Nurses are usually non-prescribers, so that means that anti-infective stewardship is the domain of the prescribing doctors and pharmacists, right? Wrong! Nurses have an enormous and enormously under-estimated role in anti-infective stewardship! Continue reading
Always great to see infection-related data in the top medical journals, like the recent overview of antibiotic use in the US published recently in JAMA Internal Medicine. There’s good news and bad news in the article: overall use of antibiotics in data from 300 US hospitals did not increase between 2006 and 2012. However, the use of key broad spectrum agents did increase significantly, including the carbapenems. I am sure that many of these uses of ‘top shelf’ agents is indicated by the resistance patterns of the organisms being treated, but the net effect is perpetuating the antibiotic-resistant monster! Continue reading
It’s great to be able to report some much-need progress on the drug discovery front, with a Nature paper about a new antibacterial, lugdunin. Lugdunin is produced by S. lugdunensis and probably explains why this organism can out-compete S. aureus to colonise the nasal passages. Whilst the research has generated a great deal of positive press coverage – and so it should – but much like teixobactin, it will not go far to alleviate our problems with anti-infective-resistant bacteria.
Guest blogger Dr Tim Rawson (bio below) writes…
With antimicrobial resistance taking its place alongside climate change on the global political agenda, the role of antimicrobial stewardship in healthcare has come to the forefront. Being a good steward of antibiotics goes beyond simply possessing the technical ability to maintain the effectiveness of antimicrobials. It requires an understanding of why we all, as healthcare providers, should practice stewardship and an ability to confront many of the social and behavioural barriers preventing good practice. Whilst the infection community and some policy makers are now highly engaged with antimicrobial resistance, there is very little evidence to support engagement with AMS-AMR within other clinical specialties.
I am currently reading ‘The Drugs Don’t Work’ by Professor Dame Sally Davies, Dr Jonathan Grant and Professor Mike Catchpole (yes, I know I’m several years late to this particular party). I might do a book review for the blog once I’ve finished it – but an interesting question emerged in the early chapters. The author seem to make a point of referring to ‘antimicrobials’ rather than ‘antibiotics’ in the early part of the book, but later on, antibiotics appears as a common term. Which got me to thinking about what is the most appropriate generic term for what most people would term ‘antibiotics’ (what your GP gives you when you’ve got a snuffle, I mean potentially serious bacterial infection)?
I found out about a new free online antimicrobial stewardship course yesterday. The course is a collaboration between the the University of Dundee and the British Society for Antimicrobial Chemotherapy, and comes highly recommended. The course is designed for healthcare professionals.
If anybody completes the course, I’d be interested to hear your feedback.
We welcome another guest post from Prof Peter Collignon (bio below) on the risk of antibiotic resistance in the food chain…
Codex has recently announced they are doing more work on antimicrobial resistance. This is an opportunity get Codex to have a couple of standards to better protect public health from one of the worst types of antibiotic resistance that might develop in the next few years or decade. Specifically to help prevent carbapenem-resistant bacteria transferring to people via the food chain including via imported foods into countries (some useful background on this issue from European Food Safety Authority (EFSA) here).
Guest blogger, Prof Peter Collignon (bio below) writes…
EU proposals on colistin use in food animals are just restrictions. Why not a ban?
We are now in a situation around the world where rising levels of resistance means that for many life-threatening infections with Gram-negative bacteria such as E.coli, the only effective antibiotic is now IV colistin. Colistin (polymyxin E) is an old drug that has been resurrected for use because there are no other alternatives available – even though it has major renal and neural toxicities.
The final report from Jim O’Neill’s Review on AMR is published today. The report summarises the key findings of the reports published by The Review. The key interventions outlined in the report are:
Not a great deal on infection prevention in the report – but this was covered in detail in a previous report. Some more excellent infographics, and an impressive Review. Well worth a read.
A study protocol has caught my eye this week, a trial of oral probiotics vs placebo as prophylaxis for UTI in spinal cord patients, a very high risk group for these infections and associated complications. It will be a multi-site randomised double-blind double-dummy placebo-controlled factorial design study running over 24 weeks conducted in New South Wales, Australia. Probably about as robust as it gets scientifically. Continue reading
Reflections on Infection Prevention and Control 