Top Infectious Disease News of the Week—May 26, 2019

#5: New Recommendations for Managing Surgical Site Infections in Solid Organ Transplantation

Surgical site infections (SSIs) can occur in as many as 53% of transplant patients depending on the affected organ, and these infections are increasingly caused by multidrug-resistant organisms, leading to higher mortality and morbidity.

The American Society of Transplantation Infectious Diseases Community of Practice has issued a new section of guidelines as part of its series of evidence-based graded recommendations for the diagnosis, prevention, and management of SSIs.

Lilian Abbo, MD, FIDSA, chief of Infection Prevention and Antimicrobial Stewardship with Jackson Health System and associate professor of infectious diseases at University of Miami’s Miller School of Medicine, shared the key updates in an interview with Contagion®.

Read about the updated recommendations.

#4: Recommendations, Side Effects Influence Likelihood of PrEP Uptake

Recommendations from health care providers and attitudes about side effects were among the biggest factors influencing likelihood of taking HIV pre-exposure prophylaxis (PrEP), according to a recent study of heterosexual individuals in high-risk areas of Philadelphia.

The study, published in the journal Sexual Health, included 192 HIV-negative heterosexual participants from areas in Philadelphia with a high prevalence of HIV with the aim of better understanding barriers and facilitators to PrEP uptake.

“In a diverse sample of heterosexual persons accessing HIV testing in Philadelphia assessing attitudes towards PrEP, uptake intentions were significantly influenced by receiving a PrEP recommendation from a healthcare provider,” corresponding author Alexis Roth, PhD, MPH, assistant professor Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, told Contagion^®. “This suggests providers could play an important role in increasing PrEP uptake, specifically through assessing client HIV risk, via a non-judgmental sexual and drug use history, and providing PrEP recommendations. Our research also suggests patient concerns about PrEP side effects also impact PrEP intentions. Thus, increasing self-efficacy related to dealing with side-effects is likely to help patients get on and stay on PrEP.”

Read about influences that impact PrEP uptake.

#3: Baking Flour Stirs Up Controversy in Multistate E coli Outbreak

Bakers beware—the US Centers for Disease Control and Prevention (CDC) has announced a multistate E coli O26 outbreak likely linked to all-purpose flour sold at ALDI locations.

As of May 24, 2019, 17 people infected with the outbreak strain have been documented across 8 states. Whole genome sequencing conducted on bacteria isolated from ill individuals showed that they were closely related genetically, which indicates that the ill involved in this outbreak are more likely to share a common source of infection.

The ill individuals range in age from 7 to 86 years with a median age of 23 years, and 65% are female. Thus far, 3 individuals have been hospitalized and no deaths have been reported at this time.

Read about the E coli outbreak.

#2: Trial to Evaluate Long-Acting Injectables for People Struggling to Adhere to Daily Oral ART

Adherence to antiretroviral therapy (ART) is paramount to igniting and maintaining virologic suppression in individuals living with HIV. Despite this, some people struggle with adhering to a daily ART regimen and thereby struggle to achieve and maintain suppression.

Long-acting injectables may be a solution to this difficult problem, as the treatment replaces the burden of taking a pill daily with the option of receiving an injection once a month. Monthly injections were well-tolerated and well-received by volunteers enrolled in both the FLAIR and ATLAS trials.

“Adhering to daily medication remains a major health care challenge for patients with chronic health conditions,” Jose Castillo-Mancilla, MD, associate professor of medicine at the University of Colorado School of Medicine, and protocol co-chair of LATITUDE, said in a press release. “The generous volunteers who enroll in this study will help to ensure that more people living with HIV may have effective treatment regimens that work for them.”

Read about the LATITUDE study here.

#1: NJ Documents 5 Deaths in Ongoing Legionnaires' Disease Outbreak

The New Jersey Department of Health (NJDOH) has announced an investigation into a Legionnaires’ disease outbreak that turned deadly in 1 county.

According to a statement issued by the health agency late Friday afternoon, there have been 22 confirmed cases of Legionnaires’ disease in individuals who reside in or visited Union County. As of May 23, 2019, there have been 5 deaths recorded in the outbreak, all of which occurred in older adults with “other significant medical conditions.”

NJDOH is working alongside the US Centers for Disease Control and Prevention (CDC) and local health departments to investigate this cluster. Each year there are between 250-350 cases of Legionnaires’ disease in the state, however a cluster is considered an outbreak where 2 or more individuals fall ill following exposure to Legionella bacteria in the same place or at the same time. In this particular outbreak, all 22 individuals fell ill between March 8^th and May 13^th.

At this time, NJDOH is conducting epidemiologic and environmental investigations to identify possible sources of exposure to the bacteria. At this point in time, state health officials have not identified a specific exposure location, but the ongoing investigation has identified some potential sources and remediation has begun.

Health officials are conducting environmental sampling for Legionella and recommending environmental remediation strategies to prevent further transmission of Legionnaires’ disease. However, the statement notes that it is possible that there are multiple sources of bacteria in this outbreak.

According to New Jersey Health Commissioner Shereef Elnahal, MD, the risk of acquiring the disease is low for the average person. “This is a continuing investigation. The risk to any resident of, or recent visitor to Union County is very small,” he said in a press release.

Read about the Legionnaires’ disease outbreak.