Throat and rectal swabs may have an important role in MRSA screening of critically ill patients.

OBJECTIVE: Methicillin-resistant Staphylococcus aureus (MRSA) is a major problem in intensive care units (ICU). International guidelines recommend screening patients for MRSA on admission, although consensus on sites required for optimum detection has not been reached. Our aim was to determine whether throat and rectal swabs identified a significant number of additional MRSA-colonised patients not captured by swabbing at keratinized skin carriage sites (anterior nares, perineum and axillae). DESIGN: Prospective cohort study. SETTING: 30-Bed medical and surgical ICU in a tertiary teaching hospital. PATIENTS: One thousand four hundred and eighty adult patients consecutively admitted over 15 months. MEASUREMENTS AND RESULTS: Swabs from carriage sites (anterior nares, perineum, axillae, throat and rectum), wounds and clinical samples taken within 48 h of ICU admission were analysed to identify patients admitted with MRSA. A complete set of carriage swabs were received from 1,470 patients. 105 (7%) patients were admitted with MRSA of which 63 (60%) were detected by a pooled keratinized skin swab (anterior nares, perineum, axillae). A further 36 (34%) patients were detected only by throat or rectal swabs. Indeed, throat and rectal swabs combined had a higher sensitivity than pooled keratinised skin swabs (76 vs. 60% P = 0.0247). Swabs from all carriage sites together detected 95% (100) of MRSA positive patients, with five patients being positive at wound sites only. CONCLUSIONS: The throat and rectum are important and potentially hidden sites of MRSA carriage in critically ill patients. These findings prompt the need for larger studies to determine the most cost-effective screening strategy for MRSA detection. DESCRIPTOR: Non-pulmonary nosocomial infections

Estimating the effect of healthcare-associated infections on excess length of hospital stay using inverse probability-weighted survival curves

Background: Studies estimating excess length of stay (LOS) attributable to nosocomial infections have failed to address time-varying confounding, likely leading to overestimation of their impact. We present a methodology based on inverse probability–weighted survival curves to address this limitation. Methods: A case study focusing on intensive care unit–acquired bacteremia using data from 2 general intensive care units (ICUs) from 2 London teaching hospitals were used to illustrate the methodology. The area under the curve of a conventional Kaplan-Meier curve applied to the observed data was compared with that of an inverse probability–weighted Kaplan-Meier curve applied after treating bacteremia as censoring events. Weights were based on the daily probability of acquiring bacteremia. The difference between the observed average LOS and the average LOS that would be observed if all bacteremia cases could be prevented was multiplied by the number of admitted patients to obtain the total excess LOS. Results: The estimated total number of extra ICU days caused by 666 bacteremia cases was estimated at 2453 (95% confidence interval [CI], 1803–3103) days. The excess number of days was overestimated when ignoring time-varying confounding (2845 [95% CI, 2276–3415]) or when completely ignoring confounding (2838 [95% CI, 2101–3575]). Conclusions: ICU-acquired bacteremia was associated with a substantial excess LOS. Wider adoption of inverse probability–weighted survival curves or alternative techniques that address time-varying confounding could lead to better informed decision making around nosocomial infections and other time-dependent exposures

Micropalaeontology reveals the source of building materials for a defensive earthwork (English Civil War?) at Wallingford Castle, Oxfordshire

Microfossils recovered from sediment used to construct a putative English Civil War defensive bastion at Wallingford Castle, south Oxfordshire, provide a biostratigraphical age of Cretaceous (earliest Cenomanian) basal M. mantelli Biozone. The rock used in the buttress – which may have housed a gun emplacement – can thus be tracked to the Glauconitic Marl Member, base of the West Melbury Marly Chalk Formation. A supply of this rock is available on the castle site or to the east of the River Thames near Crowmarsh Gifford. Microfossils provide a unique means to provenance construction materials used at the Wallingford site. While serendipity may have been the chief cause for use of the Glauconitic Marl, when compacted, it forms a strong, almost ‘road base’-like foundation that was clearly of use for constructing defensive works. Indeed, use of the Glauconitic Marl was widespread in the area for agricultural purposes and its properties may have been well-known locally

Solar System: Sifting through the debris

A quadrillion previously unnoticed small bodies beyond Neptune have been spotted as they dimmed X-rays from a distant source. Models of the dynamics of debris in the Solar System's suburbs must now be reworked.Comment: 3 pages, 1 figure; Nature News and Views on Chang et al. 2006, Nature, 442, 660-66

Staphylococcus aureus bloodstream infection: A pooled analysis of five prospective, observational studies

Objectives: Staphylococcus aureus bacteraemia is a common, often fatal infection. Our aim was to describe how its clinical presentation varies between populations and to identify common determinants of outcome. Methods: We conducted a pooled analysis on 3395 consecutive adult patients with S. aureus bacteraemia. Patients were enrolled between 2006 and 2011 in five prospective studies in 20 tertiary care centres in Germany, Spain, United Kingdom, and United States. Results: The median age of participants was 64 years (interquartile range 50–75 years) and 63.8% were male. 25.4% of infections were associated with diabetes mellitus, 40.7% were nosocomial, 20.6% were caused by methicillin-resistant S. aureus (MRSA), although these proportions varied significantly across studies. Intravenous catheters were the commonest identified infective focus (27.7%); 8.3% had endocarditis. Crude 14 and 90-day mortality was 14.6% and 29.2%, respectively. Age, MRSA bacteraemia, nosocomial acquisition, endocarditis, and pneumonia were independently associated with death, but a strong association was with an unidentified infective focus (adjusted hazard ratio for 90-day mortality 2.92; 95% confidence interval 2.33 to 3.67, p < 0.0001). Conclusion: The baseline demographic and clinical features of S. aureus bacteraemia vary significantly between populations. Mortality could be reduced by assiduous MRSA control and early identification of the infective focus.Junta de Andalucía PI 0185/201

Second Anthropocene Working Group meeting

The second meeting of the Anthropocene Working Group (AWG) was held at the McDonald Institute for Archaeological Research, University of Cambridge, on 24th and 25th November 2015. It took the form of a workshop with 12 members of the working group and numerous archaeologists from the Institute in lively conversation with each other. Discussion was focused on anthropogenic strata and matters of chronostratigraphy. The AWG was set up in 2009 to consider the case for formalizing the term ‘Anthropocene’ in the Geological Time Scale. The working group reports to the Subcommission on Quaternary Stratigraphy, which sits within the broader framework of the International Commission on Stratigraphy (ICS). Unusually for a working group of the ICS, it consists of researchers from a wide variety of Earth Sciences, including archaeology