The colour of the global crisis of antibiotic resistance is red (if te Gram stain is your reference). In rich countries we have ESBL-producing Enterobacterales (mainly E. coli), but the real problem are carbapenemase-producing strains (Klebsiella, Pseudomonas and Acinetobacter) that are already endemic in lower and middle-income countries. The unanswered question is “where did these resistant bacteria come from”? Animals or bathrooms? Continue reading
MDR-GNR
The infinite trio from South Africa
Last week I had the pleasure of attending the 8th FIDSSA Congress in Johannesburg (Federation of Infectious Diseases Societies of Southern Africa). I was invited to talk on infection control in the Netherlands, SDD and empiric antibiotic strategies in ICU. I never felt more distance between my habitat and that of my hosts. It surpassed the 3732 miles in the air. I learned a lot; from how it is to go into military conflict areas to identify Ebola cases, fighting a cholera outbreak after a tropical cyclone in Mozambique to the infinite trio, which stands for carbapenem resistant Klebsiella, Pseudomonas and Acinetobacter. Continue reading
A pore way of dying (for MDR-GNB)
The lack of new antibiotics for Gram-negative bacteria is one of the cornerstones of the global crisis of antibiotic resistance. The quest is finding a molecule with antibacterial activity that can pass the double-layered cell wall and that manages to remain in the cell long enough to kill. New lab-based studies suggest that such antibiotics may already exist, and that the solution to activate them is widely available, and for free. As these findings were published in not-so-well-known-and-hardly-read journals for clinicians, such as EMBO journal and Scientific Reports, here follows the summary for dummies (written by a dummy). Continue reading
The war against CPE
An interesting publication on the control of CPE last week. Not in Nature, Science of Journal of Hospital Infection, but in the “Staatsblad van het Koninkrijk der Nederlanden”. The paper, “Besluit van 26 april 2019, houdende aanpassing van het Besluit publieke gezondheid vanwege een meldingsplicht voor Carbapenemaseproducerende Enterobacteriaceae”, with King Willem-Alexander as first author, implies that on April 26th it was decided that from July 1st 2019 on, by law, all CPE detected in the Netherlands must be notified, see. A next step in our war against CPE.
That sinking feeling
I’m at ECCMID in Amsterdam currently listening to a nice report of an OXA-48 Klebsiella pneumoniae outbreak in Gran Canaria in which sinks were found to be contaminated and replaced. Earlier today I listened to a nice paper on how sinks that drain slowly are more likely to contaminate the local environment for up to 1 metre from Paz Aranega Bou who, together with Ginny Moore and other colleagues has published this nice paper . So many papers on sinks now and I do wonder if we have lost sight of what they do and what they really are.
From crowded house to ESBL-free house
A few weeks ago, Jon Otter blogged about a novel risk factor for ESBL Enterobacterales (ESBL-E) carriage, a “crowded house”, based on his work recently published in CMI: among 1,633 subjects in the catchment area of South-East London a crowded house, was associated with ESBL-E carriage, with an odds ratio of 1.5 (95% CI 1.1-2.2). Jon hinted towards future community-based interventions to reduce ESBL-E carriage and his blog naturally reached our research meeting. Continue reading
AMR deaths in Europe (part 2)
“33000 people die every year due to infections with antibiotic-resistant bacteria” this is what ECDC released on Nov 6, 2018, on their website. “Superbugs kill 33,000 in Europe every year” said CNN and the same wording was used (in Dutch) by our Telegraaf. Naturally, the headings were based on the ECDC study published that day in Lancet ID, which happened to be the most downloaded paper ever of the journal. But was this really what was published? Valentijn Schweitzer and I got lost in translation when trying to answer that question. Continue reading
AMR deaths in Europe & America
Just before Christmas a follow-up on that what bothers us most: patients dying because of antibiotic resistance. I previously tried, see here, to disentangle from the ECDC study (33.000 deaths per year in Europe) how they got to 206 AMR casualties in the Netherlands and ended with a recommendation to not “focus too much on the absolute numbers as they may not be very precise.” With Valentijn Schweitzer I spent some more time in the 200 pages supplement, only to find out – in the end – that the Americans do these kind of studies much better. Continue reading
Fighting AMR: Close schools and use antibiotics
The global dynamics of antimicrobial resistance (AMR) are extremely complex, but we usually focus on the selective pressure created by antibiotic consumption and spread of resistant strains. The brave ones amongst us (or the ignorant) try to disentangle all the facets of global AMR dynamics, and even attempt to quantify the relative contribution of each of these factors. Well, some brave investigators tried to do just that and published their findings in Lancet Planet Health. Perfect Journal Club material. Continue reading
AMR deaths in Europe
“In case of an emergency check your own pulse first”, that’s one of the rules of the House of God. More than 33.000 deaths due to AMR in Europe per year, as reported yesterday, definitely is an emergency. Therefore, I tried to disentangle what that means for my small country that so vividly tried to keep these superbugs out of the country. Continue reading
Reflections on Infection Prevention and Control 