Antibiotics and the Netherlands

Schermafbeelding 2015-09-13 om 21.03.43

Antimicrobial resistance, control of antibiotic use and infection control are some of the things the Dutch presumably do well. Some of the Dutch infection control policies, such as “Search & Destroy” helped to stop the introduction of MRSA for a long time. I addition, the prevalence of other MDRO is low in comparison to many other countries. Still, more needed to be done, and consequently, the Dutch were (one of) the first that made antimicrobial stewardship teams (A-teams) compulsory for every hospital and presently plan introduction in other healthcare settings. Last but not least, the fight against antimicrobial resistance will be an important topic, while the Dutch hold the Presidency of the European Union in the first half of 2016.

Thus, what else could we ask for? A few weeks ago, I had at least one request: basic antibiotics.

Due to fading reimbursement policies and the constant pressure to sale drugs for decreasingly lower prices, the production for and/or distribution of several drugs within the Netherlands is no longer possible. Latest victim: i.v. penicillin, which is no longer available in my country (high-resource setting). While it seems difficult to argue for small spectrum antibiotics in the absence of one of the important ones, there is some good news: I no longer have to argue whether to use penicillin or a 3rd generation cephalosporin for certain indications. Ceph it is!

What drives carbapenem resistance? Carbapenem use, stupid!

An outstanding study from colleagues at Imperial shows that if you use a bucket-load of meropenem (a carbapenem antibiotic) one year, you see an uptick in carbapenem-resistant Enterobacteriaceae (CRE) the next. The figure below plots meropenem use in the previous year with the incidence rate of OXA-48 producing K. pneumoniae CRE.

mero usage correlation

Figure: The use of meropenem in the previous year plotted against the incidence rate of OXA-48 producing K. pneumoniae

Continue reading

Dispatches: Pan-drug-resistant doom – are we there yet?


Guest blogger and Acute Medicine trainee Dr Nicola Fawcett (bio below) writes…As the local Prophet of Antibiotic Resistance Doomsday to our population of hospital physicians, I’m always interested in finding out if the pan-drug-resistant superbug has emerged that is going to wipe us all out, for credibility purposes if nothing else. (Resistance Is Coming! Prepare thyself! Wash thy hands and document thy indication and duration or face Everlasting audits and perpetual personal protective equipment!). For the record – I’m actually a Registrar in Acute and General (Internal) Medicine. I’m doing some time in the world of ID/Micro/Genomics in the hope that it will help me work out whether it’s ok to just hand out co-amoxifrusiclavamide + nebs to everyone if not sure what’s going on. However  this question seems rather inextricably linked to antibiotic resistance, and having spent some time now with people who seem to know what they’re doing,  I’m increasingly flabbergasted at the massive divide between the views of microbiologists who see the latest data, and the views of the common garden hospital physician. Therefore my side-mission, if you like, has become to spread the good, or rather, spectacularly bad news that antimicrobial resistance is currently spreading around our biosphere at a scale and speed at which we simply cannot react fast enough.

Continue reading

Reflections from the front line: why doctors don’t listen to the ‘impending doom’ of antibiotic resistance


Guest blogger and Acute Medicine trainee Dr Nicola Fawcett (bio below) writes…I’ve just returned from the European Conference for Clinical Microbiology and Infectious Diseases (ECCMID) in Copenhagen. I got the chance to pop into a few sessions on my first love in Microbiology – Stewardship and behaviour change. Before you all think I’m crazy, I’ll just add that I’m actually a trainee in Acute Medicine – I started out in the overlap area of how you change antibiotic use in acute admissions.

Continue reading