Science in transition, or not?

Something is happening in my university. My dean, prof. Frank Miedema (H-index >70), and friends discovered that the blibliometric way of evaluating quality of science (of a person or an institute) is wrong. (Especially) Young researchers are pursuing – for the wrong reasons – a high H-index (many papers cited frequently) and the publication pressure distracts them from doing the better things for patients and society. So, they decided to break free, and they tell their story this week in Nature (high impact factor, isn’t that what they call irony?).

I whole-heartedly agree with the philosophy of “Science in transition”. The impact system is sick, see. In Nature, also the story of Mark Ferguson, former dean of biology at the University of Manchester: as a predecessor of the Science Transitioners he decided 20 years ago that professor applicants should, instead of their impressive publication list, submit what they considered their 3 most important publications, with motivation.

That made me think. What would I submit? Here they are:

The recognition that the number of other patients with VRE in a ward is the best predictor for new acquisitions, see. Bob Weinstein named it colonization pressure, and the subsequent recognition that this number in the ward is influenced not only by acquisitions, but also by admitted and discharged patients got me on a plane to Oxford to learn about mathematical modelling and that the dynamics of AMR in a hospital are quite similar to malaria (healthcare workers being mosquitos). Today, I still enjoy working with mathematicians.

Two years later we had the first 2 outbreaks with VRE in the Netherlands. We studied these isolates, together with a bunch of isolates I took home from Chicago and other outbreaks across the globe. Rob Willems and Janetta Top discovered that all outbreak isolates contained the esp-gene (and others did not), see. Now we know that a subclade of E. faecium, containing esp and much more, is responsible fort he global pandemic of ampicillin-resistant and vancomycin-resistant E. faecium. Today, I still enjoy working with molecular biologists.

Six years ago we thought of ways to bypass the hurdles that killed clinically relevant research for treating community-acquired pneumonia (CAP); antibiotics before randomization to study antibiotics and enrolling only a fraction of those actually treated for CAP. Inspired by a previous study we used a cluster randomized approach and changed the hospital antibiotic policy every 4 months, see. The 3 options were – without preference – recommended by our national guideline. It took us 3 years  to get funding and IRB approval, but in the end we were among the first to integrate randomized comparative effectiveness research with patient care, see. I firmly believe that this type of research is the future for infection prevention.

Not sure if I would have been hired, since all 3 studies were published in respectable journals (and were cited). My point, science must transit, but it should not stop us from publishing our work in journals that are read by many colleagues, as I am convinced that these studies would not have received the same attention if published in non-peer-reviewed journals. I trust my dean & Science in Transition are with me on this.

I wrote this blog while listening to my playlist on Spotify, and at the end of writing Carly Simon sang “You’re so vain”.

Breaking the chain of infection – hygiene is everyone’s responsibility

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As International Infection Prevention Week (#IIPW) continues, Prof Sally Bloomfield writes a guest blog on the principles of breaking the chain of infection. Whilst the blog is focused on home and everyday life settings, the principles are relevant to healthcare facilities too!

This is international Infection Prevention Week. To address this year’s theme “Breaking the Chain of Infection” the International Scientific Forum on Home Hygiene (IFH) has produced a simple online resource Breaking the Chain of Infection.

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Chased by an antibiotic-induced C difficile-shaped shadow

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A fascinating new JAMA Internal Medicine study suggests that being admitted to a room when the prior occupant had taken antibiotics increases the risk of the subsequent occupant of the same room developing C. difficile infection (CDI). Quite a few convincing epi studies have showed that admission to a room when the prior occupant was known to have a number of key pathogens (including C. difficile) increased the chance of acquisition for the subsequent occupant. But this study extends the ‘prior room occupancy’ concept into a new dimension!

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(no More) fear of flying*

Last Friday Jarne van Hattem presented findings on ESBL carriage in Dutch travelers returning from ESBL-rich countries at our NCOH meeting and the next day the results appeared in Lancet ID. A great study; quantifying things we already thought, extending our knowledge on risk factors and providing new information on the public health aspects of these imported bacteria. They concluded that acquistion and spread are “substantial and worrisome”. Too bad: all the quantified knowledge lost in 2 meaningless words.

In short, they studied 2001 travelers (ESBL carriage before travel 6.1%) and 34.3% of the non-carriers acquired ESBL during travel; especially in southern Asia (75.1%). Risk fators for acquisition: persisting diarrhea, ciprofloxacin use and eating street food. The median duration of carriage after return was 30 days and 11.3% was still colonized ater 1 year. This implies that returning travelers (depending on region) must be considered at risk for ESBL-carriage (no matter whether they have additonal risk factors) during a certain period of time. Yet, median duration of carriage is short and after 1 year that risk is fairly close to the ESBL-prevalence in the Dutch population.

Is this carriage a health risk for travelers? With >500,000 Dutch travelers to ESBL high-endemicity regions per year, many will acquire (according to what we can detect) ESBL, but how many will develop infections caused by these ESBL-producing bugs? That now is a burning question.

Is this import of ESBL a risk for the Dutch public, that we intend to protect against infections caused by AMR? They also investigated the occurrence of within-household transmission of these bacteria in 215 non-travelling household members and quantified rates with a Markov model. The figure that got most attention was the “12% probability of transmitting ESBL-E to another household member”. Yet, much more informative is the actual transmission rate from which one can derive the effective R0. This rate was 0,0013/carriage day and the calculated effective R0 was around 0.2 (Martin Bootsma personal communication), which might include some overestimation due to false-positive transmission events (no molecular typing). An R0 of 0.2  seems not enough to cause continued transmission – leading to endemicity – coming from these sources, especially since transmission to the next ring (to non-household members) will be less effective. Simply said: returning travelers their household members seem to be – in the Netherlands – dead-end roads for ESBL-producing bacteria. That could be expressed as reassuring.

*Title stolen from Gary Brooker

CPE Thrill-seeking

Yesterday I attended a meeting at the Wellcome headquarters in the middle of London. I deliberately exposed myself to several risks: by car from home to Schiphol, by plane to London City and by public transport to the meeting. Each transition harbors a quantifiable risk of ending up in a hospital (accidents, assaults, cardiac events) where there is a quantifiable risk of developing HAI, and I am especially afraid of CPE.

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I see a GNBSI reduction target on the horizon…

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I have finally got around to reading the UK Government response to the AMR Review, which includes some interesting details about aspirations to reduce Gram-negative BSIs (GNBSI) and antibacterial agent usage in human and animal health.

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Reflections from Infection Prevention 2016

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As is now becoming traditional, I thought I’d share a few reflections from the recent IPS conference in Harrogate. Fantastic to see the submitted abstract published, full and free, in a Journal of Infection Prevention supplement.

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