The antibiotic resistance crisis resolved by bacteriophages (part 3)

Last October Dutch people were “informed” about the potential of bacteriophages. In short, “bacteriophages work where antibiotics fail because of resistance in critically ill patients, something that is already known for 100 years, and that is neglected by modern medicine”. Some questions were raised, see here and here, but curretly Dutch physicians receive many/daily requests from patients on phage therapy and the most desperate patients pay thousands of euros to seek help abroad, without reimbursement from health insurance. Last week, we had invited the most experienced clinical experts and scientists acting at the cutting edge of preclinical bacteriophage research. Here is my impression of the clinical part. Continue reading


Preventing S. aureus SSI: Who does what?

Pre-operative (or better peri-operative) treatment of nasal S. aureus carriage is one of the most – if not the most – effective infection prevention measure. A large double-blind randomized controlled trial convincingly confirmed the meta-analysis results of previously performed smaller studies: 5 days of nasal mupirocin ointment together with chlorhexidine showering reduced the incidence of deep-seated S. aureus surgicial site infection (SSI) with 80% among S. aureus carriers undergoing orthopaedic or cardiothoracic surgery. Eight years after publication of these findings I (and others) still have the feeling that many hospitals have not implemented this measure. Continue reading

All models are wrong…..

Yesterday, our study on antibiotic cycling strategies in ICUs was published. Thanks to Joppe van Duijn, involved in all study phases, we could report that in 8 ICUs in 5 countries with 8,776 patients the unit-wide prevalence of antibiotic resistance was similar when cycling antibiotics every 6 weeks or when cycling antibiotics for every next patient treated (mixing). The study was motivated by prior mathematical models, of which most predicted that cycling would do better. So, now all can raise their voices: (1) “all models are wrong, but some are useful”; (2) “most studies are wrong, but some are useful”; or (3) “if model predictions are not confirmed, where did the study go wrong?”

Continue reading


Test-negative design: the best study design ever?

To kick off the 2018 Journal Club our PhD students discussed a bewildering new trial design* to determine vaccine effectiveness (VE) published in Lancet ID, from which Meri Varkila reports.  The classical approach to quantify VE was to spend the best 5 years of your life to find 2,000 general practitioners, to invite 600,000 elderly to randomize 85.000 and to find 139 primary endpoints in 57 hospitals while all involved remain blinded. This new approach, called the test-negative design (TND) study would give you that number in a year, by just studying a few hundred patients with community-acquired pneumonia. A true Quality-of-Life enhancer for many…., if reliable. 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


The antibiotic resistance crisis resolved by bacteriophages (part 2)

Earlier this week I blogged on the potential (yet poorly proven) effects of bacteriophages as salvage therapy for infections caused by AMR, and stated: “Phages and their active enzymes are proteins that evoke an immunological host response when injected, and up till now all attempts to circumvene those unwanted effects have failed.” Two recent case reports challenge part of that statement. 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