Shiloh
Editor, Senior Moderator
Source: http://www.cidrap.umn.edu/news-perspective/2020/02/news-scan-feb-20-2020
News Scan for Feb 20, 2020
Antibiotic resistance in UK chicken meat; Contact isolation in European hospitals; Fast detection of carbapenem resistance; Lassa fever in Nigeria
Filed Under:
Lassa fever; Diagnostics; E coli; Foodborne Disease; Antimicrobial Stewardship; VHF
[h=3]Surveys find less antibiotic-resistant bacteria in UK chicken meat[/h] The United Kingdom's Food Standards Agency (FSA) released two surveillance reports this week on antimicrobial resistance (AMR) in chicken meat.
The two surveys looked at antibiotic-resistant Escherichia coli and Campylobacter in fresh chicken sold at UK retail stores in 2017 and 2018. Of the 309 samples tested for resistant E coli, no samples were positive for carbapenem resistance or plasmid-mediated colistin resistance, while 23 (8.4%) expressed extended-spectrum beta-lactamase (ESBL)-phenotype resistance, 16 (5.2%) expressed AmpC-phenotype resistance, and 3 expressed both ESBL- and AmpC-phenotype resistance.
Overall, the proportion of chicken meat samples positive for ESBL-producing E coli fell from 65.4% in 2013-2014 to 8.4% in 2018, and AmpC-producing E coli fell from 16.3% in 2016 to 5.2% in 2018. The FSA said this decrease could be linked to the banning of cephalosporins in poultry meat flocks by the UK Poultry Council in 2012.
Of the 392 samples tested for resistant Campylobacter bacteria, ciprofloxacin resistance was detected in 52% of Campylobacter jejuni isolates (171/328), and 48% of Campylobacter coli isolates (31/65). Multidrug resistance was found in 5 of 328 C jejuni isolates (2%) and 6 of 65 C coli isolates (9%). Overall, the proportions of antibiotic-resistant and multidrug-resistant Campylobacter isolates identified were similar to those found in previous survey years.
"While there is evidence that AMR bacteria are present on chicken sold in the UK, it is encouraging to see the levels holding steady and even reducing," Paul Cook, FSA science lead in microbiological risk assessment, said in an agency press release. "The risk of getting AMR-related infections through eating or preparing contaminated meat remains very low as long as you follow good hygiene and cooking practices."
Feb 18 FSA press release
Feb 18 FSA E coli survey
Feb 18 FSA Campylobacter survey
[h=3]Study: Contact isolation doesn't reduce spread of resistant organisms [/h] A study of patients in four European hospitals has found that contact isolation showed no benefit when added to standard precautions for controlling the spread of ESBL-producing Enterobacteriaceae (ESBL-E) on non-critical care wards with extensive surveillance screening, researchers reported yesterday in the Lancet Infectious Diseases.
In the cluster-randomized trial conducted at university hospitals in Germany, the Netherlands, Spain, and Switzerland, patients in medical, surgical, and combined medical-surgical wards were randomized to continue standard precautions alone or implement contact isolation alongside standard precautions for 12 months, followed by a 1-month washout period and 12 months of an alternative strategy. Patients were screened for ESBL-E on carriage within 3 days of admission, once a week thereafter, and on discharge. The primary outcome was the incidence density of ESBL-E.
Between Jan 6, 2014, and Aug 31, 2016, 38,357 patients were admitted to the hospital wards. Among 15,184 patients with a length of stay of more than 1 week, 11,368 patients (75%) were screened at least twice. The incidence density of ward-acquired ESBL-E was 6.0 events per 1,000 patient-days at risk (95% confidence interval [CI], 5.4 to 6.7) during periods of contact isolation and 6.1 (95% CI, 5.5 to 6.7) during periods of standard precautions (P = 0?9710). Multivariable analysis adjusted for length of stay, percentage of patients screened, and prevalence in first screening cultures yielded an incidence rate ratio of 0.99 (95% CI, 0.80 to 1.22; P = 0.9177) for care under contact isolation compared with standard precautions.
"The results of this trial suggest that current real-life practice in many countries, including the targeted identification of carriers and expanded use of contact isolation, is ineffective in preventing the spread of ESBL-E in endemic settings," the authors conclude.
The findings are significant because while many guidelines recommend the use of contact isolation for patients colonized or infected with multidrug-resistant bacteria, several studies in recent years have questioned their effectiveness. In addition, research has shown that patients under contact isolation express greater dissatisfaction with their treatment.
Feb 19 Lancet Infect Dis abstract
[h=3]Two tests detect carbapenem resistance in lower respiratory tract samples[/h] Spanish investigators yesterday in the Journal of Antimicrobial Chemotherapy reported good results from using two commercial rapid diagnostic tests—Xpert Carba-R and Eazyplex SuperBug CRE—to detect bacterial carbapenem resistance genes directly in lower respiratory tract samples.
The researcher team used the two tests—the former a real-time polymerase chain reaction (PCR) test and the other employing loop-mediated isothermal amplification—for detecting carbapenemase carriage in Enterobacteriaceae directly from bronchoalveolar lavage (BAL). The researchers added well-characterized carbapenemase-producing Enterobacteriaceae strains to the BAL samples to observe how the tests would perform.
Xpert Carba-R demonstrated 100% agreement with carbapenemase characterization by PCR and sequencing for all final bacteria concentrations. Eazyplex SuperBug CRE showed 100%, 80% and 27% agreement with PCR and sequencing at diminishing pathogen concentrations. False-negative results for Eazyplex SuperBug CRE matched the highest cycle threshold values for Xpert Carba-R. Hands-on time for both assays was about 15 min, but Eazyplex SuperBug CRE results were available within 30 min, whereas Xpert Carba-R took around 50 min.
The authors say their results could be used as proof-of-concept data for validating the tests for this purpose.
Feb 19 J Antimicrob Chemother abstract
[h=3]Nigeria reports 309 new Lassa fever cases, 472 total so far this year[/h] In the first 5 weeks of 2020, Nigeria has confirmed 472 Lassa fever cases, including 70 deaths, the World Health Organization (WHO) said in an update today. The outbreak has grown by 309 confirmed cases and 46 deaths since a WHO update on Jan 28.
The cases were reported from Jan 1 through Feb 9, and 26 of 36 states are affected. Edo (167 cases) and Ondo (156) are by far the hardest-hit states.
Fifteen healthcare workers have contracted the disease, one of whom died. Another health worker who had a probable case also died. Officials confirmed 793 Lassa fever cases in Nigeria in all of 2019, but this year cases are outpacing those seen during the same period last year.
Lassa fever is endemic in Nigeria, typically with an annual peak in the dry season (December through April) following the reproduction cycle of Mastomys rats (common African rats) in the wet season (May through June).
The WHO said, "Given that 90-95% of human infections are due to indirect exposure to (through food or household items contaminated by infected rats' urine and faeces) or direct contact with infected Mastomys rats, the very high density and high circulation of Lassa fever virus in young non-immune rat population during the wet season create a potential for further human infection, thus, the number of infections is expected to continue to rise until the end of the dry season."
Feb 20 WHO update
Jan 28 CIDRAP News scan on earlier report
News Scan for Feb 20, 2020
Antibiotic resistance in UK chicken meat; Contact isolation in European hospitals; Fast detection of carbapenem resistance; Lassa fever in Nigeria
Filed Under:
Lassa fever; Diagnostics; E coli; Foodborne Disease; Antimicrobial Stewardship; VHF
[h=3]Surveys find less antibiotic-resistant bacteria in UK chicken meat[/h] The United Kingdom's Food Standards Agency (FSA) released two surveillance reports this week on antimicrobial resistance (AMR) in chicken meat.
The two surveys looked at antibiotic-resistant Escherichia coli and Campylobacter in fresh chicken sold at UK retail stores in 2017 and 2018. Of the 309 samples tested for resistant E coli, no samples were positive for carbapenem resistance or plasmid-mediated colistin resistance, while 23 (8.4%) expressed extended-spectrum beta-lactamase (ESBL)-phenotype resistance, 16 (5.2%) expressed AmpC-phenotype resistance, and 3 expressed both ESBL- and AmpC-phenotype resistance.
Overall, the proportion of chicken meat samples positive for ESBL-producing E coli fell from 65.4% in 2013-2014 to 8.4% in 2018, and AmpC-producing E coli fell from 16.3% in 2016 to 5.2% in 2018. The FSA said this decrease could be linked to the banning of cephalosporins in poultry meat flocks by the UK Poultry Council in 2012.
Of the 392 samples tested for resistant Campylobacter bacteria, ciprofloxacin resistance was detected in 52% of Campylobacter jejuni isolates (171/328), and 48% of Campylobacter coli isolates (31/65). Multidrug resistance was found in 5 of 328 C jejuni isolates (2%) and 6 of 65 C coli isolates (9%). Overall, the proportions of antibiotic-resistant and multidrug-resistant Campylobacter isolates identified were similar to those found in previous survey years.
"While there is evidence that AMR bacteria are present on chicken sold in the UK, it is encouraging to see the levels holding steady and even reducing," Paul Cook, FSA science lead in microbiological risk assessment, said in an agency press release. "The risk of getting AMR-related infections through eating or preparing contaminated meat remains very low as long as you follow good hygiene and cooking practices."
Feb 18 FSA press release
Feb 18 FSA E coli survey
Feb 18 FSA Campylobacter survey
[h=3]Study: Contact isolation doesn't reduce spread of resistant organisms [/h] A study of patients in four European hospitals has found that contact isolation showed no benefit when added to standard precautions for controlling the spread of ESBL-producing Enterobacteriaceae (ESBL-E) on non-critical care wards with extensive surveillance screening, researchers reported yesterday in the Lancet Infectious Diseases.
In the cluster-randomized trial conducted at university hospitals in Germany, the Netherlands, Spain, and Switzerland, patients in medical, surgical, and combined medical-surgical wards were randomized to continue standard precautions alone or implement contact isolation alongside standard precautions for 12 months, followed by a 1-month washout period and 12 months of an alternative strategy. Patients were screened for ESBL-E on carriage within 3 days of admission, once a week thereafter, and on discharge. The primary outcome was the incidence density of ESBL-E.
Between Jan 6, 2014, and Aug 31, 2016, 38,357 patients were admitted to the hospital wards. Among 15,184 patients with a length of stay of more than 1 week, 11,368 patients (75%) were screened at least twice. The incidence density of ward-acquired ESBL-E was 6.0 events per 1,000 patient-days at risk (95% confidence interval [CI], 5.4 to 6.7) during periods of contact isolation and 6.1 (95% CI, 5.5 to 6.7) during periods of standard precautions (P = 0?9710). Multivariable analysis adjusted for length of stay, percentage of patients screened, and prevalence in first screening cultures yielded an incidence rate ratio of 0.99 (95% CI, 0.80 to 1.22; P = 0.9177) for care under contact isolation compared with standard precautions.
"The results of this trial suggest that current real-life practice in many countries, including the targeted identification of carriers and expanded use of contact isolation, is ineffective in preventing the spread of ESBL-E in endemic settings," the authors conclude.
The findings are significant because while many guidelines recommend the use of contact isolation for patients colonized or infected with multidrug-resistant bacteria, several studies in recent years have questioned their effectiveness. In addition, research has shown that patients under contact isolation express greater dissatisfaction with their treatment.
Feb 19 Lancet Infect Dis abstract
[h=3]Two tests detect carbapenem resistance in lower respiratory tract samples[/h] Spanish investigators yesterday in the Journal of Antimicrobial Chemotherapy reported good results from using two commercial rapid diagnostic tests—Xpert Carba-R and Eazyplex SuperBug CRE—to detect bacterial carbapenem resistance genes directly in lower respiratory tract samples.
The researcher team used the two tests—the former a real-time polymerase chain reaction (PCR) test and the other employing loop-mediated isothermal amplification—for detecting carbapenemase carriage in Enterobacteriaceae directly from bronchoalveolar lavage (BAL). The researchers added well-characterized carbapenemase-producing Enterobacteriaceae strains to the BAL samples to observe how the tests would perform.
Xpert Carba-R demonstrated 100% agreement with carbapenemase characterization by PCR and sequencing for all final bacteria concentrations. Eazyplex SuperBug CRE showed 100%, 80% and 27% agreement with PCR and sequencing at diminishing pathogen concentrations. False-negative results for Eazyplex SuperBug CRE matched the highest cycle threshold values for Xpert Carba-R. Hands-on time for both assays was about 15 min, but Eazyplex SuperBug CRE results were available within 30 min, whereas Xpert Carba-R took around 50 min.
The authors say their results could be used as proof-of-concept data for validating the tests for this purpose.
Feb 19 J Antimicrob Chemother abstract
[h=3]Nigeria reports 309 new Lassa fever cases, 472 total so far this year[/h] In the first 5 weeks of 2020, Nigeria has confirmed 472 Lassa fever cases, including 70 deaths, the World Health Organization (WHO) said in an update today. The outbreak has grown by 309 confirmed cases and 46 deaths since a WHO update on Jan 28.
The cases were reported from Jan 1 through Feb 9, and 26 of 36 states are affected. Edo (167 cases) and Ondo (156) are by far the hardest-hit states.
Fifteen healthcare workers have contracted the disease, one of whom died. Another health worker who had a probable case also died. Officials confirmed 793 Lassa fever cases in Nigeria in all of 2019, but this year cases are outpacing those seen during the same period last year.
Lassa fever is endemic in Nigeria, typically with an annual peak in the dry season (December through April) following the reproduction cycle of Mastomys rats (common African rats) in the wet season (May through June).
The WHO said, "Given that 90-95% of human infections are due to indirect exposure to (through food or household items contaminated by infected rats' urine and faeces) or direct contact with infected Mastomys rats, the very high density and high circulation of Lassa fever virus in young non-immune rat population during the wet season create a potential for further human infection, thus, the number of infections is expected to continue to rise until the end of the dry season."
Feb 20 WHO update
Jan 28 CIDRAP News scan on earlier report