Must we screen for resistant bacteria?

This is a cry for help. In 2 weeks time I have a pro-con debate on the statement “screening for highly-resistant microorganisms is a must”. I face 2 problems: the organizers gave me the “PRO” position and my opponent is professor Andreas Voss.

We will be watched by a Dutch audience, so the bacteria involved are MRSA, VRE, anything resistant to carbapenems and ESBL-producing Gram-negatives, and I (and hopefully Andreas too) interpreted the question as “screening at the time of hospital admission”.

I am desperately seeking high-level scientific evidence supporting my allocated point. 

My question to the knowledgeable reflectionsipc readership is: What do you consider the single most convincing piece of evidence underpinning my case.

As in all good practice I will provide feedback (if I survive the battle).

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Mapping C. dfficile hospital acquisition: short-stay diagnostic areas are important!

Recent genomic studies have concluded that hospital-acquired acquisition of C. difficile is rare, suggesting that acquisition of C. difficile outside of hospitals followed by hospital-onset disease is the most common explanation for C. difficile infection. These studies hinge on an assumption that in-hospital patient contact occurs due to shared or recent stay on the same hospital ward. A short publication in JAMA Internal Medicine eloquently challenges this assumption, suggesting that hospital contact that we would usually assume to be casual and not a risk for acquisition of hospital pathogens (e.g. short-stay diagnostic areas such as ultrasound and endoscopy) can be an important source of acquisition.

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Exposed: Dutch and London clinical microbiologists

Six weeks ago I blogged on the exposure of Dutch clinical microbiologists by Marcel Levi, former boss of the Academic Medical Center in Amsterdam and now leading 5 academic centers in London. Apart from describing his new “totally resistance-free” work situation, he criticized  the microbiologists in both countries for “not attempting to change the money-wasting and empty-brain practice of microbiological diagnostics”. Unfortunately, Marcel Levi is not just “another person” with an opinion. So, here are four suggestions to change his opinion, before all microbiologists have been sacked. Continue reading

Friday Afternoon: ATP vs UV vs eyeball Vs K9 and Going Commando in Surgery

Screen Shot 2017-06-02 at 12.26.42Well I was looking for a Friday afternoon sort of post and you know when you wait a while and two come at once?.. So firstly, some may recall that I have previously highlighted the utility of a sensitive nose in detecting a variety of things in a previous post. In a study just posted online first in the Journal of Hospital Infection, a springer spaniel was trained to detect C. difficile in the environment with a fair degree of success, especially for detecting rooms in which C. difficile was not present. Continue reading

C. auris questionnaire – the outcome

Overall 61 colleagues from 17 countries answered the questionnaire.  A large proportion (26 of 61) of the answers came from the UK, which might have to do with the fact that the first European outbreak was described in England.

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Of the respondents 32.8% said that their institution released a warning about C. auris.  Analyzing the data separately for the UK and the other participating countries, it became clear that the first European outbreak had impact on the preparedness. In the UK 42.3% of the institutions were warned about the unique capacities of C. auris, versus 25.7 in all other countries.  Regarding the existence of a written guideline dealing with C. auris, the differences were far less pronounced, namely 26.9% versus 20.0%, respectively.

53.9% of the UK responders believe that their lab can correctly diagnose C. auris, versus 31.4% in the other countries.  In addition, the proportion of responders, who didn’t know if their lab was prepared, was higher outside the UK (45.7% versus 26.9%, respectively).

Despite the emerging spread of  C. auris clusters this questionnaire is an indication that most institutions are not adequately prepared.  Obviously the sample is really small, but the outcome was predictable.  With an increasing body of literature, including papers on diagnostic methods and infection control measures, we should hope that the situation should change very soon.  Thus, don’t lean back, start writing.

 

Candida auris part III. Are you prepared?

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MMWR just published on the ongoing transmission of Candida auris in the US, while at the same time PLOS Pathogens came with an excellent review on the topic.

By now I had the debatable pleasure to be around for the birth of a few “superbugs”, but this one is clearly putting a lot of effort into reaching the top of the list. I believe (classical pessimist) that many institutions still ignore this new adversary (or are even unaware), and most certainly have no game-plan to prevent its introduction and consequent spread.  In the MMWR publication the current recommendations for C. auris–colonized or infected patients were repeated, with only one change from previous recommendations, namely that a more effective (sporicidal) disinfectant is needed, but I seriously wonder who follows this guidance.

Thus, here it comes, another 30-seconds-questionaire.  Why?  Because I hope that you will prove me wrong and that we – the infection control people at the frontline – act on threat, instead of re-act once we are overrun.

Link to questions  https://www.surveymonkey.com/r/QCK9RWS

References

Notes from the Field: Ongoing Transmission of Candida auris in Health Care Facilities — United States, June 2016–May 2017. Weekly / May 19, 2017 / 66(19);514–515 https://www.cdc.gov/mmwr/volumes/66/wr/mm6619a7.htm?s_cid=mm6619a7_e

Chowdhary A, Sharma C, Meis J. Candida auris: A rapidly emerging cause of hospital-acquired multidrug-resistant fungal infections globally. PLOS Pathogens  https://doi.org/10.1371/journal.ppat.1006290 May 18, 2017

Fluoroquinolone use and C. difficile infections: The English miracle (not) yet explained? (part 2)

Two months ago I blogged on the reduction of fluoroquinolone-resistant but not fluoroquinolone-susceptible C. diff infections (CDI) in English hospitals, coined as “the English C. diff miracle”. A very simple model challenged the conclusion that this was caused by a reduction in fluoroquinolone use in hospitals. A debate on the assumptions of the model now provides the perfect outline for a PhD thesis. Continue reading