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CIDRAP Stewardship / Resistance Scan - Drug-resistant Brucellosis; MDRO's in nursing homes, acute care

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  • CIDRAP Stewardship / Resistance Scan - Drug-resistant Brucellosis; MDRO's in nursing homes, acute care

    Source: http://www.cidrap.umn.edu/news-persp...an-feb-11-2019


    Stewardship / Resistance Scan for Feb 11, 2019
    Drug-resistant Brucellosis; MDRO's in nursing homes, acute care

    Filed Under:
    Antimicrobial Stewardship; MRSA; Foodborne Disease

    CDC: 19 states may have raw milk exposure to drug-resistant Brucella

    Today the Centers for Disease Control and Prevention (CDC) announced that health workers are investigating potential exposures to a drug-resistant Brucella strain RB51 in 19 states. The strain comes from raw (unpasteurized) milk from Millerís Biodiversity Farm in Quarryville, Pennsylvania.
    "One case of RB51 infection (brucellosis) has been confirmed in New York, and an unknown number of people may have been exposed to RB51 from drinking the milk from this farm," the CDC said. "This type of Brucella is resistant to first-line drugs and can be difficult to diagnose because of limited testing options and the fact that early brucellosis symptoms are similar to those of more common illnesses like flu.*"
    In November of 2018, a New York resident became the third American to be diagnosed as having brucellosis caused by the RB51 strain. Two cases (unrelated to the Quarryville farm) were also reported in 2017, in New Jersey and Texas.
    The 19 states in question are Alabama, California, Connecticut, Florida, Georgia, Iowa, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, New Jersey, New York, North Carolina, Ohio, Pennsylvania, Rhode Island, South Carolina, and Virginia.
    The CDC said anyone who has consumed raw milk from the farm between January of 2016 and January 2019 may have been exposed to the strain.
    Feb 8 CDC alert
    Study: MDROs prevalent in California nursing homes, long-term acute care

    A team of researchers studying nursing homes and long-term acute care facilities in southern California reported today in Clinical Infectious Diseases that a large majority of residents and patients in these facilities harbor multidrug-resistant organisms (MDROs).
    The one-day point prevalence study was conducted by researchers with the Shared Health Intervention to Eliminate Life-Threatening Dissemination of MDROs in Orange County (SHIELD OC), a regional public health collaborative to measure the impacts of a coordinated infection prevention initiative on MDRO carriage and infection at 18 nursing homes (NHs), 17 short term acute care hospitals, and 3 long term acute care facilities (LTACs). The aim was to establish baseline MDRO prevalence in the NH and LTACS settings, as patients and residents in these facilities are transferred frequently and are known to serve as a source of MDRO transmission.
    From September 2016 to March 2017, a random sampling of 1,050 patients from the 21 facilities were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistance Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, axilla/groin, and peri-rectal swabs. In addition, researchers performed multivariate analyses of swab data to evaluate person-level and facility-level characteristics associates with MDRO carriage.
    The overall prevalence of MDROs in the 21 facilities was 67%, with at least one MDRO found in 65% of NH residents and 80% of LTAC residents. Twenty-seven percent of NH residents and LTAC patients were found to carry multiple MDRO pathogens. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). MDRO status was known for only 18% of NH residents and 49% of LTAC patients. Multivariable models indicated that history of MRSA (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.2 to 2.4, P = 0.04), VRE (OR 2.1; 95% CI, 1.2 to 3.8, P = 0.01), ESBL (OR, 1.6; 95% CI, 1.1 to 2.3, P = 0.03) and diabetes (OR, 1.3; 95% CI, 1.0 to 1.7, P = 0.03) were associated with any MDRO carriage.
    "In summary, MDRO colonization prevalence is high within the NH and LTAC setting, far exceeding published reports in acute care hospitals. These data demonstrate the importance of NH/LTACs as a dominant MDRO reservoir in the healthcare system," the authors of the study write. "Investment in universal strategies of infection prevention and antimicrobial stewardship that are applicable to nursing homes and long term acute care hospitals are greatly needed and arguably overdue."
    Feb 11 Clin Infect Dis abstract



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