- Multistate Outbreak of Burkholderia cepacia Infections
- C. Difficile – Are Carriers Spreading the Germ?
- Overcoming Infection Control Challenges
- Share Your Ideas and Feedback with the Presidential Advisory Council
- Early Detection of New Antibiotic Resistance
- Setting Goals for Antibiotic Prescribing
- Prevention Epicenters
- The Core Elements of Antibiotic Stewardship for Nursing Homes
- State-by-State Fact Sheets Show CDC’s Work to Combat AR
Multistate Outbreak of Burkholderia cepacia Infections
Update August 10, 2016
FDA released an updated statement including a voluntary recall of all of liquid products manufactured by PharmaTech and distributed by: Rugby, Major, Bayshore, Metron, Centurion, and Virtus.
This issue remains under investigation. In addition to the above recall of all liquid products manufactured by PharmaTech, both FDA and CDC continue to recommend that clinicians and patients not use any brand of liquid docusate sodium product as a stool softener or for any other medical purpose.
To date, CDC has confirmed 60 cases from 8 states.
An update will be posted in approximately one week.
Update July 18, 2016
Case count corrected as of July 18, 2016. CDC has confirmed 49 cases from 5 states.
Update July 16, 2016
FDA has released a statement regarding a voluntary recall of certain liquid docusate products. The extent of this issue remains under investigation; therefore, both FDA and CDC continue to recommend that clinicians and patients not use any liquid docusate sodium product as a stool softener or for any other medical purpose.
Update July 14, 2016
At this time, CDC and FDA continue to actively investigate this issue. CDC has confirmed 53 cases from 5 states. All recommendations detailed in the last update stand. We will provide an update to this announcement soon. Please direct questions to firstname.lastname@example.org. Members of the media should contact the CDC Media Office at email@example.com.
Update July 8, 2016
CDC continues to work with FDA, health departments and multiple healthcare facilities to investigate a multi-state outbreak of infections caused by Burkholderia cepacia complex (also known as “B. cepacia complex”). At this time, CDC continues to recommend that clinicians not use any liquid docusate product as a stool softener or for any other medical purpose. This recommendation is now expanded to all patient populations. If an oral liquid docusate stool softener is medically necessary, alternative medicines should be used.
CDC urges healthcare providers and laboratories to remain on alert for infections caused by B. cepacia complex occurring among non-cystic fibrosis (CF) patients and should inform infection prevention staff immediately when these infections are identified. In addition, although infections caused by B. cepacia complex are known to occur among patients with CF, any clusters of such infections should be reported. Cases and clusters should be reported to state or local public health authorities.
Facilities that identify infections caused by B. cepacia complex among non-CF patients or clusters of these infections among CF patients should sequester and save all docusate products used in the facility.
To date, 47 B. cepacia complex cases have been confirmed by molecular typing to match one of two outbreak strain types identified from healthcare facilities in five states. Reports of possible cases from additional states are currently being investigated. CDC has confirmed that two samples of unused oral liquid docusate product received from one of the affected hospitals have tested positive for B. cepacia complex. Further testing is being conducted to determine if bacteria from these samples match the outbreak strains. FDA is currently testing multiple liquid docusate products that are epidemiologically linked to reported B. cepacia complex cases. To date, CDC has confirmed one product as having B. cepacia complex growth; however, because of epidemiologic links, CDC is concerned about potential contamination of multiple liquid docusate products, pending FDA’s ongoing investigation of shared ingredients in the products in question.
Update July 7, 2016
At this time, CDC and FDA are actively investigating this issue. Additional updates will be posted soon.
Update June 29, 2016
Preliminary information continues to indicate that contaminated oral liquid docusate products might be related to B. cepacia complex infections in one state. At this time, there is no epidemiologic or laboratory evidence to suggest oral capsules or enemas are affected. Until more information is available, CDC continues to recommend that facilities not use any oral liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed. Facilities that experience B. cepacia complex infections among non-cystic fibrosis patients or clusters of B. cepacia complex infections among cystic fibrosis patients should sequester all oral liquid docusate products.
Healthcare providers and laboratories should remain on alert for B. cepacia complex infections occurring among non-cystic fibrosis patients and should inform infection prevention staff when these infections occur. In addition, clusters of B. cepacia complex infections among patients with CF should be reported when infection rates appear above endemic rates. Cases should be reported to state or local public health authorities.
CDC will provide an update to this announcement by July 7. Please direct questions to CDC at firstname.lastname@example.org.
Update June 24, 2016
The Centers for Disease Control and Prevention (CDC) is collaborating with the Food and Drug Administration (FDA), multiple state and local health departments, and numerous healthcare facilities to investigate a multi-state outbreak of Burkholderia cepacia infections. These infections have occurred primarily in ventilated patients without cystic fibrosis and who are being treated in intensive care units.
Preliminary information indicates that a contaminated liquid docusate product might be related to cases in one state. Until more information is available, CDC recommends that facilities not use any liquid docusate products for patients who are critically ill, ventilated, or immunosuppressed. Institutions with non-cystic fibrosis patients in whom there are B. cepacia infections should sequester all liquid docusate products.
Healthcare providers and laboratories should be on alert for B. cepacia cases occurring among non-cystic fibrosis patients and should inform infection prevention staff when these infections occur. Cases should be reported to state or local public health authorities.
Please direct questions to CDC at email@example.com.
C. Difficile – Are Carriers Spreading the Germ?
A Commentary in JAMA Internal Medicine
On today’s CDC Safe Healthcare Blog, CDC’s Dr. Clifford McDonald talks about the bacteria that most often causes healthcare-associated infections – Clostridium difficile (C. difficile). There is increasing evidence that patients who carry C. difficile but who are not sick can still spread the germ and make other people sick.
Dr. McDonald and CDC colleague Dr. Alice Guh dig further into this issue in a recent JAMA Internal Medicine article. Their piece is focused on a recent study where clinicians proactively looked for and isolated C. difficile carriers (patients without symptoms) upon hospital admission. In this study, this practice was linked to far fewer cases of healthcare-associated C. difficile infections.
Read Dr. McDonald’s blog post at DHQP’s Safe Healthcare Blog to learn more.
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Overcoming Infection Control Challenges in Post-Acute and Long-Term Care Settings
On CDC’s Safe Healthcare Blog, Hudson Garrett, PhD, discusses unique infection control challenges in post-acute and long-term care settings.
Dr. Garrett, Editor-in-Chief of The Director: Journal of the National Association of Directors of Nursing Administration in Long Term Care (NADONA), explains that post-acute and long-term care settings cater to a complex patient population transitioning out of the hospital. These patients still require a significant amount of care and support, which can make infection control and prevention difficult.
In order to reduce healthcare-associated infections (HAIs) in these settings, it is important for healthcare professionals across disciplines to collaborate by sharing best practices, championing HAI reduction initiatives, and sharing data.
Read Dr. Garrett’s blog post at DHQP’s Safe Healthcare Blog to learn more and join the conversation!
Antibiotic Resistance: Share Your Ideas and Feedback with the Presidential Advisory Council
The Presidential Advisory Council on Combating Antibiotic Resistant Bacteria (PACCARB) has issued a public Request for Information (RFI) regarding antibiotic resistance and use.
The purpose of the RFI is to gain additional input from the public about the National Action Plan for Combating Antibiotic Resistant Bacteria. Responses gathered from the RFI will be taken into consideration as PACCARB moves forward with activities.
Share your feedback by June 22: http://www.hhs.gov/webforms/paccarb-request-for-information.
Join the PACCARB public meeting, June 21-22, 2016: http://www.hhs.gov/ash/advisory-committees/paccarb/meetings/upcoming-meetings/june-21-22-2016-public-meeting/index.html.
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Just over a year ago, President Obama released a National Action Plan for Combating Antibiotic Resistant Bacteria. As part of that plan, he also charged the DoD, USDA and HHS with co-chairing a Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria (Advisory Council). In the past year, our three agencies and the Council have held numerous stakeholder meetings, made new discoveries, and undertaken new research to preserve the effectiveness of antibiotics.
In recent weeks, our three agencies have made some important discoveries regarding antibiotic resistance in the United States. Earlier this week, the Department of Defense notified stakeholders that its Multidrug-resistant Organism Repository and Surveillance Network (MRSN) at the Walter Reed Institute of Research had identified the first colistin-resistant mcr-1 E. coli in a person in the United States. A USDA and HHS search for colistin-resistant bacteria in food animals, retail meats and people also has found colistin-resistant E. coli in a single sample from a pig intestine.
These discoveries are of concern because colistin is used as a last-resort drug to treat patients with multi-drug resistant infections. Finding colistin-resistant bacteria in the United States is important, as it was only last November that scientists in China first reported that the mcr-1 gene in bacteria confers colistin resistance. Following the revelation in China, scientists across the globe began searching for other bacteria containing the mcr-1 gene, and the bacteria have since been discovered in Europe and Canada. Read more on the HHS blog.
FREE CDC Webinar: Setting Goals for Antibiotic Prescribing in U.S. Outpatient Settings
In May, the Centers for Disease Control and Prevention (CDC), in collaboration with Pew Charitable Trusts and others, released new data showing that at least 30 percent of all prescriptions written in doctors’ offices and emergency rooms are completely unnecessary. Now that we have this alarming data, how do we improve?
- A detailed explanation of the findings published in the May 2016 JAMA article
- What CDC is doing to promote antibiotic stewardship across healthcare settings
- An update on Get Smart About Antibiotics Week 2016
Webinar: United States Outpatient Antibiotic Prescribing and Goal Setting
Tuesday, June 28, 2016 from 1:00–2:00 p.m. EDT
Register for the meeting online: https://cc.readytalk.com/r/de4m2f81fneq&eom
Learn more about CDC’s Antibiotic Stewardship work:
- Get Smart: Know When Antibiotics Work: Information and resources on appropriate antibiotic prescribing across healthcare settings.
- Get Smart for Healthcare: Information and resources on appropriate antibiotic prescribing in inpatient healthcare facilities.
- Get Smart About Antibiotics Week 2016: Information on the upcoming one-week observance, November 14-20, 2016, to raise awareness of the threat of antibiotic resistance and the importance of appropriate antibiotic prescribing and use.
Pressing Fast Forward on Patient Safety: CDC Announces $26 million for Prevention Epicenters
CDC has awarded $26 million to support applied research at five academic medical centers as part of a patient safety effort known as Prevention Epicenters Program. Together with CDC, these Prevention Epicenters develop and test innovative approaches to preventing infections and improving patient safety in healthcare settings. The new funding more than doubles previous awards and expands and extends the Prevention Epicenters program to 2020.
Prevention Epicenters funded from 2016 to 2020:
- Chicago Prevention and Intervention Epicenter at Rush University Medical Center and Cook County Health and Hospitals System
- Duke University and the University of North Carolina
- The Harvard Pilgrim Health Care and University of California, Irvine
- The University of Pennsylvania
- Washington University School of Medicine in St. Louis and BJC Healthcare
“For nearly two decades, the Epicenters have advanced the fight against healthcare-associated infections with practical clinical innovations that have saved lives,” said CDC Director Tom Frieden, M.D., M.P.H. “Antibiotic-resistant infections are on the rise, making this research even more critical today than ever.”
To learn more: http://www.cdc.gov/HAI/epiCenters/about.html
Also, today, on CDC’s Safe Healthcare Blog, Epicenter Principal Investigators Drs. Mary Hayden and William Trick discuss how their organizations are accelerating practical patient safety and antibiotic resistance research. From studying the best way to clean patients’ skin to figuring out how gut bacteria affect a patient’s risk of getting a drug-resistant infection – the Chicago Prevention and Intervention Epicenter is helping drive patient safety and transform patient care.
Join the conversation! Read the full blog at http://blogs.cdc.gov/safehealthcare/?p=5482
State-by-State Fact Sheets Show CDC’s Work to Combat AR
Just released, a new tool shows CDC’s key investments to combat antibiotic resistance (AR) across the nation.
The CDC AR Investment Map includes an interactive web app and printable state- and city-specific fact sheets describing CDC’s work to tackle AR using fiscal year 2016 funds. Use these fact sheets to see how CDC supports AR activities in your area.
View funding amounts by state and activity, including investments in:
- State and local public health partners to fight AR in healthcare facilities, the community, and food.
- Innovations and investigations to implement new ways to prevent antibiotic-resistant infections and contain their spread.
- Public health laboratories to boost state and local testing capacity and technology to detect and contain, support response to, and prevent AR threats nationwide.
Combating antibiotic resistance is a CDC priority. We must remain vigilant to address and contain this ongoing threat as demonstrated by this week’s publication in CDC’s Morbidity and Mortality Weekly (MMWR) report.
With these investments and the AR Solutions Initiative, CDC, in partnership with health departments, academia, and healthcare, is transforming how the nation combats and slows antibiotic resistance at all levels. Working together we can stand up a full, faster response to protect Americans from this threat.