Special issue on MDR-GNR

The Journal of Hospital Infection have published a welcome special issue on multidrug-resistant Gram-negative bacteria. The collection includes some updates on epidemiology, staff carriage (again!), clinical microbiology, and patient perspectives on CPE, and is well worth a read.

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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

Money makes the AMR bugs go round in Europe? A reflection from ECCMID 2017

 

If you pick an AMR bacterium of your choice, go to EARS-Net and plot prevalence across Europe, in most cases you’ll see a rough ‘north-south’ divide, with northern European countries doing better than southern European countries in terms of AMR rates (e.g. see below for antibiotic-resistant K. pneumoniae). What is driving this difference in AMR rates? A session at this year’s ECCMID asked just that question, hypothesising that weather / climate, economics, patient mix, or culture explain the difference. It was a fascinating session, so I thought I’d share some highlights!

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Promiscuous plasmids: a rapid reflection from ECCMID 2017

I came to ECCMID 2017 with a very specific question: do we need to think beyond ‘same-bug-same-gene’ horizontal transmission from a practical IPC view point in order to address the threat of IPC? The answer, unfortuantely, is yes!

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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

Dogs can be useful – Woof of concept obtained

I’m not a dog lover. Far from it in fact, however a new paper in the Journal of Hospital Infection caught my eye today. Yesterday I was sitting in the Longitude Prize Advisory 7318105948_2aa4449f9f_zCommittee meeting bemoaning the lack of ‘left field’ ideas coming forward. Harrison himself, winner of the original prize was such a person. He came at the problem of solving the longitude issue from a completely different direction when all of the respected science at the time was convinced that astrology was the answer. Problem: cloud, and not much of a silver lining. So we are looking for a new way to diagnose infection rapidly, distinguishing between those caused by viruses and bacteria in the hope of turning the increasing tide of resistance. So what does Fido (or Nimbus in this case) have to do with this?

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