Antibiotic Resistance on Surgery and Cancer chemotherapy Antibiotic Prophylaxis in the USA

What is the impact of declining antibiotic susceptibility on antibiotic prophylaxis in surgery and cancer chemotherapy? Here is  paper recently published on that subject in Lancet Infectious Diseases by my colleague Dan Morgan from the University of Maryland.

The authors estimated that between 39% and 51% of pathogens causing surgical site infections (SSIs) and 27% of pathogens causing infections after chemotherapy are resistant to standard prophylactic antibiotics in the USA.

This is a problem and we definitely need more data to systematically assess the efficacy of antibiotic prophylaxis. Further, we need timely guidance on how best to modify prophylaxis based on the evolving landscape of antimicrobial resistance.

As part of SSI tracking, health system epidemiology teams should critically assess the antibiograms of all SSI isolates to better understand the local prophylactic drug-bug mismatch. This should include assessment of mupirocin and chlorhexidine resistance when staphylococcal decolonization is attempted pre-operatively.

This is precisely our strategy at VCU Health.

Cold and Flu Season Revisited- Media Interview and VCU Health Twitter Chat.

I appears that there is a resurgent interest in cold and flu season, at least locally in Richmond, VA.

Here is a link to the local CBS 6 news interview on influenza.

On November 24, 2015, I participated in a VCU Health Twitter Chat on cold and flu season, accessible here.

I am frequently asked how best to stay healthy and to avoid getting "colds." 

For many, the answer is simple and obvious. 

Stop smoking!

1st Annual VCU Gordon Archer Infectious Diseases, Microbiology and Immunology Research Day

Today we inaugurated the 1st Annual Gordon Archer Infectious Diseases, Microbiology and Immunology Research Day, in honor of renowned researcher Dr. Gordon Archer, now Professor Emeritus at Virginia Commonwealth University.

The idea of having a dedicated, integrated research day arouse only several months ago. With the support of the VCU Department of Medicine and the Dean of the VCU School of Medicine, along with my colleagues in Allergy/Immunology (Dr. Larry Schwartz)  and Microbiology (Dr. Dennis Ohman), we were able to pull it off.  

A special thanks and kudos to my administrative assistants, Peggy Andrews and Krystle Shaw, for doing the hard part, actually organizing the event from start to finish. Invaluable.

The ultimate goal was to learn from each other and to develop new collaborations. 
Mission accomplished.

Below are images from the event along with the roster of presentations.

Dr. Archer is recognized by Dean Strauss

Plenary Session

Plenary Session- Dr. Sean Evans

Plenary Session- Dr. Rebecca Martin

Poster Session

Poster Session

Award plaque for Dr. Archer

Plenary Session- Dr. Amy Pakyz

With Peggy Andrews, Krystle Shaw and Nadia Masroor

VCU Division of ID Administrative Staff (L to R) - Peggy Andrews and Krystle Shaw

Presentations and Posters- 2015:

8:00-8:45 AM- Breakfast

8:45- 8:55 AM- Dean Strauss recognizing Dr. Gordon Archer

8:55- 9:00 AM Opening Comments by Dr. Gonzalo Bearman

9:00- 10:20 AM- 4 Presentations, 20 minutes each

• Amy Pakyz, PharmD. – “Impact of High-risk Medication Usage on Healthcare facility-onset C. difficile Infection”
• Gail Christie (PI, Microbiology-Immunology)- The Prp protease – a novel target for antibiotic development in S. aureus and other Gram-positive pathogens
• Lawrence Schwartz- “Tryptase and its ongoing story”
• Yoshi Fukuoka (Lawrence Schwartz)-" Effects of the angiotensin and bradykinin pathways on human mast cells."

10:20- 10:40 AM- Break

10:40 AM-12:00 PM- 4 Presentations, 20 minutes each

• Michelle Doll, M.D. (Gonzalo Bearman/Mike Stevens)– “PPE training perceptions/beliefs”
• Sean Evans (Carlyon Lab, Microbology-Immunology)- “The obligate intracellular pathogen, Orientia tsutsugamushi, modulates NF-κB via secreted effectors, Ank1 and Ank6”
• Rebecca Martin (Conrad Lab, Microbiology-Immuno) – “Is helminth-induced B1 IgE protective against allergic disease?”
• Greg Buck (PI, Microbiology-Immuno) – Overview of microbiome projects and the technologies available.

12:00-1:00 PM- Lunch/ Posters 

1:00-2:20 PM- 4 Presentations, 20 minutes each

• Anne Masich, PharmD. Candidate 2016 (Patricia Fulco) –  “Retrovirus and Opportunistic Infections”
• Betty A. Forbes, PhD, D(ABMM) & Christopher D. Doern, PhD - “Using Mass Spectrometry to Define the Clinical Significance of Alloscardovia omnicolens”
• Mike McVoy- “Cytomegalovirus shed in urine is insensitive to antibody neutralization”
• Sahar Lotfi-Emran (Lawrence Schwartz)- “Interferon gamma enhances mast cell ability to activate CD4+ T cell response to cytomegalovirus”

2:20-2:45 PM- Break

2:45- 4:05 PM- 4 Presentations, 20 minutes each

• Nadia Masroor, Project Coordinator (Gonzalo Bearman/Mike Stevens) – “HH Technologies”
• Dan Nixon, Director, VCU HIV/AIDS Center – “Effects of Statins on Biomarkers of Inflammation and Immune Activation in Virologically Suppressed Individuals with HIV”
• Brant Ward (Lawrence Schwartz)- “Antigen uptake and processing by human mast cells, a new paradigm”
• Dan Markley (Michael Stevens/Gonzalo Bearman)- “A Survey to Inform and Optimize the Design of an Antimicrobial Stewardship & Infectious Disease Smartphone App at an Academic Medical Center”

4:05- 4:15 PM- Conclusion 

Posters in Infectious Diseases:

• Laura Pederson (Gonzalo Bearman/Mike Stevens) – “Hand Hygiene in the OR” & “Endoscopy Procedure Suites”
• Nadia Masroor (Gonzalo Bearman/Mike Stevens) – “The Association of Climate Temperature and Bare Below Elbow Compliance”
• Matt Nottingham (Gonzalo Bearman/Mike Stevens)- “UV-C Light as a Means of Disinfecting the Anesthesia Workstation”

• Salma Abbas Muhammad (Michael Stevens/Gonzalo Bearman) - Station-Based Honduras Outreach Trip Education Project.
• Jason Cook (Michael Stevens/Gonzalo Bearman) - Impact of Chlorination of a Gravity Operated Water Distribution System on Clinical Incidence of Diarrhea and Fecal Contamination in Rural Honduras
• Nathaniel Warner (Michael Stevens/Gonzalo Bearman)- “Investigating the Impact of Dengue and Chikungunya in a Rural Population in Yoro, Honduras”
• Jennifer Dinnel (Michael Stevens/Gonzalo Bearman) - "Barriers to Breast Cancer Screening in Paraiso, Dominican Republic
• Meghan Kaumaya (Michael Stevens/Gonzalo Bearman) - Cervical Cancer Screening in Developing Regions: Observations from Paraiso, an Underserved Community in the Dominican Republic
• Nehal Naik (Michael Stevens/Gonzalo Bearman) - Knowledge and Attitudes about Soil-Transmitted Helminth Infection Risk in Rural Honduras
• Soumya Murag (Michael Stevens/Gonzalo Bearman) - Dengue and Chikungunya Virus in the Dominican Republic: Knowledge, Awareness and Preventative Practices
• Lucas Potter (Michael Stevens/Gonzalo Bearman) - Biosand Filter for Use in Decentralized Water Treatment.” 
• Kristina Kelly (Michael Stevens/Gonzalo Bearman) - Rainwater Catchment and Purification System for Rural Honduras
• Anita Molayi (Michael Stevens/Gonzalo Bearman) - The Effectiveness of Antimicrobial Restriction: Trends in Usage of Restricted and Unrestricted Gram-Positive Antimicrobial Agents at VCU Medical Center
• Dan Markley (Michael Stevens/Gonzalo Bearman) - "Designing the Ultimate Antibiotic App: Results of a Survey at An Academic Medical Center"
• Dan Markley (Michael Stevens//Gonzalo Bearman)- “Deploying a Novel Metric to Contextualize Overuse of Carbapenems at an Academic Tertiary Care Hospital”

Poster Presentations from Microbiology & Immunology:

• Katie R. Bradwell, Vladimir Lee, Andrey Matveyev, Myrna Serrano, and Gregory Buck (Buck Lab, Micro-Immunol). “Genome Architecture of Trypanosoma cruzi.”
• Preethi Iyengar, Myrna Serrano, Andrey Matveyev, Vishal Koparde, and Gregory Buck (Buck Lab, Micro-Immunol). The trypanosomatid mitochondrial genomes and the evolution of RNA editing in the order Kinetoplastida.
• Katie R. Bradwell, Vishal N. Koparde, Andrey V. Matveyev, Myrna G. Serrano, João M. P. Alves, Bernice Huang, Hardik Parikh, and Gregory A. Buck. “Comparative Genomics of Trypanosoma conorhini, T. rangeli, and T. cruzi.”
• Bernice Huang, Myrna Serrano, Vishal Koparde, and Gregory A. Buck (Buck Lab, Micro-Immunol). “Evolution of Trypanosoma cruzi and the Bat trypanosomes.”
• Niels Asmussen, Anita Marinelli, Myrna Serrano, Hardik Parikh, Bernice Huang, Nihar Sheth, Kim Jefferson, Jennifer Fettweis, the Vaginal Microbiome Consortium, and Gregory Buck (Buck Lab, Micro-Immunol). “Gardnerella vaginalis Types and Their Role in Vaginal Health.”
• Aminat Oki (Carlyon Lab, Micro-Immunol) - “Developing a system to efficiently transform obligate intracellular bacteria”
• Kathryn Hebert (Carlyon Lab, Micro-Immunol) - “Anaplasma marginale Outer Membrane Protein A-Receptor Interactions”
• Cheisea Cockburn (Carlyon Lab, Micro-Immunol) - “[endif]Anaplasma phagocytophilum Parasitizes Host Sphingolipids for Completion of its Replication Cycle”
• Andrea Beyer and Ryan Green (Carlyon Lab, Micro-Immunol) - “Orientia tsutsugamushi Ank9 interacts with COPB2 to Co-opt Host Cell Retrograde Traffic”
• Kyle Rodino (Carlyon Lab, Micro-Immunol) - “Pathogen induced host cell ER stress benefits the intracellular bacterium, Orientia tsutsugamushi”
• Sheela Damle (Conrad Lab, Micro-Immunol) - "The role of ADAM10 on dendritic cells in allergic disease"
• Joe Lownik (Conrad Lab, Micro-Immunol) -The importance of adam10 and adam17 on immune regulation
• Devin Cash (Cornelissen Lab, Micro-Immunol) - Transferrin-iron utilization in Neisseria gonorrhoeae as a possible target for treatment and prevention of gonorrhea. 
• Abigail L. Glascock, the Vaginal Microbiome Consortium and Jennifer M. Fettweis (Fetweis Lab, Micro-Immunol), Clinical and Genomic Characterization of Two Vaginal Megasphaera Species
• Nicole R Jimenez, the Vaginal Microbiome Consortium, and Jennifer M Fettweis (Fetweis Lab, Micro-Immunol), Characterization of Bifidobacterium breve Strains in the Vaginal Microbiome 
• Hien Dang*, Dylan N. David*, Suryanaren Kummarapurugu*, Abigail L. Glascock, Sarah K. Rozycki, Nicole R. Jimenez, Alan Alves, Jennifer M. Fettweis (Fetweis Lab, Micro-Immunol) - Isolation, Identification and Analysis of Lactobacillus and Bifidobacterium from the Human Vaginal Microbiome (*Equal contribution).
• Naren GK, Daniel Contaifer, Dayanjan S. Wijesinghe and Kimberly Jefferson (Jefferson Lab, Micro-Immunol) - "Role of Staphylococcus aureus lipases in delaying wound healing”
• Ayana Scott-Elliston (Lee Lab, Obstetrics Gyn & Micro-Immunol) - "Determination of HLA-C and KIR gene association to preeclampsia."
• Eun Lee (PI, Obstetrics Gyn & Micro-Immunol) - “Expression of ERAP2 Variant plus HLA-C in trophoblast Cells Activates Immune Response and Increases CD3-CD69+ cells.”
• Hussein Aqbi (Manjili Lab, Micro-Immunol) - “Treatment-induced tumor dormancy”
• Jerilyn Izac (Marconi Lab, Micro-Immunol) – Title TBA.
• Lee Oliver (Marconi Lab, Micro-Immunol) – Title TBA.
• Mike McVoy (PI, Pediatircs / Micro-Immunol)- “A Vaxfectin®-formulated DNA Vaccine Induces Antibodies that Block Cytomegalovirus Entry into Fibroblasts and Epithelial Cells”
• Eliezer Diaz (Ohman Lab, Micro-Immunol) - “Discovering a novel way to inhibit alginate production in Pseudomonas aeruginosa via a drug screen of a chemical library.”
• Jing Yang (Zhou Lab, Micro-Immunol) -”Taurocholate Induces Cyclooxygenase-2 Expression via the Sphingosine 1-phosphate Receptor 2 in a Human Cholangiocarcinoma Cell Line”
• Mike Hinton (Zhou Lab, Micro-Immunol) - “Alcohol Potentiates HIV protease inhibitor-induced ER stress and hepatic lipotoxicity”
• Jing Yang (Zhou Lab, Micro-Immunol) -”Taurocholate Induces Cyclooxygenase-2 Expression via the Sphingosine 1-phosphate Receptor 2 in a Human Cholangiocarcinoma Cell Line”
• Mike Hinton (Zhou Lab, Micro-Immunol) - “Alcohol Potentiates HIV protease inhibitor-induced ER stress and hepatic lipotoxicity”

We Continue to Debate the Use of the White Coat in Inpatient Settings

Source: Boston Globe

We  continue to debate the use of the hallowed white coat in inpatient settings. Most people who know me are well aware of my opinion on the matter. 

Here is an article in the Boston Globe where both Miked Edmond and I are interviewed on bare below the elbows, something which we started at VCU Medical Center. Our monthly compliance with bare below the elbows for inpatient care is between 70-80%.

Without a mandate, we have made bare below the elbows for inpatient care normative behavior, part of our broad based, horizontal infection program which rigorously promotes infection prevention best practices and minimizes bioburden in the inanimate environment. The bare below the elbows component was highlighted in the VCU School of Medicine Magazine, 12th and Marshall.

Back to the Boston Globe article, to reproduce the closing quote by Dr. Neil Fishman, from the University of  Pennsylvania: “I’m just left scratching my head, trying to figure out why some really bright people who I respect have latched onto this issue.” 

Really?

Fecal Patina in the OR- Dr. Silvia Munoz-Price at VCU Combined Anesthesia and Surgery Grand Rounds- November 12, 2015

It was standing room only at the VCU Kontos Medical  Sciences Building for Dr. Silvia Munoz-Price's lecture on the Fecal Patina in the Operating Room. The lecture is largely based on the editorial published in 2015 in Anesthesia and Analgesia.

The OR environment and anesthesia work areas are teeming with pathogens which can lead to IV line stopcock colonization and likely heighten the risk of bloodstream infections and surgical site infections.

Bioburden reduction in the OR is a looming challenge for decreasing surgical site infection risk. 

More to come.

The Common Cold vs. Influenza- Q&A for VCU News

Here is the link to a brief Q & A that I recently did for VCU News.

By no means was this a comprehensive review on the matter. I am frequently asked about measures to decrease the risk of getting ' a cold' or 'the flu.' Much of it come down to simple common sense. Get enough rest, alcohol in moderation, wash your hands and, for many, quit smoking! Last, an influenza vaccine is also a good idea to limit the risk of influenza.

Simple, common sense measures that go a long way to preventing respiratory viral infections.

Hospital Room Disinfection- Many Unanswered Questions

I spent much of this rainy Saturday in my home office reading and listening to vinyl records. 

I fortuitously came across this excellent publication, a thorough review on cleaning hospital surfaces to prevent health care associated infections. 

This may be a surprise to some, but we have no slam dunk evidence to confirm that hospital room surface disinfection directly results in decreased health care associated infections. Comparative effectiveness studies with patient centered outcomes (health care associated infections) are exceedingly uncommon. To make matters even more unsettling, there is no clear definition of how to assess cleanliness or even how to best define a 'clean' hospital room.

The corresponding commentary to this article highlights a point which really makes sense to me. Although we clamor for heightened daily and terminal room disinfection, environmental service workers are frequently a marginalized part of the health care staff. 

We need to recognize and appreciate environmental service workers as critical and valued members of the healthcare team. Train them, compensate them fairly, and celebrate their work. Without their valued service, attempts to attain 'cleanliness' in the environment will fall short of expectations.