Top 5 Infectious Disease New Stories Week of November 2-8

Identifying Risk Factors for Reduced Vancomycin Susceptibility in Clostridioides difficile Infections

A recent study found that 29% of hospitalized patients with Clostridioides difficile infection (CDI) showed reduced susceptibility to vancomycin, a concerning trend that highlights the need for enhanced monitoring of these strains. Specifically, ribotype 027 was identified as a significant independent risk factor for reduced vancomycin susceptibility, with an odds ratio of 13.4, suggesting a strong association. While patient demographics and disease characteristics did not predict infections with vancomycin-resistant strains, the study emphasized that identifying RT 027 through diagnostic testing could guide antibiotic prescribing, especially in determining whether vancomycin or fidaxomicin should be used. This reduced susceptibility correlates with poorer clinical outcomes, including lower sustained clinical response rates and higher treatment failure, reinforcing the need for more targeted surveillance and antibiotic stewardship in the management of CDI.

INSPIRE Trials: Reducing Antibiotic Prescribing For Skin and Soft Tissue And Abdominal Infections

The INSPIRE trials, led by Shruti K. Gohil, MD, MPH evaluated the use of computerized physician order entry prompts with real-time patient-specific multidrug-resistant organism risk estimates to reduce the use of extended-spectrum antibiotics (ES) in hospitalized patients, without compromising patient safety. Conducted across 92 hospitals in 15 states, the trials included over 300,000 patients and demonstrated a 28% reduction in ES antibiotic use for skin and soft tissue infections and up to 35% for abdominal infections. Importantly, there were no changes in ICU transfer rates or hospital length of stay, suggesting the intervention could help shift clinical practices toward using narrow-spectrum antibiotics for low-risk patients, potentially mitigating the rise of antimicrobial resistance.

Photohydrolysis Technology Achieves Reduction in Fungal Colony-Forming Units and C auris In Hospital Settings

A recent study presented at IDWeek explored ActivePure’s advanced photohydrolysis (AP) technology to reduce microbial load, including Candida auris (C auris), in hospital settings. Deborah Birx, MD, and Amy Carenza, BBA, discussed the results; a 99% reduction in fungal colony-forming units (CFUs) and a 98% reduction in aerobic bacteria, with a 66% decrease in C auris, although the latter reduction was not statistically significant. Conducted across high-acuity hospital units from September 2023 to January 2024, the study showed that AP technology could effectively reduce environmental bioburden, particularly on hospital floors and high-touch surfaces, without additional labor or resources. While there were some fluctuations in pathogen levels, the technology demonstrated promise in preventing infections and reducing complications, offering the potential for improving patient outcomes in high-risk healthcare environments. Pt 2 of our interview: Infection Control: AP Technology's Impact on Reducing HAIs and AMR Pathogens

New Peptide Vaccine for Universal Influenza Protection

A novel peptide-based vaccine designed for universal influenza protection was introduced at IDWeek, Jeffery Lipman addresses the threat of influenza pandemics caused by reassortant strains from human, avian, and swine origins. This new unconjugated single composite peptide vaccine, which targets highly conserved epitopes from hemagglutinin, neuraminidase, and matrix proteins, was shown to generate broadly reactive antibodies against a wide range of influenza strains, including seasonal and pandemic variants. In preclinical trials, the vaccine effectively neutralized both human and avian influenza viruses, inducing strong immune responses in mice. The vaccine is formulated with the ALFQ adjuvant, which enhances its efficacy, and its single peptide approach simplifies production and scalability. Looking ahead, the developers plan to test the vaccine as a mucosal intranasal vaccine to potentially prevent infections altogether, offering a promising tool for mitigating future influenza outbreaks and reducing the global impact of the disease.

What's New In 2024: From the CLSI Subcommittee on Antimicrobial Susceptibility Testing

In 2024, the Clinical and Laboratory Standards Institute (CLSI) Subcommittee on Antimicrobial Susceptibility Testing updated key breakpoints and testing criteria to improve clinical care and antimicrobial stewardship. Notably, they refined recommendations for carbapenemase testing in Enterobacterales, emphasizing the need for more specific criteria to guide when testing for carbapenemase production. They also introduced investigational breakpoints for the combination of cefepime and zidebactam, a promising treatment for multidrug-resistant infections, while reviewing and maintaining breakpoints for ampicillin/sulbactam in Acinetobacter infections. Additionally, the subcommittee revised minocycline breakpoints for Acinetobacter to better align with clinical dosing regimens and outcomes. These updates, published in the M100 (35th edition), are aimed at improving susceptibility testing accuracy and enhancing treatment effectiveness against resistant pathogens.