How to predict ESBL BSI (part 2)

A month ago (April 11) I blogged on the difficulties in predicting the presence of ESBL-producing bacteria as a cause of infection at the time antibiotics must be started. Wouter Rottier (PhD student) developed 2 prediction rules (for community-onset and hospital-onset infection), that seem to do better than current guideline recommendations (especially for reducing unnecessary carbapenem use). Another PhD student (Tim Deelen) now wants to validate these rules, globally. The “crowd-funding study approach” worked and sites across the world joined us…. Continue reading

Fluoroquinolone use and C. difficile infections: The English miracle (not) yet explained? (part 2)

Two months ago I blogged on the reduction of fluoroquinolone-resistant but not fluoroquinolone-susceptible C. diff infections (CDI) in English hospitals, coined as “the English C. diff miracle”. A very simple model challenged the conclusion that this was caused by a reduction in fluoroquinolone use in hospitals. A debate on the assumptions of the model now provides the perfect outline for a PhD thesis. Continue reading

ECCMID2017: new kids on the blog & UK pearls

Three “new antibiotics” and two chapters in our textbooks that need to be rewritten. Six slam-dunk top publications, that was all (!) in the clinical trials late-breaker session at ECCMID2017. The “antibiotics” are a beta-lactamase that inactivates cephalosporins in the gut to prevent C. difficile infection (CDI), and two drugs with activity against CPE: a new aminoglycoside (plazomicin) and a ciderophore cephalosporin (cefiderocol). The antibiotic pipeline starts dripping again. Continue reading

On antibiotic resistance, “complex systems” and tipping points

This morning I chaired the session “Which mathematical models for antimicrobial resistance?” at ECCMID2017. Three excellent talks, making one thing more crystal clear (to me, at least)  than before. Antibiotic resistance epidemiology should be considered as a “complex system”.  What does that mean? Continue reading

Let others use your data!

The following story is not a fairy tale. It is “your worst nightmare” for some, “recognition at last” for others and an important lesson for all of us. It’s the story of a great study, made possible by the unpaid collaboration of 16 ICUs, and the tremendous work of a PhD student and research nurse. Yet, two years after publication in JAMA, there appeared to be 1 error, which had a major impact on the study outcome. Continue reading

How to predict ESBL bloodstream infection?

Each day we prescribe antibiotics without knowing the specific cause of infection, yet. Some patients will have an infection caused by an ESBL-producing bug, and they would benefit from immediate treatment with a carbapenem or addition of an aminoglycoside. At the same time we don’t want to misuse carbapenems or hurt kidneys. Wouldn’t it be great if we could accurately predict who would need a carbapenem? Now you can. Continue reading

The faces of antibiotic resistance

IDSA published 13 Faces of Antimicrobial Resistance to highlight the consequences of AMR for individual patients. The report illustrates the grim future of bacterial infections. In each of the 13 cases I asked myself whether this could happen in an “AMR-virgin country” (the Netherlands), and whether likelihood of that infection had increased in the last 10 years (as in a crisis)?  Continue reading