If you read this, you may well be concerned about antibiotic resistance and consider reducing the burden of disease caused by AMR as one of your professional goals. Broad attention helps us to fight the problem: it creates awareness and funds for research. So, how do we cope with data that may jeopardize these ambitions (raising awareness fort he problem AMR)? Here is the eaxmple of mcr-1. Continue reading
Epidemiology
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
SSI – It’s not what you do, but the way that you do it?
Another of my favourite guitarists succumbed to sepsis following surgery just before Xmas, with the sad passing of Rick Parfitt following shoulder surgery, spookily the day after his band Status quo performed their final electric gig (which I was at). The other was Rory Gallagher, who died a few years ago now of MRSA. Surgical procedures are normally carried out under what should be the most controllable of conditions, yet there are variations in practice, a paucity of quality studies on even the most basic of interventions (such as pre-op bathing) and even when there is good evidence, it is ignored. However I do also wonder if we have been missing something. A paper that suggests no difference between Chlorhexidine (CHG) and Povidone Iodine (PI) for pre-surgical skin prep (both aqueous) recently piqued my interest. It was an RCT (non-blinded) undertaken in clean-contaminated upper gastrointestinal or hepatobiliary–pancreatic open surgery, however that wasn’t the aspect that I became interested in. Continue reading
“Santa isn’t coming to town”
WARNING: This isn’t a heart-warming Christmas tale. It’s actually rather sad.
In Christmas BMJ classic, a team of US researchers have explored associations with Sanda Claus not visiting paediatric wards over Christmas 2015. Whilst I am pleased to report that Santa made an appearance on 90% of the wards overall, heart-wrenchingly, Santa was least likely to visit paediatric wards in the most deprived areas.
The art of predicting “broad brush estimates” of people dying from AMR
Sometimes you read something you wished you had authored. For me, that is the essay “Will 10 Million People Die a Year due to Antimicrobial Resistance by 2050?” published yesterday in PLoS Medicine. At last, a scientific response to the highly praised AMR review from Jim O’Neill. Summarized in a few words: scrutinized to the bone, hardly anything remains. Continue reading
WHO guideline on SSI prevention: more clear than feasible?
The WHO guideline for SSI prevention was launched as if it were the iPhone8. I immediately went looking for what I think is the intervention with the strongest evidence: pre-op nasal mupirocine and CHX bathing, see why here. After an interesting read I’m pleased that the guideline is clear, but I missed an evaluation on feasibility and the evidence for simplification is turned around.
(no More) fear of flying*
Last Friday Jarne van Hattem presented findings on ESBL carriage in Dutch travelers returning from ESBL-rich countries at our NCOH meeting and the next day the results appeared in Lancet ID. A great study; quantifying things we already thought, extending our knowledge on risk factors and providing new information on the public health aspects of these imported bacteria. They concluded that acquistion and spread are “substantial and worrisome”. Too bad: all the quantified knowledge lost in 2 meaningless words.
In short, they studied 2001 travelers (ESBL carriage before travel 6.1%) and 34.3% of the non-carriers acquired ESBL during travel; especially in southern Asia (75.1%). Risk fators for acquisition: persisting diarrhea, ciprofloxacin use and eating street food. The median duration of carriage after return was 30 days and 11.3% was still colonized ater 1 year. This implies that returning travelers (depending on region) must be considered at risk for ESBL-carriage (no matter whether they have additonal risk factors) during a certain period of time. Yet, median duration of carriage is short and after 1 year that risk is fairly close to the ESBL-prevalence in the Dutch population.
Is this carriage a health risk for travelers? With >500,000 Dutch travelers to ESBL high-endemicity regions per year, many will acquire (according to what we can detect) ESBL, but how many will develop infections caused by these ESBL-producing bugs? That now is a burning question.
Is this import of ESBL a risk for the Dutch public, that we intend to protect against infections caused by AMR? They also investigated the occurrence of within-household transmission of these bacteria in 215 non-travelling household members and quantified rates with a Markov model. The figure that got most attention was the “12% probability of transmitting ESBL-E to another household member”. Yet, much more informative is the actual transmission rate from which one can derive the effective R0. This rate was 0,0013/carriage day and the calculated effective R0 was around 0.2 (Martin Bootsma personal communication), which might include some overestimation due to false-positive transmission events (no molecular typing). An R0 of 0.2 seems not enough to cause continued transmission – leading to endemicity – coming from these sources, especially since transmission to the next ring (to non-household members) will be less effective. Simply said: returning travelers their household members seem to be – in the Netherlands – dead-end roads for ESBL-producing bacteria. That could be expressed as reassuring.
*Title stolen from Gary Brooker
CPE Thrill-seeking
Yesterday I attended a meeting at the Wellcome headquarters in the middle of London. I deliberately exposed myself to several risks: by car from home to Schiphol, by plane to London City and by public transport to the meeting. Each transition harbors a quantifiable risk of ending up in a hospital (accidents, assaults, cardiac events) where there is a quantifiable risk of developing HAI, and I am especially afraid of CPE.
“HCAI”
I read a Controversies blog today, reflecting on a recent editorial suggesting that, because of frequent over-diagnosis, we should use quote marks every time we write “CAUTI” – and even use air quotes every time we say it! But why stop at CAUTI? Should we be talking about “CLABSI”, “CDI”, “SSI” and, well, any “HCAI” really?
Reflections on Infection Prevention and Control 