Who will win the all-important Lyme conspiracy theorist vote?

I have no idea, but the Romney-Ryan campaign seems to have the advantage. Slate and the Weekly Standard describe the details of a direct mail campaign in Virginia, courting the votes of those who believe that there exists a conspiracy to underdiagnose and undertreat Lyme Disease. Here’s an excerpt from the mailer:

SUPPORT TREATMENT
Encourage increased options for treatment of Lyme Disease and provide local physicians with protection from lawsuits to ensure they can treat the disease with the aggressive antibiotics that are required.

Translation: we’re in favor of protecting doctors who commit malpractice and place patients’ lives at risk by prescribing weeks of unnecessary antibiotic therapy for a disease that their patients do not have.

During my first few years of infectious diseases practice, I was asked to consult on a young mother admitted to the ICU for severe sepsis due to drug-resistant Pseudomonas, acquired by virtue of the weeks of intravenous ceftriaxone she’d been prescribed for a misdiagnosis of “chronic Lyme”. Her actual diagnosis was post-partum depression, for which she was eventually treated successfully, after barely surviving her hospitalization. Others haven’t been so lucky.

Reducing preventable harm, fraternity edition

Don't do this. 

It could cause death from alcohol poisoning. Also, it is generally unhygienic, and I suspect that it wreaks havoc on the colonic microbiome.

Guest Post: A "Hybrid" Surveillance approach for SSI

Dr. Connie Savor Price has been co-project director and PI on a 2009 AHRQ ACTION contract charged with improving the measurement of surgical site infection risk stratification and outcome detection. The final report has just been published online and she was kind enough to stop by our humble blog to briefly describe the project.

With pressure on infection control programs to expand surveillance for public reporting and pay-for -performance, increasing surveillance efficiency without sacrificing data validity creates a conundrum. Purely automated systems for surgical site infection (SSI) surveillance have been developed and utilized, but are not validated or generalizable for these purposes.

In this report, we describe development of "hybrid" surveillance approach using highly sensitive electronic algorithms for detection of SSI targeted for subsequent human-adjudication. Electronic algorithms to detect deep and organ-space SSI after coronary artery bypass grafting, total hip and knee arthroplasties, and herniorrhaphies were created using a sample of nationwide Veterans Affairs Surgical Quality Improvement Program data (VASQIP). The algorithms were tested against VASQIP data, and then assessed for generalization using data from hospitals from three different, external (non-VA) healthcare systems.

Although all algorithms performed reasonably well at identifying deep and organ-space SSI among the VASQIP test data set, performance was variable when tested against data from the outside systems. As one would expect, the observed variation was primarily due to differences in the data collected and stored electronically in each system. While not surprising, perhaps some are disappointed that this research did not produce a universally applicable surveillance tool for "out-of-the-box" utility for all infection control programs. But just wait. As meaningful use incentives help us move toward interoperable electronic health records throughout the United States, this surveillance strategy will hold promise as a reliable tool for detecting potential surgical site infection.

Man who first synthesized AZT, d4T and ddC dies at 93

Many of us probably have never heard of Jerome Horwitz, but there are few who have done as much for public health and infection prevention as he has. Dr. Horwitz synthesized the nucleoside analog reverse transcriptase inhibitors, AZT, d4t and ddC back in the 1960's as potential chemotherapeutic agents. They were pulled off the shelves in the 1980's and 1990's and proved to be some of the first successful antivirals effective against HIV and served as a model for future discoveries. Sadly, he never obtained patents on these agents and thus, someone else profited from his genius and efforts. To read more about Dr. Horwitz, please read the obituary in the NYT.

A couple errors are present in the current obit: Dr. Horwitz discovered zalcitabine (ddC) and not didanosine (ddI) and it is stuvadine (d4T) and not "stauvidine" that he synthesized.

The depredations of the Staphylococcus

From: Public Health Image Library

“Among the more chastening chapters in the annals of microbiological research is the story of our apparently dismal failure to control the depredations of the staphylococcus.”

The above quote, by Canadian microbiologist Claude Dolman, remains as true today as when he wrote it in 1955. Each time I attend on our busy ID consult service, I’m astonished again at how very nasty, and how very common, is S. aureus. Earlier this week we saw a patient with a confusing clinical presentation (confusing to me, anyway). At the end of the day, as we were going back over plausible etiologies for his symptoms, I said, “it’ll probably end up being just another presentation of invasive S. aureus disease”. As I was saying those words, his admission blood cultures were turning positive for….yes, S. aureus (in this case, methicillin-susceptible S. aureus). At any given time, I’d say about half the patients on our consult service have invasive S. aureus disease (evenly divided between community-acquired and “community-onset healthcare-associated”).

If you type “aureus” into the IDWeek online program planner, you’ll get 170 matches. That’s a lot of learnin’ you could do about S. aureus epidemiology, diagnosis, treatment and prevention! So if you haven’t yet signed up, please join us next month in San Diego.

The nation is talking....about KPCs!

Later today our colleague and fellow-blogger Eli will be one of the experts interviewed on NPRs Talk of the Nation. He will be discussing “the next steps in the fight against superbugs”. According to the preview, this segment will be aired during the second hour of the show. Tune in to hear Eli talk to the nation, revealing for the first time ever what the letters “KPC” really mean. If you miss it live, you can listen here once the show has aired.

Nothing to see here, please move along

It's been a quiet week out here on the edge of the blogging prairie. Some of us are recertifying, some are in the middle of huge grant deadlines and some are chairing a giant meeting planning committee with the meeting imminent. But, we still think about you every second and we miss providing you with up-to-date infection prevention information...

In the interim, we have created a little poll off to the right, which you can use to let us know how you like to read or follow the blog.  Vote early and often.

From the nothing to see here column: We've heard new reports that the NIH KPC outbreak that was halted by whole-genome sequencing is back. On September 7th there was a new case of the KPC strain, the first since January and 19th overall. The blood stream infection resulted in the unfortunate death of boy from Minnesota, the seventh fatality attributable to the strain.

NOW SEE THIS: Registration for ScienceOnline2013 is now officially open. It's the seventh annual un-conference exploring science on the Web and takes place Jan. 30-Feb. 2, 2013, in Raleigh, NC. Registration for the first round of 100 slots is closed for today, but there are two more opportunities to register: Thursday, Sept 20, 2012 at 2:00 PM (EDT) and Friday, Sept 21, 2012 at 11:00 PM (EDT). By rumor I heard that these sessions last only minutes, so log on near those start times and keep refreshing your browser. All seems pretty exciting.