Top Infectious Disease News of the Week—March 24, 2019

#5 More European Countries Reported Antibiotic-Resistant Gonorrhea in 2017

More countries in the European Union and European Economic Area (EU/EEA) reported antibiotic-resistant isolates of Neisseria gonorrhoeae in 2017, according to a new surveillance report from the European Centre for Disease Prevention and Control (ECDC).

Gonorrhea treatment often includes dual therapy with azithromycin and ceftriaxone. However, resistance among gonococcal isolates to azithromycin recently led health officials in the United Kingdom to cease recommending the dual therapy with azithromycin, replacing it with increased doses of ceftriaxone, the use of ciprofloxacin in certain cases, and adding extra-genital testing in cases of known or suspected antimicrobial resistance. The new ECDC report details surveillance data on antibiotic resistance patterns among gonorrhea isolates collected in Europe and reports that azithromycin resistance threatens the effectiveness of the current regimen.

“The emergence and spread of antimicrobial resistance in Neisseria gonorrhoeae is a serious threat to the treatment and control of gonorrhea,” the investigators wrote in the report. “The main therapeutic agents currently recommended in Europe, extended-spectrum cephalosporins, are the last remaining options for effective empiric first-line antimicrobial monotherapy.”

Read about the rise of antibiotic-resistant gonorrhea.

#4 WHO Updates 2019-2020 Influenza Vaccine Recommendations for Northern Hemisphere

The World Health Organization (WHO) has announced that a new influenza A(H3N2) component is recommended for the 2019-2020 seasonal flu vaccine. The decision comes following a delay in the decision to replace the component that was included in the vaccine for the 2018-2019 flu season.

Each year, WHO convenes technical consultations in February and September to set recommendations for influenza vaccines for flu seasons in the northern and southern hemispheres. At the WHO consultation on February 19-21, 2019, experts reviewed surveillance data on seasonal influenza activity collected from September 2018 to January 2019. “The majority of A(H3N2) viruses collected from September 2018 to January 2019 belonged to the phylogenetic subclade 3C.2a1b; however, the number of clade 3C.3a viruses has increased substantially since November 2018 in several geographic regions,” the experts noted in the February report. “There has continued to be considerable genetic diversification of the HA and NA genes.”

Due to recent changes in the proportions of genetically and antigenically diverse A(H3N2) viruses, in February the members of the WHO Global Influenza Surveillance and Response System postponed the recommendation of the A(H3N2) component. On March 21, 2019, the WHO released an addendum to the February report with a decision to recommend a A/Kansas/14/2017 (H3N2)-like virus for use in flu vaccines for use in the northern hemisphere’s 2019-2020 flu season. The new component replaces an A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus in use in the northern hemisphere flu vaccine for 2018-2019 flu season.

Read about updated vaccine recommendations for 2019-2020.

#3 Reducing Antibiotic Use Cuts Hospital-Onset C Diff Infections

Decreased use of antibiotics is associated with reductions in hospital-onset Clostridium difficile (C diff) infection, according to a new study released by the US Centers for Disease Control and Prevention (CDC).

"The effect of antibiotics on increasing risk for [C diff] in patients has been well documented, but what this study adds is that antibiotic use on the population level (within a hospital) is associated with hospital rates of [C diff]. Specifically, hospitals with higher rates of total inpatient antibiotic use were found to have higher rates of [hospital-onset C diff]," Sophia Kazakova, MD, MPH, PhD, from the Division of Healthcare Quality Promotion at the National Center for Emerging and Zoonotic Infectious Diseases at the CDC, and a corresponding author of the study, told Contagion^®.

The study, which looked at data from more than 500 acute care hospitals in the United States between 2006 and 2012, also found that the specific antibiotic classes—third- and fourth-generation cephalosporins and carbapenems—were associated with higher rates of hospital-onset C diff. It was the largest ecological investigation of the association to date.

Read about how reducing antibiotic use cut C diff infections.

#2 Pertussis and Other Diseases Could Return If Vaccination Rates Lag

In theory, the process is simple. Public health agencies set recommended vaccine schedules, children receive vaccinations during well visits and, as a result, some of the most pernicious diseases known to man fade into history.

Yet, for the past 2 decades—ever since a dubious paper questioning the safety of vaccines was published in a premier medical journal—that theoretical equation has been complicated.

Vaccinations have become optional in the minds of some parents, and scary in the minds of others. The result has been a series of outbreaks of preventable diseases, most recently measles.

Read about the potential consequences of vaccination lag.

#1 Can Cockroaches in Hospital Environments Harbor MRSA?

Cockroaches. The mere use of the word elicits shudders and retches, even more so when you consider how these critters are often associated with disease and a lack of cleanliness. These insects have an affinity for human excrement and trash, which leads many of us to hit the panic button when we see them.

They’re gross when found in a home, but imagine if you stumbled across a cockroach within a hospital…

Not only is it a huge patient and staff dissatisfier to see one of these insects scuttling across the floor during medical treatment, but it presents a major issue for hospital administration, which can’t easily exterminate an entire hospital with insect spray. And unfortunately, the concern over cockroaches in hospitals goes beyond just the “ick” factor; the bugs can also put patient safety at risk from an infection control perspective.

Urban pests are a big enough concern that the World Health Organization (WHO) put together a reportregarding the public health significance of pests in 2008.

Guess which pest landed first in the table of contents? That’s right—the cockroach.

The WHO noted that cockroaches are the “most significant pest found in apartments, homes, food-handling establishments, hospitals, and health care facilities worldwide.” Within the report, there is an entire table of pathogenic microbes isolated from cockroaches. This list ranges from Campylobacter jejuni, Klebsiella penumoniae, Salmonella Newport, Yersinia pestis, and includes a considerable amount of fungi and molds, not to mention poliomyelitis.

In addition to the WHO report, a recent study published in the journal of Antimicrobial Resistance & Infection Control identified resistant bacteria on hospital cockroaches in Iran.

From an infection prevention standpoint, this is pretty close to our worst nightmare. The investigators studied the phenotypic and genotypic characterization of the antibiotic resistance in the Methicillin-resistant Staphylococcus aureus (MRSA) strains that they isolated from cockroaches collected at the tertiary hospitals of the Tehran Province in Iran from 2016-2017. To capture the insect, they used sticky traps, vacuum cleaners, and hand-catch methods from human dwellings (that team of researchers deserves an extra round of applause). Traps were placed on the floors, under patient beds, in cupboards, wood racks, and under benches for 2 consecutive days. Following capture, the insects were placed in a sterile test tube and immobilized via freezing.

Read about the potential for cockroaches to harbor MRSA.