Study: Decolonizing Parents Could Reduce Staph Risk for Newborns

The results of a new clinical trial indicate that treating parents with short-course intranasal mupirocin and topical chlorhexidine bathing can reduce the risk of transmitting Staphylococcus aureus (S aureus) to newborns in intensive care units (ICUs).

The randomized trial, which had its findings published in JAMA, included 190 neonates with parents colonized with S aureus. Parents were treated with intranasal mupirocin and chlorhexidine-impregnated cloths or placebo (petrolatum intranasal ointment and nonmedicated soap cloths).

The findings revealed that the use of the impregnated cloths "… significantly reduced the hazard of acquiring colonization with a parental S aureus strain."

The authors note that this trial suggests parents represent a "major reservoir" from which neonates acquire S aureus in the neonatal intensive care unit (NICU). Neonates are unique because they an immature microbiome upon NICU admission and rarely have preexisting S aureus colonization. Rather, neonates acquire S aureus colonization in the NICU from exposure to people and objects.

S aureus, the authors note, is a leading cause of healthcare-associated infections in the NICU. Parents with S aureus may expose neonates to S aureus colonization, which is a well-established predisposing factor to invasive S aureus disease. As the Centers for Disease Control and Prevention notes, staph infections can be serious or fatal and the risk of more serious staph infection is higher for patients in ICUs.

The randomized trial had a study period of November 2014 through December 2018. It was conducted by conducted by clinicians and researchers at Baltimore's Johns Hopkins University School of Medicine and Johns Hopkins Bloomberg School of Public Health.

CDC List of Top 2019 Threats Prominently Features Infections

The Centers for Disease Control and Prevention (CDC) has issued its list of "Nine Health Threats That Made Headlines in 2019." Infections, infectious diseases and infection-related issues appear throughout the list.

They are as follows:

• Antibiotic and antimicrobial resistance. CDC highlights the significant threat of antibiotic-resistant bacteria and fungi, noting that they cause millions of infections and thousands of deaths annually in the United States. On average, someone contracts an antibiotic-resistant infection every 11 seconds, while someone dies every 15 minutes. Prevention efforts have helped reduce the number of deaths, but significant challenges remain.

• Measles. One statistic essentially tells the whole story of measles in 2019: This year, there were more U.S. measles cases than in any of the last 25 years. As of early December, CDC reported nearly 1,300 cases of measles in 31 states for 2019. This is the largest number of cases reported in the United States since 1992. A major contributing factor, as CDC notes: "Despite high nationwide coverage with the measles, mumps and rubella vaccine, there are still communities where low vaccination rates leave people vulnerable to these dangerous diseases."

• Immunization and vaccination. The threat of low immunization and vaccination rates receives its own section. CDC discusses the importance of pregnant women receiving the two vaccines recommended during pregnancy (influenza and whooping cough (pertussis)), the annual seasonal influenza vaccine and human papilloma virus (HPV) vaccine.

• Pregnancy-related deaths. CDC highlights a report that shows three in five pregnancy-related deaths could have been prevented. Infections is one of several causes of pregnancy-related deaths.

• HIV. "Progress in HIV prevention has stalled," CDC states, pointing to alarming statistics concerning diagnosing people living with HIV and the number of people who should be taking a daily HIV-prevention pill. A new initiative aims to reduce new HIV infections by 90% by 2030. 

• Ebola. Back in the spotlight because of the outbreak in the Democratic Republic of the Congo (DRC). The number of Ebola cases in DRC has surpassed 3,300, with more than 2,200 deaths. 

• Foodborne outbreaks. CDC states that in 2019, it investigated and resolved more than 75 outbreaks related to food or animal contact. 

Also on the list of threats: lung injuries linked to e-cigarettes/vaping and opioids.

Access the CDC's 2019 list.

Study: Ambulatory Care Clinics Prescribe Millions of Inappropriate Antibiotics

The results of a new study indicate that at least one out of every four antibiotics prescribed during ambulatory care visits were inappropriate.

The study, published in BMJ, examined data from the 2015 National Ambulatory Medical Care Survey. Researchers analyzed more than 28,000 sample visits representing close to a billion ambulatory care visits nationwide.

Their conclusions include the following:

• Antibiotics were prescribed during about 13% of ambulatory care visits in 2015.

• About 25% were for inappropriate indications (~32 million prescriptions).

• In addition, 18% lacked a documented indication (~24 million prescriptions).

• Combined, as many as 43% of prescriptions were potentially inappropriate.

• Factors contributing significantly to antibiotic prescribing without an indication were being an adult male, having at least one chronic disease, spending more time with the provider and seeing a non-primary care specialist.

• Prescriptions for sulfonamides and urinary anti-infectives were commonly associated with the absence of a documented infection.

In the study's conclusion, researchers state, "Antibiotic prescribing in the absence of a documented indication may severely bias national estimates of appropriate antibiotic use in this setting and misinform antimicrobial stewardship efforts. … With 60% of antibiotic expenditure and up to 90% of antibiotic use originating in ambulatory care settings, more focus is needed to support well informed stewardship efforts beyond the hospital."

Patient Lab Specimens Contaminated By Mycobacterium From Tap Water

A hospital's investigation into patient laboratory specimens contaminated with Mycobacterium porcinum identified tap water as the source.

The hospital laboratory identified clusters of isolates that tested positive for the nontuberculous mycobacterium from January 2017 into April 2018, according to Morbidity and Mortality Weekly Report, which is published by the U.S. Centers for Disease Control and Prevention (CDC). A total of 20 isolates was obtained from 16 patients. M. porcinum is associated with infections of the respiratory tract, bloodstream, surgical sites and soft tissue.

The investigation was conducted by the hospital's infection prevention team and the Wisconsin State Laboratory of Hygiene. Investigators eventually traced M. porcinum to two ice machines and one water dispenser. Inspection revealed debris on internal parts and dispenser spouts.

New machines and parts were installed in June 2018, and the hospital revised its cleaning protocols. Staff members no longer use tap water when collecting respiratory cultures. CDC stated no further M. porcinum patient isolates have been identified.

As the report concludes, "Tap water is not sterile, can lead to false-positive culture results and should be avoided when collecting biologic specimens intended for culture. Hospital water management programs should engage clinical partners to ensure safe water use as part of patient care and address maintenance of ice machines and water dispensers within their facilities."

FDA Hopes New App Will Help With Treatment of Infectious Diseases

The U.S. Food and Drug Administration (FDA) has launched a new app that will allow healthcare professionals to share new uses of FDA-approved drugs to treat difficult-to-treat infectious diseases.

FDA is hoping that by allowing members of the clinical community to share their experiences via the CURE ID app, this crowdsourcing platform will help guide new interventions and facilitate development of new drugs for neglected diseases.

The CURE ID app, described by the FDA as an "internet-based repository," is designed to capture clinical outcomes when medications are used for new indications, in new populations, in new doses or in new combinations. Caregivers complete a simple case report form about their experience using an approved product for an unapproved use.

The app also allows healthcare professionals to browse cases that have already been documented, including successful and unsuccessful treatments, and view relevant clinical trials and those open to enrollment at clinicaltrials.gov. Users can also participate in a treatment discussion forum with fellow providers globally.

In a news release, Dr. Amy Abernethy, FDA principal deputy commissioner, said, "Our hope is that this app will serve as a connector among major treatment centers, academics, private practitioners, government facilities and other healthcare professionals from around the world and ultimately get treatments to patients faster.”

CURE ID is a collaboration between the FDA and the National Center for Advancing Translational Sciences, which is part of the National Institutes of Health.

To download and use the CURE ID application, click here or download "CURE ID" from the App or Play Store.