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
Now online in Lancet ID an impressive and important retrospective study describing the faith of 437 patients with BSI caused by carbapenamase-producing Enterobacteriaceae (CPE). When scanning the conclusions of your weekly diarrhea of new papers (as I do) this one might have escaped your attention: (in short) “Appropriate therapy is good. Combination therapy too. Patients with BSIs due to CPE should receive active therapy.” Yet, there is much more interesting stuff in this paper. Continue reading
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
Most of those casting their vote supported Martin’s (somewhat pessimistic) view that we can’t halve Gram-negative BSI by 2021 (see the figure, below). Let me first give you my own, unspoiled opinion (written before the results of this survey were known). I was intending to vote for option 3 (the English can’t, the Dutch might) but I am not even sure of that; actually, I believe that neither the English nor the Dutch can.
We’ll be publishing the results of the vote on whether or not we can halve HA-GNBSI by 2021 later this week. Right now, it looks like Martin is heading for a comfortable, if somewhat depressing victory (“No, we can’t halve GNBSI by 2021”) but there’s still time to ride a wave of positivity and vote with me that “Yes, we can halve GNBSI by 2021”. So, I thought that now would be an appropriate time to review the recent JHI paper that both Martin and I referred to, providing some enhanced epidemiological data on E. coli BSIs in England.
The UK government has recently announced their ambition to halve the rate of Gram-negative BSIs by 2021. Looking at the latest mandatory reporting dataset (see Figure 1 below), you can see why. Impressive reductions in MRSA BSI and C. difficile, but a notable increase in E. coli BSI. And this combined this with worrying data around increased antimicrobial resistance in Gram-negative bacteria from the ESPAUR report. In this post, Martin Kiernan and Jon Otter present both sides of the argument as to whether Gram-negative BSIs can be reduced by 2021, with comment from Andreas Voss and Marc Bonten! And you get to vote on which side of the argument you come down on after reading the arguments. Let battle commence…
My previous blog on “mcr-1 and the end of the world” evoked responses on the important effects of colistin resistance on patient outcome, referring to a new study in CID with the following abstract closure: “Importantly, mortality was increased in patients with colistin-resistant isolates.” The wording is correct, but I’m afraid that it will be interpreted incorrectly. Continue reading