Monday, June 30, 2014

Asymptomatic Bacteriuria and Prosthetic Joint infection- Less is More

I am back on the ID consult service today. This will certainly keep me busy and conflict with viewing the World Cup games. 

Here is an intriguing article in Clinical Infectious Diseases that caught my eye this weekend.This was a multicenter study of patients undergoing total hip or total knee arthroplasty. A urine sample was cultured in all patients, and those with asymptomatic bacteriuria were identified. A total of 2497 patients were enrolled. The prevalence of asymptomatic bacteriuria was 12.1% (303 of 2497), 16.3% in women and 5.0% in men (odds ratio, 3.67; 95% confidence interval, 2.65-5.09; P < .001). The overall prosthetic joint infection rate was 1.7%. The infection rate was significantly higher in the asymptomatic bacteriuria group than in the non-asymptomatic bacteriuria group (4.3% vs 1.4%; odds ratio, 3.23; 95% confidence interval, 1.67-6.27; P = .001). 

But here is the most intriguing finding: in the asymptomatic bacteriuria group, there was no significant difference in joint infection rate between treated (3.9%) and untreated (4.7%) patients. Also, prosthetic joint infections did not correlate to isolates from urine cultures!
To me this underscores, again, that asymptomatic bacteriuria should not be treated except in pregnancy and in patients about to undergo invasive bladder procedures. Treatment of asymptomatic bacteriuria does not impact outcomes and likely breeds antibacterial resistance. 
With respect to treating asymptomatic bacteriuria, less is more.

Wednesday, June 25, 2014

The Staphoscope- A Potential Vector for Healthcare Associated Infections

I have previously blogged about our dirty stethoscopes (staphoscopes) and about possible disinfection strategies at the point of care. 

Here is a recent entry from the National Patient Safety Foundation Blog on 'Foaming in and Foaming Out,' both in the context of hand hygiene and stethoscope disinfection. 

An ongoing challenge for infection prevention professionals is accurately estimating the degree to which an instrument such as a stethoscope is responsible for hospital acquired infections. This would support the argument of decontaminating stethoscopes and any other material which comes into direct contact with patients in the clinical environment.

Much like hand hygiene, the disinfection of stethoscopes will require a behavioral change, aided by education, ubiquitous access to disinfection wipes, observation, feedback and accountability. 

To date, there is no prospective study assessing the impact of stethoscope disinfection on the rate of hospital acquired infections so making a convincing argument in favor of a behavior change is based on commonsense and biological plausibility. 

Changing behavior is much easier said than done.

Monday, June 23, 2014

World Cup Time- Why So Many Soccer Fans Dislike Argentina

I have taken a break from blogging as of late, the reasons are multiple. The most immediate reason is that the World Cup has diverted my attention.

Being both a soccer player, albeit over the hill, and an Argentine, the title of this article in the NY Times was eye catching.

I certainly hope that we win the World Cup. Being boastful and arrogant never gets you too far.

In sport or otherwise, it is helpful to remember the following: 
All Glory is Fleeting- General George C. Patton