Top Infectious Disease News of the Week—January 5, 2020

#5: A Dangerous Duo: Patient Colonization and Environmental Contamination with VRE

As we work towards making health care safer and establishing a stronger role for infection control in patient care, the role of bioburden and environmental contamination is a common conversation topic. The US Centers for Disease Control and Prevention (CDC) recently reported that each year roughly 2.8 million Americans are infected with antibiotic-resistant infections, which result in 35,000 associated deaths. Organisms like vancomycin-resistant Enterococci (VRE), drug-resistant Candida, Methicillin-resistant Staphylococcus aureus, are all considered serious threats in the CDC’s 2019 Antibiotic Resistance Threats Report.

One conversation that we consistently have in infection prevention is about isolation and screening of patients with multidrug-resistant organisms (MDROs) and/or Clostridioides difficile. What is the role of patients without active infection who are likely just colonized in transmission? Will they shed such organisms and contaminate their environmental surroundings? Such issues are all things that impact isolation and environmental cleaning in health care settings. With this in mind, investigators of a new study, published in Open Forum Infectious Diseases, sought to understand the relationship between environmental contamination and patient colonization with VRE and whether it impacted negative health outcomes.

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#4: NTM Cases Up, Especially Among Women and Older Adults

There has been a noted increase in the number of new nontuberculous mycobacterial (NTM) lung disease infections, especially among women and adults aged 65 or older, according to a new report published in the Annals of the American Thoracic Society.

Investigators from Oregon Health & Science University retrospectively studied national managed care claims in order to estimate NTM in order to provide better understanding of the public health and economic impacts of the disease and its treatment. Risk factors for the disease—which only infects a small fraction of the general population—include comorbid chronic obstructive pulmonary disease, cystic fibrosis, or an otherwise immunocompromised system. There are more than 160 different species of NTM bacteria, which are found naturally in the environment.

There were about 27 million members annually in the database the investigators used, which represented a geographically diverse population between 2007 and 2016.

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#3: Earlier Initiation of Daptomycin-Ceftaroline for MRSA Bacteremia May Improve Outcomes

Vancomycin or daptomycin monotherapy are the recommended first-line treatments for Methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. It is known that these treatments are associated with high failure rates, but greater clarity is needed when it comes to alternatives and salvage therapies following initial treatment failure.

Daptomycin and ceftaroline (DAP-CPT) combination therapy is one of the frequent salvage therapies for persistent MRSA bacteremia, but there have been few comparison studies involving the treatment. Results from a retrospective, matched cohort study published in Open Forum Infectious Diseases demonstrate that although DAP-CPT treatment is often delayed in MRSA bacteremia, the therapy may be beneficial if initiated earlier.

The study took place among patients with MRSA bacteremia at 4 hospitals in the United States.

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#2: Medical Care Coordination Program Can Increase Life Expectancy for People with HIV

A medical care coordination (MCC) program is a cost-effective way to address the medical and psychosocial needs of people with HIV, a new study of such a program implemented by the Los Angeles County Division of HIV and STD Programs found.

The study, published in Open Forum Infectious Diseases, evaluated the impact and cost-effectiveness of the MCC program, finding that life expectancy increased from 10.07 to 10.94 quality-adjusted life-years while lifetime medical cost increased from $311,300 to $335,100. At 2 years, viral suppression was 57% and retention in care was 72%, compared with 33% and 59% respectively for patients with no MCC.

“The innovative program of multidisciplinary services implemented by the Los Angeles County (LAC) Division of HIV and STD programs and supported through the Ryan White HIV/AIDS Program, known as the MCC program, nearly doubled viral suppression at 2 years for people at risk for poor health outcomes with major medical and behavioral comorbidities, at an annual cost of $2700 per person,” first author Moses Flash and senior author Emily Hyle, MD, MSc, of Massachusetts General Hospital told Contagion^®.

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#1: 'Enhanced' Flu Vaccines Provide Better Protection for Elderly

As the push to boost flu vaccination rates rolls on, public health officials will put a particular emphasis on vulnerable groups such as the elderly and young children. Now, new research is shedding new empirical light on which vaccines might work best for the elderly.

Most people who receive a flu vaccine receive a trivalent or quadrivalent inactivated influenza vaccine, with 45 micrograms of hemagglutinin (HA) and 15 micrograms each of 2 influenza A strains and 1 or 2 influenza B strains.

Over the past decade, however, new “enhanced” versions of the flu vaccine have become available. Some early evidence has suggested that these stronger versions might better protect elderly patients against the flu, but scientific data has so far been relatively scant. In a new study in Clinical Infectious Diseases, a multinational team of investigators report on what they found when they directly compared standard-dose vaccines with 3 enhanced vaccines.

Corresponding author Benjamin J. Cowling, PhD, of Hong Kong University’s School of Public Health, noted that the elderly population is disproportionately affected by the flu.

“Influenza epidemics cause considerable health impact, and an average winter influenza season is responsible for 12,000-61,000 deaths and 140,000-810,000 hospitalizations in the US,” he said. “The majority of these occur in older adults, and this age group are a particular target for influenza vaccination campaigns.”

Cowling told Contagion® that because standard-dose flu vaccines tend to be merely “moderately” effective, it was important to understand whether enhanced vaccines would better protect this community.

“Each of the enhanced vaccines is thought to work better than standard dose vaccines in older adults, based on previous studies,” Cowling said. Our trial is the first large trial to provide direct comparisons between the vaccines.”

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