Year: 2015

The 12 Days of Infection Prevention and Control

Jon Otter (@jonotter) Infection Prevention and Control ,

outbreak phylogenetic tree

You have to sing this. Out loud. Loud.

 

On the twelth day of Christmas my true love sent to me:

Twelve bowels running

Eleven lines infecting

Ten kids a whooping

Nine hand hygiene dancers

Eight babes a milking

Seven stools a swimming

Six geese a sneezing

No g-o-l-d rings*

Four oozing wounds

Three copper pens

Two sterile golves

And – an – outbreak – in – a – phylogenetic – tree.

 

* Plain metal bands allowed.

 

This blog is inspired by a tweet from @IPS_Infection:

Image: HMS Beagle Blog (awaiting permission).

Surface contamination and respiratory viruses with pandemic potential (SARS, MERS and influenza): an underestimated reservoir?

Jon Otter (@jonotter) Viruses , , , , ,

Droplet airborne direct and indirect contact figure_final

Most virologists would probably tell you that enveloped viruses are generally pretty fragile outside of their host and so wouldn’t survive for long on dry surfaces. They may well say “If you were talking about a non-enveloped virus (like norovirus) then, yes, it would probably survive on surfaces for quite a while. But enveloped viruses, no – you’d be lucky if it survived for more than a few hours.” But when I looked at the literature to investigate the potential for dry surface-mediated transmission of respiratory viruses with pandemic potential (SARS, MERS and influenza), the picture that emerged was quite different. These respiratory viruses can survive on dry surfaces for ages, and the contaminated environment may well be an underestimated reservoir for their transmission. This is summarised in a review published recently in the Journal of Hospital Infection.

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Could phages pre-programed for a “surgical strike” against antibiotic resistant bacteria be the ultimate microbiome-sparing surface disinfectant or skin sanitiser?

Jon Otter (@jonotter) Antibiotic resistance , , , , , ,

phage

It is becoming increasingly clear that a happy, healthy microbiome is fundamentally important to human health. Perturbation of the microbiome – especially in the gut – is responsible for C. difficile infection and probably many other diseases directly and indirectly linked to the gut. This has led to a move towards microbiome-sparing approaches to therapy. Faecal microbiota transplantation is one such approach, which happens to be spectacularly effective for treating recurrent CDI and may also be useful for decolonising carriers of resistant Gram-negative bacteria. A related approach is using a ‘competitive exclusion’ to reduce the level of contamination of hospital surface with hospital pathogens by seeding the surfaces with live Bacillus sp. spores. But wouldn’t it be great if there was a way to specifically target antibiotic-resistant bacteria and leave yourself with an antibiotic-susceptible population?

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Can a wound dressing colour change indicate infection?

Jon Otter (@jonotter) Wound care , , ,

wound dressing

For many years, diagnostic labs have used colour change as a marker for the growth of specific microbes. Think of all those chromogeneic agar plates that your lab goes through each day. And there are all sorts of broths that change colour in response to specific chemical changes caused by microbial growth. One of the first projects I was ever involved with was environmental sampling for MRSA at Lewisham hospital, where we used a selective broth that turned bright yellow when MRSA was present. So in a way, it is surprising that this approach has not been adopted as a marker to indicate wound infection.

Scientists at Bath Uni have developed a neat novel wound dressing that fluoresces when the early signs of an infection are present. The concept is simple: a gel containing tiny sacs of dye are included in a hydrogel dressing; if cytotoxins that are indicative of bacterial infection are present, they lyse the sacs and release the dye, which fluoresces under UV light.

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Is it true that I have to finish my antibiotic treatment as prescribed?

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , ,

Schermafbeelding 2015-11-21 om 15.01.52

It is always the same. If I think that I had a reasonable idea and put it on-line, it will only take a day or two, until friends and colleagues let me know, that others had the same idea – just earlier. In this case, John Ferguson (@mdjkf), brought to my attention, that Professor Lyn Gilbert started the same discussion in Australia (Link). As always, I am depressed for about 5 seconds and start to come up with a new, old idea.

Despite the discussion in Down-under, I have promised to post the results of my questionnaire. On Twitter, some were surprised how little evidence exists to support antibiotic prescribing dogmas (Eli Perencevich, @eliowa), whereas others like Christina Vandenbroucke-Grauls (@ChristinaGrauls) believe that we have plenty of evidence from lab experiments and theory to answer the question. Most importantly, “every bit of antibiotic leads to resistance”.

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Transmissible colistin resistance – made in China

Jon Otter (@jonotter) Antibiotic resistance , , , ,

colistin made in china

The emergence of CPE (and carbapenem-resistance in other Gram-negative bacteria) has forced us to reach to the dusty old antibiotic shelf to revive the clinical use of older agents with activity against Gram-negative bacteria, principally colistin. Colistin isn’t perfect by any means – it has poor tissue penetration compared with the carbapenems, and is associated with nephrotoxicity (although the high levels of nephrotoxicity in the older medical literature has not been reported due to better management of the drug). Furthermore, resistance has already been reported. To date – this has been mutational resistance, which does not have the capacity to spread horizontally. It was only a matter of time before a colistin resistance gene mobilised.

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Antibiotic Awareness: background and links

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , , ,

European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project

The EuSCAPE project aimed to improve understanding of the occurrence and spread of CPE. LINK

Schermafbeelding 2015-11-17 om 22.29.04.png

About European Antibiotic Awareness Day

European Antibiotic Awareness Day is a European health initiative coordinated by ECDC which aims to provide a platform and support for national campaigns on the prudent use of antibiotics. Each year across Europe, the European Antibiotic Awareness Day is marked by national campaigns on the prudent use of antibiotics during the week of 18 November. Prudent use means only using antibiotics when they are needed, with the correct dose, dosage intervals and duration of the course. Follow the European Antibiotic Awareness Day: #EAAD. http://antibiotic.ecdc.europa.eu

About World Antibiotic Awareness Week

The World Health Organization is leading a global campaign for the first World Antibiotic Awareness Week with the slogan “Antibiotics: Handle with Care”. The campaign calls on individuals, governments and health and agriculture professionals to take action to address this urgent health problem. The first World Antibiotic Awareness Week will take place on 16-22 November. Follow the World Antibiotic Awareness Week: #AntibioticResistance. www.who.int/drugresistance.
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European Antibiotic Awareness Day 2015: ESPAUR report highlights progress and challenges

Jon Otter (@jonotter) Antibiotic resistance , , ,

eaad_2015

For those of you who have had your head in a hole all week, you may not be aware that today is European Antibiotic Awareness Day, which coincides with Global Antibiotic Awareness Week. The antibiotic stewards amongst us (which should really be all of us!) have launched many and varied campaigns to highlight the need to handle antibiotics, our ‘miracle drugs’, with care (see Andreas’ 30-second-antibiotics-myth-buster-survey, for example).

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The 30-Second-Questionnaire: Antibiotic Myth Buster

Andreas Voss (@AVIPNL) Antibiotic resistance, General , , ,

Schermafbeelding 2015-11-13 om 11.53.54

Here we are again, the year flew by and it’s time for Antibiotic Awareness Day/Week. This time around, I will spend my time in a call-center, answering questions of concerned citizens/ex-patients in Germany. Smart idea of a friend in the German public health service and probably smarter than doing what we usually do: organize a meeting, ask all our colleagues to come, and preach to our own community.

While I believe that there is no ID or Clin Micro person left that is not convinced of the importance of saving our miracle drugs (Australian campaign), I know that I will get questions I can’t answer, or at least, don’t know if my answers are truly true.

Here it goes, my antibiotic conundrum that could  be classified as “Antibiotic Myth”:

Is it true that I have to finish my antibiotic treatment as prescribed?

Will “too short” lead to antimicrobial resistance, or is it the “too long”? My guess, 99% of the professionals will answer this question by releasing an avalanche of questions, regarding the bug, the host and the site of infection, but I have to insist on a simple “yes” or “no”. Sorry, but those are the rules of the “30-Second-Questionnaire” and you can’t argue the rules.

Thus here is my request. Follow the link to the questionnaire, take 30 seconds to answer the question (and 4 others) and email, twitter, blog or use any kind of communication you can think of to forward it to your friends and family. I promise, I will post the outcome right here, a week or two later.

 

UK guidelines for the control of multidrug-resistant Gram-negative bacteria

Jon Otter (@jonotter) MDR-GNR , , , , ,

amr wiki

The UK guidelines for the prevention and control of multidrug-resistant Gram-negative bacteria (MDR-GNB) are published this week. It’s useful that the publication of these guidelines coincides with Antibiotic Awareness Week because MDR-GNB are brining us ever closer to the end of antibiotics. Although the guidelines don’t cover the treatment of MDR-GNB (this will be addressed in a forthcoming guideline), these highly resistant MDR-GNB leave few therapeutic options. Even when they remain susceptible to some antibiotics, these antibiotics are not front-line antibiotics for a reason (including poor tissue penetration and side effects). Furthermore, we are already seeing resistance to last-line (aka end of the golden-antibiotic-road) antibiotics e.g. colistin. Therefore, the old adage that ‘prevention is better than cure’ has never been so true!

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