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Source: http://www.cidrap.umn.edu/news-persp...an-mar-23-2017
News Scan for Mar 23, 2017
Antibiotic resistance in the community; Zika testing in pregnancy; Africa polio vaccination; Meningitis outbreak conviction
Filed Under:
Antimicrobial Stewardship; Zika; Polio; Meningitis
Review finds drug resistance is not just a problem with hospital infections
A new study in Clinical Infectious Diseases has found that antibiotic resistance has a significant clinical impact for patients with common infections managed in the community.
While much is known about the consequences of antibiotic-resistant infections in hospitalized patients, less is known about how antibiotic resistance affects clinical outcomes in common community-associated infections like urinary tract infections (UTIs) and respiratory infections. And because clinicians rarely report treatment failure from antibiotic resistance in these infections, there is a perception that antibiotic resistance doesn't have an effect on individual patients.
To get a better understanding of how antibiotic resistance can affect these conditions, the researchers set out to compare clinical outcomes between antibiotic-resistant and antibiotic-sensitive infections for patients with community-associated UTIs, respiratory tract infections, and skin and soft-tissue infections. To do that, they searched electronic databases for studies conducted in community settings that reported patient-level data on lab-confirmed infections, antibiotic resistance, and clinical outcomes.
The primary outcome of the study was clinical response failure. Secondary outcomes were re-consultation, further antibiotic prescriptions, symptom duration, and symptom severity.
The results of the 26 studies included in the review showed that, when compared with antibiotic-sensitive infections, clinical response failure was significantly more likely in patients who had antibiotic-resistant Escherichia coli UTIs (odds ratio [OR], 4.19), Streptococcus pneumoniae otitis media (OR, 2.51), and Streptococcus pneumoniae community-acquired pneumonia (OR, 2.15). In addition, patients with antibiotic-resistant E coli UTIs were found to be more likely to re-consult a healthcare professional and experience prolonged and more severe infections compared with patients who had antibiotic-sensitive infections.
"Antibiotic resistance has worse implications for patients' illness burden in the community," the authors write. "These findings could usefully inform better dialogue between clinician and patient, guidelines and campaigns about the benefits and risks of antibiotic treatment."
Mar 20 Clin Infect Dis abstract
Developing timelines for Zika testing in asymptomatic in pregnant women
Asymptomatic pregnant women who live in an area with active Zika transmission should be tested for the disease if they conceived within 8 weeks of the calculated active transmission end date and up to 6 months after (to account for how long the virus can live in semen). These are the guidelines suggested today in Morbidity and Mortality Weekly Report (MMWR).
The authors of the report used data from the outbreak in American Samoa to conservatively estimate when a pregnant woman could have been exposed to the virus, which can cause severe congenital birth defects, including microcephaly.
According to the report, active transmission ended when Zika testing revealed no new cases in a 45-day period (three 15-day incubation periods).
The authors suggest that establishing a testing timeline can help preserve resources, guide pregnant women, and create standards for practitioners in Zika-affected areas. "The rationale described in this report might be adapted by similar jurisdictions with small populations and a potential for interruption of Zika virus transmission," they write.
Mar 24 MMWR report
Massive polio vaccine campaign launches in 13 African nations
In one of the largest polio vaccine campaigns ever planned for Africa, 190,000 vaccinators will fan out in 13 countries to immunize more than 116 million children over the next week, the World Health Organization (WHO) said today. The agency said the effort is part of urgent measures to permanently stop polio on the continent.
The coordinated effort targets all children under age 5 in the following countries: Benin, Cameroon, Central African Republic, Chad, Cote d'Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, and Sierra Leone.
In 2016, four cases were detected in Nigeria's Borno state, a security-compromised area thought to be the only place in Africa where polio remains.
Matshidiso Moeti, MD, the WHO's regional director for Africa, said in a statement that governments and health workers have cornered polio to a final reservoir, but she warned that progress is fragile, given the nature of the virus. Experts have warned that the virus could easily spread to areas were kids are undervaccinated.
Volunteers and health workers will deliver bivalent oral polio vaccine to every house across the 13 countries, working up to 12 hours a day and carrying the vaccine in special ice-pack bags to keep it at the proper temperature.
Michael McGovern, chair of Rotary International's PolioPlus Committee, said in the statement, "This extraordinary coordinated response is precisely what is needed to stop this polio outbreak."
Mar 23 WHO statement
Executive convicted in fungal meningitis outbreak trial
Following a 9-week trial, a federal jury yesterday convicted Barry Cadden, owner and head pharmacist of New England Compounding Center (NECC), of racketeering and mail fraud regarding a 2012 nationwide fungal meningitis outbreak that sickened 753 people, 64 of them fatally. The jury acquitted Cadden on all 25 counts of second-degree murder.
In a statement, the US Department of Justice (DOJ) said Cadden directed and authorized shipping of contaminated methylprednisolone acetate, used in injections, before sterility test results were known and never notified customers when tests showed the products weren't sterile or when ingredients had expired. Also, certain batches of drugs were made by an unlicensed pharmacist, and Cadden repeatedly took steps to shield NECC operations from federal regulatory oversight.
Sentencing is scheduled for Jun 21, and the DOJ said he faces a maximum of 20 years in prison on each of the mail fraud and racketeering counts.
The outbreak is the largest public health crisis ever linked to a pharmaceutical product. The event prompted an investigation of compounding pharmacies and enhanced oversight.
Mar 22 DOJ press release
News Scan for Mar 23, 2017
Antibiotic resistance in the community; Zika testing in pregnancy; Africa polio vaccination; Meningitis outbreak conviction
Filed Under:
Antimicrobial Stewardship; Zika; Polio; Meningitis
Review finds drug resistance is not just a problem with hospital infections
A new study in Clinical Infectious Diseases has found that antibiotic resistance has a significant clinical impact for patients with common infections managed in the community.
While much is known about the consequences of antibiotic-resistant infections in hospitalized patients, less is known about how antibiotic resistance affects clinical outcomes in common community-associated infections like urinary tract infections (UTIs) and respiratory infections. And because clinicians rarely report treatment failure from antibiotic resistance in these infections, there is a perception that antibiotic resistance doesn't have an effect on individual patients.
To get a better understanding of how antibiotic resistance can affect these conditions, the researchers set out to compare clinical outcomes between antibiotic-resistant and antibiotic-sensitive infections for patients with community-associated UTIs, respiratory tract infections, and skin and soft-tissue infections. To do that, they searched electronic databases for studies conducted in community settings that reported patient-level data on lab-confirmed infections, antibiotic resistance, and clinical outcomes.
The primary outcome of the study was clinical response failure. Secondary outcomes were re-consultation, further antibiotic prescriptions, symptom duration, and symptom severity.
The results of the 26 studies included in the review showed that, when compared with antibiotic-sensitive infections, clinical response failure was significantly more likely in patients who had antibiotic-resistant Escherichia coli UTIs (odds ratio [OR], 4.19), Streptococcus pneumoniae otitis media (OR, 2.51), and Streptococcus pneumoniae community-acquired pneumonia (OR, 2.15). In addition, patients with antibiotic-resistant E coli UTIs were found to be more likely to re-consult a healthcare professional and experience prolonged and more severe infections compared with patients who had antibiotic-sensitive infections.
"Antibiotic resistance has worse implications for patients' illness burden in the community," the authors write. "These findings could usefully inform better dialogue between clinician and patient, guidelines and campaigns about the benefits and risks of antibiotic treatment."
Mar 20 Clin Infect Dis abstract
Developing timelines for Zika testing in asymptomatic in pregnant women
Asymptomatic pregnant women who live in an area with active Zika transmission should be tested for the disease if they conceived within 8 weeks of the calculated active transmission end date and up to 6 months after (to account for how long the virus can live in semen). These are the guidelines suggested today in Morbidity and Mortality Weekly Report (MMWR).
The authors of the report used data from the outbreak in American Samoa to conservatively estimate when a pregnant woman could have been exposed to the virus, which can cause severe congenital birth defects, including microcephaly.
According to the report, active transmission ended when Zika testing revealed no new cases in a 45-day period (three 15-day incubation periods).
The authors suggest that establishing a testing timeline can help preserve resources, guide pregnant women, and create standards for practitioners in Zika-affected areas. "The rationale described in this report might be adapted by similar jurisdictions with small populations and a potential for interruption of Zika virus transmission," they write.
Mar 24 MMWR report
Massive polio vaccine campaign launches in 13 African nations
In one of the largest polio vaccine campaigns ever planned for Africa, 190,000 vaccinators will fan out in 13 countries to immunize more than 116 million children over the next week, the World Health Organization (WHO) said today. The agency said the effort is part of urgent measures to permanently stop polio on the continent.
The coordinated effort targets all children under age 5 in the following countries: Benin, Cameroon, Central African Republic, Chad, Cote d'Ivoire, Democratic Republic of Congo, Guinea, Liberia, Mali, Mauritania, Niger, Nigeria, and Sierra Leone.
In 2016, four cases were detected in Nigeria's Borno state, a security-compromised area thought to be the only place in Africa where polio remains.
Matshidiso Moeti, MD, the WHO's regional director for Africa, said in a statement that governments and health workers have cornered polio to a final reservoir, but she warned that progress is fragile, given the nature of the virus. Experts have warned that the virus could easily spread to areas were kids are undervaccinated.
Volunteers and health workers will deliver bivalent oral polio vaccine to every house across the 13 countries, working up to 12 hours a day and carrying the vaccine in special ice-pack bags to keep it at the proper temperature.
Michael McGovern, chair of Rotary International's PolioPlus Committee, said in the statement, "This extraordinary coordinated response is precisely what is needed to stop this polio outbreak."
Mar 23 WHO statement
Executive convicted in fungal meningitis outbreak trial
Following a 9-week trial, a federal jury yesterday convicted Barry Cadden, owner and head pharmacist of New England Compounding Center (NECC), of racketeering and mail fraud regarding a 2012 nationwide fungal meningitis outbreak that sickened 753 people, 64 of them fatally. The jury acquitted Cadden on all 25 counts of second-degree murder.
In a statement, the US Department of Justice (DOJ) said Cadden directed and authorized shipping of contaminated methylprednisolone acetate, used in injections, before sterility test results were known and never notified customers when tests showed the products weren't sterile or when ingredients had expired. Also, certain batches of drugs were made by an unlicensed pharmacist, and Cadden repeatedly took steps to shield NECC operations from federal regulatory oversight.
Sentencing is scheduled for Jun 21, and the DOJ said he faces a maximum of 20 years in prison on each of the mail fraud and racketeering counts.
The outbreak is the largest public health crisis ever linked to a pharmaceutical product. The event prompted an investigation of compounding pharmacies and enhanced oversight.
Mar 22 DOJ press release