Where does your ESBL come from?

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

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All models are wrong…..

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?”

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From collateral damage to collateral sensitivity

“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

The prevention paradox: E. coli versus Klebsiella

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

What about E. coli ST131?

One of the faces of the global antibiotic resistance crisis is Escherichia coli ST131, frequently portrayed as a pandemic clone, combining hypervirulence, ciprofloxacin resistance and ESBL production. A recent study in Genome Research, a journal you may not read every month, though, sheds a whole new light on this “superbug”. Continue reading

No more antibiotics for animals

That’s what the WHO stated this week, and it was based on a study, in Lancet Planetary Health. In most news items that I saw animal antibiotic use was directly linked to human infections caused by antibiotic resistant bacteria. A journalist even asked if eating meat was safe. Although most of us (including me) support reduction of unnecessary antibiotic use, it’s worth reading this excellent meta-analysis, initiated by WHO. Did this study answer the burning research question “to what extent does animal antibiotic use influence infections in humans?“ Continue reading

Making MRSA carriage a crime?

A new chapter has been added to our successful MRSA Search and Destroy policy. Yesterday, a healthcare professional, providing homecare to elderly, testified on Dutch television (item starts @ 12.30 minutes) how unnoticed MRSA carriage had influenced her and her family’s life. It is very laudable that she was willing to share her experience, but it was kind of spooky that she felt that she could only do this if unrecognizable, as if the underworld was still after her and her family. Apparently, MRSA carriage has become a criminal or shameful thing. Continue reading