Top 5 Infectious Disease News of the Week—April 15, 2018

#5: Drug-Resistant Gonorrhea and Other Emerging Issues in STIs

Previous downward trends in the rates of sexually transmitted infections (STIs) have reversed in recent years, and their incidence is on the rise in both men and women in the United States. In particular, the 3 most common reportable STIs—gonorrhea, chlamydia, and syphilis—represent a growing health threat, according to the US Centers for Disease Control and Prevention (CDC).

CDC surveillance data showed that more than 2 million cases of gonorrhea, chlamydia, and syphilis were diagnosed in 2016, the highest number of these STIs ever reported. Most of these new cases were due to chlamydia infection. Although all three of these STIs remain treatable with antibiotics in the majority of cases (Table 1), without timely diagnosis, they may lead to deleterious consequences such as infertility, stillbirth, and neonatal mortality. And, adding to the public health threat associated with these infections, antibiotic resistance is making gonorrhea increasingly harder to treat.

Read more about drug-resistant gonorrhea.

#4: Long-Acting Anti-MRSA Agents: One Dose to Cure?

Methicillin-resistant Staphylococcus aureus (MRSA) is a significant cause of both health care—associated and community-associated infections. The most common types of infections caused by MRSA are skin and soft-tissue infections, bacteremia, infective endocarditis, pneumonia, and osteomyelitis. Per current guidelines, oral antimicrobials for the treatment of mild-to-moderate MRSA skin infections include trimethoprim/ sulfamethoxazole, clindamycin, doxycycline, minocycline, and linezolid. Alternatively, vancomycin tends to be the most common intravenous (IV) agent for empiric coverage of a potentially serious MRSA infection. Serious infections caused by MRSA have a high morbidity and mortality, with estimates for mortality as high as 30% to 37% with endocarditis. Treatment durations for MRSA infections can vary widely based on the site and source of infection. Because of growing resistance and the need for a single-dose treatment option to help patients avoid hospitalization, facilitate their earlier discharge, or eliminate their need for continued outpatient parenteral antimicrobial therapy (OPAT), long-acting anti-MRSA agents have been developed.

Read more about long-acting anti-MRSA agents.

#3: Can Infectious Disease Physicians Help Prevent Violence?

About 1.6 million individuals die from violence each year on a global scale; in fact, more Americans have died from gunshot wounds in the past 50 years than have died from all wars combined since the American Revolution.

Where peace has been shown to correlate strongly with education, health, economic opportunity and a lower prevalence of infectious disease, the world is currently struggling with a long-term epidemic of violence. As new high-velocity bullets increase the severity of trauma seen with gunshot wounds, there is a growing concern that weapon technology may be more advanced than the scientific capacity to understand and prevent the violence they contribute to.

We need to methodically understand all contributors, deterrents, and acute triggers to violence in the same way in which we study airplane crashes and perform hospital quality assurance.

Read more about how infectious disease physicians could help prevent violence.

#2: Over 200 Million Eggs Recalled As More Fall Ill in Salmonella Outbreak

Infectious disease outbreaks seem to be springing up left and right in the United States, leaving health officials scrambling to get them under control.

Now, the US Food and Drug Administration (FDA) has announced that they are in the process of investigating an outbreak of Salmonella Braenderup infections that have been linked to shell eggs in multiple states.

Working in collaboration with the Centers for Disease Control and Prevention (CDC) along with other state partners, the FDA performed traceback activities to identify a potential source, which officials think to be eggs.

A laboratory analysis conducted on samples collected from Rose Acre Farms’ Hyde County Farm detected the rare strain of Salmonella that had been found in those who had fallen ill.

Read more about the Salmonella outbreak linked to Rose Acre Farms’ Hyde County Farm shell eggs. For the most recent case counts associated with the outbreak, be sure to check out the Contagion^® Outbreak Monitor.

#1: Meeting the Challenges of Infection Control in Hemodialysis Facilities

Dialysis is a vital and life-saving measure for millions of individuals around the world suffering from renal failure. End-stage renal disease (ie, kidney failure) impacts more than 660,000 Americans alone, meaning that the availability of dialysis is paramount to their health. Roughly 468,000 of those Americans suffering from end-stage renal disease (ESRD) rely on dialysis to remove toxins, solutes, and excess water from their blood.

Unfortunately, dialysis also carries with it an increased risk for infection, namely, bloodstream infections. The main tools in the infection control toolbox for reducing dialysis infections are hand hygiene, vascular (and catheter) access, staff education, patient/family education, skin antiseptic, and catheter hub disinfection. However, even something as simple (but critical) as hand hygiene can be challenging in hemodialysis facilities.

The Centers for Disease Control and Prevention (CDC) has worked tirelessly to provide the tools and education to help health care providers working in these facilities reduce the risk of infections associated with dialysis. One initiative, the Making Dialysis Safer for Patients Coalition, involves bringing forth all members of the care team to help educate and reduce infections.

Hand hygiene and environmental contamination are 2 common sources of bloodstream infection outbreaks in such environments. To this end, the authors of a recent article in the Clinical Journal of the American Society of Nephrology focused on the use of infection prevention procedures in hemodialysis facilities. A focus on hand hygiene was a common component; however, it can be easy for nurses to forget hand hygiene is needed before and after they move from the patient to the environment, and to the machine and back again.

Hand hygiene, especially when working with arteriovenous fistulas, central venous catheters (CVC), and other vascular accesses, is extremely important to help reduce the potential for infection. For their study, the investigators recommended the use of checklists and frequent audits to monitor hand-hygiene adherence and serve as reminders for staff. They also called out the importance of hub scrub (catheter hub disinfection) and dialysis station disinfection as well as the careful use of single-dose and multi-dose medications.

Read more about the challenges of infection control in hemodialysis facilities.