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Cremers AJH, Coolen JPM, Bleeker-Rovers CP, van der Geest-Blankert ADJ, Haverkate D, Hendriks H, Henriet SSV, Huynen MA, Kolwijck E, Liem D, Melchers WJG, Rossen JW, Zoll J, van Heijst A, Hopman J, Wertheim HFL. Surveillance-embedded genomic outbreak resolution of methicillin-susceptible Staphylococcus aureus in a neonatal intensive care unit. Sci Rep 2020; 10:2619. [PMID: 32060342 PMCID: PMC7021795 DOI: 10.1038/s41598-020-59015-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 01/22/2020] [Indexed: 01/14/2023] Open
Abstract
We observed an increase in methicillin-susceptible Staphylococcus aureus (MSSA) infections at a Dutch neonatal intensive care unit. Weekly neonatal MSSA carriage surveillance and cross-sectional screenings of health care workers (HCWs) were available for outbreak tracing. Traditional clustering of MSSA isolates by spa typing and Multiple-Locus Variable number tandem repeat Analysis (MLVA) suggested that nosocomial transmission had contributed to the infections. We investigated whether whole-genome sequencing (WGS) of MSSA surveillance would provide additional evidence for transmission. MSSA isolates from neonatal infections, carriage surveillance, and HCWs were subjected to WGS and bioinformatic analysis for identification and localization of high-quality single nucleotide polymorphisms, and in-depth analysis of subsets of isolates. By measuring the genetic diversity in background surveillance, we defined transmission-level relatedness and identified isolates that had been unjustly assigned to clusters based on MLVA, while spa typing was concordant but of insufficient resolution. Detailing particular subsets of isolates provided evidence that HCWs were involved in multiple outbreaks, yet it alleviated concerns about one particular HCW. The improved resolution and accuracy of genomic outbreak analyses substantially altered the view on outbreaks, along with apposite measures. Therefore, inclusion of the circulating background population has the potential to overcome current issues in genomic outbreak inference.
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Affiliation(s)
- A J H Cremers
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands.
| | - J P M Coolen
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - C P Bleeker-Rovers
- Department of Internal Medicine, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | | | - D Haverkate
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - H Hendriks
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - S S V Henriet
- Department of Pediatrics, Radboudumc Amalia Children's Hospital, Nijmegen, the Netherlands
| | - M A Huynen
- Centre for Molecular and Biomolecular Informatics, Radboud Institute for Molecular Life Sciences, Radboudumc, Nijmegen, the Netherlands
| | - E Kolwijck
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - D Liem
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - W J G Melchers
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - J W Rossen
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - J Zoll
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - A van Heijst
- Department of Neonatology, Radboudumc, Nijmegen, the Netherlands
| | - J Hopman
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
| | - H F L Wertheim
- Department of Medical Microbiology, Radboudumc center for infectious diseases, Nijmegen, the Netherlands
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Bijleveld YA, Mathôt R, van der Lee JH, Groenendaal F, Dijk PH, van Heijst A, Simons S, Dijkman KP, van Straaten H, Rijken M, Zonnenberg IA, Cools F, Zecic A, Nuytemans D, van Kaam AH, de Haan TR. Population Pharmacokinetics of Amoxicillin in Term Neonates Undergoing Moderate Hypothermia. Clin Pharmacol Ther 2017; 103:458-467. [PMID: 28555724 DOI: 10.1002/cpt.748] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 05/15/2017] [Indexed: 12/23/2022]
Abstract
The pharmacokinetics (PK) of amoxicillin in asphyxiated newborns undergoing moderate hypothermia were quantified using prospective data (N = 125). The population PK was described by a 2-compartment model with a priori birthweight (BW) based allometric scaling. Significant correlations were observed between clearance (Cl) and postnatal age (PNA), gestational age (GA), body temperature (TEMP), and urine output (UO). For a typical patient with GA 40 weeks, BW 3,000 g, 2 days PNA (i.e., TEMP 33.5°C), and normal UO, Cl was 0.26 L/h (interindividual variability (IIV) 41.9%) and volume of distribution of the central compartment was 0.34 L/kg (IIV of 114.6%). For this patient, Cl increased to 0.41 L/h at PNA 5 days and TEMP 37.0°C. The respective contributions of both covariates were 23% and 27%. Based on Monte Carlo simulations we recommend 50 and 75 mg/kg/24h amoxicillin in three doses for patients with GA 36-37 and 38-42 weeks, respectively.
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Affiliation(s)
- Y A Bijleveld
- Department of Pharmacy, Academic Medical Center, Amsterdam, The Netherlands
| | - Raa Mathôt
- Department of Pharmacy, Academic Medical Center, Amsterdam, The Netherlands
| | - J H van der Lee
- Paediatric Clinical Research Office, Emma Children's Hospital, Academic Medical Center, University of Amsterdam, The Netherlands
| | - F Groenendaal
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Center Utrecht, Utrecht, The Netherlands
| | - P H Dijk
- Department of Neonatology, University of Groningen, Groningen, The Netherlands
| | - A van Heijst
- Department of Neonatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Shp Simons
- Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - K P Dijkman
- Department of Neonatology, Máxima Medical Center Veldhoven, Veldhoven, The Netherlands
| | - Hlm van Straaten
- Department of Neonatology, Isala Clinics, Zwolle, The Netherlands
| | - M Rijken
- Department of Neonatology, Leiden University Medical Center, Leiden, The Netherlands
| | - I A Zonnenberg
- Department of Neonatology, VU University Medical Center, Amsterdam, The Netherlands
| | - F Cools
- Department of Neonatology, Vrije Universiteit Brussel, Brussels, Belgium
| | - A Zecic
- Department of Neonatology, Academic Medical Center, Gent, Belgium
| | | | - A H van Kaam
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
| | - T R de Haan
- Department of Neonatology, Emma Children's Hospital, Academic Medical Center, Amsterdam, The Netherlands
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Geurtzen R, Draaisma J, Hermens R, Scheepers H, Woiski M, van Heijst A, Hogeveen M. Prenatal (non)treatment decisions in extreme prematurity: evaluation of Decisional Conflict and Regret among parents. J Perinatol 2017; 37:999-1002. [PMID: 28617426 DOI: 10.1038/jp.2017.90] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 05/01/2017] [Accepted: 05/15/2017] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate Decisional Conflict and Regret among parents regarding the decision on initiating comfort or active care in extreme prematurity and to relate these to decision-making characteristics. STUDY DESIGN A nationwide, multicenter, cross-sectional study using an online survey in the Netherlands. Data were collected from March 2015 to March 2016 among all parents with infants born at 24+0/7-24+6/7 weeks gestational age in 2010-2013. The survey contained a Decisional Conflict and Decision Regret Scale (potential scores range from 0 to 100) and decision-making characteristics. RESULTS Sixty-one surveys were returned (response rate 27%). The median Decisional Conflict score was 28. From the subscores within Decisional Conflict, 'values clarity' revealed the highest median score of 42-revealing that parents felt unclear about personal values for benefits and risks of the decision on either comfort care or active care. The median Decision Regret score was 0. Regret scores were influenced by the actual decision made and by outcome: Decision Regret was lower in the active care group and in the survivor group. CONCLUSION We found little Decisional Conflict and no Decision Regret among parents regarding decision-making at 24 weeks gestation.
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Affiliation(s)
- R Geurtzen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - J Draaisma
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - R Hermens
- Scientific Institute for Quality of Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Scheepers
- Department of Gynecology, Maastricht UMC+, Maastricht, The Netherlands
| | - M Woiski
- Department of Gynecology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A van Heijst
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
| | - M Hogeveen
- Department of Pediatrics, Radboud University Medical Center Amalia Children's Hospital, Nijmegen, The Netherlands
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Reiss I, Schaible T, van den Hout L, Capolupo I, Allegaert K, van Heijst A, Gorett Silva M, Greenough A, Tibboel D. Standardized postnatal management of infants with congenital diaphragmatic hernia in Europe: the CDH EURO Consortium consensus. Neonatology 2010; 98:354-64. [PMID: 20980772 DOI: 10.1159/000320622] [Citation(s) in RCA: 197] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 08/24/2010] [Indexed: 11/19/2022]
Abstract
Congenital diaphragmatic hernia (CDH) is associated with high mortality and morbidity. To date, there are no standardized protocols for the treatment of infants with this anomaly. However, protocols based on the literature and expert opinion might improve outcome. This paper is a consensus statement from the CDH EURO Consortium prepared with the aim of achieving standardized postnatal treatment in European countries. During a consensus meeting between high-volume centers with expertise in the treatment of CDH in Europe (CDH EURO Consortium), the most recent literature on CDH was discussed. Thereafter, 5 experts graded the studies according to the Scottish Intercollegiate Guidelines Network (SIGN) Criteria. Differences in opinion were discussed until full consensus was reached. The final consensus statement, therefore, represents the opinion of all consortium members. Multicenter randomized controlled trials on CDH are lacking. Use of a standardized protocol, however, may contribute to more valid comparisons of patient data in multicenter studies and identification of areas for further research.
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Affiliation(s)
- I Reiss
- Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands. i.reiss @ erasmusmc.nl
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van Heijst A. Ecstasy intoxication and gastric lavage. J Toxicol Clin Toxicol 1999; 37:345. [PMID: 10384801 DOI: 10.1081/clt-100102520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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