An endless one-sided confidence in Pip-tazo?

This weeks’ publication of the highly controversial results of the MERINO trial in JAMA caused quite a stir on social media. The paper has been viewed >50,000 times and the unexpected outcome has been challenged by many. But what was the conclusion in JAMA? “Among patients with E. coli or K. pneumoniae bloodstream infection (BSI) and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a non-inferior 30-day mortality.” Not and  in the same sentence, a doubled denial, is confusing. More important, as formulated, the study was inconclusive, which nobody seems to accept. We dived into the depths of the reporting and then tried to explain it. Continue reading

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How to predict ESBL (part 5)

A brief update on the ESBL predict study, after the last update  from 6 months ago. Tim Deelen from our group is still running the show and we are still seeking hospitals for participation. It’s for free, it’s easy, relevant and fun! We passed the 5,500 episodes and we learn a lot, including how countries deal with the ethical aspects of this study. Continue reading

Where does your ESBL come from?

Last Friday the results of the ESBL Attribution study (ESBLAT) were presented. After considerable media attention for ESBL-producing bacteria on our meat (especially retail chicken meat) and a 84-year old woman being “the first deadly victim of the new chicken-ESBL bacterium” a research consortium was asked to quantify the role of ESBL in animal industry for human health. The “research lab” was the Netherlands: one of the most densely populated countries in the world for both humans and animals, with the highest antibiotic use in the world for animals and the lowest for humans. If anywhere, zoonotic transmission should happen there! Continue reading

What’s up for 2018?

I hope you enjoyed Christmas time and wish you all the best for this year. From my side, I will continue to reflect what I meet professionally, what surprises me, confirms what I thought to know or what confirms my ignorance. In 2017 I did that 41 times (a surprise to me!) and here are some trending topics that will most likely return in 2018. Continue reading

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

What about E. coli ST131?

One of the faces of the global antibiotic resistance crisis is Escherichia coli ST131, frequently portrayed as a pandemic clone, combining hypervirulence, ciprofloxacin resistance and ESBL production. A recent study in Genome Research, a journal you may not read every month, though, sheds a whole new light on this “superbug”. Continue reading

No more antibiotics for animals

That’s what the WHO stated this week, and it was based on a study, in Lancet Planetary Health. In most news items that I saw animal antibiotic use was directly linked to human infections caused by antibiotic resistant bacteria. A journalist even asked if eating meat was safe. Although most of us (including me) support reduction of unnecessary antibiotic use, it’s worth reading this excellent meta-analysis, initiated by WHO. Did this study answer the burning research question “to what extent does animal antibiotic use influence infections in humans?“ Continue reading