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
Science
Reflections IPC pre-ECCMID event
“How do we communicate our scientific results, beliefs and doubts to our peers, policy makers and the lay men?”
Posting blogs on Reflections on Infection Prevention and Control is a possibility. For the occasion of the ECCMID 2019 meeting in Amsterdam, the “Reflections on IPC blog team” and UMCU PhD students invite you to this pre-ECCMID event, on the Friday before ECCMID (April 12th) in Amsterdam.
We have a high-quality entertaining program and hope to meet you in a most pleasant atmosphere. Jop de Vrieze is a prominent Dutch science journalist with a great interest in infectious diseases. He writes for Science, de Groene Amsterdammer and Volkskrant, to name a few. Miquel Ekkelenkamp is a clinical microbiologist with a PhD in day-time, but at night he writes (real) novels and razor-sharp columns. Muge Cevik is an infectious diseases registrar from the United Kingdom, who worked on an analysis of all the tweets sent during the ECCMID 2018 conference in Madrid. Martin Kiernan, a Visiting Clinical Fellow at the Richard Wells Research Centre of the University of West London and distinguished IPC blog writer will present the top 10 reflections on IPC. And Rinze Benedictus from the UMC Utrecht will end the program with explaining the concepts of Science in Transition, an international movement to change several aspects of the current academic system, such as the pressure to publish as much as possible in journals with high impact factors, and where that all can lead to.
Now, since this all happens in the Netherlands we must obey to Dutch rules. One of them is that you need to sign up and pay €25,– AIOS/PhD and €45,–. for medical specialists. This is an evidence-based intervention to reduce the “no-show rate” from 80% (with free entrance) to at most 10%, and to prevent us ending the evening with loads of uneaten “bitterballen”. We can host about 70 guests!
Venue: Cafe Weesper, Weesperzijde 144, Amsterdam
18.00-19.00 Wellcome
19.00-19.20 Jop de Vrieze: Science and communication
19.20-19.40 Miquel Ekkelenkamp: the art of science
19.40-20.00 Muge Cevik: Science in tweets
20.00-20.30 Break with Dutch cuisine and drinks
20.30-20.50 Martin Kiernan: The Top Ten Reflections on IPC
20.50-21.15 Rinze Bendictus: Science in Transition
Happy gathering. Hope to see you there.
You can sign in here: https://webshop.umcutrecht.nl/umcutrecht/nl/Products.aspx
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
The end of investigator-initiated research?
The beauty of ECCMID is the abundance of investigator-initiated studies being presented. The cruelty is that the logistical nightmares that each presenter has gone through to get that study approved and done, cannot be reflected in a 10-minute oral or on a poster. The good news, though, is that that will change: the EU directive 536/2014 will make everything much easier and faster, in order “to let more European patients benefit from recent scientific achievements”. True? …. or does it reduce investigator-suffering by just killing any investigator-initiated study initiative? Continue reading
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
The future of infection surveillance is ….. Google
If you feel that your hospitals’ Electronic Health Record (EHR) can do more for you, read this. Not yet peer-reviewed, but still very impressive. Using all 46 billion (!) data points in the EHR from 216.221 patients in 2 hospitals they predicted (at day 1 of admission) in-hospital mortality, long length of stay and readmission, pretty accurately, and much better than existing prediction models. How? Deep learning techniques. Who are they? The paper has 35 authors, of which 32 work at Google Inc, Mountain View, California. 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?”
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
From collateral damage to collateral sensitivity
“Every disadvantage has an advantage” is one of the many brilliant quotes from the late Dutch philosopher Johan Cruijff. This now also seems to hold for antibiotic resistance. The conventional belief is that resistance development is unidirectional: pathogens cumulatively acquire resistance traits, until being a multidrug resistant superbug. This now seems not always true; resistance development to antibiotic A, may – at the same time – increase susceptibility to antibiotic B, a phenomenon called “collateral sensitivity” that may help us in treating chronic infections. Continue reading
What’s up for 2018?
I hope you enjoyed Christmas time and wish you all the best for this year. From my side, I will continue to reflect what I meet professionally, what surprises me, confirms what I thought to know or what confirms my ignorance. In 2017 I did that 41 times (a surprise to me!) and here are some trending topics that will most likely return in 2018. Continue reading
Reflections on Infection Prevention and Control 