Controversies in Hospital Infection Prevention

Back in the 1990's when I was a wide-eyed ID fellow, I'd wonder out loud to my co-fellows Sara Cosgrove and Dan Levy why it was that we needed an oncologist's approval to prescribe chemotherapy but any clinician could prescribe antibiotics. My reasoning was that if you make a mistake with chemotherapy in a cancer patient, you only harm that one patient, but when untrained clinicians prescribe antibiotics all willy-nilly they harm the whole planet. Well, it's 2013 and I'm still wide-eyed and […]

Over the past several days I have spent a lot of time talking to patients, trying to explain why I've had to cancel their upcoming fecal transplant. The FDA has ruled that stool is an investigational new drug (IND), which now imposes a huge bureaucratic hurdle to getting a much needed therapy for patients with recurrent or intractable C. difficile infection. Today's Omaha World-Herald covers the new ruling and features our fellow blogger Dan Diekema.  Even before the FDA did this, there […]

One of my favorite epidemiological study designs is the temporal association "ecological" study that attempts to imply causation by showing one exposure increasing and one outcome increasing and implying that the exposure is causing the outcome. You know, "Hey, they are both going up so one thing causes another." Vaccine use and autism rates anyone?  So, just for fun I've produced the graph above and as you can see, through the efforts of CDC, WHO, VA and many individually hard-working IPs […]

This will be the correct response if Alex Trebek ever says: “American vaccinologist credited with saving more lives than any other scientist in the 20th century”. It amazes me that Hilleman is not a household name, and that he didn’t win a Nobel prize. Even after paying close attention during medical school, internal medicine residency, and two fellowships (in infectious diseases and clinical microbiology), I had very little understanding of his immense contributions […]

Not sure how we missed last week's JAMA medical news piece featuring our very own co-blogger Dan, but I suspect we might have been distracted by something pretty terrible. The article highlights the rise of carbepenem (CRE) and 3rd-generation cephalosporin-resistant Klebsiella pneumonia strains originally described in ICHE by Braykov et al. The CDC's Arjun Srinivasan emphasized that these strains are almost exclusively hospital-associated and now is the time for hospitals to […]