Chinese carbapenamases: Fly like an eagle

I blogged on mcr-1 (colistin resistance) in China last week, to share the latest reassuring data. Well, the paper on which todays’ blog is printed will be used to wrap tomorrows’ market fish (typical Dutch expression). Nicolle Stoesser (Oxford) send me the latest news, coming from a Nature Microbiology study providing evidence for the potential of spread of carbapenamases by flies and birds. Not reassuring at all, and potentially with major consequences. Continue reading

Colistin resistance and mortality

 

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

Mcr-1 and the end of the world

If you read this, you may well be concerned about antibiotic resistance and consider reducing the burden of disease caused by AMR as one of your professional goals. Broad attention helps us to fight the problem: it creates awareness and funds for research. So, how do we cope with data that may jeopardize these ambitions (raising awareness fort he problem AMR)? Here is the eaxmple of mcr-1. Continue reading

CPE Thrill-seeking

Yesterday I attended a meeting at the Wellcome headquarters in the middle of London. I deliberately exposed myself to several risks: by car from home to Schiphol, by plane to London City and by public transport to the meeting. Each transition harbors a quantifiable risk of ending up in a hospital (accidents, assaults, cardiac events) where there is a quantifiable risk of developing HAI, and I am especially afraid of CPE.

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Reducing Gram-negative BSI…by accident

E_choli_Gram

We have precious little data on what works to prevent the transmission of MDR-GNR. An interesting article published recently in CID provides invaluable data that an infection control programme aimed at reducing MRSA (and succeeding) was also effective in reducing GNR BSI!

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Preventing UTI: Could probiotics help?

24142960319_9117fccedc_zA study protocol has caught my eye this week, a trial of oral probiotics vs placebo as prophylaxis for UTI in spinal cord patients, a very high risk group for these infections and  associated complications. It will be a multi-site randomised double-blind double-dummy placebo-controlled factorial design study running over 24 weeks conducted in New South Wales, Australia. Probably about as robust as it gets scientifically. Continue reading

UK guidelines for the control of multidrug-resistant Gram-negative bacteria

amr wiki

The UK guidelines for the prevention and control of multidrug-resistant Gram-negative bacteria (MDR-GNB) are published this week. It’s useful that the publication of these guidelines coincides with Antibiotic Awareness Week because MDR-GNB are brining us ever closer to the end of antibiotics. Although the guidelines don’t cover the treatment of MDR-GNB (this will be addressed in a forthcoming guideline), these highly resistant MDR-GNB leave few therapeutic options. Even when they remain susceptible to some antibiotics, these antibiotics are not front-line antibiotics for a reason (including poor tissue penetration and side effects). Furthermore, we are already seeing resistance to last-line (aka end of the golden-antibiotic-road) antibiotics e.g. colistin. Therefore, the old adage that ‘prevention is better than cure’ has never been so true!

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