Analysis of the news of February 22, 2022

The ECDC warns that the Italian candida auris the epidemic could spread

The European Center for Disease Prevention and Control (ECDC) yesterday issued a warning about an ongoing outbreak of multidrug resistant yeast candida auris in Italy.

The epidemic began with a single case detected in a hospital in Liguria in July 2019. In February 2020, a case was detected in the intensive care unit of the same hospital for COVID-19 patients, and cowries the number of cases continued to increase at the facility through 2020 and 2021. Whole genome sequencing of isolates from 10 of the first cases showed that the isolates belonged to the South Asian clade and that all but one were part of the same group from the Cas index.

To date, at least 277 cases have been detected in eight hospitals in Liguria, including 210 in the initial hospital. Eleven other cases were detected in establishments in the neighboring region of Emilia-Romagna.

cowries was first identified in Japan in 2009 and has since been detected in 40 countries on six continents. It can cause serious invasive infections in patients who have underlying disease or immunosuppression, and clinicians have limited treatment options. Almost all cowries isolates described worldwide have been reported to be resistant to fluconazole, with varying levels of resistance to other azoles, echinocandins, and amphotericin B.

The ECDC says that, given the high number of cases and inter-regional spread, the risk of further spread in Italy is considered high.
February 21 ECDC rapid risk assessment

VA study finds most dental antibiotic prophylaxis prescriptions are inappropriate

Another study of antibiotic prescribing by veterans’ (VA) dentists found that five out of six prescriptions for antibiotic prophylaxis were inconsistent with guidelines, researchers reported today in Infection control and hospital epidemiology.

The cross-sectional study of visits to VA dentists from 2015 to 2019 examined all antibiotics prescribed within 7 days of a visit in the absence of oral infection. In the primary analysis, antibiotic prophylaxis was deemed appropriate only if combined with a visit involving manipulation of the gum tissue and if the patient had a cardiac condition with the highest risk of an adverse outcome of the infective endocarditis as directed.

In the secondary analysis, antibiotic prophylaxis was considered appropriate if combined with dental extractions or implants and patients had heart disease or were immunocompromised.

Investigators analyzed data from 369,102 prophylaxis prescriptions for 358,078 visits. More than 90% of visits were classified as gingival manipulations. The median duration of prescription was 7 days; only 6.5% were prescribed for 1 day.

In the primary analysis, using a narrow definition of appropriate, 15% of prophylaxis prescriptions were considered appropriate. In the secondary analysis, with a broader definition, 72% of prophylaxis prescriptions were deemed appropriate. Off-guideline prophylaxis has increased over time.

For the narrow definition, multivariate analysis revealed that black (vs. white) race, Latino (vs. non-Latino) ethnicity, and visits located in the Western Census Area were associated with unnecessary prophylaxis. Variables associated with a lower risk of inappropriate prophylaxis were older age, joint prostheses, immunocompromised status and rural location. Similar predictors were identified in multivariate analysis for the broad definition, although Latin American ethnicity was less likely to be associated with inappropriate prophylaxis and dental visits in the northeast were more likely. .

The study authors say pressure on dentists to prescribe antibiotics by medical clinicians may play a role in the lack of consistency in guidelines.

“Other factors that may be associated with potentially unnecessary prescribing by dentists include time constraints, an aging population, dental implant placements, underinsurance, and emergency procedural skills,” they write.
February 22 Hosp Epidemiol Infection Control abstract

WHO survey reveals gaps in infection prevention and control worldwide

A World Health Organization (WHO) survey of infection prevention and control (IPC) professionals found significant gaps in IPC implementation, researchers from the IPC reported yesterday. WHO in Lancet Infectious Diseases.

From January 16 to December 31, 2019, 4,440 IPC professionals from 81 countries completed the WHO Online IPC Assessment Framework (IPCAF), a questionnaire that scores responses to questions on eight core components WHO IPC: (1) IPC program; (2) IPC guidelines; (3) education and training in IPC; (4) surveillance of nosocomial infections (IAS); (5) multimodal strategies; (6) monitoring and auditing of IPC practices and feedback; (7) workload, staffing and bed occupancy; and (8) materials and equipment for the IPC. Each section generates a score from 0 to 100.

The overall weighted median IPCAF score indicated an advanced level of IPC implementation (605), but significantly lower scores were found in low-income (385) and lower-middle-income countries (500) , as well as in public health facilities (515 ). Core Component 8 (90) and Core Component 2 (87.5) received the highest scores, and Core Component 7 (70) and Core Component 3 (70) received the highest scores. lower.

Overall, only 15.2% (588 of 3,873) of properties met all of IPCAF’s minimum requirements, ranging from 0% (0 of 417) in low-income countries to 25.6% ( 278 of 1,087) in primary schools, 9% (24 of 268) in secondary schools, and 19% (18 of 95) in tertiary schools in high-income countries.

The authors of the article say the findings identify key opportunities to inform ongoing global CPI improvement efforts, particularly in low- and lower-middle-income countries, and note that improvements will be needed. to reduce the global burden of nosocomial infections and antimicrobial resistance (AMR).

“The endemic burden of HAIs and AMR continues to affect patient safety, hamper high standards of quality of care, and hamper the achievement of universal health coverage,” they wrote.

“To address these challenges and achieve substantial and lasting progress on IPC, greater emphasis is needed on developing and enforcing stronger policies and regulations, supported by leadership and accountability mechanisms. at the highest levels, as well as a trained IPC workforce at the facility level.”
the 21st of February Lancet Infect Dis study

WHO adds details to deadly UK Lassa cluster reports

Yesterday the WHO gave more details of the family cluster of imported Lassa fever cases – including one fatal – recently reported in the UK.

The first patient fell ill after returning from a late 2021 trip to Mali, where Lassa fever is endemic. He was hospitalized and recovered. The second and third cases involved family members who had not travelled.

WHO notes that these cases constitute the second known case of Lassa secondary transmission in Europe. The last secondary cases of Lassa in Europe were reported in 2016 in Germany in a person who performed post-mortem care on a person who died from Lassa virus infection.

In the UK group, the other two family members were hospitalized and one died. According to British media, the deceased patient was a newborn.

Contact tracers have identified people who were exposed and are being monitored for 21 days. People exposed at high risk were offered post-exposure prophylaxis.

Lassa fever is endemic in several West African countries where mastomys rats spread the virus, which can cause hemorrhagic disease in humans who consume food or water contaminated with feces or urine from infected animals. Human-to-human infections can occur through contact with the body fluids of an infected patient.
21 February WHO declaration
February 16 BBC story

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