I blogged recently about the new ESCMID guidelines on resistant Gram-negative carriage and decolonisation, which supported a “once positive, always positive” approach to CPE carriers due to the lack of effective decolonisation options. A new study suggests that a large majority (75%) of patients who were once identified as CPE carriers no longer had CPE detectable when they were readmitted. This has implications for the management of CPE carriers in hospitals.
Month: October 2019
Single rooms for ESBLs anyone?
A comprehensive and impressive cluster randomised crossover study published in Lancet ID examines whether it makes sense to use single rooms (as compared with multi-bed bays) to apply contact precautions for patients known to be carrying ESBL-Enterobacteriaceae. I need to be careful what I say, because fellow bloggers Marc and Andreas are co-authors. However, the gist seems to be: don’t bother with single rooms for ESBL-E carriers – but many hospitals don’t have capacity to do that anyway, so this may not be a practice-changing finding in many parts of the world!
Formatting scientific papers: a waste of time, money, and grey matter!
Those of you who have published a scientific paper or two will recognise the following process:
Format.
Submit.
Reject.
Reformat.
Submit.
Reject.
Reformat.
Submit.
Accept.
By the end of this process, not only have you lost the will to live (or ever reformat a scientific paper ever again), you’ve also wasted time = money. And chances are, the money has been entrusted to you to perform research, not reformat documents! A recently study counts the cost of this process, concluding that the average scientist spends 52 hours per person per year on formatting / reformatting scientific papers, with a cost of around $500 USD per manuscript or ~$2k per year.
Intra-operative vancomycin: to randomize or not
Today we discussed a recent paper published by our orthopedic surgeons on using powdered vancomycin in the wounds of spinal surgery to prevent surgical site infections (SSI). Two years ago I already had a post on the topic. The powder is spread deep in the wounds, on the bone and metal, before fascia and skin are closed. Yet, none of the 3 guidelines addressing prevention of surgical site infections that appeared recently recommends this intervention; WHO (2016) didn’t even include the intervention, CDC (2017) said “don’t do it”, and NICE (2019) acknowledged that the procedure is widely used without strong supporting evidence and recommended: stop doing it and do a trial. Continue reading
Reflections on Infection Prevention and Control 