Infectious Diseases Society of America, Oct. 2-6
The annual meeting of the Infectious Diseases Society of America was held from Oct. 2 to 6 in Washington, D.C., and attracted more than 5,000 participants from around the world, including scientists, physicians, and other health care professionals. The conference featured comprehensive educational programs that focused on the latest advances in the diagnosis, treatment, and prevention of infectious diseases, as well as insight into emerging infections, new diagnostics, vaccines, and therapeutic interventions.
In one study, Nkuchia M'ikanatha, Dr.P.H., of the Pennsylvania Department of Health in Harrisburg, and colleagues determined that 96 of 2,520 poultry, ground beef, and pork chop samples (3.8 percent) purchased during 2015 to 2017 from randomly selected stores in Pennsylvania contained nontyphoidal Salmonella. The investigators tested the Salmonella-contaminated meat samples and 109 cultures from human Salmonella infections collected during the same period for susceptibility to 15 antibiotics.
"In the Salmonella cultures from meat, 28 (29.2 percent) were resistant to three or more antibiotic classes and 17 (17.7 percent) were resistant to five or more antibiotic classes. Resistance to ceftriaxone, the antibiotic most often used to treat serious Salmonella infection, was found in three of 25 (12 percent) in 2015, 10 of 37 (27 percent) in 2016, and five of 34 (14.7 percent) in 2017," M'ikanatha said. "Furthermore, four contained genes that make bacteria resistant to eight antibiotic classes."
In the Salmonella cultures from humans, 28 (25.7 percent) were resistant to more than three antibiotic classes and 12 (11 percent) were resistant to more than five antibiotic classes. None were resistant to ceftriaxone in 2015, six of 48 (12.5 percent) were resistant in 2016, and nine of 37 (24.3 percent) were resistant in 2017. In addition, two had genes that make bacteria resistant to eight antibiotic classes.
"Consumers should read production labels and make informed choices based on the evidence about the risk of poultry contamination with drug-resistant Salmonella. Resistance genes identified in Salmonella are carried in transmissible elements (e.g., plasmids) and can be shared with other bacteria such as Escherichia coli, resulting in resistance to other drugs," M'ikanatha added. "Clinicians need to be aware that not all Salmonella infections are caused by 'garden variety' Salmonella. When antimicrobial treatment is indicated for severe Salmonella infections, it is important to look at the susceptibility test results, and determine the appropriate drug(s) to use."
Katie Suda, Pharm.D., of the Hines VA Hospital and the University of Illinois at Chicago College of Pharmacy, and colleagues found that antibiotic prophylaxis prior to dental visits may be associated with patient harm.
"We found that approximately 4 percent of patients who received unnecessary antibiotic prophylaxis prior to their dental visit experienced a serious adverse event," Suda said. "Most of these adverse events were related to either an emergency department visit or allergy. Less commonly, we saw patients who experienced anaphylaxis or Clostridioides difficile infection. These two events were rare; however, they are very serious."
Importantly, according to Suda, dentists are the top outpatient prescribers of clindamycin, and use of this agent is associated with a higher risk for adverse events compared with amoxicillin.
"To improve antibiotic prescribing, a collaboration between dentists, physicians, pharmacists, and patients needs to occur," Suda said. "The U.S. Centers for Disease Control and Prevention core elements of outpatient antibiotic stewardship apply to dentistry and can serve as a model to develop dental antimicrobial stewardship programs. This is an effective approach to improve and standardize prescribing, as we have demonstrated in our earlier study."
One author disclosed financial ties to BioK+.
Angela Campbell, M.D., M.P.H., from the CDC in Atlanta, and colleagues found that receiving the influenza vaccine prevented children from being hospitalized with the flu. More specifically, the investigators found that during a two-season period, influenza vaccination reduced the likelihood of children being admitted to the hospital with influenza by one-half.
For their study, the investigators enrolled children with acute respiratory illness through the New Vaccine Surveillance Network, which includes data from seven CDC-funded pediatric hospital sites during the 2016-2017 and 2017-2018 flu seasons. Approximately, 10 percent of those children enrolled were found to have laboratory-confirmed flu.
"When we compare the ratio of children vaccinated among those who did have flu to the ratio of children vaccinated among those who tested negative for flu, we found evidence that vaccination prevented flu hospitalizations. The vaccine effectiveness against influenza hospitalizations with any influenza virus for fully vaccinated children over the combined 2016-17 and 2017-18 flu seasons was 50 percent, with a 95 percent confidence interval of 36 to 61 percent," Campbell said. "Influenza A(H3N2) viruses were the most common viruses detected nationally in those seasons, but there were also other influenza viruses detected, including influenza A(H1N1)pdm09 viruses and influenza B viruses. Furthermore, in each study year, all of the influenza virus types were associated with hospitalization in children. In fact, in each year, over one-third of children hospitalized with flu had influenza B."
Several authors disclosed financial ties to the pharmaceutical industry.
Shikha Garg, M.D., M.P.H., of the CDC in Atlanta, and colleagues found that in adults 18 to 64 years who were hospitalized with the H1N1 virus, vaccination was associated with a reduced odds of death by 36 percent, a reduced need for mechanical ventilation by 34 percent, reduced intensive care unit (ICU) admission by 19 percent, and reduced pneumonia rates by 17 percent, as well as a shorter ICU length of stay. In addition, vaccination was associated with a reduced odds of mechanical ventilation by nearly one-half and ICU admission by nearly one-third, as well as a shortened hospital length of stay.
"What we did, is use the Influenza Hospitalization Surveillance Network (FluSurv-NET) to analyze data from over 40,000 adults hospitalized with lab-confirmed flu across five flu seasons in over 250 acute care hospitals and across 13 states. We compared outcomes, including the need for ICU admission, development of pneumonia, mechanical ventilation, and death in those patients who received flu vaccine versus those who did not receive the flu vaccine prior to their hospitalization," Garg said. "Our large, population-based study showed that flu vaccine reduced the risk of severe outcomes, including death, among adults who were hospitalized with the flu despite getting vaccinated."
Two authors disclosed financial ties to the pharmaceutical industry.
Martin Hoenigl, M.D., of the University of California in San Diego, and colleagues evaluated risk behavior, HIV preexposure prophylaxis (PrEP) use, and Grindr usage (a geosocial networking app) among men who have sex with men receiving community-based HIV and bacterial sexually transmitted infection screening in central San Diego.
"Overall, 580 of 1,256 participants (46 percent) indicated that they used Grindr in the previous seven days," Hoenigl said. "Grindr users reported significantly higher-risk behavior (greater number of male partners and condomless sex) and were more likely to test positive for chlamydia or gonorrhea (8.6 percent of users versus 4.7 percent of nonusers)."
In addition, the investigators found that Grindr users were also more likely to be on PrEP (18.7 percent of users versus 8.7 percent of nonusers) and had fewer newly diagnosed HIV infections (nine in users versus 26 in nonusers). Grindr users not on PrEP were nearly twice as likely as nonusers to initiate PrEP after the testing encounter (24.6 versus 14 percent).
"Given the higher-risk behavior and greater acceptance of PrEP among Grindr users, PrEP promotional messages on the Grindr platform could enhance PrEP uptake, as well as increase testing for HIV and sexually transmitted infections," Hoenigl said. "The surge of dating apps and their association with high-risk sex offers unique opportunities for broad delivery of prevention messages. Grindr may provide a real opportunity to reach those at risk and substantially increase PrEP awareness and uptake."
One author disclosed financial ties to Gilead.