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

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

Preventing S. aureus SSI: Who does what? (part 2)

A month ago I blogged on the practices of pre-operative (or better peri-operative) treatment of nasal S. aureus carriage to prevent S. aureus surgical site infection (SSI) in orthopaedic or cardiothoracic surgery patients. The issue brought forward was that a “treat-all” (thus “screen none”) strategy is more feasible, more effective and cheaper than the “screen & treat” strategy. The latter strategy, is associated with less mupirocin exposure and thus less selective pressure for mupirocin-resistance genes. There was a poll with 2 questions. What is your current practice for patients undergoing orthopaedic or cardiothoracic surgery and what do you think the strategy should be, with 3 options for each question; “do nothing”, “screen & treat”, or “treat all”. Today the results. Continue reading

When quality improvement fails

In this weeks’ PhD journal club Darren Troeman discussed the paper “Effect of a multifaceted educational intervention for anti-infectious measures on sepsis mortality: a cluster randomized trial”.  The plan was to improve compliance with guidelines, thereby reducing time before start of antimicrobial therapy (AT) which should reduce 28-day mortality. The intervention was compared to conventional medical education. Disappointingly, the trial provided more lessons for trialists than for healthcare providers. Continue reading

The antibiotic course has had its day? (part 2)

British colleagues found no scientific evidence for “completing your course of antibiotics”. Nothing new, but in the absence of competing news (the White House has become a daily soap) they opened Pandoras’ box for the lay press, with patients being recommended to stop their antibiotics, whenever they want. The birth of yet another inconvenient truth, as we cannot translate our knowledge into daily medical practice, and patients get even more confused. The good news: a new research agenda. Continue reading

HAP: In the ‘too difficult box’?

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User:KGH at Wikimedia Commons

I’ve had an enjoyable time at ICPIC. Sessions (abstracts here) have been great, speakers excellent, meeting well-organised but one session rattled my cage. Point prevalence surveys (PPS) and their value was an interesting session, however at the end of it I was wondering whether this was ‘Surveillance in action’ or ‘Surveillance inaction’. Continue reading

The Big C

Screen Shot 2017-06-12 at 13.42.20I’ve blogged before about compliance. It’s a big thing for me. If I had a pound (actually after the last week, if I had a dollar) for every time that I think I’ve implemented some intervention to find after a while that it has not been embedded I’d be on a yacht in the Med. But I’m not, instead I’m reading the very nice meta-analysis of the effectiveness of bundles in preventing CLABSI recently published in the Lancet ID. Ok, so the conclusion is that bundles work, but it’s not that which interested me, as a glance at the figures made me consider whether we should move on from effectiveness to implementation. Continue reading