An endless one-sided confidence in Pip-tazo?

marcbonten Antibiotic resistance, antibiotic stewardship, antimicrobial resistance, ESBL, GNBSI, MDR-GNR, publication

This weeks’ publication of the highly controversial results of the MERINO trial in JAMA caused quite a stir on social media. The paper has been viewed >50,000 times and the unexpected outcome has been challenged by many. But what was the conclusion in JAMA? “Among patients with E. coli or K. pneumoniae bloodstream infection (BSI) and ceftriaxone resistance, definitive treatment with piperacillin-tazobactam compared with meropenem did not result in a non-inferior 30-day mortality.” Not and  in the same sentence, a doubled denial, is confusing. More important, as formulated, the study was inconclusive, which nobody seems to accept. We dived into the depths of the reporting and then tried to explain it. Continue reading →

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Hand hygiene edutainment via YouTube

Jon Otter (@jonotter) Hand hygiene , ,

We’re always seeking new and engaging ways to deliver IPC-related education. An interesting study in AJIC provides a useful framework to evaluate and assess the education content of YouTube videos aiming to deliver hand hygiene education.

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A POET with a sledgehammer

marcbonten antibiotic stewardship, publication

Imagine, the look on the face of that ambitious PhD student, each day screening six hospitals for patients with S. aureus endocarditis, opening the NEJM and seeing that the Danes randomized 400 patients with Infective endocarditis (IE). And then his supervisor rubbing in that these 400 all underwent two extra transoesphageal echocardiograms for study purposes, that there were zero losses to follow-up and telling him how many samples of blood were collected to analyze antibiotic concentrations. Luckily, he was scheduled for our Journal club, which allowed him to apply the “trias scientifica”. Continue reading →

Focusing on the role of nurses in environmental hygiene

Jon Otter (@jonotter) environmental hygiene , , , , , , , ,

I was asked to write a series of articles in the Nursing Times (along with my colleague and co-author Tracey Galletly) on the role of nurses in environmental hygiene*. Et voila:

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Gaming with non-inferiority in antibiotic stewardship

marcbonten antibiotic stewardship, Epidemiology, publication

An early switch from IV to oral treatment is one of the pillars of antibiotic stewardship. Oral antibiotics are mostly cheaper, hospital stay shortens and thus also the risk of healthcare-associated infections. One problem: before we change our current practice, we must demonstrate that the new strategy is safe. The best evidence comes from a non-inferiority trial. Yet, that usually implies enrolment of many patients. The solution to that problem: put on your poker face when drafting your sample size calculation and hope for the best. Our Danish colleagues show how.  Continue reading →

Must we screen for resistant bacteria?

marcbonten Uncategorized

This is a cry for help. In 2 weeks time I have a pro-con debate on the statement “screening for highly-resistant microorganisms is a must”. I face 2 problems: the organizers gave me the “PRO” position and my opponent is professor Andreas Voss.

We will be watched by a Dutch audience, so the bacteria involved are MRSA, VRE, anything resistant to carbapenems and ESBL-producing Gram-negatives, and I (and hopefully Andreas too) interpreted the question as “screening at the time of hospital admission”.

I am desperately seeking high-level scientific evidence supporting my allocated point. 

My question to the knowledgeable reflectionsipc readership is: What do you consider the single most convincing piece of evidence underpinning my case.

As in all good practice I will provide feedback (if I survive the battle).

I mean cleaning…no, disinfection…no, both. (What you mean is ”environmental hygiene”!)

Jon Otter (@jonotter) environmental hygiene , , , ,

I’ve been struggling for years to find the best ‘catch-all’ term to describe hospital cleaning or disinfection or both. And, after much thought, I’ve settled on a proposal to share with you, dear reader: “environmental hygiene”.

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