Predicting colonisation with antibiotic-resistant bacteria at the time of hospital admission

A systematic review and meta-analysis identify 22 studies that used various methods to predict colonisation with antibiotic-resistant bacteria at the time of hospital admission. The models were chosen to focus on MRSA and CPO colonisation. The “performance” of these tools varied widely, with a sensitivity of 15–100% and specificity of 46–98.6% for MRSA, and sensitivity of 30–81.3% and specificity of 79.8–99.9% for CPO. I think my main take-away from this that simple risk tools for predicting colonisation with MRSA and CPO (which are often used to determine who to test) are pretty blunt instruments. However, the more advanced tools making use of big datasets and machine learning can take us forward in predicting the risk of MRSA and CPO colonisation at the time of admission.

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The ‘thorny 5th Moment for Hand Hygiene’: hands and surfaces collide

We talk often about the 5 Moments for Hand Hygiene but frequently neglect the 5th moment (after contact with a patient’s environment). So much so, that you might even describe this as the “Cinderella moment for hand hygiene”! Could it be that the Cinderella moment is actually the most important in the transmission of pathogens that cause HCAI? Maybe sometimes. But that’s missing the point. If we don’t focus our attention on all moments for hand hygiene, we won’t be as effective as we could be in preventing cross-transmission.

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CPE carriage – once positive, always positive…or maybe not?

I blogged recently about the new ESCMID guidelines on resistant Gram-negative carriage and decolonisation, which supported a “once positive, always positive” approach to CPE carriers due to the lack of effective decolonisation options. A new study suggests that a large majority (75%) of patients who were once identified as CPE carriers no longer had CPE detectable when they were readmitted. This has implications for the management of CPE carriers in hospitals.

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Cheap and slow (culture) is usually better than fast and expensive (PCR) for CPE screening: Bertha says so!

BMC Medicine has published some research from our group reporting the findings of a mathematical model comparing various approaches to screening for CPE carriage. The model compared how several operational metrics varied with different approaches to screening (‘slow and cheap’ laboratory culture vs. ‘fast and expensive’ PCR) and in various specialties with variable levels of compliance with CPE admission screening and at various levels of admission prevalence of CPE. The main conclusion was that culture proved to be the best approach in most scenarios, balancing risk and resource.

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What is the fitness cost of mupirocin resistance?

Jon posted a blog last week on mupirocin resistance in MRSA. This week, guest blogger Dr Gwen Knight (bio below) writes about a companion paper also published in the Journal of Antimicrobial Chemotherapy, which models mupirocin resistance…

It is a truth universally acknowledged, that acquiring most mechanisms of drug resistance incurs a fitness cost to the host bacterium. Determining the size of this cost and the impact that this cost will have on the spread of drug resistance is difficult. Is a 10% reduction in growth rate in the laboratory enough to stop resistance spreading in a hospital?

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We need to work together to reduce CRE and other pathogens

Some fascinating modelling from the CDC Vital Signs programme suggests that a co-ordinated, multi-facilitiy approach will be much more effective than each hospital doing its own prevention interventions.

The team first estimated the burden of key infections in the US: CRE, multi-resistant  P. aeruginosa, invasive MRSA and CDI combined were responsible for 310,000 infections in 2011, which would increase 10% to 340,000 over 5 years. However, with an ‘aggressive’ national intervention, this could be reduced to below 200,000 by 2019. It would be a huge undertaking to implement and co-ordinate a national campaign in the US, where there is so much heterogeneity in the way that hospitals are structured and funded. But if anybody can do it, the CDC can!

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