More VRSA

Earlier this week, Eli posted on the first case of VRSA in Europe. Today, a posting on ProMed reports on the first VRSA case in Latin America. This is also the first time VRSA has been isolated from the blood; all previous strains were isolated from wounds. The patient was a 35 year old man from Sao Paulo, Brazil with diabetes and Sezary Syndrome. His bloodstream infection was controlled with daptomycin but he died 3 weeks after VRSA was isolated. The vanA gene was detected in the VRSA strain as well as from an Enterococcus faecalis strain isolated from the same patient.

Graphic:  Wikipedia

Epidemiologic activists

There's an excellent article in this morning's New York Times on the quest by the Cochrane group to determine the efficacy of Tamiflu, which is part of a bigger story on how pharmaceutical companies selectively release data regarding their products. It demonstrates how epidemiology can involve more than just data analysis and how political activism is sometimes required to find the data to answer basic questions.

Photo: Dr. Tom Jefferson by Chris Warde-Jones for the New York Times.

Top Infection Control Papers - ICPIC 2013 Edition

Andreas Widmer and I had the honor of presenting the "Best" Papers lectures at ICPIC this year. In case we spoke too quickly or you couldn't make it to Geneva this year, we have have posted the slides below. We wish we could have included many more papers since the quality of infection prevention research has increase immensely over the past decade (e.g. Huang's REDUCE MRSA study and Bonten's MOSAR trial).

And now for something completely different...

I posted back in October about some “microtargeting” of the chronic Lyme disease vote in Virginia, and in the comment section I referenced a short New Yorker blog post by Michael Specter. In a recent interview on NPR, Mr. Specter noted that he got “about 207 million pieces of hate mail” after that post, such an astonishing response that he convinced his editors that he should do a longer piece on the topic. 

That piece, “Lyme Wars”, is in this week’s New Yorker and is well worth a read.

More dirty laundry......

A new study in the American Journal of Infection Control by Dr. Silvia Munoz-Price and her team at the University of Miami provides additional insights on laundering of clothing worn in the clinical setting. In a convenience sample of 160 physicians and medical students, the Miami team found that white coats were laundered on average every 12.4 days, while scrubs were laundered every 1.7 days. I found it a little surprising that for scrubs the frequency wasn't closer to 1.0, but that's tremendously better than 12 days! For both coats and scrubs, faculty laundered their attire more often than housestaff or students. Interestingly, the major reasons given for wearing white coats were: (1) ego (makes me looks and feel like a doctor, 29%), and (2) storage needs (25%). Neither is a good reason.

Late last year, the same team published a study that found that white coats were more commonly contaminated with pathogens than were scrubs in the ICU setting. Moreover, if the hands were contaminated with a pathogen, white coats were more commonly contaminated than were scrubs. And all of the HCWs with negative hand cultures were dressed in scrubs.

Both studies were relatively small and performed in a single (though very large) medical center. Nonetheless, there is a body of evidence accumulating that clothing contamination in the clinical setting is a real phenomenon and probably should no longer be ignored by infection prevention programs. So I was delighted a few days ago to see that West Virginia University Hospitals is considering banning ties and white coats.

Photo:  Dr. Munoz-Price (far right), in scrubs!

VRSA - First Case in Europe

Lost among the attention given to MERS in the recent NEJM and the H7N9 papers published in the Lancet today is a report of the first vancomycin-resistant S. aureus case in Europe. 

The case was in a 74yo in Portugal with diabetes on dialysis. She had prior pseudomonal and MRSA diabetic foot infections treated with vancomycin. This May she had VRSA detected in pus from a toe amputation wound with MIC for vancomycin of >256 μg/mL and MIC of 24μg/mL for teicoplanin. VRE and P. aeruginosa were also cultured. The VRSA strain was sequence type ST105, SCCmec type II, and had both the mecA and vanA genes (from her VRE). This VRSA was resistant to erythromycin, clindamycin, gentamicin, and ciprofloxacin, and susceptible to co-trimoxazole, tetracycline, tygecycline, linezolid, daptomycin, quinupristin/dalfopristin, fusidic acid, cloramphenicol, rifampicin, and mupirocin.

A bundled intervention to decrease surgical site infections: A Video Abstract

Last week we discussed a recent BMJ meta-analysis of SSI prevention intervention studies in cardiac and orthopedic surgery. Who better to tell you about the important results than the authors themselves. Loreen Herwaldt and Marin Schweizer offer their thoughts. Enjoy!