Yet another meta-analysis telling us that we are doing something very valuable: antibiotic stewardship (AS). Nobody wants to (or should) question that good AS is important for our patients, just as hand hygiene, being sober when working and following the latest professional developments. How nice would it be if we could reliably quantify the effects of our good practice. One study is no study (say those that usually don’t perform studies), so the meta-analysis was invented. But what is told by a meta-analysis? Continue reading
Antibiotic resistance
The Extended Study on Prevalence of Infection in Intensive Care (EPIC III)
On the World Sepsis Day, September 13, 2017, The Extended Study on Prevalence of Infection in Intensive Care (EPIC III) will be performed. EPIC III is a 24-hour point-prevalence study that will collect data on demographics, infection management, degree of organ dysfunction and patient outcomes in ICUs around the world. The EPIC study was performed in 1992 and EPIC II in 2007. Every ICU can join the project and participation will provide a nice opportunity for data comparison between ICUs, countries and continents.
EPIC III will be observational and non-interventional, and patient data will be anonymous. Data collection will be limited to simple variables that are easy to collect and routinely recorded. Data will be recorded using electronic case report forms (eCRF) (paper versions can be provided if online access is problematic or not available). In each country a coordinating center has obtained ethical approval fort he study, and participation will, therefore, only require informing your ethical committee according to local requirements.
The first EPIC study (the E stood for European) was performed in 1,417 ICUs in 17 countries in Western Europe that enrolled 10,038 patients. The EPIC II study (with the E from Extended) had 13,796 adult patients in 1,265 participating ICUs from 75 countries on the study day. Interested? Contact the study team at this page.
The antibiotic course has had its day? (part 2)
British colleagues found no scientific evidence for “completing your course of antibiotics”. Nothing new, but in the absence of competing news (the White House has become a daily soap) they opened Pandoras’ box for the lay press, with patients being recommended to stop their antibiotics, whenever they want. The birth of yet another inconvenient truth, as we cannot translate our knowledge into daily medical practice, and patients get even more confused. The good news: a new research agenda. Continue reading
The antibiotic course has had its day?
In a recent BMJ article, Llewelyn et al. argue that the old dogma of completing a prescribed course of antibiotics to prevent antibiotic-resistance is a myth, not based on evidence. Actually the opposite, namely taking antibiotics for longer than necessary, increases the risk of resistance.
While I love breaking down old dogmas (we actually had a poll on this topic some time back), many of today’s papers in the Netherlands (and I am pretty sure elsewhere, too) misinterpret the study, by slaughtering the message to patients to “always complete the full prescription”. One of the Netherlands most influential newspapers the Volkskrant, already wrote: “Finishing antibiotic course? Nonsense.”
More coffee = less AMR?
This one is for lovers of the brown stuff (no, the other brown stuff). I was taken by a large impressive epi study published in AIM showing that coffee consumption is associated with reduced all-cause mortality. Part of this seems to be tied up in a modified inflammatory response. Whilst the study didn’t mention infection specifically, clearly infection and inflammation are closely linked. So, this got me to asking whether anybody has looked at coffee consumption and infection / AMR outcomes?
How to predict ESBL (part 3)
Six weeks ago I introduced the ESBL-predict study that Tim Deelen from our group coordinates. Every hospital in the world can participate through a user-friendly electronic CRF (in a secured environment). My blog-invitation to particpate worked and some sites already started. In June >1,000 episodes were entered! Here is a short update and info for those that want to join. Continue reading
Exposed: Dutch clinical microbiologists
Exposed; that’s what we are. We, Dutch clinical microbiologists. Globally acknowledged for our capacity to control antibiotic resistance, prevent hospital-acquired infections (HAI) and practice the most rational and restrictive antibiotic policies. That we are self-confident, loud and arrogant is taken for granted, as most do with Christiano Ronaldo. But it is with great sadness that I have to announce that it was all FAKE. The balloon was pricked by professor Marcel Levi. Continue reading
Real-time whole genome sequencing (RT-WGS) & spread of resistant bacteria
At last weeks’ ICPIC I crossed arguments with John Rossen on the question whether RT-WGS helps us to control the spread of resistant bacteria. The setting is the hospital and the definition of RT is “in time to guide essential decision making”. Is RT-WGS a “need-to-have” or a “nice-to-have” thing? Continue reading
The rocket-science of a CPE screen & isolate policy
Last weeks’ blog from Jon Otter on the practice of CPE screening and isolation raised some interesting comments (on twitter) emphasizing the difficulties in policy making for infection control. The two comments that struck me were: (1) … screening for CPE sounds logical “but does it work in long-term care facilities with high-levels of endemicity?” And “I use it in my hospital, but face difficulties in convincing others because of lacking scientific evidence for CPE.” Continue reading
Take care. Not antibiotics.
Mindful of our need to up our game in terms of communication to non-experts around AMR-related issues, I have been scouting around for a good video to portray the basic of AMR, and came across this by Health Education England. It’s not the best animation that I have seen, but I quite like it – and the strap line at the end is interesting (“Take care. Not antibiotics”). I’d be interested in your views on this video, and please feel free to flag any other good ones out there.
Reflections on Infection Prevention and Control 