Renaissance man

The definition of a Renaissance man is a person who has broad intellectual interests and is accomplished in areas of both the arts and sciences. Who fits that definition better than Dick Wenzel? By day he's a great doctor, teacher and epidemiologist. By night, he's a novelist, tango dancer, and actor. His latest gig is VCU's production of Love Letters. 

Love Letters

Written by A. R. Gurney • Directed by David S. Leong 

Featuring Richard Wenzel & Nancy F. Langston

Starring former Dean of the VCU/MCV School of Nursing Dr. Nancy Langston and Dr. Richard Wenzel, world renowned doctor of infectious diseases and former chair of the VCU Dept of Internal Medicine. Love Letters is a charming 50-year love story told through the letters of Melissa and Andrew who share their hopes and ambitions, dreams and disappointments. A heartfelt evening of surprising comedy with an ending that will squeeze tears out of all but the stoniest hearts.

Infectious Art

The University of Iowa College of Public Health has a fascinating new fund raising event - Infectious Art.  The College collaborated with a local design group to create jeweled representations of a wide variety of human pathogens and vectors. The aim was "to present the dichotomy between the aesthetic beauty of pathogens and the havoc they wreak on humanity." Ever wanted a Borrelia ring (one ring to bring them all and in the darkness bind them), Influenza A cufflinks, or HIV earrings? Me too. All proceeds will go to support the College of Public Health. Items may be viewed and purchased online or at American Public Health Association Annual Meeting Nov. 2-6 in Boston, Mass., at the University of Iowa College of Public Health's booth (#1331).

Aspergillus Pin

h/t Cassie Cunningham

KPC (Yeah You Know Me)

Now that I have your attention, I wanted to point out a recent review in Lancet ID by Silvia Munoz-Price and colleagues. It's behind a paywall with a $31 charge, so hopefully you have access through your institution or can email one of the authors to request a copy. The co-authors do a wonderful job highlighting the emergence of KPC containing strains in the US (1996) and subsequent spread of these β-lactamases throughout the world. Importantly, they discuss treatment options (or lack thereof) and emphasize the important role that infection prevention will play for the foreseeable future. They also suggest that stewardship might be more relevant in plasmid (non-clonal) outbreaks.

Touch your patient.

Here's an interesting and thoughtful piece on gloving by Dr. Karen Sibert, an anesthesiologist. I agree with her perspective.

You are what you wear

Mike has posted extensively on appropriate attire in clinical settings and perhaps folks are starting to notice. This month's ACP Hospitalist has a balanced piece by Charlotte Huff on the subject and quotes extensively from the good doctor Edmond. The most compelling part of the article for me was how much ideas and standards of what attire is considered appropriate change over time AND can be changed through education.  For example, a highlighted 1987 JAMA study reported that 34% of patients wanted female physicians to wear skirts. Can you imagine that in 2013? - makes 1987 seem almost Victorian. What was most encouraging to me was the 2008 JHI study Mike mentioned in the article. That study found that a simple education session could shift the proportion of patients preferring their surgeons wear scrubs from 24% to 62%. Hopefully soon, we will all be wearing scrubs... and black vests.

Outbreak investigation: Truth stranger than fiction?

I stumbled upon a post on a Vermont online news site that really grabbed me (some additional details here). This is like something from a movie. It's the story of a cluster of infections occurring after arthroscopic procedures in a Vermont hospital. The infections were clustered over a one-month period and the procedures were all performed by the same surgeon. All of the infections were caused by different organisms. Ok, so far, nothing terribly exciting. But the surgeon claims that the patients were intentionally infected by the hospital who was trying to defame him. So the surgeon hires Dr. Bill Jarvis, a noted hospital epidemiologist, to investigate, and the plot thickens. Dr. Jarvis comes to the conclusion that the patients were infected by irrigation fluid used in the OR that had been intentionally contaminated (see his report here). He goes even further, noting that the organisms that caused the infection had been purchased by the hospital from the ATCC (American Type Culture Collection) weeks to months before the intentional contamination occurred. Now that's some herculean dot connecting! Of course, without having the organisms from the infections available for molecular typing to compare to the ATCC strains the hypothesis can't be proven. If this goes to trial, it will be very interesting to follow.

Addendum:  Another article about this outbreak from a different angle. Hat tip: Deb Burdsall.

Photo: thedetectivechannel.com

The copper kerfuffle, continued:

Several months ago we invited a guest post from Stephan Harbarth and Matthias Maiwald, a post that questioned the biological plausibility of a recently published clinical trial of copper surfaces that claimed a more than 50% reduction in the rate of healthcare-associated infection (HAI) and/or MRSA-VRE colonization. Now Harbarth, Maiwald and Stephanie Dancer have published a more extended critique of the study in a letter-to-the-editor in the September issue of Infection Control and Hospital Epidemiology. I encourage you to read the letter, and the reply from the authors, and make up your own mind about the validity of the findings and the transparency with which the authors reported their outcomes.

My two cents: the authors’ have been caught out in a case of selective reporting (or at least egregious obfuscation) of their outcomes, and it would probably have been better for them not to issue a reply (mostly because the reply is not persuasive). The reply claims that “any HAI” wasn’t reported because it would have also included some patients with colonization, and the development of infection versus colonization may be biologically different. But it is still OK to report the outcome “HAI and/or colonization”? They also make the case that Harbarth, et al cannot question the biological plausibility of their findings because they themselves have also argued that the environment is a source of HAI pathogens. This of course misses the point entirely. Harbarth, et al aren’t arguing that the environment has no role, they are arguing that it is implausible, given what we know about the pathogenesis of HAIs, that the environment has the major role suggested by the findings of this study.

A well-designed, persuasive, multicenter, randomized controlled trial that demonstrated a greater than 50% reduction in HAI by changing high-touch surface composition should have been published in a very high impact journal (e.g. JAMA, NEJM, Lancet), and the findings should have been front-page news in major media outlets. Alas, that didn’t happen with this study, for some of the reasons outlined in the letter by Harbarth, et al.

Pro-biotics, Con-biotics

A couple recent meta-analyses and a Cochrane review have provided support for the use of probiotics for prevention of antibiotic-associated diarrhea (AAD) and C. difficile.

Now, however, a randomized, controlled trial (RCT) of a lactobacilli/bifidobacteria combination in antibiotic-exposed adults over 65 years of age showed…..no difference in AAD (10.8% in treatment vs. 10.4% in control group) or C. difficile (0.8% vs. 1.2%). The trial was fairly large (almost 3000 patients enrolled), large enough that one would hope to see a difference in AAD, but the overall C. difficile rate was too low to say much (confidence interval for RR was 0.34-1.47). One major finding hidden in Table 3 of the manuscript: the treatment group had a statistically-significant increase in flatus (insert fart noises here).

What to do with this seemingly contradictory finding? A single negative RCT, performed in a narrowly defined population (inpatients over the age of 65) doesn’t exclude a potential benefit from probiotic use in other groups or if tested in a larger population with a higher baseline incidence of C. difficile. 

This does serve as another reminder, though, that when it comes to probiotics, there’s no substitute for the real thing.

Hospital epidemiologist in the spotlight

There's a nice profile of  Dr. Tara Palmore, a hospital epidemiologist at the NIH, in the Washington Post. The piece focuses on her role in bringing the KPC outbreak at the NIH Clinical Center under control via her collaboration with Dr. Julie Segre, a molecular biologist. Ten years ago it would be hard to imagine that a newspaper would publish an article about a hospital epidemiologist. The important role that infection prevention professionals play is finally coming to light.

Photo:  Hilary Schwab, BethesdaMagazine.com