The Journal of Hospital Infection have published a welcome special issue on multidrug-resistant Gram-negative bacteria. The collection includes some updates on epidemiology, staff carriage (again!), clinical microbiology, and patient perspectives on CPE, and is well worth a read.
BMC Medicine have recently published a study from researchers in Oxford, PHE, and Manchester illuminating the importance of referral networks in the transmission of CPE. The bottom line is that regional referral networks seem to be the most important driver of CPE spread, such that a small CPE problem close to home is more of a threat than a larger CPE problem in a distant referral network!
A clear simple study has a stark headline: 16% of admissions to a Spanish surgical ICU carry CPE. This sort of carriage prevalence is at a ‘practice-affecting’ level: the empiric antibiotic choices may be altered and you begin to wonder what is left when the first signs of infection develop in almost 1 in every 5 patients…
Many guidelines now recommend screening some patients on admission for carriage of CPE. However, very few cost-effectiveness analyses have been performed. A Canadian group have just published a modelling study with a tantalising conclusion: universal admission screening for CPE is likely to be cost-effective, and may even be cost-saving!
I am currently involved in some research that requires a clear distinction between CPE (i.e. Enterobacteriaceae that produce a carbapenemase) and non-carbapenemase-producing CRE. Since ‘non-carbapenemease-producing carbapenem-resistant Enterobacteriaceae’ is a bit of a mouthful, I need to come up with some sort of acronym. I would appreciate your thoughts on the scheme set out below:
You can read more thoughts on acronyms for carbapenem-resistant bacteria in a previous post here.
I blogged on mcr-1 (colistin resistance) in China last week, to share the latest reassuring data. Well, the paper on which todays’ blog is printed will be used to wrap tomorrows’ market fish (typical Dutch expression). Nicolle Stoesser (Oxford) send me the latest news, coming from a Nature Microbiology study providing evidence for the potential of spread of carbapenamases by flies and birds. Not reassuring at all, and potentially with major consequences. Continue reading
My previous blog on “mcr-1 and the end of the world” evoked responses on the important effects of colistin resistance on patient outcome, referring to a new study in CID with the following abstract closure: “Importantly, mortality was increased in patients with colistin-resistant isolates.” The wording is correct, but I’m afraid that it will be interpreted incorrectly. Continue reading