Hyukmin Lee, Eun-Jeong Yoon, Dokyun Kim, Seok Hoon Jeong, Eun Jeong Won, Jong Hee Shin, Si Hyun Kim, Jeong Hwan Shin, Kyeong Seob Shin, Young Ah Kim, Young Uh, Ji Woo Yang, Il Hwan Kim, Chan Park and Kwang Jun Lee

The Korean government established an antimicrobial resistance (AMR) surveillance system, compatible with the Global AMR Surveillance System (GLASS): Kor-GLASS. We describe results from the first year of operation of the Kor-GLASS from May 2016 to April 2017, comprising all non-duplicated clinical isolates of major pathogens from blood, urine, faeces and urethral and cervical swabs from six sentinel hospitals. Antimicrobial susceptibility tests were carried out by disk diffusion, Etest, broth microdilution and agar dilution methods. Among 67,803 blood cultures, 3,523 target pathogens were recovered. The predominant bacterial species were Escherichia coli (n = 1,536), Klebsiella pneumoniae (n = 597) and Staphylococcus aureus (n = 584). From 57,477 urine cultures, 6,394 E. coli and 1,097 K. pneumoniae were recovered. Bloodstream infections in inpatients per 10,000 patient-days (10TPD) were highest for cefotaxime-resistant E. coli with 2.1, followed by 1.6 for meticillin-resistant Sta. aureus, 1.1 for imipenem-resistant Acinetobacter baumannii, 0.8 for cefotaxime-resistant K. pneumoniae and 0.4 for vancomycin-resistant Enterococcus faecium. Urinary tract infections in inpatients were 7.7 and 2.1 per 10TPD for cefotaxime-resistant E. coli and K. pneumoniae, respectively. Kor-GLASS generated well-curated surveillance data devoid of collection bias or isolate duplication. A bacterial bank and a database for the collections are under development.…

Simone Iacchini, Michela Sabbatucci, Carlo Gagliotti, Gian Maria Rossolini, Maria Luisa Moro, Stefania Iannazzo, Fortunato D’Ancona, Patrizio Pezzotti and Annalisa Pantosti

Following the rapid increase of infections due to carbapenemase-producing Enterobacteriaceae (CPE) in Italy, the national surveillance of bloodstream infections (BSI) due to CPE (Klebsiella pneumoniae and Escherichia coli) was instituted in 2013. All CPE-BSI cases reported to the surveillance in the years 2014–17 were analysed in order to investigate incidence rate (IR), trend, main individual characteristics and enzymes involved in CPE resistance. Throughout this period, 7,632 CPE-BSI cases (IR: 3.14/100,000 inhabitants) were reported from all 21 regions and autonomous provinces in Italy, with an increasing number of reported cases (2014: 1,403; 2015: 1,838; 2016: 2,183; 2017: 2,208). CPE-BSI cases mainly occurred in subjects aged over 60 years (70.9%) and more frequently in males (62.7%) than in females. Most of the cases originated in hospitals (87.2%), mainly in intensive care units (38.0%), and were associated with central or peripheral venous catheter use (23.9%) or with urinary tract infections (21.1%). Almost all CPE-BSI (98.1%) were due to K. pneumoniae carrying the K. pneumoniae carbapenemase (KPC) enzyme (95.2%). These data show that carbapenemase-producing K. pneumoniae are endemic in our country, causing a high number of BSI and representing a threat to patient safety.…

Kati Räisänen, Irma Koivula, Heikki Ilmavirta, Santeri Puranen, Teemu Kallonen, Outi Lyytikäinen and Jari Jalava

In December 2018, a ceftazidime-avibactam (CAZ-AVI)-resistant KPC-2-producing Klebsiella pneumoniae strain was isolated in Finland. CAZ-AVI resistance was observed 34 days after CAZ-AVI treatment in a trauma patient transferred from a hospital in Greece who had been colonised with blaKPC-2-producing K. pneumoniae ST39, and later developed a bloodstream infection. The CAZ-AVI-resistant strain contained a novel 15 amino acid insertion in the KPC-2 protein causing structural changes proximal to the KPC-2 active site.…

Shalom Ben-Shimol, Noga Givon-Lavi, David Greenberg, Michal Stein, Orli Megged, Avihu Bar-Yochai, Shahar Negari, Ron Dagan and on behalf of the Israel Bacteremia and Meningitis Active Surveillance Group

Background Empiric treatment of pneumococcal meningitis includes ceftriaxone with vancomycin to overcome ceftriaxone resistant disease. The addition of vancomycin bears a risk of adverse events, including increased antibiotic resistance. We assessed antibiotic resistance rates in pneumococcal meningitis before and after pneumococcal conjugate vaccine (PCV) implementation. Methods All pneumococcal meningitis episodes in children aged 5 years and younger, from 2004 to 2016, were extracted from the nationwide bacteremia and meningitis surveillance database. For comparison purposes, we defined pre-PCV period as 2004–2008 and PCV13 period as 2014–2016. Minimal inhibitory concentration (MIC) > 0.06 and > 0.5 μg/mL were defined as penicillin and ceftriaxone resistance, respectively. Results Overall, 325 episodes were identified. Pneumococcal meningitis incidence rates declined non-significantly by 17%, comparing PCV13 and pre-PCV periods. Throughout the study, 90% of isolates were tested for antibiotic susceptibility, with 26.6%, 2.1% and 0% of isolates resistant to penicillin, ceftriaxone and vancomycin, respectively. Mean proportions (± SD) of meningitis caused by penicillin-resistant pneumococci were 40.5% ± 8.0% and 9.6% ± 7.4% in the pre-PCV and the PCV13 periods, respectively, resulting in an overall 83.9% reduction (odd ratio:0.161; 95% confidence interval: 0.059–0.441) in penicillin resistance rates. The proportions of meningitis caused by ceftriaxone resistant pneumococci were 5.0% ± 0.8% in the pre-PCV period, but no ceftriaxone resistant isolates were identified since 2010. Conclusions PCV7/PCV13 sequential introduction resulted in > 80% reduction of penicillin- resistant pneumococcal meningitis and complete disappearance of ceftriaxone resistant disease. These trends should be considered by the treating physician when choosing an empiric treatment for pneumococcal meningitis.…

Maria Luisa Ricci, Antonella Grottola, Giulia Fregni Serpini, Antonino Bella, Maria Cristina Rota, Francesca Frascaro, Emanuela Pegoraro, Marisa Meacci, Anna Fabio, Elena Vecchi, Antonietta Girolamo, Fabio Rumpianesi, Monica Pecorari and Maria Scaturro

Aim To evaluate real-time PCR as a diagnostic method for Legionnaires’ disease (LD). Detection of Legionella DNA is among the laboratory criteria of a probable LD case, according to the European Centre for Disease Prevention and Control, although the utility and advantages, as compared to culture, are widely recognised. Methods Two independent laboratories, one using an in-house and the other a commercial real-time PCR assay, analysed 354 respiratory samples from 311 patients hospitalised with pneumonia between 2010–15. The real-time PCR reliability was compared with that of culture and urinary antigen tests (UAT). Concordance, specificity, sensitivity and positive and negative predictive values (PPV and NPV, respectively) were calculated. Results Overall PCR detected eight additional LD cases, six of which were due to Legionella pneumophila (Lp) non-serogroup 1. The two real-time PCR assays were concordant in 99.4% of the samples. Considering in-house real-time PCR as the reference method, specificity of culture and UAT was 100% and 97.9% (95% CI: 96.2–99.6), while the sensitivity was 63.6% (95%CI: 58.6–68.6) and 77.8% (95% CI: 72.9–82.7). PPV and NPV for culture were 100% and 93.7% (95% CI: 91.2-96.3). PPV and NPV for UAT were 87.5% (95% CI: 83.6-91.4) and 95.8% (95% CI: 93.5-98.2). Conclusion Regardless of the real-time PCR assay used, it was possible to diagnose LD cases with higher sensitivity than using culture or UAT. These data encourage the adoption of PCR as routine laboratory testing to diagnose LD and such methods should be eligible to define a confirmed LD case.…

Annemarie Fritsch, Brunhilde Schweiger and Barbara Biere

Introduction Recent data on influenza C virus indicate a possible higher clinical impact in specified patient populations than previously thought. Aim We aimed to investigate influenza C virus circulation in Germany. Methods A total of 1,588 samples from 0 to 4 year-old children presenting as outpatients with influenza-like illness (ILI) or acute respiratory infection were analysed retrospectively. The samples represented a subset of all samples from the German national surveillance system for influenza in this age group in 2012–14. The presence of influenza C virus was investigated by real-time PCR. For positive samples, information on symptoms as well as other respiratory virus co-infections was considered. Retrieved influenza C viral sequences were phylogenetically characterised. Results Influenza C viral RNA was detected in 20 (1.3% of) samples, including 16 during the 2012/13 season. The majority (18/20) of influenza C-positive patients had ILI according to the European Union definition, one patient had pneumonia. Viruses belonged to the C/Sao Paulo and C/Kanagawa lineages. Most (11/20) samples were co-infected with other respiratory viruses. Conclusion Our data are the first on influenza C virus circulation in Germany and notably from a European national surveillance system. The low detection frequency and the identified virus variants confirm earlier observations outside a surveillance system. More virus detections during the 2012/13 season indicate a variable circulation intensity in the different years studied. Influenza C virus can be considered for ILI patients. Future studies addressing its clinical impact, especially in patients with severe disease are needed.…

Åsa Wiman, Theresa Enkirch, AnnaSara Carnahan, Blenda Böttiger, Tove Samuelsson Hagey, Per Hagstam, Rosmarie Fält and Mia Brytting

In January 2019, a human seasonal reassortant influenza A(H1N2) virus with a novel 7:1 genetic constellation was identified in a 68-year-old female patient with suspected pneumonia. The virus harboured A(H3N2) neuraminidase and remaining genes from A(H1N1)pdm09. The patient recovered after severe illness. No additional cases have been detected. This is the second identified A(H1N2) seasonal reassortant in a human in Europe within 1 year; a previous case was detected in the Netherlands in March 2018.…

Sören L. Becker, Fabian K. Berger, Susanne K. Feldner, Irem Karliova, Manfred Haber, Alexander Mellmann, Hans-Joachim Schäfers and Barbara Gärtner

Three German patients developed nosocomial pneumonia after cardiac surgery and had Burkholderia cepacia complex detected in respiratory specimens. Two patients died of septic multi-organ failure. Whole-genome sequencing detected genetically identical B. cepacia complex strains in patient samples, from a batch of octenidine mouthwash solution, which had been used for nursing care, as well as in samples obtained from the manufacturer during production. Contamination of medical products during manufacturing may lead to international outbreaks.…

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Pneumonia -- Vietnam…

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Equine Herpes Virus -- United StatesHerpesvirus is highly contagious among horses and can cause a variety of ailments in equids, including rhinopneumonitis (a respiratory disease usually found in young horses), abortion in broodmares, and equine herpes myeloencephalopathy (EHM, the neurologic form).In many horses, the first or only sign of EHV-1 infection is fever, which can go undetected. In addition to fever, other common signs of EHV-1 infection in young horses include cough, decreased appetite, depression, and a nasal…

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Equine Herpes Virus -- United StatesHerpesvirus is highly contagious among horses and can cause a variety of ailments in equids, including rhinopneumonitis (a respiratory disease usually found in young horses), abortion in broodmares, and EHM.In many horses, the 1st or only sign of EHV-1 infection is fever, which can go undetected. In addition to fever, other common signs of EHV-1 infection in young horses include cough, decreased appetite, depression, and a nasal discharge. Pregnant mares typically show no signs of…

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Equine Herpes Virus -- NorwayInformation received on [and dated] 08 Mar /2019 from Dre Kristina Landsverk, Chief Veterinary Officer, Norwegian Food Safety Authority, Norwegian Food Safety Authority, Brumunddal, NorwaySummaryReport type: immediate notificationDate of start of the event: 25 Feb 2019Date of confirmation of the event: 27 Feb 2019Report date: 8 Mar 2019Date submitted to OIE: 8 Mar 2019Reason for notification: recurrence of a listed diseaseDate of previous occurrence: 2006Manifestation of…

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Other Animal Disease -- United KingdomThere has been an outbreak of equine viral arteritis (EVA), a serious viral disease in horses, in Dorset.The UK's Chief Veterinary Officer confirmed today (5 Apr 2019) that 2 cases of EVA in non-thoroughbred stallions have been discovered on a premises in the county.Although deaths from EVA are very rare in healthy adults, pregnant mares that become infected may abort, and very young foals may die from a form of pneumonia as a result of it.Humans can spread the disease…

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Pneumonia -- United StatesThe Division of Wildlife Resources has found that a herd of bighorn sheep on Antelope Island [Utah] has somehow contracted a devastating respiratory disease and is dying off.About 150 animals were counted among the herd last year [2018]. But KSL-TV reports biologists on [Wed 9 Jan 2019] flew over the island and found only 26 sheep left.Division of Wildlife Resources spokesman Mark Hadley says, "This disease has taken all of the sheep," and there are no vaccinations or medications that…

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Pneumonia -- United StatesSigns of bighorn sheep were scattered inches away from the cliff edge: Dirt packed down from where they slept, round droppings, and a still-pungent smell. The animals themselves were gone, melting away into distant layers of mountain and rock.Steve Kilpatrick, a retired biologist now leading the Wyoming Wild Sheep Foundation, was in the mountains on the border of Grand Teton National Park in August [2018] surveying sheep as part of an annual effort to keep tabs on its dwindling…

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Other Animal Disease -- AntarcticaYou can give your cat the flu. You can also pass pneumonia to a chimpanzee or tuberculosis to a bird. This kind of human-to-animal disease transmission, known as reverse zoonosis, has been seen on every continent except one: Antarctica. Now, human-linked pathogens in bird poop reveal, for the 1st time, that even animals on this isolated ice-bound landmass can pick up a bug from tourists or visiting scientists. This newly identified infection route could have devastating consequences for…

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Equine Herpes Virus -- Germany…

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Equine Herpes Virus -- Sweden…

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Dengue -- Sri LankaAn uncommon combination of triple diseases -- dengue, chikungunya, and scrub typhus, has shocked Sawai Man Singh Hospital (SMS) hospital doctors. 2 such cases have already been reported in 11 days.When a 63-year-old was rushed to SMS Hospital from Kotputli of Jaipur district, she had double pneumonia, breathing problems, low platelet count, and abnormal functioning of liver and kidneys. She was brought to SMS hospital on [19 Aug 2018] and died on [23 Aug 2018] while undergoing treatment.

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Legionnaires' -- United StatesOfficials from the California Department of Rehabilitation and Corrections are investigating the presence of deadly Legionnaires' disease bacteria at a Central Valley prison. Last month [March 2019], one inmate at the California Health Care Facility in Stockton (CHCF) died of the disease -- considered a severe form of pneumonia -- and a 2nd inmate tested positive for the bacteria but is now in stable condition.Corrections officials had thought the bacteria were isolated to one housing unit…

I 2017 blev 278 patienter med legionella-pneumoni rapporteret til Statens Serum Institut. Det er 65 % flere end Ã¥ret før.…

What antibiotic would you prescribe when de-escalating therapy for community-acquired pneumonia? …

Legionella-pneumoni 2017…