What do sinks & contact lenses have in common?

Every infectious diseases doctor hates Fusarium, as therapeutic options are limited and relatively ineffective. I suspect the ophthalmologists do too, since Fusarium can cause severe keratitis in contact lens wearers.

This month's issue of Journal of Clinical Microbiology has an interesting study, funded in part by Bausch and Lomb (the maker of a particular contact lens cleaning solution that appeared to be associated with cases of Fusarium keratitis), on detecting the environmental source of the organism. Like many of the pathogens that infect profoundly immunosuppressed patients, Fusarium is also found in the environment, but unlike many other opportunistic fungal pathogens, it doesn't enter the body via the respiratory tract.

Investigators in this study sampled nearly 500 drains, primarily of bathroom sinks in 7 eastern states as far north as Pennsylvania, as far south as Florida, as well as California. They found that 66% of sink drains harbored Fusarium. Moreover, the most common strains detected are the most common strains that cause clinical infections. Importantly, this organism produces and lives in biofilm, which not only coats your sink drain, but can coat your contact lenses when they are inappropriately cleaned.

Photo: Fusarium macroconidia

Two papers linking XMRV and chronic fatigue syndrome retracted

Mike posted on a paper refuting the possible link between XMRV and chronic fatigue syndrome over a year ago.  Now it appears that both the 2009 Science paper and  2010 PNAS paper supporting such a link have been retracted.  The reasons for retraction of each paper appear to be very different.  For example, the story of the Science paper authors' possible image manipulation described by blogger Abbie Smith is pretty fascinating.  A great description of both retractions and related media reports can be found for both the Science and PNAS paper at Retraction Watch.  All of this is very unfortunate for the scientific community and especially the affected patients.

Sources:

Retraction of Lombardi et al., Science 326 (5952) 585-589 in Science 23 December 2011: Vol. 334 no. 6063 p. 1636 

NY Times, David Tuller 12/26/2011

h/t Ivan Oransky at Retraction Watch Blog 12/26/2011

Scientific inquiry, biosafety, and censorship

Investigators at the University of Wisconsin and at Erasmus University in the Netherlands have modified the H5N1 avian influenza strain so that it is not only highly virulent but also can be efficiently transmitted (at least among ferrets). Since the release of such a strain (high lethality, high transmissibility) would set the stage for a real-life version of the movie Contagion, there has been some high level angst about the wisdom of publishing the details of these experiments. This is kind of a big deal now, with a U.S. government panel appealing to two high-profile scientific journals (Nature and Science) to keep the experimental details out of the published reports of these experiments.

It appears that the scientists and institutions involved will comply with the recommendations of the National Science Advisory Board for Biosecurity. However, this work has already been presented at open scientific meetings, and detailed articles have been sent for peer review. And as Ron Fouchier, the lead investigator at Erasmus, says in today’s NY Times, “as soon as you share information with more than 10 people, the information will be on the street.” Finally, one purpose of the work was to identify those mutations that lead to greater transmissibility, so that they can be quickly detected during surveillance to help guide prevention efforts. I don’t think this can be done while simultaneously keeping those mutations a secret.

Contact precautions, and why I hate them, holiday edition

Investigators at the University of Maryland (and one or two who used to be there) are among few who are carefully examining the unintentional adverse consequences of contact precautions. Their latest publication comes out in January’s ICHE. In this paper, they report an association between starting contact precautions during hospitalization and delirium.

After adjusting for comorbid conditions, age, sex, ICU status, and length of stay, Day and colleagues found that patients newly placed under contact precautions during hospitalization were more likely to experience delirium (odds ratio 1.75, 95% CI 1.6-1.9). Delirium was defined by ICD-9 code, supplemented by use of restraints and anti-psychotic meds (this measure was validated by randomly-selected chart review). Curiously, this association did not hold for patients admitted to the hospital under contact precautions. As the authors point out, those admitted under contact precautions weren’t nearly as sick as those newly placed under precautions during hospitalization, which may account for this difference.

I’ll be the first to point out that this study doesn’t prove causation—however, the study does support our previous recommendations that patients placed under contact precautions should be carefully monitored for adverse psychiatric consequences.

Congratulations, Mike!

On being selected by HealthLeaders magazine as one of their 2011 “HealthLeaders 20”, twenty individuals they consider to be “changing healthcare for the better”. Mike’s profile can be found here. And yes, I found a photo of him wearing a tie.

No White Coats in Miami!!

I know it never gets cold in Miami, so they have one less excuse to hear from clinicians, but we wanted to share with you a new practice at Jackson Memorial Hospital in Miami, Florida.  Silvia Munoz-Price, Medical Director for Infection Control, shared that this past month they have found that white coats and scrubs were contaminated with the same pathogens as found on the hands of providers wearing the coats/scrubs. Thus, for the past 2 weeks they have been doing ID rounds wearing scrubs or bare below the elbow and without white coats. They report receiving "no negative feedback from the staff nor patients." Way to go Team Miami!

Failure of Freakonomics

Andrew Gelman (Columbia) and Kaiser Fung (NYU) have an interesting article in the Jan/Feb 2012 issue of American Scientist that is worth a read. They review the popular Freakonomics franchise of Steven Levitt and Stephen Dubner. Freakonomics and SuperFreakonomics have set the standard for the popular statistics/economics genre, from which Gelman and Fung have both benefited. (click on their names to see their books)

However, Gelman and Fung have identified a "tendency in the Freakonomics body of work to present speculative or even erroneous claims with an air of certainty."  Overall, I'm not so worried about the small errors they outline, but the reasons for the errors are concerning and the solutions are important ones to consider in any scientific discipline, including healthcare epidemiology.

One major problem they identify is Levitt and Dubner's reliance on linear informal social networks. For example, in the original Freakonomics, the network was "Levitt did the research, Dubner trusted Levitt, the Times trusted Dubner." However, as time pressures built and the need for more unique stories increased in SuperFreakonomics the network devolved into "Levitt trusts brilliant stars such as Myhrvold or Oster, Dubner trusts Levitt, and we the readers trust the Freakonomics brand."

The solution offered was that they should "leave friendship at the door."  I think this is something all scientific disciplines could benefit from.  It is clear that editorial boards, grant review committees and annual meeting planning committees are all at risk from reliance on a "linear" closed social network (in the past called "old boys' network"). They suggest that building more "non-linearity" into their research and evaluation would protect the process from what I might call a "friendship" bias.  Excellent advice, perhaps difficult to put into practice, but worth the effort.

link: American Scientist Jan/Feb 2012