Staff screening for MDROs: closing Pandora’s Box

A brave study from the Palmore/Frank group at NIH has opened the Pandora’s Box that is screening staff for MDROs, and, I’m delighted to say, firmly closed it with their findings! Only 3% of staff carried ESBLs, one carried a CPE, and none carried VRE, and this despite extensive contact with MDRO patients for many of the staff sampled!

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How to predict ESBL BSI (part 2)

A month ago (April 11) I blogged on the difficulties in predicting the presence of ESBL-producing bacteria as a cause of infection at the time antibiotics must be started. Wouter Rottier (PhD student) developed 2 prediction rules (for community-onset and hospital-onset infection), that seem to do better than current guideline recommendations (especially for reducing unnecessary carbapenem use). Another PhD student (Tim Deelen) now wants to validate these rules, globally. The “crowd-funding study approach” worked and sites across the world joined us…. Continue reading

Fluoroquinolone use and C. difficile infections: The English miracle not yet explained?

A few weeks ago in LID this marvellous paper, clearly demonstrated the reduction of fluoroquinolone-resistant but not fluoroquinolone-susceptible C. diff infections (CDI) in English hospitals, coined as “the English C. diff miracle”. The CDI decline coincided with the reduction of fluoroquinolone use, but also with a period in which “horizontal” infection control measures, such as hand hygiene, were improved. As the latter would be equally effective in preventing transmission of resistant and susceptible strains, the fluoroquinolone reduction was considered causative for the observed reduction. A very simple model tells us that that is not necessarily the case. Continue reading

VRE: MRSA or MRSE?

To me, VRE is an old love that never let me down. In 1995 (!) I studied its epidemiology in Chicago (using PFGE), and we described it as the “triple-threat bug”: a gut colonizer like Gram-negatives, a skin colonizer like MRSA and an environmental contaminator like C. diff. A new study in CID, using WGS, illustrates its complex epidemiology. After 20 years, that complexity seems explained, and now we can no longer avoid the question what to do with VRE. Keep on cherishing its “feared pathogen status” like MRSA, or accept that it is just something like MRSE, and stop bothering. Continue reading

How much S. aureus is hospital acquired? Mk II

I posted a blog a couple of years ago (was it really that long!) on a fascinating study suggesting that only 1/5 of S. aureus in hospital patients is hospital-acquired. My key conclusion from that study was that the number of potential sources for S. aureus that the team investigated was inadequate to draw any firm conclusions (they didn’t include staff, surfaces, or visitors). I concluded that ‘the next frontier of transmission mapping must be a more comprehensive evaluation of other potential sources…’. The authors must have been reading, because this study from the same group was published recently in Lancet ID, which is a more comprehensive evaluation of other potential sources.

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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

Colistin resistance and mortality

 

My previous blog on “mcr-1 and the end of the world” evoked responses on the important effects of colistin resistance on patient outcome, referring to a new study in CID with the following abstract closure: “Importantly, mortality was increased in patients with colistin-resistant isolates.” The wording is correct, but I’m afraid that it will be interpreted incorrectly. Continue reading