Shiloh
Editor, Senior Moderator
Source: https://www.cidrap.umn.edu/news-perspective/2022/05/stewardship-resistance-scan-may-06-2022
Stewardship / Resistance Scan for May 06, 2022
Healthcare-associated infection toll; Resistant gonorrhea surveillance; Pseudomonas outbreak in Norway
Filed Under:
Gonorrhea; Antimicrobial Stewardship; Healthcare-Associated Infections
WHO report highlights global toll of healthcare-associated infections
The World Health Organization (WHO) today issued a report highlighting the threat of healthcare-associated infections (HAIs) and the role that infection prevention and control (IPC) programs can play in reducing that threat.
According to the report, out of every 100 patients in acute care hospitals, 7 patients in high-income countries and 15 in low- and middle-income countries (LMICs) will acquire on average at least one HAI during their stay, and up to 30% of patients in intensive care units will acquire one. Nearly one quarter (23.6%) of hospital-treated sepsis cases are healthcare-associated.
The impact is not limited to acute care hospitals. Data show that 4.4 million HAIs occur in long-term care facilities every year in European countries, while 1 out of every 43 US nursing home residents has an HAI.
The problem is exacerbated by antimicrobial resistance (AMR), with data showing that mortality is at least two to three times higher among those with HAIs caused by resistant microorganisms.
Meanwhile, progress on implementing and funding national IPC programs has been slow, particularly in LMICs. While recent WHO surveys show that 61.3% of countries have a national IPC program, only 54.7% of them have an active, functioning program with annual work plans and a budget, and only 4 of the 106 countries (3.8%) have met all minimum requirements for an IPC program. Compared to LMICs, high-income countries were five to eight times more likely to have a more advanced IPC implementation status.
The report suggests that implementing a range of IPC interventions, such as hand hygiene and enhanced environmental hygiene, could reduce HAI rates by 35% to 70%, halve the risk of dying from an HAI caused by a resistant pathogen, and decrease the associated long-term complications and health burden of AMR by 40%.
"WHO is calling on all countries around the globe to increase their investment in IPC programmes to ensure quality of care and patient and health workers' safety," the agency said in a press release. "This will not only protect their populations, increased investment in IPC has also demonstrated to improve health outcomes and reduce health-care costs and out-of-pocket expenses."
May 6 WHO report on infection prevention and control
May 6 WHO press release
Drug-resistant gonorrhea surveillance lacking, researchers warn
Two reports published yesterday in Eurosurveillance stress the need for better surveillance, control, and management of drug-resistant gonorrhea.
In a systematic review of literature on surveillance systems targeting AMR in gonorrhea, a team of Australian researchers found 40 records describing 32 country-level Neisseria gonorrhoeae surveillance system and 10 records describing four regional surveillance systems. The proportion of countries with surveillance systems in each of the WHO's six regions ranged from 1 of 22 countries in the Eastern Mediterranean and 5 of 54 in Africa, to 3 of 11 countries in Southeast Asia.
Only four countries (Australia, New Zealand, Canada, and the United Kingdom) had gonorrhea AMR surveillance systems that were both comprehensive (covering all culture-evaluable gonorrhea diagnoses) and national (covering more than 50% of jurisdictions. Most striking, the study authors noted, was the lack of surveillance in LMICs that have a high burden of gonorrhea.
"We have found that in most WHO regions, information on adequate systems was only available from a few countries," they wrote. "We also found major gaps in coverage, comprehensiveness and representativeness as well as wide variation in the methodology. These gaps indicate serious vulnerability in countries' capacity to detect, accurately monitor and respond to N. gonorrhoeae AMR and represents a global health risk in a world connected through travel."
In the other report, researchers from the WHO, European Centre for Disease Prevention and Control (ECDC), and the UK Health Security Agency note that since the ECDC issued its response plan to control and manage multidrug-resistant N gonorrhoeae in Europe in 2012, several strains of extensively drug-resistant gonorrhea have emerged, prompting an update to the plan in 2019, including strengthened surveillance and treatment failure monitoring. The authors conclude that the plan should be reviewed every 2 years to identify and address areas for improvement
"Along with prevention, diagnostic, treatment and epidemiological surveillance strategies, AMR surveillance is essential for effective control of gonorrhoea," they wrote.
May 5 Eurosurveill systematic review
May 5 Eurosurveill perspective
Pseudomonas outbreak in Norway linked to disposable washcloths
In another report published yesterday in Eurosurveillance, Norwegian researchers described a nationwide Pseudomonas aeruginosa outbreak in Norway linked to disposable washcloths.
The outbreak began in November 2021, when the Norwegian Institute of Public Health was notified by the University Hospital of North-Norway of three patients hospitalized with severe COVID-19 who had died from bloodstream infections caused by indistinguishable P aeruginosa strains, only a few days apart. Whole-genome sequencing (WGS) revealed the infections were caused by the novel sequence type ST3875.
Additional cases caused by P aeruginosa ST3875 were then rapidly detected in hospitals in all four regions of Norway, strongly indicating a common source of infection. By Apr 25, 2022, the outbreak included 339 cases at 38 hospitals. While most patients were colonized or had mild urinary tract or wound infections, 53 patients (15.3%) died, with 7 of the deaths (2.1%) directly attributable to P aeruginosa.
On Mar 18, Oslo University Hospital detected P aeruginosa—which thrives in warm, moist environments—in disposable pre-moistened washcloths after systematic testing of several hundred different products that were used on the hospital wards that treated identified cases. Subsequent polymerase chain reaction (PCR) testing and WGS identified the P aeruginosa isolates from the washcloths as the outbreak strain, ST387. After use of the washcloths was stopped, there was a rapid decline in cases over the next 4 weeks. Screening for further cases is ongoing.
On Mar 23, the Norwegian Food Safety Authority banned contaminated lots of the product from the Norwegian market and on Apr 9 issued a warning in Norway against use of all products from the manufacturer. But investigators warn that the washcloths have been sold and used in many countries, and that the outbreak may be ongoing and undetected in EU countries and beyond.
"Consequently, it is prudent to advise further investigations of P. aeruginosa ST3875 infections, and when identified, investigate if they are linked to the same product," they wrote.
May 5 Eurosurveill rapid communication
Stewardship / Resistance Scan for May 06, 2022
Healthcare-associated infection toll; Resistant gonorrhea surveillance; Pseudomonas outbreak in Norway
Filed Under:
Gonorrhea; Antimicrobial Stewardship; Healthcare-Associated Infections
WHO report highlights global toll of healthcare-associated infections
The World Health Organization (WHO) today issued a report highlighting the threat of healthcare-associated infections (HAIs) and the role that infection prevention and control (IPC) programs can play in reducing that threat.
According to the report, out of every 100 patients in acute care hospitals, 7 patients in high-income countries and 15 in low- and middle-income countries (LMICs) will acquire on average at least one HAI during their stay, and up to 30% of patients in intensive care units will acquire one. Nearly one quarter (23.6%) of hospital-treated sepsis cases are healthcare-associated.
The impact is not limited to acute care hospitals. Data show that 4.4 million HAIs occur in long-term care facilities every year in European countries, while 1 out of every 43 US nursing home residents has an HAI.
The problem is exacerbated by antimicrobial resistance (AMR), with data showing that mortality is at least two to three times higher among those with HAIs caused by resistant microorganisms.
Meanwhile, progress on implementing and funding national IPC programs has been slow, particularly in LMICs. While recent WHO surveys show that 61.3% of countries have a national IPC program, only 54.7% of them have an active, functioning program with annual work plans and a budget, and only 4 of the 106 countries (3.8%) have met all minimum requirements for an IPC program. Compared to LMICs, high-income countries were five to eight times more likely to have a more advanced IPC implementation status.
The report suggests that implementing a range of IPC interventions, such as hand hygiene and enhanced environmental hygiene, could reduce HAI rates by 35% to 70%, halve the risk of dying from an HAI caused by a resistant pathogen, and decrease the associated long-term complications and health burden of AMR by 40%.
"WHO is calling on all countries around the globe to increase their investment in IPC programmes to ensure quality of care and patient and health workers' safety," the agency said in a press release. "This will not only protect their populations, increased investment in IPC has also demonstrated to improve health outcomes and reduce health-care costs and out-of-pocket expenses."
May 6 WHO report on infection prevention and control
May 6 WHO press release
Drug-resistant gonorrhea surveillance lacking, researchers warn
Two reports published yesterday in Eurosurveillance stress the need for better surveillance, control, and management of drug-resistant gonorrhea.
In a systematic review of literature on surveillance systems targeting AMR in gonorrhea, a team of Australian researchers found 40 records describing 32 country-level Neisseria gonorrhoeae surveillance system and 10 records describing four regional surveillance systems. The proportion of countries with surveillance systems in each of the WHO's six regions ranged from 1 of 22 countries in the Eastern Mediterranean and 5 of 54 in Africa, to 3 of 11 countries in Southeast Asia.
Only four countries (Australia, New Zealand, Canada, and the United Kingdom) had gonorrhea AMR surveillance systems that were both comprehensive (covering all culture-evaluable gonorrhea diagnoses) and national (covering more than 50% of jurisdictions. Most striking, the study authors noted, was the lack of surveillance in LMICs that have a high burden of gonorrhea.
"We have found that in most WHO regions, information on adequate systems was only available from a few countries," they wrote. "We also found major gaps in coverage, comprehensiveness and representativeness as well as wide variation in the methodology. These gaps indicate serious vulnerability in countries' capacity to detect, accurately monitor and respond to N. gonorrhoeae AMR and represents a global health risk in a world connected through travel."
In the other report, researchers from the WHO, European Centre for Disease Prevention and Control (ECDC), and the UK Health Security Agency note that since the ECDC issued its response plan to control and manage multidrug-resistant N gonorrhoeae in Europe in 2012, several strains of extensively drug-resistant gonorrhea have emerged, prompting an update to the plan in 2019, including strengthened surveillance and treatment failure monitoring. The authors conclude that the plan should be reviewed every 2 years to identify and address areas for improvement
"Along with prevention, diagnostic, treatment and epidemiological surveillance strategies, AMR surveillance is essential for effective control of gonorrhoea," they wrote.
May 5 Eurosurveill systematic review
May 5 Eurosurveill perspective
Pseudomonas outbreak in Norway linked to disposable washcloths
In another report published yesterday in Eurosurveillance, Norwegian researchers described a nationwide Pseudomonas aeruginosa outbreak in Norway linked to disposable washcloths.
The outbreak began in November 2021, when the Norwegian Institute of Public Health was notified by the University Hospital of North-Norway of three patients hospitalized with severe COVID-19 who had died from bloodstream infections caused by indistinguishable P aeruginosa strains, only a few days apart. Whole-genome sequencing (WGS) revealed the infections were caused by the novel sequence type ST3875.
Additional cases caused by P aeruginosa ST3875 were then rapidly detected in hospitals in all four regions of Norway, strongly indicating a common source of infection. By Apr 25, 2022, the outbreak included 339 cases at 38 hospitals. While most patients were colonized or had mild urinary tract or wound infections, 53 patients (15.3%) died, with 7 of the deaths (2.1%) directly attributable to P aeruginosa.
On Mar 18, Oslo University Hospital detected P aeruginosa—which thrives in warm, moist environments—in disposable pre-moistened washcloths after systematic testing of several hundred different products that were used on the hospital wards that treated identified cases. Subsequent polymerase chain reaction (PCR) testing and WGS identified the P aeruginosa isolates from the washcloths as the outbreak strain, ST387. After use of the washcloths was stopped, there was a rapid decline in cases over the next 4 weeks. Screening for further cases is ongoing.
On Mar 23, the Norwegian Food Safety Authority banned contaminated lots of the product from the Norwegian market and on Apr 9 issued a warning in Norway against use of all products from the manufacturer. But investigators warn that the washcloths have been sold and used in many countries, and that the outbreak may be ongoing and undetected in EU countries and beyond.
"Consequently, it is prudent to advise further investigations of P. aeruginosa ST3875 infections, and when identified, investigate if they are linked to the same product," they wrote.
May 5 Eurosurveill rapid communication
