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Weekly Digest: Healthcare worker-mediated contact networks aid in VRE transmission; Officials prepare for COVID-19 outbreak to become a pandemic; ‘Smart regulation’ could optimize antimicrobial use in LMICs.

Weekly Digest: Healthcare worker-mediated contact networks aid in VRE transmission; Officials prepare for COVID-19 outbreak to become a pandemic; ‘Smart regulation’ could optimize antimicrobial use in LMICs.

Healthcare worker-mediated contact networks aid in the transmission of VRE. Researchers from CDDEP and the Johns Hopkins University School of Medicine conducted a retrospective analysis of electronic health records to assess the impact of healthcare worker-mediated contact networks on the transmission of vancomycin-resistant enterococci (VRE) in hospitals. On average, patients who acquired VRE had 3.1 daily healthcare worker connections to VRE-positive patients, while patients without VRE had 2.0 daily connections. Patients with a connection to a VRE-positive patient had significantly higher odds of acquiring VRE compared to patients without a connection (adjusted OR: 1.64). Using electronic health record data on healthcare worker-mediated contact networks could inform interventions aimed at controlling the spread of multidrug-resistant pathogens. [Open Forum Infectious Diseases]

Health officials prepare for COVID-19 outbreak to become a global pandemic. As of February 24, 2020, there have been nearly 80,000 cases of COVID-19 and 2,619 deaths reported across 30+ nations worldwide. Health officials are preparing for the outbreak to become a global pandemic as cases spike in Iran, Italy, and South Korea. [WHO, CNN]

  • The US Department of Health and Human Services announced a collaboration with Sanofi Pasteur and Johnson & Johnson to develop vaccine candidates and therapies to prevent and treat COVID-19. The organizations are screening approved and experimental therapeutics for successful treatment of the virus and using previous research on severe acute respiratory syndrome (SARS) as a starting point in vaccine development. [Sanofi, HHS, CIDRAP]
  • Three passengers who were infected with the novel coronavirus aboard the Diamond Princess cruise ship have died, and nearly 700 former passengers have tested positive for the virus on the ship, which was quarantined off the coast of Japan for 14 days. Concerns over local spread of the virus in Japan are increasing, with 144 cases reported on land. [CDC, WHO, ABC News]
  • Meanwhile, hospitals in the United States are preparing for the COVID-19 outbreak to become a pandemic, and plan to use the national flu surveillance system to capture unreported cases of the virus that may be circulating silently. [CDC]

‘Smart regulation’ could optimize antimicrobial use in LMICs. A group of researchers including CDDEP’s Head of South Asia, Jyoti Joshi, published an article in BMJ Global Health highlighting how ‘smart regulation’ of antimicrobials can be used to supplement traditional regulatory approaches in optimizing the use of antimicrobials in low- and middle-income countries (LMICs). Traditional antimicrobial use regulation involves a top-down approach between regulators and entities, enforcing compliance to standards, while smart regulation takes a more flexible/innovative approach of social control.  [BMJ Global Health]

India takes action to limit antibiotic waste released into waterways. The Indian government published a draft bill last month limiting the amount of antibiotic residue that pharmaceutical factories can release into nearby waterways and the surrounding environment in an effort to curb the spread of antibiotic resistance. The draft bill sets restrictions for 121 common antibiotics. Pharmaceutical factories in India and China produce a majority of the world’s antibiotics, and up until now, there have not been any policies in place to regulate antibiotic waste being released into the environment.  [The Bureau of Investigative Journalism]

Researchers discover new way in which antibiotics can kill bacteria. Researchers in the US and Canada discovered a new way in which antibiotics can kill bacteria- by inhibiting the growth of the bacterial cell wall. The antibiotics, corbomycin and complestatin, are produced through soil bacteria, and were shown to reduce methicillin-resistant Staphylococcus aureus (MRSA) skin infections in mice. [Nature,]

Adding second antibiotic to treat MRSA shows no advantage over standard therapy. A clinical trial that was terminated early due to safety concerns found that adding a second antibiotic to standard Methicillin-resistant Staphylococcus aureus (MRSA) therapy did not significantly improve patient outcomes. The trial found an insignificant difference in the primary endpoint (a 90-day composite of mortality, persistent bacteremia at day 5, microbiological relapse, and microbiological treatment failure) between MRSA patients randomized to receive anti-staphylococcal β-lactam in addition to standard therapy and MRSA patients randomized to receive standard therapy only (absolute difference: −4.2 percent [−14.3 to 6.0 percent]). The trial involved 352 adults hospitalized with MRSA across 27 hospitals in Australia, Singapore, Israel, and New Zealand. [JAMA]

Drop in C.diff test orders tied to electronic medical record intervention. Researchers from Emory University found that an electronic medical record intervention was linked to a reduction in testing for hospital-onset C difficile infection. After implementing a “nudge” that alerts clinicians of inappropriate C. diff test orders if a patient had received a laxative or stool softener in the last 24 hours, monthly orders decreased by 21 percent, and the rate of inappropriate C. diff test orders decreased significantly over time (RR: 0.95). [Infection Control and Hospital Epidemiology]

Study finds that applying sewage sludge to farmland does not promote AMR. A study from the University of Gothenburg found that spreading sewage sludge on farmland does not clearly contribute to the development or spread of antimicrobial resistance (AMR) in southern Sweden. Researchers did not detect significant differences in the accumulation of antibiotics, phenotypic resistance, enrichment of resistance genes, or the composition of microbial communities in sludge-amended soil samples vs. controls. [Environment International]

Scaling up HPV vaccination, screening & treatment would significantly decrease cervical cancer mortality in LMICs. In a modeling analysis including 78 low- and middle-income countries (LMICs), the WHO Cervical Cancer Elimination Modelling Consortium (CCEMC) estimated that scaling up human papillomavirus (HPV) vaccination, once or twice-lifetime cervical screening, and cancer treatment to 90, 70, and 90 percent respectively would significantly reduce cervical cancer mortality in LMICs. Scaling up HPV vaccination to 90 percent would lead to a 61.7 percent reduction in cervical cancer mortality by 2070, and an 89.5 percent reduction by 2120. Scaling up once or twice lifetime screening and cancer treatment would avert 13.3 and 14.6 milli0n cervical cancer deaths respectively by 2070, as well as 60.8 and 62.6 million deaths by 2120. Over the next 100 years, nearly 90 percent of these averted deaths would occur in sub-Saharan Africa and South Asia. [The Lancet]

Health insurance coverage linked to increased flu vaccine uptake in Texas. The Brazos County Health Department in Texas analyzed data from 417 influenza cases in December 2017 and found a strong link between health insurance coverage and seasonal influenza vaccination uptake. Individuals with public or private health insurance had double the odds of receiving the influenza vaccine compared to individuals without insurance (adjusted OR: 2.05, 1.77), and this association was particularly strong among individuals 18–64 years old. The authors suggest that free flu shots should be more readily available to improve influenza prevention among the uninsured in Brazos County.  [Vaccine]

Drug resistance in Pseudomonas aeruginosa in India has declined in recent years. [CDDEP]