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?”
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
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
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
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 old dogma to “always complete your antibiotic course” has been challenged recently, see BMJ and previous blogs. Is it safe to tell patients to stop whenever they feel better? Purely by coincidence this paper appeared, and was discussed in our PhD’s Journal Club. The paper’s title was Individualizing duration of antibiotic therapy in community-acquired pneumonia (CAP), and the students were surprised by the final result, reports Valentijn Schweitzer. Continue reading
With this blog I am leaving my beaten path: neonatal sepsis and probiotics. But so does this double-blind placebo-controlled study published today in Nature. To me, probiotics are still “something promising since 25 years”, without ever having substantiated that promise (like Ajax and the Chicago Cubs, until recently). In fact, colleagues of mine once led a study in which probiotics apparently killed patients with acute pancreatitis. This new study may change my view completely.