AMR deaths in Europe

“In case of an emergency check your own pulse first”, that’s one of the rules of the House of God. More than 33.000 deaths due to AMR in Europe per year, as reported yesterday, definitely is an emergency. Therefore, I tried to disentangle what that means for my small country that so vividly tried to keep these superbugs out of the country. Continue reading


What about E. coli ST131 (part 2); is it foodborne?

Last November I blogged on E. coli ST131, frequently portrayed as a pandemic clone, combining hypervirulence, ciprofloxacin resistance and ESBL production. The question is whether the undeniable high prevalence of this bug among clinical isolates results from its virulence and antibiotic resistance or whether it is just a reflection of carriage prevalence in the general population, without any relationship to virulence or resistance. Two recently published studies try to shed new light on the debate; one bringing in chicken retail meat as the source…… Continue reading

An endless one-sided confidence in Pip-tazo?

This weeks’ publication of the highly controversial results of the MERINO trial in JAMA caused quite a stir on social media. The paper has been viewed >50,000 times and the unexpected outcome has been challenged by many. But what was the conclusion in JAMA? “Among patients with E. coli or K. pneumoniae bloodstream infection (BSI) and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a non-inferior 30-day mortality.” Not and  in the same sentence, a doubled denial, is confusing. More important, as formulated, the study was inconclusive, which nobody seems to accept. We dived into the depths of the reporting and then tried to explain it. Continue reading

A POET with a sledgehammer

Imagine, the look on the face of that ambitious PhD student, each day screening six hospitals for patients with S. aureus endocarditis, opening the NEJM and seeing that the Danes randomized 400 patients with Infective endocarditis (IE). And then his supervisor rubbing in that these 400 all underwent two extra transoesphageal echocardiograms for study purposes, that there were zero losses to follow-up and telling him how many samples of blood were collected to analyze antibiotic concentrations. Luckily, he was scheduled for our Journal club, which allowed him to apply the “trias scientifica”. Continue reading

Gaming with non-inferiority in antibiotic stewardship

An early switch from IV to oral treatment is one of the pillars of antibiotic stewardship. Oral antibiotics are mostly cheaper, hospital stay shortens and thus also the risk of healthcare-associated infections. One problem: before we change our current practice, we must demonstrate that the new strategy is safe. The best evidence comes from a non-inferiority trial. Yet, that usually implies enrolment of many patients. The solution to that problem: put on your poker face when drafting your sample size calculation and hope for the best. Our Danish colleagues show how.  Continue reading

Must we screen for resistant bacteria?

This is a cry for help. In 2 weeks time I have a pro-con debate on the statement “screening for highly-resistant microorganisms is a must”. I face 2 problems: the organizers gave me the “PRO” position and my opponent is professor Andreas Voss.

We will be watched by a Dutch audience, so the bacteria involved are MRSA, VRE, anything resistant to carbapenems and ESBL-producing Gram-negatives, and I (and hopefully Andreas too) interpreted the question as “screening at the time of hospital admission”.

I am desperately seeking high-level scientific evidence supporting my allocated point. 

My question to the knowledgeable reflectionsipc readership is: What do you consider the single most convincing piece of evidence underpinning my case.

As in all good practice I will provide feedback (if I survive the battle).

No jab, no play; no jab, no pay

It may be the annual “cucumber time” or Trump-fatigue, but childhood vaccination is dominating Dutch news. The problem: the proportion of children being immunized against, for instance measles, is (slowly) declining and approaches the level that offers herd protection. That is a risk for children in the time window between passive protection by mothers’ IgG and active immunisation (at 14 months) and for persons that cannot be immunized for medical reasons. We were familiar with parents refusing immunization of their kids for religious reasons (because someone forgot to mention vaccination in the bible), but now non-religious and well-educated parents do the same. These “philosophic refusals” mostly decide to do so on information derived from internet. How can epidemiology help us to curb this problem? Continue reading