Weekly Digest: First U.S. Zika death; Decline in antibiotic-resistant Salmonella in U.S. poultry

“[F]unding for ICDS (Integrated Child Development Services) should probably be fully restored and a hard look taken at systemic inefficiencies,” write CDDEP researchers Arindam Nandi and Ramanan Laxminarayan in Ideas for India. The column, based on their recent research, argues that nutrition is potentially t­­he most critical determinant of a child’s long-term health and wellbeing—including, e.g., adult height and reducing the chances of developing cardiovascular disease in adulthood. These findings have “tremendous significance for policy,” and the authors argue for restoring ICDS funding cut in 2013 to ensure that the full benefits are realized, while taking the opportunity to reduce systemic inefficiencies through comprehensive restructuring. [Ideas for India]

The new combination drug ceftazidime-avibactam is as effective as carbapenems against ceftazidime-resistant Enterobacteriaceae and Pseudomonas infections. Avibactam is a beta-lactamase inhibitor that counteracts the bacteria’s resistance to ceftazidime. The REPRISE phase 3 trial randomly assigned 333 patients from hospitals in 16 countries with complicated urinary tract infection or complicated intra-abdominal infections to ceftazidime-avibactam or the best available alternative treatment (mainly a carbapenem). Ninety-one percent of patients in both groups were clinically cured 7-10 days after completion of therapy. Mild to moderate adverse reactions, mostly gastrointestinal, occurred in about one-third of patients in both groups. [Lancet Infectious Diseases]

The first U.S. Zika-related death was reported this week in Puerto Rico. The victim, a Puerto Rican man in his 70s, experienced typical Zika symptoms, such as rash and fever, which initially resolved. Days later, he suffered a rare immune reaction and died of extensive internal bleeding. Puerto Rico has seen 683 confirmed Zika infections; 17 of those patients were hospitalized, seven of them with Guillain-Barre syndrome. The U.S. Food and Drug Administration approved emergency use of the first commercial Zika diagnostic, from Focus Diagnostics, on April 28. [The New York Times, Outbreak News Today]

Antibiotic stewardship programs (ASPs)—especially those with automated components and a focus on doctor-patient communication—can lower hospital antibiotic use and healthcare-associated infection (HAI) rates, according to the Pew Charitable Trusts, based on case studies of 10 American hospitals that implemented ASPs with CDC’s “Core elements of antibiotic stewardship”: leadership commitment, accountability, drug expertise, action (e.g, systems to monitor treatment and bug-drug matches), education, tracking and reporting. The most successful ASPs included routine review of the appropriateness of antibiotic therapy, with treatment monitoring and interventions to limit unnecessary use. Regular and clear communication between clinicians, lab employees and pharmacists was also a key predictor of effectiveness. [CIDRAP, Pew]

Rates of antibiotic-resistant Salmonella in U.S. poultry products have fallen since 2011, according to the FDA’s National Antimicrobial Resistance Monitoring System (NARMS) in 14 states. Resistance of Salmonella to ceftriaxone in raw chicken was 5 percent and in raw turkey, 4 percent in the first half of 2015, down from 38 percent in 2009 for chicken and 22 percent in 2011 for turkey. The proportion of resistant bacteria that were multi-drug resistant also declined in both products, from 45 and 50 percent in 2011 for chicken and turkey respectively, down to 20 and 36 percent in June 2015. Overall Salmonella prevalence in retail poultry has declined to 6 percent in ground turkey and 9 percent in raw chicken, the lowest levels since FDA began collecting data in 2002.   [FDA]

Six measles cases have been reported in Tennessee, all in unvaccinated individuals. The cluster, centered in Memphis, likely originated from a traveler who arrived from outside the country with a measles infection. According to CDC, 96 percent of Tennessee children over five were vaccinated against measles, though the state allows parents to refuse vaccination for religious reasons. [CIDRAP]

A bacterium that kills mosquito larvae—and grows in coconuts—may be useful for controlling Zika and malaria. More than 20 years ago, “biological coconut bombs” were developed to deliver the bacterial insecticide Bacillus thuringiensis israelensis (Bti) into ponds in Salitral, Peru. Grade-school children were taught to inoculate coconuts with the bacteria, wait for the bacteria to multiply, and then throw the coconuts into ponds filled with Aedes egypti mosquito larvae. The Bti toxin affects more than 72 species of mosquitoes and blackflies, but not humans or other larger animals. In the 1995 study, coconut bombs killed 80-90 percent of larvae, depending on the number of coconuts deployed. A follow-up more than a decade later discovered the communities maintained reduced rates of dengue and malaria transmission. Researchers now think Bti could be useful where commercial pesticide resistance is high. [Engineering for Change]

Gut microbiome composition may be predictive of cancer chemotherapy-related bloodstream infections. University of Minnesota researchers, reporting in Genome Medicine, sequenced the gut bacterial DNA of 28 non-Hodgkin’s lymphoma patients—who are at high risk of bloodstream infections after high-dose chemotherapy in preparation for bone marrow or stem cell transplants—before chemotherapy began.  Eleven of 28 patients who contracted bloodstream infections after treatment had significantly different gut microbiome composition than non-infected patients. The researchers developed an algorithm that could predict with 85 percent accuracy which patients would acquire an infection. Said study author Dan Knights, “This research is an early demonstration that we may be able to use the bugs in our gut to predict infections and possibly develop new prognostic models in other diseases.” [University of Minnesota, Genome Medicine]