Exposed; that’s what we are. We, Dutch clinical microbiologists. Globally acknowledged for our capacity to control antibiotic resistance, prevent hospital-acquired infections (HAI) and practice the most rational and restrictive antibiotic policies. That we are self-confident, loud and arrogant is taken for granted, as most do with Christiano Ronaldo. But it is with great sadness that I have to announce that it was all FAKE. The balloon was pricked by professor Marcel Levi.
Marcel Levi was Dutchman of the year in 2016, because he is a great scientist (coagulation), a brilliant internist, succesful hospital manager (AMC 2010-2016), respected opinion maker and serious columnist. Nobody (in our country) was surprised that our future minister of Health was contracted as CEO by the University College London, where he is now, since 6 months, leading 5 academic hospitals. I know Marcel, highyly respect him professionally and personally, and I will be the last one doubting his words.
His columns in Medisch Contact (the Dutch BMJ) address his experiences in London. This weeks’ column is entitled “MRSA is really exceptional here”. I previously blogged on the ecological safety of visiting London, but Levi’s column nicely explains the why. After 25 years of practice in the Academic Medical Center (AMC), Amsterdam, he is now very pleased to see how “alternative practices lead to better results”. Happily surprised he sees “how fanatic everyone is engaged in preventing HAIs and antibiotic resistance; that he, as a CEO, weekly receives detailed reports of cultured bacteria and their susceptibilities, that each MRSA is seen as a serious incident and that every HCW knows the latest HAI incidence rates in their ward, by head.” The trick is that every ward has a nurse trained as infection control practitioner, implementing necessary measures, “which works much better than the commands executed by the alien force, alias the centralized infection control department, as he experienced it before. “
“Prescription of a non-first-line antibiotic, even at the outpatient clinic, leads – almost always – immediately to a friendly phone call of the hospital pharmacist. And there is no way of entering a hospital ward with long sleeves or without extensive use of alcohol handrub, not even for the Prince of Wales.”
The results are fantastic! HAI rates are much lower than he was used to. MRSA is a rarity, MDR E. coli and K. pneumoniae sporadic and C. difficile hasn’t been seen for weeks. He is now using antibiotics that he used 25 years ago: penicillin for pneumococci and co-trimoxazol for UTI.
There are also similarities: microbiological diagnostics are outrageous (mostly unnecessary) and not a single microbiologist is curtailing this money-wasting-industry.
And, there is only one thing they can still learn from us: antibiotic stewardship. But wait a minute: penicilline, cotrimpxazol and a pharmacist that calls you? No antibiotic resistance? And much lower HAI rates than in AMC? Can’t think of anything more to learn.
Many questions arise: Is this (unnamed) hospital representative fort he UK? And is his prior experience in AMC representative for the Netherlands? I cannot imagine that he would have written this if any of both questions should be answered with NO. Or am I wrong?
So, now you all know. You won’t see or hear Dutch clinical microbiologists anymore on international conferences. And you can also discontinue your famous and highly appreciated British politeness: stop providing high resistance numbers to EARSS and to other international surveillance systems, stop publishing manuscripts with high HAI infection and resistance rates, only to make us (Dutch) look good. Be honest, and admit that CDI doesn’t exist, CPE is a fairy tale and that carbapenems are not even registered. Sack your microbiologists and rename NHS from No Hope for Survival (old, silly joke) to New Heights in Susceptibility.