Each week our PhD students have their own Journal Club. Apparently they recently developed an interest in http://www.reflectionsipc and asked whether I was interested in getting their input. What a great idea, I thought, and here is the first one. Josephine van Dongen discussed a Scientific Reports paper on acute gastroenteritis (AGE) due to rotavirus. A global burden among children, but it can be prevented effectively by vaccination (still not recommended in our country!). Rotavirus discriminates: if your genes encode your cells to have a “secretor status” or being “Lewis positive” your infection risk increases (there even is a meta-analysis, for those still in doubt). And you are more likely to have these genotypes (at least secretor) if you’re Asian. Whether genotypes also predispose for more severe infection is unknown, and that’s what the study was about. Continue reading
With this blog I am leaving my beaten path: neonatal sepsis and probiotics. But so does this double-blind placebo-controlled study published today in Nature. To me, probiotics are still “something promising since 25 years”, without ever having substantiated that promise (like Ajax and the Chicago Cubs, until recently). In fact, colleagues of mine once led a study in which probiotics apparently killed patients with acute pancreatitis. This new study may change my view completely.
As a young and angry PhD student I was confronted with the concept of Selective Digestive Decontamination (SDD). That was in the early nineties (previous millennium). Coming from the field of microbiology I expected that SDD would increase antibiotic resistance. It were intensivists that told me not to worry: “antibiotics in SDD kill bacteria and dead bacteria cannot mutate”. They may have been right, suggests a new study. Continue reading
Six weeks ago I blogged on the exposure of Dutch clinical microbiologists by Marcel Levi, former boss of the Academic Medical Center in Amsterdam and now leading 5 academic centers in London. Apart from describing his new “totally resistance-free” work situation, he criticized the microbiologists in both countries for “not attempting to change the money-wasting and empty-brain practice of microbiological diagnostics”. Unfortunately, Marcel Levi is not just “another person” with an opinion. So, here are four suggestions to change his opinion, before all microbiologists have been sacked. Continue reading
Yet another meta-analysis telling us that we are doing something very valuable: antibiotic stewardship (AS). Nobody wants to (or should) question that good AS is important for our patients, just as hand hygiene, being sober when working and following the latest professional developments. How nice would it be if we could reliably quantify the effects of our good practice. One study is no study (say those that usually don’t perform studies), so the meta-analysis was invented. But what is told by a meta-analysis? Continue reading
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.