Dr. Cliff McDonald, Chief, Prevention and Response Branch at the CDC

The Silent Role of Biofilms in Chronic Disease Forums Biofilm Community Expert Interviews Dr. Cliff McDonald, Chief, Prevention and Response Branch at the CDC

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        Center for Disease Control
        Interview with Cliff McDonald, MD, FACP, FSHEA
        Chief, Prevention and Response Branch, Division of Healthcare Quality Promotion, NCEZID

        Cliff McDonald, MD, is a former officer in the Epidemic Intelligence Service and is currently the Chief of the Prevention and Response Branch in the Division of Healthcare Quality Promotion at the CDC. This division seeks to protect patients and healthcare personnel and promotes safety and quality in healthcare delivery systems. Examples of activities include programs for addressing antimicrobial resistance, healthcare-associated infections, and other adverse events affecting patients and healthcare workers. Dr. McDonald is an expert in Clostridium difficile, an antibiotic resistant bacterium.

        QUESTION: In the field of infectious disease, what are some of the biggest challenges you are facing, and which ones are you tackling and why?

        DR. CLIFF MCDONALD: One of the biggest issues that we are facing, and we think a lot about and talk a lot about and work on quite a bit, is the area of antibiotic resistance in healthcare associated infections. Our division, as you know, is really focused on healthcare associated infections and addressing that. And antibiotic resistance has been an increasing problem there. And that, of course, does pertain a lot to biofilms and this whole issue of biofilms and healthcare associated infections or HAI’s, I will refer them, refer to them as HAI’s throughout my discussion today…

        …part of it leads into the discussion of biofilms so much because so much of resistance in healthcare settings is generated by the use of antibiotics to treat biofilms or infections caused by biofilms, which are inherently, of course, as you know, inherently resistant to treatment. And it leads to prolonged exposure of these organisms to antibiotics. Sometimes subinhibitory concentrations of antibiotics. This is a big area and so it is very pertinent to the issue of biofilms and certain pertinent to what we do.

        QUESTION: So out of all these different sub-missions, if you will, which one of them would have the greatest impact on the prevention of biofilm based infections?

        DR. CLIFF MCDONALD: Well, really, biofilms are a major part of all of our major infections. We have long focused on the device and procedure associated infections. Device associated infections that are most common are central line associated bloodstream infections. These are associated with a central venous catheter usually placed in the subclavian of their neck to administer IV medications and whatnot. These have a propensity for becoming infected and almost always involve a biofilm when they do. Ventilator associated pneumonia involves the insertion of an endotracheal tube into the trachea. Those also involve biofilms when infections develop. These are pneumonias that usually develop. Catheter associated urinary tract infection. Sometimes abbreviated as CAUTI, also associated with biofilms on those catheters.

        And then the surgical site infections. Especially those associated with prosthetic devices are almost always associated with a biofilm. So we have been working seriously to prevent those. I’ll just highlight some of those. The SSI’s, the surgical site infections, certainly we are even increasing our focus on those that are most biofilm related. As we go forward into producing more, uh, updated guidelines, we will be focusing more on preventing infections associated with arthroplasties and the placement of prosthetic joints. There’s of course other bioprosthetic and even tissue transplants that when they become infected can also be associated with biofilms, and our division also deals with those infections.

        There are some other biofilm related infections that are healthcare associated that we probably have not been as focused on to date. And I think we’ve talked about those before. Like some of the diabetic foot infections. Those are not always clearly associated with some uh lapse in patient safety, but they certainly develop in people who are under the care of healthcare providers. Those chronic wounds, chronic leg ulcers-all involve biofilms. And, of course, pressure ulcers also. Pressure ulcers, the prevention of pressure ulcers, is certain a big initiative from the federal government across our sister agencies. The Center for Medicare/Medicaid Services is certainly very interested in preventing these, as is the Agency for Health Research and Quality-AHRQ. We do not have that as our primary mission to prevent the ulcers, but I think certainly into the future, looking at the prevention of infection of those ulcers will be important.

        QUESTION: But is there any way to differentiate in the case of these statistics that you mention, are they usually acute infection versus low grade subclinical chronic infections?

        DR. CLIFF MCDONALD: I think most of these are going, well, the catheter associated urinary tract infections could definitely be chronic and low grade. In fact, many of them are. If…it depends on how long the patients have been catheterized. And it is interesting you bring that up, because there’s certain populations where catheter associated urinary tract infections is much higher. We’ve been seeing recently that in some of the rehab units these are patients with much longer catheterization times that they have much higher rates. And so, those are probably very…even when they are not actively…do not appear actively infected, they may well have some chronic infection ongoing. For the catheter-associated blood stream infections, we think that most of those are pretty acute infections. They usually manifest as fever, sometimes even sepsis and/or local acute infection. Uh, again, also probably true with the ventilator associated pneumonias.

        The surgical site infections, most of those are going to be acute infections that present within 30 days. The exception there also though, is some of the prosthetic implant associated infections. Where we, actually as a surveillance definition, try to track those out for a year after implantation. So they definitely can be chronic infections that then finally become (there is a clinical awareness of them) and then they are diagnosed finally. So there is a mix there.

        See a ten-minute excerpt of the HD video here.

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