Special issue on MDR-GNR

The Journal of Hospital Infection have published a welcome special issue on multidrug-resistant Gram-negative bacteria. The collection includes some updates on epidemiology, staff carriage (again!), clinical microbiology, and patient perspectives on CPE, and is well worth a read.

One of the papers in the  collection is a large survey of staff colonisation with MDR-GNR and other antibiotic resistant bacteria in Chinese ICUs. Whilst the carriage rate of MRSA and VRE was reassuringly low (<1% for both), the carriage rate of MDR-GNR was pretty high at 9%. This is much higher than the US study that I posted about last week. Worth remembering though that there are important differences in staff groups (these were ICU staff vs. a mixture of general clinical staff and lab staff in the US study), setting (US vs. China), and sample type (perirectal vs nasal). This last point raises an interesting question: if 9% of staff had nasal colonisation with MDR-GNR, how many had rectal colonisation?! [CORRECTION: on closer inspection, 16% of staff had nasal GNR colonisation, and 9% of staff had either hand or nasal colonisation / contamination with MDR-GNR; we are not told (unless I missed it) the % of staff with nasal carriage of MDR-GNR.]

A fascinating letter by Barbara Slevin and colleagues from Limerick in Ireland highlights the patient perspective on CPE. I heard Barbara present her experiences of the quality improvement initiative at ECCMID last month, and managed to speak to her afterwards. It sounds like the entire organisation were taken on a difficult but ultimately fruitful journey to improve their communication around CPE and other antibiotic-resistant bacteria. The starting point was patients being ‘confused by communication to them of their CPE and the explanatory leaflets provided‘ and using ‘emotive terms such as ‘leper’, ‘pariah’ and ‘plague’ to describe their treatment by staff…‘. I can relate to this: when conducting a universal screening study for MDR-GNR carriage in London, we worked hard on messaging to patients. We began by trying to explain the meaning of technical jargon (the prime example being “CPE”), whereas we found that that starting point needed to be much more straightforward (i.e. antibiotic-resistant germs) with the option to describe specific organisms in more detail for some patients. This change in message resulted in a stark increase in participation in the study.

This also recalls another talk from ECCMID – by Kirsten Schaffer – on the need for better public engagement in AMR generally. The fact is that the AMR-related terms that we use mean nothing to the public, as evidenced by reports from Wellcome and WHO. The O’Neill Review on AMR represents a true step forward in political engagement, but we may need a new vocabulary if we are to achieve successful public engagement.

I could go on, but I’ll leave you to read the rest!

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