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.
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.
Addenbrookes hospital in Cambridge (UK) have recently performed a point prevalence survey for antibiotic resistant bacteria. None of 540 patient samples grew CPE, but 130 (24%) grew VRE. So, why no CPE but so much VRE?
Just in case you aren’t yet sick of 1980s pop culture references on this blog, here’s another: ESBL likes Crowded House! Our study of more than 4000 admissions to a London hospital group found that 9% of patients carried an ESBL, and living in an area where overcrowded housing was common was an ESBL risk factor.
Brett Mitchell and colleagues have just published the exciting findings of the Researching Effective Approaches to Cleaning in Hospitals (REACH) study in the Lancet Infectious Diseases, along with my editorial. This large 11-centre randomised intervention study found that a low-cost enhancement to environmental hygiene managed to significantly reduce VRE infections, but did not reduce S. aureus bacteraemia or C. difficile infections.
Urine should not be seen as a useless excretion product. Doping experts know, as do clinical microbiologists. In two recently published studies zillions of urine cultures were drained from computer systems and linked to primary care data, yielding very interesting findings. One study from Israel quantified the effects of direct and indirect fluoroquinolone use on antibiotic resistance in E. coli, see also our comments to that study. The second comes from the UK, the country that has an ambition to reduce Gram-negative bacterial bloodstream infection rates by 50%, because of increasing BSI rates. This study may provide both the reason for the problem and the direction to meet that ambition. Continue reading
A team of authors surveyed NHS acute hospitals in England to determine the approach to CPE detection, including laboratory methods. The findings provide an opportunity to compare the approach to CPE detection and prevalence nationally, identifying higher CPE prevalence in the North-West, North-East and the South-East (the region that includes London) of England. The findings also suggest that more screening for CPE would detect more carriers – and perhaps help to prevent a silent epidemic of CPE in some regions.
One of the questions that we often ask ourselves is whether carriers of CPE (and other MDR-GNR) can de-isolated. Most of the guidelines are pretty non-committal on this point due to lack of evidence. Some new guidelines from ESCMID-EUCIC address this issue head on. But, unfortunately, the answer is that de-isolation of CPE carriers, particularly over the course of a single hospitalisation, isn’t going to work because there’s no effective decolonisation method.
“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
Yesterday we had another episode on the miracles of bacteriophage therapy on Dutch television. In the show I asked our minister of Health to modify the Dutch law, in order to make scientific evaluation of this approach in patients possible. Yet, the reasons why we need this change were not broadcasted. As several patients explained how they had been treated across Europe, this must have bee confusing, people not understanding why I – the knucklehead – failed to do studies. Let me explain. Continue reading
Reflections on Infection Prevention and Control 