Top Infectious Disease News of the Week—July 14, 2019

#5: Infectious Disease: The Dark Passenger on a Ride Along With Opioid Addiction

The opioid crisis the United States has challenged us in ways we simply didn’t expect. As public health, public policy, drug enforcement, and health care officials work to stop the opioid crisis in the United States, we’re learning more about the unexpected repercussions of addiction. One of these outcomes, it turns out, is a surge in infectious diseases.

Drug overdose is now the leading cause of death in Americans under the age of 50 years. It is estimated that more than 60,000 Americans suffer addiction-related deaths, accounting for 27% of the world’s overdose deaths, despite the fact that America only accounts for 4% of the world’s population.

Given these high rates of opioid use and death, it’s not surprising that this patient population would also be at risk for infectious diseases and, as a result, many in the medical community are pushing for the issue to be seen as an infectious disease threat. The move from oral opioid use to injection use is 1 that carries an inherent risk and as Anthony Fauci, MD, director of the National Institutes of Health, noted, “Patients with [injection drug use]-associated infectious diseases often receive treatment for the infection by an infectious diseases provider who may not recognize and/or address the underlying cause—opioid use disorder.”

Read about the link between ID and opioid addiction.

#4: Pipeline of PrEP Alternatives Grows, but There Are No Easy Answers

This spring, when the United States Preventative Services Task Force announcedits “Grade A” recommendation for pre-exposure prophylaxis (PrEP), advocates for people at risk of acquiring HIV cheered, hoping the move would lead to increased access for patients who currently have difficulty finding or paying for the daily pill.

However, a new study published in the journal Current HIV/AIDS Reports, notes that cost isn’t the only significant barrier. Matthew R. Beymer, PhD, MPH, and colleagues, say PrEP medication adherence is also a serious problem—1 that must be solved for the promise of PrEP to be realized.

“Among individuals who decide to initiate PrEP, demonstration projects and clinical databases suggest that medication adherence is insufficient to provide high levels of HIV protection among select population,” wrote Beymer, of the Department of Health and Mental Health Services at the Los Angeles LGBT Center.

Read about the PrEP pipeline.

#3: Ebola Outbreak Declared Public Health Emergency of International Concern

The World Health Organization (WHO) International Health Regulations Emergency Committee has recommended that WHO director-general Tedros Adhanom Ghebreyesus, PhD, declare the Ebola outbreak in the Democratic Republic of the Congo (DRC) a public health emergency of international concern (PHEIC). Dr. Tedros has accepted the recommendation, making it official.

The committee convened on Wednesday, July 17, 2019, in Geneva, Switzerland, to vote for the fourth time on whether the outbreak should be designated a PHEIC.

"The declaration of the Public Health Emergency of International Concern is not a reflection on the performance of the Ebola response team in DRC," the WHO said in a tweet. "It is a measure that recognizes the possible increased national & regional risks & the need for intensified & coordinated action to manage them."

Read more about the PHEIC declaration.

#2: Utilizing MRSA Nasal Screening for Antimicrobial Stewardship

Staphylococcus aureus is a common pathogen in health care-associated infections (HAIs).¹ Upwards of 40% of deep-seated S aureus infections confer methicillin-resistance. Patients with methicillin-resistant S aureus (MRSA) bacteremia and endocarditis may carry a mortality rate of 40%.^1,4 Current guidelines from the Infectious Diseases Society of America (IDSA) recommend empiric MRSA coverage in patients with certain risk factors.^2-6 Even without risk factors, most patients receive empirical vancomycin therapy. MRSA nasal screening, with clinical context, can be utilized to prevent unnecessary exposure, adverse events, and increased expense. ⁷ MRSA colonization can be detected via culture (1-3 days; 86.9% sensitivity) or polymerase chain reaction (PCR) (<1 day; 92.5% sensitivity). ^8,9 The prevalence of MRSA directly impacts the performance of the nasal screen in predicting clinical MRSA infection. A higher prevalence will result in lower negative predictive value. This systematic review by Carr et al., summarized available literature on adult inpatients for whom MRSA nasal swab screening was conducted.¹⁰

Read this In the Literature piece.

#1: FDA Approves Imipenem/Cilastatin + Relebactam

The US Food and Drug Administration has approved imipenem/cilastatin + relebactam (Recarbrio) for the treatment of complicated urinary tract infections and complicated intra-abdominal bacterial infections in adults who have limited or no alternative treatments available.

A new drug application (NDA) was accepted in February for the combination of relebactam, Merck’s investigational beta-lactamase inhibitor, with imipenem/cilastatin for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) caused by certain susceptible gram-negative bacteria.

Recarbrio is indicated in patients 18 years of age and older who have limited or no alternative treatment options, for the treatment of cUTI, including pyelonephritis, caused by the following susceptible gram-negative microorganisms: Enterobacter cloacae, Escherichia coli, Klebsiella aerogenes, Klebsiella pneumoniae, and Pseudomonas aeruginosa. It is also indicated for the treatment of cIAI caused by the following susceptible gram-negative microorganisms: Bacteroides caccae, Bacteroides fragilis, Bacteroides ovatus, Bacteroides stercoris, Bacteroides thetaiotaomicron, Bacteroides uniformis, Bacteroides vulgatus, Citrobacter freundii, Enterobacter cloacae, Escherichia coli, Fusobacterium nucleatum, Klebsiella aerogenes, Klebsiella oxytoca, Klebsiella pneumoniae, Parabacteroides distasonis and Pseudomonas aeruginosa.

Imipenem is a penem antibacterial drug, cilastatin sodium is a renal dehydropeptidase inhibitor, and relebactam is a beta-lactamase inhibitor. Cilastatin limits the renal metabolism of imipenem and does not have antibacterial activity. The FDA designated the combination of relebactam with imipenem/cilastatin for intravenous use as a Qualified Infectious Disease Product (QIDP) with Fast Track status for the treatment of cUTI, cIAI, and hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/VABP).

Read about the FDA approval.