No jab, no play; no jab, no pay

It may be the annual “cucumber time” or Trump-fatigue, but childhood vaccination is dominating Dutch news. The problem: the proportion of children being immunized against, for instance measles, is (slowly) declining and approaches the level that offers herd protection. That is a risk for children in the time window between passive protection by mothers’ IgG and active immunisation (at 14 months) and for persons that cannot be immunized for medical reasons. We were familiar with parents refusing immunization of their kids for religious reasons (because someone forgot to mention vaccination in the bible), but now non-religious and well-educated parents do the same. These “philosophic refusals” mostly decide to do so on information derived from internet. How can epidemiology help us to curb this problem? Continue reading

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The antipathy against SDD explained

With the first paper on Selective Digestive Decontamination in ICU patients published in 1983, this year marks the 35th anniversary of one the fiercest controversies in intensive care medicine, infection prevention and clinical microbiology. To celebrate this, Intensive Care Medicine published 3 editorials called the “Antipathy against SDD is justified”: 1 arguing Pro, 1 Con and 1 wasn’t sure. If the contents of these editorials had been patients, a (good) physician would have called them “diagnostic”. SDD is where clinical epidemiology becomes psychology and sociology. Continue reading

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

The reality of AMR in Greece

This week I attend the general assembly of COMBACTE, this year in Athens. COMBACTE stands for COMBatting AntibiotiC resistance in Europe (www.combacte.com) and is part of the New Drugs for Bad Bugs (ND4BB) program of the Innovative Medicines Initiative. Our local host is professor George Daikos, who opened the meeting with an overview of the epidemiology of antibiotic resistance in his country. Continue reading

Preventing S. aureus SSI: Who does what? (part 2)

A month ago I blogged on the practices of pre-operative (or better peri-operative) treatment of nasal S. aureus carriage to prevent S. aureus surgical site infection (SSI) in orthopaedic or cardiothoracic surgery patients. The issue brought forward was that a “treat-all” (thus “screen none”) strategy is more feasible, more effective and cheaper than the “screen & treat” strategy. The latter strategy, is associated with less mupirocin exposure and thus less selective pressure for mupirocin-resistance genes. There was a poll with 2 questions. What is your current practice for patients undergoing orthopaedic or cardiothoracic surgery and what do you think the strategy should be, with 3 options for each question; “do nothing”, “screen & treat”, or “treat all”. Today the results. Continue reading

Preventing S. aureus SSI: Who does what?

Pre-operative (or better peri-operative) treatment of nasal S. aureus carriage is one of the most – if not the most – effective infection prevention measure. A large double-blind randomized controlled trial convincingly confirmed the meta-analysis results of previously performed smaller studies: 5 days of nasal mupirocin ointment together with chlorhexidine showering reduced the incidence of deep-seated S. aureus surgicial site infection (SSI) with 80% among S. aureus carriers undergoing orthopaedic or cardiothoracic surgery. Eight years after publication of these findings I (and others) still have the feeling that many hospitals have not implemented this measure. Continue reading

The future of infection surveillance is ….. Google

If you feel that your  hospitals’ Electronic Health Record (EHR) can do more for you, read this. Not yet peer-reviewed, but still very impressive. Using all 46 billion (!) data points in the EHR from 216.221 patients in 2 hospitals they predicted (at day 1 of admission) in-hospital mortality, long length of stay and readmission, pretty accurately, and much better than existing prediction models. How? Deep learning techniques. Who are they? The paper has 35 authors, of which 32 work at Google Inc, Mountain View, California. Continue reading