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Are contact isolation precautions (CP) necessary when caring for patients infected or colonized with endemic MRSA or VRE?

Researchers from the University of Nebraska Medical Center Division of Infectious Diseases and Nebraska Medicine Department of Infection Control and Epidemiology recently published results from a two-year observational study indicating that routine use of contact isolation precautions (CP) are not needed in caring for patients with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). (Rupp ME, et al.  Infection Control and Hospital Epidemiology 38:1005-1007, 2017).

The CDC has long recommended use of CP (i.e. private room, gowns and gloves, limitation of potential fomites) when caring for patients colonized or infected with multi-drug resistant pathogens (MRSA, VRE).  However, some studies have indicated that CP adversely influence provider behavior (fewer and shorter provider-patient interactions) and may result in delays in patient admissions and transfers, excess adverse events, and psychologic harm.

In the UNMC two-year quasi-experimental before-after study, it was noted that the rate of infection due to MRSA or VRE did not change in the yearlong period after CP were discontinued compared to the previous year.  However, it was also noted that the discontinuation of CP was conducted in an institution with excellent horizontal infection control interventions in place [hand hygiene (>90%), careful attention to environmental cleanliness (>90% clean rate on high-touch surfaces) and a practice of routine patient bathing with chlorohexidine].

This recently published paper adds additional support for re-examining the need for CP in the routine care of patients colonized/infected with endemic MRSA or VRE.

Read the article at:  https://www.cambridge.org/core/product/905595BFE67B3D41CF603C2D497EE517

Content courtesy of Dr. Mark Rupp. 

See more from the UNMC ID Division here.


 

Cephalexin with or without TMP-SMX Showed Similar Clinical Cure Rates for Uncomplicated Cellulitis

Content courtesy of Philip Chung, PharmD, MS, BCPS

The Infectious Diseases Society of America recommends use of antimicrobial agent active only against streptococci (e.g., cephalexin) for management of cellulitis in patients without systemic signs of infection, penetrating trauma, evidence of MRSA, and injection drug use.  Despite this recommendation, healthcare providers frequently prescribe additional antimicrobial agents with anti-MRSA activity (e.g., cephalexin plus trimethoprim-sulfamethoxazole).

A recent multicenter, double-blind, randomized, controlled trial evaluated the efficacy of cephalexin alone or in combination with trimethoprim-sulfamethoxazole (TMP-SMX) for treatment of acute uncomplicated cellulitis in the outpatient setting.  Clinical cure rates were similar between the combination therapy arm (83.5%) and the monotherapy arm (85.5%).  Adverse event rates and secondary outcomes (including overnight hospitalization, recurrent skin infections, and similar infection in household contacts) were not different between treatment arms.

For additional details, please read Moran GJ, et al. JAMA 2017;317(20):2088-96.


 

THINK FUNGUS – Fungal Disease Awareness Week!

Welcome to the first Fungal Disease Awareness Week sponsored by the CDC and partners! In Infectious Diseases, we truly to see lives saved by thinking about possible fungal diseases and we treat them often. Interested in learning more about Fungal Diseases? Check out the CDC video and the website here.

Share the post to help the CDC increase awareness of these important infections!

Site content and images from CDC link above. 


 

 

Antimicrobial Stewardship in Long-Term Care Facilities – The Time is Now!

Antibiotic use is common in long-term care facilities (LTCF) with 70% residents receiving at least one course of systemic antibiotic every year. A significant proportion of the antibiotic use (40% to 75%) in nursing homes has been found to be unnecessary or inappropriate. The prevalence of multi-drug resistant organisms and C. difficile infections are already a significant problem for the post-acute and long-term care facilities. As these facilities are now providing care to more medically complex individuals with increasing numbers of post-acute care (Medicare) admissions, these problems may continue to amplify unless new interventions are introduced to promote appropriate antibiotic use in this setting. Antibiotic stewardship programs have demonstrated effectiveness in reducing inappropriate antibiotic use in long-term care facilities. The Center for Medicare and Medicaid Services (CMS) revised the condition of participation for LTCF in October 2016 and mandated LTCF to develop antibiotic stewardship program as a part of their infection prevention and control program.

Dr. Ashraf and other national speakers spoke on the topic of antimicrobial stewardship in long-term care facilities at 2017 Illinois Summit on Antimicrobial Stewardship. They discussed the strategies for implementation of such a program and introduced the participants to the free resources, which they can use to develop a program at their facilities.

If you would like to learn more about the talk and the available resources, the slides of the presentation are available at the following link:

http://www.dph.illinois.gov/sites/default/files/publications/antimicrobial-stewardship-long-term-care-ashraf-frentzel-mahajan-072617.pdf

 

Content courtesy of Dr. Ashraf. 

Pharmacist-Driven Intervention Improves Care of Patients with Staphylococcus aureus Bacteremia

Staphylococcus aureus bacteremia (SAB) is associated with significant morbidity and mortality.  Previous studies have shown Infectious Diseases (ID) consultation for patients with SAB optimizes care and reduces mortality.  A recent study highlights outcomes of a pharmacist-driven intervention to encourage adherence to SAB quality-of-care measures and ID consultation in an Ohio medical center.  The study investigators found that these interventions significantly increased compliance to SAB quality-of-care measures from 69% to 92% and ID consultation from 76% to 95%.  Although not statistically significant, all-cause mortality reduced by 6-fold, from 15.6% to 2.6%, after implementation of these interventions.  For additional details, please read Wenzler E, et al. Clin Infect Dis 2017;65(2):194-200.

Content courtesy of Philip Chung, PharmD, MS, BCPS

 

Microbiology and Infectious Diseases – The Ghostbusters of Medicine

 

Medicine is a team sport, there is no denying that, but together the Microbiologist and Infectious Diseases(ID) specialists create a powerhouse of for diagnosis and treatment. Detect, Identify and Destroy.

Infectious Disease physicians are called in to start the investigation – does the patient have an infection? What do we think is the most likely infection? What tests do we need to determine what it is and how to treat it? Do we need to isolate the patient for risk of spreading infection?

Then the tag-team starts and we order tests to look for different germs (bacteria, viruses, fungi) to figure out what infection the patient may have. Our amazing microbiology colleagues run the tests, try to identify and if possible, grow the germ, and sometimes can even tell us which medicines are the best for treating it. They can tell us if it is one of the “superbugs” that some antibiotics no longer work against. Sometimes, the work is more dangerous and requires special precautions if it could be contagious! They really are the scientists with all the technology and expertise we rely on for this critical information.

Tag! Back to the ID team to review those results and help decide if the patient needs treatment, and if so, what it may be.

ID relies on everyone in microbiology to do our job well EVERY DAY.

We ain’t afraid of no bugs. Who you gonna call?????

 

Content courtesy of Dr. Paul Fey and Dr. Kelly Cawcutt. 


 

 

Dr. Sue Swindells on “Why I Love ID”

Dr. Sue Swindells on “Why I Love ID”: 

“So, I found myself in a fancy maternity hospital in San Francisco not too long ago, while my daughter was having a baby.  The nurses there were very excited to have an Infectious Diseases doctor in the room.  I had thought they might be a bit nervous about my presence, but they were very happy to have me because they had lots of questions.  More than one of them said that they thought Infectious Diseases doctors were amongst the smartest, and that we are really good at solving difficult patient problems.  Mostly they had personal questions like whether going to Brazil on honeymoon was a good idea or not, in light of the ongoing Zika epidemic.  That one was pretty easy to answer.

It was very rewarding to be thought of as a “smart” doctor, and I do believe that many Infectious Diseases doctors that I know are very wise and thoughtful people.  This is important in a discipline where we are mostly paid to think, rather than to do procedures or operate on people.  I have now been an HIV doctor for more than 30 years, and can say that this disease has entirely shaped my career.  It was unheard of when I was in medical school, and only discovered when I was a very junior doctor.  The disease still fascinates me and I learn new things every week.  Every year I also get Christmas cards from patients who credit me with saving their lives – there are very few professions where you actually get to save lives.  At the risk of sounding sappy, I can honestly say I view this as a privilege.”

 

See more about Dr. Swindells and the UNMC HIV team here.


 

Lisa Hill, NP on “Why I Love ID”

Lisa Hill, Nurse Practitioner with Transplant Infectious Diseases on “Why I Love ID”

“ID is like a puzzle. You are looking at each piece trying to see how it fits in the big picture.  Sometimes the edges are clear and sometimes pieces are missing. It is our job to look at all the details to take the best care of each person and their family.  No two days or situations are the same. I love the variety.”

 

See more about UNMC ID here.


 

Hope is Not a Plan – Preparing for Public Health Emergencies.

Dr. Hewlett presented her talk “Hope is Not a Plan” for the SHEA/CDC Outbreak Response Training Workshop(ORTP) in Philadelphia in June. The workshop was geared towards Hospital Epidemiologists and focused on hospital preparedness for public health emergencies. Dr. Hewlett specifically spoke on key steps in preparing for a high-consequence pathogen infection, travel and screening tools for locations and risks, multi-drug resistant organisms and the facilitators/barriers for preparing for emerging infections.

If you would like to learn more, there is addition online training available and listings for future workshops here.

 

Content courtesy of Dr. Hewlett. 


 

Dr. Alison Freifeld on “Why I Love ID”

Dr. Freifeld on “Why I Love ID”: 

“My 30+ year career in managing infections in the most vulnerable immunosuppressed cancer patients has been an incredible journey and one I would choose again! Infectious complications in this population are often complex and life-threatening, but work of diagnosing and managing those problems (and often there are multiple infectious problems involving viral, fungal and/or bacterial pathogens) is both challenging and rewarding because it so often allows patients to continue their cancer treatments despite these complicating infections. I especially love working in concert with a wonderful team of oncologists and other practitioners in the field to provide the best patient care and to improve the lives of people living with cancer. ”

 

See more about Dr. Freifeld and the rest of the UNMC ID division here.

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