How to predict ESBL (part 4)

Two months ago I provided an update on the ESBL-predict study that Tim Deelen from our group coordinates. In short: Every hospital in the world can participate, through a user-friendly electronic CRF (in a secured environment), in the validation of 2 scoring systems to predict that sepsis is caused by ESBL-producing bacteria. Only relevant for those of us that are not yet ready to start meropenem/amikacine for every patient that starts with antibiotics! This tool may help, …. if reliable. We passed the 3,000 episodes! Here is a short update and info for those that want to join. Continue reading

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The hidden reservoir of SDD users

A next little piece of evidence on the effectiveness of Selective Digestive Decontamination (SDD). Nienke Plantinga pooled all data from the 16,528 patients that had been enrolled in a randomized evaluation of SDD since 25 years, in an Individual Patient Data meta-analysis, see. Not surprisingly SDD was associated with better survival in intensive care unit (ICU), as it was in most of the individual studies. Yet, the pooled etsimates also provide more certainty (and precision) on the beneficical effects of SDD on hospital survival and failed to confirm previous suggestions that SDD was more effective in surgical than in medical patients. Continue reading

Houston, we have a problem

While the world was watching the Texas water ballet with Melanie Trump on stiletto heels, about 1500 people died in South-East Asia because of floodings. And while the western world is searching for another irrelevant mcr-gene, Patrick Musicha soberly describes the true antibiotic resistance crisis in Malawi, see. It is becoming more and more obvious that antibiotic resistance will be the next plague for the least privileged on earth. Continue reading

Dead bacteria cannot mutate

As a young and angry PhD student I was confronted with the concept of Selective Digestive Decontamination (SDD). That was in the early nineties (previous millennium). Coming from the field of microbiology I expected that SDD would increase antibiotic resistance. It were intensivists that told me not to worry: “antibiotics in SDD kill bacteria and dead bacteria cannot mutate”. They may have been right, suggests a new study. Continue reading

On the effects of antibiotic stewardship: I met a analysis

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

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