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Weekly Digest: Global transmission of MRSA clone driven by travel and family contacts in the Indian subcontinent; Antibiotic resistance in foodborne bacteria is rising; Ebola treatments reduce mortality in DRC.

Weekly Digest: Global transmission of MRSA clone driven by travel and family contacts in the Indian subcontinent; Antibiotic resistance in foodborne bacteria is rising; Ebola treatments reduce mortality in DRC.

Global transmission of MRSA clone driven by travel and family contacts in the Indian subcontinent. A team of researchers documented the evolution and spread of the Bengal Bay clone (ST772), a multidrug-resistant, community-associated Staphylococcus aureus lineage. This clone combines the multidrug resistance of traditional health care-associated clones with the epidemiological transmission of community-associated methicillin-resistant S. aureus (MRSA).  The study used whole genome sequencing to analyze 340 isolates from 14 countries, and found that ST772 emerged in the 1960s on the Indian subcontinent before quickly spreading globally in the 1990s. Small-scale outbreaks and global transmission of the clone were associated with travel and family contacts within the region. The researchers noted antimicrobial resistance as a key driver in the emergence and evolution of the Bengal Bay clone. [mBio]

Antibiotic resistance in foodborne bacteria is rising. The 2016-2017 National Antimicrobial Resistance Monitoring System (NARMS) Integrated Summary reveals increasing resistance to first-line antibiotics used to treat Salmonella infections. From 2015 to 2017, ceftriaxone resistance to Salmonella in humans rose from 2.8 to 3.4 percent, and ceftriaxone resistance in chickens rose from 6.5 to 9.3 percent. Salmonella isolates with decreased susceptibility to ciprofloxacin in humans doubled between 2013 and 2017 to 8 percent, and multidrug resistant Salmonella increased from 9.5 to 18 percent among routinely sampled chickens from 2015 to 2017. Resistance rates among Campylobacter and E. coli remained stable in most human and animal populations that were studied. [FDA]

Ebola treatments significantly reduce mortality in DRC. Researchers conducted a randomized controlled trial of four experimental therapies for Ebola virus amid the ongoing outbreak in the Democratic Republic of the Congo (DRC) between 2018 and 2019. In August, health officials intervened and eliminated two of the less promising treatments from the trial, switching patients to receive only MAb114, REGN-EB3, or the standard of care. The study found that significantly fewer deaths occurred at 28 days among patients in the MAb114 treatment group compared to the control (35.1 vs. 49.7 percent). Likewise, significantly fewer patients in the REGN-EB3 treatment group died compared to the control (33.5 vs. 51.3 percent). [NEJM]

New pediatric HIV medication to cost $1 a day. Quadrimune, a new pediatric HIV medication from the Indian generic drug manufacturer Cipla, comes in strawberry-flavored granules that can be easily mixed into baby food and will likely be available for $1 per day. Current pediatric HIV medications consist of difficult-to-swallow pills or bitter syrups that require refrigeration, which presents challenges to poor families in Africa where 80,000 young children die of AIDS each year. Quadrimune has been hailed as an accessible alternative by pediatric AIDS experts and is expected to prevent thousands of child deaths each year. It is currently under review by the US Food and Drug Administration (FDA), and a decision is expected by May. [NYTimes]

Resistance genes detected in hospital wastewater samples from Scotland. In a 24 hour period in 2017, researchers detected 1047 bacterial genera and 174 antimicrobial resistance genes from hospital wastewater samples collected from a tertiary hospital in Scotland. The analysis identified a greater abundance of AMR genes in hospital wastewater than compared to community wastewater, as well as a positive correlation between mean length of stay and AMR gene abundance in hospital wastewater samples (IRR=2.05). Class-level antibiotic consumption was also associated with an increase in AMR gene abundance in hospital wastewater from the same class (IRR=2.8). [The Lancet]

Antibiotic prescribing rate is higher in care homes than general population. In a cross-sectional study of 13,487 care home residents in the UK between 2016 and 2017, 2.7 antibiotics were prescribed per resident-year, which is higher than the prescribing rate among the general population. Of 9,986 reported infections, 5,237 were prescribed antibiotics. More than half of chest infections (55 percent), many of which may be viral, 55 percent of urinary tract infections, and 57 percent of cellulitis infections led to an antibiotic prescription. [The Lancet]

Household environment is a key factor in MRSA transmission. Researchers in St. Louis, Missourianalyzed the transmission of methicillin-resistant Staphylococcus aureus (MRSA) from children with community-onset MRSA infections to household contacts, pets, and the environment. The study found that frequent hand washing decreased the odds of MRSA introduction into the household (OR=0.86), whereas sharing a room or bath towels with a MRSA-colonized child was linked with greater odds of MRSA transmission (OR=1.33, 1.25). Pets rarely acted as the only source of MRSA transmission, although transmission to pets was common. [The Lancet Infectious Diseases]

Fidaxomicin proven effective against C diff in children. In a phase 3 clinical trial of fidaxomicin and vancomycin for the treatment of Clostridium difficile infection (CDI) in 148 pediatric patients, researchers found that at two days following end of treatment, the rate of confirmed clinical response was 77.6 percent for children randomized to fidaxomicin and 70.5 percent for vancomycin. At the end of the study, the rate of global C. difficile cure (confirmed clinical response without recurrence of CDI) was significantly higher among patients who received fidaxomicin compared to those who received vancomycin (68.4 vs. 50.0 percent). [Clinical Infectious Diseases]

Increasing vaccine coverage could save India over $1 billion per year. In a study on the pneumococcal conjugate, Haemophilus influenzae type b (Hib), and rotavirus vaccines across the Bihar, New Delhi, Maharashtra and Tamil Nadu states in India, researchers estimated that increasing coverage of these vaccines could save India more than $1 billion and avert over 90,000 child deaths per year. A majority of the cost savings would come from reversing productivity lost due to early pneumococcal death (88 percent), and from reversing productivity lost due to pneumococcal, Hib, or rotavirus-related disability (10 percent). [Vaccine]

Resistance of Klebsiella pneumoniae is high across India. [CDDEP]