In our team Thijs ten Doesschate does a PhD in clinical epidemiology addressing some clinical aspects on fosfomycin; An old antibiotic, active against Enterobacteriaceae, and surfacing as promising alternative to beta-lactams and fluoroquinolones in times of antibiotic resistance. He is currently coordinating a multi-center double-blind placebo-controlled randomized trial to determine non-inferiority of fosfomycin (against ciprofloxaxin) in the step-down oral treatment of complicated Urinary Tract Infections (UTI). If non-inferior, we could reduce cipro usage. For himself (and now for us) he summarized fosfomycin news at ECCMID. Most presentations (O) and posters (P) can also be found on http://www.eccmidlive.org/ .
The latest edition of Journal Roundup is now available on the Journal of Hospital Infection website, freely accessible here.
- Ebola science continues to make waves in the big journals. One of the most interesting aspects of the new developments prompted by the Ebola outbreak in West Africa is real advances in vaccine development for Ebola and related viruses.
- We still use a lot more antibiotics than we need to. Why should 50% of inpatients in US hospitals be on antibiotics but only 35% in European hospitals? Is it really that different on either side of the Atlantic?
- Selective digestive decontamination (SDD) results in more pronounced increases in antibiotic resistant bacteria.
- One of the key arguments against contact precautions is an increase in the rate of adverse events due to lower observation. However, a study found that abandoning contact precautions for MRSA and VRE didn’t affect the rate of adverse events. Could it be that the increase in adverse events blamed on contact precautions is explained by underlying risk factors?
- Reference to an outbreak of NDM-producing CRE, prompting calls for sterilization of duodenoscopes (made especially topical by the recent duodenoscope-associated outbreak of CRE in LA).
- Seeding hospital surfaces with Bacillus spores to prevent contamination with multidrug-resistant organisms. That just can’t be a good idea!
- Some brief updates from ID Week in Philadelphia and HIS in Lyon.
Journal Roundup is changing! As a result of feedback received from six months of Journal Roundup, I’ve decided to change the format to write a little more detail on fewer articles. This gives me a good opportunity to accept submissions from others to include in the Roundup. So, Journal Roundup is seeking submissions! If you read an article that you think should be included in the Journal Roundup, please submit a short critique (100 to 300 words) of the article as a comment below to be considered for inclusion in a future edition of the Roundup. I won’t publish the comment on this blog, but your contribution will be acknowledged, of course!
Let’s get those submissions rolling in!
Image: Bacterial spores.
This month’s Roundup, as ever freely available on the Journal of Hospital Infection website, showcases some of the useful data emerging from the field of the ongoing outbreak of Ebola in West Africa. For example, emerging data suggests that the R0 (basic reproductive number) of Ebola is around 2, meaning that two transmissions will occur from every case. This means that Ebola is not massively transmissible compared with other infectious diseases – but this hasn’t stopped it increasing more or less exponentially in parts of West Africa!
Some interesting studies on the increasing or decreasing prevalence of MDROs are also covered in the Roundup. For example, one study reported a worrying doubling of the rate of CDI in the USA, whereas another study reports impressive reductions in S. aureus bacteraemia in Australia.
The Roundup includes a brief overview of the Infection Prevention 2014 conference, covered in more detail in a previous post in this blog, and finally, features Catherine Makison-Booth’s brilliant Vomiting Larry (pictured below)!
As ever, I’d be delighted to receive your feedback as to how the Roundup should evolve.
Another month, another Journal Roundup (free and open acces in Journal of Hospital Infection). This month, Ebola tops the bill as the outbreak continues unabated, it seems inevitable that repatriations of healthcare workers from West Africa will continue and increase. The big journals discuss the appropriate level of PPE, and how to test experimental medicines, amongst other things.
A number of useful environmental science updates feature in the Roundup. For example, an age-old question is whether contaminated hands or surfaces contribute most to transmission. A modeling study found that improvements in hand hygiene compliance are about twice as effective in preventing the transmission of multidrug-resistant organisms compared with improvements in environmental hygiene. So hands are more important right? Well, as the single most important intervention to prevent transmission, then yes.
Several studies on the theme of multidrug resistant Gram-negative rods (MDR-GNR) serve mainly to highlight the limitations in the evidence base for establishing what works to prevent MDR-GNR. One of the major problems here is that ‘MDR-GNR’ is a heterogeneous group comprised of several species and resistance mechanisms, not to mention strain variation. The prevention and control prospects for MDR-GNR are different to pathogens like MRSA, VRE and C. difficile. You need to cover all bases – and there are more bases to cover!
The Reviews and Guidelines section includes a thoughtful piece considering the “hygiene hypothesis” vs. the idea of “biome depletion”, the inadequate level of funding in HCAI research, infection control practice in the ER, the cost of CDI, prospects of phage therapy and interrupting regulatory RNA function.
And finally, a UK study finds pretty high levels of ATP on the beverage trolley. So time to ban the beverage trolley as an infection control risk (along with flowers, pets and child visitors)? Not yet – it’s not that surprising to find ATP (which may originate from food, not microbes) on a beverage trolley. That said, if they’d found a lot of MRSA or, worse, CRE then I’d think twice about a cuppa!
Image credit: CDC Global.
The August edition of the Journal of Hosptial Infection Journal Roundup is now available, featuring:
- A whopping five-fold increase in the detection of CRE in 25 US community hospitals.
- MALDI-TOF as a new frontier for rapid detection of carbapenemase activity.
- More on fist bumping instead of hand shaking. (Would you like a fist bump greeting from your doctor? No thanks!)
- Triclosan-impregnated stitches would be cost-effective if they were only a little bit effective, but turns out they’re not effective at all.
- The new ‘crAssphage bacteriophage’, C. difficile biofilms, and increasing rates of antibiotic resistance – all in the human gut microbiome.
- Some hope for Ebola drug and vaccine targets.
- How to reduce the number of sickies that children take from school (through effective school-based immunization programmes).
- Thoughtful analysis on S. aureus outbreaks of old with lessons for now.
- Reviews of CRE mortality, global antibiotic use, microbial hitchhikers, overdiagnosis & overtreatment, useless reporting of science in the mainstream media, and whether biocide use drives biocide resistance.
I’ve written three editions of the Journal of Hosptial Infection Roundup now (June, July and August), so there’s a few examples to review. You can read about my methods for producing the Roundup in the blog accompanying the June edition. I thought that now would be a good time to get some feedback, specifically:
- Is the title right? A few people have expected it to be an overview of articles in the Journal of Hospital Infection only.
- Is the length about right? (Do you fall asleep reading it or find yourself begging for more?)
- Is the depth right? Or would you like to read more about less articles, or less about more articles?
Any feedback that you have would be most appreciated. Please either submit a comment below or email me.
Photo credit: ‘Fist bump’.
The July Journal Roundup is now available at the Journal of Hospital Infection website.
Topics this month include:
- The Longitude Prize.
- Randomized controlled trials of two novel glycopeptide antibiotics.
- Developments in antimicrobial therapy, including several new approaches to augmenting the activity of existing agents.
- Using chemicals for the prevention and treatment of skin wounds.
- Updates on antibiotic cycling (which does seem to work afterall).
- Commentary on ‘Mass Gatherings Medicine’.
- Further updates to the SHEA Compendium.
- Consideration of ‘horizontal’ (universal) vs. ‘vertical’ (targeted) strategies.
- A randomized controlled trial on the effectiveness of issuing mobile phone reminders for HIV appointments.
- A video surveillance study reporting a truly shocking level of hand hygiene compliance among anesthesiologists: 2.9%!
- Reviews on colistin, rapid nucleic acid based diagnostics, and the hithertofore unrecognised importance of free living amoebae in some healthcare-associated infection.
- And finally…what makes Twitter light up with antibiotic chat more than anything else?
Enjoy, and let me know if you have any questions or comments.
I’ve been asked by the Editor of the Journal of Hospital Infection to begin writing a monthly column providing an overview of key updates in the infection prevention and control literature. I’m pleased to say that the first edition (June 2014) is now available on the Journal of Hospital Infection website, and I’m delighted that the Journal Roundup is open access.
I thought it would be useful to outline how I produced this roundup. I began by scanning the tables of contents of the following journals, pulling out articles of interest: AJIC, Ann Intern Med, BMJ, CID, ICHE, JAMA, JAMA Intern Med, JHI, JID, JIP, Lancet, Lancet ID, NEJM. This was easy for the “big five” (Lancet, BMJ, AIM, JAMA and NEJM) because only a handful of articles are directly relevant. It was more tricky for the specialist journals, since all articles are likely to be of interest. I’ve tried to avoid focusing solely on my own research interests, but these doubtless come through. One way to mitigate this in future is for others to provide a Journal Roundup now and then – or at least make some contribution. If you’re interested in this, please do let me know.
Highlights of this inaugural issue include a spike in MERS-CoV cases, coverage of the WHO report on antimicrobial resistance, more evidence that faecal microbiota transplantation works for curing recurrent CDI, the impact of nursing education on patient mortality, individualized antibiotic dosing, CA-MRSA in US Fire Stations, a successful community-based hand hygiene intervention, an outbreak of CRE in Ireland, updated SHEA guidelines for SSI and CDI, the identification of ‘optimum outlier’ (aka ‘positive deviant’) cleaners, a disturbing patient story, an update on the move towards ‘bare below the elbow’ in the US, an overview of the regulatory environment for healthcare apps, conference abstracts from APIC and ECCMID, and the use of Yelp (a customer review website) to identify cases that would otherwise have gone unreported during a foodborne outbreak.
Please feel free to share this with your colleagues, and let me know if you have any thoughts or comments.