Last Friday the results of the ESBL Attribution study (ESBLAT) were presented. After considerable media attention for ESBL-producing bacteria on our meat (especially retail chicken meat) and a 84-year old woman being “the first deadly victim of the new chicken-ESBL bacterium” a research consortium was asked to quantify the role of ESBL in animal industry for human health. The “research lab” was the Netherlands: one of the most densely populated countries in the world for both humans and animals, with the highest antibiotic use in the world for animals and the lowest for humans. If anywhere, zoonotic transmission should happen there! Continue reading
I caught the 15 minute drama on BBC R4 today (The Truth About Hawaii) and, to my surprise, it was a post-antibiotic apocalypse story. A ten year old girl gets a scratch on the knee that develops into a serious infection that without antibiotics has become life threatening. The Prime Minister is personally involved in enforcing a restriction policy for the last remaining antibiotic. And, as with pretty much every other Radio 4 drama, a happy ending seems unlikely.
Yesterday, our study on antibiotic cycling strategies in ICUs was published. Thanks to Joppe van Duijn, involved in all study phases, we could report that in 8 ICUs in 5 countries with 8,776 patients the unit-wide prevalence of antibiotic resistance was similar when cycling antibiotics every 6 weeks or when cycling antibiotics for every next patient treated (mixing). The study was motivated by prior mathematical models, of which most predicted that cycling would do better. So, now all can raise their voices: (1) “all models are wrong, but some are useful”; (2) “most studies are wrong, but some are useful”; or (3) “if model predictions are not confirmed, where did the study go wrong?”
“Every disadvantage has an advantage” is one of the many brilliant quotes from the late Dutch philosopher Johan Cruijff. This now also seems to hold for antibiotic resistance. The conventional belief is that resistance development is unidirectional: pathogens cumulatively acquire resistance traits, until being a multidrug resistant superbug. This now seems not always true; resistance development to antibiotic A, may – at the same time – increase susceptibility to antibiotic B, a phenomenon called “collateral sensitivity” that may help us in treating chronic infections. Continue reading
I hope you enjoyed Christmas time and wish you all the best for this year. From my side, I will continue to reflect what I meet professionally, what surprises me, confirms what I thought to know or what confirms my ignorance. In 2017 I did that 41 times (a surprise to me!) and here are some trending topics that will most likely return in 2018. Continue reading
The prevention paradox, as described in 1981, is the “seemingly contradictory situation where the majority of cases of a disease come from a population at low or moderate risk of that disease, and only a minority of cases come from the high risk population (of the same disease). This is because the number of people at high risk is small”, see. In our world this reflects the question how to prevent transmission of ESBL-producing E. coli (ESBL-EC) or K. pneumoniae (ESBL-KP), or both. A new study may help to decide. Continue reading