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Source: http://www.cidrap.umn.edu/news-persp...an-jun-08-2018
Stewardship / Resistance Scan for Jun 08, 2018
Highly resistant gonorrhea outbreak; CDC on resistant Shigella; XDR-TB in China
Filed Under:
Antimicrobial Stewardship; Tuberculosis
UK study details 118 cases of high-level antibiotic-resistant gonorrhea
In what appears to be an underreported outbreak, officials with Public Health England (PHE) yesterday in Eurosurveillance detailed 118 laboratory-confirmed cases of high-level azithromycin-resistant Neisseria gonorrhoeae, noting that cases emerged among heterosexuals in Leeds but then spread across England and into networks of men who have sex with men (MSM).
The cases occurred from November 2014 through May 2018, and cases per month, after initially staying level, increased from 2.6 to 3.4 from 2015 to the present time. The 118 patients include the man first reported by the PHE whose infection was also resistant to ceftriaxone, a particularly worrisome development.
The outbreak began in late 2014 and early 2015 among young heterosexuals living in "deprived areas" of Leeds, the authors said. Among 15 patients, the median age was 18 (range, 16 to 53). As the outbreak spread geographically, "cases among MSM were first identified in November 2015 mainly from a large, high-throughput clinic in London, which serves a substantial MSM population," the authors write. MSM patients had a median age of 30 years but also lived in disadvantaged areas.
The researchers found few direct epidemiologic links between heterosexual cases and none between MSM cases. They were able to establish 11 separate transmission networks, the largest linking four of the earlier Leeds cases.
"The few epidemiological links identified indicate substantial under-diagnosis of cases and this, along with the upturn in cases in 2017, highlights the difficulties in controlling the outbreak," the authors conclude.
Jun 7 Eurosurveillance report
Mar 28 CIDRAP News story "In world first, UK reports high-level gonorrhea resistance"
CDC issues alert over Shigella infections with low antibiotic susceptibility
The Centers for Disease Control and Prevention (CDC) yesterday published a Health Alert Network (HAN) update on managing and reporting Shigella infections that may have reduced susceptibility to not only ciprofloxacin but also azithromycin.
The HAN guidance is a follow-up to a HAN advisory last April. Officials are especially concerned about people who are at high risk for multidrug-resistant Shigella infections and are more likely to require antibiotic treatment.
The CDC "continues to identify an increasing number of Shigella isolates that test within the susceptible range for the fluoroquinolone antibiotic ciprofloxacin (minimum inhibitory concentration [MIC] values of 0.12-1 μg/mL), but harbor one or more resistance mechanisms. CDC remains concerned about potential clinical failures with fluoroquinolone treatment," the agency said.
Clinicians should carefully monitor patients who have Shigella infections and require fluoroquinolone treatment and report any possible treatment failures, the CDC said. "CDC has also identified an increasing number of Shigella isolates with azithromycin MICs that exceed the epidemiological cutoff value (ECV), and is requesting reports of any possible treatment failures occurring among patients with Shigella infections treated with azithromycin," the update said.
The agency said people at highest risk include MSM, homeless patients, and immunocompromised people. These individuals often have more severe disease, prolonged shedding, and recurrent infections.
Jun 7 HAN update
Apr 18, 2017, HAN advisory
China's XDR-TB status termed an emerging crisis
The authors of a Chinese study published yesterday in BMC Infectious Diseases?who previously claimed that the incidence of extensively drug-resistant tuberculosis (XDR-TB) in their country has been underestimated?determined that in reality, the situation is alarming owing to a sizable proportion of newly transmitted cases, high mortality, and patients' remaining in the community setting for long periods.
The patient population comprised all 67 patients diagnosed with XDR-TB for the first time in four specialized TB centers between March 2013 and February 2015. Patients were actively tracked through February 2017 by means of phone calls or home visits to them or to family members to ascertain survival information. Factors associated with death were evaluated with multivariable Cox regression models.
Mean patient age was 48.7 years, and 51 (76%) were men. Fourteen patients (21%) were treatment-naive so were considered to have been infected through primary transmission. At hospital discharge, 58 (86.8%) of patients remained positive on sputum smear or culture.
During the median follow-up period of 32 months, 20 patients died, for an overall mortality rate of 128 per 1,000 person-years. Among these, 17 (85%) had returned to the community setting and died at home; median survival duration was 5.4 months. Factors predictive of death were body mass index less than 18.5 kg per square meter (adjusted hazard ratio [aHR], 4.5; 95% confidence interval [CI], 1.3-15.7), smoking (aHR, 4.7; 95% CI, 1.7-13.2), and clinically significant comorbidity (aHR, 3.5; 95% CI, 1.3-9.4).
The authors conclude that the situation "calls for urgent actions . . . including providing regimens with high chances or cure and palliative care, and enhanced infection control measures."
Jun 7 BMC Infect Dis article
Stewardship / Resistance Scan for Jun 08, 2018
Highly resistant gonorrhea outbreak; CDC on resistant Shigella; XDR-TB in China
Filed Under:
Antimicrobial Stewardship; Tuberculosis
UK study details 118 cases of high-level antibiotic-resistant gonorrhea
In what appears to be an underreported outbreak, officials with Public Health England (PHE) yesterday in Eurosurveillance detailed 118 laboratory-confirmed cases of high-level azithromycin-resistant Neisseria gonorrhoeae, noting that cases emerged among heterosexuals in Leeds but then spread across England and into networks of men who have sex with men (MSM).
The cases occurred from November 2014 through May 2018, and cases per month, after initially staying level, increased from 2.6 to 3.4 from 2015 to the present time. The 118 patients include the man first reported by the PHE whose infection was also resistant to ceftriaxone, a particularly worrisome development.
The outbreak began in late 2014 and early 2015 among young heterosexuals living in "deprived areas" of Leeds, the authors said. Among 15 patients, the median age was 18 (range, 16 to 53). As the outbreak spread geographically, "cases among MSM were first identified in November 2015 mainly from a large, high-throughput clinic in London, which serves a substantial MSM population," the authors write. MSM patients had a median age of 30 years but also lived in disadvantaged areas.
The researchers found few direct epidemiologic links between heterosexual cases and none between MSM cases. They were able to establish 11 separate transmission networks, the largest linking four of the earlier Leeds cases.
"The few epidemiological links identified indicate substantial under-diagnosis of cases and this, along with the upturn in cases in 2017, highlights the difficulties in controlling the outbreak," the authors conclude.
Jun 7 Eurosurveillance report
Mar 28 CIDRAP News story "In world first, UK reports high-level gonorrhea resistance"
CDC issues alert over Shigella infections with low antibiotic susceptibility
The Centers for Disease Control and Prevention (CDC) yesterday published a Health Alert Network (HAN) update on managing and reporting Shigella infections that may have reduced susceptibility to not only ciprofloxacin but also azithromycin.
The HAN guidance is a follow-up to a HAN advisory last April. Officials are especially concerned about people who are at high risk for multidrug-resistant Shigella infections and are more likely to require antibiotic treatment.
The CDC "continues to identify an increasing number of Shigella isolates that test within the susceptible range for the fluoroquinolone antibiotic ciprofloxacin (minimum inhibitory concentration [MIC] values of 0.12-1 μg/mL), but harbor one or more resistance mechanisms. CDC remains concerned about potential clinical failures with fluoroquinolone treatment," the agency said.
Clinicians should carefully monitor patients who have Shigella infections and require fluoroquinolone treatment and report any possible treatment failures, the CDC said. "CDC has also identified an increasing number of Shigella isolates with azithromycin MICs that exceed the epidemiological cutoff value (ECV), and is requesting reports of any possible treatment failures occurring among patients with Shigella infections treated with azithromycin," the update said.
The agency said people at highest risk include MSM, homeless patients, and immunocompromised people. These individuals often have more severe disease, prolonged shedding, and recurrent infections.
Jun 7 HAN update
Apr 18, 2017, HAN advisory
China's XDR-TB status termed an emerging crisis
The authors of a Chinese study published yesterday in BMC Infectious Diseases?who previously claimed that the incidence of extensively drug-resistant tuberculosis (XDR-TB) in their country has been underestimated?determined that in reality, the situation is alarming owing to a sizable proportion of newly transmitted cases, high mortality, and patients' remaining in the community setting for long periods.
The patient population comprised all 67 patients diagnosed with XDR-TB for the first time in four specialized TB centers between March 2013 and February 2015. Patients were actively tracked through February 2017 by means of phone calls or home visits to them or to family members to ascertain survival information. Factors associated with death were evaluated with multivariable Cox regression models.
Mean patient age was 48.7 years, and 51 (76%) were men. Fourteen patients (21%) were treatment-naive so were considered to have been infected through primary transmission. At hospital discharge, 58 (86.8%) of patients remained positive on sputum smear or culture.
During the median follow-up period of 32 months, 20 patients died, for an overall mortality rate of 128 per 1,000 person-years. Among these, 17 (85%) had returned to the community setting and died at home; median survival duration was 5.4 months. Factors predictive of death were body mass index less than 18.5 kg per square meter (adjusted hazard ratio [aHR], 4.5; 95% confidence interval [CI], 1.3-15.7), smoking (aHR, 4.7; 95% CI, 1.7-13.2), and clinically significant comorbidity (aHR, 3.5; 95% CI, 1.3-9.4).
The authors conclude that the situation "calls for urgent actions . . . including providing regimens with high chances or cure and palliative care, and enhanced infection control measures."
Jun 7 BMC Infect Dis article