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
Author: marcbonten
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
Fluoroquinolone use and C. difficile infections: The English miracle not yet explained?
A few weeks ago in LID this marvellous paper, clearly demonstrated the reduction of fluoroquinolone-resistant but not fluoroquinolone-susceptible C. diff infections (CDI) in English hospitals, coined as “the English C. diff miracle”. The CDI decline coincided with the reduction of fluoroquinolone use, but also with a period in which “horizontal” infection control measures, such as hand hygiene, were improved. As the latter would be equally effective in preventing transmission of resistant and susceptible strains, the fluoroquinolone reduction was considered causative for the observed reduction. A very simple model tells us that that is not necessarily the case. Continue reading
VRE: MRSA or MRSE?
To me, VRE is an old love that never let me down. In 1995 (!) I studied its epidemiology in Chicago (using PFGE), and we described it as the “triple-threat bug”: a gut colonizer like Gram-negatives, a skin colonizer like MRSA and an environmental contaminator like C. diff. A new study in CID, using WGS, illustrates its complex epidemiology. After 20 years, that complexity seems explained, and now we can no longer avoid the question what to do with VRE. Keep on cherishing its “feared pathogen status” like MRSA, or accept that it is just something like MRSE, and stop bothering. Continue reading
Chinese carbapenamases: Fly like an eagle
I blogged on mcr-1 (colistin resistance) in China last week, to share the latest reassuring data. Well, the paper on which todays’ blog is printed will be used to wrap tomorrows’ market fish (typical Dutch expression). Nicolle Stoesser (Oxford) send me the latest news, coming from a Nature Microbiology study providing evidence for the potential of spread of carbapenamases by flies and birds. Not reassuring at all, and potentially with major consequences. Continue reading
Colistin resistance and mortality
My previous blog on “mcr-1 and the end of the world” evoked responses on the important effects of colistin resistance on patient outcome, referring to a new study in CID with the following abstract closure: “Importantly, mortality was increased in patients with colistin-resistant isolates.” The wording is correct, but I’m afraid that it will be interpreted incorrectly. Continue reading
Reflections on Infection Prevention and Control 