Top Infectious Disease News of the Week—August 4, 2019

#5: Does Decreased Renal Function Predict Worse Outcomes With Newer Antimicrobials?

In 2013, the US Centers for Disease Control and Prevention (CDC) reported that at least 2 million people are infected by an anti­biotic-resistant infection, and at least 23,000 of those people die each year in the United States.¹ A more recent estimate has the actual annual incidence of inpatient and outpa­tient deaths closer to 150,000.² In response to this global threat, there have been several new antibiotics (Table 1) marketed that target bacteria that are considered to be serious risks by the CDC and World Health Organization.^3,4

Antimicrobial therapy targeted to these multidrug-resistant (MDR) bacteria is evolving, particularly in regard to appropriate dosing. Multiple factors must be considered when developing dosing regimens for these new antimicrobials, such as the pharmacoki­netic/pharmacodynamic (PK/PD) parameters, interpatient variability, minimum inhibitory concentration (MIC) breakpoints, and issues with resistance emergence.

Bidell and Lodise looked at using renal impairment dosing guidelines for ceftazidime/ avibactam (CAZ-AVI), ceftolozane/tazobactam (TOL-TAZ), daptomycin, and telavancin and if these dosing recommendations affected outcomes in patients with moderate renal impairment.⁵ They found that in all 4 phase 3 trials, there was a trend of reduced efficacy in patients with baseline renal impairment. This review will focus on the phase 3 studies which evaluated the antimicrobials CAZ-AVI and TOL-TAZ.

Read this In the Literature article.

#4: Driving Hand Hygiene Compliance, Improvements, and Sustainability

Hand hygiene. It’s one of the most important things we can do to stop the spread of infectious microorganisms and yet one of our biggest struggles in health care. For infection prevention programs, working to increase and then maintain hand hygiene compliance is often an insurmountable task. Historically, hand hygiene compliance rates have been at or below 50% within the United States health care system. Part of the challenge is in maintaining engagement and, frankly, making it a habit instead of a chore.

Although hand hygiene is an infection prevention effort we’re struggling within the United States, we’re not alone. Perhaps understanding what other countries are doing could help guide our own efforts. Investigators in Japan have provided insight into their efforts and lessons learned in a new study published in the American Journal of Infection Control. Using a multimodal intervention in 3 hospitals, the research team pieced together guidance from the World Health Organization (WHO), US Centers for Disease Control and Prevention (CDC), and other initiatives.

The multimodal intervention began in 2012 and employed the suggestions of the WHO by focusing on educating health care workers on the importance of hand hygiene while also ensuring there was adequate alcohol-based hand gel (ABHG) for health care workers to use. Each health care facility was allowed to choose which interventions to implement, allowing for a sense of personalization in their efforts. The personalization was in addition to basic efforts, including ABHG in patient rooms, staff education, informational posters, and feedback from both the department heads and the infection prevention team. All hand hygiene was monitored internally through direct observation or hand gel consumption. Leadership support of this effort was important and observations took place across at least 3 units within the hospitals—inpatient surgical, inpatient medicine, emergency, and intensive care units.

Read about hand hygiene compliance and sustainability.

#3: RSV Vaccine Candidate DS-Cav1 Shows Early Promise in Phase 1 Trial

Each year respiratory syncytial virus (RSV) leads to 57,527 hospitalizations among children under 5 years and 177,000 hospitalizations among adults over the age of 65 years, according to the US Centers for Disease Control and Prevention.

But now, hope may be on the horizon as the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has announced promising results from a phase 1 clinical trial evaluating a novel experimental vaccine.

"A vaccine to prevent RSV is a long-sought goal that has eluded us for decades," Anthony S. Fauci, MD, director of NIAID, said in a press release. "The early results of this trial suggest that this structure-based strategy for developing an RSV vaccine may bring that goal within reach."

Read about RSV vaccine candidate DS-CAV1.

#2: Opioid Injection in Rural US is Challenging Efforts to End the HIV Epidemic

It’s no secret that the opioid crisis in the United States has presented new challenges for various areas of public health. An increase in injection opioid abuse has been linked to everything from hepatitis A outbreaks to wound infections to endocarditis and, of course, the HIV epidemic in the United States.

In February’s State of the Union address, President Trump announced his plan to end the HIV epidemic in the United States. The plan seeks to decrease the number of new HIV infections in the United States by 75% in 5 years, 90% in 10 years, and ending the epidemic once and for all by 2030.

In a new viewpoint published in JAMA, Andrea M. Lerner, MD, and Anthony S. Fauci, MD, both of the National Institute of Allergy and Infectious Diseases, address how injection opioid use in rural communities in the United States is a growing threat to attaining the goal of ending the HIV epidemic.

Read about how opioid use in rural United States is stalling progress in ending HIV.

#1: Florida Declares Public Health Emergency in Response to Hepatitis A Outbreak

Florida Surgeon General Scott Rivkees, MD, has declared a public health emergency in Florida in response to the statewide hepatitis A outbreak.

The Sunshine State has documented 2582 hepatitis A cases between January 1, 2018, and July 27, 2019. According to the Florida Department of Health, 98% of cases in this outbreak have been acquired within the state. Additionally, case counts in 2019 have already surpassed the total number of cases recorded in 2018.

"I am declaring this public health emergency as a proactive step to appropriately alert the public to this serious illness and prevent further spread of hepatitis A in our state," Rivkees said in a press release. "The best way to prevent hepatitis A is through vaccination. It is important that we vaccinate as many high-risk individuals as possible in order to achieve herd immunity.”

Prior to declaring a public health emergency, State Surgeon General Celeste Philip, MD, MPH, issued a public health advisory in November 2018, which reemphasized the importance of hepatitis A vaccine recommendations following a “substantial increase” in infections across the state.

Under the new declaration, the state health agency will request assistance from the US Centers for Disease Control and Prevention (CDC) in controlling and responding to the outbreak. It is also important for Florida health care providers to understand the importance of screening and vaccinating individuals at high-risk for acquiring hepatitis A. Although anyone can contract the virus, high-risk populations include individuals experiencing homelessness, intravenous and non-intravenous drug users, and men who have sex with men.

The declaration also recommends vaccination for individuals who may have an increased risk of suffering from complications associated with hepatitis A, including those with chronic liver disease, clotting factor disorders, and adults over the age of 60 years with underlying medical conditions who reside in a county with a high level of transmission occurring.

As of July 26, 2019, hepatitis A outbreaks have been identified in 25 states since 2016. A total of 22,566 cases, 13,352 hospitalizations, and 221 deaths have been reported.

Read about Florida’s Hepatitis A outbreak.