David Livermore fights NDM-1, the 'super' superbug

David Livermore and NDM-1

There is a new story at MSNBC.com highlighting David Livermore, NDM-1, and the myriad of reasons for the expansion of MDR-bacteria and hospital infections: little investment in antibiotic discovery and infection prevention.  I like this quote from the article in regards to infection prevention: "If it is done properly, it can ease the demand for drugs in the first place."  Dr. Livermore is the Director of the Antibiotic Resistance Monitoring & Reference Laboratory (ARMRL) at the HPA Centre for Infections in London. The story is surprisingly well-written, includes the usual human-interest angle and quite long but worth a read.

h/t Mark Vander Weg

Treating KPCs? - Eat Yogurt? NOT

CNN's advice for KPCs? - Eat Yogurt

In a recent piece on CNN, Elizabeth Cohen discusses the recent KPC outbreak in SoCal.  She offers some advice to patients and families as to how they can help prevent these 'superbug' infections under the heading "sorting fact from fiction."  Let's go through this: 1) Wash hands - check  2) Remove unnecessary catheters - check  and ....3) Eat Yogurt.?!?  What the?  To be fair, when she was challenged by the other news person, she backed off and said yogurt prevented some infections and not specifically KPCs, but why include it in the graphic?  Was yogurt the fiction to the hand hygiene fact?  Is the data even suggestive that yogurt "prevents" C. diff? Maybe this is a case of powerpoint making us stupid because she felt the need to have at least three bullet points per slide?

A study in Altern Ther Health Med from 2005 found no benefit of a non-dairy probiotic on the gut microflora including Klebsiella. The CNN article quotes my long lost co-fellow Mitch Schwaber, who was the author of the Israeli KPC outbreak that we highlighted last week. Hopefully Mitch will be in Dallas and I can ask him about the yogurt...

Serratia marcescens outbreak: Alabama

There is a new outbreak linked to TPN feeds in Alabama.  There have been 19 cases with 9 deaths due to Serratia marcescens contamination at 6 Alabama hospitals.  The  outbreak was identified on March 16th and the product manufactured by Med IV was subsequently recalled.  I wonder if this is too late for a SHEA late breaker...

BBC News 3/30
AOL News 3/29
CNN story from 3/29

See you in Dallas: SHEA 2011

Safe travels to anybody heading to Dallas this week for SHEA 2011 (and everyone else too). We hope to see some of you there. If you're unable to make it to Dallas, SHEA is offering on-demand webcasts with audio AND video.  This is the last year (for the foreseeable future) for a stand-alone SHEA meeting, as the meeting will be combined with IDSA in the fall of 2012. Change is change.

the New York Times is dead to me

Dan, Mike and I have frequently posted on content from the NY Times. As most of you have heard, on Monday the NY Times began charging for digital content.  This is the so called pay wall or pay fence or pay sponge. I have no problem paying for digital content as I subscribe to the Economist, National Geographic, etc on my iPad with specific apps or through Zinio, which is a great app if you haven't tried it. What troubles me with the Times current plan is that they are charging me based on what device I use to read their content.  I mainly read the NY Times (and everything else) on my iPad and phone.  With other digital subscriptions this doesn't matter since I pay a single amount and can access on any device. For example, the Economist charges $110 for a year subscription no matter how I read their content. The NY Times, however, has decided that they will charge $15/4 weeks ($195/year) to read on a phone and an additional $20/month ($260/year) to read the same content on an iPad, for a total of $455/year.  Crazy.

I know there are work arounds like linking off Facebook or through google searchs, but do I really want to do that?  I could also enter my username and password each time and just read on the iPad browser, but that is not the point.  I know I could subscribe to the Sunday Times for $8/week ($416/year) and save $39, but I don't really want to kill trees and waste fuel and this option isn't available in all places.  It is almost like they don't realize there is a digital age upon us.  Netflix doesn't care if I stream on a TV, laptop, or phone and why should they? Do they have extra reporters giving me inside information that only goes to my iPad? No!  There is almost no additional cost (marginal cost) for them to upload the same content to my iPad or phone, so it makes no sense for me to spend $260/year for something that costs them nothing.  They need to join the 21st century and not race back to the past. I thought the Times was called the Gray Lady since it had few pictures, but perhaps there is another reason. So, until they offer one price for digital access, the Times is dead to me.  I won't read (all bookmarks and apps removed) and I won't review, link or comment on NY Times generated content.

EOR

Economist online subscription page (so you can see what the world could look like)

WBUR's On Point has a great discussion on this subject that you can listen to.

Measles in Minnesota

So there is another measles outbreak, this time in Minnesota. Unlike recent experience with mumps, in which outbreaks are associated with vaccine failure (over 60% of cases occurring among recipients of two mumps vaccines), measles outbreaks occur primarily among the unvaccinated, and are sustained by those who reject or avoid the MMR (see prior posts here and here). Of the 13 confirmed Minnesota cases, 5 were too young to be vaccinated, 6 should have been vaccinated but were not, and 2 so far are of unknown vaccine status. Regular updates can be found on the Minnesota Department of Health website. There’s also an interesting article in the Star-Tribune about resistance in the local Somali community to receipt of MMR, out of fears of….you guessed it, autism.

We’ve covered this ground before—go here for our prior posts on the anti-vaccine movement. We recently had some local news coverage of a pediatrician who was declining patients if the parents refused vaccinations. I believe this is a perfectly reasonable position for a pediatrician to take. In fact, if a pediatrician does accept anti-vaccine families, he or she has a duty to warn all the other patients in the practice of the increased risk to infants or immunocompromised children from being in that office waiting room.

Is your hot water hot enough?

There's an interesting paper in the March issue of Emerging Infectious Diseases that examines water cultures from homes of patients with nontuberculous mycobacterial infections (full text here). This paper caught my eye because it's our perception at VCU that we're seeing more patients with pulmonary atypical mycobacterial infections. Curiously, we rarely see Legionella, another waterborne pathogen.

In this study, water samples were obtained from 31 NTM-infected patients' homes from across the US. 59% of the homes had NTMs found in the water, and 46% had matching species. Of note, patients whose hot water temperature was <125° were two-fold more likely to have contaminated water than those whose water was >130°. The author recommends that patients at risk of NTM infections (slender elderly persons and cystic fibrosis heterozygotes), crank up the heat on their hot water tanks.