The Wonderful ESCMID-SHEA Course - Potsdam

I just returned from Potsdam and the 14th ESCMID-SHEA Training Course in Hospital Epidemiology. The faculty and students were all incredible people and I really enjoyed the interactive discussions.  It all started with a wonderful dinner at Professor Petra Gastmeier's home and thanks to the Aesculap Akademie staff, we truly were Sans Souci "Without Worries." Looking forward to future courses in Brussels and other wonderful locales.

35 cases now and counting...

For those of you following the Aspergillus nosocomial meningitis outbreak, there are new newspaper articles with additional details here and here. The New York Times article today focused on the lack of oversight of compounding pharmacies. Also, CDC has a webpage with useful information for clinicians that can be found here.

Map:  CDC.

Aspergillus outbreak expands

The outbreak of nosocomial meningitis due to Aspergillus that we noted yesterday is larger than initially reported. Today's New York Times now reports that there have been 34 cases (4 deaths) that involve patients in 5 states. The cases have been traced to contaminated methylprednisolone solution used for epidural injections that was compounded at a pharmacy in Massachusetts.

CDC is recommending that suspected cases be treated with IV voriconazole and consideration be given to the addition of IV amphotericin B.

Photo:  Janet Carr, CDC.

Nosocomial Aspergillus meningitis outbreak

This morning's New York Times reports on an alarming outbreak of Aspergillus meningitis in Tennessee. At this point there have been 14 cases, two of whom have died. All patients received steroid injections into their lumbar spines. From time to time we see sporadic cases of infections due to injections of steroids, most commonly into joints, but the vast majority of those cases are due to Staph. aureus. In the current outbreak, it is postulated that the contamination occurred in a compounding pharmacy prior to shipment to the facility where the injections were performed. Because Aspergillus is an extremely rare cause of meningitis, it is unlikely that clinicians would suspect this infection and it's also unlikely that the organism would be seen on initial microscopic view of the spinal fluid. Thus, delays in diagnosis would not be surprising.

Photo:  CDC.

HAI stories

Via the CDC's Safe Healthcare blog, a healthcare-associated infection story worth reading, told from the perspective of Brenda Helms, Infection Preventionist. 

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.