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

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An empty gut before surgery?

We Dutch, we love gut decontamination. Not only in critically ill patients, but also in those undergoing elective colorectal  surgery. A decontaminated gut is a safe gut, and that feeling was based on data from Dutch studies. A new study from Finland, published in Lancet, now questions whether our gut feeling was correct. Continue reading

Summer break – don’t go near the water?

I trust you are enjoying a well-deserved summer break or packing your bags to take off. In case you missed this paper in the daily list of new ones on biorxiv, it tells you where to swim safely and where not. Elena Buelow, from Germany, a former PhD student in our lab in Utrecht and now post-doc in Limoges, France, reported. So, if you are floating quietly in a pittoresque small river and you see a hospital building on the hill near the next bend in the river, are you still in safe waters? Continue reading

How a bundle kills Cochrane – or not?

Nice paper this week in JAMA Internal Medicine. How to treat patients hospitalized with Community-Acquired Pneumonia (CAP)? Antibiotics, sure, but can you do more to improve outcome and shorten length of stay (LOS)? You could choose any of 4 evidence-based interventions, that, according to (Cochrane) meta-analyses, improve patient outcome. Or decide to include all 4 in a bundle, as the Australian investigators did. And then the bundle fails to provide benefit and increases harm. Valentijn Schweitzer and I tried to explain. Continue reading

How a bundle kills Cochrane – or not?

Nice paper this week in JAMA Internal Medicine. How to treat patients hospitalized with Community-Acquired Pneumonia (CAP)? Antibiotics, sure, but can you do more to improve outcome and shorten length of stay? You could choose any of 4 evidence-based interventions, that, according to (Cochrane) meta-analyses, improve patient outcome. Or decide to include all 4 in a bundle, as the Australian investigators did. And then the bundle fails to provide benefit and increases harm. Valentijn Schweitzer and I tried to explain. 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.

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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