“33000 people die every year due to infections with antibiotic-resistant bacteria” this is what ECDC released on Nov 6, 2018, on their website. “Superbugs kill 33,000 in Europe every year” said CNN and the same wording was used (in Dutch) by our Telegraaf. Naturally, the headings were based on the ECDC study published that day in Lancet ID, which happened to be the most downloaded paper ever of the journal. But was this really what was published? Valentijn Schweitzer and I got lost in translation when trying to answer that question. Continue reading
Although there’s some controversy about whether or not we should apply contact precautions (by that I mean single room isolation, enhanced PPE, enhanced disinfection etc) all the time for all organisms, it would be a brave hospital to eschew contact precautions for CPE carriers. And so the question of whether and when we should ‘de-isolate’ patients with known CPE is an FAQ. And so enter a recent study in CMI comparing the spontaneous apparent loss of colonisation with various CPEs, concluding that KPC carbapenemases seem to hang around for longer than NDM carbapenemases, but both almost always last for the duration of a single hospitalisation.
Just before Christmas a follow-up on that what bothers us most: patients dying because of antibiotic resistance. I previously tried, see here, to disentangle from the ECDC study (33.000 deaths per year in Europe) how they got to 206 AMR casualties in the Netherlands and ended with a recommendation to not “focus too much on the absolute numbers as they may not be very precise.” With Valentijn Schweitzer I spent some more time in the 200 pages supplement, only to find out – in the end – that the Americans do these kind of studies much better. Continue reading
BMC Medicine has published some research from our group reporting the findings of a mathematical model comparing various approaches to screening for CPE carriage. The model compared how several operational metrics varied with different approaches to screening (‘slow and cheap’ laboratory culture vs. ‘fast and expensive’ PCR) and in various specialties with variable levels of compliance with CPE admission screening and at various levels of admission prevalence of CPE. The main conclusion was that culture proved to be the best approach in most scenarios, balancing risk and resource.
“In case of an emergency check your own pulse first”, that’s one of the rules of the House of God. More than 33.000 deaths due to AMR in Europe per year, as reported yesterday, definitely is an emergency. Therefore, I tried to disentangle what that means for my small country that so vividly tried to keep these superbugs out of the country. Continue reading
Continuing the theme of CPE (or CRE if you prefer) Toolkit evaluation, a US research group has performed a modelling study to evaluate the economic impact of the US CDC CRE Toolkit. Curiously, whilst all approaches generated cost savings eventually, hospitals acting independently rather than as a co-ordinated region resulted in faster but ultimately smaller cost savings.
A research group at Bristol in collaboration with PHE have just published an evaluation of the CPE Toolkit. I don’t think any of the findings are especially surprising, confirm that the Toolkit is not implementable in acute NHS hospitals, but provides useful information and guidance to build a local CPE policy.