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Journal Roundup

Published:August 15, 2014DOI:https://doi.org/10.1016/j.jhin.2014.08.001

      Research

      Infection Control and Hospital Epidemiology (ICHE) contains a much-publicized article demonstrating a five-fold increase in the detection of carbapenem-resistant Enterobacteriaceae (CRE) in 25 US community hospitals from 2008 to 2012.
      • Thaden J.T.
      • Lewis S.S.
      • Hazen K.C.
      • et al.
      Rising rates of carbapenem-resistant Enterobacteriaceae in community hospitals: a mixed-methods review of epidemiology and microbiology practices in a network of community hospitals in the southeastern United States.
      It's disturbing that these were community hospitals, not large academic centres, suggesting that CRE is becoming established in a wider population. It's also disturbing that hospitals that had adopted the lower breakpoint detected more CRE, suggesting that these statistics are an underestimate. Even more concerning is the report of a regular flow of colistin-resistant Klebsiella pneumoniae into an Indian cancer centre.
      • Goel G.
      • Hmar L.
      • Sarkar De M.
      • Bhattacharya S.
      • Chandy M.
      Colistin-resistant Klebsiella pneumoniae: report of a cluster of 24 cases from a new oncology center in eastern India.
      Matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) presents an alternative diagnostic approach: a Brazilian study in the Journal of Antimicrobial Chemotherapy reports the use of MALDI-TOF for detecting carbapenemase activity directly from blood cultures.
      • Carvalhaes C.G.
      • Cayo R.
      • Visconde M.F.
      • et al.
      Detection of carbapenemase activity directly from blood culture vials using MALDI-TOF MS: a quick answer for the right decision.
      The overall sensitivity was only 72%, but seemed to be higher for the Enterobacteriaceae over non-fermenters, so perhaps MALDI-TOF is best viewed as a rapid screening test, backed-up by subsequent conventional methods, for now at least.
      An important review in Emerging Infectious Diseases reports mortality associated with carbapenem resistance in Entero-bacteriaceae.
      • Falagas M.E.
      • Tansarli G.S.
      • Karageorgopoulos D.E.
      • Vardakas K.Z.
      Deaths attributable to carbapenem-resistant Enterobacteriaceae infections.
      The key finding is that patients infected with carbapenem-resistant Enterobacteriaceae were twice as likely to die as those infected with carbapenem-susceptible Enterobacteriaceae.
      It seems from a study in the American Journal of Infection Control and a recent study in the Journal of Hospital Infection that a ‘fist bump’ transfers fewer bacteria than a handshake.
      • Mela S.
      • Whitworth D.E.
      The fist bump: a more hygienic alternative to the handshake.
      • Ghareeb P.A.
      • Bourlai T.
      • Dutton W.
      • McClellan W.T.
      Reducing pathogen transmission in a hospital setting. Handshake versus fist bump: a pilot study.
      But how would you feel if your GP greeted you with a hearty fist bump? Perhaps we need to embrace ‘no-touch’ greetings?
      The Lancet mourns the loss of all aboard flight MH17, including prominent HIV researchers.
      • Samarasekera U.
      MH17 tragedy: HIV community mourns loss of colleagues.
      The Lancet also publishes a large randomized controlled study of triclosan-impregnated sutures for preventing abdominal surgical site infection: the bottom line is that no reduction in surgical site infection (SSI) was detected in the triclosan arm.
      • Diener M.K.
      • Knebel P.
      • Kieser M.
      • et al.
      Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the random-ised controlled PROUD trial.
      This makes the timing of an economic evaluation published in ICHE demonstrating that triclosan-impregnated sutures would be cost-effective with a small reduction in SSI somewhat unfortunate!
      • Singh A.
      • Bartsch S.M.
      • Muder R.R.
      • Lee B.Y.
      An economic model: value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections.
      It seems that the microbiome of every organ and secretion is being investigated, and semen is no different! A PLOS Pathogens article finds an intriguing association between the semen microbiome and HIV viral load.
      • Liu C.M.
      • Osborne B.J.
      • Hungate B.A.
      • et al.
      The semen microbiome and its relationship with local immunology and viral load in HIV infection.
      An analysis of the gut microbiome reported in Nature Communications has resulted in the discovery of a new bacteriophage present in most human faecal microbiomes: the amusingly named ‘crAssphage’!
      • Dutilh B.E.
      • Cassman N.
      • McNair K.
      • et al.
      A highly abundant bacteriophage discovered in the unknown sequences of human faecal metagenomes.
      It does seem that bacteriophages represent a possible new frontier in the treatment of infectious diseases, although a Lancet Infectious Diseases book review on Phage therapy: current research and applications demonstrates that phage therapy still has a long way to go.
      • Asavarut P.
      • Hajitou A.
      The phage revolution against antibiotic resistance.
      While on the topic of phages, PLOS Pathogens publishes an important review on the concerning capacity of phages to serve as vehicles for antibiotic resistance genes in the environment.
      • Balcazar J.L.
      Bacteriophages as vehicles for antibiotic resistance genes in the environment.
      Continuing the gut theme, a Journal of Antimicrobial Chemotherapy article reports a potential role for intestinal biofilms in recurrent Clostridium difficile infection.
      • Crowther G.S.
      • Chilton C.H.
      • Todhunter S.L.
      • et al.
      Comparison of planktonic and biofilm-associated communities of Clostridium difficile and indigenous gut microbiota in a triple-stage chemostat gut model.
      Bacterial endospores + biofilm = a formidable challenge to therapy! Meanwhile, ‘selective’ digestive decontamination (SDD) continues to be en vogue in The Netherlands, so it's interesting that a Dutch study demonstrates a doubling of antibiotic resistance genes in the gut resistome of a patient undergoing SDD!
      • Buelow E.
      • Gonzalez T.B.
      • Versluis D.
      • et al.
      Effects of selective digestive decontamination (SDD) on the gut resistome.
      As the Ebola outbreak continues unabated in Sierra Leone and Liberia, a Journal of Infectious Diseases article identifies a number of biomarkers that are associated with haemorrhage and death.
      • McElroy A.K.
      • Erickson B.R.
      • Flietstra T.D.
      • et al.
      Ebola hemorrhagic fever: novel biomarker correlates of clinical outcome.
      These could be promising candidates for much-needed therapy.
      • Ansumana R.
      • Bonwitt J.
      • Stenger D.A.
      • Jacobsen K.H.
      Ebola in Sierra Leone: a call for action.
      An article in Clinical Infectious Diseases reports the success of school-based influenza vaccination.
      • Pannaraj P.S.
      • Wang H.L.
      • Rivas H.
      • et al.
      School-located influenza vaccination decreases laboratory-confirmed influenza and improves school attendance.
      The results clear: schools that had a vaccination programme had less influenza and vaccinated children missed fewer school days than unvaccinated children (2.8 vs 4.3 per 100 school-days). There was also an interesting ‘herd immunity’ effect, whereby unvaccinated children in schools with a vaccination programme were also protected. So, form an orderly queue children …
      Continuing the vaccination theme, commentary in Annals of Internal Medicine discusses the readiness for dealing with measles in the USA in light of recent outbreaks.
      • Sammons J.S.
      Ready or not: responding to measles in the postelimination era.
      Sadly, outbreaks due to this readily vaccine-preventable viral disease are also increasing in the UK.
      • Vivancos R.
      • Keenan A.
      • Farmer S.
      • et al.
      An ongoing large outbreak of measles in Merseyside, England, January to June 2012.
      Perhaps this re-emergence of measles argues for retaining our laboratory stocks of smallpox, just in case.
      • Friedrich M.J.
      Smallpox lives to die another day.
      Two global views are published in the Lancet Infectious Diseases. The first reports that the global prevalence of norovirus in cases of acute gastroenteritis is around 20%, which is a little lower than you may expect.
      • Ahmed S.M.
      • Hall A.J.
      • Robinson A.E.
      • et al.
      Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis.
      The second provides an overview of global antibiotic usage from 2000 to 2010.
      • Van Boeckel T.P.
      • Gandra S.
      • Ashok A.
      • et al.
      Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data.
      Surprisingly, Australia and New Zealand have some of the highest and most rapidly increasing rates of antibiotic usage in the world!
      The Journal of Infection Prevention Outbreak Column continues with a thorough overview of S. aureus outbreaks of old, which identifies considerable variation in the scale and impact of response, making it difficult to know what really works to bring outbreaks under control.
      • Curran E.T.
      Outbreak Column 14: Staphylococcus aureus – new outbreaks of old infections.

      Reviews

      • The review from Traven et al. in PLOS Pathogens entitled ‘Microbial Egress: A Hitchhiker's Guide to Freedom’ discusses survival and escape strategies for intracellular pathogens.
        • Traven A.
        • Naderer T.
        Microbial egress: a hitchhiker's guide to freedom.
        Traditionally restricted to pathogens such as Mycobacterium species and Leishmania species, intracellular survival may be an important issue for other pathogens such as S. aureus.
        • Korea C.G.
        • Balsamo G.
        • Pezzicoli A.
        • et al.
        The staphylococcal Esx proteins modulate apoptosis and release of intracellular Staphylococcus aureus during infection in epithelial cells.
      • A PLOS Medicine review discusses the problems of overdiagnosis and overtreatment.
        • Moynihan R.
        • Henry D.
        • Moons K.G.
        Using evidence to combat overdiagnosis and overtreatment: evaluating treatments, tests, and disease definitions in the time of too much.
        This issue is especially important in terms of successfully restricting the use of antibiotics.
      • A Journal of Antimicrobial Chemotherapy review provides a useful alternative perspective on the accumulating evidence for chlorhexidine for skin antisepsis.
        • Maiwald M.
        • Chan E.S.
        Pitfalls in evidence assessment: the case of chlorhexidine and alcohol in skin antisepsis.
        The review highlights that many studies cited in support of chlorhexidine also include alcohol, potentially obscuring the impact of chlorhexidine alone.
      • We all know that the news media are not brilliant at reporting healthcare news stories; this JAMA Internal Medicine review illustrates some common pitfalls.
        • Schwitzer G.
        A guide to reading health care news stories.
      • JAMA has launched a series on Research Methods and Statistics, which should prove to be a useful resource.
        • Livingston E.H.
        Introducing the JAMA guide to statistics and methods.
      • A thoughtful Journal of Hospital Infection point–counterpoint review discusses whether reduced susceptibility to biocides and antiseptics is a risk in healthcare.
        • Harbarth S.
        • Tuan Soh S.
        • Horner C.
        • Wilcox M.H.
        Is reduced susceptibility to disinfectants and antiseptics a risk in healthcare settings? A point/counterpoint review.
        The jury is out …
      And finally … as healthcare becomes increasingly digitalized, not least the rapid adoption of electronic patient records, the risk of hacking grows.
      • Sheikh A.
      • Jha A.
      • Cresswell K.
      • Greaves F.
      • Bates D.W.
      Adoption of electronic health records in UK hospitals: lessons from the USA.
      A high-profile hacking of Boston Children's Hospital prompts discussion in the New England Journal of Medicine about cybersecurity in healthcare.
      • Perakslis E.D.
      Cybersecurity in health care.
      Let's hope the NHS servers are thoroughly locked down!

      References

        • Thaden J.T.
        • Lewis S.S.
        • Hazen K.C.
        • et al.
        Rising rates of carbapenem-resistant Enterobacteriaceae in community hospitals: a mixed-methods review of epidemiology and microbiology practices in a network of community hospitals in the southeastern United States.
        Infect Control Hosp Epidemiol. 2014; 35: 978-983
        • Goel G.
        • Hmar L.
        • Sarkar De M.
        • Bhattacharya S.
        • Chandy M.
        Colistin-resistant Klebsiella pneumoniae: report of a cluster of 24 cases from a new oncology center in eastern India.
        Infect Control Hosp Epidemiol. 2014; 35: 1076-1077
        • Carvalhaes C.G.
        • Cayo R.
        • Visconde M.F.
        • et al.
        Detection of carbapenemase activity directly from blood culture vials using MALDI-TOF MS: a quick answer for the right decision.
        J Antimicrob Chemother. 2014; 69: 2132-2136
        • Falagas M.E.
        • Tansarli G.S.
        • Karageorgopoulos D.E.
        • Vardakas K.Z.
        Deaths attributable to carbapenem-resistant Enterobacteriaceae infections.
        Emerg Infect Dis. 2014; 20: 1170-1175
        • Mela S.
        • Whitworth D.E.
        The fist bump: a more hygienic alternative to the handshake.
        Am J Infect Cont. 2014; 42: 916-917
        • Ghareeb P.A.
        • Bourlai T.
        • Dutton W.
        • McClellan W.T.
        Reducing pathogen transmission in a hospital setting. Handshake versus fist bump: a pilot study.
        J Hosp Infect. 2013; 85: 321-323
        • Samarasekera U.
        MH17 tragedy: HIV community mourns loss of colleagues.
        Lancet. 2014; 384: 293
        • Diener M.K.
        • Knebel P.
        • Kieser M.
        • et al.
        Effectiveness of triclosan-coated PDS Plus versus uncoated PDS II sutures for prevention of surgical site infection after abdominal wall closure: the random-ised controlled PROUD trial.
        Lancet. 2014; 384: 142-152
        • Singh A.
        • Bartsch S.M.
        • Muder R.R.
        • Lee B.Y.
        An economic model: value of antimicrobial-coated sutures to society, hospitals, and third-party payers in preventing abdominal surgical site infections.
        Infect Control Hosp Epidemiol. 2014; 35: 1013-1020
        • Liu C.M.
        • Osborne B.J.
        • Hungate B.A.
        • et al.
        The semen microbiome and its relationship with local immunology and viral load in HIV infection.
        PLoS Pathog. 2014; 10: e1004262
        • Dutilh B.E.
        • Cassman N.
        • McNair K.
        • et al.
        A highly abundant bacteriophage discovered in the unknown sequences of human faecal metagenomes.
        Nat Commun. 2014; 5: 4498
        • Asavarut P.
        • Hajitou A.
        The phage revolution against antibiotic resistance.
        Lancet Infect Dis. 2014; 14: 686
        • Balcazar J.L.
        Bacteriophages as vehicles for antibiotic resistance genes in the environment.
        PLoS Pathog. 2014; 10: e1004219
        • Crowther G.S.
        • Chilton C.H.
        • Todhunter S.L.
        • et al.
        Comparison of planktonic and biofilm-associated communities of Clostridium difficile and indigenous gut microbiota in a triple-stage chemostat gut model.
        J Antimicrob Chemother. 2014; 69: 2137-2147
        • Buelow E.
        • Gonzalez T.B.
        • Versluis D.
        • et al.
        Effects of selective digestive decontamination (SDD) on the gut resistome.
        J Antimicrob Chemother. 2014; 69: 2215-2223
        • McElroy A.K.
        • Erickson B.R.
        • Flietstra T.D.
        • et al.
        Ebola hemorrhagic fever: novel biomarker correlates of clinical outcome.
        J Infect Dis. 2014; 210: 558-566
        • Ansumana R.
        • Bonwitt J.
        • Stenger D.A.
        • Jacobsen K.H.
        Ebola in Sierra Leone: a call for action.
        Lancet. 2014; 384: 303
        • Pannaraj P.S.
        • Wang H.L.
        • Rivas H.
        • et al.
        School-located influenza vaccination decreases laboratory-confirmed influenza and improves school attendance.
        Clin Infect Dis. 2014; 59: 325-332
        • Sammons J.S.
        Ready or not: responding to measles in the postelimination era.
        Ann Intern Med. 2014; 161: 145-146
        • Vivancos R.
        • Keenan A.
        • Farmer S.
        • et al.
        An ongoing large outbreak of measles in Merseyside, England, January to June 2012.
        Euro Surveill. 2012; 17 (pii: 20226)
        • Friedrich M.J.
        Smallpox lives to die another day.
        JAMA. 2014; 312: 222
        • Ahmed S.M.
        • Hall A.J.
        • Robinson A.E.
        • et al.
        Global prevalence of norovirus in cases of gastroenteritis: a systematic review and meta-analysis.
        Lancet Infect Dis. 2014; 14: 725-730
        • Van Boeckel T.P.
        • Gandra S.
        • Ashok A.
        • et al.
        Global antibiotic consumption 2000 to 2010: an analysis of national pharmaceutical sales data.
        Lancet Infect Dis. 2014; 14: 742-750
        • Curran E.T.
        Outbreak Column 14: Staphylococcus aureus – new outbreaks of old infections.
        J Infect Prevent. 2014; 15: 148-153
        • Traven A.
        • Naderer T.
        Microbial egress: a hitchhiker's guide to freedom.
        PLoS Pathog. 2014; 10: e1004201
        • Korea C.G.
        • Balsamo G.
        • Pezzicoli A.
        • et al.
        The staphylococcal Esx proteins modulate apoptosis and release of intracellular Staphylococcus aureus during infection in epithelial cells.
        Infect Immun. 2014 Jul 21; (pii: IAI.01576-14 [Epub ahead of print])
        • Moynihan R.
        • Henry D.
        • Moons K.G.
        Using evidence to combat overdiagnosis and overtreatment: evaluating treatments, tests, and disease definitions in the time of too much.
        PLoS Med. 2014; 11: e1001655
        • Maiwald M.
        • Chan E.S.
        Pitfalls in evidence assessment: the case of chlorhexidine and alcohol in skin antisepsis.
        J Antimicrob Chemother. 2014; 69: 2017-2021
        • Schwitzer G.
        A guide to reading health care news stories.
        JAMA Intern Med. 2014; 174: 1183-1186
        • Livingston E.H.
        Introducing the JAMA guide to statistics and methods.
        JAMA. 2014; 312: 35
        • Harbarth S.
        • Tuan Soh S.
        • Horner C.
        • Wilcox M.H.
        Is reduced susceptibility to disinfectants and antiseptics a risk in healthcare settings? A point/counterpoint review.
        J Hosp Infect. 2014; 87: 194-202
        • Sheikh A.
        • Jha A.
        • Cresswell K.
        • Greaves F.
        • Bates D.W.
        Adoption of electronic health records in UK hospitals: lessons from the USA.
        Lancet. 2014; 384: 8-9
        • Perakslis E.D.
        Cybersecurity in health care.
        N Engl J Med. 2014; 371: 395-397