Infection PreventioneBug Bytes

January 2015

Influenza virus

MRSA infections increased risk for death after discharge

• VA Researchers evaluated the long-term effects of MRSA health care-associated infections (HAIs) by conducting a retrospective cohort study of patients hospitalized at 123 VA acute care facilities from October 2007 to September 2010. The patients were followed after discharge until death or 365 days. The researchers also evaluated a propensity score matched subsample of patients.

• The cohort included 369,743 patients, including 3,599 with a positive MRSA culture, an incidence of 0.83 infections per 1,000 patient-days at risk. The propensity score matched sample included 3,592 patients with MRSA and 3,592 matched patients without MRSA. In the entire cohort, a multivariable model indicated patients with MRSA were more likely to die than those without MRSA (HR=1.42; 95% CI, 1.32-1.53). Patients with MRSA HAIs were 49% more likely to die than non-MRSA patients. Patients with MRSA colonization were 41% more likely to die. In the propensity score-matched sample, the estimates were similar. Positive MRSA cultures increased the adjusted risk for death by 35%, and MRSA HAIs increased the risk by 46%. Also - further investigations are needed to determine if the increased mortality related to MRSA infections is due to reinfection or due to complications from the initial infection.

• Source: Nelson RE. Am J Infect Control. 2015:43:38-43

Superbug spread through contaminated scopes sickened dozens in Seattle

• A drug-resistant superbug infected 32 people at a Seattle hospital over a two-year period, with the bacteria spreading through contaminated medical scopes that had been cleaned to the manufacturer's recommendation. Eleven of the patients infected at Virginia Mason Medical Center between 2012 and 2014 eventually died, the hospital and city health officials said. But those patients were critically ill before being infected and it was unclear what role, if any, the bacteria played in their deaths.

• The patients were infected with drug-resistant bacteria, including the rare Carbapenem-resistant enterobacteriaceae. The report follows similar incidents in Pittsburgh in 2012 and Chicago in 2014, where contaminated endoscopes infected dozens of patients, health officials said. No fatalities were directly linked to the infections. In the Seattle case, public health officials said the germs apparently spread from patient to patient by endoscopes used to treat liver and pancreatic illnesses. The scopes at Virginia Mason Medical Center were sterilized to existing standards before each use. It took investigators many months to pinpoint the contamination, and the hospital has since instituted a rigorous decontamination process that exceeds national standards.

• http://news.yahoo.com/superbug-spread-contaminated-scopes-sickened-dozens-seattle-221725400--finance.html

Bacterial 'bunches' linked to some colorectal cancers

• Researchers from Johns Hopkins have found that dense mats of interacting bacteria, called biofilms, were present in the majority of cancers and polyps, particularly those on the right side of the colon. The presence of these bacterial bunches, they say, may represent an increased risk for colon cancer and could form the basis of new diagnostic tests.

• Like tooth plaque and slime on pond stones, bacterial biofilms may coat the mucus layer of cells lining the colon, causing inflammation and some noncancerous bowel diseases. The bacteria invade the layer of mucus that protects epithelial cells in these areas and upend the whole biology of the system.

• In an examination of healthy and cancerous tissue biopsied from 118 people undergoing surgery or colonoscopy at The Johns Hopkins Hospital or at the University of Malaya Medical Centre in Malaysia, researchers found that biofilms were present on 89 percent of tumors - 13 of 15 cancers and four of four polyps - removed from the right or ascending colon. By contrast, biofilms, for reasons not known, were found only 12 percent of the time on tumors on the left side of the colon - two of 15 cancers and no polyps. Overall, the researchers say, their data suggest the risk of developing colorectal cancer might be fivefold higher in patients with biofilms on the right side of the colon, compared to patients without the bacterial mats. The research team also noted that probiotic treatments might be one strategy to reduce biofilms, but there is as yet no evidence that their use will reduce cancer risk or should be recommended to the public.

• http://www.medicalnewstoday.com/releases/287260.php?tw&utm_source=12.30.14&utm_campaign=12.30.14&utm_medium=email

CDC chief: 'World of difference' in Ebola fight, but complacency a risk

• Dr. Frieden, CDC Director, visited West Africa countries with Ebola recently and highlighted some of the most alarming concerns in the region, including that medical aid group Doctors Without Borders recently reported a one-day shortage of beds to isolate patients in the capital of Guinea for the first time since the outbreak began. He also pointed out that in Liberia, where health officials have vastly scaled up their Ebola response in the capital, Monrovia, and gained the upper hand in the fight against the disease, small response teams are now busy responding to hot spots of transmission in remote areas of the country.

• He said that in Sierra Leone, currently the country with the highest number of Ebola cases, at least 10 people confirmed to have Ebola are dying every day outside of treatment centers, meaning they can potentially spread the disease farther. The latest numbers released by the World Health Organization show that the disease is believed to have infected more than 19,000 people and killed more than 7,500, a picture vastly different from the dire one the CDC painted in September with its projection that there could be as many as 1.4 million cases of Ebola by January's end if nothing further was done. (12/22/2014)

• Source: http://www.latimes.com/world/africa/la-fg-cdc-ebola-frieden-20141222-story.html?utm_source=12.30.14&utm_campaign=12.30.14&utm_medium=email

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Trumenba Vaccine for Meningococcal Disease:

• Clinical Features• Fever, headache and stiff neck in meningococcal meningitis cases, and sepsis and rash in

meningococcemia.• Etiologic Agent• Multiple serogroups of Neisseria meningitidis. Serogroups B, C, and Y cause the majority of disease in

the United States. Serogroup W causes a small portion of disease, and serogroup A causes disease in developing countries and the meningitis belt of sub-Saharan Africa.

• The first serogroup B meningococcal disease vaccine was approved by the Food and Drug Administration (FDA). Trumenba would prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B. Meningococcal disease is caused by bacteria that infect the bloodstream and the lining that surrounds the brain and spinal cord. According to the CDC fewer than 1,000 cases of meningococcal disease occur annually, but 10% - 15% of cases are fatal and up to 19% of survivors suffer permanent disabilities. The Advisory Committee on Immunization Practices recommends routine vaccination of adolescents aged 11 through 18 years (a single dose of vaccine should be administered at age 11 or 12 years, with a booster dose at age 16 years for persons who receive the first dose before age 16 years) and vaccination of persons in at-risk populations.

• Source: http://www.cdc.gov/meningococcal/clinical-info.html

Infections Increase Death Risk by 35% for ICU Patients

• Elderly patients admitted to intensive care units (ICUs) are about 35% more likely to die within five years of leaving the hospital if they develop an infection during their stay, a new study finds. Preventing two of the most common healthcare-acquired infections – bloodstream infections caused by central lines and pneumonia caused by ventilators – can increase the odds that these patients survive and reduce the cost of their care by more than $150,000.

• The study looked at outcomes for 17,537 elderly Medicare patients admitted to 31 hospitals in 2002 to assess the cost and effectiveness of infection prevention efforts. Then, the researchers used an additional five years of Medicare claims data to assess the long-term outcomes and health costs attributed to healthcare-acquired infections. While 57% of all the elderly ICU patients died within five years, the researchers found that infections made death more likely. For those who developed CLABSI, 75% died within five years, as did 77% of those who developed VAP. On average, the ongoing cost of running an infection prevention program in the ICU is about $145,000, the study found. Prevention efforts reduced ICU costs by $174,713 per patient for each instance of CLABSI, and by $163,090 for VAP. This evidence points definitively to the value of investing in infection prevention

• Source: Stone P, Larson E. A decade of investment in infection prevention: A cost-effectiveness analysis. Amer Journ Infec Contr January 2015

Occupationally Acquired HIV Infection Among Health Care Workers — United States, 1985–2013

• During 1985–2013, 58 confirmed and 150 possible cases of occupationally acquired HIV infection among HCWs were reported to CDC; since 1999, only one confirmed case (a laboratory technician sustaining a needle puncture while working with a live HIV culture in 2008) has been reported. Among the 58 confirmed cases, the routes of exposure resulting in infection were: percutaneous puncture or cut (49 cases), mucocutaneous exposure (five), both percutaneous and mucocutaneous exposure (two), and unknown (two).

• A total of 49 HCWs were exposed to HIV-infected blood, four to concentrated virus in a laboratory, one to visibly bloody fluid, and four to unspecified body fluids. Occupations of the HCWs with confirmed or possible HIV infection have varied widely. CDC recommends the use of standard precautions to prevent exposure of HCWs to potentially infectious body fluids when working with any patient, whether known to be infected with HIV or not. HCWs should assume that body fluids from all patients are infectious even if the patients are not known to be infected with HIV. Proper implementation of standard precautions (e.g., use of safety devices and barriers such as gloves and goggles) minimizes exposure risk.

Source: MMWR: January 9, 2015 / 63(53);1245-1246

Antibiotic Resistance Will Kill 10 Million People A Year By 2050

• According to the CDC, at least two million people become infected with bacteria resistant to antibiotics each year, and of those at least 23,000 die. A recent review on antimicrobial resistance released last month estimated that if bacteria keep evolving at the current rate, by 2050 10 million people will die a year from otherwise curable diseases. Doctors overprescribing antibiotics and farmers feeding daily doses of antibiotics to animals helped bring about the current situation. Not finishing a course of antibiotics and then using the “leftovers” months later when you feel yourself getting sick helped the bacteria to evolve resistance at an unnatural and unprecedented rate.

• Scientists throughout the globe are joining forces to both create new antibiotics as well as devise ways to tackle infection without the need for these drugs in the first place. The fact that more scientists as well as lay people are becoming aware of the current issue of antibiotic resistance is cause for optimism. We all play a role in ensuring that our planet does not revert back to the “dark ages of medicine,” and in order to ensure the future of our children, it’s time to not only recognize but also act on the issue of antibacterial resistance.

• Source: Jim O’Neill. Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations. The Review on Antimicrobial Resistance. 2014.

Nine people infected with measles after visits to Disney parks

• At least nine people came down with the measles after visiting Disneyland Park last month. The confirmed cases include seven in five different California cities and two in Utah. California has three other suspected cases. The confirmed California patients range in age from 8 months to 21 years, and all but one hadn't been vaccinated. The people sickened were all at Disneyland between December 15-20. State health officials say they know of eight who were not vaccinated, including two who were too young.

• The state is tracing the contacts the patients have had to determine the spread of the disease, a respiratory infection that causes a rash and can lead to pneumonia. While the measles is relatively rare in the U.S. because a vaccine is available, it persists in other countries, making international tourist destinations like Disneyland vulnerable. The U.S. Centers for Disease Control and Prevention reported 20 measles outbreaks through November of last year, leading to 610 cases, a record since the disease was temporarily eliminated in 2000.

• Source: http://www.bloomberg.com/news/2015-01-07/nine-people-infected-with-measles-after-visits-to-disney-parks.html

The Santa Barbara Smokehouse Inc Voluntary Recall Because of Possible Health Risk• 01/10/2015 07:58 PM EST• The Santa Barbara Smokehouse Inc. of Santa Barbara, CA, is

voluntarily recalling the following brands and batches of cold smoked salmon produced and packed between December 17th and December 24th 2014 because they have the potential to be contaminated with Listeria monocytogenes, an organism which can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems.

• Although healthy individuals may suffer only short-term symptoms such as high fever, severe headache, stiffness, nausea, abdominal pain and diarrhea, Listeria infection can cause miscarriages and stillbirths among pregnant women.

• Source: http://www.fda.gov/Safety/Recalls/ucm429733.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery

Widespread flu continues; antivirals are effective but underused

• The CDC reports that there is widespread flu activity in most U.S. states. The most common circulating virus is influenza A (H3N2) and about two-thirds of these H3N2 viruses are genetically different from those H3N2 viruses in the flu vaccine. This difference suggests that vaccine effectiveness may be reduced this season. This particular virus in past flu seasons has been associated with more severe disease and deaths in older people and young children, and in this flu season, high hospitalization rates are also being observed. As such, the CDC's recommendation for the use of influenza antiviral drugs as an adjunct to vaccination becomes even more important than usual in protecting people from serious complications. However these antiviral drugs are being underused. The CDC continues to recommend vaccination as long as flu viruses are circulating. The use of antiviral medications to treat flu has been shown to reduce symptoms, length of time of illness and severe outcomes. The CDC recommends that patients with suspected flu at high risk for serious complications and those hospitalized should be treated as soon as possible with one of the three available flu antiviral medication without waiting for confirmatory tests. While antiviral drugs work best when given early, there is still benefit even when treatment is initiated later.

• Source: http://emergency.cdc.gov/han/han00375.asp

Progress being made in infection control in U.S. hospitals

• Progress has been made in the effort to eliminate infections that commonly threaten hospital patients, including a 46 percent decrease in central line-associated bloodstream infections (CLABSI) between 2008 and 2013. However, additional work is needed to continue to improve patient safety. CDC's Healthcare-Associated Infections (HAI) progress report is a snapshot of how each state and the country are doing in eliminating six infection types that hospitals are required to report to CDC. For the first time, this year's HAI progress report includes state-specific data about hospital lab-identified methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections and Clostridium difficile (C. difficile) infections (deadly diarrhea).

• The annual National and State Healthcare-associated Infection Progress Report expands upon and provides an update to previous reports detailing progress toward the goal of eliminating HAIs. The report summarizes data submitted to CDC's National Healthcare Safety Network (NHSN), the nation's healthcare-associated infection tracking system, which is used by more than 14,500 healthcare facilities across all 50 states, Washington, D.C., and Puerto Rico.

• Source: http://www.cdc.gov/hai/progress-report/index.html

How E. coli passes safely through stomach acid

• In some parts of the world, many small children become infected with severe diarrhea which often proves fatal. The condition is usually caused by strains of Escherichia coli bacteria, and bacteria of the genus Yersinia. These bacteria attach themselves to the wall of the small intestine and use a needle-like apparatus to inject toxins into the tissue. Yet these bacteria usually enter the human body via the mouth -- and you would expect them to be killed off by the strong acid in the stomach, which provides a barrier against infection. E. coli and Yersinia bacteria attack cells in the small intestine which absorb nutrients. They use adhesins such as intimin (a protein; the name comes from "intimate adherence") to stick to intestinal epithelial cells and to subsequently form tiny channels between the bacteria and the intestinal cells. In this way they are able to introduce diarrhea-causing toxins into the intestine. The intimin is inserted into the bacterial cell envelope, where it binds with the bacteria´s stabilizing structure, peptidoglycan, a mesh-like molecule consisting of sugars and amino acids. Researches assume that this mechanism protects against acidic and mechanical stress and that E. coli bacteria can pass through the stomach unharmed. The researchers suspect that intimin boosts the bacteria's virulence.

• Source: Jack C. et al. The Intimin periplasmic domain mediates dimerisation and binding to peptidoglycan. Molecular Microbiology, 2015; 95 (1): 80