Antimicrobial-resistant infections

HONOLULU – Could gut microbiota be a better predictor than clinical factors of a patient’s response to treatment for Clostridium difficile infection?

In a study of 88 patients with C. difficile, the overall treatment failure rate was 12.5% – but clinical factors such as age, sex, ongoing antibiotic exposure, and hospitalization status failed to predict which patients wouldn’t respond to treatment.

So, “we aimed to identify if there are any gut microbiota signatures to predict treatment response and treatment failure,” explained the study’s lead author, Dr. Sahil Khanna of the Mayo Clinic, Rochester, Minn.

In an interview at the annual meeting of the American College of Gastroenterology, Dr. Khanna discussed the study results and why gut microbiota may be an effective predictor of treatment responders and nonresponders.

HONOLULU – Could gut microbiota be a better predictor than clinical factors of a patient’s response to treatment for Clostridium difficile infection?

In a study of 88 patients with C. difficile, the overall treatment failure rate was 12.5% – but clinical factors such as age, sex, ongoing antibiotic exposure, and hospitalization status failed to predict which patients wouldn’t respond to treatment.

So, “we aimed to identify if there are any gut microbiota signatures to predict treatment response and treatment failure,” explained the study’s lead author, Dr. Sahil Khanna of the Mayo Clinic, Rochester, Minn.

In an interview at the annual meeting of the American College of Gastroenterology, Dr. Khanna discussed the study results and why gut microbiota may be an effective predictor of treatment responders and nonresponders.

HONOLULU – Could gut microbiota be a better predictor than clinical factors of a patient’s response to treatment for Clostridium difficile infection?

In a study of 88 patients with C. difficile, the overall treatment failure rate was 12.5% – but clinical factors such as age, sex, ongoing antibiotic exposure, and hospitalization status failed to predict which patients wouldn’t respond to treatment.

So, “we aimed to identify if there are any gut microbiota signatures to predict treatment response and treatment failure,” explained the study’s lead author, Dr. Sahil Khanna of the Mayo Clinic, Rochester, Minn.

In an interview at the annual meeting of the American College of Gastroenterology, Dr. Khanna discussed the study results and why gut microbiota may be an effective predictor of treatment responders and nonresponders.

SAN DIEGO – Fecal microbiota transplantation (FMT) is now first-line therapy for Clostridium difficile infection (CDI) in much of Scandinavia. At an annual conference on infectious diseases, two specialists debated whether that should be the case in the United States, too.

The epidemiology of CDI has changed greatly in the past decade, as other researchers have noted (Infect Drug Resist. 2014;7:63-72). Incidence, severity, and case-fatality rates have risen substantially, and individuals who lack the usual risk factors for CDI are now acquiring it in community settings. Moreover, CDI adds about 5-6 days to a patient’s average hospital stay, and almost one in three affected patients is rehospitalized (Am J Infect Control. 2015 Apr 1;43[4]:314-7.) – most often within a week of discharge, said Dr. Thomas Moore, who is at the University of Kansas, Wichita.

“Should FMT be used as first-line therapy? Not just yes, but hell, yes! It has superior efficacy,” Dr. Moore said.

Courtesy CDC/Dr. Gilda Jones

He pointed to the recent landmark study (N Engl J Med. 2013;368:407-15) of CDI in which duodenal infusions of donor feces more than tripled the rates of relapse-free cure, compared with vancomycin monotherapy or vancomycin with bowel lavage (P less than .001 for both comparisons). Moreover, diarrhea resolved for 81% of patients after the first fecal infusion, and the observed superiority over the vancomycin regimens was so marked that investigators stopped the study after the interim analysis.

Evidence suggests FMT is safe as well as effective, said Dr. Moore. Centers in Norway, Sweden, Denmark, Finland, and Holland have treated at least 900 patients with no reported adverse effects and with cure rates of about 90%, he noted. Of more than 1,000 published FMT studies worldwide, there has been one only report of peritonitis after colonoscopy, one case of irritable bowel syndrome, three reports of mild enteritis, one case of upper gastrointestinal bleeding, one death from sepsis from a dislodged gastrostomy tube, and one case of new-onset obesity, which occurred after a patient received fecal microbiota donated by an obese relative, he added (Open Forum Infect Dis. 2015 Feb 1. doi: 10.1093/ofid/ofv004). Patients now receive fecal microbiota donations from normal-weight individuals, he noted (http://www.openbiome.org/stool-donation/).

“Fecal microbiota transplantation could save lives,” Dr. Moore concluded. Donor material is “cheap and unlimited, the procedure is cost-effective, easy to perform, can even be done at home, and patient satisfaction is very high.”

But Dr. Johan S. Bakken, an infectious disease specialist at St. Luke’s Hospital in Duluth, Minn., argued that FMT is not ready for first-line use for CDI in the United States. “There are no published FMT practice guidelines for initial therapy, even in Scandinavia, and no randomized controlled trials of FMT conducted anywhere,” said Dr. Bakken. He noted that because the Food and Drug Administration has not approved FMT for first-line use in CDI, utilization could require an approved Investigational New Drug application, leading to “unavoidable” treatment delays.

Clinicians also should not gloss over concerns about adverse effects with FMT, Dr. Bakken said. In addition to the case of new-onset obesity, there are risks of aspirating fecal material or perforating hollow viscera. Furthermore, the potential long-term adverse consequences of FMT are unknown, he said.

In contrast, the rate of resolution of initial CDI with per oral vancomycin or fidaxomicin is more than 80%, Dr. Bakken said. Moreover, liquid vancomycin at an appropriate dose and frequency for CDI costs about $4.25 per day in Duluth, he added. “No comparative outcomes data are available for FMT, but it is more costly than vancomycin, may not be locally available, and requires several days or weeks of planning,” he emphasized.

Cost-reimbursement issues with third-party payers are also likely with FMT, according to Dr. Bakken. “There also are potential or perceived medicolegal issues with FMT,” he said. “Keep in mind that about 80% of the world’s lawyers work and practice in the U.S.A.”

Dr. Moore had no disclosures. Dr. Bakken reported being an advisory board member of Rebiotix, which is developing a biologic drug to treat recurrent CDI.

SAN DIEGO – Fecal microbiota transplantation (FMT) is now first-line therapy for Clostridium difficile infection (CDI) in much of Scandinavia. At an annual conference on infectious diseases, two specialists debated whether that should be the case in the United States, too.

The epidemiology of CDI has changed greatly in the past decade, as other researchers have noted (Infect Drug Resist. 2014;7:63-72). Incidence, severity, and case-fatality rates have risen substantially, and individuals who lack the usual risk factors for CDI are now acquiring it in community settings. Moreover, CDI adds about 5-6 days to a patient’s average hospital stay, and almost one in three affected patients is rehospitalized (Am J Infect Control. 2015 Apr 1;43[4]:314-7.) – most often within a week of discharge, said Dr. Thomas Moore, who is at the University of Kansas, Wichita.

“Should FMT be used as first-line therapy? Not just yes, but hell, yes! It has superior efficacy,” Dr. Moore said.

Courtesy CDC/Dr. Gilda Jones

He pointed to the recent landmark study (N Engl J Med. 2013;368:407-15) of CDI in which duodenal infusions of donor feces more than tripled the rates of relapse-free cure, compared with vancomycin monotherapy or vancomycin with bowel lavage (P less than .001 for both comparisons). Moreover, diarrhea resolved for 81% of patients after the first fecal infusion, and the observed superiority over the vancomycin regimens was so marked that investigators stopped the study after the interim analysis.

Evidence suggests FMT is safe as well as effective, said Dr. Moore. Centers in Norway, Sweden, Denmark, Finland, and Holland have treated at least 900 patients with no reported adverse effects and with cure rates of about 90%, he noted. Of more than 1,000 published FMT studies worldwide, there has been one only report of peritonitis after colonoscopy, one case of irritable bowel syndrome, three reports of mild enteritis, one case of upper gastrointestinal bleeding, one death from sepsis from a dislodged gastrostomy tube, and one case of new-onset obesity, which occurred after a patient received fecal microbiota donated by an obese relative, he added (Open Forum Infect Dis. 2015 Feb 1. doi: 10.1093/ofid/ofv004). Patients now receive fecal microbiota donations from normal-weight individuals, he noted (http://www.openbiome.org/stool-donation/).

“Fecal microbiota transplantation could save lives,” Dr. Moore concluded. Donor material is “cheap and unlimited, the procedure is cost-effective, easy to perform, can even be done at home, and patient satisfaction is very high.”

But Dr. Johan S. Bakken, an infectious disease specialist at St. Luke’s Hospital in Duluth, Minn., argued that FMT is not ready for first-line use for CDI in the United States. “There are no published FMT practice guidelines for initial therapy, even in Scandinavia, and no randomized controlled trials of FMT conducted anywhere,” said Dr. Bakken. He noted that because the Food and Drug Administration has not approved FMT for first-line use in CDI, utilization could require an approved Investigational New Drug application, leading to “unavoidable” treatment delays.

Clinicians also should not gloss over concerns about adverse effects with FMT, Dr. Bakken said. In addition to the case of new-onset obesity, there are risks of aspirating fecal material or perforating hollow viscera. Furthermore, the potential long-term adverse consequences of FMT are unknown, he said.

In contrast, the rate of resolution of initial CDI with per oral vancomycin or fidaxomicin is more than 80%, Dr. Bakken said. Moreover, liquid vancomycin at an appropriate dose and frequency for CDI costs about $4.25 per day in Duluth, he added. “No comparative outcomes data are available for FMT, but it is more costly than vancomycin, may not be locally available, and requires several days or weeks of planning,” he emphasized.

Cost-reimbursement issues with third-party payers are also likely with FMT, according to Dr. Bakken. “There also are potential or perceived medicolegal issues with FMT,” he said. “Keep in mind that about 80% of the world’s lawyers work and practice in the U.S.A.”

Dr. Moore had no disclosures. Dr. Bakken reported being an advisory board member of Rebiotix, which is developing a biologic drug to treat recurrent CDI.

SAN DIEGO – Fecal microbiota transplantation (FMT) is now first-line therapy for Clostridium difficile infection (CDI) in much of Scandinavia. At an annual conference on infectious diseases, two specialists debated whether that should be the case in the United States, too.

The epidemiology of CDI has changed greatly in the past decade, as other researchers have noted (Infect Drug Resist. 2014;7:63-72). Incidence, severity, and case-fatality rates have risen substantially, and individuals who lack the usual risk factors for CDI are now acquiring it in community settings. Moreover, CDI adds about 5-6 days to a patient’s average hospital stay, and almost one in three affected patients is rehospitalized (Am J Infect Control. 2015 Apr 1;43[4]:314-7.) – most often within a week of discharge, said Dr. Thomas Moore, who is at the University of Kansas, Wichita.

“Should FMT be used as first-line therapy? Not just yes, but hell, yes! It has superior efficacy,” Dr. Moore said.

Courtesy CDC/Dr. Gilda Jones

He pointed to the recent landmark study (N Engl J Med. 2013;368:407-15) of CDI in which duodenal infusions of donor feces more than tripled the rates of relapse-free cure, compared with vancomycin monotherapy or vancomycin with bowel lavage (P less than .001 for both comparisons). Moreover, diarrhea resolved for 81% of patients after the first fecal infusion, and the observed superiority over the vancomycin regimens was so marked that investigators stopped the study after the interim analysis.

Evidence suggests FMT is safe as well as effective, said Dr. Moore. Centers in Norway, Sweden, Denmark, Finland, and Holland have treated at least 900 patients with no reported adverse effects and with cure rates of about 90%, he noted. Of more than 1,000 published FMT studies worldwide, there has been one only report of peritonitis after colonoscopy, one case of irritable bowel syndrome, three reports of mild enteritis, one case of upper gastrointestinal bleeding, one death from sepsis from a dislodged gastrostomy tube, and one case of new-onset obesity, which occurred after a patient received fecal microbiota donated by an obese relative, he added (Open Forum Infect Dis. 2015 Feb 1. doi: 10.1093/ofid/ofv004). Patients now receive fecal microbiota donations from normal-weight individuals, he noted (http://www.openbiome.org/stool-donation/).

“Fecal microbiota transplantation could save lives,” Dr. Moore concluded. Donor material is “cheap and unlimited, the procedure is cost-effective, easy to perform, can even be done at home, and patient satisfaction is very high.”

But Dr. Johan S. Bakken, an infectious disease specialist at St. Luke’s Hospital in Duluth, Minn., argued that FMT is not ready for first-line use for CDI in the United States. “There are no published FMT practice guidelines for initial therapy, even in Scandinavia, and no randomized controlled trials of FMT conducted anywhere,” said Dr. Bakken. He noted that because the Food and Drug Administration has not approved FMT for first-line use in CDI, utilization could require an approved Investigational New Drug application, leading to “unavoidable” treatment delays.

Clinicians also should not gloss over concerns about adverse effects with FMT, Dr. Bakken said. In addition to the case of new-onset obesity, there are risks of aspirating fecal material or perforating hollow viscera. Furthermore, the potential long-term adverse consequences of FMT are unknown, he said.

In contrast, the rate of resolution of initial CDI with per oral vancomycin or fidaxomicin is more than 80%, Dr. Bakken said. Moreover, liquid vancomycin at an appropriate dose and frequency for CDI costs about $4.25 per day in Duluth, he added. “No comparative outcomes data are available for FMT, but it is more costly than vancomycin, may not be locally available, and requires several days or weeks of planning,” he emphasized.

Cost-reimbursement issues with third-party payers are also likely with FMT, according to Dr. Bakken. “There also are potential or perceived medicolegal issues with FMT,” he said. “Keep in mind that about 80% of the world’s lawyers work and practice in the U.S.A.”

Dr. Moore had no disclosures. Dr. Bakken reported being an advisory board member of Rebiotix, which is developing a biologic drug to treat recurrent CDI.

SAN DIEGO – A “time-out” to review antibiotic therapy 72-96 hours into treatment increased appropriate discontinuations of vancomycin by 31%, researchers said at an annual scientific meeting on infectious diseases.

The practice fit into hospital work flow, streamlined other antibiotic stewardship practices, and respected provider autonomy, said Dr. Christopher Graber of VA Greater Los Angeles Healthcare System and the University of California, Los Angeles. It also was durable, persisting into the second 6 months of the program even though active research support had ended, he and his associates said.

©TongRo Images/thinkstock.com

The Centers for Disease Control and Prevention endorses the antibiotic time-out as a way to encourage providers to switch from empirical treatment with broad-spectrum antibiotics to a more tailored plan after culture and other laboratory results become available. The Veterans Affairs teaching hospital in greater Los Angeles created a self-directed time-out program to encourage reconsideration of broad-spectrum therapy with vancomycin and piperacillin-tazobactam after the first 3 days of empirical treatment. The program included an antimicrobial “dashboard” report, an electronic template to document time-outs, and a marketing program consisting of educational documents, lectures, “clinical champions,” and reminder notes and fliers posted near computers.

To evaluate early and late responses to the program, Dr. Graber and his associates tracked discontinuations of vancomycin and piperacillin-tazobactam, as well as decisions to continue these antibiotics through day 5 when doing so contradicted guidelines. Among 276 vancomycin episodes during the program, clinicians discontinued 175 (63%) – significantly more than before the program started (96 of 199; 48%; P = .001). They documented vancomycin time-outs 46% of the time, continued patients on vancomycin through day 5 without a time-out in 7.6% of cases, and allowed vancomycin to expire without a time-out 46% of the time.

The rate of inappropriate discontinuations of vancomycin during the program exceeded baseline (4.7% vs. none; P = .001), but this trend was balanced out by the overall rise in vancomycin discontinuations, the researchers said. Furthermore, providers documented vancomycin time-outs more often during the second 6 months, compared with the first (54% vs. 37%; P = .005). The increase in vancomycin discontinuations also was durable (about 63% throughout the two 6-month periods), and inappropriate continuations remained stable at about 4.5%.

“Piperacillin-tazobactam did not see any change in discontinuations between the two study periods,” said the researchers. The discontinuation rate was about 62% before and during the program. Clinicians performed time-outs about half the time, and inappropriately continued the antibiotics beyond day 5 in 10% of cases, compared with 2% before the program started (P = .02). Clinicians continued performing piperacillin-tazobactam time-outs at the same rate in the second 6 months of the program as during the beginning, and rates of discontinuation and inappropriate continuations also remained similar.

The investigators reported these results at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

CDC funded the research with a grant to the University of Utah. The researchers reported no conflicts of interest.

SAN DIEGO – A “time-out” to review antibiotic therapy 72-96 hours into treatment increased appropriate discontinuations of vancomycin by 31%, researchers said at an annual scientific meeting on infectious diseases.

The practice fit into hospital work flow, streamlined other antibiotic stewardship practices, and respected provider autonomy, said Dr. Christopher Graber of VA Greater Los Angeles Healthcare System and the University of California, Los Angeles. It also was durable, persisting into the second 6 months of the program even though active research support had ended, he and his associates said.

©TongRo Images/thinkstock.com

The Centers for Disease Control and Prevention endorses the antibiotic time-out as a way to encourage providers to switch from empirical treatment with broad-spectrum antibiotics to a more tailored plan after culture and other laboratory results become available. The Veterans Affairs teaching hospital in greater Los Angeles created a self-directed time-out program to encourage reconsideration of broad-spectrum therapy with vancomycin and piperacillin-tazobactam after the first 3 days of empirical treatment. The program included an antimicrobial “dashboard” report, an electronic template to document time-outs, and a marketing program consisting of educational documents, lectures, “clinical champions,” and reminder notes and fliers posted near computers.

To evaluate early and late responses to the program, Dr. Graber and his associates tracked discontinuations of vancomycin and piperacillin-tazobactam, as well as decisions to continue these antibiotics through day 5 when doing so contradicted guidelines. Among 276 vancomycin episodes during the program, clinicians discontinued 175 (63%) – significantly more than before the program started (96 of 199; 48%; P = .001). They documented vancomycin time-outs 46% of the time, continued patients on vancomycin through day 5 without a time-out in 7.6% of cases, and allowed vancomycin to expire without a time-out 46% of the time.

The rate of inappropriate discontinuations of vancomycin during the program exceeded baseline (4.7% vs. none; P = .001), but this trend was balanced out by the overall rise in vancomycin discontinuations, the researchers said. Furthermore, providers documented vancomycin time-outs more often during the second 6 months, compared with the first (54% vs. 37%; P = .005). The increase in vancomycin discontinuations also was durable (about 63% throughout the two 6-month periods), and inappropriate continuations remained stable at about 4.5%.

“Piperacillin-tazobactam did not see any change in discontinuations between the two study periods,” said the researchers. The discontinuation rate was about 62% before and during the program. Clinicians performed time-outs about half the time, and inappropriately continued the antibiotics beyond day 5 in 10% of cases, compared with 2% before the program started (P = .02). Clinicians continued performing piperacillin-tazobactam time-outs at the same rate in the second 6 months of the program as during the beginning, and rates of discontinuation and inappropriate continuations also remained similar.

The investigators reported these results at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

CDC funded the research with a grant to the University of Utah. The researchers reported no conflicts of interest.

SAN DIEGO – A “time-out” to review antibiotic therapy 72-96 hours into treatment increased appropriate discontinuations of vancomycin by 31%, researchers said at an annual scientific meeting on infectious diseases.

The practice fit into hospital work flow, streamlined other antibiotic stewardship practices, and respected provider autonomy, said Dr. Christopher Graber of VA Greater Los Angeles Healthcare System and the University of California, Los Angeles. It also was durable, persisting into the second 6 months of the program even though active research support had ended, he and his associates said.

©TongRo Images/thinkstock.com

The Centers for Disease Control and Prevention endorses the antibiotic time-out as a way to encourage providers to switch from empirical treatment with broad-spectrum antibiotics to a more tailored plan after culture and other laboratory results become available. The Veterans Affairs teaching hospital in greater Los Angeles created a self-directed time-out program to encourage reconsideration of broad-spectrum therapy with vancomycin and piperacillin-tazobactam after the first 3 days of empirical treatment. The program included an antimicrobial “dashboard” report, an electronic template to document time-outs, and a marketing program consisting of educational documents, lectures, “clinical champions,” and reminder notes and fliers posted near computers.

To evaluate early and late responses to the program, Dr. Graber and his associates tracked discontinuations of vancomycin and piperacillin-tazobactam, as well as decisions to continue these antibiotics through day 5 when doing so contradicted guidelines. Among 276 vancomycin episodes during the program, clinicians discontinued 175 (63%) – significantly more than before the program started (96 of 199; 48%; P = .001). They documented vancomycin time-outs 46% of the time, continued patients on vancomycin through day 5 without a time-out in 7.6% of cases, and allowed vancomycin to expire without a time-out 46% of the time.

The rate of inappropriate discontinuations of vancomycin during the program exceeded baseline (4.7% vs. none; P = .001), but this trend was balanced out by the overall rise in vancomycin discontinuations, the researchers said. Furthermore, providers documented vancomycin time-outs more often during the second 6 months, compared with the first (54% vs. 37%; P = .005). The increase in vancomycin discontinuations also was durable (about 63% throughout the two 6-month periods), and inappropriate continuations remained stable at about 4.5%.

“Piperacillin-tazobactam did not see any change in discontinuations between the two study periods,” said the researchers. The discontinuation rate was about 62% before and during the program. Clinicians performed time-outs about half the time, and inappropriately continued the antibiotics beyond day 5 in 10% of cases, compared with 2% before the program started (P = .02). Clinicians continued performing piperacillin-tazobactam time-outs at the same rate in the second 6 months of the program as during the beginning, and rates of discontinuation and inappropriate continuations also remained similar.

The investigators reported these results at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

CDC funded the research with a grant to the University of Utah. The researchers reported no conflicts of interest.

SAN DIEGO – In households of children with methicillin-resistant Staphylococcus aureus (MRSA) infection, pet dogs and cats often were colonized with S. aureus. In addition, the S. aureus strains colonizing the pets were likely to be concordant with those found on humans and/or their environmental surfaces within the household.

Those are key findings from a study that set out to determine the molecular epidemiology of S. aureus colonization of pets in the context of their human contacts and household environments, in households of children with community-associated MRSA infections.

“S. aureus is a significant pathogen in both health care and community settings and causes a spectrum of infections ranging from superficial skin and soft tissue infections (SSTIs) to invasive, life-threatening infections,” Ryley M. Thompson said at an annual scientific meeting on infectious diseases. “Due to the enormous clinical and economic burden posed by S. aureus, transmission prevention is essential.”

According to traditional dogma, “humans are the source of S. aureus for their pets and … pets are not a natural reservoir for S. aureus,” said Mr. Thompson, a clinical research study assistant in the Clinical and Translational Research Laboratory of Dr. Stephanie Fritz in the department of pediatrics at Washington University, St. Louis. “This is supported by the fact that pets often clear colonization without antimicrobial treatment. Risk factors for pet colonization include veterinary health care contact, contact with children, and using their mouths to interact with their environment. To date, directionality of S. aureus transmission between humans and pets is unclear.”

Between 2012 and 2015, the researchers enrolled 100 households of children with active or recent community-associated MRSA SSTIs who had been treated at St. Louis Children’s Hospital or other pediatric practices in the area. Over the course of 1 year, five study visits were conducted in each of the patient’s homes. Every 3 months, cultures were obtained from index patients and their household contacts, indoor dogs and cats, and 21 household environmental surfaces. The index patients and household contacts were swabbed at their axillae, nares, and inguinal folds; indoor dogs and cats were swabbed at their nares and dorsal fur; and household surfaces thought to be frequently touched by multiple household members were swabbed, such as TV remote controls, refrigerator door handles, and toilet seats. Researchers also administered a detailed survey to evaluate health, hygiene, and activities that may be associated with S. aureus infection transmission.

Molecular typing of all S. aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness, and staphylococcal cassette chromosome mec (SCCmec) characterization was performed by multiplex PCR.

Of 100 households, 49 had a total of 89 pets: 63 dogs and 26 cats. Of the 63 dogs, 13 (21%) were colonized with S. aureus (9 with MRSA) and 2 of 26 cats (8%) were colonized with MRSA. Eleven isolates were SCCmec type IV (MRSA), one was type II (MRSA), and two were type III (MRSA). At baseline, the researchers recovered 16 S. aureus isolates from 15 pets: 13 from the nares and 3 from pet dorsal fur.

One dog was colonized at both sites with concordant strains. In the three households that had two colonized pets, one household had two colonized dogs with matching strain types, the second had two dogs with nonmatching strain types, and the third had a dog and a cat with nonmatching strain types, Mr. Thompson reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Pet characteristics significantly associated with S. aureus colonization at study enrollment were older age (P = .04) and advanced number of years living in the home (P = .03), but sleeping in the same bed as a household member was not (P =. 96).

Molecular analysis revealed that the primary caretaker for 10 of the 15 colonized pets (67%) also was colonized with S. aureus, and 70% of these strains were concordant with the pet strain. In addition, seven of eight humans (88%) who shared a bed with a colonized pet also were colonized with S. aureus, and 43% of these strains were concordant with the pet strain.

Mr. Thompson also presented the longitudinal molecular epidemiology results in pets. In this analysis, 37 of the 89 pets were colonized with S. aureus at some point over the period of 12 months. Of these, 24 were colonized just once, while 13 were colonized at more than one of the samplings over time. Among these 13, two (15%) had concordant strains at all samplings, five (39%) had concordant and discordant strains, and six (46%) had discordant strains over the longitudinal study period.

Mr. Thompson and his associates intend to complete enrollment and analysis of 150 households in a 2-year longitudinal study. After this, he said, “we will be able to determine the directionality of human-pet S. aureus transmission as well as define the role of pets in S. aureus household transmission dynamics.”

The study was funded by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, the Agency for Healthcare Research and Quality, and the National Institutes of Health. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – In households of children with methicillin-resistant Staphylococcus aureus (MRSA) infection, pet dogs and cats often were colonized with S. aureus. In addition, the S. aureus strains colonizing the pets were likely to be concordant with those found on humans and/or their environmental surfaces within the household.

Those are key findings from a study that set out to determine the molecular epidemiology of S. aureus colonization of pets in the context of their human contacts and household environments, in households of children with community-associated MRSA infections.

“S. aureus is a significant pathogen in both health care and community settings and causes a spectrum of infections ranging from superficial skin and soft tissue infections (SSTIs) to invasive, life-threatening infections,” Ryley M. Thompson said at an annual scientific meeting on infectious diseases. “Due to the enormous clinical and economic burden posed by S. aureus, transmission prevention is essential.”

According to traditional dogma, “humans are the source of S. aureus for their pets and … pets are not a natural reservoir for S. aureus,” said Mr. Thompson, a clinical research study assistant in the Clinical and Translational Research Laboratory of Dr. Stephanie Fritz in the department of pediatrics at Washington University, St. Louis. “This is supported by the fact that pets often clear colonization without antimicrobial treatment. Risk factors for pet colonization include veterinary health care contact, contact with children, and using their mouths to interact with their environment. To date, directionality of S. aureus transmission between humans and pets is unclear.”

Between 2012 and 2015, the researchers enrolled 100 households of children with active or recent community-associated MRSA SSTIs who had been treated at St. Louis Children’s Hospital or other pediatric practices in the area. Over the course of 1 year, five study visits were conducted in each of the patient’s homes. Every 3 months, cultures were obtained from index patients and their household contacts, indoor dogs and cats, and 21 household environmental surfaces. The index patients and household contacts were swabbed at their axillae, nares, and inguinal folds; indoor dogs and cats were swabbed at their nares and dorsal fur; and household surfaces thought to be frequently touched by multiple household members were swabbed, such as TV remote controls, refrigerator door handles, and toilet seats. Researchers also administered a detailed survey to evaluate health, hygiene, and activities that may be associated with S. aureus infection transmission.

Molecular typing of all S. aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness, and staphylococcal cassette chromosome mec (SCCmec) characterization was performed by multiplex PCR.

Of 100 households, 49 had a total of 89 pets: 63 dogs and 26 cats. Of the 63 dogs, 13 (21%) were colonized with S. aureus (9 with MRSA) and 2 of 26 cats (8%) were colonized with MRSA. Eleven isolates were SCCmec type IV (MRSA), one was type II (MRSA), and two were type III (MRSA). At baseline, the researchers recovered 16 S. aureus isolates from 15 pets: 13 from the nares and 3 from pet dorsal fur.

One dog was colonized at both sites with concordant strains. In the three households that had two colonized pets, one household had two colonized dogs with matching strain types, the second had two dogs with nonmatching strain types, and the third had a dog and a cat with nonmatching strain types, Mr. Thompson reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Pet characteristics significantly associated with S. aureus colonization at study enrollment were older age (P = .04) and advanced number of years living in the home (P = .03), but sleeping in the same bed as a household member was not (P =. 96).

Molecular analysis revealed that the primary caretaker for 10 of the 15 colonized pets (67%) also was colonized with S. aureus, and 70% of these strains were concordant with the pet strain. In addition, seven of eight humans (88%) who shared a bed with a colonized pet also were colonized with S. aureus, and 43% of these strains were concordant with the pet strain.

Mr. Thompson also presented the longitudinal molecular epidemiology results in pets. In this analysis, 37 of the 89 pets were colonized with S. aureus at some point over the period of 12 months. Of these, 24 were colonized just once, while 13 were colonized at more than one of the samplings over time. Among these 13, two (15%) had concordant strains at all samplings, five (39%) had concordant and discordant strains, and six (46%) had discordant strains over the longitudinal study period.

Mr. Thompson and his associates intend to complete enrollment and analysis of 150 households in a 2-year longitudinal study. After this, he said, “we will be able to determine the directionality of human-pet S. aureus transmission as well as define the role of pets in S. aureus household transmission dynamics.”

The study was funded by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, the Agency for Healthcare Research and Quality, and the National Institutes of Health. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – In households of children with methicillin-resistant Staphylococcus aureus (MRSA) infection, pet dogs and cats often were colonized with S. aureus. In addition, the S. aureus strains colonizing the pets were likely to be concordant with those found on humans and/or their environmental surfaces within the household.

Those are key findings from a study that set out to determine the molecular epidemiology of S. aureus colonization of pets in the context of their human contacts and household environments, in households of children with community-associated MRSA infections.

“S. aureus is a significant pathogen in both health care and community settings and causes a spectrum of infections ranging from superficial skin and soft tissue infections (SSTIs) to invasive, life-threatening infections,” Ryley M. Thompson said at an annual scientific meeting on infectious diseases. “Due to the enormous clinical and economic burden posed by S. aureus, transmission prevention is essential.”

According to traditional dogma, “humans are the source of S. aureus for their pets and … pets are not a natural reservoir for S. aureus,” said Mr. Thompson, a clinical research study assistant in the Clinical and Translational Research Laboratory of Dr. Stephanie Fritz in the department of pediatrics at Washington University, St. Louis. “This is supported by the fact that pets often clear colonization without antimicrobial treatment. Risk factors for pet colonization include veterinary health care contact, contact with children, and using their mouths to interact with their environment. To date, directionality of S. aureus transmission between humans and pets is unclear.”

Between 2012 and 2015, the researchers enrolled 100 households of children with active or recent community-associated MRSA SSTIs who had been treated at St. Louis Children’s Hospital or other pediatric practices in the area. Over the course of 1 year, five study visits were conducted in each of the patient’s homes. Every 3 months, cultures were obtained from index patients and their household contacts, indoor dogs and cats, and 21 household environmental surfaces. The index patients and household contacts were swabbed at their axillae, nares, and inguinal folds; indoor dogs and cats were swabbed at their nares and dorsal fur; and household surfaces thought to be frequently touched by multiple household members were swabbed, such as TV remote controls, refrigerator door handles, and toilet seats. Researchers also administered a detailed survey to evaluate health, hygiene, and activities that may be associated with S. aureus infection transmission.

Molecular typing of all S. aureus strains was performed by repetitive-sequence polymerase chain reaction to determine strain relatedness, and staphylococcal cassette chromosome mec (SCCmec) characterization was performed by multiplex PCR.

Of 100 households, 49 had a total of 89 pets: 63 dogs and 26 cats. Of the 63 dogs, 13 (21%) were colonized with S. aureus (9 with MRSA) and 2 of 26 cats (8%) were colonized with MRSA. Eleven isolates were SCCmec type IV (MRSA), one was type II (MRSA), and two were type III (MRSA). At baseline, the researchers recovered 16 S. aureus isolates from 15 pets: 13 from the nares and 3 from pet dorsal fur.

One dog was colonized at both sites with concordant strains. In the three households that had two colonized pets, one household had two colonized dogs with matching strain types, the second had two dogs with nonmatching strain types, and the third had a dog and a cat with nonmatching strain types, Mr. Thompson reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Pet characteristics significantly associated with S. aureus colonization at study enrollment were older age (P = .04) and advanced number of years living in the home (P = .03), but sleeping in the same bed as a household member was not (P =. 96).

Molecular analysis revealed that the primary caretaker for 10 of the 15 colonized pets (67%) also was colonized with S. aureus, and 70% of these strains were concordant with the pet strain. In addition, seven of eight humans (88%) who shared a bed with a colonized pet also were colonized with S. aureus, and 43% of these strains were concordant with the pet strain.

Mr. Thompson also presented the longitudinal molecular epidemiology results in pets. In this analysis, 37 of the 89 pets were colonized with S. aureus at some point over the period of 12 months. Of these, 24 were colonized just once, while 13 were colonized at more than one of the samplings over time. Among these 13, two (15%) had concordant strains at all samplings, five (39%) had concordant and discordant strains, and six (46%) had discordant strains over the longitudinal study period.

Mr. Thompson and his associates intend to complete enrollment and analysis of 150 households in a 2-year longitudinal study. After this, he said, “we will be able to determine the directionality of human-pet S. aureus transmission as well as define the role of pets in S. aureus household transmission dynamics.”

The study was funded by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital, the Agency for Healthcare Research and Quality, and the National Institutes of Health. The researchers reported having no financial disclosures.

[email protected]

SAN DIEGO – An automated outbreak detection system was popular among infection preventionists and detected pathogenic clusters about 5 days sooner than did hospitals themselves, researchers said at an annual scientific meeting on infectious diseases.

“The vast majority of hospitals were very pleased to expand surveillance beyond multidrug-resistant organisms, and most thought this system would improve their ability to detect outbreaks and streamline their work,” said Dr. Meghan Baker of Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston.

(c) Janice Haney Carr/CDC

Patients in acute-care hospitals acquired almost 782,000 healthcare-associated infections (HAIs) in 2011, according to the Centers for Disease Control and Prevention.

Traditionally, infection preventionists at these hospitals look for HAIs by identifying temporal or spatial clusters of “a limited number of prespecified pathogens,” Dr. Baker said. But some real clusters do not meet these empirical rules, leading to more cases and potentially severe consequences for patients. Automated HAI outbreak detection systems can help, but not if they constantly trigger false alarms or, conversely, are so specific that they miss outbreaks.

Using the Premier SafetySurveillor infection control tool and free statistical software, Dr. Baker and her associates analyzed 83 years of historical microbiology data from 44 hospitals. The system signaled for any cluster involving at least three cases, even if cases occurred by chance less than once a year, she said. The researchers compared the results with outbreak data submitted by a convenience sample of hospitals that used their usual surveillance methods.

The automated approach identified 230 clusters. Most were detected based on antimicrobial resistance, but others shared the same ward or specialty service and some produced more than one signal. Clusters most often involved Staphylococcus aureus, Enterococcus, Pseudomonas, Escherichia coli, and Klebsiella, but most organisms were not under routine surveillance. As a result, 89% of clusters detected by the automated tool were not detected by hospitals using their usual methods, she emphasized. “Some were not real breaks, as determined later by genetic typing,” she added. “Most real clusters were [methicillin-resistant S. aureus], Clostridium difficile, and some were resistant gram-negative rods.”

When surveyed, 76% of infection preventionists said the automated tool moderately or greatly improved their ability to detect outbreaks, Dr. Baker reported. They would have wanted notification about 81% of the clusters, and considered 47% to be moderately or highly concerning. Notably, 51% of clusters expanded after detection.

“If these had been detected in real time, it would have been possible to intervene and possibly curtail the outbreak,” and 237 (42%) of 559 infections might have been avoided if these interventions were successful, she said.

Dr. Baker and her associates reported their findings at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Baker reported no competing interests. Two of her associates reported financial and relationships with Premier, Sage, Molnycke, and 3M.

SAN DIEGO – An automated outbreak detection system was popular among infection preventionists and detected pathogenic clusters about 5 days sooner than did hospitals themselves, researchers said at an annual scientific meeting on infectious diseases.

“The vast majority of hospitals were very pleased to expand surveillance beyond multidrug-resistant organisms, and most thought this system would improve their ability to detect outbreaks and streamline their work,” said Dr. Meghan Baker of Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston.

(c) Janice Haney Carr/CDC

Patients in acute-care hospitals acquired almost 782,000 healthcare-associated infections (HAIs) in 2011, according to the Centers for Disease Control and Prevention.

Traditionally, infection preventionists at these hospitals look for HAIs by identifying temporal or spatial clusters of “a limited number of prespecified pathogens,” Dr. Baker said. But some real clusters do not meet these empirical rules, leading to more cases and potentially severe consequences for patients. Automated HAI outbreak detection systems can help, but not if they constantly trigger false alarms or, conversely, are so specific that they miss outbreaks.

Using the Premier SafetySurveillor infection control tool and free statistical software, Dr. Baker and her associates analyzed 83 years of historical microbiology data from 44 hospitals. The system signaled for any cluster involving at least three cases, even if cases occurred by chance less than once a year, she said. The researchers compared the results with outbreak data submitted by a convenience sample of hospitals that used their usual surveillance methods.

The automated approach identified 230 clusters. Most were detected based on antimicrobial resistance, but others shared the same ward or specialty service and some produced more than one signal. Clusters most often involved Staphylococcus aureus, Enterococcus, Pseudomonas, Escherichia coli, and Klebsiella, but most organisms were not under routine surveillance. As a result, 89% of clusters detected by the automated tool were not detected by hospitals using their usual methods, she emphasized. “Some were not real breaks, as determined later by genetic typing,” she added. “Most real clusters were [methicillin-resistant S. aureus], Clostridium difficile, and some were resistant gram-negative rods.”

When surveyed, 76% of infection preventionists said the automated tool moderately or greatly improved their ability to detect outbreaks, Dr. Baker reported. They would have wanted notification about 81% of the clusters, and considered 47% to be moderately or highly concerning. Notably, 51% of clusters expanded after detection.

“If these had been detected in real time, it would have been possible to intervene and possibly curtail the outbreak,” and 237 (42%) of 559 infections might have been avoided if these interventions were successful, she said.

Dr. Baker and her associates reported their findings at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Baker reported no competing interests. Two of her associates reported financial and relationships with Premier, Sage, Molnycke, and 3M.

SAN DIEGO – An automated outbreak detection system was popular among infection preventionists and detected pathogenic clusters about 5 days sooner than did hospitals themselves, researchers said at an annual scientific meeting on infectious diseases.

“The vast majority of hospitals were very pleased to expand surveillance beyond multidrug-resistant organisms, and most thought this system would improve their ability to detect outbreaks and streamline their work,” said Dr. Meghan Baker of Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston.

(c) Janice Haney Carr/CDC

Patients in acute-care hospitals acquired almost 782,000 healthcare-associated infections (HAIs) in 2011, according to the Centers for Disease Control and Prevention.

Traditionally, infection preventionists at these hospitals look for HAIs by identifying temporal or spatial clusters of “a limited number of prespecified pathogens,” Dr. Baker said. But some real clusters do not meet these empirical rules, leading to more cases and potentially severe consequences for patients. Automated HAI outbreak detection systems can help, but not if they constantly trigger false alarms or, conversely, are so specific that they miss outbreaks.

Using the Premier SafetySurveillor infection control tool and free statistical software, Dr. Baker and her associates analyzed 83 years of historical microbiology data from 44 hospitals. The system signaled for any cluster involving at least three cases, even if cases occurred by chance less than once a year, she said. The researchers compared the results with outbreak data submitted by a convenience sample of hospitals that used their usual surveillance methods.

The automated approach identified 230 clusters. Most were detected based on antimicrobial resistance, but others shared the same ward or specialty service and some produced more than one signal. Clusters most often involved Staphylococcus aureus, Enterococcus, Pseudomonas, Escherichia coli, and Klebsiella, but most organisms were not under routine surveillance. As a result, 89% of clusters detected by the automated tool were not detected by hospitals using their usual methods, she emphasized. “Some were not real breaks, as determined later by genetic typing,” she added. “Most real clusters were [methicillin-resistant S. aureus], Clostridium difficile, and some were resistant gram-negative rods.”

When surveyed, 76% of infection preventionists said the automated tool moderately or greatly improved their ability to detect outbreaks, Dr. Baker reported. They would have wanted notification about 81% of the clusters, and considered 47% to be moderately or highly concerning. Notably, 51% of clusters expanded after detection.

“If these had been detected in real time, it would have been possible to intervene and possibly curtail the outbreak,” and 237 (42%) of 559 infections might have been avoided if these interventions were successful, she said.

Dr. Baker and her associates reported their findings at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Dr. Baker reported no competing interests. Two of her associates reported financial and relationships with Premier, Sage, Molnycke, and 3M.

An increase of surgical site infections (SSIs) stemming from pathogens resistant to antibiotic prophylaxis could result in thousands of infection-related deaths in surgical and chemotherapy patients, according to a new study published in the Lancet Infectious Diseases.

A total of 31 published meta-analyses of randomized or quasi–randomized controlled trials were included in the study by Dr. Ramanan Laxminarayan of the Center for Disease Dynamics, Economics & Policy in Washington, and his associates. The researchers surveyed the 10 most common surgeries in which antibiotic prophylaxis provides the greatest benefit. The infection rate in surgical patients receiving prophylaxis was 4.2%, and was 11.1% in patients who did not receive prophylaxis. Relative risk reduction for infection was least in cancer chemotherapy at 35% and greatest in pacemaker implantation at 86%.

Between 38.7% and 50.9% of SSIs and 26.8% of infections after chemotherapy are caused by antibiotic-resistant pathogens. A decrease in prophylaxis effectiveness of 10% would cause 40,000 additional infections and 2,100 additional deaths, while a decrease in effectiveness of 70% would cause 280,000 additional infections and 15,000 additional deaths.

The authors say more data are needed to establish how antibiotic prophylaxis recommendations should be modified in the context of increasing rates of resistance.

In a related comment, Dr. Joshua Wolf from St. Jude Children’s Research Hospital, Memphis, said, “To improve stewardship outcomes, we need more research that focuses on understanding impediments to appropriate antibiotic prescribing, strategies that target these impediments, resources to implement the strategies, and leadership that understands the urgency and complexity of the task. In view of the lack of progress so far, mandatory implementation of these steps could be necessary to achieve notable change.”

Find the full study in the Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00270-4).

[email protected]

An increase of surgical site infections (SSIs) stemming from pathogens resistant to antibiotic prophylaxis could result in thousands of infection-related deaths in surgical and chemotherapy patients, according to a new study published in the Lancet Infectious Diseases.

A total of 31 published meta-analyses of randomized or quasi–randomized controlled trials were included in the study by Dr. Ramanan Laxminarayan of the Center for Disease Dynamics, Economics & Policy in Washington, and his associates. The researchers surveyed the 10 most common surgeries in which antibiotic prophylaxis provides the greatest benefit. The infection rate in surgical patients receiving prophylaxis was 4.2%, and was 11.1% in patients who did not receive prophylaxis. Relative risk reduction for infection was least in cancer chemotherapy at 35% and greatest in pacemaker implantation at 86%.

Between 38.7% and 50.9% of SSIs and 26.8% of infections after chemotherapy are caused by antibiotic-resistant pathogens. A decrease in prophylaxis effectiveness of 10% would cause 40,000 additional infections and 2,100 additional deaths, while a decrease in effectiveness of 70% would cause 280,000 additional infections and 15,000 additional deaths.

The authors say more data are needed to establish how antibiotic prophylaxis recommendations should be modified in the context of increasing rates of resistance.

In a related comment, Dr. Joshua Wolf from St. Jude Children’s Research Hospital, Memphis, said, “To improve stewardship outcomes, we need more research that focuses on understanding impediments to appropriate antibiotic prescribing, strategies that target these impediments, resources to implement the strategies, and leadership that understands the urgency and complexity of the task. In view of the lack of progress so far, mandatory implementation of these steps could be necessary to achieve notable change.”

Find the full study in the Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00270-4).

[email protected]

An increase of surgical site infections (SSIs) stemming from pathogens resistant to antibiotic prophylaxis could result in thousands of infection-related deaths in surgical and chemotherapy patients, according to a new study published in the Lancet Infectious Diseases.

A total of 31 published meta-analyses of randomized or quasi–randomized controlled trials were included in the study by Dr. Ramanan Laxminarayan of the Center for Disease Dynamics, Economics & Policy in Washington, and his associates. The researchers surveyed the 10 most common surgeries in which antibiotic prophylaxis provides the greatest benefit. The infection rate in surgical patients receiving prophylaxis was 4.2%, and was 11.1% in patients who did not receive prophylaxis. Relative risk reduction for infection was least in cancer chemotherapy at 35% and greatest in pacemaker implantation at 86%.

Between 38.7% and 50.9% of SSIs and 26.8% of infections after chemotherapy are caused by antibiotic-resistant pathogens. A decrease in prophylaxis effectiveness of 10% would cause 40,000 additional infections and 2,100 additional deaths, while a decrease in effectiveness of 70% would cause 280,000 additional infections and 15,000 additional deaths.

The authors say more data are needed to establish how antibiotic prophylaxis recommendations should be modified in the context of increasing rates of resistance.

In a related comment, Dr. Joshua Wolf from St. Jude Children’s Research Hospital, Memphis, said, “To improve stewardship outcomes, we need more research that focuses on understanding impediments to appropriate antibiotic prescribing, strategies that target these impediments, resources to implement the strategies, and leadership that understands the urgency and complexity of the task. In view of the lack of progress so far, mandatory implementation of these steps could be necessary to achieve notable change.”

Find the full study in the Lancet Infectious Diseases (doi: 10.1016/S1473-3099[15]00270-4).

[email protected]

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.

Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.

©CDC/James Archer

“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.

The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.

Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).

The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.

Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.

©CDC/James Archer

“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.

The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.

Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).

The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) in children is low but has increased significantly since 1999, particularly among isolates from intensive care units and from blood and lower respiratory tract cultures, new data suggest.

Analysis of 316,253 Enterobacteriaceae isolates reported to 300 U.S. laboratories participating in the Surveillance Network-USA database between 1999 and 2012 showed 0.08% of isolates were carbapenem resistant, with the most common resistant isolates being Enterobacter species isolated from urinary sources and from the inpatient non-ICU setting.

©CDC/James Archer

“Unlike for adults, where increases were greater than for children, we did not find that the increase in CRE in children appeared to be related to residence in long-term care facilities, because only 0.1% of CRE isolates came from this setting,” wrote Dr. Latania K. Logan, director of pediatric infectious diseases at Rush University Medical Center, Chicago, and her coauthors.

The study, published Oct. 14 in Emerging Infectious Diseases, showed a significant overall increase from 0% to 0.47% in carbapenem-resistant Enterobacteriaceae over the 12-year study period; among ICU isolates, the prevalence increased from 0% to 4.5% over the same period.

Many of the carbapenem-resistant isolates also were resistant to other antimicrobial drugs, such as trimethoprim/sulfamethoxazole and ciprofloxacin, and nearly half (48.3%) were resistant to more than three antimicrobial drug classes (Emerg Infect Dis. 2015 Oct 14. doi: 10.3201/eid2111.150548).

The study was supported by the National Institutes of Health, the Children’s Foundation, the Global Antibiotic Resistance Partnership, the Bill and Melinda Gates Foundation, and the Health Grand Challenges Program at Princeton University. No conflicts of interest were declared.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Less than a third of hospitals reprocessed duodenoscopes adequately to prevent potential transmission of carbapenem-resistant Enterobacteriaceae (CRE) and other pathogens, investigators reported at an annual scientific meeting on infectious diseases.

Moreover, only a third of facilities had conducted active surveillance for multidrug-resistant infections related to use of their duodenoscopes in the past year, reported Susan Beekmann of the Emerging Infections Network of the Infectious Diseases Society of America. “These findings suggest that endemic bacterial transmission associated with duodenoscopy may occur and may go unrecognized,” said Ms. Beekmann, program coordinator for EIN at the University of Iowa Carver College of Medicine in Iowa City.

©CDC/James Archer

Duodenoscopes, which are used in endoscopic retrograde cholangiopancreatography (ERCP), became a hot topic earlier this year after causing outbreaks of fatal CRE infections in Los Angeles County. The Food and Drug Administration has acknowledged that the “complex design of the devices makes it difficult to remove contaminants compared to other types of endoscopes,” and both the CDC and the FDA have recommended specific reprocessing and surveillance steps to reduce the chances that the scopes transmit serious infections.

To understand how hospitals were actually reprocessing and culturing the scopes at the time CDC released its guidance, Ms. Beekmann and her colleagues electronically surveyed 740 hospital epidemiologists through IDSA-EIN. They received responses from 378 physicians (52%), of which half said their facilities used duodenoscopes, Ms. Beekmann reported at the combined annual meetings of the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, the HIV Medicine Association, and the Pediatric Infectious Diseases Society.

Only 55 (29%) of these respondents said their facilities reprocessed duodenoscopes to an extent that the IDSA researchers defined as adequate – that is, manual reprocessing with high-level disinfection, either alone or in combination with other options, Ms. Beekmann said. Furthermore, only a third of facilities had cultured their duodenoscopes or done any other surveillance for bacterial transmission after duodenoscopy in the past year, even though most said they reviewed their reprocessing policies and procedures more often than once a year.

Respondents also described widely varying methodologies for sampling and culturing, Ms. Beekmann said. “Although we did not ask about them, ten respondents mentioned ATP bioluminescence assays,” she added. Based on the findings, better reprocessing technologies and consistent, real-time strategies to monitor the effectiveness of scope reprocessing are “urgent patient safety needs,” she and her colleagues concluded.

Ms. Beekmann and her associates reported no relevant financial disclosures.

SAN DIEGO – Oral fosfomycin, a drug used for more than 4 decades to treat urinary tract infections in women, has gained a new life as a promising treatment for chronic prostatitis.

In the largest patient series reported to date, a 6-week course of fosfomycin resulted in an 85% clinical cure rate in 20 men with chronic prostatitis due to multidrug-resistant pathogens, Dr. Ilias Karaiskos reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Bruce Jancin/Frontline Medical News

This is a most welcome development because chronic prostatitis is a common condition and Escherichia coli – the number-one pathogen – is becoming increasingly resistant to fluoroquinolones, long considered the first-line therapy. The quinolone resistance issue is of particular concern because most other antibiotics lack the pharmacokinetics required to penetrate the prostate gland, explained Dr. Karaiskos of Hygeia General Hospital in Athens.

A recent study by other investigators showing that fosfomycin penetrates the prostate and achieves potentially therapeutic levels (Clin Infect Dis. 2014 Feb;58[4]:e101-5) inspired Dr. Karaiskos and coworkers to conduct their open 20-patient trial. Participants averaged 2.25 prior episodes of prostatitis.

Urine cultures showed that the most common pathogen was indeed E. coli, and that 15 of the 20 strains were resistant to fluoroquinolones. Most strains were also resistant to minocycline and trimethoprim-sulfamethoxazole. However, all strains were sensitive to fosfomycin (Monurol).

Dosing of fosfomycin in the study was 3 g once daily for the first week, then 3 g every 48 hours for the next 5 weeks.

Seventeen of 20 patients experienced clinical cure, defined as resolution of all symptoms plus absence of any evidence of inflammation upon follow-up imaging of the prostate by transrectal ultrasound or MRI upon treatment completion after 6 weeks of fosfomycin. Two patients failed to respond, and one discontinued treatment due to diarrhea.

Diarrhea was the most common treatment-emergent adverse event, affecting 5 of 20 patients. In most instances, diarrhea subsided when the dosing intervals were extended.

Further studies are needed to clarify the best fosfomycin dosing regimen for chronic prostatitis, Dr. Karaiskos said. For uncomplicated urinary tract infections the drug is typically given in a single megadose.

Dr. Karaiskos reported having no financial conflicts regarding this study, conducted free of commercial support.

[email protected]

SAN DIEGO – Oral fosfomycin, a drug used for more than 4 decades to treat urinary tract infections in women, has gained a new life as a promising treatment for chronic prostatitis.

In the largest patient series reported to date, a 6-week course of fosfomycin resulted in an 85% clinical cure rate in 20 men with chronic prostatitis due to multidrug-resistant pathogens, Dr. Ilias Karaiskos reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Bruce Jancin/Frontline Medical News

This is a most welcome development because chronic prostatitis is a common condition and Escherichia coli – the number-one pathogen – is becoming increasingly resistant to fluoroquinolones, long considered the first-line therapy. The quinolone resistance issue is of particular concern because most other antibiotics lack the pharmacokinetics required to penetrate the prostate gland, explained Dr. Karaiskos of Hygeia General Hospital in Athens.

A recent study by other investigators showing that fosfomycin penetrates the prostate and achieves potentially therapeutic levels (Clin Infect Dis. 2014 Feb;58[4]:e101-5) inspired Dr. Karaiskos and coworkers to conduct their open 20-patient trial. Participants averaged 2.25 prior episodes of prostatitis.

Urine cultures showed that the most common pathogen was indeed E. coli, and that 15 of the 20 strains were resistant to fluoroquinolones. Most strains were also resistant to minocycline and trimethoprim-sulfamethoxazole. However, all strains were sensitive to fosfomycin (Monurol).

Dosing of fosfomycin in the study was 3 g once daily for the first week, then 3 g every 48 hours for the next 5 weeks.

Seventeen of 20 patients experienced clinical cure, defined as resolution of all symptoms plus absence of any evidence of inflammation upon follow-up imaging of the prostate by transrectal ultrasound or MRI upon treatment completion after 6 weeks of fosfomycin. Two patients failed to respond, and one discontinued treatment due to diarrhea.

Diarrhea was the most common treatment-emergent adverse event, affecting 5 of 20 patients. In most instances, diarrhea subsided when the dosing intervals were extended.

Further studies are needed to clarify the best fosfomycin dosing regimen for chronic prostatitis, Dr. Karaiskos said. For uncomplicated urinary tract infections the drug is typically given in a single megadose.

Dr. Karaiskos reported having no financial conflicts regarding this study, conducted free of commercial support.

[email protected]

SAN DIEGO – Oral fosfomycin, a drug used for more than 4 decades to treat urinary tract infections in women, has gained a new life as a promising treatment for chronic prostatitis.

In the largest patient series reported to date, a 6-week course of fosfomycin resulted in an 85% clinical cure rate in 20 men with chronic prostatitis due to multidrug-resistant pathogens, Dr. Ilias Karaiskos reported at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.

Bruce Jancin/Frontline Medical News

This is a most welcome development because chronic prostatitis is a common condition and Escherichia coli – the number-one pathogen – is becoming increasingly resistant to fluoroquinolones, long considered the first-line therapy. The quinolone resistance issue is of particular concern because most other antibiotics lack the pharmacokinetics required to penetrate the prostate gland, explained Dr. Karaiskos of Hygeia General Hospital in Athens.

A recent study by other investigators showing that fosfomycin penetrates the prostate and achieves potentially therapeutic levels (Clin Infect Dis. 2014 Feb;58[4]:e101-5) inspired Dr. Karaiskos and coworkers to conduct their open 20-patient trial. Participants averaged 2.25 prior episodes of prostatitis.

Urine cultures showed that the most common pathogen was indeed E. coli, and that 15 of the 20 strains were resistant to fluoroquinolones. Most strains were also resistant to minocycline and trimethoprim-sulfamethoxazole. However, all strains were sensitive to fosfomycin (Monurol).

Dosing of fosfomycin in the study was 3 g once daily for the first week, then 3 g every 48 hours for the next 5 weeks.

Seventeen of 20 patients experienced clinical cure, defined as resolution of all symptoms plus absence of any evidence of inflammation upon follow-up imaging of the prostate by transrectal ultrasound or MRI upon treatment completion after 6 weeks of fosfomycin. Two patients failed to respond, and one discontinued treatment due to diarrhea.

Diarrhea was the most common treatment-emergent adverse event, affecting 5 of 20 patients. In most instances, diarrhea subsided when the dosing intervals were extended.

Further studies are needed to clarify the best fosfomycin dosing regimen for chronic prostatitis, Dr. Karaiskos said. For uncomplicated urinary tract infections the drug is typically given in a single megadose.

Dr. Karaiskos reported having no financial conflicts regarding this study, conducted free of commercial support.

[email protected]