Infection PreventioneBug Bytes

May 2015

E.Coli in cell division (every 20 minutes)

MRSA Can Linger in Homes, Spreading Among its Inhabitants

• MRSA are strains of the bacterium Staphylococcus aureus that are resistant to almost all antibiotics related to penicillin, known as the beta-lactams. Since the 1990s, community-associated MRSA infections, mostly skin infections, have been seen in healthy people. The predominant community-associated strain of MRSA, called USA300, is virulent and easily transmissible. For the study, researchers used a laboratory technique called whole genome sequencing on 146 USA300 MRSA samples. These samples were collected during a previous study from 21 households in Chicago and Los Angeles where a family member had presented to the emergency room with a skin infection found to be caused by USA300 MRSA. During that study, published in 2012 in the journal Clinical Infectious Diseases, investigators visited the homes of 350 skin infection patients, culturing their and their family members' noses, throats and groins for bacterial colonization. Among 1,162 people studied (350 skin infection patients and 812 household members), S. aureus colonized at one or more body sites of 40 percent (137 of 350) of patients with skin infections and 50 percent (405 of 812) of their household contacts. The researchers found that isolates within households clustered into closely related groups, suggesting a single common USA300 ancestral strain was introduced to and transmitted within each household. "The study adds to the knowledge base of how USA300 MRSA has spread throughout the country," said study coauthor Timothy D. Read, PhD. "We're also getting hints at how it evolves inside households. Decolonization of household members may be a critical component of prevention programs to control USA300 MRSA spread in the United States.“ Source: American Society for Microbiology

FDA: 142 Contaminated Duodenoscope Reports Since 2010

• The FDA says it has received 142 reports of contaminated duodenoscopes since 2010, along with 4 additional reports dating back to 1997. Of the 146 total, 13 involved patient deaths and 121 involved injuries, says the agency. Each incident had the potential to expose multiple patients. While the agency is convening an advisory panel this week to address the issue, its previous response to the contamination concerns haven't indicated a radical shift in direction. "The transmission of infectious material from patient to patient during ERCP (endoscopic retrograde cholangiopancreatography), although uncommon, represents a serious public health concern," the FDA stated in its latest report, which stood by its decision not to recall the scopes. The agency estimates that 669,000 ERCP procedures were performed last year alone.

• Olympus, which holds an 85% share of the U.S. market for duodenoscopes, recently issued new reprocessing instructions for its TJF-Q180V duodenoscope and was scheduled to begin providing customers with small-bristle cleaning brushes in early May. The brushes are intended to help decontaminate the forceps elevator channel, thought to be the source of most cross-contamination-associated infections.

• Source: Outpatient Surgery – May 2015

FDA Advisory Committee Slated to Review Procedures for Reprocessing Endoscopes

• On May 14 and 15, 2015, the Gastroenterology and Urology Devices Panel of the Medical Devices Advisory Committee to the FDA will convene to offer expert opinion related to reprocessing of duodenoscopes and other endoscopes. The committee meeting comes on the heels of an FDA safety communication that was issued in February of 2015 regarding recent reports of multidrug-resistant bacterial infections in patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) with reprocessed duodenoscopes. On March 12, 2015, the FDA released final guidance for reprocessing of reusable medical devices aimed at enhancing the safety of reusable medical devices and reducing risk of spread of infectious agents between uses. The Advisory Committee is being asked to make recommendations on the following:

• •The effectiveness of cleaning, high-level disinfection, and sterilization methods.• •The amount and type of premarket validation data and information needed to support labeling claims and technical

instructions.• •The appropriate use of other risk mitigation, such as surveillance cultures.• •Best practices and guidelines for reprocessing duodenoscopes and endoscopes at user facilities to minimize the

transmission of infections.

• •Approaches for ensuring patient safety during ERCP procedures, including a discussion of appropriate patient selection. Source: FDA

Stomach bug traced to swimming in contaminated lake • An outbreak of gastrointestinal illness that was traced back to an Oregon lake

has led U.S. health officials to issue guidelines on swimming hygiene.• Seventy people who swam at a lake near Portland last July were sickened by

norovirus, according to a report from the U.S. Centers for Disease Control and Prevention. More than half of those sickened in the Oregon outbreak were children aged 4 to 10 years.

• Health officials believe a swimmer infected with norovirus vomited or had diarrhea in the water, and other swimmers swallowed the contaminated water. People who swam in the lake were 2.3 times more likely to become ill than those who visited the park but did not go in the water, according to the report published in the May 15 issue of the CDC's Morbidity and Mortality Weekly Report.

• The lake was closed to swimmers for 10 days to prevent further transmission.• Source: U.S. Centers for Disease Control and Prevention, news release, May 14,

2015

MERS fear prompts South Korea to quarantine people in bid to curb virus' spreadSouth Korean government is planning to bar people exposed to the Middle East Respiratory Syndrome (MERS) from leaving the country, in a bid to contain the disease's spread. Over the past 12 days, 18 people have been diagnosed with MERS and the country is working to isolate hundreds of others who have come into contact with those infected by the virus. The country's health minister Moon Hyung Pyo said that the measure was necessary to contain the virus' spread after a man, who was in close contact with a MERS patient in South Korea, later decided to leave the country for China. He is currently in isolation after being diagnosed with the disease. MERS has so far killed hundreds of people in the Middle East and the first case of MERS in the country was detected in a 68-year-old man who had travelled to Bahrain in April and May. The hospital where the first outbreak was reported has been closed and all patients were being treated in quarantine. The country's government also said Sunday that it would form a MERS task force, which would include experts from the private sector. By Monday, 682 people of the 715 people who have been in close contact with MERS patients have been put in isolation. Another 33 were released for not showing any symptoms after a 14-day incubation period. The country has yet to report any tertiary infections yet. This means that the 17 people currently diagnosed with MERS became infected after they came in close contact with the first patient. If a tertiary infection occurs, then any of the 18 could become a carrier. There is no treatment yet for MERS, a viral respiratory illness that was first reported in 2012 in Saudi Arabia. Since then, 23 countries have reported 1,142 cases. Source: http://www.ibtimes.com/mers-fear-prompts-south-korea-quarantine-people-bid-curb-virus-spread-1945916

Lives could be saved with Hepatitis C treatment

The word "hepatitis" means swelling of the liver. Hepatitis is most often caused by a virus. In the United States, the most common type of viral hepatitis is hepatitis C. Hepatitis C is primarily spread through contact with blood from an infected person. More than 15,000 Americans, most of them baby boomers, die each year from hepatitis C-related illness.Deaths related to hepatitis C have been on the rise and are expected to increase. Hepatitis C is a leading cause of liver cancer and the leading reason for liver transplants. Other serious health problems related to hepatitis C include:•Liver damage•Cirrhosis•Liver failurePeople born during 1945 through 1965 are five times more likely than other adults to be infected with hepatitis C. If you were born during these years, talk to your doctor about getting tested. In fact, 75 percent of adults with hepatitis C were born during these years. The reason that baby boomers have the highest rates of hepatitis C is not completely understood. Most boomers may have become infected in the 1970s and 1980s when rates of hepatitis C were the highest. Many baby boomers could have gotten infected from tainted blood and blood products before testing of the blood supply began in 1992. Others may have become infected from injecting drugs, even if only once in the past. Still, many baby boomers do not know how or when they were infected. Source: www.apic.org

Bacterial cause behind fatal heart complications discovered

• As Streptococcus pneumoniae is a respiratory pathogen that does not infect the heart, however, this association with heart problems has puzzled clinicians and researchers, particularly as even prompt use of antibiotics does not provide any protection from cardiac complications. A multidisciplinary research team, at the University of Liverpool, has now shown that the cause of cardiac injury is a toxin called pneumolysin, which is released by the bacteria during infection. They found that this toxin could directly attack heart muscle cells, causing injury, damage and death. "We have discovered that the toxin pneumolysin, which is released during infection with Streptococcus pneumoniae, is the main reason why a significant number of patients develop rapidly progressive and fatal heart complications even if the bacteria does not directly infect the heart.” Importantly, the researchers also found that the use of antibiotics could exacerbate damage to heart muscle cells during infection with S. pneumoniae, as antibiotic-induced bacterial death releases large amounts of pneumolysin into the blood circulation. To circumvent this problem, the team used specially engineered fat bodies, called liposomes, to bind to and neutralise pneumolysin and prevent it from damaging heart muscle cells.

• Source: Yasir A et al: Circulating Pneumolysin Is a Potent Inducer of Cardiac Injury during Pneumococcal Infection. PLOS Pathogens, 2015; 11 (5): e1004836

Gel filled with Nanosponges cleans up MRSA infectionsNanoengineers at the University of California, San Diego developed a gel filled with toxin-absorbing nanosponges that could lead to an effective treatment for skin and wound infections caused by MRSA. This "nanosponge-hydrogel" minimized the growth of skin lesions on mice infected with MRSA -- without the use of antibiotics. To make the nanosponge-hydrogel, the team mixed nanosponges, which are nanoparticles that absorb dangerous toxins produced by MRSA, E. coli and other antibiotic-resistant bacteria, into a hydrogel, which is a gel made of water and polymers. The hydrogel holds the nanosponges in place so that they can remove toxins at the infected spot. Since the nanosponge-hydrogel treatment does not involve antibiotics, it will not likely be affected by existing bacterial antibiotic resistance. Also, because antibiotics are not involved, the treatment will likely not cause bacteria to develop new resistance. One way to treat these infections is to remove the toxins, which act as a weapon and a defense shield for the bacteria that produce them. Researchers hypothesized that without the toxins, the bacteria become significantly weakened and exposed, allowing the body's immune system to kill them more easily without the use of drugs. How does the nanosponge-hydrogel treatment work? Each nanosponge is a nanoparticle coated in a red blood cell membrane. This coating disguises the nanosponges as red blood cells, which are the real targets of the harmful toxins produced by MRSA. By masquerading as red blood cells, the nanosponges attract harmful toxins and remove them from the bloodstream. In order for the nanosponges to remove toxins from a specific spot, such as an infected skin wound, a lot of them need to be held at that spot. Source: Wang A et al. Hydrogel Retaining Toxin-Absorbing Nanosponges for Local Treatment of Methicillin-ResistantStaphylococcus aureusInfection. Advanced Materials, 2015

Researchers find off-patent antibiotics effectively combat MRSA skin infectionsResearchers funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, have found that two common antibiotic treatments work equally well against bacterial skin infections caused by methicillin-resistant Staphylococcus aureus (MRSA) acquired outside of hospital settings. Known as community-associated MRSA, or CA-MRSA, these skin infections have been reported in athletes, daycare-age children, students, military personnel and prison inmates, among others, and can lead to hospitalization, surgical procedures, bacteria in the blood, and in severe cases, death. Although MRSA is an increasingly common pathogen and the most common cause of skin infection in the United States, there is no standard treatment approach for CA-MRSA. As CA-MRSA emerged in community settings, there were concerns about how to identify the best treatment options and preserve the effectiveness of last-line drugs. Two older antibiotics that are no longer under patent, clindamycin and TMP-SMX, are recommended to treat CA-MRSA. It was unknown whether one antibiotic was associated with better outcomes in patients. To answer this question, scientists tested clindamycin and TMP-SMX in adults and children with uncomplicated skin infections for 10 days. Of 466 study participants who received either antibiotic, the cure rate was 89.5 percent for clindamycin and 88.2 percent for TMP-SMX. The side effects of both drugs were comparable. The findings, which appear in the New England Journal of Medicine, suggest that uncomplicated skin infectious acquired outside of hospitals can be treated inexpensively and successfully with either drug, according to the researchers. Source: Loren G et al. Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin Infections. New England Journal of Medicine, 2015; 372 (12): 1093