We tend to find that the flu season in Australia is an early predictor for the severity of the coming flu season in the Europe. And the early indications are the flu in Aus this year is bad – unprecedentedly bad. So, let’s get our flu vaccination campaign planning hats on!
I participated in Imperial College London’s school outreach programme by doing an intro to infectious disease epidemiology with a group of year 10-12 students (age 15-18) (you can download my slides here). It was hugely rewarding and highly recommended for anybody considering supporting this sort of work. The group were sharp, good fun, and asked good questions – and perhaps included one of the next generation of infectious disease epidemiologists?
A team of authors surveyed NHS acute hospitals in England to determine the approach to CPE detection, including laboratory methods. The findings provide an opportunity to compare the approach to CPE detection and prevalence nationally, identifying higher CPE prevalence in the North-West, North-East and the South-East (the region that includes London) of England. The findings also suggest that more screening for CPE would detect more carriers – and perhaps help to prevent a silent epidemic of CPE in some regions.
Today, the Journal of Hospital Infection have published an article from our research group about E. coli BSI sources. The key message is that the sources of E. coli BSIs at a large teaching hospital differ considerably from the national average, with a large proportion related to febrile neutropaenia (18%) and diverse gastrointestinal sources (15%). This calls into question the ‘preventable’ proportion of these cases – and adds something to the discussion as to whether the national ambition to halve GNBSI by 2021 is feasible.
Marc recently posted about the second clinical outcome findings from the BETR-D study, recently published in the Lancet Infectious Diseases. Marc contended that the team may have been ‘blinded by the [UV] light’ in reaching the conclusion that enhanced terminal room disinfection led to a hospital wide reduction in acquisition of key pathogens. Here, in the spirit of healthy academic debate, I offer another perspective.
I posted recently on the potential risk of CPE contamination of sinks, drains, and hospital wastewater. The question in my mind then was whether contamination is a smoking gun or innocent bystander regarding CPE transmission? What we really need is an intervention to show that better management of sinks and drains results in reduce CPE transmission. And now, we have one! The findings suggest that attempts to control CPE will go down the drain if we don’t intervene to improvement the management of sinks and drains.
In a remarkable quirk of academic publishing, two virtually identical studies by separate research groups in the UK (one in London, and one in Cambridge) published a week apart have come to the same conclusion: that we are missing a sizable portion of MRSA transmission by focussing solely on wards in a single hospital. A referral-network level view is required for an accurate picture of MRSA transmission. (You may have seen some press about the Cambridge article, e.g. on the BBC here.)
A genomic study of 44 isolates of CPE from various species identified between 2008 and 2010, mainly from the Northwest of England, has concluded that plasmids played a key role in the early dissemination of CPE.
The Journal of Hospital Infection have published a welcome special issue on multidrug-resistant Gram-negative bacteria. The collection includes some updates on epidemiology, staff carriage (again!), clinical microbiology, and patient perspectives on CPE, and is well worth a read.
A clear simple study has a stark headline: 16% of admissions to a Spanish surgical ICU carry CPE. This sort of carriage prevalence is at a ‘practice-affecting’ level: the empiric antibiotic choices may be altered and you begin to wonder what is left when the first signs of infection develop in almost 1 in every 5 patients…
Reflections on Infection Prevention and Control 