations.

Nationwide, high rates of resistance to antibiotics used for urinary tract infections (UTIs) were observed, including beta-lactams (60.8% and 55.8% for inpatient and ambulatory settings, respectively), fluoroquinolones (27.5% and 21.6%), trimethoprim/sulfamethoxazole (25.4% and 22.4%), and nitrofurantoin (27% and 21.6%). Isolates with an extended-spectrum beta-lactamase (ESBL)-producing phenotype (13.2% and 8.6%) and multidrug resistance (23.4% and 17.7% for ≥2 drugs; 9.9% and 6.4% for ≥3 drugs) were also common.

Statistically significant differences by geographic region were observed for all AMR classes in both inpatient and ambulatory settings, with the highest rates generally observed in the East South Central region.

The study authors note that while there were clear geographic variations, all regions showed AMR levels high enough to negate the use of common empiric UTI therapies according to Infectious Diseases Society of America recommended thresholds (>20% for trimethoprim/sulfamethoxazole and >10% for nitrofurantoin).

"The elevated levels of resistance to commonly used empiric UTI therapies highlight the need for new oral antibiotics effective against resistant uropathogens," they wrote. "Until such therapies are available, appropriate UTI management may require judicial use of pathogen diagnostic tests and antimicrobial susceptibility panels along with antimicrobial stewardship programs designed to reduce resistance in uropathogens."
Mar 29 Int J Infect Dis study

 

ECDC: Antibiotic resistance to common foodborne pathogens still high

Originally published by CIDRAP News Mar 29

New data from the European Centre for Disease Prevention and Control (ECDC) show that antibiotic resistance in Salmonella and Campylobacter bacteria—two of the most common foodborne pathogens in humans—is still high, but resistance to critically important antibiotics remains low for E coliSalmonella, and Campylobacter in samples from both humans and food-producing animals.

The findings are published in a new report of antimicrobial resistance in 2019–2020 in Salmonella, Campylobacter, and indicator E coli isolates in poultry, pigs, and cows and subsequent human infections.

For all human Salmonella infections in 2019 and 2020, resistance to ampicillin, sulfonamides and tetracyclines was observed at overall high levels, while resistance to third-generation cephalosporins in 2020 was noted at overall very low levels of 0.8% for both cefotaxime and ceftazidime, which are both deemed critically important antibiotics.

"Combined resistance to critically important antimicrobials (cephalosporins and fluoroquinolones) was generally uncommon in E. coli in all animal categories," the authors wrote.

"Furthermore, in more than half of the European Union countries, a statistically significant decreasing trend in the prevalence of extended-spectrum β-lactamase (ESBL)-producing E. coli was observed in food-producing animals. This is an important finding as particular strains of ESBL-producing E. coli are responsible for serious infections in humans."
Mar 29 ECDC report

 

Multidisciplinary stewardship tied to less antibiotic use in a NICU

Originally published by CIDRAP News Mar 28

A team of researchers from Drexel University determined that a multidisciplinary antibiotic stewardship team, coupled with a consensus for antibiotic therapy duration, prescriber justification of antibiotic necessity, and use of antibiotic stop dates can effectively reduce unnecessary antibiotic use in the neonatal intensive care unit (NICU). The study was published today in Antimicrobial Stewardship & Healthcare Epidemiology.

The goal of the study was to reduce unnecessary antibiotic use by 20% in St. Christopher's Hospital for Children's 39-bed level IV NICU.

To do so, the researchers conducted a retrospective chart review to determine common indications and treatment duration for antibiotics. A multidisciplinary stewardship team conducted several educational interventions, and providers in the NICU were subject to manual antibiotic stop dates and justification of antibiotic use .

The percentage of unnecessary antibiotic days, defined as days beyond the consensus guidelines, dropped from 42% to 12% during the year-long intervention. In total, 139 of 250 neonates (55%) were exposed to at least 1 antibiotic in the baseline period, compared with 123 of 264 (46%) in the postintervention period, the authors said.

"Developing evidence-based guidelines with infectious disease input was key to engage the neonatologists and create consensus," the authors concluded. 
Mar 28 Antimicrob Steward Healthc Epidemiol study

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