Archive for May, 2016

Escherichia coli Harboring mcr-1 and blaCTX-M on a Novel IncF Plasmid: First report of 2 mcr-1 in the USA

Antimicrob. Agents Chemother. May 26, 2016

Patrick McGann1#*, Erik Snesrud1*, Rosslyn Maybank1 , Brendan Corey1 , Ana C. Ong1 3 , Robert Clifford1, Mary Hinkle1 , Timothy Whitman2 , Emil Lesho1 , and Kurt E. Schaecher3# 4

1 5 Multidrug-resistant Organism Repository and Surveillance Network, Walter Reed Army

6 Institute of Research, Silver Spring, Maryland, USA.

2 7 Department of Infectious Diseases, Walter Reed National Military Medical Center, MD, USA .

3 8 Department of Pathology, Walter Reed National Military Medical Center, MD, USA.

Patrick Mc Gann, PhD Walter Reed Army Institute of Research, 2S35 Silver Spring, Maryland 20910, USA Phone: (301) 319 9912 Email: patrick.t.mcgann4.ctr@mail.mil

The recent discovery of a plasmid-borne colistin resistance gene, mcr-1, heralds the emergence of truly pan-drug resistant bacteria (1). The gene has been found primarily in Escherichia coli, but has also been identified in other members of the Enterobacteriaceae from human, animal, food and environmental samples on every continent (2-5). In response to this threat, starting in May 2016, all extended-spectrum β-lactamase (ESBL)-producing E.coli clinical isolates submitted to the clinical microbiology laboratory at the Walter Reed National Military Medical Center (WRNMMC) were tested for resistance to colistin by E-test. Herein we report the presence of mcr-1 in an E. coli cultured from a patient with a urinary tract infection (UTI) in the United States….

PDF

http://aac.asm.org/content/early/2016/05/25/AAC.01103-16.full.pdf

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May 30, 2016 at 8:38 am

Initiating antiretroviral therapy for HIV at a patient’s first clinic visit – The RapIT randomized controlled trial.

PLoS Med 2016 May 10; 13:e1002015

Sydney Rosen , Mhairi Maskew, Matthew P. Fox, Cynthia Nyoni, Constance Mongwenyana, Given Malete, Ian Sanne, Dorah Bokaba, Celeste Sauls, Julia Rohr, Lawrence Long

Background

High rates of patient attrition from care between HIV testing and antiretroviral therapy (ART) initiation have been documented in sub-Saharan Africa, contributing to persistently low CD4 cell counts at treatment initiation. One reason for this is that starting ART in many countries is a lengthy and burdensome process, imposing long waits and multiple clinic visits on patients. We estimated the effect on uptake of ART and viral suppression of an accelerated initiation algorithm that allowed treatment-eligible patients to be dispensed their first supply of antiretroviral medications on the day of their first HIV-related clinic visit.

Methods and Findings

RapIT (Rapid Initiation of Treatment) was an unblinded randomized controlled trial of single-visit ART initiation in two public sector clinics in South Africa, a primary health clinic (PHC) and a hospital-based HIV clinic. Adult (≥18 y old), non-pregnant patients receiving a positive HIV test or first treatment-eligible CD4 count were randomized to standard or rapid initiation. Patients in the rapid-initiation arm of the study (“rapid arm”) received a point-of-care (POC) CD4 count if needed; those who were ART-eligible received a POC tuberculosis (TB) test if symptomatic, POC blood tests, physical exam, education, counseling, and antiretroviral (ARV) dispensing. Patients in the standard-initiation arm of the study (“standard arm”) followed standard clinic procedures (three to five additional clinic visits over 2–4 wk prior to ARV dispensing). Follow up was by record review only. The primary outcome was viral suppression, defined as initiated, retained in care, and suppressed (≤400 copies/ml) within 10 mo of study enrollment. Secondary outcomes included initiation of ART ≤90 d of study enrollment, retention in care, time to ART initiation, patient-level predictors of primary outcomes, prevalence of TB symptoms, and the feasibility and acceptability of the intervention. A survival analysis was conducted comparing attrition from care after ART initiation between the groups among those who initiated within 90 d. Three hundred and seventy-seven patients were enrolled in the study between May 8, 2013 and August 29, 2014 (median CD4 count 210 cells/mm3). In the rapid arm, 119/187 patients (64%) initiated treatment and were virally suppressed at 10 mo, compared to 96/190 (51%) in the standard arm (relative risk [RR] 1.26 [1.05–1.50]). In the rapid arm 182/187 (97%) initiated ART ≤90 d, compared to 136/190 (72%) in the standard arm (RR 1.36, 95% confidence interval [CI], 1.24–1.49). Among 318 patients who did initiate ART within 90 d, the hazard of attrition within the first 10 mo did not differ between the treatment arms (hazard ratio [HR] 1.06; 95% CI 0.61–1.84). The study was limited by the small number of sites and small sample size, and the generalizability of the results to other settings and to non-research conditions is uncertain.

Conclusions

Offering single-visit ART initiation to adult patients in South Africa increased uptake of ART by 36% and viral suppression by 26%. This intervention should be considered for adoption in the public sector in Africa.

Trial Registration

ClinicalTrials.gov NCT01710397, and South African National Clinical Trials Register DOH-27-0213-4177.

 

FULL TEXT

http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002015

PDF

http://journals.plos.org/plosmedicine/article/asset?id=10.1371%2Fjournal.pmed.1002015.PDF

May 28, 2016 at 9:30 am

Maternal and infant outcomes among women vaccinated against pertussis during pregnancy

Human Vaccines & Immunotherapeutics March 2016

Research Paper

Abbey B. Berensonab*, Jacqueline M. Hirthab, Mahbubur Rahmanab, Tabassum H. Laza, Richard E. Ruppac & Kwabena O. Sarpongac

Tetanus, diphtheria, and acellular pertussis (Tdap) vaccination is recommended for all women during each pregnancy to prevent pertussis in young infants. However, data on the safety of this protective measure are limited and conflicting. To assess maternal and infant outcomes associated with administration of this vaccine during pregnancy, we reviewed medical records of 1,759 women who delivered a singleton infant at a southeast Texas public hospital between November 1, 2012 and June 30, 2014. After excluding women who had inadequate prenatal care or who delivered at <27 weeks gestation, we used multivariable logistic regression analyses to compare 13 outcomes between those who did and did not receive the Tdap vaccine. We examined 6 maternal outcomes (chorioamnionitis, postpartum endometritis, preterm delivery, preterm premature rupture of membranes, induced labor, and mode of delivery) and 7 infant outcomes (low birth weight, very low birth weight, small for gestational age, 5-minute Apgar score, birth defects, and neonatal intensive care unit admission). Maternal Tdap vaccination was associated with decreased odds of cesarean delivery. No associations between maternal Tdap vaccination and infant outcomes were observed. This study demonstrates that Tdap vaccination during pregnancy does not increase the risk of adverse outcomes.

FULL TEXT

http://www.tandfonline.com/doi/full/10.1080/21645515.2016.1157241

PDF

http://www.tandfonline.com/doi/pdf/10.1080/21645515.2016.1157241

 

May 27, 2016 at 7:54 am

Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina

Emerging Infectious Diseases June 2016 V.22 N.6

Letter

To the Editor:

Antimicrobial resistance in Neisseria gonorrhoeae is increasing globally. In recent years, gonococcal strains with resistance to the extended-spectrum cephalosporin (ESC) ceftriaxone have been reported from many countries (1). In South America, 7 ceftriaxone-resistant strains (MICs >0.25 μg/mL) were reported from Brazil in 2007; however, these isolates have not been characterized (2). Emergence of cephalosporin-resistant gonorrhea would substantially limit treatment options and represent a major public health concern. We report an N. gonorrhoeae isolate in Argentina that was resistant to ceftriaxone and cefixime…..

PDF

http://wwwnc.cdc.gov/eid/article/22/6/pdfs/15-2091.pdf

 

2016-06 Neisseria gonorrhoeae Resistant to Ceftriaxone and Cefixime, Argentina EID

May 21, 2016 at 10:45 am

Rapid Detection of Polymyxin Resistance in Enterobacteriaceae

Emerging Infectious Diseases June 2016 V.22 N.6

Patrice Nordmann, Aurélie Jayol, and Laurent Poirel

University of Fribourg, Fribourg, Switzerland

For identification of polymyxin resistance in Enterobacteriaceae, we developed a rapid test that detects glucose metabolization associated with bacterial growth in the presence of a defined concentration of colistin or polymyxin B. Formation of acid metabolites is evidenced by a color change (orange to yellow) of a pH indicator (red phenol). To evaluate the test, we used bacterial colonies of 135 isolates expressing various mechanisms of colistin resistance (intrinsic, chromosomally encoded, and plasmid-mediated MCR-1) and 65 colistin-susceptible isolates. Sensitivity and specificity were 99.3% and 95.4%, respectively, compared with the standard broth microdilution method. This new test is inexpensive, easy to perform, sensitive, specific, and can be completed in <2 hours. It could be useful in countries facing endemic spread of carbapenemase producers and for which polymyxins are last-resort drugs.

PDF

http://wwwnc.cdc.gov/eid/article/22/6/pdfs/15-1840.pdf

May 21, 2016 at 10:41 am

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

Emerging Infectious Diseases June 2016 V.22 N.6

Rafael San-Juan, Esther Viedma, Fernando Chaves, Antonio Lalueza, Jesús Fortún, Elena Loza, Miquel Pujol, Carmen Ardanuy, Isabel Morales, Marina de Cueto, Elena Resino-Foz, Alejandra Morales-Cartagena, Alicia Rico, María P. Romero, María Ángeles Orellana, Francisco López-Medrano, Mario Fernández-Ruiz, and José María Aguado

University Hospital–Research Institute 12 de Octubre, Madrid, Spain (R. San-Juan, E. Viedma, F. Chaves, A. Lalueza, E. Resino-Foz, A. Morales-Cartagena, M.Á. Orellana, F. López-Medrano, M. Fernández-Ruiz, J. María Aguado); Hospital Universitario Ramón y Cajal, Madrid (J. Fortún, E. Loza); University Hospital–Bellvitge Institute for Biomedical Research, Barcelona, Spain (M. Pujol, C. Ardanuy); Hospital Universitario Virgen de la Macarena, Seville, Spain (I. Morales, M. de Cueto); Hospital Universitario La Paz, Madrid (A. Rico, M.P. Romero)

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications.

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http://wwwnc.cdc.gov/eid/article/22/6/pdfs/15-1709.pdf

May 20, 2016 at 3:39 pm

Human Adenovirus Associated with Severe Respiratory Infection, Oregon, USA, 2013–2014

Emerging Infectious Diseases June 2016 V.22 N.6

Magdalena Kendall Scott, Christina Chommanard, Xiaoyan Lu, Dianna Appelgate, LaDonna Grenz, Eileen Schneider, Susan I. Gerber, Dean D. Erdman, and Ann Thomas

Oregon Public Health Division, Portland, Oregon, USA (M. Kendall Scott, A. Thomas); Centers for Disease Control and Prevention, Atlanta, Georgia, USA (C. Chommanard, X. Lu, E. Schneider, S.I. Gerber, D.D. Erdman); PeaceHealth Department of Quality and Improvement, Springfield, Oregon, USA (D. Appelgate); Oregon Public Health Laboratory, Hillsboro, Oregon, USA (L. Grenz)

Several human adenoviruses (HAdVs) can cause respiratory infections, some severe. HAdV-B7, which can cause severe respiratory disease, has not been recently reported in the United States but is reemerging in Asia. During October 2013–July 2014, Oregon health authorities identified 198 persons with respiratory symptoms and an HAdV-positive respiratory tract specimen. Among 136 (69%) hospitalized persons, 31% were admitted to the intensive care unit and 18% required mechanical ventilation; 5 patients died. Molecular typing of 109 specimens showed that most (59%) were HAdV-B7, followed by HAdVs-C1, -C2, -C5 (26%); HAdVs-B3, -B21 (15%); and HAdV-E4 (1%). Molecular analysis of 7 HAdV-B7 isolates identified the virus as genome type d, a strain previously identified only among strains circulating in Asia. Patients with HAdV-B7 were significantly more likely than those without HAdV-B7 to be adults and to have longer hospital stays. HAdV-B7 might be reemerging in the United States, and clinicians should consider HAdV in persons with severe respiratory infection……

PDF

http://wwwnc.cdc.gov/eid/article/22/6/pdfs/15-1898.pdf

May 20, 2016 at 3:37 pm

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