How to predict ESBL (part 4)

Two months ago I provided an update on the ESBL-predict study that Tim Deelen from our group coordinates. In short: Every hospital in the world can participate, through a user-friendly electronic CRF (in a secured environment), in the validation of 2 scoring systems to predict that sepsis is caused by ESBL-producing bacteria. Only relevant for those of us that are not yet ready to start meropenem/amikacine for every patient that starts with antibiotics! This tool may help, …. if reliable. We passed the 3,000 episodes! Here is a short update and info for those that want to join. Continue reading

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Houston, we have a problem

While the world was watching the Texas water ballet with Melanie Trump on stiletto heels, about 1500 people died in South-East Asia because of floodings. And while the western world is searching for another irrelevant mcr-gene, Patrick Musicha soberly describes the true antibiotic resistance crisis in Malawi, see. It is becoming more and more obvious that antibiotic resistance will be the next plague for the least privileged on earth. Continue reading

How to predict ESBL (part 3)

Six weeks ago I introduced the ESBL-predict study that Tim Deelen from our group coordinates. Every hospital in the world can participate through a user-friendly electronic CRF (in a secured environment). My blog-invitation to particpate worked and some sites already started. In June >1,000 episodes were entered! Here is a short update and info for those that want to join.  Continue reading

Water, water everywhere (or nowhere?)

Karakum-Desert-Turkmenistan.-Author-David-Staney.-Licensed-under-the-Creative-Commons-AttributionA new paper by Hopman and colleagues (Andreas is also another author but is being modest) has evaluated the effect of removing sinks from the ICU. The trigger for this intervention was an outbreak caused by an ESBL-Enterobacter that could be related to contaminated sinks. The study looked at what happens if you remove all water sources from the ICU, and all water-related activities were migrated to a tap water-free solution. Continue reading

How to predict ESBL BSI (part 2)

A month ago (April 11) I blogged on the difficulties in predicting the presence of ESBL-producing bacteria as a cause of infection at the time antibiotics must be started. Wouter Rottier (PhD student) developed 2 prediction rules (for community-onset and hospital-onset infection), that seem to do better than current guideline recommendations (especially for reducing unnecessary carbapenem use). Another PhD student (Tim Deelen) now wants to validate these rules, globally. The “crowd-funding study approach” worked and sites across the world joined us…. Continue reading

How to predict ESBL bloodstream infection?

Each day we prescribe antibiotics without knowing the specific cause of infection, yet. Some patients will have an infection caused by an ESBL-producing bug, and they would benefit from immediate treatment with a carbapenem or addition of an aminoglycoside. At the same time we don’t want to misuse carbapenems or hurt kidneys. Wouldn’t it be great if we could accurately predict who would need a carbapenem? Now you can. Continue reading

“Can I swab your rectum please?” ‘Pre-analytical’ factors skew prevalence studies

The analytical lab methods that we use to grow antibiotic-resistant bacteria make a big difference in terms of recovery. However, ‘pre-analytical’ factors are just as important in determining the sensitivity of prevalence studies. We are used to the idea of studies to work out the most sensitive anatomical site to sample for detecting colonisation with antibiotic-resistant bacteria. However, there are other ‘pre-analytical’ factors that may skew the findings of prevalence studies. A study from my old research group at KCL highlights how staff and patient choices, behaviours, and demographics can be pre-analytical factors that could skew prevalence studies.

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