IDSA published 13 Faces of Antimicrobial Resistance to highlight the consequences of AMR for individual patients. The report illustrates the grim future of bacterial infections. In each of the 13 cases I asked myself whether this could happen in an “AMR-virgin country” (the Netherlands), and whether likelihood of that infection had increased in the last 10 years (as in a crisis)? Continue reading
I’m not a dog lover. Far from it in fact, however a new paper in the Journal of Hospital Infection caught my eye today. Yesterday I was sitting in the Longitude Prize Advisory Committee meeting bemoaning the lack of ‘left field’ ideas coming forward. Harrison himself, winner of the original prize was such a person. He came at the problem of solving the longitude issue from a completely different direction when all of the respected science at the time was convinced that astrology was the answer. Problem: cloud, and not much of a silver lining. So we are looking for a new way to diagnose infection rapidly, distinguishing between those caused by viruses and bacteria in the hope of turning the increasing tide of resistance. So what does Fido (or Nimbus in this case) have to do with this?
Today it became official that the Dutch Workingparty on Infection Prevention (WIP) will no longer be supported by funds from the Dutch Ministry of Health. Therefore, after 30-years of coordinated, voluntary work by infection control nurses, infectious diseases specialists, and clinical microbiologists (supported and strengthened by various, topic-specific healthcare professions) the number one IPC guideline organization found a sudden and in-part unexpected death. I am proud to have been part of the WIP, which was rightfully seen as one of the beacons of IPC, admired by many countries who had none or by far not as well organized guideline organization. The WIP was fundamental to the success of Infection Control in the Netherlands and even if some say that it wasn’t the only contributing factor, all those doing Infection Control know that the present state of AMR and HAI control could not have been achieved without the WIP. Was all the WIP produced “gold”? Certainly not. Despite best intentions some recent guidelines went over the top, but overall the set of guidelines produced by the WIP are of high quality and an enormous treasure, that might now be lost for the future.
Rumor has it that Dutch Public Health Services, the Professional Society for Elderly Care Specialists (Verenso) and other professional medical societies will take it on them to issue infection control guidelines (in part for their own specialty). If that is truly the case, why stop at killing coordinated and independent Infection Control guidelines, why not take over Infection Control at whole, starting with surveillance. I can ensure (by the lessons of the past) that HAI rate will immediately drop by up to 50%. The Dutch have a nice saying about situations that are wrong by default and don’t leave you with a lot of trust or hope: “The butcher who checks the quality and safety of his own meat”.
I believe that only an independent, integrated and coordinated approach (= by one organizational structure) can ensure the basics of effective and sound infection control. If the Dutch Ministry of Health and the medical professional societies are serious about their engagement to control AMR and HAI, in my opinion, a future solution can only be the formation of a WIP 2.0.
Disclaimer. The opinion in this post is a personal and does not reflect the opinion of the national professional boards I am a member of.
Tomorrow is the European Antibiotic Awareness Day: one of these days in that the Dutch feel proud…., when the rest of (most of) Europe recognizes and acknowledges that the Netherlands do a fantastic job in controlling antibiotic resistance. How? Difficult to say, and may be the “diagnosis” should be established by exclusion. Here are at least 3 reasons that did NOT contribute to our success (although many think otherwise)….. Continue reading
All of a sudden, Candida auris seems to become the “new” global super villain. Antimicrobial Resistance and Infection Control recently published the first, large European outbreak of C. auris in London with 50 cases (Schelenz et al.) and CDC just published the first 17 US cases (Vallabhaneni et al.). While I believe that C. auris deserves our full attention, as it is a multi-resistant yeast, with increased MICs to all three major classes of antifungals, likes to evades traditional diagnostic methods, seems to be difficult to eradicate from the hospital environment, and causes invasive nosocomial infections with high mortality, I am still amazed by the fact that – despite the global society we live in – this “new” villain first has to come to Europe or even more important the US, before becoming a recognized “superbug”.
C. auris was first described in 2009 in Japan and cases of candidemia have since been reported from South Korea, India, South Africa, and Kuwait, in addition to unpublished reports from Colombia, Venezuela, and Pakistan. While “global migration” may come to mind for the rise of C. auris, it seems unlikely, as different continents and countries seem to have their own clones. Selection pressure due to the increasing use of antifungals in healthcare, livestock, and agriculture might be a more feasable explanation, but the true reasons for the recent emergence are still unknown.
I assume that many countries will issue guidelines with regard to diagnostic methods, reporting to health authorities, environmental cleaning and infection control, but as that might take time, those of us in infection control should get prepared and stay informed, not to be surprised to see C. auris emerging within their own setting.
Literature and links
Schelenz et al. First hospital outbreak of the globally emerging Candida auris in a European hospital, Antimicrobial Resistance & Infection Control20165:35
Chowdhary et al. Multidrug resistant Candida auris: New kid on the block in hospital associated infections? Journal of Hospital Infection August 2016, DOI: 10.1016/j.jhin.2016.08.004
Satoh et al., Candida auris sp. nov., a novel ascomycetous yeast isolated from the external ear canal of an inpatient in a Japanese hospital. Microbiol Immunol, 2009;53:41-44
Lee et al., First three reported cases of nosocomial fungemia caused by Candida auris. J Clin Microbiol, 2011;49:3139-42.
Chowdhary et al. New clonal strain of Candida auris, Delhi, India. Emerg Infect Dis, 2013; 19:1670-73.
After years of no recent international guidelines to prevent SSI, today (November 3rd,2016), WHO published the first ever Global guidelines for the prevention of surgical site infection. They include a list of 29 concrete recommendations that are available on the WHO website (link). The recommandations are also available as publication in Lancet ID, split into 2 documents: 13 recommandations specific tot he pre-operative period (link); 16 recommendations specific to the intra-operative and post-operative periods (link). I have seen drafts of the HICPAC guideline and would assume that this guidelines should be released soon, too, which will be interesting as I can’y wait to see the differences.