What is Sepkowitz saying about antibiotic resistance?
I give up. What am I supposed to do to protect my patients from his MDR-homeboys?Source: Kent Sepkowitz, Slate, 1 March 2012
I give up. What am I supposed to do to protect my patients from his MDR-homeboys?Source: Kent Sepkowitz, Slate, 1 March 2012
Hey Eli,
ReplyDeletePerhaps Kent will chime in for himself, but I assume he is merely expanding upon a point made in a recent JAMA editorial on MRSA prevention, wherein the authors stated, "However, it may be presumptuous to assume that hospital-based infection prevention efforts have a major effect on the natural history of [S. aureus/MRSA]..."
http://jama.ama-assn.org/content/304/6/687.full
I know, different bugs, but it seems clear that Kent's current emphasis is on our hubris in assuming that simple interventions (like hand hygiene or reducing antibiotic use) can have a big impact in the interplay between man and microbiota.
Dan
I don't know the man, but from reading a few of his writings he seems to be a contrarian in general, and a debunker. The problem with people who tend to be debunkers is often they end up saying that some things that (I think) are not bunk are bunk. Being a debunker, all else being equal, also makes one more interesting to editors that might "publish" what one writes.
ReplyDeleteAgree. He is acting as the anti-chicken little when the sky is actually falling. If it didn't have negative consequence it might be interesting.
DeleteI read the piece three times. I think Kent is trying to put the problem of antibiotic resistance into a bigger perspective. As a doctor who prescribed colistin and fosfomycin just last week, I'm able to see firsthand the consequences of antibiotic resistance. But as a hospital epidemiologist, I have always struggled with our raison d'etre--to incrementally improve the quality of care for a very small proportion of the world's population. Someone once said that nosocomial infections are a pimple on the ass of public health. You could interpret that to be demeaning to hospital epidemiologists or you could use that to help you keep your perspective.
ReplyDeleteI thought infectious diseases were one of Jared Diamond's Guns Germs and Steel? I can't remember which one, I think Guns. Anyway, hard to pooh pooh resistance (and thus infectious diseases). I agree that in-hospital infection prevention is a pimple, but he is talking about pubic health, of which infectious diseases have and will increasingly be with MDR a larger part.
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