There have been a few important updates on the prevention and control of MDR-GNR from ECCMID, here in Madrid. I thought I’d share a couple of key reflections.
CRE
Are our attempts to contain CPE going down the drain?
I posted recently on the potential risk of CPE contamination of sinks, drains, and hospital wastewater. The question in my mind then was whether contamination is a smoking gun or innocent bystander regarding CPE transmission? What we really need is an intervention to show that better management of sinks and drains results in reduce CPE transmission. And now, we have one! The findings suggest that attempts to control CPE will go down the drain if we don’t intervene to improvement the management of sinks and drains.
The reality of AMR in Greece
This week I attend the general assembly of COMBACTE, this year in Athens. COMBACTE stands for COMBatting AntibiotiC resistance in Europe (www.combacte.com) and is part of the New Drugs for Bad Bugs (ND4BB) program of the Innovative Medicines Initiative. Our local host is professor George Daikos, who opened the meeting with an overview of the epidemiology of antibiotic resistance in his country. Continue reading
CPE transmission: modes and modulators
I was asked to do a talk today on the modes of CPE transmission at a PHE Workshop on tackling CPE. It caused me to do a lot of thinking and write a new presentation, so I thought I’d share. You can download the slides here.
CPE guidelines galore: ECDC and ACSQH join the party
I recently posted on the WHO CPE guidelines. A couple of people have alerted me to two other recently published guidelines, one from ECDC, and the other from Australian Commission on Safety and Quality in Healthcare. So, we now have a wealth of guidelines to prevent and control CPE. But how to they compare?
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
WHO guidelines for the prevention and control of carbapenem-resistant organisms
WHO have just released some guidelines for the prevention and control of carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aerugionsa. This guideline builds on the excellent WHO core components for IPC guidelines.
Mutational colistin resistance in CPE is the clear and present danger, not plasmid-mediated mcr genes
There has been a lot of concern in scientific journals and the mainstream media about colistin resistance in Enterobacteriaceae caused by plasmid-mediated resistance genes (the mcr genes). However, an article published today by our group suggests that mutational colistin resistance rather than plasmid-mediated mcr genes is a more pressing clinical threat.
Counting the cost of CPE Mk II
Earlier this year, CMI published our article on the cost of a CPE outbreak in London, which cost 1.1m (Euros) over 10 months. EID have recently published a similar article, reporting a 0.6m (Euro) outbreak of CPE in the Netherlands.
Looking back on a CPE plasmid attack in the Northwest of England
A genomic study of 44 isolates of CPE from various species identified between 2008 and 2010, mainly from the Northwest of England, has concluded that plasmids played a key role in the early dissemination of CPE.
Reflections on Infection Prevention and Control 