Aktuelle smitsomme sygdomme

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 21-27 May 2023 May 2023 and includes updates on COVID-19, influenza, Marburg virus disease, poliomyelitis, extensively drug-resistant Pseudomonas aeruginosa, and suspected fungal meningitis.

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 21-27 May 2023 May 2023 and includes updates on COVID-19, influenza, Marburg virus disease, poliomyelitis, extensively drug-resistant Pseudomonas aeruginosa, and suspected fungal meningitis.

BackgroundAntimicrobial resistance (AMR) is of public health concern worldwide. AimWe aimed to summarise the German AMR situation for clinicians and microbiologists. MethodsWe conducted a systematic review and meta-analysis of 60 published studies and data from the German Antibiotic-Resistance-Surveillance (ARS). Primary outcomes were AMR proportions in bacterial isolates from infected patients in Germany (2016–2021) and the case fatality rates (2010–2021). Random and fixed (common) effect models were used to calculate pooled proportions and pooled case fatality odds ratios, respectively. ResultsThe pooled proportion of meticillin resistance in Staphylococcus aureus infections (MRSA) was 7.9% with a declining trend between 2014 and 2020 (odds ratio (OR) = 0.89; 95% CI: 0.886–0.891; p 

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 19-25 March 2023 and includes updates on Marburg virus disease, iatrogenic botulism, COVID-19, Influenza, Group A streptococcal infection, cholera, poliomyelitis, measles, and extensively drug-resistant Pseudomonas aeruginosa.

P. aeruginosa -- United StatesFederal inspectors found dozens of issues at an eye drops manufacturer now linked to a fatal outbreak of drug-resistant bacteria, inspection records released by the Food and Drug Administration show, ranging from dirty equipment and clothing to missing safeguards and procedures.The FDA's findings were detailed in citations issued to Indian manufacturer Global Pharma Healthcare Pvt Ltd after an inspection from 20 Feb through 2 Mar 2023. This appears to have been the company's 1st visit from…

This issue of the ECDC Communicable Disease Threats Report (CDTR) covers the period 19-25 March 2023 and includes updates on Marburg virus disease, iatrogenic botulism, COVID-19, Influenza, Group A streptococcal infection, cholera, poliomyelitis, measles, and extensively drug-resistant Pseudomonas aeruginosa.

P. aeruginosa -- United States'As of 14 Mar 2023, CDC, in partnership with state and local health departments, identified 68 patients in 16 states (CA, CO, CT, FL, IL, NC, NJ, NM, NY, NV, PA, SD, TX, UT, WA, WI) with VIM-GES-CRPA, a rare strain of extensively drug-resistant _P. aeruginosa_. Thirty-seven patients were linked to 4 healthcare facility clusters. One person has died and there have been 8 reports of vision loss and 4 reports of enucleation (surgical removal of eyeball). Dates of specimen collection were from May…

P. aeruginosa -- United StatesThe Food and Drug Administration (FDA) has warned against using 'Artificial Tears' eye drops produced by a Tamil Nadu-based firm after an outbreak of drug-resistant infections was linked to the drug in the USA. This is the 3rd such controversy involving an Indian pharma company.Another controversy has hit India's pharmaceutical industry as the United States warned that an eye drop manufactured by a Tamil Nadu-based firm has caused an outbreak of the drug-resistant bacterium _Pseudomonas…

P. aeruginosa -- United StatesPatients should stop using EzriCare Artificial Tears pending additional information and guidance from CDC and FDA. If patients were advised to use EzriCare Artificial Tears by their healthcare provider, they should follow up with their healthcare provider for recommendations about alternative treatment options. Patients who have used EzriCare preservative-free artificial tears and who have signs or symptoms of an eye infection should seek medical care immediately. At this time, there is no…

P. aeruginosa -- United StatesOne person has died and at least 3 others are left with permanent vision loss because of a bacterial infection possibly linked to a brand of over-the-counter eyedrops, according to the Centers for Disease Control and Prevention (CDC). A majority of those affected reported using preservative-free EzriCare Artificial Tears before becoming ill, CDC reported in a statement dated 20 Jan 2023. While the infections have not been definitively traced to the eyedrops, CDC recommended that 'patients…

Background

Bloodstream infections (BSI) cause substantial morbidity and mortality.

Aim

We explored the role of causative pathogens and patient characteristics on the outcome of community-acquired (CA) and healthcare-associated (HA) BSI, with particular interest in early death.

Methods

We used national register data to identify all BSI in Finland during 2004–18. We determined the origin of BSI, patients´ underlying comorbidities and deaths within 2 or 30 days from specimen collection. A time-dependent Cox model was applied to evaluate the impact of patient characteristics and causative pathogens on the hazard for death at different time points.

Results

A total of 173,715 BSI were identified; 22,474 (12.9%) were fatal within 30 days and, of these, 6,392 (28.4%) occurred within 2 days (7.9 deaths/100,000 population). The 2-day case fatality rate of HA-BSI was higher than that of CA-BSI (5.4% vs 3.0%). Patients who died within 2 days were older than those alive on day 3 (76 vs 70 years) and had more severe comorbidities. Compared with other BSI, infections leading to death within 2 days were more often polymicrobial (11.8% vs 6.3%) and caused by Pseudomonas aeruginosa (6.2% vs 2.0%), fungi (2.9% vs 1.4%) and multidrug-resistant (MDR) pathogens (2.2% vs 1.8%), which were also predictors of death within 2 days in the model.

Conclusions

Overrepresentation of polymicrobial, fungal, P. aeruginosa and MDR aetiology among BSI leading to early death is challenging concerning the initial antimicrobial treatment. Our findings highlight the need for active prevention and prompt recognition of BSI and appropriate antimicrobial treatment.…

Hospital-Related Infection -- Norway…

In November 2021, a clonal outbreak of Pseudomonas aeruginosa of novel sequence type ST3875 was detected in three patients who died of bloodstream infections in one hospital. By 25 April 2022, the outbreak included 339 cases from 38 hospitals across Norway. Initial hospital reports indicate Pseudomonas infection as the main contributing cause in seven deaths. In March 2022, the outbreak strain was identified in non-sterile pre-moistened disposable washcloths, used to clean patients, from three lots from the same international manufacturer.…

P. aeruginosa -- Bangladesh…

Background

Intensive care units (ICU) constitute a high-risk setting for antimicrobial resistance (AMR).

Aim

We aimed to describe secular AMR trends including meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), extended-spectrum cephalosporin-resistant Escherichia coli (ESCR-EC) and Klebsiella pneumoniae (ESCR-KP), carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) from Swiss ICU. We assessed time trends of antibiotic consumption and identified factors associated with CRE and CRPA.

Methods

We analysed patient isolate and antibiotic consumption data of Swiss ICU sent to the Swiss Centre for Antibiotic Resistance (2009–2018). Time trends were assessed using linear logistic regression; a mixed-effects logistic regression was used to identify factors associated with CRE and CRPA.

Results

Among 52 ICU, MRSA decreased from 14% to 6% (p = 0.005; n = 6,465); GRE increased from 1% to 3% (p = 0.011; n = 4,776). ESCR-EC and ESCR-KP increased from 7% to 15% (p < 0.001, n = 10,648) and 5% to 11% (p = 0.002; n = 4,052), respectively. CRE, mostly Enterobacter spp., increased from 1% to 5% (p = 0.008; n = 17,987); CRPA remained stable at 27% (p = 0.759; n = 4,185). Antibiotic consumption in 58 ICU increased from 2009 to 2013 (82.5 to 97.4 defined daily doses (DDD)/100 bed-days) and declined until 2018 (78.3 DDD/100 bed-days). Total institutional antibiotic consumption was associated with detection of CRE in multivariable analysis (odds ratio per DDD: 1.01; 95% confidence interval: 1.0–1.02; p = 0.004).

Discussion

In Swiss ICU, antibiotic-resistant Enterobacterales have been steadily increasing over the last decade. The emergence of CRE, associated with institutional antibiotic consumption, is of particular concern and calls for reinforced surveillance and antibiotic stewardship in this setting.

Background

While 20–80% of regular visitors to (sub)tropical regions become colonised by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), those hospitalised abroad often also carry other multidrug-resistant (MDR) bacteria on return; the rates are presumed to be highest for interhospital transfers.

Aim

This observational study assessed MDR bacterial colonisation among patients transferred directly from hospitals abroad to Helsinki University Hospital. We investigated predisposing factors, clinical infections and associated fatalities.

Methods

Data were derived from screening and from diagnostic samples collected between 2010 and 2019. Risk factors of colonisation were identified by multivariable analysis. Microbiologically verified symptomatic infections and infection-related mortality were recorded during post-transfer hospitalisation.

Results

Colonisation rates proved highest for transfers from Asia (69/96; 71.9%) and lowest for those within Europe (99/524; 18.9%). Of all 698 patients, 208 (29.8%) were colonised; among those, 163 (78.4%) carried ESBL-PE, 28 (13.5%) MDR Acinetobacter species, 25 (12.0%) meticillin-resistant Staphylococcus aureus, 25 (12.0%) vancomycin-resistant Enterococcus, 14 (6.7%) carbapenemase-producing Enterobacteriaceae, and 12 (5.8%) MDR Pseudomonas aeruginosa; 46 strains tested carbapenemase gene-positive. In multivariable analysis, geographical region, intensive care unit (ICU) treatment and antibiotic use abroad proved to be risk factors for colonisation. Clinical MDR infections, two of them fatal (1.0%), were recorded for 22 of 208 (10.6%) MDR carriers.

Conclusions

Colonisation by MDR bacteria was common among patients transferred from foreign hospitals. Region of hospitalisation, ICU treatment and antibiotic use were identified as predisposing factors. Within 30 days after transfer, MDR colonisation manifested as clinical infection in more than 10% of the carriers.

Other Plant Disease -- KazakhstanA survey of fruit crops in 13 regions of Kazakhstan was carried out to identify foci of fire blight, the extent of its spread, the range of affected crops, and the identification of infection reserves. It was established that the disease was mainly concentrated in the south and southeast of Kazakhstan, in the main fruit growing zone. Symptoms were characteristic of 2 bacterial diseases: namely, necrosis with _Pseudomonas syringae_ as the causative agent and fire blight as such, caused by…

Verona integron-encoded metallo-β-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa and other carbapenemase-producing organisms represent an emerging U.S. public health threat.