How does a study become an internet meme?

According to the internet the steps to starting an internet meme are: (1) have an idea, (2) find a picture that reflects what you want to imply and (3) "now this is where the skill comes in."  The first two steps are pretty easy to understand, but I'm currently trying to sort out what step 3 actually means.

For an example of a study becoming a meme witness Maggie Carrel's (geography professor at Iowa) recent ICHE study where she geocoded Iowa Veterans and found that those living near a large pig CAFO where at greater risk for MRSA nasal colonization on admission to an acute care hospital. You can read a bit more about her study in Maryn McKenna's Wired blog post.  I suspect Maryn's writing is where the skill comes in because Maggie's study is now a meme (image below) from PEW's health initiative - Supermoms Against Superbugs. Super.

h/t to co-author Tara Smith for finding the meme.

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.

What does 'antibiotic resistance' mean to patients?

We've all heard a patient or family member claim that "they've become resistant to an antibiotic." Clinicians and public health campaigns often attempt to communicate the importance of appropriate antibiotic use, yet how patients interpret the concept of 'antibiotic resistance' may impede their best efforts. Thus, could patient misunderstanding hinder antibiotic stewardship efforts?

In July's JGIM (abstract free here), Lucy Brookes-Howell and colleagues from nine European countries completed semi-structured interviews of 121 patients with a recent lower respiratory tract infection, in order to determine their understanding of 'antibiotic resistance'. The most common theme that emerged from this study was that patients conceptualized antibiotic resistance as being 'the resistant human body' with 43 of 121 expressing this idea. Only 28 patients correctly understood that resistance was a property of the bacteria. Thus, substantial confusion was present in the majority of patients.

With almost two-thirds of patients not understanding the basics of antibiotic resistance, it is unclear if current public health campaigns that suggest that individual misuse promotes resistance can ever be effective. The authors of this study correctly wonder whether a community focus might be a better approach and also mention that using terms like 'superbug' might improve patient understanding. Maryn McKenna might be onto something...

Image source: (here)

Addendum: Really nice editorial by Timothy Edgar accompanies the study.

Science Friday (the 13th): TDR-TB

Maryn McKenna (@marynmck) of Superbug fame will be on Science Friday (Hour 1: 2-3pm ET) tomorrow to discuss Totally Drug-Resistant TB.  She has had some very informative posts recently on the topic, including discussion of the two earliest known patients in Italy who died in 2003.  She also reports on the latest twelve TDR-TB cases in a single Indian hospital and points us to an ahead-of-print letter in CID posted in December that discusses the diagnosis and care of the first four of these patients in India.  Turn on, tune in...


Superbug post #2: Earliest Cases of TDR-TB
Superbug post #1: Latest Cases of TDR-TB in India

(Eli @eliowa)

Tragedy of the commons: Antibiotics in Agriculture

@marynmck broke the story right before Christmas that FDA had silently posted that they are backing-off of their long-held (1977) plan to limit overuse of agricultural antibiotics. Instead of formal bans and policy change the FDA now hopes to “focus its efforts for now on the potential for voluntary reform and the promotion of the judicious use of antimicrobials in the interest of public health.”

So here is the current US policy for protecting a critical and diminishing resource for public health:  Please Please Please don't use antibiotics!  Please?  How about if I'm nice? No? Pretty Please. Sugar on top?  Perhaps we should call this the "Don't let the Pigeon Drive the Bus Policy."  I guess it kinda worked in the book. Kinda.

So after burying the bad news on a Thursday before a major holiday weekend, the FDA posted some sort of half-good news right after the new year. You guys excited?  So what was the good news?  They will limit cephalosporins (woo woo) but with so many loopholes and restrictions that it won't matter much. Today, a NYT Editorial in frustration pointed out that FDA "will ban the injection of the antibiotics into chicken eggs and halt the practice of giving large, sustained doses to cattle and pigs. But it still allows widespread use in animals like rabbits and ducks, and veterinarians will still be able to use the drugs in ways not specifically approved by the FDA."

We've written about this issue many times before.  It's amazing that we continue to squander critical antibiotics in animal populations, while at the same time barely funding efforts to develop new antibiotics or new infection prevention strategies. The NYT stated today that "it’s time for the FDA to consider the public’s health as carefully as it considers the interests of intensive agriculture and pharmaceutical companies." Hear Hear.

Sources:

1) Maryn McKenna, Superbug Blog 12/23/2011
2) NYT Editorial "FDA Creeps Forward" 1/11/2012

Funding for antibacterial resistance research. Not so much.

At least no funding for ESCKAPE pathogen research

I just got back from attending the World HAI Forum in Annecy and the 1st ICPIC meeting in Geneva.  Both great meetings.  I will share my thoughts on the implications of ICPIC in a later post.

Last year at IDSA, Roy (Trip) Gulick stated that there are now 10,000 possible ART combinations for HIV treatment.  When he said that, I instantly got a sinking feeling in my gut.  Right now, there are many people colonized and infected with resistant bacteria for which we have NO EFFECTIVE THERAPY.  Sorry for shouting.  Think about the MDR-Acinetobacter or NDM-1 strains that are circulating.  Pretty soon we won't even have effective therapy for community UTIs.

As I thought about why this might be, I looked for the federal funding picture for antibacterial resistance research, but there were no published data.  So, we found the numbers ourselves.  I presented the data last week and Marin McKenna kindly described our findings at the World HAI Forum on her Wired Superbug blog.  She did a much better job describing our research findings than I could have.  If you're interested in reading about how much NIH/NIAID spends on antibacterial resistance research, head on over to her blog...

UPDATE:  We published these findings in the first batch of articles in the ARIC journal, see: Kwon et al. 2012 ARIC

SUPERBUG - now in paperback

We've posted several times (here and here) on Maryn McKenna's homage to MRSA.  Head on over to Maryn's Wired Science Superbug blog to hear more about the book.  It's too bad that there is a new C. difficile PCR out. Now the world is conspiring to turn C. diff into the new superbug leaving poor old MRSA in the dust.  I have a sneaking feeling that MRSA doesn't read the news though, so I would imagine that it won't change its behavior too much.

Maryn McKenna visits Iowa City (and 1957 Cleveland)

McKenna's latest book

We've written before about Maryn McKenna, who is the author of Superbug, a journalist and a blogger.  After PepsiGate tore through ScienceBlogs, she had to relocate her blog to here and finally here, so I wanted to make sure you all could still find her.  She writes extensively about antibiotic resistance and other infectious diseases at Wired - she knows her science, which is rare among journalists, and she's a wonderful storyteller too.  Check out her latest post on the pre-publication NDM-1 EID papers.

Maryn was on the UI campus today and spoke at a UI College of Public Health conference on MRSA; she gave a wonderful history of resistant Staphylococcus aureus and MRSA. She even mentioned in passing the important conference in Cleveland on November 14, 1957.

Do you know that conference?  This conference was sponsored by 15 organizations including the AMA with ACP, ACS, AHA, ACOG, AAP, VA, CDC, USPHS, FDA and APHA among others. The presentations and discussions at this conference led to the development of a national program for the eradication of S. aureus in hospitals and to the following recommendations for the AMA trustees:

1. That every hospital establish a responsible officer or committee charged with the investigation and control of infections within that hospital and with the institution of procedures and practices designed to prevent such infections.

2. That encouragement and funds be channeled into scientific research concerning the etiology and epidemiology and the immune relationships of pyogenic staphylococci, their relationships to the defensive cells of the body and the mechanism of their mutability to drug and antibiotic resistance.

The AMA trustees approved this within one month and referred it to the Joint Commission, which in the spring of 1958 added #1 above to the requirements for hospitals seeking accreditation. Thus we have these people, groups and S. aureus to thank for infection control programs as we know them today. I wonder if we need a similar conference now on MDR-Gram negatives?

Reference: Wise RI, et al. Reviews of Infect Dis, Nov-Dec 1989

Question: Why was the conference in Cleveland?

Perhaps because Charles Henry Rammelkamp, Jr., M.D was there. He was well known for his work demonstrating the impact of a sulfonamide derivatives on staphylococci and reporting the first penicillin-resistant strain of staphylococcus. He also contributed to the understanding of the epidemiology of staphylococci in nurseries and the role of coagulase in the evolution of staphylococcal disease.  Not sure if that's why, but seems like a good enough reason to me.

Good move Maryn McKenna

We have written often on conflicts of interest. So, I've been following the recent "problems" over at ScienceBlogs.com closely. Quick story is that 2 weeks ago the editors there added a Food Frontiers blog completely funded and written by PepsiCo. I think internist PalMD said it best:

"It could be argued that since it is clearly announced that the content is PepsiCo's, that transparency is maintained, but it's not. Readers of the other 70-odd blogs at Sb expect independent content in the center column. What's more, Sb is indexed by Google News. As a news outlet, we should be held to a high standard. If the SEED management can't see what's wrong with this, this may be an insoluble problem."

PalMD left and returned to his old site as did Maryn McKenna. Many other great bloggers have left too. It must have been a difficult decision to leave the collective, but it is a good one.

PalMD's White Coat Underground (link) and PalMD's full comments (here)
McKenna's Superbug blog (link)
The Guardian's take (here)
Our COI posts (here)