Thursday, March 1, 2012

What is Sepkowitz saying about antibiotic resistance?

I give up. What am I supposed to do to protect my patients from his MDR-homeboys?

In his new Slate piece, Kent raps about resistant gonorrhea, MDRO-bogeyman and the Masters-of-the-Universe complex of antimicrobial stewardship. Last week I gave up washing my hands, but I'm not sure what I should do now. I think I'm supposed to give up.  Help me out here.

Source: Kent Sepkowitz, Slate, 1 March 2012

5 comments:

  1. Hey Eli,

    Perhaps 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

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  2. 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.

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    1. Agree. 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.

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  3. I 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.

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    1. I 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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