People have been talking in apocalyptic terms for years – probably decades – about the threat of AMR. But has this really materialised? MRSA BSIs are now rare in the UK, and C. difficile infections are rarer than they once were. But things are looking considerably gloomier in other parts of the world. For example, a frankly shocking study from a Greek ICU gives us a view of what a post-antibiotic apocalypse may look like…
The Department of Health have published a new 5 year National Action Plan to combat AMR (2019-2024) to follow on from the 2013-2018 edition. IPC and antimicrobial stewardship are high on the agenda – but we have a long way to go if we are to fulfil the 20 year vision for AMR: ‘By 2040, our vision is of a world in which antimicrobial resistance is effectively contained, controlled and mitigated.’
Allow me to set the scene: I was visiting an elderly relative in an NHS hospital recently (they would deny being elderly – but I’m afraid it is now true). I witnessed a healthcare worker moving efficiently from bed to bed examining each patient (including direct patient contact) to take observations without any hand hygiene between patients and without decontamination of the reusable blood-pressure cuff. I explained to my relative the need to challenge this behaviour. My relative asked – almost pleaded with me – not to intervene saying “you’ll clear off and they’ll be left caring for me overnight”. So, did I have the courage to defy my relative and challenge this behaviour?
Although there’s some controversy about whether or not we should apply contact precautions (by that I mean single room isolation, enhanced PPE, enhanced disinfection etc) all the time for all organisms, it would be a brave hospital to eschew contact precautions for CPE carriers. And so the question of whether and when we should ‘de-isolate’ patients with known CPE is an FAQ. And so enter a recent study in CMI comparing the spontaneous apparent loss of colonisation with various CPEs, concluding that KPC carbapenemases seem to hang around for longer than NDM carbapenemases, but both almost always last for the duration of a single hospitalisation.
Now that 2018 is behind us, I thought I’d share with you, dear readers, the hottest reflections from 2018.
It’s becoming a bit of a tradition for me to post about an article from the fabulous Christmas BMJ with a spurious link to infection (see 2016 [depressing] and 2017’s [uplifting] version here). This year, it’s a short-term behavioural intervention to prevent weight gain over Christmas. And the links to infection: obesity is a big (!) risk factor for all-things-infection, and we’re all about achieving meaningful and sustained behaviour change.
I attended a thought-provoking session at the recent Healthcare Infection Society (HIS) conference in Liverpool on reducing GNBSI (you can download some of the speaker abstracts here). It seems that the hefty majority of E. coli BSIs are rooted in issues outwith the walls of acute hospitals. So the question is, who’s going to tackle these issues to prevent GNBSI? Who’s going to go for GNBSI (sorry, couldn’t resist another pop-culture reference to the ‘80s – who could forget ‘Going for Gold’ with Henry Kelly).