Dreams can come true

“Throw your dreams into space like a kite, 

and you do not know what it will bring back, 

a new life, a new friend, a new love, a new country.”

-Anais Nin

Dreams come in all shapes and sizes. Some dream of being an astronaut and others dream of an article in NYTimes Weddings with their one true love. Those of us out here in the Midwest have larger but perhaps more simple dreams. As an example, Erik Dubberke, CDI investigator extraordinaire from Wash U. in St Louis, has dreamed of making the "Times Travels" section of the Webster-Kirkwood Times. To accomplish this goal he needed to submit a photo holding the Times while traveling and he enlisted some ID colleagues to pose with him. It was great to spend a 1/2 day touring the museums of Vienna with Erik and colleagues and making a dream come true ;)

Update from ECCMID: Infectious disease and medical overuse

This is a guest post by Dan Morgan, MD MS. He's an Associate Professor of Epidemiology and Medicine at the University of Maryland, Baltimore.


At the European Congress of Clinical Microbiology and Infectious Diseases (ECCMID) meeting last week in Vienna, Austria, a session was dedicated to Medical Overuse and Infectious Disease. To me, it was great to hear smart people thinking about my job, infectious diseases, in the context/language of my hobby, medical overuse.  Medical overuse has been defined as the provision of care in which harms outweigh benefits or the benefits are so small that informed patients would not want care. Although it was the last session of the meeting, it was surprisingly well attended. A few high points follow:

Céire Costelloe from the UK presented work showing 80% of antibiotics are given as outpatients and promote risk of resistance greatest in the first week but antibiotics have a persistent effect six months after use. Targeting overuse of antibiotics in outpatient settings is likely key to address antibiotic resistance.

Alexander Friedrich from the Netherlands, presented a balanced view of how tests can drive overuse—such as blood cultures or rapid malaria testing, but also that testing may have a role in reducing overuse in the use of procalcitonin to stop antibiotics. If clinicians default to antibiotics, then testing may help them step back. However, if clinicians aren’t prone to empiric treatment, testing may increase treatment.

Stephan Harbarth from Switzerland then gave a great overview of how implanted devices like urinary, central-venous catheters and endotracheal tubes are risks for HAIs, MDRO colonization and are often overused. His message was that reducing use of devices is the primary way of reducing infections. (Although note, CDC and other agencies use rates per catheter day, which discourages removal of low risk catheters, so we may need a better metric—like “days of utilization”)

Finally I spoke, closing the session and the conference. My talk focused on what do we know about Overuse more generally and what can we do to prevent Overuse? To me, the basis of Overuse is a skewed view of testing and treatment. I reviewed the evidence of physician over-enthusiasm for benefits of testing and treatment and tendency to underestimate harms of both. I presented a general model for how to address overuse, the Choosing Wisely campaign and how CW could be used by those encouraging stewardship. On the theme of stewardship, there have been interesting studies showing the benefits of diagnostic stewardship, identifying what seems to be a growing trend to modify testing to improve antibiotic use.

There was, of course, much more from ECCMID that is publicly available. Take advantage of their site that has recordings of talks!

Love song to America?

This week I attended the 2017 ECCMID planning meeting in Rome. It's going to be a great meeting if the ~5000 abstracts we reviewed and slotted are any indication. I hope you're able to make it to Vienna this April. Of course, when not debating where to slot an abstract - podium, poster, mini-oral e-poster or e-poster, many of my European colleagues asked me about the state of affairs in the US and the world. I didn't have much to say since I've heretofore lived my life by two simple rules: "never get involved in a land war in Asia" and "never go in against a Sicilian when death is on the line." I simply don't have much opinion on amassing troops in Poland other than it didn't end well in the 1930s. So, most of the conversations went like this:

ECCMID colleague: "wtf?"

Me: "wtf."

ECCMID colleague: "WTF?"

Me: "WTF!"

On my taxi ride to Fiumicino Airport, Lady Gaga's "Million Reasons" was playing on the radio and it seemed to sum up how I feel about the current situation in the US. The song was released on November 9th...I wonder. And if you say something that you might even mean - It's hard to even fathom which parts I should believe... With all that's going on, many are looking for one good reason to stay

Public Reporting - Do we need big brother?

I was fortunate to be an invited speaker at the 2016 ECCMID meeting in Amsterdam last week. My topic was "Monitoring Process of Care: Do We Need Big Brother?" I used the opportunity to take a big picture view of public reporting of HAI and MDRO data in the US and Europe and a closer look at the selection of process versus outcomes measures for reporting. I've posted my slides below and you can also listen to my talk on ECCMID's website. As I believe Dan stated earlier, I hope that all meetings evolve to allow free/open access to presentations like ECCMID has.

ECCMID: Year in Infection Control

First, a hearty THANKS to ECCMID organizers for setting up a truly excellent website that allows for almost real-time access to presentations (at least those for which the presenter gave permission). Head to this link to hear two of the "Year in Infection Control" talks from this morning, by Drs. Anucha Apisarnthanarak and Sebastian Lemmen. Just click on the screen icon to the left of the speaker's name and you're off to the races. 

Regarding the talks in the sepsis session I blogged about yesterday, unfortunately only one of the four speakers appears to have agreed to have the talk accessible on the web--Dr. Tom van der Poll's talk is available here.

I consider any talk I give to be in the public domain immediately afterwards, so I don't understand why presenters would decline to have their talks posted to a conference website. Maybe it's just a paperwork snafu.

My week with SIRS

I’ve been down for several days this week with influenza A, which is not shocking since this year’s vaccine (yes, I did receive it) has a whopping 51% effectiveness against the predominant circulating strain. You’ll have to find our prior posts on the horrible influenza vaccine on your own, myalgias prevent me from adding more links. 

Early into illness, I had a vivid dream in which I was being admitted to a hospital. A doctor who looked exactly like the Phillie Phanatic told me I met criteria for SIRS/sepsis, and started administering vancomycin and piperacillin-tazobactam by direct injection into my kidneys. 

But the only thing more boring than stories about people's self-limited viral infections are stories about their dreams, so I’ll stop now and retire quickly to my sofa (this, of course, is a really bad sepsis pun about the new qSOFA score). For while I did meet SIRS criteria, I never met qSOFA criteria (RR >= 22/min, altered mentation, or SBP <= 100 mm Hg), demonstrating with an N of 1 that qSOFA is more specific for identifying those likely to suffer "poor outcomes typical of sepsis".

Eli already linked to the Third International Consensus Definitions for sepsis, which are well worth a read. There is also an excellent piece in Slate about sepsis, by Dr. Jeremy Faust (an Emergency Medicine resident at Mt. Sinai in NYC), that accessibly covers the new definitions and the unintended adverse consequences of the CMS sepsis measure, including those that impact antibiotic stewardship. Finally, ECCMID is underway and I’ve already read tweets about a terrific session on sepsis there today—I’m assuming the content will be available at this link once the session is uploaded.

Guest Post: Social Media Survey

This is a guest post from Dr. Jon Otter, an epidemiologist focused on Infection Prevention and Control at Imperial College Healthcare NHS Trust in London. Jon has a degree in Microbiology and a PhD in epidemiology. His research interests include the epidemiology of MRSA, CDI and MDR-GNR, the role of contaminated surfaces in transmission, and molecular typing methods including whole genome sequencing. If you're interested in reading more of Jon's excellent musings, he's a blogger at the Reflections on Infection Prevention and Control blog.

Social media (in all its guises) is being used increasingly in our personal and professional lives. The advent of social media brings with it a number of challenges (time-consuming, unhelpful interactions, new liabilities) but also some important potential benefits for healthcare professionals and patients (principally unique opportunities for reaching colleagues and patients). I've been asked to do a talk at ECCMID in Amsterdam next month on the use of social media among healthcare professionals. I was able to find some reasonable data on the use of social media among scientists, but I could find very little data on the use of social media among healthcare professionals in general, and IPC/micro/ID folks in particular. So, I've produced a simple survey to fill this gap, and ask that you share the link (https://www.surveymonkey.co.uk/r/KWYMDPM) with your colleagues so that they can complete it too. It is important that the survey is circulated outside of social media channels, for obvious reasons! I’ll be including the results of the survey in my ECCMID talk, and will make the slides available afterwards here. Many thanks to the Controversies bloggers for the opportunity to tell you about this survey.

(Editor's note: Survey takes 30 seconds so please help Jon out if you can, Thanks!)

ECCMID 2015 - "Best Of" Infection Control Literature (Part 1)

Every year it seems that one of us at the University of Iowa is roped into giving one of these "Best of Infection Control" talks at an annual conference. This year it seems that almost all of us have been asked and for some inexplicable reason, we all said yes! I was the lucky one to kick off the 2015 season with this talk I gave last week at ECCMID in Copenhagen. I covered S. aureus, MRSA, VRE, VRSA, surgical site infections and hand hygiene. I look forward to Mike's talk at SHEA. Loren Herwaldt's talk at ICPIC and Dan's talk at IDWeek. On Iowa.

The Year in Infection Control - 2014 (Part 2)

A couple weeks ago, I posted an excellent summary of the year in infection control given at ECCMID 2014 by Christina M.J.E Vandenbroucke-Grauls. That talk was Part 2 of the session. Below I've posted Part 1 as delivered by Professor Barry Cookson. It was also excellent. Thanks to both for sharing their slides. Enjoy!

The Year in Infection Control - 2014

Earlier this week, I was lucky enough to attend ECCMID in Barcelona. What a wonderful meeting and amazing city. One of the highlights for me was attending the Update in Infection Control session chaired by Professors Barry Cookson and Christina M.J.E Vandenbroucke-Grauls. Christina has shared excerpts from her talk, which I've posted below. Her talk was great - hope you enjoy. Thanks Christina!

The Year in Infection Control: Almost Live from ECCMID 2012

Jan Kluytmans and Maria Luisa Moro were kind enough to share their presentation from ECCMID in London earlier this month.  What a great review - wish I was there. Enjoy! The Year in Infection Control