Guest Post: IDWeek in Review

This is a special guest post by Dan Morgan, MD MS. He's an assistant professor at the University of Maryland, Baltimore.

After a hectic few days of conferencing at IDWeek I’m looking forward to my more hermit-like routine. Although fields of knowledge tend to advance relatively slowly, this IDWeek was inspiring for a number of interesting ideas emerging in hospital epidemiology. Although I'm sure I missed most of what happened while I was talking in the hallways or waiting in the lunch line, I'm still mulling over a few ideas on flights back to the East Coast that I would like to share.

Antimicrobial-resistance is increasing. This is a worldwide phenomenon in which what happens in one country affects other countries. This is an issue in the hospital with carbapenem-resistant enterobacteriaceae and Acinetobacter and although declining, MRSA is still a large problem. The community also is critical, holding a huge burden of resistance not only in MRSA but gonorrhea and other sexually transmitted infections, along with other pathogens like malaria and TB.

Manipulation of the microbiome is beginning to be seen as a therapeutic target. The remarkable experience with fecal transplants was frequently mentioned and a neater, cleaner method for taking a pill containing poop to populate the colonic microbiome is under evaluation in an ongoing trial in Canada from Thomas Louie at colleagues. Beyond C. difficile, nasal MRSA decolonization through microbiome manipulation was discussed by Mary-Claire Roghmann and the exploratory papers on obesity and other non-infectious diseases was reviewed by Bob Weinstein.

Public policies to promote HAI prevention were hailed as a success in a video presentation from Denise Cardo, and regardless of ones perspective, as stated by David Calfee and Brad Spellberg, public reporting of process measures and outcomes is here to stay.

Infection prevention outside the hospital was highlighted in multiple sessions. From debates on contact precautions in nursing homes, interventional studies by Lona Moody showing a benefit secondary to improved attention to standard infection control in long-term care facilities, and Mary Hayden's presentation on a bundle to prevent CRE in LTACHs.

Methodology of infection prevention studies is improving. Multiple cluster trials were discussed (those above by Mary and Lona and the BUGG study by Anthony Harris—full disclosure, I was a co-author with Anthony on this study) and methods to perform more rigorous quasi-experimental and pragmatic studies were well described by Jessina McGregor, Ebb Lautenbach and Marin Schweitzer in an advanced epidemiological session.

Technology is improving but several technologies (e.g interventions for room cleaning (Curtis Donskey) or hand hygiene (Kal Gupta)). However, when they are ready for prime time they will need to be integrated appropriately as one part of healthcare epidemiology.

Chlorhexidine patient bathing is the new black. After recent NEJM papers by Susan Huang, Mike Climo (and most other luminaries in healthcare epidemiology) there seems to be a move towards widespread adoption in the United States. At IDWeek, CHG was also presented as potentially beneficial for CRE prevention in LTACHs and despite nervousness around FDA warnings, is being used in NICUs. Some expressed concern for the possibility for future decreasing susceptibility to CHG.

Shutdowns have an effect! A power outage on Saturday ended some sessions early but the more remarkable shutdown was federal. Notable were the absences of organizer Scott Fridkin and many leaders who work for the CDC or VA. The rapture realized!