An outstanding study from colleagues at Imperial shows that if you use a bucket-load of meropenem (a carbapenem antibiotic) one year, you see an uptick in carbapenem-resistant Enterobacteriaceae (CRE) the next. The figure below plots meropenem use in the previous year with the incidence rate of OXA-48 producing K. pneumoniae CRE.
Figure: The use of meropenem in the previous year plotted against the incidence rate of OXA-48 producing K. pneumoniae
I was privileged to be asked to speak at the inaugural Healthcare Infection Society Middle East Summit in Dubai this week on ‘European approaches to MDR-GNR prevention and control’. You can download my slides here.
I began with a (probably too lengthy) preamble outlining some overall points:
Sorry, as part of the ICPIC organizers, I can’t stop myself to post this.
At ICPIC 2015, there will be a large number of activities related to Ebola virus disease (EVD). Due to the unique experience of field workers and scientific experts present at ICPIC 2015, and considering the large demand, the organizers and scientific committee members are glad to inform ICPIC participants about the many activities around EVD that will take place during ICPIC 2015.
Ebola virus disease will be addressed:
We are convinced that ICPIC participants will get the best insight and advice on Ebola virus disease out of these activities.
For those interested in Ebola I might add that ARIC just published “Preparedness of institutions around the world for managing patients with Ebola virus disease: an infection control readiness checklist” a first project of the newly establish ISC working group on infection prevention and control.
Guest blogger and Acute Medicine trainee Dr Nicola Fawcett (bio below) writes…As the local Prophet of Antibiotic Resistance Doomsday to our population of hospital physicians, I’m always interested in finding out if the pan-drug-resistant superbug has emerged that is going to wipe us all out, for credibility purposes if nothing else. (Resistance Is Coming! Prepare thyself! Wash thy hands and document thy indication and duration or face Everlasting audits and perpetual personal protective equipment!). For the record – I’m actually a Registrar in Acute and General (Internal) Medicine. I’m doing some time in the world of ID/Micro/Genomics in the hope that it will help me work out whether it’s ok to just hand out co-amoxifrusiclavamide + nebs to everyone if not sure what’s going on. However this question seems rather inextricably linked to antibiotic resistance, and having spent some time now with people who seem to know what they’re doing, I’m increasingly flabbergasted at the massive divide between the views of microbiologists who see the latest data, and the views of the common garden hospital physician. Therefore my side-mission, if you like, has become to spread the good, or rather, spectacularly bad news that antimicrobial resistance is currently spreading around our biosphere at a scale and speed at which we simply cannot react fast enough.
So I’m really quite interested in seasonality of infections. I first became interested in it when looking at increases in E. coli bacteraemia for ARHAI (report here) because of Jennie Wilson’s excellent paper showing seasonality of gram negative bacteraemia, echoed by similar observations and conjecture on warmer weather, more infection. This is true in hospitals as well as the community. Why would this be? We have tussled with increasing E. coli bacteraemia in the UK for a few years now. Goes up every summer, does not return to the baseline, goes up again next summer etc., etc.. Other countries have also reported this. I have heard some suggest this is due to longer hours of daylight leading to more barbeques and more sexual activity. Given that the majority of infections in the UK are >70 years of age, my senior years have no fears for me then.
In a short, but important Dutch study, the added value of selective pre-enrichment for the detection of ESBL-producing enterobacteriacea (ESBL-E) was evaluated. The authors used their yearly prevalence study to shed more light onto the question if pre-enrichment (using a broth) might be equally improving the performance of ESBL-E detection, as it does with MRSA. While the literature on the topic might be controversial, this straightforward, well-performed study showed that direct culture failed to identify 25.9% (7/27) ESBL-E rectal carriers, which corresponds to 1.2% (7/562) of the screened population. While the overall rate of ESBL-E rectal carriage is not very high (4.8%) this study still demonstrates the importance of improving our methods to detect multi-drug resistant pathogens.
I always knew it. Pancakes with maple syrup are so good, they must be “healthy”.
Canadian researchers took a different look at North American maple tree syrup. They published that the phenolic compounds contained in the syrup potentiates antimicrobial susceptibility by increasing outer-membrane permeability and effectively inhibit efflux pump activity, in addition to reducing biofilm formation.
After all the research into the antimicrobial activity of foods & spices (e.g. garlic), I am happy to see a less smelly product being promoted. In addition, this may explain why antimicrobial resistance is low in the Netherlands, a country with a proud tradition of pancake restaurants everywhere.
Seriously, antimicrobial activities have been reported from many extracts of “food & spices”, but none really made it into clinical practice. So far the mushrooms seem to be winning. Go Penicillium.
Photo: wikipedia
I gave a talk today at a Pint of Science event entitled “Crapsules: the cure for Cdiff and more”. You can download my slides here. Cdiff infection (CDI) is a nasty disease, usually occurring in those who have taken antibiotics in hospital. It’s characterised by frequent loose stools (often 5 or more movements per day) and frequent recurrence. Around 15-35% of patients with CDI will have a repeat episode. The mainstay treatment for recurrent CDI is antibiotics but the cure rate is poor at around 30%. Remarkably a ‘faecal microbiota transplantation’ (FMT) is way more effective, with a cure rate in excess of 90%.
Vandini et al. (1) evaluate the effect of a microbial cleaner, containing spores of food grade Bacillus subtilis, Bacillus pumilus and Bacillus megaterium in two Italian and one Belgium hospital.
According to the abstract 20,000 microbiological samples were taken from surfaces, during the 24-week investigation, which would equal approximately 120 samples per day!
While nothing about blinding or block-randomization (or any possible approach that would eliminate bias) was mentioned, it is stated that the cleaning staff was not aware which cleaning product they used. Seen the fact that chlorine based-cleaners were the standard products in the two Italian hospitals, this seems hard to believe. The study period started at different times in the hospitals (but not by design) and in opposite to the abstract for different periods of time, namely 6, 24, and 66 weeks, respectively.
I thought for quite some time about whether the title to this post ought to be a statement or a question. I decided on a statement: pretty much wherever you are in the world, I am certain that CRE is now one (hospital) degree of separation from you.
I gave this talk yesterday at the imaginatively named “Darling Bugs of May” IPS conference, and you can download my slides here. I’ve given similar talks before, but the whole thing took on greater significance now I have had some first hand experience of making decisions around the management of CRE patients.
Reflections on Infection Prevention and Control 