H5N1

Branswell: How a fungus got health officials' attention

Via STAT, a July 31 report by Helen Branswell: A 'perfect storm' superbug: How a fungus got health officials' attention. Excerpt:

Try as they might, the infection control specialists at Royal Brompton Hospital could not eradicate the invasive fungus that was attacking already gravely ill patients in the intensive care unit.  

Enhanced cleaning didn’t stop the dangerous bug from spreading from one patient to the next in the 296-bed hospital. Neither did segregating infected patients, to keep them from spreading the fungus. 

Eventually, officials who run the Royal Brompton, located a couple of miles from Buckingham Palace in London’s tony Chelsea neighborhood, resorted to a last-ditch move no hospital ever wants to have to take. They temporarily shut their ICU. That appears to have put a stop to the more than year-long outbreak, which ended last year and which involved at least 50 patients.  

The lengths to which the Royal Brompton was forced to resort to rid the hospital of Candida auris — a member of a broader fungal family named Candida — raised red flags for the small community of scientists who study fungi that infect people. 

“They did the Cadillac of drastic actions to make that happen, which we generally wouldn’t be doing for Candidal infections,” Dr. Tom Chiller, the chief of mycotic — fungal — diseases at the Centers for Disease Control and Prevention, told STAT in a recent interview. 

The fear is that that’s what U.S. hospitals may be facing if C. auris breaches their infection control defenses. Last year at this time, the CDC knew of a single U.S. case, which occurred in 2013. As of mid-July, the case count had risen to 98 in nine states, though the lion’s share have been reported by two — New York (68) and neighboring New Jersey (20).  

These days the term “superbug” is tossed around with the frequency of presidential tweets. But on the ever-growing list of bad bugs, C. auris is one of the most unsettling. Dr. Anne Schuchat, who served as the CDC’s acting director this spring, termed it a “catastrophic threat.”  

Said Chiller: “It’s a high priority for really sick people right now and we at CDC are taking a very aggressive approach to see if we can’t control, contain, and even eradicate it from the places it exists.”

Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery

Via The Lancet Infectious Diseases: Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study. The summary:

Background 

Since 2013, over 100 cases of Mycobacterium chimaera prosthetic valve endocarditis and disseminated disease were notified in Europe and the USA, linked to contaminated heater–cooler units (HCUs) used during cardiac surgery. We did a molecular epidemiological investigation to establish the source of these patients' disease. 

Methods 

We included 24 M chimaera isolates from 21 cardiac surgery-related patients in Switzerland, Germany, the Netherlands, and the UK, 218 M chimaera isolates from various types of HCUs in hospitals, from LivaNova (formerly Sorin; London, UK) and Maquet (Rastatt, Germany) brand HCU production sites, and unrelated environmental sources and patients, as well as eight Mycobacterium intracellulare isolates. Isolates were analysed by next-generation whole-genome sequencing using Illumina and Pacific Biosciences technologies, and compared with published M chimaera genomes. 

Findings 

Phylogenetic analysis based on whole-genome sequencing of 250 isolates revealed two major M chimaera groups. Cardiac surgery-related patient isolates were all classified into group 1, in which all, except one, formed a distinct subgroup. This subgroup also comprised isolates from 11 cardiac surgery-related patients reported from the USA, most isolates from LivaNova HCUs, and one from their production site. Isolates from other HCUs and unrelated patients were more widely distributed in the phylogenetic tree.  

Interpretation 

HCU contamination with M chimaera at the LivaNova factory seems a likely source for cardiothoracic surgery-related severe M chimaera infections diagnosed in Switzerland, Germany, the Netherlands, the UK, the USA, and Australia. Protective measures and heightened clinician awareness are essential to guarantee patient safety.

Delivering on antimicrobial resistance agenda not possible without improving fungal diagnostic capabilities

Via Emerging Infectious Diseases: Ahead of Print -Delivering on Antimicrobial Resistance Agenda Not Possible without Improving Fungal Diagnostic Capabilities. The abstract:

Antimicrobial resistance, a major public health concern, largely arises from excess use of antibacterial and antifungal drugs. Lack of routine diagnostic testing for fungal diseases exacerbates the problem of antimicrobial drug empiricism, both antibiotic and antifungal. 

In support of this contention, we cite 4 common clinical situations that illustrate this problem: 1) inaccurate diagnosis of fungal sepsis in hospitals and intensive care units, resulting in inappropriate use of broad-spectrum antibacterial drugs in patients with invasive candidiasis; 2) failure to diagnose chronic pulmonary aspergillosis in patients with smear-negative pulmonary tuberculosis; 3) misdiagnosis of fungal asthma, resulting in unnecessary treatment with antibacterial drugs instead of antifungal drugs and missed diagnoses of life-threatening invasive aspergillosis in patients with chronic obstructive pulmonary disease; and 4) overtreatment and undertreatment of Pneumocystis pneumonia in HIV-positive patients. 

All communities should have access to nonculture fungal diagnostics, which can substantially benefit clinical outcome, antimicrobial stewardship, and control of antimicrobial resistance.