antibiotic resistance

Antibiotic surgical prophylaxis: stewardship’s ‘elephant in the room’?

Jon Otter (@jonotter) Antibiotic resistance , ,

Doxycycline_100mg_capsules

We are all pretty comfortable with the idea that we have used too many antibiotics in the past and now we are reaping the consequences. I think we are also all in agreement that we need to start using antibiotics much more rationally – and keep the big guns firmly on the top shelf, double-wrapped in password-protected packaging that you can only access with a fingerprint and retinal scan (whilst acknowledging that they will still somehow be prescribed by a junior doctor at 3am for a sniffle). But I get the feeling that we all have a bit of a blind spot (or soft spot) for surgical prophylaxis. Here, the situation is different, surely, because the consequence of an SSI is so great that the likely ‘cost’ of widespread surgical prophylaxis is outweighed by the gain of fewer SSIs? But has this become stewardship’s elephant in the room? We are comfortable talking about restricting carbapenem use in acute hospitals, but I don’t hear as much discussion about stopping the use of antibiotics for surgical prophylaxis! On one level, isn’t this is the same arguments as for ‘selective’ digestive or oral decontamination (SDD / SOD) in the ICU? Here, the argument in factor of SDD / SOD is compelling: fewer deaths and less spread of resistant bacteria. But indiscriminate use of antibiotics, which is bound to fuel antibiotic resistance in the long run, just cannot be a good idea, particularly in the high-risk ICU population.

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Which is more important? Antibiotic resistance or pyelonephritis?

Jon Otter (@jonotter) Antibiotic resistance , , ,

200 mg generic Ibuprofen from Safeway grocery store.

As we move inexorably towards the end of antibiotics, antibiotic-sparing approaches to the management of infectious diseases become more and more attractive. A study published recently in the BMJ compared the ‘symptomatic’ treatment of uncomplicated UTI in women in the community using ibuprofen with antibiotic treatment using fosfomycin.

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Could phages pre-programed for a “surgical strike” against antibiotic resistant bacteria be the ultimate microbiome-sparing surface disinfectant or skin sanitiser?

Jon Otter (@jonotter) Antibiotic resistance , , , , , ,

phage

It is becoming increasingly clear that a happy, healthy microbiome is fundamentally important to human health. Perturbation of the microbiome – especially in the gut – is responsible for C. difficile infection and probably many other diseases directly and indirectly linked to the gut. This has led to a move towards microbiome-sparing approaches to therapy. Faecal microbiota transplantation is one such approach, which happens to be spectacularly effective for treating recurrent CDI and may also be useful for decolonising carriers of resistant Gram-negative bacteria. A related approach is using a ‘competitive exclusion’ to reduce the level of contamination of hospital surface with hospital pathogens by seeding the surfaces with live Bacillus sp. spores. But wouldn’t it be great if there was a way to specifically target antibiotic-resistant bacteria and leave yourself with an antibiotic-susceptible population?

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Is it true that I have to finish my antibiotic treatment as prescribed?

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , ,

Schermafbeelding 2015-11-21 om 15.01.52

It is always the same. If I think that I had a reasonable idea and put it on-line, it will only take a day or two, until friends and colleagues let me know, that others had the same idea – just earlier. In this case, John Ferguson (@mdjkf), brought to my attention, that Professor Lyn Gilbert started the same discussion in Australia (Link). As always, I am depressed for about 5 seconds and start to come up with a new, old idea.

Despite the discussion in Down-under, I have promised to post the results of my questionnaire. On Twitter, some were surprised how little evidence exists to support antibiotic prescribing dogmas (Eli Perencevich, @eliowa), whereas others like Christina Vandenbroucke-Grauls (@ChristinaGrauls) believe that we have plenty of evidence from lab experiments and theory to answer the question. Most importantly, “every bit of antibiotic leads to resistance”.

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Transmissible colistin resistance – made in China

Jon Otter (@jonotter) Antibiotic resistance , , , ,

colistin made in china

The emergence of CPE (and carbapenem-resistance in other Gram-negative bacteria) has forced us to reach to the dusty old antibiotic shelf to revive the clinical use of older agents with activity against Gram-negative bacteria, principally colistin. Colistin isn’t perfect by any means – it has poor tissue penetration compared with the carbapenems, and is associated with nephrotoxicity (although the high levels of nephrotoxicity in the older medical literature has not been reported due to better management of the drug). Furthermore, resistance has already been reported. To date – this has been mutational resistance, which does not have the capacity to spread horizontally. It was only a matter of time before a colistin resistance gene mobilised.

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Antibiotic Awareness: background and links

Andreas Voss (@AVIPNL) Antibiotic resistance , , , , , , ,

European Survey of Carbapenemase-Producing Enterobacteriaceae (EuSCAPE) project

The EuSCAPE project aimed to improve understanding of the occurrence and spread of CPE. LINK

Schermafbeelding 2015-11-17 om 22.29.04.png

About European Antibiotic Awareness Day

European Antibiotic Awareness Day is a European health initiative coordinated by ECDC which aims to provide a platform and support for national campaigns on the prudent use of antibiotics. Each year across Europe, the European Antibiotic Awareness Day is marked by national campaigns on the prudent use of antibiotics during the week of 18 November. Prudent use means only using antibiotics when they are needed, with the correct dose, dosage intervals and duration of the course. Follow the European Antibiotic Awareness Day: #EAAD. http://antibiotic.ecdc.europa.eu

About World Antibiotic Awareness Week

The World Health Organization is leading a global campaign for the first World Antibiotic Awareness Week with the slogan “Antibiotics: Handle with Care”. The campaign calls on individuals, governments and health and agriculture professionals to take action to address this urgent health problem. The first World Antibiotic Awareness Week will take place on 16-22 November. Follow the World Antibiotic Awareness Week: #AntibioticResistance. www.who.int/drugresistance.
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The 30-Second-Questionnaire: Antibiotic Myth Buster

Andreas Voss (@AVIPNL) Antibiotic resistance, General , , ,

Schermafbeelding 2015-11-13 om 11.53.54

Here we are again, the year flew by and it’s time for Antibiotic Awareness Day/Week. This time around, I will spend my time in a call-center, answering questions of concerned citizens/ex-patients in Germany. Smart idea of a friend in the German public health service and probably smarter than doing what we usually do: organize a meeting, ask all our colleagues to come, and preach to our own community.

While I believe that there is no ID or Clin Micro person left that is not convinced of the importance of saving our miracle drugs (Australian campaign), I know that I will get questions I can’t answer, or at least, don’t know if my answers are truly true.

Here it goes, my antibiotic conundrum that could  be classified as “Antibiotic Myth”:

Is it true that I have to finish my antibiotic treatment as prescribed?

Will “too short” lead to antimicrobial resistance, or is it the “too long”? My guess, 99% of the professionals will answer this question by releasing an avalanche of questions, regarding the bug, the host and the site of infection, but I have to insist on a simple “yes” or “no”. Sorry, but those are the rules of the “30-Second-Questionnaire” and you can’t argue the rules.

Thus here is my request. Follow the link to the questionnaire, take 30 seconds to answer the question (and 4 others) and email, twitter, blog or use any kind of communication you can think of to forward it to your friends and family. I promise, I will post the outcome right here, a week or two later.

 

State of the World’s antibiotics

Andreas Voss (@AVIPNL) Antibiotic resistance ,

Schermafbeelding 2015-09-24 om 20.07.42

The State of the World’s antibiotcs, 2015, was just released by the Center for Diseases Dynamics, Economics & Policy (http://www.cddep.org). For all those interested in antimicrobial resistance this report is a must read.

To cite from the publication, this State of the World’s Antibiotics report records the status of this important global resource and provides critical policy analysis on three issues:

  • global patterns and trends in antibiotic resistance and 
antibiotic use in human beings and animals
  • the existing antibiotic supply and the research and development pipeline
  • interventions that have been shown to help rationalize antibiotic use and are practicable in all countries.

While being wonderful, the reports include a figure from a 2013 Lancet ID publication, a colleague (@ChristinaGrauls) alerted me to. According to figure 2-2: Carbapenem retail sales in selected countries, 2005–2010, the retail sales and thus probable consumption of carbapenems per 1,000 population is identical for the Netherlands and the USA. Somehow, I find that hard to believe.

Mupirocin use drives mupirocin resistance…or does it?

Jon Otter (@jonotter) MRSA , , ,

mupirocin

I’ve blogged before that mupirocin resistance is an inevitable consequence of mupirocin use. Whilst I still think that this is true, my old colleagues from GSTT / KCL have just published an article suggesting that mupirocin resistance in MRSA has more to do with clonal variation than with mupirocin use.

The study is part of an ambitious project to sequence the genome of around 1000 MRSA isolates from across Central and South-East London (Guy’s and St. Thomas’, King’s, and Lewisham). Each isolate was then tested for phenotypic high (HMR) and low (LMR) mupirocin resistance, the genome was scoured for the genetic determinants known to be associated with mupirocin resistance, and clone was derived from the genome sequence. Risk factors for both HMR and LMR were then explored.

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Just passing through

Martin Kiernan (@emrsa15) Antibiotic resistance, Epidemiology, MDR-GNR , ,
Picture courtesy of Shanna Trim
Picture courtesy of Shanna Trim

Travel is easy, cheap (well, depending on your desire for luxury) and you get to meet some interesting characters on your way. Unfortunately, as this recent study from France just published in Clinical Infectious Diseases shows, some of the species that you interact with may have escaped your attention (unless you’re carrying agar plates or some fancy molecular kit with you).

The authors studied travellers attending five vaccination clinics in France prior to and post-travel looking for acquisition of MDR Enterobacteriaeceae. Over 50% came home with more than they bargained for, smuggling MDROs into France in their colons.

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