Top Infectious Disease News of the Week—March 17, 2019

#5 Pneumonia Linked With 43% of Unexpected Infectious Deaths in Study

Infectious diseases can lead to rapid and unexpected deaths, highlighting the importance of prevention strategies, according to a study published in Open Forum Infectious Diseases by investigators at the Sunnybrook Health Sciences Center in Ontario, Canada.

"There is very little prior attention on sudden, unexpected deaths from infectious diseases," Nick Daneman, MD, FRCPC, MSc, a scientist with Sunnybrook Health Sciences Centre and an author of the report, told Contagion^®.

The population-wide cohort study examined all unexpected deaths in Ontario between January 2016 and December 2017 and found that infectious causes were responsible for 6% of all unexpected deaths.

Read about unexpected infectious disease deaths.

#4 Bloodstream Infections Increase When Older Adults Aren't Given Antibiotics for UTIs

The push to limit the use of antibiotics in the treatment of urinary tract infections (UTIs) could be leading to an increase in bloodstream infections in elderly patients.

New research published last month in The BMJ offers new data points that could fuel additional discussion about how to tailor antibiotic stewardship programs so they sufficiently curtail antibiotic resistance while also limiting adverse effects associated with the reduction of the use of the drugs.

A team of British investigators wanted to gain a better handle on potential negative impacts of delaying or avoiding antibiotic use in elderly patients who see a primary care physician for the treatment of UTIs. The team leveraged a database of patient records stretching from 2007-2015 and encompassing more than 157,000 patients over the age of 65 who sought care for more than 312,000 urinary tract infections.

Read about bloodstream infection risks in older adults with UTIs.

#3 FDA Approves Label Expansion for Ceftazidime and Avibactam to Include Pediatric Patients

The US Food and Drug Administration (FDA) has approved a supplemental New Drug Application (sNDA), expanding the label for ceftazidime and avibactam (AVYCAZ) to include pediatric patients 3 months and older for the treatment of complicated urinary tract infections (cUTI) and complicated intra-abdominal infections (cIAI) in combination with metronidazole.

"Difficult-to-treat gram-negative pathogens pose a significant health risk, particularly to the vulnerable and sensitive pediatric patient population with few options for treatment," David Nicholson, PhD, chief research & development officer at Allergan said in a statement, further indicating that this marks the first approval of an indication for cUTI and cIAI in pediatric patients in more than a decade.

Ceftazidime/avibactam is a fixed-dose combination antibacterial. Avibactam is a non-beta-lactam beta-lactamase inhibitor, which protects ceftazidime from degradation by some beta-lactamases. Avibactam does not decrease the activity of ceftazidime against ceftazidime-susceptible organisms. Ceftazidime is a third-generation cephalosporin with a well-established efficacy and safety profile.

Read about the label expansion for ceftazidime/avibactam.

#2 Leronlimab (PRO 140) Advances as an HIV Combination Therapy Candidate

The makers of leronlimab (PRO 140) have filed the non-clinical portion of the drug’s Biologics License Application (BLA) as a combination therapy for HIV, the first of 3 sections of the submission, using the US Food and Drug Administration’s (FDA) Rolling Review process.

“This is the most important milestone yet in CytoDyn’s history,” Nader Pourhassan, PhD, president, CEO, and director of CytoDyn, the company developing PRO 140, said in a statement.

“We continue to execute on the submission of our BLA and are well positioned for potential revenue in 2020, subject to final approval. Our team is working diligently to complete the clinical and CMC portions, which represent the remaining two components of the BLA. We are also currently evaluating certain licensing opportunities relating to the commercialization of leronlimab upon approval.”

Read about the HIV combination therapy candidate.

#1 Abundance of Enteroviruses in the Gut Linked to Type 1 Diabetes Precursor

A new study by Columbia University's Mailman School of Public Health investigators has added new findings on the link between the presence of enteroviruses in children’s intestinal tracts and the onset of islet autoimmunity, which leads to type 1 diabetes.

Nonpolio enteroviruses made the news in 2018 after 1 enterovirus was linked to an outbreak of acute flaccid myelitis in Colorado children. Although enteroviruses can also cause illnesses such as hand, foot, and mouth disease, the recent study published in the journal Scientific Reports adds to the evidence linking these viruses to childhood-onset type 1 diabetes, once known as juvenile diabetes. According to the US Centers for Disease Control and Prevention (CDC), there are nearly 18,000 children and adolescents younger than 20 years diagnosed with type 1 diabetes annually.

There is currently no known way to prevent type 1 diabetes. In an interview with Contagion^®, study author Thomas Briese, PhD, associate professor of epidemiology at the Columbia University Medical Center, explained why the cause of the condition is so mysterious.

“Type 1 diabetes results from a complex interplay of genetic predisposition, immunologic capability, and environmental triggers. Even in monozygotic twins, one sees divergent outcomes,” said Dr. Briese. “This shows that genetic background alone is not sufficient for type 1 diabetes and stresses the importance of environmental factors, including nutrition, hygiene, geography, and virus infections.”

In the study, investigators characterized the virome of 93 Australian children—45 of whom had the type 1 diabetes precursor islet autoimmunity and 48 matched controls—using blood and feces samples. The children were part of a prospective birth cohort, known as the Australian Viruses in the Genetically at Risk study, with at least 1 first-degree relative with type 1 diabetes. Using a viral sequencing tool that is up to 10,000 times more powerful at identifying viruses than conventional sequencing methods, the study team identified 129 viruses in the fecal samples that were more abundant in the guts of children with islet autoimmunity compared with age and gender-matched controls. Among those, there were 5 enterovirus-A viruses, which investigators found to be significantly more abundant in some cases.

Read about enteroviruses and the link to type 1 diabetes.