Unit Based ChampionsInfection Prevention

eBug BytesOctober 2013

Hong Kong quarantines 19people after second case of H7N9

Hong Kong health officials have quarantined 19 people who had contact with an 80-year-old man confirmed to have the city's second case of H7N9 influenza, which has killed 45 people in China this year. The patient is a long-term resident of mainland China who was hospitalized in the border city of Shenzhen from Nov. 13 to Nov. 29 for treatment of an underlying chronic illness, the Hong Kong government said in a statement on Dec. 6. He moved to Hong Kong on Dec. 3 and was admitted to Tuen Mun Hospital, where he tested positive for the new strain of bird flu after developing a fever, the statement shows.The government said it will transfer the patient, who is in stable condition, to the isolation ward at Princess Margaret Hospital. It's not yet known if he had contact with live poultry though he is thought to have eaten chicken, Hong Kong's Commercial Radio reported yesterday, citing Ko Wing-man, the city's health secretary.A total of 19 people had contact with the man after he arrived in Hong Kong, including 13 patients in Tuen Mun Hospital, five relatives and one taxi driver.Source: http://www.bloomberg.com/news/2013-12-08/hong-kong-quarantines-19people-after-second-case-of-h7n9.html

Resistant H7N9 flu virus keeps contagiousness

• H7N9 erupted in eastern China earlier this year. The first laboratory-confirmed cases occurred among three people in the Shanghai area and were reported on March 31. In all, 139 human cases of H7N9 have been reported, with 45 deaths, according to the WHO's website. H7N9 is believed to have spread to humans from poultry, where it circulates naturally. The UN's World Health Organization (WHO) says that "so far", no evidence has emerged of "sustained" transmission of H7N9 among people.

• Replicating the virus in high-security conditions, they found it had a mutation that made it resistant to the two frontline antiviral drugs-Tamiflu (lab name oseltamivir) and Peramivir-and partially resistant to a third drug, Relenza (zanamivir). The mutant variety of H7N9 replicated as easily and as virulently as the non-mutant strain in human respiratory cells in a lab dish, in mice lungs and in guinea pigs.

• The discovery is unusual as "seasonal" influenza-common-or-garden flu strains that erupt every winter-typically loses some of its contagiousness when a strain becomes drug-resistant. Source: Nature Communications Dec 2013

Public gets early snapshot of MRSA and C. difficile infections in individual hospitals

• New data gathered through the Centers for Disease Control and Prevention's (CDC) National Healthcare Safety Network (NHSN) gives patients a first look at how their local hospitals are doing at preventing Clostridium difficile infections (deadly diarrhea) and methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections.

• C. difficile causes at least 250,000 hospitalizations and 14,000 deaths every year, and was recently categorized by CDC as an urgent threat to patient safety. On the other hand, although still a common and severe threat to patients, invasive MRSA infections in healthcare settings appear to be declining. Between 2005 and 2011 overall rates of invasive MRSA dropped 31 percent. Success began with preventing central-line-associated bloodstream infections caused by MRSA, for which rates fell nearly 50 percent from 1997 to 2007. Major teaching hospitals, hospitals with more than 400 beds and those with high community-onset rates continue to have the highest risk for C. difficile and MRSA bloodstream infections, all of which is taken into account by risk adjustment when the clinical quality measure is calculated.

FDA: Anti-bacterial soaps may not curb bacteria

• Triclosan is an ingredient added to many consumer products to reduce or prevent bacterial contamination. It may be found in products such as clothing, kitchenware, furniture, and toys. It also may be added to antibacterial soaps and body washes, toothpastes, and some cosmetics—products regulated by the U.S. Food and Drug Administration (FDA). Triclosan is not currently known to be hazardous to humans. But several scientific studies have come out since the last time FDA reviewed this ingredient that merit further review. Animal studies have shown that triclosan alters hormone regulation. However, data showing effects in animals don’t always predict effects in humans. Other studies in bacteria have raised the possibility that triclosan contributes to making bacteria resistant to antibiotics.

• The Federal Drug Administration proposed a rule Dec 16th which would require manufacturers of antibacterial cleaners to prove their products are not only safe, but more effective than plain soap and water. The FDA proposes that if the antibacterial manufacturers cannot demonstrate their products to be more effective and less harmful then soap and water, their products will have to be reformulated, relabeled, or removed from the market.http://www.fda.gov/ForConsumers/ConsumerUpdates/ucm205999.htm

Yogurt a solution to hospital infection?

• In a medical system rife with complex equipment and outrageously expensive drugs, a Pennsylvania hospital has turned to a cheap, low-tech solution for one of modern medicine’s most challenging problems. Holy Redeemer in Montgomery County, Pa., is using yogurt — the kind you could buy at the grocery store — to fight C. difficile, a hospital-acquired infection that has been growing throughout the country.

• After dietitians began encouraging patients taking antibiotics to eat yogurt, the infection rate fell by two-thirds. Holy Redeemer has now expanded the program to its nursing-home residents. “We were really surprised by how easy it was and how quick it worked,” said Jeanie Ryan, a registered dietitian, who helped coordinate the effort. “It was just so sudden and such a big impact, that it was striking.” The Hospital & Health system Association of Pennsylvania earlier this year gave Holy Redeemer an Innovation Award for the program. Other hospitals remain skeptical. Thomas Jefferson University Hospital uses probiotics, or beneficial yeast and bacteria, in pill form only in clinically stable patients who must take antibiotics for long periods. http://www.reporternews.com/news/2013/dec/17/yogurt-a-solution-to-hospital-infection/

Epidemic of E.coli infections traced to one strain of bacteria

• In the past decade, a single strain of Escherichia coli, or E. coli, has become the main cause of bacterial infections in women and the elderly by invading the bladder and kidneys, according to a study published in the American Society for Microbiology's open access journal mBio.

• Besides becoming more resistant to antibiotics, the strain H30-Rx gained an unprecedented ability to spread from the urinary tract to the blood, leading to the most lethal form of bacterial infections - sepsis- and posing a looming threat to the more than 10 million Americans who annually suffer from urinary tract infections (UTIs). This new study could help trace the evolutionary history of this superbug and possibly lead to the development of a vaccine. H30-Rx, appears to be much more adept than other E. coli at ascending from the bladder to the kidneys and then into the bloodstream, where it can be lethal, and the study suggests that H30-Rx may be responsible for 1.5 million UTIs and tens of thousands of deaths annually in the United States. This study shows that, by focusing on H30-Rx, researchers might find a vaccine that could prevent many infections. Vaccines for highly resistant strains of superbugs could protect people from ever getting sick in the first place. http://sphhs.gwu.edu/content/epidemic-escherichia-coli-infections-traced-one-strain-bacteria

Bipolaris in cardiac surgery patients - Call for cases

• The Centers for Disease Control and Prevention (CDC), together with state and local health department partners, continues to investigate an outbreak of Bipolaris surgical site infections among cardiothoracic surgery patients. Mediastinal infections due to molds following cardiothoracic surgery are a rare but known complication, however Bipolaris is a very rare cause of these.

• To date, 13 culture-confirmed cases from six hospitals in two states have been identified. Positive cultures were obtained between December 2008 and November 2013; nine cases have occurred since May 2013. Cases ranged in age from 1 month to 82 years, all cases are male. Commonalities include a history of recent open cardiothoracic surgery (including CABG, heart transplantation and valve replacement/repair); ICU care; and extended periods of open chest wounds prior to eventual closure. Bipolaris isolates were obtained from tissue and pleural/mediastinal fluid samples. Associated mortality has been high.

• Please report any cultures of Bipolaris obtained since 2008 from chest surgery patients to Dr. Anne Purfield (aip4@cdc.gov) of the Mycotic Diseases Branch of the CDC.

E anophelis outbreak in an intensive-care unit

• The hospital infection-control team at the National University Hospital of Singapore identified three patients in the cardiothoracic intensive-care unit (ICU) and two patients from the surgical ICU that were colonized with Elizabethkingia during a 3 week period in 2012. The five patients, who were ventilated via tracheostomy and had central venous catheters in situ, received multiple courses

• of broad-spectrum antibiotics. Before isolation of Elizabethkingia, three of the patients had underlying solid-organ malignancy, one patient had multiple abdominal surgeries, two patients underwent thoracic surgery, and one patient was on extracorporeal membrane oxygenation. After isolation of the Elizabethkingia strain, all patients were treated with intravenous piperacillin and tazobactam, cotrimoxazole, or levofloxacin, either alone or in combination. Three of the five patients died during their hospitalization. The history of this microorganism starts with its description as a cause of infant meningitis by Centers for Disease Control and Prevention (CDC). It was first isolated in 1959 and named it Flavobacterium meningosepticum. It was subsequently renamed Chryseobacterium meningosepticum, and classified in the new genus Elizabethkingia, in 2005 . Source: Lancet. 2013 Sep 7;382(9895):855-6