Thursday, October 31, 2013

Free Antimicrobial Stewardship Educational Materials for Use in Medical Schools

Methicillin-resistant Staphylococcus aureus (MRSA)
Here is a Letter to the Editor from Dr. Luther and colleagues at Wake Forest that was published in the November 1st edition of Clinical Infectious Diseases highlighting a free Antimicrobial Stewardship curriculum for use in medical schools.

This curriculum was developed as a joint venture by the Wake Forest School of Medicine, the Association of American Medical Colleges and the Centers for Disease Control and Prevention; it is available free online.

The above is a great resource and includes both didactic lectures and small group activities, for use in both the pre-clinical and clinical years.

It is estimated that 50% of antibiotic use is inappropriate; hopefully the above material (or similar educational programs) will help inform the next generation of physicians about optimal antibiotic prescribing.

Wednesday, October 30, 2013

Antibiotic Resistance: Getting Some Well Deserved [Bad] Press

Graphic from CDC report
Some really great resources have recently been released focused on the problem of antibiotic resistance.

The first is CDC's 2013 Antibiotic Resistance "Threat Report," available here. This document outlines, in a clear and easily understandable way, the current problem of antibiotic resistance and the implications of this. Basically, the following is true:

1) Antibiotic resistance is complex and ancient
2) Antibiotic use (appropriate and inappropriate) drives resistance
3) Resistance has outpaced the development of new antibiotics
4) Certain organisms are particularly worrisome: some have developed resistance to all known antibiotics

The report is definitely worth taking a look at and is a compelling, easy read.

Graphic from CDC report
The next resource is a "FRONTLINE" segment called "Hunting the Nightmare Bacteria," available here.
This video powerfully captures just how nightmarish the problem of antibiotic resistance is.

I lecture about antibiotic resistance to college and medical students and often quote from Sir William Osler's19th century medicine textbook where he states:

"The treatment of septicaemia and pyaemia is largely a surgical problem... we have no remedy... the brilliant and remarkable results which follow complete evacuation of the pus with thorough drainage give the indication for the only successful treatment of this condition."

Picture of "bloodletting" in 1860s
Essentially what he is saying is that for some patients with serious infections the only chance for cure (and often survival) is to cut the infected part out; this is 19th century medicine prior to the development of antibiotics.

What is alarming is that for many patients we have returned to practicing 19th century medicine; this is expertly, and disturbingly illustrated in the FRONTLINE segment. The two patients highlighted in the show had essentially untreatable infections and to achieve cure the infected tissue had to be surgically removed.

It has only been 70 years since the widespread introduction of antibiotics in the 1940s and many patients have already entered the "post-antibiotic era." Both the CDC report and the FRONTLINE segment highlight just how dire this problem is and are well worth taking a look at.

*Many consider Sir William Osler to be 'the father' of modern internal medicine 

Monday, October 14, 2013

Global Burden of Disease Study: More Free Online Interactive Graphics

In preparing for a journal club I am leading later today on one of the excellent Global Burden of Disease (GBD) study articles I came across some new interactive graphics available online at the Institute for Health Metrics and Evaluation (IHME) site. One particularly nice feature is the "GBD Insight" graphic which provides annotated data by country and displays a variety of different metrics.  Below are some screenshots:

Honduras displayed in the "GBD Insight" program (IHME)
A close up of the data for Honduras (IHME)
The data from the GBD study are really impressive. More impressive still is the excellent way the IHME is able to translate these data into meaningful and easy to understand interactive graphics. Definitely worth taking a look!

Honduras: DALYs in 2010 (IHME); note: high burden of non-infectious diseases (in blue)
including major contributions from violence and road injuries (green)