The winner takes it all  for S. aureus

As usual, some of the most interesting presentations at ECCMID were in the late-breakers “clinical trials” session. Four of 5 presentations were on treatment or prevention of S. aureus infection, the other one on oral treatment in patients with refractory fungal disease. With all respect to fungi, the meat was in the aureus, with nothing less than a Shakespearian tragedy. Continue reading

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The continuous need of outcome data of continuous beta-lactam infusion (or not?)

When I received this invitation for a PRO-CON, I accepted within 1 minute. Only later to realize that it was on “Optimised dosing according to PK/PD principles in patients – does it improve the efficacy of antibiotics?” Luckily I was given the CON, but I was in a poor position upfront: In a twitter poll 93% of voters were PRO (bias not excluded) and my opponent was Jason Roberts. So, this was my line of reasoning: Continue reading

That sinking feeling

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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.

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Using qualitative methods to understand determinants of antibiotic prescribing

A couple of new studies provide insight into determinants of antibiotic prescribing using qualitative methodology. A systematic review in the Journal of Hospital Infection highlights the tension between the immediate need of the sick patient (“give ‘em broad spectrum antibiotics and keep ‘em on them for as long as I can get away with” [my caricature]) and the societal needs related to AMR (“we need to balance the individual needs of the patient with the bigger picture of AMR” [again, my caricature]). Also, a clever study by Esmita Charani and colleagues from Imperial College London provides new insight into antibiotic prescribing practice by “going native” and joining ward rounds – effectively becoming a fly on the wall to understand poor antibiotic prescribing practice. The study identified a contrast between antibiotic prescribing in Medicine, where decisions were generally multidisciplinary and policy-informed, and Surgery, where decisions were often ‘defensive’, resulting in prolonged and inappropriate antibiotic use.

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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

Preventing infection to tackle AMR

We’ve been blogging for a while about the need to prevent infection to tackle AMR – and am really pleased to see that this idea is central to various AMR long-term strategies (e.g. the 5 and 20 year UK AMR strategies). So I endorse wholeheartedly this new poster from IPS promoting messages aimed at healthcare professionals around preventing infection to reduce AMR.

Mcr-1 plasmid-mediated colistin resistance genes in environmental Enterobacteriaceae

An interesting new Italian study has identified the mcr-1 gene, a plasmid-mediated colistin resistance gene, in 8% of environmental Enterobacteriaceae isolates. This suggests that environmental Enterobacteriaceae and perhaps even environmental surfaces themselves could be important reservoirs in the spread of mcr-1 and colistin resistance.

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