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.
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
Well 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
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.
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.
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
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
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
Earlier today, ARIC’s (www.aricjournal.com) publisher (BioMed Central) signed the San Francisco Declaration on Research Assessment (DORA).
Eighteen years ago, when the start of open access changed the world of scientific publishing and distribution of research, the “new” open access journals continued to rely on a “quality measure” of their journals that is in place since 1975; the Impact Factor (IF). A measure based on the number of citations over the number of citable articles.
Many academic institutions judge(d) the academic merit of their researchers by IF points gathered, rather than the quality of their work. Consequently, researchers select a journal for their submission by the IF. Still, as BMC stated in todays announcement: “over-reliance on the IF has never felt right to us. No one metric should be the be-all-and-end-all”. Therefore, many journals including ARIC, include Altmetrics on their articles, based on downloads, Twitter, blog posts and other (social) media use. By the way, Preeti Malani explained Altimetrics nicely in the meet-the-expert session at ECCMID we gave together. Other metric scores are presently implemented by Elsevier.
BMC wants to go further by signing the San Francisco Declaration on Research Assessment and thereby pledging to “greatly reduce emphasis on the journal Impact Factor as a promotional tool by presenting the metric in the context of a variety of journal-based metrics”. For all those still relying on IF scores for their academic career, don’t worry, BMC will not entirely cease promoting the IF, but look forward to see more and new metric scores.