The reality of AMR in Greece

This week I attend the general assembly of COMBACTE, this year in Athens. COMBACTE stands for COMBatting AntibiotiC resistance in Europe (www.combacte.com) and is part of the New Drugs for Bad Bugs (ND4BB) program of the Innovative Medicines Initiative. Our local host is professor George Daikos, who opened the meeting with an overview of the epidemiology of antibiotic resistance in his country. Continue reading

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Preventing S. aureus SSI: Who does what? (part 2)

A month ago I blogged on the practices of pre-operative (or better peri-operative) treatment of nasal S. aureus carriage to prevent S. aureus surgical site infection (SSI) in orthopaedic or cardiothoracic surgery patients. The issue brought forward was that a “treat-all” (thus “screen none”) strategy is more feasible, more effective and cheaper than the “screen & treat” strategy. The latter strategy, is associated with less mupirocin exposure and thus less selective pressure for mupirocin-resistance genes. There was a poll with 2 questions. What is your current practice for patients undergoing orthopaedic or cardiothoracic surgery and what do you think the strategy should be, with 3 options for each question; “do nothing”, “screen & treat”, or “treat all”. Today the results. Continue reading

Preventing S. aureus SSI: Who does what?

Pre-operative (or better peri-operative) treatment of nasal S. aureus carriage is one of the most – if not the most – effective infection prevention measure. A large double-blind randomized controlled trial convincingly confirmed the meta-analysis results of previously performed smaller studies: 5 days of nasal mupirocin ointment together with chlorhexidine showering reduced the incidence of deep-seated S. aureus surgicial site infection (SSI) with 80% among S. aureus carriers undergoing orthopaedic or cardiothoracic surgery. Eight years after publication of these findings I (and others) still have the feeling that many hospitals have not implemented this measure. 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 Not yet peer-reviewed, but still very impressive.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

The Extended Study on Prevalence of Infection in Intensive Care (EPIC III)

On the World Sepsis Day, September 13, 2017, The Extended Study on Prevalence of Infection in Intensive Care (EPIC III) will be performed. EPIC III  is a 24-hour point-prevalence study that will collect data on demographics, infection management, degree of organ dysfunction and patient outcomes in ICUs around the world. The EPIC study was performed in 1992 and EPIC II in 2007. Every ICU can join the project and participation will provide a nice opportunity for data comparison between ICUs, countries and continents.

EPIC III will be observational and non-interventional, and patient data will be anonymous. Data collection will be limited to simple variables that are easy to collect and routinely recorded. Data will be recorded using electronic case report forms (eCRF) (paper versions can be provided if online access is problematic or not available). In each country a coordinating center has obtained ethical approval fort he study, and participation will, therefore, only require informing your ethical committee according to local requirements.

The first EPIC study (the E stood for European) was performed in 1,417 ICUs in 17 countries in Western Europe that enrolled 10,038 patients. The EPIC II study (with the E from Extended) had 13,796 adult patients in 1,265 participating ICUs from 75 countries on the study day. Interested? Contact the study team at this page.

How to predict ESBL (part 3)

Six weeks ago I introduced the ESBL-predict study that Tim Deelen from our group coordinates. Every hospital in the world can participate through a user-friendly electronic CRF (in a secured environment). My blog-invitation to particpate worked and some sites already started. In June >1,000 episodes were entered! Here is a short update and info for those that want to join.  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.

Continue reading