Attacking the fecal veneer (part 2)

Last year (Jan 17, 2017) I blogged on an excellent pragmatic cluster-randomized crossover study in which 4 patient room cleaning strategies were tested for their effectiveness to reduce acquisition of bacterial carriage for the incoming patients. The authors’ conclusion was that “enhanced terminal room disinfection decreases the risk of pathogen acquisition”, which I interpreted as “Not for C. diff, may be for MRSA and yes for VRE.” Now the same group published the effects of these interventions on infection/colonization with these pathogens in ALL patients admitted to the hospital during the study period, see. Authors’ conclusion this time: “Enhanced terminal room disinfection with UV in a targeted subset of high-risk rooms led to a decrease in hospital-wide incidence of C difficile and VRE.” Really? Continue reading

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Antibiotic resistance after the toilet is flushed

Last week Jon ended his reflection with a grade A recommendation to close the toilet lid before flushing, as the best way to minimize the potential impact of “toilet flushing plumes”. Even better: do not flush at all. This week we take it from there, in a discovery of what happens subsequently. Let’s take the loo with the highest likelihood of being soiled with antibiotic-resistant bacteria (ARB) and antimicrobial resistance genes (ARGs): the hospital loo. Elena Buelow, former Phd student in our group and now post-doc in Limoges, France, quantified how hospital sewage contributes to the quantity and diversity of ARGs in the general sewerage system. The work was published on-line today.
Continue reading

Chinese carbapenamases: Fly like an eagle

I blogged on mcr-1 (colistin resistance) in China last week, to share the latest reassuring data. Well, the paper on which todays’ blog is printed will be used to wrap tomorrows’ market fish (typical Dutch expression). Nicolle Stoesser (Oxford) send me the latest news, coming from a Nature Microbiology study providing evidence for the potential of spread of carbapenamases by flies and birds. Not reassuring at all, and potentially with major consequences. Continue reading

ESBL on meat: be aware of filet Americain

Tabloids have repeatedly warned the people for superbugs on chicken meat, after researchers had convincingly shown that the chicken filets that we buy are contaminated with ESBL-producing bacteria, mainly E. coli. Widely considered a public health threat, it was a decisive argument to insist on reductions in antibiotic use in the agricultural industry in the Netherlands. Yet, whether meat contamination constitutes a risk for human health is unknown. This was now quantified, with surprising results. Continue reading

Attacking the fecal veneer*

What an excellent start of 2017. A great study from the USA today in Lancet: In a pragmatic cluster-randomized crossover study they tested 4 patient room cleaning strategies on the effectiveness to reduce acquisition with relevant bacteria for the incoming patients. The conclusion states that “enhanced terminal room disinfection decreases the risk of pathogen acquisition.” Yet, this paper is so “data-dense” that you must read the methods (and supplements) to get the picture. In one shot: Not for C. diff, may be for MRSA and yes for VRE. Continue reading

Back to the floor..

flooringA little while ago I blogged about the excellent study from Nottingham that demonstrated significant VRE and MRSA contamination on socks used to prevent falls in the hospitalised elderly. This has been followed by another paper suggesting that shoe coverings undurprisingly become contaminated. So, what? How does this really impact on transmission? A new study from Curtis Donskey’s group has looked at hand contamination in patients directly relating to floor contamination. Continue reading

Up-date on M. chimaera

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More and more reports and guidance (Ref) appear with regard to Mycobacterial infections associated with heater cooler units used during thoracic surgery. As mentioned in this blog before, the infections are attributed to aerosol generated by the contaminated heater cooler units that are located in or adjacent to the operating room (Ref).

Just now, researchers published 10 patients with disseminated Mycobacterium chimaera infections subsequent to open-heart surgery at three (CH, GER, NL) European Hospitals (Eur Heart J. 2015 Jul 17).

What makes this infections special, is the fact that the time to infection may takes months to years and that the micro-organism in question is easily missed by routine bacterial diagnostics.

The word is out, that other, difficult to diagnose micro-organisms e.g. Legionella are possibly causing post-operative infections, too. Thus, I believe that we can expect more cases with different pathogens in the near future.

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