Author: Andreas Voss (@AVIPNL)

Hand hygiene – social norms and compassion

Andreas Voss (@AVIPNL) Hand hygiene, Uncategorized , , ,

Schermafbeelding 2016-04-26 om 21.00.15

I just saw Sanjay Saint’s TEDx UofM-talk and have to say that I was impressed. The message is clear, the characters portrayed recognizable, and the conclusion something we all have to agree with. I “love” his final thoughts (and if you watch the talk to the end you know why I used “love”) and I share his views on compassion. Intentionally we branded our campaign for better infection control as “iCare”.Schermafbeelding 2016-04-26 om 21.02.03

Hope you enjoy Sanjay’s talk as much as I did: http://www.youtube.com/watch?v=U3MtvvNjUR4&sns=em

LA-MRSA: The Never-ending Sequel

Andreas Voss (@AVIPNL) MRSA, Uncategorized , , ,

Over the last years, we have been getting used to the fact, that commercial pig, veal, and chicken farms, as well as horse breeding, is associated with a risk of animal to human transmission of livestock-associated Methicillin-resistant Staphylococcus aureus (LA-MRSA). In the line of suspects, chicken were the last to be conformed as true source of LA-MRSA. Van Duijkeren et al (J Antimicrob Chemother 2016;71:58-62) investigated addition feathered suspects, namely dugs and turkeys.

Schermafbeelding 2016-04-23 om 16.20.16First of all lets get Donald & friends of the list of suspects. In only one of 10 duck farms that were investigated, MRSA was found in the samples from the animals and duck houses. None of the humans living or working on duck farms, nor any part of their residence, was MRSA-positive. It therefore seems save to conclude that ducks pose no danger for transmission of LA-MRSA.

 

Schermafbeelding 2016-04-23 om 16.16.27Unfortunately, the story about turkeys seems to be different. Overall, 3 of the 10 turkey farms harbored MRSA. In addition, MRSA was found in 16% of the humans and 31% of the farmhouse samples. The highest risk was seen among the turkey farmers themselves (45.5% MRSA-positive), but employees and family members (6.3%) weren’t free of risk, either. Significant risk factors found by the investigators were: having physical contact with the animals and visiting poultry houses.

In 2 out of 3 frams in which MRSA was found among the animals and the humans, whole genome mapping showed >95% homology, corroborating the strong evidence for animal-to-human transmission of MRSA on turkey farms.

Poultry production and antimicrobial resistance in India

Andreas Voss (@AVIPNL) Antibiotic resistance , ,

Schermafbeelding 2016-03-31 om 00.46.37

Take a look at these three stories on intensive poultry production and antimicrobial resistance in India published yesterday on the Bloomberg website. In accordance with what the movie industry does, these articles should be accompanied by a warning: “These articles contains scenes that some readers may find disturbing”. As the editor of the articles said in an email to colleagues that forwarded it to me: “I think you’ll agree that these are important stories and deserve attention (and hopefully a response from the appropriate authorities and the community).” Obviously, I do agree.

http://www.bloomberg.com/news/features/2016-03-29/antibiotic-apocalypse-fear-stoked-by-india-s-drugged-chickens

http://www.bloomberg.com/news/articles/2016-03-29/hen-s-eye-view-of-drug-use-in-the-fastest-growing-chicken-market

http://www.bloomberg.com/news/articles/2016-03-29/baby-s-death-shows-global-threat-from-wonder-drug-s-demise

Adapt to adopt | Didier Pittet | TEDxPlaceDesNations

Andreas Voss (@AVIPNL) Hand hygiene, Uncategorized ,

Schermafbeelding 2016-03-21 om 22.42.44

Just as another way of sharing here the link to Didier’s TEDx PlaceDesNations talk: http://tinyurl.com/AdaptToAdopt or click on the picture.

Probable Person-to-Person Transmission of Legionella

Andreas Voss (@AVIPNL) Legionella , ,

Schermafbeelding 2016-03-04 om 00.40.08

Ana M. Correia and colleagues (N Engl J Med 374;5 February 4, 2016) present a convincing case of person-to-person transmission of Legionnaires’ disease between son and mother. Seen the epidemiology of the two cases and the results of whole-genome sequencing, the only part of the short report I do not understand is the “probable” in the title. I wouldn’t know what else to include in order to call it “proven”.

Consequently, the question is whether this “new” transmission route has implication for infection control in the hospital setting. The mother had very close contact over an extended amount of hours with her severely coughing son, in a small and badly ventilated room. In opposite to HCWs who in this situation generally would wear a mask, she obviously used no personal protective equipment. Finally, while described as formerly healthy, no further details are given about the conditions possibly increasing the susceptibility of the 74-year old to Legionella.

Thus, while person-of-person transmission seems proven in the present case, I believe that the circumstances are unique and don’t require to change the present infection control measures taken in patients with Legionnaires disease.

Crapsules part 2

Andreas Voss (@AVIPNL) C. difficile , ,

How do you like your crap? Fresh or frozen?

Schermafbeelding 2016-01-19 om 22.44.47Since Jon’s post on crapsules is one of the most favorite on the blog, I assumed that many of you might enjoy a sequel.

Clostridium difficile infections (CDI), most certainly after the emergence of hypervirulent strains at the beginning of this millennium, have become a major cause of morbidity and mortality in hospital and (to a lesser degree) community patients. One in four patients will suffer from recurrent CDI and treatment options are limited. Consequently, fecal microbiota transplantation (FMT) has become a valuable alternative, but is not readily available. Using frozen FMT would make the logistics far easier and finally something frozen seems to be as good as fresh, according to this JAMA study!

Is it true that I have to finish my antibiotic treatment as prescribed?

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , ,

Schermafbeelding 2015-11-21 om 15.01.52

It is always the same. If I think that I had a reasonable idea and put it on-line, it will only take a day or two, until friends and colleagues let me know, that others had the same idea – just earlier. In this case, John Ferguson (@mdjkf), brought to my attention, that Professor Lyn Gilbert started the same discussion in Australia (Link). As always, I am depressed for about 5 seconds and start to come up with a new, old idea.

Despite the discussion in Down-under, I have promised to post the results of my questionnaire. On Twitter, some were surprised how little evidence exists to support antibiotic prescribing dogmas (Eli Perencevich, @eliowa), whereas others like Christina Vandenbroucke-Grauls (@ChristinaGrauls) believe that we have plenty of evidence from lab experiments and theory to answer the question. Most importantly, “every bit of antibiotic leads to resistance”.

Continue reading →

Antibiotic Awareness: background and links

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , , ,

European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project

The EuSCAPE project aimed to improve understanding of the occurrence and spread of CPE. LINK

Schermafbeelding 2015-11-17 om 22.29.04.png

About European Antibiotic Awareness Day

European Antibiotic Awareness Day is a European health initiative coordinated by ECDC which aims to provide a platform and support for national campaigns on the prudent use of antibiotics. Each year across Europe, the European Antibiotic Awareness Day is marked by national campaigns on the prudent use of antibiotics during the week of 18 November. Prudent use means only using antibiotics when they are needed, with the correct dose, dosage intervals and duration of the course. Follow the European Antibiotic Awareness Day: #EAAD. http://antibiotic.ecdc.europa.eu

About World Antibiotic Awareness Week

The World Health Organization is leading a global campaign for the first World Antibiotic Awareness Week with the slogan “Antibiotics: Handle with Care”. The campaign calls on individuals, governments and health and agriculture professionals to take action to address this urgent health problem. The first World Antibiotic Awareness Week will take place on 16-22 November. Follow the World Antibiotic Awareness Week: #AntibioticResistance. www.who.int/drugresistance.
Continue reading →

The 30-Second-Questionnaire: Antibiotic Myth Buster

Andreas Voss (@AVIPNL) Antibiotic resistance, General , , ,

Schermafbeelding 2015-11-13 om 11.53.54

Here we are again, the year flew by and it’s time for Antibiotic Awareness Day/Week. This time around, I will spend my time in a call-center, answering questions of concerned citizens/ex-patients in Germany. Smart idea of a friend in the German public health service and probably smarter than doing what we usually do: organize a meeting, ask all our colleagues to come, and preach to our own community.

While I believe that there is no ID or Clin Micro person left that is not convinced of the importance of saving our miracle drugs (Australian campaign), I know that I will get questions I can’t answer, or at least, don’t know if my answers are truly true.

Here it goes, my antibiotic conundrum that could  be classified as “Antibiotic Myth”:

Is it true that I have to finish my antibiotic treatment as prescribed?

Will “too short” lead to antimicrobial resistance, or is it the “too long”? My guess, 99% of the professionals will answer this question by releasing an avalanche of questions, regarding the bug, the host and the site of infection, but I have to insist on a simple “yes” or “no”. Sorry, but those are the rules of the “30-Second-Questionnaire” and you can’t argue the rules.

Thus here is my request. Follow the link to the questionnaire, take 30 seconds to answer the question (and 4 others) and email, twitter, blog or use any kind of communication you can think of to forward it to your friends and family. I promise, I will post the outcome right here, a week or two later.

 

Influenza among afebrile and vaccinated HCWs

Andreas Voss (@AVIPNL) Influenza , , ,

sneeze 2

Picture: gerardnadal.com

Influenza is considered to contribute to the morbidity and mortality of our patients and during the flu season, some estimate that as many as 1 in 5 patients contract nosocomial influenza; via infected HCWs.

After having had close and personal experience with influenza last season I do have a better understanding for some things.

  1. You don’t want influenza if you can avoid it!
  2. I fully understand while you wish your worst enemies to have an inflammation of their pleura (Dutch saying: “Go and have pleuritis”) – it really, really hurts – A LOT.
  3. Flu vaccination programs for HCWs and guidelines preventing febrile HCWs to work may be a pretty smart idea! Or not?

In a recent study, Ridgway et al. had a look at the validity of “febrile” as an indicator of having influenza. After screening 449 HCWs with respiratory symptoms, they found a total of 41 (9.1%) with proven influenza. Only half of the HCWs actually were febrile, with no significant differences between vaccinated and non-vaccinated HCWs.

Thus, while we should continue to vaccinate our HCWs (in my opinion, not part of the article) and hope for a match of the vaccine with the circulating virus, the practice to only look for influenza in febrile HCWs needs to be reconsidered.

Reference

Ridgway JP, Bartlett AH, Garcia-Houchins S, Cariño S, Enriquez A, Marrs R, Perez C, Shah M, Guenette C, Mosakowski S, Beavis KG, Landon E. Influenza among afebrile and vaccinated healthcare workers. Clin Infect Dis. 2015 Jun 1;60(11):1591-5.