Infection PreventioneBug Bytes

April 2015

E.Coli in cell division (every 20 minutes)

CDC's plan to battle nightmare infections

• A group of Chicago hospitals has managed to cut by half the number of infections caused by an especially deadly type of superbug. The CDC is pointing to the success of the Chicago Prevention Epicenter, one of five such CDC-funded programs nationally that coordinate research between local scientists and public health officials. The Chicago study focused on four long-term acute care hospitals, which tend to have above average rates of carbapenem-resistant Enterobacteriaceae, or CRE, called a "nightmare bacteria" because even the strongest antibiotics fail to subdue it.

• The program involved testing all patients for CRE infections at the time of admission and again two weeks later. Patients who developed CRE were isolated in a private room or in a ward with other CRE-infected patients. Healthcare workers wore protective gowns while tending to them, using some of the procedures used when caring for patients with Ebola. All infected patients were bathed in chlorhexidine gluconate, an antiseptic commonly used in hospitals. At the end of three years, cases of CRE infections fell by half. While the CDC has no regulatory authority, the government's Center for Medicare and Medicaid health insurance programs require all participating hospitals to develop a stewardship strategy within three years. Failure to do so would disqualify them from the health plans.

• The president's plan for the CDC calls for a 60 percent reduction in CRE infections by the end of this decade and halving infections caused by clostridium difficile, as well as MRSA bloodstream infections. Source: Reuters - Battling Nightmare Infections - March 29 2015

Bacteria from Texan cattle yards are now airborne

• A new study says the DNA from antibiotic-resistant bacteria found in American cattle yards has become airborne, creating a new pathway by which such bacteria can potentially spread to humans and hinder treatment of life-threatening infections. Researchers gathered airborne particulate matter (PM) from around 10 commercial cattle yards within a 200 mile radius of Lubbock, TX over a period of six-months. They found the air downwind of the yards contained antibiotics, bacteria and a "significantly greater" number of microbial communities containing antibiotic-resistant genes. That's according to the study to be published in next month's issue of Environmental Health Perspectives. Co-author Phil Smith told the Texas Tribune that the bacteria could be active for a long time and "could be traveling for long distances."Because antibodies are poorly absorbed by cows they are released into the environment through excretion. Once in the environment, bacteria will undergo natural selection and genes that have acquired natural immunities will survive. The genes that have gone airborne are contained in dried fecal matter that has become dust and gets picked up by winds as they whip through the stockyards.

A new strain of Enterovirus D68

• Scientists have linked a specific strain of the respiratory illness enterovirus D68 to the previously-unexplained rash of childhood paralysis and muscle weakness that struck dozens of children between 2012 and 2014. Researchers found the genetic imprint of a relatively new strain of enterovirus D68 -- B1 -- in children who developed acute flaccid myelitis (paralysis or muscle weakening) after having a fever or respiratory illness. After checking patients' respiratory secretions, blood and cerebrospinal fluid for a variety of different pathogens, they couldn't find any other probable cause of the paralysis in these children. While this study strengthens the link between EV-D68 and sudden paralysis or muscle weakening in pediatric patients, it doesn't definitively establish the virus as the cause of acute flaccid myelitis. Nor does it explain by which mechanism EV-D68 may cause paralysis. But the finding points to the urgency for further research of EV-D68 and a possible vaccine. The B1 strain of EV-D68 emerged around four years ago, and is similar to other viruses like EV-D70 or poliovirus, which cause nerve damage and paralysis. It was the most dominant strain of EV-D68 circulating during the 2014 outbreak, and only a small minority of children -- 115 across 34 states -- went on to develop paralysis or muscle weakening between Aug. 2014 and Mar. 2015. Source: Enterovirus D68 Paralysis - Huffington Post

Recalls of Ice Cream, Hummus Spur Listeria Warnings

• As U.S. health officials deal with nationwide recalls of Blue Bell ice cream and Sabra Dipping Co. hummus, consumers are getting up to speed on a little known but potentially fatal bacteria, listeria.

• Listeria-tainted ice cream is linked to a total of five illnesses and three deaths in Texas and Kansas, the U.S. Centers for Disease Control and Prevention said Thursday. Also this week, Sabra recalled 30,000 cases of classic hummus, because of listeria-contamination concerns. About 260 deaths occur as a result -- far fewer than the number linked to salmonella, another foodborne illness. Most people who eat food contaminated by listeria won't become very ill. They can have nausea, vomiting, muscle ache and diarrhea. There is a more invasive type of illness that can affect people with weakened immune systems, such as those who have HIV, or people with diabetes, heart disease, pregnant women, infants and the frail elderly. Listeria has been found in unpasteurized dairy products and in ready-to-eat meats, especially hot dogs and deli meats. Unlike most other bacteria, listeria can grow and multiply in the refrigerator. Listeria bacteria can live in a food-processing factory for years, sometimes contaminating food products. http://www.cdc.gov/listeria/

Cancer rates among patients with hepatitis C are increased compared to those not infected

• Results recently announced at The International Liver CongressTM 2015 show that cancer rates in patients with the hepatitis C virus (HCV) were significantly increased compared to the non-HCV cohort. The researchers suggest an extrahepatic manifestation of HCV may be an increased risk of cancer. A retrospective study at Kaiser Permanente, Southern California, USA, was conducted. The study authors recorded all cancer diagnoses in patients over 18 years of age with or without HCV during 2008-2012. Within the timeframe of the study 145,210 patient years were included in the HCV cohort, and 13,948,826 patient years were included in the non-HCV cohort. In the HCV cohort there were 2,213 cancer diagnoses (1,524/100,000) during the 5-year period and 1,654 cancer diagnoses when liver cancer was excluded (1,139/100,000). In the non-HCV cohort there were 84,419 cancer diagnoses (605/100,000) during the same 5-year period and 83,795 (601/100,000) when liver cancer was excluded. When all cancers are considered the rate is 2.5 times higher in the HCV cohort; when liver cancers are excluded, the rate is still almost 2 times higher. This data adds to the evidence bank linking hepatitis C with an increased risk of cancer, and highlights that there is still a long way to go in order to fully understand this complex and devastating disease

• Source: European Association for the Study of the Liver. "Cancer rates among patients with hepatitis C are increased compared to those not infected." ScienceDaily. ScienceDaily, 24 April 2015

Are hospitals doing all they can to prevent C. difficile infections?

• Hospital patients are especially prone to developing C. diff infections, and suffering serious effects -- especially after they take antibiotics that disrupt the community of bacteria in their digestive systems. In a paper published online in Infection Control & Hospital Epidemiology, the team from the University of Michigan Medical School and VA Ann Arbor Healthcare System reports the results of their survey of a national random sample of hospitals. Virtually all the hospitals had programs to monitor for C. diff infections, and use protective gear, separate hospital rooms and special cleaning techniques when treating a C. diff-infected patient, so that it doesn't spread to other patients. In addition to being present in bodily fluids, C. diff can form spores that can persist in the hospital environment for weeks. But the lack of antimicrobial stewardship programs, as antibiotic-limiting efforts are called, persists in nearly half of hospitals -- despite the fact that the infection control leaders surveyed almost all agree that such efforts have been proven to prevent C. diff infections. In addition to the lack of antimicrobial stewardship programs, the researchers also found a widespread lack of written policies to test patients for C. diff infection when they developed diarrhea while taking antibiotics or within several months of taking them. Nearly three-quarters of hospitals didn't have such policies, though diarrhea is a key symptom of C. diff -- and can lead to dangerous complications and death in vulnerable hospitalized patients. Source: Clostridium Difficile Infection in the United States: A National Study Assessing Preventive Practices Used and Perceptions of Practice Evidence. Infection Control & Hospital Epidemiology, 2015

Never before seen tick-borne illness may be 'substantial health threat' to humans in many parts of the world

• Researchers tested 477 patients in northeastern China who had been bitten by a tick over a month-long period in the spring of 2014. Of those, 28, six percent, were found to have been infected by the new species of bacteria. This microbe is related to other Anaplasma bacteria, some of which can cause illness when transmitted from ticks to humans. The symptoms of A capra infection include fever, headache, and tiredness, dizziness and muscle aches. The researchers successfully treated the infection with antibiotics, particularly doxycycline.

• Because no one knew the bacteria existed, no one has looked for it, and it is not clear how widespread it is. In China, the species appears to be common in goats - the researchers decided to call it "capra" because the word means "goat" in Latin. But it may also infect other animals. Currently, it is difficult to diagnose infection - there is no simple blood test. The bacterium is probably transmitted via a tick species known as the taiga tick. This species, which is closely related to the deer tick, lives in Eastern Europe and across Russia and Asia, including China and Japan. If this tick species transmits A capra throughout this area, human infection may be common.