Transcript File - Working Toward Zero HAIs

Infection Prevention
eBug Bytes
May 2015
E.Coli in cell division
(every 20 minutes)
MRSA Can Linger in Homes,
Spreading Among its Inhabitants
• MRSA are strains of the bacterium Staphylococcus aureus that are resistant to almost all
antibiotics related to penicillin, known as the beta-lactams. Since the 1990s, communityassociated MRSA infections, mostly skin infections, have been seen in healthy people. The
predominant community-associated strain of MRSA, called USA300, is virulent and easily
transmissible. For the study, researchers used a laboratory technique called whole genome
sequencing on 146 USA300 MRSA samples. These samples were collected during a previous
study from 21 households in Chicago and Los Angeles where a family member had presented
to the emergency room with a skin infection found to be caused by USA300 MRSA. During
that study, published in 2012 in the journal Clinical Infectious Diseases, investigators visited
the homes of 350 skin infection patients, culturing their and their family members' noses,
throats and groins for bacterial colonization. Among 1,162 people studied (350 skin infection
patients and 812 household members), S. aureus colonized at one or more body sites of 40
percent (137 of 350) of patients with skin infections and 50 percent (405 of 812) of their
household contacts. The researchers found that isolates within households clustered into
closely related groups, suggesting a single common USA300 ancestral strain was introduced
to and transmitted within each household. "The study adds to the knowledge base of how
USA300 MRSA has spread throughout the country," said study coauthor Timothy D. Read,
PhD. "We're also getting hints at how it evolves inside households. Decolonization of
household members may be a critical component of prevention programs to control USA300
MRSA spread in the United States.“ Source: American Society for Microbiology
FDA: 142 Contaminated
Duodenoscope Reports Since 2010
• The FDA says it has received 142 reports of contaminated duodenoscopes since
2010, along with 4 additional reports dating back to 1997. Of the 146 total, 13
involved patient deaths and 121 involved injuries, says the agency. Each incident
had the potential to expose multiple patients. While the agency is convening an
advisory panel this week to address the issue, its previous response to the
contamination concerns haven't indicated a radical shift in direction. "The
transmission of infectious material from patient to patient during ERCP
(endoscopic retrograde cholangiopancreatography), although uncommon,
represents a serious public health concern," the FDA stated in its latest report,
which stood by its decision not to recall the scopes. The agency estimates that
669,000 ERCP procedures were performed last year alone.
• Olympus, which holds an 85% share of the U.S. market for duodenoscopes,
recently issued new reprocessing instructions for its TJF-Q180V duodenoscope and
was scheduled to begin providing customers with small-bristle cleaning brushes in
early May. The brushes are intended to help decontaminate the forceps elevator
channel, thought to be the source of most cross-contamination-associated
infections.
• Source: Outpatient Surgery – May 2015
FDA Advisory Committee Slated to Review
Procedures for Reprocessing Endoscopes
• On May 14 and 15, 2015, the Gastroenterology and Urology Devices Panel of the
Medical Devices Advisory Committee to the FDA will convene to offer expert
opinion related to reprocessing of duodenoscopes and other endoscopes. The
committee meeting comes on the heels of an FDA safety communication that was
issued in February of 2015 regarding recent reports of multidrug-resistant
bacterial infections in patients who underwent endoscopic retrograde
cholangiopancreatography (ERCP) with reprocessed duodenoscopes. On March 12,
2015, the FDA released final guidance for reprocessing of reusable medical devices
aimed at enhancing the safety of reusable medical devices and reducing risk of
spread of infectious agents between uses. The Advisory Committee is being asked
to make recommendations on the following:
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•The effectiveness of cleaning, high-level disinfection, and sterilization methods.
•The amount and type of premarket validation data and information needed to support labeling claims
and technical instructions.
•The appropriate use of other risk mitigation, such as surveillance cultures.
•Best practices and guidelines for reprocessing duodenoscopes and endoscopes at user facilities to
minimize the transmission of infections.
•Approaches for ensuring patient safety during ERCP procedures, including a discussion of appropriate
patient selection. Source: FDA
Stomach bug traced to swimming
in contaminated lake
• An outbreak of gastrointestinal illness that was traced back to an Oregon
lake has led U.S. health officials to issue guidelines on swimming hygiene.
• Seventy people who swam at a lake near Portland last July were sickened
by norovirus, according to a report from the U.S. Centers for Disease
Control and Prevention. More than half of those sickened in the Oregon
outbreak were children aged 4 to 10 years.
• Health officials believe a swimmer infected with norovirus vomited or had
diarrhea in the water, and other swimmers swallowed the contaminated
water. People who swam in the lake were 2.3 times more likely to become
ill than those who visited the park but did not go in the water, according to
the report published in the May 15 issue of the CDC's Morbidity and
Mortality Weekly Report.
• The lake was closed to swimmers for 10 days to prevent further
transmission.
• Source: U.S. Centers for Disease Control and Prevention, news release,
May 14, 2015
MERS fear prompts South Korea to
quarantine people in bid to curb virus' spread
South Korean government is planning to bar people exposed to the Middle East Respiratory
Syndrome (MERS) from leaving the country, in a bid to contain the disease's spread. Over the
past 12 days, 18 people have been diagnosed with MERS and the country is working to
isolate hundreds of others who have come into contact with those infected by the virus. The
country's health minister Moon Hyung Pyo said that the measure was necessary to contain
the virus' spread after a man, who was in close contact with a MERS patient in South Korea,
later decided to leave the country for China. He is currently in isolation after being diagnosed
with the disease. MERS has so far killed hundreds of people in the Middle East and the first
case of MERS in the country was detected in a 68-year-old man who had travelled to Bahrain
in April and May. The hospital where the first outbreak was reported has been closed and all
patients were being treated in quarantine. The country's government also said Sunday that it
would form a MERS task force, which would include experts from the private sector. By
Monday, 682 people of the 715 people who have been in close contact with MERS patients
have been put in isolation. Another 33 were released for not showing any symptoms after a
14-day incubation period. The country has yet to report any tertiary infections yet. This
means that the 17 people currently diagnosed with MERS became infected after they came
in close contact with the first patient. If a tertiary infection occurs, then any of the 18 could
become a carrier. There is no treatment yet for MERS, a viral respiratory illness that was first
reported in 2012 in Saudi Arabia. Since then, 23 countries have reported 1,142 cases.
Source: http://www.ibtimes.com/mers-fear-prompts-south-korea-quarantine-people-bid-curb-virus-spread-1945916
Lives could be saved with Hepatitis C
treatment
The word "hepatitis" means swelling of the liver. Hepatitis is most often caused by a virus. In
the United States, the most common type of viral hepatitis is hepatitis C. Hepatitis C is
primarily spread through contact with blood from an infected person. More than 15,000
Americans, most of them baby boomers, die each year from hepatitis C-related illness.
Deaths related to hepatitis C have been on the rise and are expected to increase. Hepatitis C
is a leading cause of liver cancer and the leading reason for liver transplants. Other serious
health problems related to hepatitis C include:
•Liver damage
•Cirrhosis
•Liver failure
People born during 1945 through 1965 are five times more likely than other adults to be
infected with hepatitis C. If you were born during these years, talk to your doctor about
getting tested. In fact, 75 percent of adults with hepatitis C were born during these years. The
reason that baby boomers have the highest rates of hepatitis C is not completely understood.
Most boomers may have become infected in the 1970s and 1980s when rates of hepatitis C
were the highest. Many baby boomers could have gotten infected from tainted blood and
blood products before testing of the blood supply began in 1992. Others may have become
infected from injecting drugs, even if only once in the past. Still, many baby boomers do not
know how or when they were infected. Source: www.apic.org
Bacterial cause behind fatal heart
complications discovered
• As Streptococcus pneumoniae is a respiratory pathogen that does not infect the
heart, however, this association with heart problems has puzzled clinicians and
researchers, particularly as even prompt use of antibiotics does not provide any
protection from cardiac complications. A multidisciplinary research team, at the
University of Liverpool, has now shown that the cause of cardiac injury is a toxin
called pneumolysin, which is released by the bacteria during infection. They found
that this toxin could directly attack heart muscle cells, causing injury, damage and
death. "We have discovered that the toxin pneumolysin, which is released during
infection with Streptococcus pneumoniae, is the main reason why a significant
number of patients develop rapidly progressive and fatal heart complications even
if the bacteria does not directly infect the heart.” Importantly, the researchers also
found that the use of antibiotics could exacerbate damage to heart muscle cells
during infection with S. pneumoniae, as antibiotic-induced bacterial death releases
large amounts of pneumolysin into the blood circulation. To circumvent this
problem, the team used specially engineered fat bodies, called liposomes, to bind
to and neutralise pneumolysin and prevent it from damaging heart muscle cells.
• Source: Yasir A et al: Circulating Pneumolysin Is a Potent Inducer of Cardiac Injury
during Pneumococcal Infection. PLOS Pathogens, 2015; 11 (5): e1004836
Gel filled with Nanosponges cleans
up MRSA infections
Nanoengineers at the University of California, San Diego developed a gel filled with toxinabsorbing nanosponges that could lead to an effective treatment for skin and wound
infections caused by MRSA. This "nanosponge-hydrogel" minimized the growth of skin lesions
on mice infected with MRSA -- without the use of antibiotics. To make the nanospongehydrogel, the team mixed nanosponges, which are nanoparticles that absorb dangerous toxins
produced by MRSA, E. coli and other antibiotic-resistant bacteria, into a hydrogel, which is a
gel made of water and polymers. The hydrogel holds the nanosponges in place so that they
can remove toxins at the infected spot. Since the nanosponge-hydrogel treatment does not
involve antibiotics, it will not likely be affected by existing bacterial antibiotic resistance. Also,
because antibiotics are not involved, the treatment will likely not cause bacteria to develop
new resistance. One way to treat these infections is to remove the toxins, which act as a
weapon and a defense shield for the bacteria that produce them. Researchers hypothesized
that without the toxins, the bacteria become significantly weakened and exposed, allowing the
body's immune system to kill them more easily without the use of drugs. How does the
nanosponge-hydrogel treatment work? Each nanosponge is a nanoparticle coated in a red
blood cell membrane. This coating disguises the nanosponges as red blood cells, which are the
real targets of the harmful toxins produced by MRSA. By masquerading as red blood cells, the
nanosponges attract harmful toxins and remove them from the bloodstream. In order for the
nanosponges to remove toxins from a specific spot, such as an infected skin wound, a lot of
them need to be held at that spot. Source: Wang A et al. Hydrogel Retaining Toxin-Absorbing Nanosponges for
Local Treatment of Methicillin-ResistantStaphylococcus aureusInfection. Advanced Materials, 2015
Researchers find off-patent antibiotics
effectively combat MRSA skin infections
Researchers funded by the National Institute of Allergy and Infectious Diseases (NIAID), part
of the National Institutes of Health, have found that two common antibiotic treatments work
equally well against bacterial skin infections caused by methicillin-resistant Staphylococcus
aureus (MRSA) acquired outside of hospital settings. Known as community-associated MRSA,
or CA-MRSA, these skin infections have been reported in athletes, daycare-age children,
students, military personnel and prison inmates, among others, and can lead to
hospitalization, surgical procedures, bacteria in the blood, and in severe cases, death.
Although MRSA is an increasingly common pathogen and the most common cause of skin
infection in the United States, there is no standard treatment approach for CA-MRSA. As CAMRSA emerged in community settings, there were concerns about how to identify the best
treatment options and preserve the effectiveness of last-line drugs. Two older antibiotics
that are no longer under patent, clindamycin and TMP-SMX, are recommended to treat CAMRSA. It was unknown whether one antibiotic was associated with better outcomes in
patients. To answer this question, scientists tested clindamycin and TMP-SMX in adults and
children with uncomplicated skin infections for 10 days. Of 466 study participants who
received either antibiotic, the cure rate was 89.5 percent for clindamycin and 88.2 percent
for TMP-SMX. The side effects of both drugs were comparable. The findings, which appear in
the New England Journal of Medicine, suggest that uncomplicated skin infectious acquired
outside of hospitals can be treated inexpensively and successfully with either drug, according
to the researchers. Source: Loren G et al. Clindamycin versus Trimethoprim–Sulfamethoxazole for Uncomplicated Skin
Infections. New England Journal of Medicine, 2015; 372 (12): 1093