Are alcohol gels doomed by resistant bacteria?

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

A high profile article was published earlier this year in Science Translational Medicine, suggesting that Enterococcus faecium can exhibit clinically relevant levels of tolerance to alcohol-based hand hygiene products. The article has generated a huge amount of press coverage and discussion amongst experts. So, I thought it was about time I gave the article a once over. My initial thought was this would be unhelpful extrapolation of low-level tolerance to alcohol gel that wouldn’t be meaningful in a clinical setting. But having read the paper, there’s genuine concern here. Overall though, if true resistance to alcohol gel was going to be a problem, I’m pretty sure it would have reared its ugly head already.

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What about E. coli ST131 (part 2); is it foodborne?

marcbonten Antibiotic resistance, antimicrobial resistance, Contamination, Epidemiology, ESBL, MDR-GNR, publication, Urinary Tract Infection, Whole genome sequencing

Last November I blogged on E. coli ST131, frequently portrayed as a pandemic clone, combining hypervirulence, ciprofloxacin resistance and ESBL production. The question is whether the undeniable high prevalence of this bug among clinical isolates results from its virulence and antibiotic resistance or whether it is just a reflection of carriage prevalence in the general population, without any relationship to virulence or resistance. Two recently published studies try to shed new light on the debate; one bringing in chicken retail meat as the source…… Continue reading →

The best IPC article of 2018: a blogoff with Brett Mitchell

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

In honour of Infection Prevention 2018, Brett Mitchell and I are having a blogoff so that you can choose the best IPC article of 2018. This post presents my case, Brett’s post (here) presents his case, and there’s a vote below so that you can choose. The results will be published next Monday morning at Infection Prevention 2018…

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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 →

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).