Antibiotic resistance

Is it true that I have to finish my antibiotic treatment as prescribed?

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , ,

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It is always the same. If I think that I had a reasonable idea and put it on-line, it will only take a day or two, until friends and colleagues let me know, that others had the same idea – just earlier. In this case, John Ferguson (@mdjkf), brought to my attention, that Professor Lyn Gilbert started the same discussion in Australia (Link). As always, I am depressed for about 5 seconds and start to come up with a new, old idea.

Despite the discussion in Down-under, I have promised to post the results of my questionnaire. On Twitter, some were surprised how little evidence exists to support antibiotic prescribing dogmas (Eli Perencevich, @eliowa), whereas others like Christina Vandenbroucke-Grauls (@ChristinaGrauls) believe that we have plenty of evidence from lab experiments and theory to answer the question. Most importantly, “every bit of antibiotic leads to resistance”.

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Transmissible colistin resistance – made in China

Jon Otter (@jonotter) Antibiotic resistance , , , ,

colistin made in china

The emergence of CPE (and carbapenem-resistance in other Gram-negative bacteria) has forced us to reach to the dusty old antibiotic shelf to revive the clinical use of older agents with activity against Gram-negative bacteria, principally colistin. Colistin isn’t perfect by any means – it has poor tissue penetration compared with the carbapenems, and is associated with nephrotoxicity (although the high levels of nephrotoxicity in the older medical literature has not been reported due to better management of the drug). Furthermore, resistance has already been reported. To date – this has been mutational resistance, which does not have the capacity to spread horizontally. It was only a matter of time before a colistin resistance gene mobilised.

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Antibiotic Awareness: background and links

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , , ,

European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project

The EuSCAPE project aimed to improve understanding of the occurrence and spread of CPE. LINK

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About European Antibiotic Awareness Day

European Antibiotic Awareness Day is a European health initiative coordinated by ECDC which aims to provide a platform and support for national campaigns on the prudent use of antibiotics. Each year across Europe, the European Antibiotic Awareness Day is marked by national campaigns on the prudent use of antibiotics during the week of 18 November. Prudent use means only using antibiotics when they are needed, with the correct dose, dosage intervals and duration of the course. Follow the European Antibiotic Awareness Day: #EAAD. http://antibiotic.ecdc.europa.eu

About World Antibiotic Awareness Week

The World Health Organization is leading a global campaign for the first World Antibiotic Awareness Week with the slogan “Antibiotics: Handle with Care”. The campaign calls on individuals, governments and health and agriculture professionals to take action to address this urgent health problem. The first World Antibiotic Awareness Week will take place on 16-22 November. Follow the World Antibiotic Awareness Week: #AntibioticResistance. www.who.int/drugresistance.
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European Antibiotic Awareness Day 2015: ESPAUR report highlights progress and challenges

Jon Otter (@jonotter) Antibiotic resistance , , ,

eaad_2015

For those of you who have had your head in a hole all week, you may not be aware that today is European Antibiotic Awareness Day, which coincides with Global Antibiotic Awareness Week. The antibiotic stewards amongst us (which should really be all of us!) have launched many and varied campaigns to highlight the need to handle antibiotics, our ‘miracle drugs’, with care (see Andreas’ 30-second-antibiotics-myth-buster-survey, for example).

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The 30-Second-Questionnaire: Antibiotic Myth Buster

Andreas Voss (@AVIPNL) Antibiotic resistance, General , , ,

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Here we are again, the year flew by and it’s time for Antibiotic Awareness Day/Week. This time around, I will spend my time in a call-center, answering questions of concerned citizens/ex-patients in Germany. Smart idea of a friend in the German public health service and probably smarter than doing what we usually do: organize a meeting, ask all our colleagues to come, and preach to our own community.

While I believe that there is no ID or Clin Micro person left that is not convinced of the importance of saving our miracle drugs (Australian campaign), I know that I will get questions I can’t answer, or at least, don’t know if my answers are truly true.

Here it goes, my antibiotic conundrum that could  be classified as “Antibiotic Myth”:

Is it true that I have to finish my antibiotic treatment as prescribed?

Will “too short” lead to antimicrobial resistance, or is it the “too long”? My guess, 99% of the professionals will answer this question by releasing an avalanche of questions, regarding the bug, the host and the site of infection, but I have to insist on a simple “yes” or “no”. Sorry, but those are the rules of the “30-Second-Questionnaire” and you can’t argue the rules.

Thus here is my request. Follow the link to the questionnaire, take 30 seconds to answer the question (and 4 others) and email, twitter, blog or use any kind of communication you can think of to forward it to your friends and family. I promise, I will post the outcome right here, a week or two later.

 

State of the World’s antibiotics

Andreas Voss (@AVIPNL) Antibiotic resistance ,

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The State of the World’s antibiotcs, 2015, was just released by the Center for Diseases Dynamics, Economics & Policy (http://www.cddep.org). For all those interested in antimicrobial resistance this report is a must read.

To cite from the publication, this State of the World’s Antibiotics report records the status of this important global resource and provides critical policy analysis on three issues:

  • global patterns and trends in antibiotic resistance and 
antibiotic use in human beings and animals
  • the existing antibiotic supply and the research and development pipeline
  • interventions that have been shown to help rationalize antibiotic use and are practicable in all countries.

While being wonderful, the reports include a figure from a 2013 Lancet ID publication, a colleague (@ChristinaGrauls) alerted me to. According to figure 2-2: Carbapenem retail sales in selected countries, 2005–2010, the retail sales and thus probable consumption of carbapenems per 1,000 population is identical for the Netherlands and the USA. Somehow, I find that hard to believe.

Antibiotics and the Netherlands

Andreas Voss (@AVIPNL) Antibiotic resistance , ,

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Antimicrobial resistance, control of antibiotic use and infection control are some of the things the Dutch presumably do well. Some of the Dutch infection control policies, such as “Search & Destroy” helped to stop the introduction of MRSA for a long time. I addition, the prevalence of other MDRO is low in comparison to many other countries. Still, more needed to be done, and consequently, the Dutch were (one of) the first that made antimicrobial stewardship teams (A-teams) compulsory for every hospital and presently plan introduction in other healthcare settings. Last but not least, the fight against antimicrobial resistance will be an important topic, while the Dutch hold the Presidency of the European Union in the first half of 2016.

Thus, what else could we ask for? A few weeks ago, I had at least one request: basic antibiotics.

Due to fading reimbursement policies and the constant pressure to sale drugs for decreasingly lower prices, the production for and/or distribution of several drugs within the Netherlands is no longer possible. Latest victim: i.v. penicillin, which is no longer available in my country (high-resource setting). While it seems difficult to argue for small spectrum antibiotics in the absence of one of the important ones, there is some good news: I no longer have to argue whether to use penicillin or a 3rd generation cephalosporin for certain indications. Ceph it is!

Just passing through

Martin Kiernan (@emrsa15) Antibiotic resistance, Epidemiology, MDR-GNR , ,
Picture courtesy of Shanna Trim
Picture courtesy of Shanna Trim

Travel is easy, cheap (well, depending on your desire for luxury) and you get to meet some interesting characters on your way. Unfortunately, as this recent study from France just published in Clinical Infectious Diseases shows, some of the species that you interact with may have escaped your attention (unless you’re carrying agar plates or some fancy molecular kit with you).

The authors studied travellers attending five vaccination clinics in France prior to and post-travel looking for acquisition of MDR Enterobacteriaeceae. Over 50% came home with more than they bargained for, smuggling MDROs into France in their colons.

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Dispatches: Pan-drug-resistant doom – are we there yet?

Guest Blogger Antibiotic resistance , , ,

Old_Testament_prophet-1

Guest blogger and Acute Medicine trainee Dr Nicola Fawcett (bio below) writes…As the local Prophet of Antibiotic Resistance Doomsday to our population of hospital physicians, I’m always interested in finding out if the pan-drug-resistant superbug has emerged that is going to wipe us all out, for credibility purposes if nothing else. (Resistance Is Coming! Prepare thyself! Wash thy hands and document thy indication and duration or face Everlasting audits and perpetual personal protective equipment!). For the record – I’m actually a Registrar in Acute and General (Internal) Medicine. I’m doing some time in the world of ID/Micro/Genomics in the hope that it will help me work out whether it’s ok to just hand out co-amoxifrusiclavamide + nebs to everyone if not sure what’s going on. However  this question seems rather inextricably linked to antibiotic resistance, and having spent some time now with people who seem to know what they’re doing,  I’m increasingly flabbergasted at the massive divide between the views of microbiologists who see the latest data, and the views of the common garden hospital physician. Therefore my side-mission, if you like, has become to spread the good, or rather, spectacularly bad news that antimicrobial resistance is currently spreading around our biosphere at a scale and speed at which we simply cannot react fast enough.

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More of a bad thing: ESBL-E

Andreas Voss (@AVIPNL) Antibiotic resistance , ,

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In a short, but important Dutch study, the added value of selective pre-enrichment for the detection of ESBL-producing enterobacteriacea (ESBL-E) was evaluated. The authors used their yearly prevalence study to shed more light onto the question if pre-enrichment (using a broth) might be equally improving the performance of ESBL-E detection, as it does with MRSA. While the literature on the topic might be controversial, this straightforward, well-performed study showed that direct culture failed to identify 25.9% (7/27) ESBL-E rectal carriers, which corresponds to 1.2% (7/562) of the screened population. While the overall rate of ESBL-E rectal carriage is not very high (4.8%) this study still demonstrates the importance of improving our methods to detect multi-drug resistant pathogens.

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