Top Infectious Disease News of the Week—September 9, 2018

#5: Gonorrhea Continues to Show High Levels of Resistance to Azithromycin Across EU

Gonorrhea is the second most common sexually transmitted infection in the European Union/European Economic Area (EU/EEA)—more than 75,000 cases were reported in 2016.

In 2009, the European Center for Disease Prevention and Control (ECDC) launched a program focused on coordinated surveillance of Neisseria gonorrhea antimicrobial susceptibility in the EU/EEA. The surveillance is designed to detect emerging, as well as increasing, antimicrobial resistance and make data readily available to develop appropriate treatment guidelines.

The ECDC has released the results of the 2016 European Gonococcal Antimicrobial Surveillance Program (Euro-GASP) which reports that Neisseria gonorrhea continues to show high levels of resistance to azithromycin across the EU.

Read more about antibiotic-resistant gonorrhea.

#4: The Forgotten Factors of Antimicrobial Resistance

Antimicrobial resistance is a complex problem. The issue stems from multiple industries and practices and there are myriad factors involved that facilitate the spread of resistant bacteria on a global scale. The challenges of constantly changing medical culture and spurring drug discovery can feel insurmountable, and now, the results of a new study indicate that factors like corruption may have a role to play in the spread of antimicrobial resistance.

Investigators pulled data from 3 separate sources—recent publications, the Resistance Map, and the World Health Organization 2014 report on antimicrobial resistance. From these data, they established 2 global indices that tracked antimicrobial resistance across 103 countries from 2008 to 2004. These country-level measure of antimicrobial resistance were 2 indices: Escherichia coli resistance to third-generation cephalosporins and fluoroquinolones and “aggregate resistance,” which includes resistance prevalence for multiple organisms and is “the combined average prevalence of E coli and Klebsiella spp resistant to third-generation cephalosporins, fluoroquinolones, and carbapenems, and methicillin-resistant Staphylococcus aureus.”

Read more about the forgotten factors of antimicrobial resistance.

#3: Seattle HIV Case Cluster Stark Reminder of Risks to Homeless: Public Health Watch

The suffering continues for a group of homeless people in the Seattle area already dealing with substance abuse problems.

On August 30, 2018, Seattle and King County public health officials announced that they had discovered an HIV case cluster involving 8 people—all of whom were homeless, heterosexual, and regular users of injection drugs—in the North Seattle neighborhood through “a combination of routine HIV testing, investigation of newly reported cases and HIV testing outreach efforts.”

Several of the individuals who tested positive admitted to “exchanging sex for money or drugs,” prompting officials to express concern that more new cases among heterosexuals who use injection drugs and those who have unprotected sex with them in exchange for money and/or drugs may emerge.

Read the rest of this week’s Public Health Watch.

#2: Shell Eggs Linked with Another Salmonella Outbreak, Prompting Recall

The US Centers for Disease Control and Preventions (CDC) and US Food and Drug Administration (FDA) are working alongside state health officials to investigate a multistate outbreak of Salmonella Enteritidis infections that are suspected to be linked to shell eggs produced by Gravel Ridge Farms.

There has been an influx of Salmonella outbreaks linked to poultry this year including an outbreak linked to Rose Acre Farms shell eggs. The previous outbreak, which consisted of infections caused by Salmonella Braenderup, also resulted in 200 million eggs being recalled. The outbreak has since been declared over by the CDC.

As of September 7, 2018, there have been 14 cases of the Salmonella Enteritidis reported from 2 states. Illnesses started on dates ranging from July 10, 2018 to August 7, 2018 with those who have fallen ill between the ages of 1 and 94 years; half of those infected are female. Two of the individuals have required hospitalization for their illnesses, but as of September 10, 2018, no deaths have been reported.

Read more about the new Salmonella outbreak linked to shell eggs.

For the most recent case counts associated with the outbreak, be sure to check out our Outbreak Monitor.

#1: Probiotic Supplements After Antibiotics May Do More Harm Than Good

The popularity of probiotic foods and products—touted for their gut health benefits—has grown in recent years, but a new pair of studies suggest that taking probiotics may not have the desired effects, including when they’re taken along with antibiotics.

Consumption of probiotic-infused foods and dietary supplements has grown as a strategy to use “good” bacteria to fight “bad” pathogenic bacteria. A 2017 National Health Interview Survey conducted by the National Institutes of Health (NIH) found that 3.9 million adults in the United States consume probiotic and prebiotic supplements, although there is lacking literature on the safety of probiotic supplementation. Recent studies have found that probiotic isolates such as Lactobacillus reuteri may offer a powerful weapon against dangerous antibiotic-resistant bacteria such as Clostridium difficile, Pseudomonas aeruginosa, Escherichia coli, and Klebsiella pneumonia. A 2017 study detailed the benefits of Lactobacillus supplementation in infants in India, where treatment with the probiotic was found to significantly reduce sepsis deaths in low birth weight infants.

Now, investigators from the Weizmann Institute of Science in Israel studying the human gut have authored 2 new papers regarding probiotics that were published on September 6, 2018 in the journal Cell. In the first study of 25 human participants, investigators found that not everyone who takes probiotics experiences intestinal colonization of the beneficial bugs. After participants received upper endoscopies and colonoscopies to sample their baseline gastrointestinal (GI) microbiome, the investigators then gave 15 participants either an 11-strain probiotic preparation or a placebo. Rather than using stool samples to analyze participants’ GI microbiomes—which the authors say may not accurately reflect the microbial gut mucosal composition and function—the investigators administered a second round of upper endoscopies and colonoscopies.

The investigators found that while the probiotics colonized the guts of some participants, dubbed “persisters,” the other participants were “resisters” and expelled the probiotics. "Surprisingly, we saw that many healthy volunteers were actually resistant in that the probiotics couldn't colonize their GI tracts,” senior author Eran Elinav, MD, PhD, in a recent statement. “This suggests that probiotics should not be universally given as a 'one-size-fits-all' supplement. Instead, they could be tailored to the needs of each individual."

Read more about probiotic supplements.