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Amissah NA, Chlebowicz MA, Ablordey A, Tetteh CS, Prah I, van der Werf TS, Friedrich AW, van Dijl JM, Stienstra Y, Rossen JW. Virulence potential of Staphylococcus aureus isolates from Buruli ulcer patients. Int J Med Microbiol 2017; 307:223-232. [PMID: 28442219 DOI: 10.1016/j.ijmm.2017.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/01/2017] [Accepted: 04/13/2017] [Indexed: 12/27/2022] Open
Abstract
Buruli ulcer (BU) is a necrotizing infection of the skin and subcutaneous tissue caused by Mycobacterium ulcerans. BU wounds may also be colonized with other microorganisms including Staphylococcus aureus. This study aimed to characterize the virulence factors of S. aureus isolated from BU patients. Previously sequenced genomes of 21 S. aureus isolates from BU patients were screened for the presence of virulence genes. The results show that all S. aureus isolates harbored on their core genomes genes for known virulence factors like α-hemolysin, and the α- and β-phenol soluble modulins. Besides the core genome virulence genes, mobile genetic elements (MGEs), i.e. prophages, genomic islands, pathogenicity islands and a Staphylococcal cassette chromosome (SCC) were found to carry different combinations of virulence factors, among them genes that are known to encode factors that promote immune evasion, superantigens and Panton-Valentine Leucocidin. The present observations imply that the S. aureus isolates from BU patients harbor a diverse repertoire of virulence genes that may enhance bacterial survival and persistence in the wound environment and potentially contribute to delayed wound healing.
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Bathoorn E, Groenhof F, Hendrix R, van der Molen T, Sinha B, Kerstjens HA, Friedrich AW, Kocks JW. Real-life data on antibiotic prescription and sputum culture diagnostics in acute exacerbations of COPD in primary care. Int J Chron Obstruct Pulmon Dis 2017; 12:285-290. [PMID: 28144133 PMCID: PMC5245804 DOI: 10.2147/copd.s120510] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are generally treated with optimization of bronchodilation therapy and a course of oral corticosteroids, mostly without antibiotics. The Dutch guidelines recommend prudent use of antibiotics, with amoxicillin or doxycycline as first choice. Here we evaluate adherence to these guidelines with regard to antibiotic prescription in AECOPD in primary care and the use of sputum cultures. Methods We retrospectively analyzed a longitudinal cohort of patients in three primary care practices in the north-eastern region of the Netherlands from 2009 to 2013 (n=36,172 subjects) participating in the Registration Network Groningen. Antibiotics prescribed for AECOPD −10/+28 days from the start date of corticosteroid courses were evaluated. In addition, we assessed regional data on the susceptibility of respiratory pathogens from COPD patients. Results We identified 1,297 patients with COPD. Of these, 616 experienced one or more exacerbations, resulting in a total of 1,558 exacerbations, for which 1,594 antibiotic courses were prescribed. The recommended antibiotics doxycycline and amoxicillin accounted for 56% of the prescribed antibiotics overall and for 35% in subsequent antibiotic courses. The alternative choices were not based on culture results because only in 67 AECOPD events (2.9%) sputum samples were taken. Regional data including 3,638 sputum samples showed that pathogens relevant in AECOPD were detected in 19% of cultures. Conclusion Our study shows that guidelines regarding the prescription of antibiotics are poorly followed, particularly in recurrent exacerbations. Sputum cultures were performed in a small minority of cases. Performing sputum diagnostics in patients with early treatment failure or a repeated exacerbation when antibiotic treatment is started may further rationalize antibiotic treatment.
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Ravensbergen SJ, Lokate M, Cornish D, Kloeze E, Ott A, Friedrich AW, van Hest R, Akkerman OW, de Lange WC, van der Werf TS, Bathoorn E, Stienstra Y. High Prevalence of Infectious Diseases and Drug-Resistant Microorganisms in Asylum Seekers Admitted to Hospital; No Carbapenemase Producing Enterobacteriaceae until September 2015. PLoS One 2016; 11:e0154791. [PMID: 27144599 PMCID: PMC4856320 DOI: 10.1371/journal.pone.0154791] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 04/19/2016] [Indexed: 11/18/2022] Open
Abstract
Introduction The current refugee crisis emphasizes the need for information on infectious diseases and resistant microorganisms in asylum seekers with possible consequences for public health and infection control. Methods We collected data from asylum seekers admitted to our university hospital or who presented at the Emergency Department (n = 273). We collected general and demographic characteristics including country of origin, the reason of presentation, and the screening results of multi-drug resistant organisms. Results 67% of the patients were male with a median age of the study group of 24 years (IQR 15–33); 48% of the patients had an infectious disease—predominantly malaria with P. vivax or tuberculosis. Patients also reported with diseases which are less common—e.g. leishmaniasis, or even conditions rarely diagnosed in Europe—e.g. louse borne relapsing fever. A carriage rate of 31% for multi-drug resistant microorganisms (MDRO) was observed, with ESBL-expressing E.coli (n = 20) being the most common MDRO. No carriage of Carbapenemase Producing Enterobacteriaceae was found. Conclusion The current refugee crisis in Europe challenges hospitals to quickly identify and respond to communicable diseases and the carriage of MDRO. A rapid response is necessary to optimize the treatment of infectious diseases amongst asylum seekers to maximize infection control.
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Dik JWH, Sinha B, Friedrich AW, Lo-Ten-Foe JR, Hendrix R, Köck R, Bijker B, Postma MJ, Freitag MH, Glaeske G, Hoffmann F. Cross-border comparison of antibiotic prescriptions among children and adolescents between the north of the Netherlands and the north-west of Germany. Antimicrob Resist Infect Control 2016; 5:14. [PMID: 27096086 PMCID: PMC4836103 DOI: 10.1186/s13756-016-0113-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/06/2016] [Indexed: 01/15/2023] Open
Abstract
Background Antibiotic resistance is a worldwide problem and inappropriate prescriptions are a cause. Especially among children, prescriptions tend to be high. It is unclear how they differ in bordering regions. This study therefore examined the antibiotic prescription prevalence among children in primary care between northern Netherlands and north-west of Germany. Methods Two datasets were used: The Dutch (IADB) comprises representative data of pharmacists in North Netherland and the German (BARMER GEK) includes nationwide health insurance data. Both were filtered using postal codes to define two comparable bordering regions with patients under 18 years for 2010. Results The proportion of primary care patients receiving at least one antibiotic was lower in northern Netherlands (29.8 %; 95 % confidence interval [95 % CI]: 29.3–30.3), compared to north-west Germany (38.9 %; 95 % CI: 38.2–39.6). Within the respective countries, there were variations ranging from 27.0 to 44.1 % between different areas. Most profound was the difference in second-generation cephalosporins: for German children 25 % of the total prescriptions, while for Dutch children it was less than 0.1 %. Conclusions This study is the first to compare outpatient antibiotic prescriptions among children in primary care practices in bordering regions of two countries. Large differences were seen within and between the countries, with overall higher prescription prevalence in Germany. Considering increasing cross-border healthcare, these comparisons are highly valuable and help act upon antibiotic resistance in the first line of care in an international approach.
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Dik JWH, Dinkelacker AG, Vemer P, Lo-Ten-Foe JR, Lokate M, Sinha B, Friedrich AW, Postma MJ. Cost-Analysis of Seven Nosocomial Outbreaks in an Academic Hospital. PLoS One 2016; 11:e0149226. [PMID: 26863145 PMCID: PMC4749280 DOI: 10.1371/journal.pone.0149226] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Nosocomial outbreaks, especially with (multi-)resistant microorganisms, are a major problem for health care institutions. They can cause morbidity and mortality for patients and controlling these costs substantial amounts of funds and resources. However, how much is unclear. This study sets out to provide a comparable overview of the costs of multiple outbreaks in a single academic hospital in the Netherlands. METHODS Based on interviews with the involved staff, multiple databases and stored records from the Infection Prevention Division all actions undertaken, extra staff employment, use of resources, bed-occupancy rates, and other miscellaneous cost drivers during different outbreaks were scored and quantified into Euros. This led to total costs per outbreak and an estimated average cost per positive patient per outbreak day. RESULTS Seven outbreaks that occurred between 2012 and 2014 in the hospital were evaluated. Total costs for the hospital ranged between €10,778 and €356,754. Costs per positive patient per outbreak day, ranged between €10 and €1,369 (95% CI: €49-€1,042), with a mean of €546 and a median of €519. Majority of the costs (50%) were made because of closed beds. CONCLUSIONS This analysis is the first to give a comparable overview of various outbreaks, caused by different microorganisms, in the same hospital and all analyzed with the same method. It shows a large variation within the average costs due to different factors (e.g. closure of wards, type of ward). All outbreaks however cost considerable amounts of efforts and money (up to €356,754), including missed revenue and control measures.
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van Alen S, Ballhausen B, Peters G, Friedrich AW, Mellmann A, Köck R, Becker K. In the centre of an epidemic: Fifteen years of LA-MRSA CC398 at the University Hospital Münster. Vet Microbiol 2016; 200:19-24. [PMID: 26878970 DOI: 10.1016/j.vetmic.2016.01.021] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 01/18/2016] [Accepted: 01/28/2016] [Indexed: 01/24/2023]
Abstract
Ten years after initial publications on livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in 2005, we report on the course of the LA-MRSA CC398 epidemic among patients of the University Hospital Münster. This tertiary care facility is located in the Dutch-German border region (EUREGIO), which is characterized by a high density of livestock production and is hence a hotspot for the occurrence of LA-MRSA CC398. Taking advantage of the unique opportunity to track the emergence and spread of MRSA CC398 among humans from the very beginning of the epidemic until today, a total of 6555 non-duplicate MRSA isolates from all screenings and clinical specimens cultivated within the period from 2000 to 2014 were included in the analysis. Retrospectively, the first MRSA CC398 isolate (spa type t034) was obtained from a screening specimen of a patient in 2000, which represents one of the first human-associated LA-MRSA CC398 isolates reported in Europe. After sporadic detections between 2000 and 2004, this clonal lineage accounted for 9.6% of all local MRSA in 2005; a proportion which increased to 35% in 2013 and became stable since then. Considering the period from 2000 to 2014, the group of MRSA CC398 isolates comprised a total of 45 different spa types among which t011 (48.3%), t034 (39.3%) and t108 (3.5%) were predominant and so far unreported types were found. Overall, LA-MRSA CC398 emerged rapidly during the past decade, developed enormous sublineage diversity and contributed substantially to the total burden of MRSA colonization and infection at the hospital.
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Bathoorn E, Tsioutis C, da Silva Voorham JM, Scoulica EV, Ioannidou E, Zhou K, Rossen JW, Gikas A, Friedrich AW, Grundmann H. Emergence of pan-resistance in KPC-2 carbapenemase-producing Klebsiella pneumoniae in Crete, Greece: a close call. J Antimicrob Chemother 2016; 71:1207-12. [PMID: 26817488 DOI: 10.1093/jac/dkv467] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/08/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES KPC-2-producing Klebsiella pneumoniae (KPC-KP) ST258 has been rapidly expanding and is often associated with serious nosocomial infections. Last-line antibiotics such as colistin and tigecycline often remain the only treatment option. We describe here the evolving genetic background of KPC-KP isolates in Crete, Greece. METHODS We tested the antibiotic susceptibility of 34 clinical isolates from patients hospitalized in 2010 and 2013-14. Whole-genome sequences of these isolates were analysed for acquired resistance genes and gene mutations. RESULTS All KPC-KP isolates belonged to ST258 with the exception of one ST147 isolate. From 2014, 26% of isolates were non-susceptible to all antibiotics, compared with 0 of 11 isolates from 2010. Colistin resistance was associated with mutations in mgrB, which was present in 61% of isolates from 2014. Core-genome MLST analysis showed that pan-resistant isolates were closely related and appeared in two separate clusters. CONCLUSIONS KPC-KP is rapidly evolving to pan-resistance in Crete. We identified molecular resistance markers for pan-resistant isolates and showed that core-genome MLST is a promising tool for molecular fingerprinting of KPC-KP ST258.
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Köck R, Werner P, Friedrich AW, Fegeler C, Becker K. Persistence of nasal colonization with human pathogenic bacteria and associated antimicrobial resistance in the German general population. New Microbes New Infect 2015; 9:24-34. [PMID: 26862431 PMCID: PMC4706603 DOI: 10.1016/j.nmni.2015.11.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Revised: 11/03/2015] [Accepted: 11/04/2015] [Indexed: 11/16/2022] Open
Abstract
The nares represent an important bacterial reservoir for endogenous infections. This study aimed to assess the prevalence of nasal colonization by different important pathogens, the associated antimicrobial susceptibility and risk factors. We performed a prospective cohort study among 1878 nonhospitalized volunteers recruited from the general population in Germany. Participants provided nasal swabs at three time points (each separated by 4–6 months). Staphylococcus aureus, Enterobacteriaceae and important nonfermenters were cultured and subjected to susceptibility testing. Factors potentially influencing bacterial colonization patterns were assessed. The overall prevalence of S. aureus, Enterobacteriaceae and nonfermenters was 41.0, 33.4 and 3.7%, respectively. Thirteen participants (0.7%) were colonized with methicillin-resistant S. aureus. Enterobacteriaceae were mostly (>99%) susceptible against ciprofloxacin and carbapenems (100%). Extended-spectrum β-lactamase–producing isolates were not detected among Klebsiella oxytoca, Klebsiella pneumoniae and Escherichia coli. Several lifestyle- and health-related factors (e.g. household size, travel, livestock density of the residential area or occupational livestock contact, atopic dermatitis, antidepressant or anti-infective drugs) were associated with colonization by different microorganisms. This study unexpectedly demonstrated high nasal colonization rates with Enterobacteriaceae in the German general population, but rates of antibiotic resistance were low. Methicillin-resistant S. aureus carriage was rare but highly associated with occupational livestock contact.
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Amissah NA, Chlebowicz MA, Ablordey A, Sabat AJ, Tetteh CS, Prah I, van der Werf TS, Friedrich AW, van Dijl JM, Rossen JW, Stienstra Y. Molecular Characterization of Staphylococcus aureus Isolates Transmitted between Patients with Buruli Ulcer. PLoS Negl Trop Dis 2015; 9:e0004049. [PMID: 26360794 PMCID: PMC4567303 DOI: 10.1371/journal.pntd.0004049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Accepted: 08/11/2015] [Indexed: 12/18/2022] Open
Abstract
Background Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans. The wounds of most BU patients are colonized with different microorganisms, including Staphylococcus aureus. Methodology This study investigated possible patient-to-patient transmission events of S. aureus during wound care in a health care center. S. aureus isolates from different BU patients with overlapping visits to the clinic were whole-genome sequenced and analyzed by a gene-by-gene approach using SeqSphere+ software. In addition, sequence data were screened for the presence of genes that conferred antibiotic resistance. Principal Findings SeqSphere+ analysis of whole-genome sequence data confirmed transmission of methicillin resistant S. aureus (MRSA) and methicillin susceptible S. aureus among patients that took place during wound care. Interestingly, our sequence data show that the investigated MRSA isolates carry a novel allele of the fexB gene conferring chloramphenicol resistance, which had thus far not been observed in S. aureus. Buruli ulcer (BU) is a skin infection caused by Mycobacterium ulcerans. The wounds of most BU patients are colonized with different microorganisms, including Staphylococcus aureus. This study investigated patient-to-patient transmission events during wound care in a health care center. S. aureus isolates from patients who visited the health center at the same time points were analyzed using whole-genome sequencing. Analysis of sequence data confirmed transmission of methicillin resistant S. aureus and methicillin susceptible S. aureus among patients that took place during wound care.
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Zingg W, Mutters NT, Harbarth S, Friedrich AW. Education in infection control: A need for European certification. Clin Microbiol Infect 2015; 21:1052-6. [PMID: 26363403 DOI: 10.1016/j.cmi.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 09/01/2015] [Accepted: 09/01/2015] [Indexed: 11/20/2022]
Abstract
Healthcare-associated infections are common adverse events in acute-care medicine, causing significant morbidity and mortality. There has been a significant increase in the commitment to infection prevention and control (IPC) among European countries in recent years. However, there is still heterogeneity in training opportunities and IPC qualifications. The European Union promotes the harmonization of IPC strategies among member states. The European Centre for Disease Prevention and Control (ECDC)-commissioned Training in Infection Control in Europe project sets the stage for harmonization of IPC activities in Europe by issuing a list of core competencies for IPC professionals. European certification of IPC training and professionals would be the next logical step, which must be achieved by close collaboration between different stakeholders in Europe such as the ECDC, the European Society of Clinical Microbiology and Infectious Diseases (ESCMID), the European Union of Medical Specialities, and the national IPC societies. Therefore, the ESCMID has launched the new European Committee on Infection Control to take the lead in the implementation of a European (board) certificate for IPC professionals.
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Dik JWH, Hendrix R, Lo-Ten-Foe JR, Wilting KR, Panday PN, van Gemert-Pijnen LE, Leliveld AM, van der Palen J, Friedrich AW, Sinha B. Automatic day-2 intervention by a multidisciplinary antimicrobial stewardship-team leads to multiple positive effects. Front Microbiol 2015; 6:546. [PMID: 26089819 PMCID: PMC4452884 DOI: 10.3389/fmicb.2015.00546] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 05/19/2015] [Indexed: 12/03/2022] Open
Abstract
Background: Antimicrobial resistance rates are increasing. This is, among others, caused by incorrect or inappropriate use of antimicrobials. To target this, a multidisciplinary antimicrobial stewardship-team (A-Team) was implemented at the University Medical Center Groningen on a urology ward. Goal of this study is to evaluate the clinical effects of the case-audits done by this team, looking at length of stay (LOS) and antimicrobial use. Methods: Automatic e-mail alerts were sent after 48 h of consecutive antimicrobial use triggering the case-audits, consisting of an A-Team member visiting the ward, discussing the patient’s therapy with the bed-side physician and together deciding on further treatment based on available diagnostics and guidelines. Clinical effects of the audits were evaluated through an Interrupted Time Series analysis and a retrospective historic cohort. Results: A significant systemic reduction of antimicrobial consumption for all patients on the ward, both with and without case-audits was observed. Furthermore, LOS for patients with case-audits who were admitted primarily due to infections decreased to 6.20 days (95% CI: 5.59–6.81) compared to the historic cohort (7.57 days; 95% CI: 6.92–8.21; p = 0.012). Antimicrobial consumption decreased for these patients from 8.17 DDD/patient (95% CI: 7.10–9.24) to 5.93 DDD/patient (95% CI: 5.02–6.83; p = 0.008). For patients with severe underlying diseases (e.g., cancer) these outcome measures remained unchanged. Conclusion: The evaluation showed a considerable positive impact. Antibiotic use of the whole ward was reduced, transcending the intervened patients. Furthermore, LOS and mean antimicrobial consumption for a subgroup was reduced, thereby improving patient care and potentially lowering resistance rates.
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Dik JWH, Hendrix R, Friedrich AW, Luttjeboer J, Nannan Panday P, Wilting KR, Lo-Ten-Foe JR, Postma MJ, Sinha B. Cost-minimization model of a multidisciplinary antibiotic stewardship team based on a successful implementation on a urology ward of an academic hospital. PLoS One 2015; 10:e0126106. [PMID: 25955494 PMCID: PMC4425554 DOI: 10.1371/journal.pone.0126106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/29/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In order to stimulate appropriate antimicrobial use and thereby lower the chances of resistance development, an Antibiotic Stewardship Team (A-Team) has been implemented at the University Medical Center Groningen, the Netherlands. Focus of the A-Team was a pro-active day 2 case-audit, which was financially evaluated here to calculate the return on investment from a hospital perspective. METHODS Effects were evaluated by comparing audited patients with a historic cohort with the same diagnosis-related groups. Based upon this evaluation a cost-minimization model was created that can be used to predict the financial effects of a day 2 case-audit. Sensitivity analyses were performed to deal with uncertainties. Finally, the model was used to financially evaluate the A-Team. RESULTS One whole year including 114 patients was evaluated. Implementation costs were calculated to be €17,732, which represent total costs spent to implement this A-Team. For this specific patient group admitted to a urology ward and consulted on day 2 by the A-Team, the model estimated total savings of €60,306 after one year for this single department, leading to a return on investment of 5.9. CONCLUSIONS The implemented multi-disciplinary A-Team performing a day 2 case-audit in the hospital had a positive return on investment caused by a reduced length of stay due to a more appropriate antibiotic therapy. Based on the extensive data analysis, a model of this intervention could be constructed. This model could be used by other institutions, using their own data to estimate the effects of a day 2 case-audit in their hospital.
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Dik JWH, Vemer P, Friedrich AW, Hendrix R, Lo-Ten-Foe JR, Sinha B, Postma MJ. Financial evaluations of antibiotic stewardship programs-a systematic review. Front Microbiol 2015; 6:317. [PMID: 25932024 PMCID: PMC4399335 DOI: 10.3389/fmicb.2015.00317] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 03/30/2015] [Indexed: 11/30/2022] Open
Abstract
Introduction: There is an increasing awareness to counteract problems due to incorrect antimicrobial use. Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs. This review will look at the economical sections of these studies and the methods that were used. Methods: A systematic review was performed of articles found in the PubMed and EMBASE databases published from 2000 until November 2014. Included studies found were scored for various aspects and the quality of the papers was assessed following an appropriate check list (CHEC criteria list). Results: 1233 studies were found, of which 149 were read completely. Ninety-nine were included in the final review. Of these studies, 57 only mentioned the costs associated with the antimicrobial medication. Others also included operational costs (n = 23), costs for hospital stay (n = 18), and/or other costs (n = 19). Nine studies were further assessed for their quality. These studies scored between 2 and 14 out of a potential total score of 19. Conclusions: This review gives an extensive overview of the current financial evaluation of ASPs and the quality of these economical studies. We show that there is still major potential to improve financial evaluations of ASPs. Studies do not use similar nor consistent methods or outcome measures, making it impossible draw sound conclusions and compare different studies. Finally, we make some recommendations for the future.
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Müller J, Voss A, Köck R, Sinha B, Rossen JW, Kaase M, Mielke M, Daniels-Haardt I, Jurke A, Hendrix R, Kluytmans JA, Kluytmans-van den Bergh MF, Pulz M, Herrmann J, Kern WV, Wendt C, Friedrich AW. Cross-border comparison of the Dutch and German guidelines on multidrug-resistant Gram-negative microorganisms. Antimicrob Resist Infect Control 2015; 4:7. [PMID: 25763183 PMCID: PMC4355569 DOI: 10.1186/s13756-015-0047-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 02/05/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In all European countries, hospital-acquired infections caused by Gram-negative multidrug-resistant microorganisms (GN-MDRO) are a major health threat, as these pathogens cannot be adequately treated anymore, or the start of effective antibiotic treatment is delayed. The efforts to limit the selection and spread of GN-MDRO remains a problem in cross-border healthcare, as the national guidelines on hygiene standards applicable for patients colonized or infected with GN-MDRO in hospitals are not harmonized between European countries. METHODS In order to point out the similarities and differences in the national guidelines of Germany and The Netherlands regarding GN-MDRO, guidelines were compared and an expert workshop was organized by the INTERREG IVa project EurSafety Health-net. RESULTS Both guidelines divide the Gram-negative organisms into subgroups based on bacterial species and antibiotic susceptibility patterns in order to define multidrug-resistant variants of these bacteria. However, the Dutch guideline defines that GN-MDRO Enterobacteriaceae requires testing for certain mechanisms causing antibiotic resistance, whereas the German guideline makes use of a newly created classification scheme, based on phenotypic characterization. Besides diagnostic issues, the main difference between the Dutch and German guideline is the divergent evaluation of ESBL-producing Enterobacteriaceae. Special hygiene measures are required for all patients with ESBL-producing Enterobacteriaceae in The Netherlands, whereas the German guideline recommends special precautions only for those cases in which patients are colonized or infected with strains showing co-resistance to ciprofloxacin ("3MRGN"). CONCLUSIONS The usage of consistent terminology and harmonized diagnostic procedures would improve the possibilities for infection prevention, treatment and patient safety. Prevention of severe non-treatable infections and outbreaks due to MDRO, caused by an increased population seeking medical treatment abroad together with an increased number of highly susceptible individuals demands gathering of regional data, and data comparable between the two sides of the Dutch-German border. The necessity to cooperate multidisciplinary and across borders is required to prevent a post-antibiotic era - in which common infections and minor injuries may lead to death.
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Zhou K, Ferdous M, de Boer RF, Kooistra-Smid AMD, Grundmann H, Friedrich AW, Rossen JWA. The mosaic genome structure and phylogeny of Shiga toxin-producing Escherichia coli O104:H4 is driven by short-term adaptation. Clin Microbiol Infect 2014; 21:468.e7-18. [PMID: 25656624 DOI: 10.1016/j.cmi.2014.12.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 12/17/2014] [Accepted: 12/17/2014] [Indexed: 01/23/2023]
Abstract
Shiga toxin-producing Escherichia coli (STEC) O104:H4 emerged as an important pathogen when it caused a large outbreak in Germany in 2011. Little is known about the evolutionary history and genomic diversity of the bacterium. The current communication describes a comprehensive analysis of STEC O104:H4 genomes from the 2011 outbreak and other non-outbreak-related isolates. Outbreak-related isolates formed a tight cluster that shared a monophyletic relation with two non-outbreak clusters, suggesting that all three clusters originated from a common ancestor. Eight single nucleotide polymorphisms, seven of which were non-synonymous, distinguished outbreak from non-outbreak isolates. Lineage-specific markers indicated that recent partitions were driven by selective pressures associated with niche adaptation. Based on the results, an evolutionary model for STEC O104:H4 is proposed. Our analysis provides the evolutionary context at population level and describes the emergence of clones with novel properties, which is necessary for developing comprehensive approaches to early warning and control.
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Grundmann H, Schouls LM, Aanensen DM, Pluister GN, Tami A, Chlebowicz M, Glasner C, Sabat AJ, Weist K, Heuer O, Friedrich AW. The dynamic changes of dominant clones of Staphylococcus aureus causing bloodstream infections in the European region: results of a second structured survey. ACTA ACUST UNITED AC 2014; 19. [PMID: 25523972 DOI: 10.2807/1560-7917.es2014.19.49.20987] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Staphylococcus aureus is one of the most important human pathogens and meticillin-resistant S. aureus (MRSA) presents a major cause of healthcare- and community-acquired infections. This study investigated the spatial and temporal changes of S. aureus causing bacteraemia in Europe over a five-year interval and explored the possibility of integrating pathogen-based typing data with epidemiological and clinical information at a European level. Between January 2011 and July 2011, 350 laboratories serving 453 hospitals in 25 countries collected 3,753 isolates (meticillin-sensitive S. aureus (MSSA) and MRSA) from patients with S. aureus bloodstream infections. All isolates were sent to the national staphylococcal reference laboratories and characterised by quality-controlled spa typing. Data were uploaded to an interactive web-based mapping tool. A wide geographical distribution of spa types was found, with some prevalent in all European countries. MSSA was more diverse than MRSA. MRSA differed considerably between countries with major international clones expanding or receding when compared to a 2006 survey. We provide evidence that a network approach of decentralised typing and visualisation of aggregated data using an interactive mapping tool can provide important information on the dynamics of S. aureus populations such as early signalling of emerging strains, cross-border spread and importation by travel.
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Jurke A, Thole S, Lunemann M, Rohde M, Gudenkauf S, Köck R, Buitenhuis J, Haitsma O, Soethoudt K, Friedrich AW, Daniels-Haardt I. Surveillance of notifiable infectious diseases for transborder infection control using an euregional databasis. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku166.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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68
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Müller J, van der Gun I, Köck R, Hendrix R, Jurke A, Friedrich AW. EurSafety Health-net: Cross-border certification as an instrument for the prevention of infections due to antimicrobial resistance. Eur J Public Health 2014. [DOI: 10.1093/eurpub/cku164.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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69
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Köck R, Friedrich AW, on behalf of the original author group C. Authors’ reply: Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus. Euro Surveill 2014; 19. [DOI: 10.2807/1560-7917.es2014.19.37.20902] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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70
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Friedrich AW. [Patient safety -- mission for the future: Healthcare-associated infections and antibiotic resistance]. Anasthesiol Intensivmed Notfallmed Schmerzther 2014; 49:474-81; quiz 482. [PMID: 25137207 DOI: 10.1055/s-0034-1386710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Healthcare-associated infections (HAI) are considered as one of the major challenges for modern health care. In the context of demographic change and the expected increase of invasive and complex patient treatment and concommittantrise in numbers of patients with underlying diseases with susceptibility to infections, quality of care and patient safety will in the near future depend strongly on the prevention of HAI. To avoid preventable HAI in terms of improved quality of care is beyond question, therefore mainly the prevalence of highly resistant microorganisms (HRMO) will becrucial for the success of treatment of unpreventable HAI. In addition to MRSA, the greatest danger in relation to antibiotic resistance worldwide are now considered tob e carbapenem-resistant Enterobacteriaceae (CRE) or multidrug-resistant Gram-negative (4MRGN) bacteria. In case oft he uncontrolled spread of HRMO unpreventable infections become also untreatable. The prevalence of HRMO varies between different countries. Especially in the Netherlands and Denmark HRMO such as MRSA, VRE and CRE/4MRGN are still significantly less common than in Germany or France. The reason lies in the fact that in nearly all Dutch hospitals anintegrative infectious disease service (clinical microbiology and/or infectious diseaseas wellinfection prevention) was established already years ago, while in Germany - with few exceptions - in most hospitals only a basic infectious disease services (consulting hygienist, microbiological diagnosis is held by laboratories often far away from the patient). As hospitals are connected with each other with respect to theircommon care of patients, one of the most important challenges in future infection prevention will be the implementation of regional and intersectoral infection prevention and control.
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Kock R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, Mielke M, Peters G, Skov RL, Struelens MJ, Tacconelli E, Witte W, Friedrich AW. Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus. ACTA ACUST UNITED AC 2014; 19. [PMID: 25080142 DOI: 10.2807/1560-7917.es2014.19.29.20860] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. The aim of this systematic literature analysis and review was to summarise the evidence for the use of bacterial cultures for active surveillance the benefit of rapid screening tests, as well as the use of decolonisation therapies and different types of isolation measures. We included 83 studies published between 2000 and 2012. Although the studies reported good evidence supporting the role of active surveillance followed by decolonisation therapy, the effectiveness of single-room isolation was mostly shown in non-controlled studies, which should inspire further research regarding this issue. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.
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Jurke A, Köck R, Becker K, Thole S, Hendrix R, Rossen J, Daniels-Haardt I, Friedrich AW. Molecular epidemiology of meticillin-resistant Staphylococcus aureus (MRSA): think regionally but use globally uniform typing languages. Euro Surveill 2013; 18. [DOI: 10.2807/1560-7917.es2013.18.43.20617] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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73
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Bathoorn E, Friedrich AW, Zhou K, Arends JP, Borst DM, Grundmann H, Rossen JW. Latent introduction to the Netherlands of multiple antibiotic resistance including NDM-1 after hospitalisation in Egypt, August 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 24176580 DOI: 10.2807/1560-7917.es2013.18.42.20610] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We describe the introduction of various multi-drug resistant bacterial strains, including an NDM-1-producing Klebsiella pneumoniae, through a traveller returning from Egypt, where they had been admitted to a private hospital. All family members of the patient were colonised with one or more extended-spectrum beta-lactamase producing strains. These findings emphasise the importance of adherence to isolation precautions for returning patients and suggest the need for inclusion of Enterobacteriaceae in admission screening.
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Thole S, Rocker D, Eikelenboom-Boskamp A, Bergen P, Friedrich AW, Pulz M, Daniels-Haardt I, Voss A. EurSafety Health-Net: First results of the euregional infection control quality certificate for nursing homes in the Dutch-German border region. Eur J Public Health 2013. [DOI: 10.1093/eurpub/ckt124.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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75
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Glasner C, Albiger B, Buist G, Tambić Andrasević A, Canton R, Carmeli Y, Friedrich AW, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Nordmann P, Poirel L, Rossolini GM, Seifert H, Vatopoulos A, Walsh T, Woodford N, Donker T, Monnet DL, Grundmann H. Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 23870096 DOI: 10.2807/1560-7917.es2013.18.28.20525] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a threat to healthcare delivery, although its extent differs substantially from country to country. In February 2013, national experts from 39 European countries were invited to self-assess the current epidemiological situation of CPE in their country. Information about national management of CPE was also reported. The results highlight the urgent need for a coordinated European effort on early diagnosis, active surveillance, and guidance on infection control measures.
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Jurke A, Köck R, Friedrich AW, Kämmerer R, Daniels-Haardt I. O035: Third federal state wide survey on MRSA management in North Rhine-Westphalian hospitals. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687744 DOI: 10.1186/2047-2994-2-s1-o35] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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77
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Ciccolini M, Arends J, Grundmann H, Friedrich AW. O085: A network-based approach using intra-hospital patient transfers to identify high-risk wards during nosocomial outbreaks. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687965 DOI: 10.1186/2047-2994-2-s1-o85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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78
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Goering RV, Köck R, Grundmann H, Werner G, Friedrich AW, on behalf of the ESCMID Study Group. From theory to practice: molecular strain typing for the clinical and public health setting. Euro Surveill 2013; 18:20383. [DOI: 10.2807/ese.18.04.20383-en] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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79
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Carriço JA, Sabat AJ, Friedrich AW, Ramirez M. Bioinformatics in bacterial molecular epidemiology and public health: databases, tools and the next-generation sequencing revolution. ACTA ACUST UNITED AC 2013; 18:20382. [PMID: 23369390 DOI: 10.2807/ese.18.04.20382-en] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Advances in typing methodologies have been the driving force in the field of molecular epidemiology of pathogens. The development of molecular methodologies, and more recently of DNA sequencing methods to complement and improve phenotypic identification methods, was accompanied by the generation of large amounts of data and the need to develop ways of storing and analysing them. Simultaneously, advances in computing allowed the development of specialised algorithms for image analysis, data sharing and integration, and for mining the ever larger amounts of accumulated data. In this review, we will discuss how bioinformatics accompanied the changes in bacterial molecular epidemiology. We will discuss the benefits for public health of specialised online typing databases and algorithms allowing for real-time data analysis and visualisation. The impact of the new and disruptive next-generation sequencing methodologies will be evaluated, and we will look ahead into these novel challenges.
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Sabat AJ, Budimir A, Nashev D, Sá-Leão R, van Dijl JM, Laurent F, Grundmann H, Friedrich AW. Overview of molecular typing methods for outbreak detection and epidemiological surveillance. ACTA ACUST UNITED AC 2013; 18:20380. [PMID: 23369389 DOI: 10.2807/ese.18.04.20380-en] [Citation(s) in RCA: 346] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Typing methods for discriminating different bacterial isolates of the same species are essential epidemiological tools in infection prevention and control. Traditional typing systems based on phenotypes, such as serotype, biotype, phage-type, or antibiogram, have been used for many years. However, more recent methods that examine the relatedness of isolates at a molecular level have revolutionised our ability to differentiate among bacterial types and subtypes. Importantly, the development of molecular methods has provided new tools for enhanced surveillance and outbreak detection. This has resulted in better implementation of rational infection control programmes and efficient allocation of resources across Europe. The emergence of benchtop sequencers using next generation sequencing technology makes bacterial whole genome sequencing (WGS) feasible even in small research and clinical laboratories. WGS has already been used for the characterisation of bacterial isolates in several large outbreaks in Europe and, in the near future, is likely to replace currently used typing methodologies due to its ultimate resolution. However, WGS is still too laborious and time-consuming to obtain useful data in routine surveillance. Also, a largely unresolved question is how genome sequences must be examined for epidemiological characterisation. In the coming years, the lessons learnt from currently used molecular methods will allow us to condense the WGS data into epidemiologically useful information. On this basis, we have reviewed current and new molecular typing methods for outbreak detection and epidemiological surveillance of bacterial pathogens in clinical practice, aiming to give an overview of their specific advantages and disadvantages.
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Rohde M, Ludwigs J, Appelrath HJ, Daniels-Haardt I, Friedrich AW, Jurke A. AMK – ein Analytisches Informationssystem zum regionalen Antibiotikamonitoring in Krankenhäusern. Dtsch Med Wochenschr 2012. [DOI: 10.1055/s-0032-1323442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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82
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Palm D, Johansson K, Ozin A, Friedrich AW, Grundmann H, Larsson JT, Struelens MJ. Molecular epidemiology of human pathogens: how to translate breakthroughs into public health practice, Stockholm, November 2011. Euro Surveill 2012. [DOI: 10.2807/ese.17.02.20054-en] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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Stefani S, Chung DR, Lindsay JA, Friedrich AW, Kearns AM, Westh H, Mackenzie FM. Meticillin-resistant Staphylococcus aureus (MRSA): global epidemiology and harmonisation of typing methods. Int J Antimicrob Agents 2012; 39:273-82. [PMID: 22230333 DOI: 10.1016/j.ijantimicag.2011.09.030] [Citation(s) in RCA: 370] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Accepted: 09/30/2011] [Indexed: 10/14/2022]
Abstract
This article reviews recent findings on the global epidemiology of healthcare-acquired/associated (HA), community-acquired/associated (CA) and livestock-associated (LA) meticillin-resistant Staphylococcus aureus (MRSA) and aims to reach a consensus regarding the harmonisation of typing methods for MRSA. MRSA rates continue to increase rapidly in many regions and there is a dynamic spread of strains across the globe. HA-MRSA is currently endemic in hospitals in most regions. CA-MRSA clones have been spreading rapidly in the community and also infiltrating healthcare in many regions worldwide. To date, LA-MRSA is only prevalent in certain high-risk groups of workers in direct contact with live animals. CA-MRSA and LA-MRSA have become a challenge for countries that have so far maintained low rates of MRSA. These evolutionary changes have resulted in MRSA continuing to be a major threat to public health. Continuous efforts to understand the changing epidemiology of S. aureus infection in humans and animals are therefore necessary, not only for appropriate antimicrobial treatment and effective infection control but also to monitor the evolution of the species. The group made several consensus decisions with regard to harmonisation of typing methods. A stratified, three-level organisation of testing laboratories was proposed: local; regional; and national. The functions of, and testing methodology used by, each laboratory were defined. The group consensus was to recommend spa and staphylococcal cassette chromosome mec (SCCmec) typing as the preferred methods. Both are informative in defining particular strain characteristics and utilise standardised nomenclatures, making them applicable globally. Effective communication between each of the different levels and between national centres was viewed as being crucial to inform and monitor the molecular epidemiology of MRSA at national and international levels.
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Saßmannshausen R, Köck R, Jurke A, Friedrich AW. Differences in the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) among health-care workers using a “single” vs. “double” screening strategy. BMC Proc 2011. [PMCID: PMC3239566 DOI: 10.1186/1753-6561-5-s6-p15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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85
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Jurke A, Flume M, Köck R, Friedrich AW. Trends in regional outpatient antibiotic prescription data and interventions in the Dutch-German EURSAFETY HEALTH-NET-project. BMC Proc 2011. [PMCID: PMC3239560 DOI: 10.1186/1753-6561-5-s6-p144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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86
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Köck R, Siam K, Al-Malat S, Christmann J, Schaumburg F, Becker K, Friedrich AW. Characteristics of hospital patients colonized with livestock-associated meticillin-resistant Staphylococcus aureus (MRSA) CC398 versus other MRSA clones. J Hosp Infect 2011; 79:292-6. [PMID: 22024921 DOI: 10.1016/j.jhin.2011.08.011] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2011] [Accepted: 08/22/2011] [Indexed: 01/24/2023]
Abstract
Meticillin-resistant Staphylococcus aureus (MRSA) associated with the clonal complex (CC) 398 has emerged among livestock and humans exposed to these animals. MRSA CC398 has so far contributed relatively little to spread of MRSA and the burden of disease in the healthcare setting. This study aimed to assess whether demographic and clinical differences in patients colonized with MRSA CC398 and those carrying other MRSA clones contribute to the observed differences in transmission and infection rates. Age, sex, length of stay (LOS), diagnoses and medical procedures were assessed in all patients with MRSA admitted to a university hospital in 2008 and 2009. S. aureus protein A gene (spa) typing was performed on the first MRSA isolate from each patient. Patients colonized or infected with MRSA that had spa types indicative of CC398 (MRSA CC398) were compared with patients who had other MRSA clones (MRSA non-CC398). Age (53 vs 59 years), mean LOS (8 vs 13 days) and percentage of patients admitted to an intensive care unit (12% vs 17%) differed significantly between MRSA CC398 and MRSA non-CC398 patients, respectively. The mean numbers and types of diagnoses and medical procedures performed for patients in these two groups also differed significantly. The differences in patient characteristics could explain, at least in part, the relatively low rates of transmission and infection associated with MRSA CC398 in the healthcare setting.
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Köck R, Becker K, Cookson B, van Gemert-Pijnen JE, Harbarth S, Kluytmans J, Mielke M, Peters G, Skov RL, Struelens MJ, Tacconelli E, Navarro Torné A, Witte W, Friedrich AW. Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe. ACTA ACUST UNITED AC 2010; 15:19688. [PMID: 20961515 DOI: 10.2807/ese.15.41.19688-en] [Citation(s) in RCA: 344] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) isa major cause of healthcare- and community-associated infections worldwide. Within the healthcare setting alone, MRSA infections are estimated to affect more than 150,000 patients annually in the European Union (EU), resulting in attributable extra in-hospital costs of EUR 380 million for EU healthcare systems. Pan-European surveillance data on bloodstream infections show marked variability among EU Member States in the proportion of S. aureus that are methicillin-resistant, ranging from less than 1% to more than 50%. In the past five years, the MRSA bacteraemia rates have decreased significantly in 10 EU countries with higher endemic rates of MRSA infections. In addition to healthcare-associated infections, new MRSA strains have recently emerged as community and livestock-associated human pathogens in most EU Member States. The prevention and control of MRSA have therefore been identified as public health priorities in the EU. In this review, we describe the current burden of MRSA infections in healthcare and community settings across Europe and outline the main threats caused by recent changes in the epidemiology of MRSA. Thereby, we aim at identifying unmet needs of surveillance, prevention and control of MRSA in Europe.
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Friedrich AW. [EUREGIO MRSA-net Twente/Münsterland: "search & follow" by Euregional network building]. DAS GESUNDHEITSWESEN 2009; 71:766-70. [PMID: 19937565 DOI: 10.1055/s-0029-1241892] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Staphylococcus aureus causes the majority of healthcare-associated infections worldwide. Particularly critical are infections caused by methicillin-resistant Staphylococcus aureus (MRSA), for which there are few possibilities of antibiotic therapy. It is known that the occurrence of MRSA is directly associated with increased morbidity and mortality. There is also evidence for an increased lethality in hospital-acquired MRSA infections and MRSA bacteraemia in comparison to methicillin-sensitive S. aureus. Besides prolonged and severe disease conditions, the occurrence of MRSA results is extremely laborious and has for the hospitals very expensive consequences, in extreme cases the closure of an entire ward. Nosocomial infections due to MRSA lead to a significantly prolonged length of stay of the patient and leads therefore to extra costs due to recommended hygiene measures (e. g. isolation in a single room). The long-term treatment options can have side effects and are often limited to expensive antibiotics. The growing number of patients treated with severe underlying diseases and the increasing number of expensive medical treatments leads to a further exacerbation of this situation. In times of limited financial resources, this might lead to irresolvable conflicts between the patient safety required and the health funding available.
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Jurke A, Koeck R, Friedrich AW, Daniels-Haardt I. Regionale Daten zum MRSA-Management in Krankenhäusern. DAS GESUNDHEITSWESEN 2009. [DOI: 10.1055/s-0029-1215507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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91
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Köck R, Brakensiek L, Mellmann A, Kipp F, Henderikx M, Harmsen D, Daniels-Haardt I, von Eiff C, Becker K, Hendrix MGR, Friedrich AW. Cross-border comparison of the admission prevalence and clonal structure of meticillin-resistant Staphylococcus aureus. J Hosp Infect 2009; 71:320-6. [PMID: 19201056 DOI: 10.1016/j.jhin.2008.12.001] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Accepted: 12/01/2008] [Indexed: 11/19/2022]
Abstract
Since patient exchange between hospitals sharing a common catchment area might favour regional spread of meticillin-resistant Staphylococcus aureus (MRSA), the reliable detection of patients colonised at admission is crucial. Thus, hospitals in the Dutch-German border area EUREGIO MRSA-net aim at synchronising their local MRSA standards in order to prevent unidentified inter-hospital as well as cross-border spread. This assumes enhanced knowledge of MRSA prevalence and risk factors associated with MRSA carriage at admission. We conducted nasal MRSA screening of all inpatients admitted to 39 German hospitals (in the period 1 November to 30 November 2006) and to one Dutch hospital (in the period 1 July to 30 September 2007) in the EUREGIO MRSA-net. A total of 390 MRSA cases were detected among 25,540 patients screened. The admission prevalence was 1.6 MRSA/100 patients (6.5% of all S. aureus) in the German and 0.5 MRSA/100 patients (1.4% of all S. aureus) in the Dutch part of the border region. Overall, the predominating S. aureus protein A gene (spa) sequence types were t003, t032 and t011. One isolate (t044) carried Panton-Valentine leukocidin (PVL) encoding genes. Altogether, 79% and 67% of all MRSA patients in the German and Dutch regions respectively, were identifiable by the classical nosocomial risk factors assessed. In patients lacking all risk factors assessed, spa types t011 and t034 were predominant (P<0.001).
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Friedrich AW, Daniels-Haardt I, Köck R, Verhoeven F, Mellmann A, Harmsen D, van Gemert-Pijnen JE, Becker K, Hendrix MGR. EUREGIO MRSA-net Twente/Münsterland – a Dutch-German cross-border network for the prevention and control of infections caused by methicillin-resistant Staphylococcus aureus. Euro Surveill 2008; 13. [DOI: 10.2807/ese.13.35.18965-en] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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Friedrich AW, Witte W, de Lencastre H, Hryniewicz W, Scheres J, Westh H. A European laboratory network for sequence-based typing of methicillin-resistant Staphylococcus aureus (MRSA) as a communication platform between human and veterinary medicine--an update on SeqNet.org. Euro Surveill 2008; 13:18862. [PMID: 18761982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
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Friedrich AW, Witte W, de Lencastre H, Hryniewicz W, Scheres J, Westh H, SeqNet.org participants C. A European laboratory network for sequence-based typing of methicillin-resistant Staphylococcus aureus (MRSA) as a communication platform between human and veterinary medicine – an update on SeqNet.org. Euro Surveill 2008. [DOI: 10.2807/ese.13.19.18862-en] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
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Daniels-Haardt I, Jurke A, Friedrich AW, Bannenberg A, Kämmerer R. MRSA an der Wurzel packen – Beispiele aus NRW. DAS GESUNDHEITSWESEN 2008. [DOI: 10.1055/s-2008-1076521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kaiser T, Langhorst J, Wittkowski H, Becker K, Friedrich AW, Rueffer A, Dobos GJ, Roth J, Foell D. Faecal S100A12 as a non-invasive marker distinguishing inflammatory bowel disease from irritable bowel syndrome. Gut 2007; 56:1706-13. [PMID: 17675327 PMCID: PMC2095695 DOI: 10.1136/gut.2006.113431] [Citation(s) in RCA: 153] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE S100A12 is a pro-inflammatory protein that is secreted by granulocytes. S100A12 serum levels increase during inflammatory bowel disease (IBD). We performed the first study analysing faecal S100A12 in adults with signs of intestinal inflammation. METHODS Faecal S100A12 was determined by ELISA in faecal specimens of 171 consecutive patients and 24 healthy controls. Patients either suffered from infectious gastroenteritis confirmed by stool analysis (65 bacterial, 23 viral) or underwent endoscopic and histological investigation (32 with Crohn's disease, 27 with ulcerative colitis, and 24 with irritable bowel syndrome; IBS). Intestinal S100A12 expression was analysed in biopsies obtained from all patients. Faecal calprotectin was used as an additional non-invasive surrogate marker. RESULTS Faecal S100A12 was significantly higher in patients with active IBD (2.45 +/- 1.15 mg/kg) compared with healthy controls (0.006 +/- 0.03 mg/kg; p<0.001) or patients with IBS (0.05 +/- 0.11 mg/kg; p<0.001). Faecal S100A12 distinguished active IBD from healthy controls with a sensitivity of 86% and a specificity of 100%. We also found excellent sensitivity of 86% and specificity of 96% for distinguishing IBD from IBS. Faecal S100A12 was also elevated in bacterial enteritis but not in viral gastroenteritis. Faecal S100A12 correlated better with intestinal inflammation than faecal calprotectin or other biomarkers. CONCLUSIONS Faecal S100A12 is a novel non-invasive marker distinguishing IBD from IBS or healthy individuals with a high sensitivity and specificity. Furthermore, S100A12 reflects inflammatory activity of chronic IBD. As a marker for neutrophil activation, faecal S100A12 may significantly improve our arsenal of non-invasive biomarkers of intestinal inflammation.
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Deurenberg RH, Vink C, Kalenic S, Friedrich AW, Bruggeman CA, Stobberingh EE. The molecular evolution of methicillin-resistant Staphylococcus aureus. Clin Microbiol Infect 2007; 13:222-35. [PMID: 17391376 DOI: 10.1111/j.1469-0691.2006.01573.x] [Citation(s) in RCA: 339] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Staphylococcus aureus is a potentially pathogenic bacterium that causes a broad spectrum of diseases. S. aureus can adapt rapidly to the selective pressure of antibiotics, and this has resulted in the emergence and spread of methicillin-resistant S. aureus (MRSA). Resistance to methicillin and other beta-lactam antibiotics is caused by the mecA gene, which is situated on a mobile genetic element, the Staphylococcal Cassette Chromosome mec (SCCmec). To date, five SCCmec types (I-V) have been distinguished, and several variants of these SCCmec types have been described. All SCCmec elements carry genes for resistance to beta-lactam antibiotics, as well as genes for the regulation of expression of mecA. Additionally, SCCmec types II and III carry non-beta-lactam antibiotic resistance genes on integrated plasmids and a transposon. The epidemiology of MRSA has been investigated by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), spa typing and SCCmec typing. Numerous MRSA clones have emerged and disseminated worldwide. SCCmec has been acquired on at least 20 occasions by different lineages of methicillin-sensitive S. aureus. Although most MRSA strains are hospital-acquired (HA-MRSA), community-acquired MRSA (CA-MRSA) strains have now been recognised. CA-MRSA is both phenotypically and genotypically different from HA-MRSA. CA-MRSA harbours SCCmec types IV or V, and is associated with the genes encoding Panton-Valentine leukocidin. The prevalence of MRSA ranges from 0.6% in The Netherlands to 66.8% in Japan. This review describes the latest developments in knowledge concerning the structure of SCCmec, the molecular evolution of MRSA, the methods used to investigate the epidemiology of MRSA, and the risk-factors associated with CA-MRSA and HA-MRSA.
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Daniels-Haardt I, Verhoeven F, Mellmann A, Hendrix MGR, Gemert-Pijnen JEC, Friedrich AW. EUREGIO-Projekt MRSA-net Twente/Münsterland. DAS GESUNDHEITSWESEN 2006; 68:674-8. [PMID: 17199200 DOI: 10.1055/s-2006-927258] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Over the last years, Germany has observed an increase in the prevalence of methicillin-resistant Staphylococcus (MRSA) in all S. aureus isolates from 2 % to about 25 % whereas in The Netherlands this proportion has continuously been kept below 1 % thanks to a consistent "search & destroy" policy. Both countries increasingly register so-called community-acquired (CA) MRSA which are a threat also to the healthy population without any known risk factor for MRSA carriership. The EUREGIO project "MRSA-net Twente/Münsterland" has made it its main goal to set up a German-Dutch network serving as a basis for a quality association which includes all those who are actively involved in health care provision on both sides of the border and to implement a coordinated strategy for MRSA control and prevention. The project is being carried out with the financial support of the European Union under the INTERREG-IIIA Community initiative and of the Ministry of Economics of the State of North Rhine-Westphalia. The epidemiological backbone of the MRSA-net is a genetic-based MRSA typing strategy (spa-typing) which has been developed by the Institute for Hygiene, University Hospital, Münster and which allows regional and cross-border comparability of laboratory results. The Faculty of Behavioural Sciences of the University of Twente examines MRSA hygiene protocols with regard to their acceptability and realisability with the intention of developing user-friendly, target group-oriented MRSA protocols for the EUREGIO. The health departments involved in the project play a central role in the coordination of the network partners in the municipalities. By performing their function of surveillance in accordance with Sections 23 and 36 of the Infectious Disease Control Act they provide an important contribution to enhancing MRSA control and prevention strategies. Thanks to its cross-border cooperation and exchange of knowledge and technology the EUREGIO project "MRSA-net" contributes to controlling the proliferation of MRSA in the EUREGIO and thus to removing obstacles to the free cross-border movement of patients and personnel.
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Strommenger B, Kettlitz C, Weniger T, Harmsen D, Friedrich AW, Witte W. Assignment of Staphylococcus isolates to groups by spa typing, SmaI macrorestriction analysis, and multilocus sequence typing. J Clin Microbiol 2006; 44:2533-40. [PMID: 16825376 PMCID: PMC1489514 DOI: 10.1128/jcm.00420-06] [Citation(s) in RCA: 228] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The implementation of the new clustering algorithm Based Upon Repeat Pattern (BURP) into the Ridom StaphType software tool enables clustering based on spa typing data for Staphylococcus aureus. We compared clustering results obtained by spa typing/BURP to those obtained by currently well-established methods, i.e., SmaI macrorestriction analysis and multilocus sequence typing/eBURST. A total of 99 clinical S. aureus strains, including MRSA and representing major clonal lineages associated with important kinds of infections which have been prevalent in Germany and Central Europe during the last 10 years, were used for comparison. SmaI macrorestriction analysis revealed the highest discriminatory power, and clustering results for all three methods resulted in concordance values ranging from 96.8% between the two sequence-based methods to 93.4% between spa typing/BURP and SmaI macrorestriction/cluster analysis. The results of this study indicate that spa typing, together with BURP clustering, is a useful tool in S. aureus epidemiology, especially because of ease of use and the advantages of unambiguous sequence analysis as well as reproducibility and exchange of typing data.
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Müller-Premru M, Strommenger B, Alikadic N, Witte W, Friedrich AW, Seme K, Kucina NS, Smrke D, Spik V, Gubina M. New strains of community-acquired methicillin-resistant Staphylococcus aureus with Panton-Valentine leukocidin causing an outbreak of severe soft tissue infection in a football team. Eur J Clin Microbiol Infect Dis 2006; 24:848-50. [PMID: 16341520 DOI: 10.1007/s10096-005-0048-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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