Weekly Digest: WHO releases new guidelines for the prevention of surgical site infections; Standardized Zika research protocols proposed

4 Nov 2016

A weekly roundup of news on drug resistance and other topics in global health.

WHO released new guidelines for the prevention of surgical site infections. The World Health Organization (WHO) released 29 new recommendations aimed at preventing surgical site infections, including guidance that antibiotics used to prevent infection should be prescribed for use only before and during surgery, not afterward. The new guidelines are intended to cut costs associated with overprescribing antibiotics and increasing antibiotic resistance. According to the WHO, 11 percent of patients who undergo surgery in low- and middle-income countries are infected in the process. Before the WHO guidelines for the prevention of surgical site infections, no international evidence-based guidelines had been available and many inconsistencies existed in the interpretation of existing national guidelines. [WHO release, WHO report]

Standardized Zika research protocols recommended; Puerto Rico case study indicates contraceptives would cut Zika costs by $65.2 million. Following a June 2016 meeting in Mexico City where public health experts discussed Zika research methods, seven study protocols to address Zika-related questions were proposed in Lancet Global Health.  Uniform protocols would increase the likelihood that data and biological samples are systematically collected and shared rapidly, and ultimately result in comparable data, no matter where in the world the samples come from or the work is done.

In a study in Emerging Infectious Diseases, the cost-effectiveness of increasing access to contraception in Puerto Rico to avoid Zika-related costs was modeled. The intervention is projected to cost $33.5 million in family planning services, but would reduce Zika-related costs by an estimated $65.2 million. Most of the savings—$62 million—come from avoided costs of Zika-associated microcephaly (ZAM) and the rest from reduced testing and monitoring. [Lancet GH, EID]

Humidity and temperature identified as global environmental drivers of flu outbreaks, in a study in Proceedings of the National Academy of Sciences. The study finds that absolute humidity drives flu prevalence across latitudes, with temperature mediating whether the association is positive or negative, and a key threshold around 75° F. The authors note that while flu outbreaks in temperate countries are well-correlated with seasonal changes in temperature and absolute humidity, tropical countries have weaker annual climate cycles and outbreaks show less seasonality. These findings point to a unified explanation for environmental drivers of flu outbreaks that can be applied globally.  [PNAS]

Can social media improve antibiotic stewardship? In a study in the American Journal of Infection Control, researchers from University of Chicago Medicine examine the potential for Facebook and Twitter to increase internal medicine residents’ (IMRs’) antibiotic knowledge and awareness of stewardship resources. Over six months, IMRs’ received Facebook posts and tweets with basic antibiotic and infectious disease information and educational tools. IMRs completed pre- and post-intervention surveys of 20 basic antibiotic and infectious disease questions. Median scores increased modestly, suggesting a possible role, but with more exploration needed to determine the most effective strategies. [AJIC]

Study links antibiotic resistance with common disinfectant chlorhexidine. A study in Antimicrobial Agents and Chemotherapy reports that five out of six strains of Klebsiella pneumoniae that had “adapted” to chlorhexidine (i.e., were more resistant to its topical effects than wild types) also became resistant to colistin, one of the most important last-resort antibiotics. Mutations in the adapted K. pneumoniae that conferred resistance to both chlorhexidine and colistin were found. The extent to which this applies to other pathogens is not yet known, but according to coauthor Dr. J. Mark Sutton, Scientific Leader, National Infections Service, Public Health England, “this might mean that we need to rethink how and where some types of critical disinfectants or antiseptics are used in the clinic.” [ASM release, ASM study]

Increased risk of sepsis may follow infection-related hospitalizations. Researchers with the Centers for Disease Control and Prevention presented a study at IDWeek 2016 that indicates an increased risk for subsequent sepsis following initial treatment with antibiotics that significantly disrupt the body’s microbiome. Among more than 9 million patients who visited 473 hospitals between 2006 and 2010, 0.6 percent had sepsis during readmission within 90 days of discharge. Compared with patients who did not get antibiotics during the first hospitalization, patients with antibiotic exposure were 50 percent more likely to be hospitalized with sepsis and 80 percent more likely if they received high-risk antibiotics. [IDWeek abstract, CIDRAP]

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