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de la Court JR, Woudt SHS, Schoffelen AF, Heijmans J, de Jonge NA, van der Bruggen T, Bomers MK, Lambregts MMC, Schade RP, Sigaloff KCE, Stuart JWTC, Melles DC, van Dijk K, Alzubaidy A, Werdmuller BFM, Blaauw GJ, Diederen BMW, Alblas HJ, der Kuil WAV, Bierman SM, de Greeff SC, Groenendijk SR, Hertroys R, Kuijper EJ, Monen JC, Notermans DW, van den Reek WJ, Smilde AE, Wielders CCH, Zoetigheid RE, van den Bijllaardt W, Kraan EM, Mattsson EE, da Silva JM, de Jong E, Maraha B, van Asselt GJ, Demeulemeester A, Wintermans BB, van Trijp M, Ott A, Sinnige J, Melles DC, Silvis W, Bakker LJ, Dorigo-Zetsma JW, Waar K, Bernards AT, Hall MALV, Schaftenaar E, Nabuurs-Franssen MH, Wertheim H, Diederen BMW, Bode L, van Rijn M, Dinant S, Pontesilli O, de Man P, Wong M, Muller AE, Renders NH, Bentvelsen RG, Buiting AGM, Vlek ALM, Stam AJ, Troelstra A, Overdevest ITMA, van Meer MPA, dos Santos CO, Wolfhagen MJHM. Third-generation cephalosporin resistant gram-negative bacteraemia in patients with haematological malignancy; an 11-year multi-centre retrospective study. Ann Clin Microbiol Antimicrob 2022; 21:54. [DOI: 10.1186/s12941-022-00544-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 11/18/2022] [Indexed: 11/30/2022] Open
Abstract
Abstract
Objectives
Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative bacteria (GNB) to third-generation cephalosporins (3GC) is increasing. In order to explore the value of using surveillance cultures to guide empirical treatment e.g. choosing between carbapenem versus ceftazidime- we aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-resistant GNB (3GC-R GNB) bacteraemia that was preceded by 3GC-R GNB colonization.
Methods
Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of 3GC-R GNB in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Colonization was defined as availability of any GNB surveillance isolate in the year before, independent of the causative micro-organism (time-paired isolates).
Results
We included 3887 patients, representing 4142 episodes of bacteraemia. GNB were identified in 715/4142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In 139 of these 221 patients a time-paired surveillance culture was available. In 76.2% (106/139) of patients these surveillance cultures already showed 3GC-R GNB isolates in the year prior to the culture date of the 3GC-R GNB positive blood isolate.
Conclusions
This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of the use of surveillance-cultures to guide empirical therapy to restrict the empirical use of carbapenems in this population.
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van Asten SAV, Boattini M, Kraakman MEM, Bianco G, Iannaccone M, Costa C, Cavallo R, Bernards AT. Ceftazidime-avibactam resistance and restoration of carbapenem susceptibility in KPC-producing Klebsiella pneumoniae infections: A case series. J Infect Chemother 2021; 27:778-780. [PMID: 33558042 DOI: 10.1016/j.jiac.2021.01.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/07/2021] [Accepted: 01/25/2021] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Since the introduction of the β-lactam/β-lactamase inhibitor ceftazidime-avibactam (CZA), rapid evolution of resistance has been reported in different KPC-producing Klebsiella pneumoniae isolates. In this multicenter retrospective study, we describe the emergence of CZA resistance and evaluate the mutations that might be responsible for the restoration of carbapenem susceptibility. METHODS During a study period of 18 months, KPC-producing K. pneumoniae isolates of five hospitalized patients were collected with phenotypic development of CZA resistance. RESULTS In vitro restoration of carbapenem susceptibility during treatment was observed in 3 isolates. Whole genome sequencing of these isolates showed a D179Y mutation in the KPC gene of 2 variants and a KPC-2 with a Δ242-GT-243 deletion (KPC-14). Two KPC-3 variants showed CZA resistance with sustained carbapenemase activity without genomic adaptations in the KPC gene. CONCLUSIONS This study confirms the emergence of CZA resistance in KPC K. pneumoniae. The role of carbapenems in treating patients with these variants is unclear and combination therapies warrant further investigation.
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Affiliation(s)
- S A V van Asten
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - M Boattini
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M E M Kraakman
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - G Bianco
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - M Iannaccone
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - C Costa
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - R Cavallo
- Microbiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, Turin, Italy
| | - A T Bernards
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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Bianco G, Boattini M, van Asten SAV, Iannaccone M, Zanotto E, Zaccaria T, Bernards AT, Cavallo R, Costa C. RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays for the rapid detection of carbapenemase-producing Enterobacterales from positive blood cultures: a comparative study. J Hosp Infect 2020; 105:162-166. [PMID: 32304724 DOI: 10.1016/j.jhin.2020.03.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 03/17/2020] [Indexed: 11/27/2022]
Abstract
We prospectively compared the performance of RESIST-5 O.O.K.N.V. and NG-Test Carba 5 assays directly from blood cultures spiked with 130 characterized Enterobacterales isolates. Overall, both assays yielded 100% sensitivity to detect KPC-type carbapenemases and OXA-48-like carbapenemases. Both assays failed to detect KPC-31 and KPC-33, D179Y point mutation variants of KPC-3 and KPC-2, that are deprived of carbapenemase activity and confer resistance to ceftazidime-avibactam. On blood culture bacterial pellets, NDM- and VIM-type carbapenemases were detected in 50.0% and 52.2%, respectively, by RESIST-5 O.O.K.N.V. vs 100% by NG-Test Carba 5. The sensitivity of RESIST-5 O.O.K.N.V. improved to 100% and 95.6%, respectively, by performing the assay on 4-h early subculture.
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Affiliation(s)
- G Bianco
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy.
| | - M Boattini
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - S A V van Asten
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Iannaccone
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - E Zanotto
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - T Zaccaria
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - A T Bernards
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - R Cavallo
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
| | - C Costa
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Turin, Italy
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de Jonge E, de Wilde RBP, Juffermans NP, Oostdijk EAN, Bernards AT, van Essen EHR, Kuijper EJ, Visser CE, Kesecioglu J, Bonten MJM. Carriage of antibiotic-resistant Gram-negative bacteria after discontinuation of selective decontamination of the digestive tract (SDD) or selective oropharyngeal decontamination (SOD). Crit Care 2018; 22:243. [PMID: 30268133 PMCID: PMC6162962 DOI: 10.1186/s13054-018-2170-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/27/2018] [Indexed: 12/04/2022]
Abstract
Background Selective decontamination of the digestive tract (SDD) and selective oropharyngeal decontamination (SOD) reduce colonization with antibiotic-resistant Gram-negative bacteria (ARGNB), incidence of nosocomial infections and improve survival in ICU patients. The effect on bacterial gut colonization might be caused by growth suppression by antibiotics during SDD/SOD. We investigated intestinal colonization with ARGNB after discharge from ICU and discontinuation of SDD or SOD. Methods We performed a prospective, observational follow-up study in regular hospital wards of three teaching hospitals in the Netherlands in patients discharged from the ICU, who were participating in a cluster randomized trial comparing SDD with SOD. We determined rectal carriage with ARGNB at ICU discharge (time (T) = 0) and 3, 6 and 10 days after discharge. The primary endpoint was time to first colonization with ARGNB that was not present at T = 0. Bacteria that are intrinsically resistant to antibiotics were not included in the primary analysis, but were included in post-hoc analysis. Results Of 1370 patients screened for inclusion, 996 patients had samples at T = 0 (507 after SDD and 489 after SOD). At ICU discharge, the prevalence of intestinal carriage with any ARGNB was 22/507 (4.3%) after SDD and 87/489 (17.8%) after SOD (p < 0.0001): 426 (SDD) and 409 (SOD) patients had at least one follow-up sample for analysis. The hazard rate for acquiring carriage of ARGNB after discontinuation of SDD, compared to SOD, in the ICU was 0.61 (95% CI 0.40–0.91, p = 0.02), and cumulative risks of acquisition of at least one ARGNB until day 10 were 13% (SDD) and 18% (SOD). At day 10 after ICU discharge, the prevalence of intestinal carriage with ARGNB was 11.3% (26/230 patients) after SDD and 12.5% (28/224 patients) after SOD (p = 0.7). In post-hoc analysis of all ARGNB, including intrinsically resistant bacteria, colonization at ICU discharge was lower after SDD (4.9 vs. 22.3%, p < 0.0001), but acquisition rates after ICU discharge were similar in both groups. Conclusions Intestinal carriage at ICU discharge and the acquisition rate of ARGNB after ICU discharge are lower after SDD than after SOD. The prevalence of intestinal carriage with ARGNB at 10 days after ICU discharge was comparable in both groups, suggesting rapid clearance of ARGNB from the gut after ICU discharge. Trial registration Netherlands Trial Registry, NTR3311. Registered on 28 february 2012. Electronic supplementary material The online version of this article (10.1186/s13054-018-2170-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- E de Jonge
- Department of Intensive Care, Leiden University Medical Center, B4-32, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
| | - R B P de Wilde
- Department of Intensive Care, Leiden University Medical Center, B4-32, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - N P Juffermans
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - E A N Oostdijk
- Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands
| | - A T Bernards
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E H R van Essen
- Department of Intensive Care, Leiden University Medical Center, B4-32, Albinusdreef 2, 2300 RC, Leiden, The Netherlands
| | - E J Kuijper
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - C E Visser
- Department of Medical Microbiology, Academic Medical Center, Amsterdam, The Netherlands
| | - J Kesecioglu
- Department of Intensive Care, University Medical Center, Utrecht, The Netherlands
| | - M J M Bonten
- Department of Medical Microbiology, University Medical Center, Utrecht, The Netherlands
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Lambregts MMC, Bernards AT, Visser LG, de Boer MGJ. Re: 'Development of diagnostic prediction tools for bacteraemia caused by 3rd generation cephalosporin-resistant Enterobacteriaceae in suspected bacterial infections' by Rottier, et al. Clin Microbiol Infect 2018; 24:1346-1348. [PMID: 30077798 DOI: 10.1016/j.cmi.2018.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 07/05/2018] [Accepted: 07/18/2018] [Indexed: 11/26/2022]
Affiliation(s)
- M M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, The Netherlands.
| | - A T Bernards
- Department of Medical Microbiology, Leiden University Medical Center, The Netherlands
| | - L G Visser
- Department of Infectious Diseases, Leiden University Medical Center, The Netherlands
| | - M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, The Netherlands
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Knoester M, de Boer MGJ, Maarleveld JJ, Claas ECJ, Bernards AT, de Jonge E, van Dissel JT, Veldkamp KE. An integrated approach to control a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit. Clin Microbiol Infect 2013; 20:O207-15. [PMID: 24707852 DOI: 10.1111/1469-0691.12372] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 01/05/2023]
Abstract
In this paper we aim to provide insight into the complexity of outbreak management in an intensive care unit (ICU) setting. In October 2010 four patients on the ICU of our tertiary care centre were colonized or infected with a multidrug-resistant strain of Pseudomonas aeruginosa (MDR-PA). An outbreak investigation was carried out and infection control measures were taken in an attempt to identify a potential source and stop transmission. The outbreak investigation included descriptive epidemiology, comprising retrospective case finding by reviewing the laboratory information system back to 2004 and prospective case finding by patient screening for MDR-PA. Furthermore, microbiological analysis, environmental screening and a case-control study were carried out. Infection control measures consisted of re-education of healthcare personnel on basic hygiene measures, auditing of hygiene procedures used in daily practice by infection control practitioners, and stepwise up-regulation of isolation measures. From February 2009 to January 2012, 44 patients on our ICU were found to be MDR-PA positive. MDR-PA isolates of the 44 patients showed two distinct AFLP patterns, with homology within each of the AFLP clusters of more than 93%. The VIM metallo-β-lactamase gene was detected in 20 of 21 tested isolates. A descriptive epidemiology investigation identified the rooms with the highest numbers of MDR-PA positive patients. The case-control study showed three factors to be independently associated with MDR-PA positivity: admission to ICU subunit 1 (OR, 6.1; 95% CI, 1.7, 22), surgery prior to or during admission (OR, 5.7; 95% CI, 1.6, 20) and being warmed-up with the warm-air blanket (OR, 3.6; 95% CI, 1.2, 11). After three environmental screening rounds, with sampling of sinks, furniture and devices in the ICU, without revealing a clear common source, a fourth environmental investigation included culturing of faucet aerators. Two faucets were found to be positive for MDR-PA and were replaced. The occurrence of new cases decreased with the strengthening of infection control measures and declined further with the removal of the common source. With this integrated approach a prolonged outbreak of P. aeruginosa was controlled. Contaminated faucet aerators on the ICU probably served as a persisting source, while interpatient transmission by medical staff was a likely way of spread. Seven months after the last case (January 2012) and 3 months after cessation of extended isolation measures (May 2012), single cases started to occur on the ICU, with a total of seven patients in the past year. No common source has yet been found.
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Affiliation(s)
- M Knoester
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
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Houben AJM, Oostdijk EAN, van der Voort PHJ, Monen JCM, Bonten MJM, van der Bij AK, Vlaspolder F, Stuart JWTC, van Hees BC, Vijfhuizen J, Wintermans RGF, der Kuil WAV, Alblas J, van der Bij AK, Frentz D, Leenstra T, Monen JC, Muilwijk J, Notermans DW, de Greeff SC, van Keulen PHJ, Kluytmans JAJW, Mattsson EE, Sebens FW, Frenay HME, Maraha B, Heilmann FGC, Halaby T, Versteeg D, Hendrix R, Schellekens JFP, Diederen BMW, de Brauwer EIGB, Stals FS, Bakker LJ, Dorigo-Zetsma JW, van Zeijl JH, Bernards AT, de Jongh BM, Vlaminckx BJM, Horrevorts A, Kuipers S, Wintermans RGF, Moffie B, Brimicombe RW, Jansen CL, Renders NHM, Hendrickx BGA, Buiting AGM, Kaan JA, Thijsen SFT, Deege MPD, Ekkelenkamp MB, Tjhie HT, van Zwet AA, Voorn GP, Ruijs GJHM, Wolfhagen MJHM. Selective decontamination of the oropharynx and the digestive tract, and antimicrobial resistance: a 4 year ecological study in 38 intensive care units in the Netherlands. J Antimicrob Chemother 2013; 69:797-804. [DOI: 10.1093/jac/dkt416] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Leverstein-van Hall MA, Waar K, Muilwijk J, Cohen Stuart J, Sabbe LJM, Frenay HME, Maraha B, van Keulen PHJ, Kluytmans JAJW, de Jongh BM, Vlaminckx BJM, de Brauwer EIGB, Stals FS, Bakker LJ, Dorigo-Zetsma JW, Sebens FW, Mattsson EE, Kaan JA, Thijsen SFT, Buiting AGM, Wintermans RGF, van Hees BC, Brimicombe RW, Ruijs GJHM, Wolfhagen MJHM, van Zeijl JH, Waar K, Renders NHM, Bernards AT, Wintermans RGF, Heilmann FGC, Halaby T, Overbeek BP, Schellekens JFP, Jansen CL, Vlaspolder F, Alblas J, van der Bij AK, Leenstra T, Leversteijn-van Hall MA, Monen J, Muilwijk J, Tjhie HT, Sturm PDJ, Diederen BMW, van Zwet AA, Deege MPD, Boel CHE, Cohen Stuart J, Hendrickx BGA. Consequences of switching from a fixed 2 : 1 ratio of amoxicillin/clavulanate (CLSI) to a fixed concentration of clavulanate (EUCAST) for susceptibility testing of Escherichia coli. J Antimicrob Chemother 2013; 68:2636-40. [DOI: 10.1093/jac/dkt218] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Paltansing S, Kraakman MEM, Ras JMC, Wessels E, Bernards AT. Characterization of fluoroquinolone and cephalosporin resistance mechanisms in Enterobacteriaceae isolated in a Dutch teaching hospital reveals the presence of an Escherichia coli ST131 clone with a specific mutation in parE. J Antimicrob Chemother 2012; 68:40-5. [DOI: 10.1093/jac/dks365] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Cazander G, van Veen KEB, Bernards AT, Jukema GN. Do maggots have an influence on bacterial growth? A study on the susceptibility of strains of six different bacterial species to maggots of Lucilia sericata and their excretions/secretions. J Tissue Viability 2009; 18:80-7. [PMID: 19362001 DOI: 10.1016/j.jtv.2009.02.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 02/28/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The maggots of Lucilia sericata are successfully used as a treatment for infected wounds. Many articles are published about possible direct antibacterial properties of maggots and their excretions/secretions (ES), but with different results. The present study reinvestigates the susceptibility of six bacterial strains to maggots and their ES. METHODS Live maggots were added to a bacterial suspension. After incubation for 16 h, the bacterial growth in this suspension was compared with the growth in a suspension without maggots. We tested Instar-1 and Instar-3 maggots and compared nutrient broths. A turbidimetric assay investigated the antibacterial activity of ES. Finally, we compared the bacterial growth of Gram-positive and Gram-negative bacteria. RESULTS The test with live maggots showed an increase of bacterial growth. Instar-1 maggots stimulated more bacterial growth than Instar-3 maggots, as well as the use of a more nutritious broth. The turbidimetric assay showed no inhibition of bacterial growth. For all bacteria, except Pseudomonas aeruginosa, an increase in bacterial growth was shown. CONCLUSION There is no direct antibacterial effect of maggots and/or ES in vitro, however in clinical observations maggot therapy is successful. More research is needed to focus on possible indirect antibacterial activity, such as an immune-related effect.
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Affiliation(s)
- G Cazander
- Department of Trauma Surgery, VU University Medical Center, P.O. Box 7057, 1007MB Amsterdam, The Netherlands
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de Smet AMGA, Kluytmans JAJW, Cooper BS, Mascini EM, Benus RFJ, van der Werf TS, van der Hoeven JG, Pickkers P, Bogaers-Hofman D, van der Meer NJM, Bernards AT, Kuijper EJ, Joore JCA, Leverstein-van Hall MA, Bindels AJGH, Jansz AR, Wesselink RMJ, de Jongh BM, Dennesen PJW, van Asselt GJ, te Velde LF, Frenay IHME, Kaasjager K, Bosch FH, van Iterson M, Thijsen SFT, Kluge GH, Pauw W, de Vries JW, Kaan JA, Arends JP, Aarts LPHJ, Sturm PDJ, Harinck HIJ, Voss A, Uijtendaal EV, Blok HEM, Thieme Groen ES, Pouw ME, Kalkman CJ, Bonten MJM. Decontamination of the digestive tract and oropharynx in ICU patients. N Engl J Med 2009; 360:20-31. [PMID: 19118302 DOI: 10.1056/nejmoa0800394] [Citation(s) in RCA: 497] [Impact Index Per Article: 33.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) are infection-prevention measures used in the treatment of some patients in intensive care, but reported effects on patient outcome are conflicting. METHODS We evaluated the effectiveness of SDD and SOD in a crossover study using cluster randomization in 13 intensive care units (ICUs), all in The Netherlands. Patients with an expected duration of intubation of more than 48 hours or an expected ICU stay of more than 72 hours were eligible. In each ICU, three regimens (SDD, SOD, and standard care) were applied in random order over the course of 6 months. Mortality at day 28 was the primary end point. SDD consisted of 4 days of intravenous cefotaxime and topical application of tobramycin, colistin, and amphotericin B in the oropharynx and stomach. SOD consisted of oropharyngeal application only of the same antibiotics. Monthly point-prevalence studies were performed to analyze antibiotic resistance. RESULTS A total of 5939 patients were enrolled in the study, with 1990 assigned to standard care, 1904 to SOD, and 2045 to SDD; crude mortality in the groups at day 28 was 27.5%, 26.6%, and 26.9%, respectively. In a random-effects logistic-regression model with age, sex, Acute Physiology and Chronic Health Evaluation (APACHE II) score, intubation status, and medical specialty used as covariates, odds ratios for death at day 28 in the SOD and SDD groups, as compared with the standard-care group, were 0.86 (95% confidence interval [CI], 0.74 to 0.99) and 0.83 (95% CI, 0.72 to 0.97), respectively. CONCLUSIONS In an ICU population in which the mortality rate associated with standard care was 27.5% at day 28, the rate was reduced by an estimated 3.5 percentage points with SDD and by 2.9 percentage points with SOD. (Controlled Clinical Trials number, ISRCTN35176830.)
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Affiliation(s)
- A M G A de Smet
- Division of Perioperative and Emergency Care, University Medical Center, Utrecht, The Netherlands.
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12
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de Boer MGJ, Brunsveld-Reinders AH, Salomons EMA, Dijkshoorn L, Bernards AT, van den Berg PCM, van den Broek PJ. Multifactorial origin of high incidence of Serratia marcescens in a cardio-thoracic ICU: analysis of risk factors and epidemiological characteristics. J Infect 2008; 56:446-53. [PMID: 18511122 DOI: 10.1016/j.jinf.2008.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2007] [Revised: 04/07/2008] [Accepted: 04/08/2008] [Indexed: 12/24/2022]
Abstract
OBJECTIVE A four-fold increase in the incidence of Serratia marcescens occurred in a cardio-thoracic ICU within a 13-month period. Clinical, epidemiological and molecular characteristics were analysed to elucidate the outbreak's origin. METHODS Epidemiological data were analysed by mapping clustered cases; isolates were genotyped by AFLP analysis. A case-control study was performed to identify risk factors for the acquisition of S. marcescens. Data were obtained from files and electronic databases of the ICU and Department of Medical Microbiology. The adherence to hygiene protocols on the ICU was reviewed by a medical audit. RESULTS Genotyping showed 16 distinct S. marcescens strains. Twenty-one cases and 39 controls were enrolled in the case-control study. Significant differences found by univariate analysis included the duration of surgery, APACHE-II-score on ICU admission, length of ICU stay, duration of mechanical ventilation, tube feeding and the sum of the number of days per invasive device. In a multivariate logistic regression model, the length of ICU stay and tube feeding were independent risk factors. Outbreak strains were not more frequently resistant to gentamicin, ciprofloxacin, meropenem or trimethoprim-sulfamethoxazole as compared to a reference group. Hygiene protocols, including hand washing, were insufficiently practiced by the ICU's medical staff. CONCLUSIONS The heterogeneity of the strains points to transmission from various sources. This outbreak of S. marcescens was most probably caused by reduced hand washing and other breaks in infection prevention protocols in combination with the presence of the identified risk factors, which act by affecting the number and intensity of potential transmission events.
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Affiliation(s)
- M G J de Boer
- Department of Infectious Diseases, Leiden University Medical Center, P.O. Box 9600, Leiden, The Netherlands.
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13
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van Nieuwkoop C, Bernards AT, Compier EA, Kraemer CVE, Visser LG. [Community-acquired Staphylococcus aureus pneumonia following influenza and the choice of empirical antibiotic treatment]. Ned Tijdschr Geneeskd 2008; 152:822-826. [PMID: 18491826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A 30-year-old man presented with community-acquired pneumonia (CAP), directly following influenza. Sputum Gram stain confirmed Staphylococcus aureus pneumonia. Initial empirical antimicrobial therapy did not cover S. aureus. The isolated S. aureus strain contained genes encoding exotoxins, such as Panton-Valentine leukocidin (PVL). This exotoxin is associated with high mortality and methicillin resistance, but in this patient the strain was susceptible to methicillin. The patient died. In the Netherlands the risk of methicillin resistance in PVL-positive S. aureus CAP is low but real. This should be taken into account when selecting empirical treatment, which can include the combination of flucloxacillin and rifampicin. This case report illustrates the difficulty in predicting the causative agent in CAP and highlights the usefulness of the sputum Gram stain. Moreover, clinical awareness and recognition of S. aureus CAP remains essential to the early initiation of directed therapy.
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Affiliation(s)
- C van Nieuwkoop
- Leids Universitair Medisch Centrum, Afd. Infectieziekten, Leiden.
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14
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Kalpoe JS, Templeton KE, Horrevorts AM, Endtz HP, Kuijper EJ, Bernards AT, Klaassen CHW. Molecular typing of a suspected cluster of Nocardia farcinica infections by use of randomly amplified polymorphic DNA, pulsed-field gel electrophoresis, and amplified fragment length polymorphism analyses. J Clin Microbiol 2007; 45:4048-50. [PMID: 17913932 PMCID: PMC2168561 DOI: 10.1128/jcm.00932-07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Randomly amplified polymorphic DNA (RAPD), pulsed-field gelelectrophoresis (PFGE), and amplified fragment length polymorphism (AFLP) analyses were used to investigate a possible outbreak of Nocardia farcinica. RAPD and PFGE analyses yielded irreproducible and unsatisfactory results, respectively. AFLP analysis seem to be a promising and welcome addition for molecular analysis of Nocardia isolates.
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Affiliation(s)
- J S Kalpoe
- Department of Medical Microbiology, E4-P, Leiden University Medical Center, 2300 RC, Leiden, The Netherlands.
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15
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Dobrewski R, Savov E, Bernards AT, van den Barselaar M, Nordmann P, van den Broek PJ, Dijkshoorn L. Genotypic diversity and antibiotic susceptibility of Acinetobacter baumannii isolates in a Bulgarian hospital. Clin Microbiol Infect 2006; 12:1135-7. [PMID: 17002615 DOI: 10.1111/j.1469-0691.2006.01530.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A set of 18 Acinetobacter baumannii isolates, collected prospectively in a Bulgarian hospital during episodes of increased A. baumannii occurrence during 2000-2002, was investigated for genotypic diversity and antibiotic susceptibility. Four genotypes were identified by amplified fragment length polymorphism genomic fingerprinting, one of which (type 1) accounted for 13 isolates, indicating that a specific strain was predominant. The single isolate allocated to type 2 was identified to European clone I. All isolates were resistant to multiple antibiotics, but most retained susceptibility to tobramycin and colistin, and all except one were susceptible to imipenem.
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Affiliation(s)
- R Dobrewski
- Department of Clinical Microbiology, Military Medical Academy, Sophia, Bulgaria
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16
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van den Broek PJ, Arends J, Bernards AT, De Brauwer E, Mascini EM, van der Reijden TJK, Spanjaard L, Thewessen EAPM, van der Zee A, van Zeijl JH, Dijkshoorn L. Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999–2001. Clin Microbiol Infect 2006; 12:837-43. [PMID: 16882288 DOI: 10.1111/j.1469-0691.2006.01510.x] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
An increase in the number of outbreaks of Acinetobacter infection was notified in The Netherlands during 1999-2001. The present study compared the outbreaks at the species and strain levels, and analysed the epidemiology and control measures at the different locations. For each institute, three representative isolates from three patients were identified to the species and strain levels by genotyping methods. A questionnaire investigated the impact of the outbreak, the control measures that were taken, and the possible effects of the measures. Seven outbreaks were associated with Acinetobacter baumannii (three outbreaks with a strain designated strain A, two outbreaks with a strain designated strain B, and one outbreak each with strains designated C and D). An additional outbreak was caused by genomic species 13TU, which is related closely to A. baumannii. Strains B and D were identified as European clones III and II, respectively. Except for two hospitals with outbreaks caused by strain A, there was no known epidemiological link between the participating hospitals. In all hospitals the outbreak occurred on one or several intensive care units, and spread to other departments was noted in two hospitals. The number of patients affected ranged from six to 66 over a period of 2-22 months. In most outbreaks, patients were the likely reservoir from which spread occurred. In all hospitals, a large panel of measures was required to bring the outbreak to an end. Extensive environmental sampling yielded numerous positive samples in most but not all hospitals.
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Affiliation(s)
- P J van den Broek
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, The Netherlands.
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17
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Jukema GN, Steenvoorde P, Wong CY, Bernards AT, van Dissel JT. [Maggot therapy for treatment of severe infections in trauma surgery: "back to the future!"]. Zentralbl Chir 2006; 131 Suppl 1:S75-8. [PMID: 16575650 DOI: 10.1055/s-2006-921510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The ancient method of larval therapy for treatment of acute and chronic infections has become a revival and a new dimension with introduction of the Biobag (Vitapad). With use of this therapy trauma patients suffering infectious complications can be treated very effective, which can reduce the overall time needed for treatment and can result in diminished invalidity.
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Affiliation(s)
- G N Jukema
- Department of Surgery, Section of Traumatology, Leiden University Medical Center, The Netherlands.
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18
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Dijkshoorn L, van Aken E, Shunburne L, van der Reijden TJK, Bernards AT, Nemec A, Towner KJ. Prevalence of Acinetobacter baumannii and other Acinetobacter spp. in faecal samples from non-hospitalised individuals. Clin Microbiol Infect 2005; 11:329-32. [PMID: 15760432 DOI: 10.1111/j.1469-0691.2005.01093.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In total, 226 individuals from the community were investigated for faecal carriage of Acinetobacter spp. by broth enrichment culture, followed by growth on blood agar and/or Leeds Acinetobacter Medium (LAM). Acinetobacter baumannii was isolated on both LAM and blood agar from one of 100 specimens in the UK and one of 126 specimens in The Netherlands. The predominant species were Acinetobactor johnsonii and genomic sp. 11, which were cultured from 22 and five specimens, respectively. A. baumannii did not seem to be widespread in the faecal flora of individuals in the community.
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Affiliation(s)
- L Dijkshoorn
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
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Bernards AT, Harinck HIJ, Dijkshoorn L, van der Reijden TJK, van den Broek PJ. Persistent Acinetobacter baumannii? Look inside your medical equipment. Infect Control Hosp Epidemiol 2005; 25:1002-4. [PMID: 15566039 DOI: 10.1086/502335] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Two outbreaks of multidrug-resistant Acinetobacter baumannii occurred in our hospital. The outbreak strains were eventually isolated from respiratory ventilators, an apparatus used to cool or warm patients, and four continuous veno-venous hemofiltration machines. Removing dust from the machines and replacing all dust filters brought the outbreaks to an end.
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Affiliation(s)
- A T Bernards
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Kuijper EJ, Schippers EF, Bernards AT. [Linezolid, an agent from a new class of antibiotics]. Ned Tijdschr Geneeskd 2004; 148:1577-81. [PMID: 15382556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
Linezolid is the first of a new class of antibacterial agents, the oxazolidinones, to become available. Linezolid has a unique mechanism of action in its inhibition of bacterial protein synthesis in Gram-positive and a number of anaerobic bacteria. Because of this unique mechanism of action, linezolid exhibits no cross-resistance with other antibiotics and is effective against methicillin-resistant staphylococci, penicillin-resistant pneumococci and vancomycin-resistant enterococci. The excellent bioavailability after oral administration (almost 100%) makes it suitable for outpatient treatment and treatment by general practitioners. In the Netherlands, however, the indications for linezolid are limited by its high cost, the availability of other effective antibiotics for the treatment of sensitive micro-organisms, and the toxicity associated with a prolonged treatment period. Resistance to the new agent was reported rather quickly after the introduction of linezolid.
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Affiliation(s)
- E J Kuijper
- Afd. Medische Microbiologie, Leids Universitair Medisch Centrum, Postbus 9600, 2300 RC Leiden.
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21
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Jukema GN, Menon AG, Bernards AT, Steenvoorde P, Taheri Rastegar A, van Dissel JT. Amputation-sparing treatment by nature: "surgical" maggots revisited. Clin Infect Dis 2002; 35:1566-71. [PMID: 12471580 DOI: 10.1086/344904] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2002] [Accepted: 09/17/2002] [Indexed: 11/04/2022] Open
Abstract
Maggots were used as adjunct treatment for infected wounds that showed no response to the classical approach of wound debridement and antibiotic therapy. We summarize findings for 11 patients with necrotic wounds who received treatment with "surgical" maggots (100-2900 applied in 3-10 changes of dressing) for 11-34 days, which apparently aided in tissue remodeling and cure, and describe 2 typical patients in detail.
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Affiliation(s)
- G N Jukema
- Section of Traumatology, Department of Surgery, Leiden University Medical Center, 2300 RC Leiden, The Netherlands.
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Abstract
BACKGROUND AND OBJECTIVES After storage, low levels of contaminating bacteria in standard blood components can reach bacteraemic levels, causing severe transfusion-associated sepsis. For cord blood (CB), the significance of low levels of contaminating bacteria and the optimal detection method is unknown and not supported by available guidelines. MATERIALS AND METHODS Spiking experiments and testing of various subfractions of CB units were used to determine the behaviour of bacteria during centrifugation, freezing and thawing. For routine testing of CB, different volumes were compared for the detection of potential pathogens and micro-organisms of low pathogenicity. RESULTS Centrifugation, as applied to CB fractionation, does not show concentration of bacteria in any particular fraction and supports the possibility of culture of waste fractions. Dimethylsulphoxide (DMSO) and freezing does not affect the viability of bacteria under the conditions used in this study. Owing to the low contamination level, a large sample volume of 20 ml was more sensitive than a 10-ml sample volume. Eighty five per cent of the isolated strains can be considered to be of low pathogenicity. CONCLUSION When an optimal waste fraction sample volume of 20 ml was cultured, the contamination rate of CB was found to be approximately 13%, with low levels of < 1 colony-forming unit (CFU)/ml. Such levels of bacteria of low pathogenicity are expected to be of clinical importance only when CB is expanded in vitro for a prolonged period of time.
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Affiliation(s)
- A Honohan
- Sanquin Blood Supply Foundation, Blood Bank Leiden-Haaglanden, Leiden, The Netherlands.
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Abstract
Acinetobacter junii caused sepsis in six preterm infants in our neonatal unit within 48 h. Each infant with clinical signs of systemic infection and activation of the acute phase response had two positive blood cultures with Acinetobacter junii. The sudden onset, the short duration of the outbreak and the fact that none of the infants were colonized by A. junii suggested a common source of A. junii administered directly into the blood. The only feature shared by all six affected newborns was an intravenous fat emulsion (Intralipid 10%), which was shown to be an excellent growth medium for A. junii. Sepsis did not occur in four infants with 20% fat emulsion or amino acids only. Vaminolact did not support growth of the outbreak strain. The immediate source of the outbreak could not be identified: samples of the actual feeds given were not available for investigation, but A. junii was not isolated from parenteral solutions with identical batch numbers used in the septic infants. We conclude that Acinetobacter junii can cause a life-threatening infection in preterm neonates. Contaminated intravenous fat emulsion is implicated as a possible source of the infection. As a part of rigid infection control, intravenous feedings should be prepared under aseptic conditions.
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Affiliation(s)
- A J de Beaufort
- Department of Paediatrics, Leiden University Medical Center, The Netherlands.
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van der Sar-van der Brugge S, Arend SM, Bernards AT, Berbee GA, Westendorp RG, Feuth JD, van den Broek PJ. Risk factors for acquisition of Serratia marcescens in a surgical intensive care unit. J Hosp Infect 1999; 41:291-9. [PMID: 10392335 DOI: 10.1053/jhin.1998.0498] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Between January 1996 and May 1997, a four-fold increased rate of isolation of Serratia marcescens was observed amongst patients admitted to the surgical Intensive Care Unit (SICU) of the Leiden University Medical Center compared to the preceding years. Random amplification of polymorphic DNA showed the involvement of genotypically distinct strains, implicating multiple different sources. After improvement of hygienic measures the frequency of isolation of S. marcescens returned to baseline. A case-control study was performed to assess patient-related risk factors for acquisition of S. marcescens. Nineteen cases and 38 controls were included. Hospital- and SICU-stay were significantly longer in case patients than in controls. By univariate analysis, statistically significant differences were found in body weight, the duration of mechanical ventilatory support, the cumulative use of antimicrobial agents, the use of aminoglycosides, parenteral nutrition and tube feeding. The sum of the number of days per invasive device (deep intravenous lines, arterial lines, wound drains and urinary catheters) was higher in cases than in controls (P = 0.08). Categorically, a cumulative number of device-days > 25 was a statistically significant risk factor for acquisition of S. marcescens. Multivariable logistic regression analysis showed that body weight, parenteral feeding and mechanical ventilation were independent predictors of acquisition of S. marcescens. As transmission of S. marcescens appears to be by the hands of personnel, the identified risk factors may act by necessitating an increased frequency and intensity of direct contacts.
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Bernards AT, Frénay HM, Lim BT, Hendriks WD, Dijkshoorn L, van Boven CP. Methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii: an unexpected difference in epidemiologic behavior. Am J Infect Control 1998; 26:544-51. [PMID: 9836836 DOI: 10.1053/ic.1998.v26.a84555] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Dutch guideline on hospital policy for the prevention of nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA) states that patients transferred from hospitals abroad must be placed in strict isolation immediately on admission to a hospital in the Netherlands. Three patients colonized with both MRSA and a multiresistant Acinetobacter were transferred from hospitals in Mediterranean countries to 3 different hospitals in the Netherlands. Despite isolation precautions, Acinetobacter spread in 2 of the 3 hospitals, whereas nosocomial spread of MRSA did not occur. METHODS For outbreak analysis, the Acinetobacter isolates, identified as Acinetobacter baumannii by the use of amplified ribosomal DNA restriction analysis, were comparatively typed by 4 methods. Comparison of isolation measures in the hospitals was performed retrospectively. RESULTS In the 2 hospitals in which nosocomial spread of Acinetobacter occurred, most of the epidemiologically related isolates were indistinguishable from the index strains. In these 2 hospitals, isolation measures were in concordance with those recommended for the prevention of contact transmission. The precautions of the hospital in which no outbreak occurred included the prevention of airborne transmission. CONCLUSIONS Precautions recommended for multiresistant gram-negative organisms are insufficient for the prevention of nosocomial spread of multiresistant Acinetobacter. The airborne mode of spread of acinetobacters should be taken into account, and guidelines should be revised accordingly.
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Affiliation(s)
- A T Bernards
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, The Netherlands
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Bernards AT, de Beaufort AJ, Dijkshoorn L, van Boven CP. Outbreak of septicaemia in neonates caused by Acinetobacter junii investigated by amplified ribosomal DNA restriction analysis (ARDRA) and four typing methods. J Hosp Infect 1997; 35:129-40. [PMID: 9049817 DOI: 10.1016/s0195-6701(97)90101-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Septicaemia caused by Acinetobacter occurred in six infants in the neonatal unit. A total of 18 acinetobacters were isolated from blood cultures, cultures of intravascular catheters, and surveillance cultures. Twelve isolates from the six affected infants were identified as Acinetobacter junii by the use of a novel method, amplified ribosomal DNA restriction analysis (ARDRA). Typing of the organisms using the biochemical profiles of the API 20NE system, antibiogram typing, cell envelope protein electrophoresis, and PCR fingerprinting with two primer sets, ERIC1/ERIC2 and ERIC2/ 1026, showed that these 12 isolates were indistinguishable, whereas the remaining six isolates were different. The six infants recovered after therapy with ciprofloxacin alone in five cases and with a combination of ciprofloxacin and gentamicin in one case. This study showed that A. junii is capable of causing a serious, though non-fatal infection in neonates. The combined use of genotypic and phenotypic methods allowed the rapid separation of epidemic from non-epidemic isolates. It is concluded that for a better understanding of the role of the various Acinetobacter genomic species in human pathology, identification of acinetobacters according to the recent taxonomy is imperative.
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Affiliation(s)
- A T Bernards
- Department of Medical Microbiology, Leiden University Hospital, The Netherlands
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Ehrenstein B, Bernards AT, Dijkshoorn L, Gerner-Smidt P, Towner KJ, Bouvet PJ, Daschner FD, Grundmann H. Acinetobacter species identification by using tRNA spacer fingerprinting. J Clin Microbiol 1996; 34:2414-20. [PMID: 8880491 PMCID: PMC229283 DOI: 10.1128/jcm.34.10.2414-2420.1996] [Citation(s) in RCA: 82] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Identification of Acinetobacter spp. to the DNA group level by phenotypic techniques is problematic, and there is a need for an alternative identification method for routine use. The present study validated the suitability of a rapid identification technique based on tRNA spacer (tDNA) fingerprinting in comparison with that of a commercially available assay involving carbon source utilization tests (Biolog MicroStation System) for identifying the 21 DNA-DNA hybridization groups belonging to the genus. For this purpose, 128 strains identified previously by DNA-DNA hybridization were analyzed by both techniques. tDNA fingerprinting was highly reproducible and classified all strains into 17 groups. Six DNA groups belonging to the A. calcoaceticus-A. baumannii complex were grouped into two distinct clusters, indicating the high degree of genetic similarity within this complex. Strains of the more recently described DNA groups BJ13 to BJ16 were ambiguously grouped and displayed three pattern types. The software used with the commercial carbon source utilization method grouped the 128 strains into 12 clusters, explaining the less discriminatory power of this system. We conclude that tDNA fingerprinting offers a quick and reliable method for the routine differentiation of most Acinetobacter spp. at the subgenus level.
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Affiliation(s)
- B Ehrenstein
- Institut für Umweltmedizin und Krankenhaushygiene, Klinikum der Albert-Ludwigs-Universität, Freiburg, Germany
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Bernards AT, van der Toorn J, van Boven CP, Dijkshoorn L. Evaluation of the ability of a commercial system to identify Acinetobacter genomic species. Eur J Clin Microbiol Infect Dis 1996; 15:303-8. [PMID: 8781881 DOI: 10.1007/bf01695662] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A collection of 130 Acinetobacter strains identified by DNA hybridization to 18 different genomic species was used to assess the ability of the API 20NE system (bioMérieux, France) to identify Acinetobacter genomic species and to determine its accuracy. Fifty-eight (87%) of the 67 strains of genomic species defined in the database (version 5.1) were identified to the appropriate genomic species. The Acinetobacter baumannii strains and the Acinetobacter haemolyticus strains were all identified correctly. Three of five Acinetobacter junii strains, three of eight Acinetobacter johnsonii strains, and 11 of 13 Acinetobacter lwoffii strains were also identified correctly. The 58 correctly identified strains represented 45% of the total 130 strains. Thirty-six of the 72 inappropriately identified strains were designated Acinetobacter baumannii. Thirty-one of these 36 strains belonged to genomic species 1 (Acinetobacter calcoaceticus), 3, or 13TU. Analysis of the profiles showed that the API system does not discriminate between genomic species 1, 2, 3, and 13TU. Lumping of these groups into the Acinetobacter calcoaceticus-Acinetobacter baumannii complex in the API 20NE database would make the system considerably more accurate. Incorporation of these data into the database may improve identification of the remaining genomic species, including some that are not defined. However, the discriminative power of the tests in the API galleries is insufficient for correct identification of all Acinetobacter genomic species.
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Affiliation(s)
- A T Bernards
- Department of Medical Microbiology, University Hospital Leiden, The Netherlands
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Veenendaal RA, Götz JM, Schroijen V, Kurban F, Bernards AT, Veselic M, Peña AS, Lamers CB. Diagnosis of Helicobacter pylori infection by specific gastric mucosal IgA and IgG pylori antibodies. J Clin Pathol 1995; 48:990-3. [PMID: 8543643 PMCID: PMC502999 DOI: 10.1136/jcp.48.11.990] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
AIMS To investigate the diagnostic value of mucosal IgA and IgG Helicobacter pylori antibodies. METHODS The study population comprised 209 consecutive patients with severe dyspeptic complaints referred for upper gastrointestinal endoscopy. A positive culture or histological identification of H pylori in gastric biopsy specimens, or both, were used to confirm infection. Specific IgA and IgG H pylori antibodies were determined using a modified ELISA technique. RESULTS Of the 209 patients, 137 were infected with H pylori. The diagnostic value of systemic IgA and IgG H pylori antibodies was confirmed. Systemic IgA antibodies had a sensitivity of 76.6% (95% confidence interval 69.5-83.7) and a specificity of 94.4% (89.1-99.7). The sensitivity and specificity for systemic IgG antibodies were, respectively, 97.1% (94.3-99.9) and 98.6% (95.9-100). A moderate but clinically important correlation was found between local and systemic IgA and IgG. Mucosal IgA H pylori antibodies had a sensitivity of 98.5% (96.5-100) and a specificity of 91.7% (85.3-98.1), while for IgG these figures were, respectively, 88.3% (82.9-93.7) and 98.6% (95.9-100). As a diagnostic test mucosal IgA H pylori antibodies were comparable with culture and histology. CONCLUSION Determination of local IgA and IgG H pylori antibody levels is a highly sensitive and specific test for the diagnosis of H pylori infection.
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Affiliation(s)
- R A Veenendaal
- Department of Gastroenterology and Hepatology, University Hospital Leiden, The Netherlands
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31
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Bernards AT, Dijkshoorn L, Van der Toorn J, Bochner BR, Van Boven CP. Phenotypic characterisation of Acinetobacter strains of 13 DNA-DNA hybridisation groups by means of the biolog system. J Med Microbiol 1995; 42:113-9. [PMID: 7869346 DOI: 10.1099/00222615-42-2-113] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
A collection of 129 Acinetobacter strains belonging to DNA groups (genomic species) 1-14 (1-7 and 10-12 sensu Bouvet and Grimont; 8 and 13-14 sensu Tjernberg and Ursing) were investigated for their ability to oxidise 95 carbon sources in the Biolog system. The strain groupings obtained by cluster analysis with the Biolog software were compared with the results of DNA-DNA hybridisation studies. Strains of DNA groups 1 (A. calcoaceticus), 2 (A. baumannii), 3 and 13 were linked in one cluster, as were DNA groups 4 (A. haemolyticus) and 6, DNA groups 10 and 11, and DNA groups 8 (A. lwoffii) and 12 (A. radioresistens). Strains of DNA group 5 (A. junii) were grouped in a single cluster with one strain of DNA group 4. Strains of DNA groups 7 (A. johnsonii) and 14 formed separate clusters. With the exception of the linkage of DNA groups 8 and 12, these results correlated with classification of reference strains of the DNA groups by DNA-DNA hybridisation, but six strains of four different DNA groups were not allocated to the clusters of their respective DNA groups. In the case of DNA groups 4, 5, 6, 7, 10, 11 and 14, at least one carbon source oxidation test could be used to differentiate them from the other DNA groups.
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Affiliation(s)
- A T Bernards
- Department of Medical Microbiology, University Hospital Leiden, The Netherlands
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Hogeweg JA, Kuis W, Huygen AC, de Jong-de vos van Steenwijk C, Bernards AT, Oostendorp RA, Helders PJ. The pain threshold in juvenile chronic arthritis. Br J Rheumatol 1995; 34:61-7. [PMID: 7881842 DOI: 10.1093/rheumatology/34.1.61] [Citation(s) in RCA: 54] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
An algometer was used to study the pain threshold (PT) on pressure at the joint capsules of the wrists, elbows, knees, ankles and at paravertebral soft tissues in 57 patients with juvenile chronic arthritis (JCA) and 69 healthy controls, aged 6-17 yr. The PTs were correlated to visual analogue scales (VAS) and values of articular disease activity, to define their relation with pain perception and joint inflammation. The PTs in JCA patients were significantly lower than in their healthy peers, both in children with active inflammation as well as in children without detectable inflammation. The JCA group with active inflammation showed significant lower PTs than without detectable inflammation. Disease activity and VAS correlated significantly with PT (r = -0.5). There is an enhanced sensitivity to noxious stimuli in all measured body areas, suggesting a change in the pain processing system in JCA. The sensitivity endures in JCA patients without clinically active disease, probably due to prolonged central sensitization after periods of active disease.
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Affiliation(s)
- J A Hogeweg
- Faculty of Medicine, University at Utrecht, University Hospital for Children and Youth, Het Wilhelmina, Kinderziekenhuis, The Netherlands
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