23 March 2010

More from Fresh Air: handwashing and a playlist

In advance of the Fresh Air interview today, their tweeter(s) asked for suggestions for a MRSA playlist! Here's some of the suggestions:
Fever, Peggy Lee
Countin' On A Miracle, Bruce Springsteen
Ready or Not, the Delfonics (or as sampled by the Fugees)
Time to Get Ill, Beastie Boys
Hurts So Good, John Mellencamp (was he John Cougar Mellencamp then?)
Infected, Bad Religion
and of course:
I've Got You Under My Skin.

They also dug up this awesome music video from University of Pennsylvania, "Heroes Wash Hands." Enjoy.

PUBLICATION DAY and so many people to thank. The short list:

Sara Austin, Susan Raihofer, Emily Loose, Maura O’Brien, Ali Pisano, Dominick Anfuso, Martha Levin, Elizabeth Stein.
Andrew Dodds, David Ratner, Shirley Sandler, Chuck Monroe, Elise Bogdan.
Penny Duckham, Deirdre Graham, Matt James, Drew Altman;  Bruce Shapiro, Frank Ochberg, MD, Dorie Griggs.
Barth Anderson, Frances Katz, Quinton and Jean Gregor, Anne Edwards, MD, Joanne Kenen, Howard Gleckman. 
Michael Coston, Crawford Kilian, Scott McPherson, “Revere.”
Michael T. Osterholm, PhD; Kristine Moore, MD; Jim Wappes, Robert Roos, Lisa Schnirring; Kathleen Kimball-Baker; Nicholas Kelley,  Paul Mamula, PhD.
Coilin Nunan; Ramanan Laxminarayan; Donald Berwick, MD, Donald Goldmann, MD Frances Griffin, Joseph McCannon, Madge Kaplan; Lisa McGiffert.
James Sliwa, Steven Baragona.
Robert S. Daum, MD, Susan Boyle-Vavra, PhD, Everly Macario, SciD, Michael Z. David, MD, PhD, Susan Crawford, MD, Christopher Montgomery, MD, Ben Yoon, Lakesha Lloyd; Robert Bielski, MD, Stephen Weber, MD, John Easton.
Henry “Chip” Chambers, MD, Francoise Perdreau-Remington, PhD, Adam Hersh, MD, Binh An Diep, PhD, Kristen Bole; Rick Loftus, MD, Steve Gray.  Elizabeth Bancroft, MD, Nolan Lee, MD, Gregory J. Moran, MD, John Edwards, Jr., MD, Loren G. Miller MD.
John Bradley, MD, Bradley Peterson, MD. Don Janssen, DVM, Nadine Lamberski, DVM, Jeff Andrews.
Nicole Coffin, David Daigle, Rachel Gorwitz, MD, Jeffrey Hageman, Fred Tenover, PhD, Timothy Naimi, MD, Denise Cardo, MD,  Joan Brunkard, PhD, David Sugerman, MD, Roberta Carey PhD, Brandi Limbago PhD, Lonnie King DVM, Jennifer Wright DVM; Susan Sanchez, PhD; Arthur Kellermann, MD, Katherine Heilpern, MD, Henry Blumberg, MD, Leon Haley, MD, Michael Huey, MD, Andre Nahmias, MD; Tom Keating, PhD.
David Edell, Cathy Supak, Mike Carroll, Marilyn Felkner, MD.  Heinz Eichenwald, MD, Mari Nicholson-Preuss.
Gregory Belzley, Martha Sperling, Anita Alberts, Nate Wenstrup, Natalie Leonard, Carrie Takahata, Eric Balaban; John Clarke, MD, Luis Rivera, MD, Timothy Faloon, Rhonda Moore; Charles Alexander, Jr., Gary Benson, David White, Chris Pearson; Pierre Tattevin, MD, Jason Farley, PhD; Elizabeth Cumming, Katie Schwartzmann, Samuel Gore, MD.
Tara Smith, PhD, Michael Male, DVM, Abby Harper; J. Scott Weese, DVM; Andreas Voss, Md, PhD,  Jan Kluytmans, Md, PhD; Pat Gardiner.
Barry Farr, MD, William Jarvis, MD, William Schaffner, MD. Jeff Bender, DVM, BJ Anderson, MD, John Odom, MD, Marjorie Hogan, MD, Kirk Smith, DVM,  Patrick Schlievert, PhD.
Paul M. Wiles, Thomas N. Zweng, MD, Stephen L. Wallenhaupt, MD, James W. Lederer, Jr., MD, Suzie Rakyta, RN, Sandy Cox, RN, Patti Deltry, RN, Kati Everett. Keith M. Ramsey, MD, Kathy Cochran, RN, Delores Nobles.
Barry Eisenstein, MD, Richard Baltz, PhD, Grace Thorne, PhD Jared Silverman, PhD,  Kevin Tally, MD. Joann Lindenmayer, DVM, Robert Moellering, MD, Jeffrey Linder, MD. John Powers, MD,  Ron Najafi, PhD, Mary Beth Minyard,  Henry Shinefield, MD,  Lisa Bayne.
Allison Agwu, MD; Steven J. Barenkamp, MD; Gonzalo Bearman, MD; Benjamin Estrada, MD; Eugene L. Green; Brenda Hollier; Christoph U. Lehmann, MD; Nkuchia Mikinatha, DrPH; Michael Nagy, MD; Louis Rice, MD; Lisa Saiman, MD; Torrance Williams.
Rose Aliberti; Kepa Askenasy; James Bell; Michael Bennett; Laura Chen Davies, Robin Cook; Stephanie Crowell; Amber Don; Eva Ferguson and Beverly and Ernie Dieringer; Nick and Janet Johnson; Kevin Keller; Mollie and Brian Logan; Diane Lore and Richard Ross; Clarissa and Tony Love; Christina Marzullo; Jane McGuinn, Molly Donohue, Charlotte McGuinn Freeman; Steve, Sue and Pat McNees; Karen Moser; Carole and Ty Moss; Victoria Nahum; Melissa Quintana; Debbie Russ; Danielle Sheffler; Scott and Katie Smith; Andrea and Jay Sorensen; Jeanine Thomas; Suzanne Turpin Upton; Tom Wolff, Christine Fusco, Lourraine Stamets.
Samara Cummins, Krista Reese, Rich Eldredge. Lt. Col. Robert J. McKenna, Cerise McKenna Vablais, PhD, Zach McKenna. Rev. Robert E. Lauder, John J. McKenna. Matthew McKenna, Darla Albrigh, Davd Tuller, Randy Dotinga, Elizabeth McKenna.
Loren D. Bolstridge III.

From my heart, thank you all.

PUBLICATION DAY! And SUPERBUG will be on Fresh Air

Constant readers, huge news: SUPERBUG will be featured in a segment today on the NPR program Fresh Air with Terry Gross. Please tune in if you can! Fresh Air's broadcast times vary across the country, but you can listen online or via podcast. The schedule is here.

Listen to the podcast here.
Read the story here.

21 March 2010

Early book reaction! Positive so far.

Folks, it's Sunday, and SUPERBUG will be officially released on Tuesday. Press copies have been landing at last. Readers who responded to my plea for pre-orders (because pre-orders are very important to how the publisher and the market behave subsequently about the book) have been telling me they're getting emails saying the book is on its way.

And a few reviews are starting to pop up!

Kirkus said: "A gripping account of one of the most devastating infectious agents on the planet… A meticulously researched, frightening report on a deadly pathogen.”

Booklist said: "Lays bare, often all too graphically, the ravages of a disease with the potential to do grievous international harm.”

But of most value to me today, my blog-friend and supporter Michael Coston of Avian Flu Diary said this morning:
I can think of a great many superlatives to describe this book; engaging, harrowing, fascinating, powerful... even terrifying at times.
But the descriptive term that keeps coming back to me is: Important. ...
Superbug, quite frankly, should be required reading for every doctor, nurse, and health care professional, if for no other reason than to alert them to the changes they must make in order to help curb the spread of these deadly pathogens.
But it should also be on the reading list of parents, students, and teachers who need to be able to recognize the early warning signs of infection.
And just as importantly, read by those who make policy at the local, state, and Federal level.  We either make institutional changes or risk serious peril from these resistant bacteria.

The cheering of Mike and other bloggers including Revere of Effect Measure and Crof of H5N1 has meant so much to me as I've worked on this book (and also written about flu and other diseases at CIDRAP.) I'm grateful.

16 March 2010

One week to publication! And the book video is up

OK, folks, mystery unveiled: Here's what I look and sound like. Simon and Schuster has put up a video for the book — not a trailer, per se, but an interview with me (backed by spooky music!).

I'm having trouble with the embed code - I can't seem to resize their monster window! — but meanwhile the link is here.

UPDATE: How's this?

15 March 2010

MRSA research round-up: hospitals, vitamins, pets

Because I've been so behind, there's so much to cover! So let's dive in:

In today's Archives of Surgery, researchers from Seattle's Harborview Medical Center report that one simple addition to the routine of caring for trauma patients made a significant difference to the patients' likelihood of acquiring a hospital-associated infection: bathing them once a day with the antiseptic chlorhexidine (in an impregnated wipe). Patients who were bathed with the antiseptic wipe, compared with patients wiped down with an inert solution, had one-fourth the likelihood of developing a catheter-related bloodstream infection and one-third the likelihood of ventilator-associated MRSA pneumonia. Cite: Evans HL et al. Effect of Chlorhexidine Whole-Body Bathing on Hospital-Acquired Infections Among Trauma Patients. Arch Surg. 2010;145(3):240-246.

How important are hospital-acquired infections? Here's a piece of research from a few weeks ago that I sadly failed to blog at the time: Just two categories of HAIs, sepsis and pneumonia, account for 48,000 deaths and $8.1 billion in health care costs in a single year. Writing in the Archives of Internal Medicine, researchers from the nonprofit project Extending the Cure analyzed 69 million hospital-discharge records issued in 40 states between 1998 and 2006. Hospital charges and number of days that patients had to stay in the hospital were 40% higher because of those infections, many of which are caused by MRSA — and all of which are completely preventable. Cite: Eber, MR et al. Clinical and Economic Outcomes Attributable to Health care-Associated Sepsis and Pneumonia. Arch Intern Med. 2010; 170(4): 347-53.

 What else could reduce the rate of MRSA infections? How about Vitamin D? South Carolina scientists analyze data from the NHANES (National Health and Nutrition Examination Survey 2001-2004), a massive database overseen by the CDC, and find an association between low blood levels of Vit. D and the likelihood of MRSA colonization. More than 28% of the population is Vitamin D deficient. MRSA colonization is increasing in the US. Can giving Vit. D decrease MRSA carriage? More research needed. Cite: Matheson EM et al. Vitamin D and methicillin-resistant Staphylococcus aureus nasal carriage. Scand J Infect Dis. 2010 Mar 8. [Epub ahead of print]

And finally: Who else carries MRSA? Some unlucky pet owners have found that animals can harbor human strains, long enough at least to pass the strain back to a human whose colonization has been cleared. So it makes sense to ask whether humans who spend time with pets are carrying the bug. Last month's Veterinary Surgery reports that the answer is Yes. Veterinarians are carrying MRSA in very significant numbers: 17% of vets and 18% of vet technicians at an international veterinary symposium held in San Diego in 2008. Cite: Burstiner, LC et al. Methicillin-Resistant Staphylococcus aureus Colonization in Personnel Attending a Veterinary Surgery Conference. Vet Surg. 2010 Feb;39(2):150-7.

11 March 2010

SUPERBUG the book: First excerpt, first interview, and news!

Constant readers: It's two weeks to publication, and I'm starting to lose my grip on everything there is to do. (As you might be able to tell by my radio silence...) I'm very backed up on great research to tell you about.

First, though, let me share some book news:

EXCERPT: The first excerpt of SUPERBUG has been published on Simon and Schuster's website! It looks like the entire Chapter One.

INTERVIEW: I was invited to Chicago the past few days to do a speech for International Women's Day, and ended up doing some sneak-preview media appearances. Here's the sound file of an interview with the fabulous Alison Cuddy of WBEZ-FM.

MORE INTERVIEWS: I'll be listing forthcoming interviews and appearances on my page at BookTour.com. You'll notice there isn't much up there yet: We're still working on publicity. So help me fill this page, OK? Here's how:

TOUR, A PLEA: My publisher, Free Press, doesn't really believe in sending authors around. They have some justification: As I can testify from my last tour, sometimes a book tour mean spending two hours making painful chit-chat in an empty bookstore whose entire population is the staff, the friend who drove you, and a street person who wandered in and is conversing quietly with her demons. (Twenty-Third Street Books, Portland, OR, thanks for asking. I hear they closed.) But that bad experience notwithstanding, I believe there's value in getting out and talking to readers, victims, disease geeks and anyone else interested in this bug, and I'm willing to do it, if you'll help.

So: If you're a clinician, a professor, or a teacher, and you're willing to host SUPERBUG and me at a class, a department brown-bag or a Grand Rounds, please get in touch. Ditto if you run a Cafe Scientifique, have a book club that wants to talk about science or medicine, have a church group, a kid's group, a med-student society... you get the idea. If I can get there, I'll come. I know already that I'll be in and out of Minneapolis and Atlanta, my two home bases, and also in North Carolina, Iowa, Chicago, and I hope San Francisco, Portland and Boston as well. Help me add to the list!

Right, back to research tomorrow.

04 March 2010

"Pig MRSA" causing human infections

Hi, everyone. Apologies for dropping out of sight! As SUPERBUG's publication draws closer (and it's very close now), I keep finding new tasks that I have do to. Last week's was to go to New York to shoot a video for the Simon & Schuster website — and while there, I got caught in Snowpocalypse, got delayed coming home, and picked up a nasty cold. So I'm a bit behind.

But there's exciting news tonight to start us up again: "pig MRSA," ST398, causing human infections in Canada and Denmark.

"Infections" is important, because up til now, most evidence for  the spread of MRSA ST398 in humans has been through detection of colonization, the symptomless carriage of MRSA on the skin and in the nostrils. The first finding of ST398 in the Netherlands was via colonization; so was its first identification in humans in Canada, and also in the United States just about a year ago.

But comes now a team of public and university scientists from Canada to say that ST398 is also causing infections in Canada. They analyzed 3,687 MRSA isolates that had been collected from patients seen for infections in Manitoba and Saskatchewan. Five were ST398. That is an exceedingly low percentage, of course. But it is striking, and odd, that the infections were present at all:
The earliest identified LA-MRSA isolate (08 BA 2176) associated with an infection was obtained from a postoperative surgical site. ... This patient is unlikely to have had any recent direct contact with livestock because she had been confined to her home with limited mobility for several years before her hospitalization. Additional nasal swabs from this patient remained positive for this strain for at least 7 months. ...
The isolate submitted to the NML by Sunnybrook Health Sciences Centre... was from a 59-year-old man from Ontario. He had been hospitalized in December 2007 for treatment of metastatic squamous cell carcinoma of the larynx. In the previous year, he had undergone a total laryngectomy, neck node dissection, and tracheostomy. .... He was unaware of any animal contact and had no history of exposure to pigs or pig farms. A review of the medical records and standard epidemiologic investigations determined that this was not a nosocomial or healthcare-associated isolate.
Just to underline, we have here a MRSA strain that is strongly associated with close contact with pigs, or with pig meat, and that has spread far enough from farms to be present in people who had no connection with pigs. You can argue that its very low prevalence means that it is not so much a threat as a curiosity. But I'd counter-argue that this is significant: because it establishes that this strain is spreading; because it demonstrates that the strain is causing infections, not just colonization; and because it inserts, into the swarm of isolates that make up MRSA, additional resistance factors that can be traded and exchanged unpredictably among the bacteria — and are likely not to be detected because our surveillance in animals is so sparse.

The authors say:
...additional surveillance efforts are required to monitor the emergence and clinical relevance of this MRSA strain in Canada, including communities, the environment, livestock, farmers, and production facility workers. Whether these strains pose a major threat to human health in light of the low livestock density and continued spread of epidemic hospital and community strains of MRSA in Canada remains unknown.
There's also a new and tantalizing report from Denmark that appears to describe not only human infections, but human to human transmission, resulting in a very serious pneumonia in a baby. I can't access the full-text even through my university account, but the abstract says:
Carriage of pig-associated methicillin-resistant Staphylococcus aureus (MRSA) is known to occur in pig farmers. Zoonotic lineages of MRSA have been considered of low virulence and with limited capacity for inter-human spread. We present a case of family transmission of pig-associated MRSA ST398, which resulted in a severe infection in a newborn.
Not good.

The cites for these are:
Golding GR, Bryden L, Levett PN, McDonald RR, Wong A, Wylie J, et al. Livestock-associated methicillin-resistant Staphylococcus aureus sequence type 398 in humans, Canada. Emerg Infect Dis; [Epub ahead of print] DOI: 10.3201/eid1604.091435
Hartmeyer GN, Gahrn-Hansen B, Skov RL, Kolmos HJ. Pig-associated methicillin-resistant Staphylococcus aureus: Family transmission and severe pneumonia in a newborn. Scand J Inf Dis. Epub Feb. 3, 2010 ahead of print.