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.
I recently posted on the WHO CPE guidelines. A couple of people have alerted me to two other recently published guidelines, one from ECDC, and the other from Australian Commission on Safety and Quality in Healthcare. So, we now have a wealth of guidelines to prevent and control CPE. But how to they compare?
In a recent BMJ article, Llewelyn et al. argue that the old dogma of completing a prescribed course of antibiotics to prevent antibiotic-resistance is a myth, not based on evidence. Actually the opposite, namely taking antibiotics for longer than necessary, increases the risk of resistance.
While I love breaking down old dogmas (we actually had a poll on this topic some time back), many of today’s papers in the Netherlands (and I am pretty sure elsewhere, too) misinterpret the study, by slaughtering the message to patients to “always complete the full prescription”. One of the Netherlands most influential newspapers the Volkskrant, already wrote: “Finishing antibiotic course? Nonsense.”
ICHE recently published an unusual article (which other article has ‘the world wide web’ as their setting) on blogging in ID and clinical micro. The article reviewed around 100 blogs and rated them using a multifaceted tool. The article has some useful qualitative feedback from bloggers and readers, and identifies some gaps in the blogosphere (especially around antimicrobial stewardship). Rachael Troughton, one of the study authors, recently published a post on the article – and here’s my take on it.
A new Lancet ID study suggests that restriction of fluoroquinolone usage has been the main driver of the national reduction in C. difficile infection in England. This paper is challenging in terms of some of the accepted approaches to controlling the transmission of C. difficile: if it’s all about reducing fluoroquinolones (and antimicrobials in general) and nothing to do with these measures, then why invest so much time and energy in isolation of symptomatic cases, cleaning and disinfection etc?
I am just getting around to reading (well detail-scanning the exec summary) of the ESPAUR report. My main reflection is what a fantastic resource this reporting stream offers us: to have freely accessible, regular, accurate, national data on antimicrobial resistance and usage, and other related indicators is pretty unique!
Nurses are usually non-prescribers, so that means that anti-infective stewardship is the domain of the prescribing doctors and pharmacists, right? Wrong! Nurses have an enormous and enormously under-estimated role in anti-infective stewardship! Continue reading