Predicting colonisation with antibiotic-resistant bacteria at the time of hospital admission

A systematic review and meta-analysis identify 22 studies that used various methods to predict colonisation with antibiotic-resistant bacteria at the time of hospital admission. The models were chosen to focus on MRSA and CPO colonisation. The “performance” of these tools varied widely, with a sensitivity of 15–100% and specificity of 46–98.6% for MRSA, and sensitivity of 30–81.3% and specificity of 79.8–99.9% for CPO. I think my main take-away from this that simple risk tools for predicting colonisation with MRSA and CPO (which are often used to determine who to test) are pretty blunt instruments. However, the more advanced tools making use of big datasets and machine learning can take us forward in predicting the risk of MRSA and CPO colonisation at the time of admission.

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How often does colonization precede infection with MDR-GNB and VRE?

Ever found yourself wondering how often colonization precedes infection with MDR-GNB and VRE? A new systematic review and meta-regression in Lancet ID gives us a pretty solid answer: about 14% of MDR-GNB and 8% for VRE. This information is helpful for us to qualify the significance of acquiring these organisms in healthcare settings.

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Does chlorhexidine mouthwash kill patients?

You may think so, with this title: “Oral mucositis as a pathway for fatal outcome among critically ill patients exposed to chlorhexidine (CHX)”, with the conclusion that the “data points to oral mucositis as the main pathway for the association between CHX exposure and enhanced in-hospital mortality.” The research letter is a post hoc analysis of a randomized clinical trial. Time to stop using CHX mouthwash? Or time to stop building strong stories on weak data? Continue reading

Ethnicity and infection: avoiding spurious associations

I’ve been meaning to blog on this editorial about ethnicity as a risk factor (or not!) for infection by Prof Leibovici in Clinical Microbiology and Infection for a while. The basic story is that “ethnicity” often falls out as associated with infection-related variables (e.g. colonisation or infection with resistant bacteria), but the editorial poses an important question: it is actually ethnicity, or something co-correlated with ethnicity (e.g. socio-economic status) that is the causal risk factor?

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On the origin of multidrug-resistant Gram-negative bacteria (MDR-GNB)

The colour of the global crisis of antibiotic resistance is red (if te Gram stain is your reference). In rich countries we have ESBL-producing Enterobacterales (mainly E. coli), but the real problem are carbapenemase-producing strains (Klebsiella, Pseudomonas and Acinetobacter) that are already endemic in lower and middle-income countries. The unanswered question is “where did these resistant bacteria come from”? Animals or bathrooms? Continue reading

An empty gut before surgery?

We Dutch, we love gut decontamination. Not only in critically ill patients, but also in those undergoing elective colorectal  surgery. A decontaminated gut is a safe gut, and that feeling was based on data from Dutch studies. A new study from Finland, published in Lancet, now questions whether our gut feeling was correct. Continue reading

The continuous need of outcome data of continuous beta-lactam infusion (or not?)

When I received this invitation for a PRO-CON, I accepted within 1 minute. Only later to realize that it was on “Optimised dosing according to PK/PD principles in patients – does it improve the efficacy of antibiotics?” Luckily I was given the CON, but I was in a poor position upfront: In a twitter poll 93% of voters were PRO (bias not excluded) and my opponent was Jason Roberts. So, this was my line of reasoning: Continue reading

From crowded house to ESBL-free house

A few weeks ago, Jon Otter blogged about a novel risk factor for ESBL Enterobacterales (ESBL-E) carriage, a “crowded house”, based on his work recently published in CMI: among 1,633 subjects in the catchment area of South-East London a crowded house, was associated with ESBL-E carriage, with an odds ratio of 1.5 (95% CI 1.1-2.2). Jon hinted towards future community-based interventions to reduce ESBL-E carriage and his blog naturally reached our research meeting. Continue reading

What urine can tell you

Urine should not be seen as a useless excretion product. Doping experts know, as do clinical microbiologists. In two recently published studies zillions of urine cultures were drained from computer systems and linked to primary care data, yielding very interesting findings. One study from Israel quantified the effects of direct and indirect fluoroquinolone use on antibiotic resistance in E. coli, see also our comments to that study. The second comes from the UK, the country that has an ambition to reduce Gram-negative bacterial bloodstream infection rates by 50%, because of increasing BSI rates. This study may provide both the reason for the problem and the direction to meet that ambition. Continue reading

“Why Dutch hospitals are so good at beating superbugs”

It is with great pleasure that I ask your attention for this article that appeared in the Economist. Yes, we still have low resistance rates in our hospitals and if you’re interested in how that happened, read it. The prosaic composition contains two parts; a very realistic thriller-like opening, followed by a second part with a rather unrealistic explanation. Both parts are separated by a short sentence of absolute nonsense. Time for a review. Continue reading