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Mak WA, Visser W, Koeleman JGM, Ong DSY. SARS-CoV-2-specific T cell responses: a comparative analysis between QuantiFERON SARS-CoV-2, T-SPOT.COVID, and an in-house Omicron ELISpot. J Virol Methods 2024:114949. [PMID: 38710307 DOI: 10.1016/j.jviromet.2024.114949] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/07/2023] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 05/08/2024]
Abstract
BACKGROUND T cell immunity plays a pivotal role in mitigating the severity of coronavirus disease 2019 (COVID-19). Therefore, reliable functional T cell assays are required to evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific T cell immunity in specific patient populations. METHODS We recruited a cohort of 23 healthcare workers who received their bivalent Omicron BA.1 / ancestral mRNA booster vaccination or were infected with the Omicron variant at a median of 144 days and 227 days before blood collection, respectively. In this cohort, we compared the performances of two widely utilized commercial SARS-CoV-2 interferon-gamma release assays (IGRAs), i.e., QuantiFERON SARS-CoV-2 and T-SPOT.COVID, and an in-house designed Omicron enzyme-linked immunospot (ELISpot). RESULTS The QuantiFERON SARS-CoV-2 and T-SPOT.COVID assays detected SARS-CoV-2 spike-specific T cells in 34.8% and 21.7% of participants, respectively. Moreover, our in-house designed ELISpot that included Omicron BA.4 and BA.5 full-spike peptides detected T cell responses in 47.8% of participants and was strongly associated with the T-SPOT.COVID. CONCLUSION The evaluation of SARS-CoV-2 T cell immunity using commercially accessible assays may yield disparate outcomes as results from different assays are not directly comparable. A specific Omicron ELISpot should be considered to assess Omicron-specific T cell immunity.
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Affiliation(s)
- Willem A Mak
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers,, Amsterdam Infection and Immunity Institute, Amsterdam, the Netherlands.
| | - Wendy Visser
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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2
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Koeleman JGM, Mol S, Brand H, Ong DSY. Evaluation of a New Standardized Nasal Sampling Method for Detection of SARS-CoV-2 RNA via RT-PCR. Microorganisms 2024; 12:210. [PMID: 38276195 PMCID: PMC10820932 DOI: 10.3390/microorganisms12010210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Revised: 01/15/2024] [Accepted: 01/16/2024] [Indexed: 01/27/2024] Open
Abstract
The aim of this study was to compare the diagnostic accuracy of nasal sampling using a novel anterior nasal swab (ANS) (Rhinoswab) versus combined oro-nasopharyngeal (OP/NP) sampling in COVID-19 suspected patients. This prospective observational study was performed from 11 November to 2 December 2021 (part 1), and from 16 January to 22 February 2022 (part 2). Adult patients who attended the emergency room with suspected COVID-19 were asked to participate. One ANS and one OP/NP sample were consecutively collected, and both were analyzed via reverse transcription polymerase chain reaction (RT-PCR). The result of the OP/NP sample was considered to be the reference standard. A total of 412 patients were included, of whom 171 (41.5%) had a positive RT-PCR of the OP/NP swab, whereas 139 (33.7%) were positive on the ANS sample. The overall diagnostic accuracy for ANS sampling in terms of sensitivity, specificity, positive predictive value, and negative predictive value was 80.7% (95% CI 73.8-86.2), 99.6% (95% CI 97.3-100), 99.3% (95% CI 95.5-100), and 87.9% (95% CI 83.3-91.4), respectively. In conclusion, ANS sampling with the Rhinoswab identified 80.7% of all presented COVID-19 patients in an emergency department. Future studies should investigate if nasal Rhinoswab self-sampling is suitable for reliable diagnosis of COVID-19 in an outpatient setting.
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Affiliation(s)
- Johannes G. M. Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, 3045 PM Rotterdam, The Netherlands; (J.G.M.K.); (H.B.)
| | - Sander Mol
- Emergency Department, Franciscus Gasthuis & Vlietland Hospital, 3045 PM Rotterdam, The Netherlands;
| | - Henk Brand
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, 3045 PM Rotterdam, The Netherlands; (J.G.M.K.); (H.B.)
| | - David S. Y. Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, 3045 PM Rotterdam, The Netherlands; (J.G.M.K.); (H.B.)
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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3
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Zwiers LC, Ong DSY, Grobbee DE. Correction: COVID-19 Vaccine-Induced Myocarditis and Pericarditis: Towards Identification of Risk Factors. Glob Heart 2024; 19:1. [PMID: 38222096 PMCID: PMC10785952 DOI: 10.5334/gh.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 01/16/2024] Open
Abstract
[This corrects the article DOI: 10.5334/gh.1252.].
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Affiliation(s)
- Laura C. Zwiers
- Julius Clinical, Zeist, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
| | - David S. Y. Ong
- Julius Clinical, Zeist, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, The Netherlands
| | - Diederick E. Grobbee
- Julius Clinical, Zeist, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands
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Maraolo AE, Ong DSY. Colistin plus meropenem versus colistin alone for invasive infections caused by carbapenem-resistant Acinetobacter baumannii: a rapid systematic review of randomized controlled trials using Bayesian meta-analysis. Clin Microbiol Infect 2023; 29:1208-1210. [PMID: 37277093 DOI: 10.1016/j.cmi.2023.05.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/27/2023] [Accepted: 05/30/2023] [Indexed: 06/07/2023]
Affiliation(s)
- Alberto E Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, Naples, Italy.
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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5
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Mak WA, Visser W, van der Vliet M, Markus HY, Koeleman JGM, Ong DSY. Ancestral SARS-CoV-2 and Omicron BA.5-specific neutralizing antibody and T-cell responses after Omicron bivalent booster vaccination in previously infected and infection-naive individuals. J Med Virol 2023; 95:e28989. [PMID: 37565645 DOI: 10.1002/jmv.28989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/28/2023] [Accepted: 07/16/2023] [Indexed: 08/12/2023]
Abstract
Coronavirus disease-2019 (COVID-19) bivalent ancestral/Omicron messenger RNA (mRNA) booster vaccinations became available to boost and expand the immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infections. In a prospective cohort study including 59 healthcare workers, we assessed SARS-CoV-2 ancestral and Omicron BA.5-specific neutralizing antibody and T-cell responses in previously infected and infection-naive individuals. Also, we assessed the effect of an ancestral/Omicron BA.1 bivalent mRNA booster vaccination on these immune responses. 10 months after previous monovalent mRNA vaccinations, ancestral SARS-CoV-2 S1-specific T-cell and anti-RBD IgG responses remained detectable in most individuals and a previous SARS-CoV-2 infection was associated with increased T-cell responses. T-cell responses, anti-RBD IgG, and Omicron BA.5 neutralization activity increased after receiving an ancestral/Omicron BA.1 bivalent booster mRNA vaccination. An Omicron BA.5 infection in addition to bivalent vaccination, led to a higher ratio of Omicron BA.5 to ancestral strain neutralization activity compared to no bivalent vaccination and no recent SARS-CoV-2 infection. In conclusion, SARS-CoV-2 T-cell and antibody responses persist for up to 10 months after a monovalent booster mRNA vaccination. An ancestral/Omicron BA.1 bivalent booster mRNA vaccination increases these immune responses and also induces Omicron BA.5 cross-neutralization antibody activity. Finally, our data indicate that hybrid immunity is associated with improved preservation of T-cell immunity.
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Affiliation(s)
- Willem A Mak
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Wendy Visser
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Marijke van der Vliet
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Hilde Y Markus
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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6
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Zwiers LC, Ong DSY, Grobbee DE. COVID-19 Vaccine-Induced Myocarditis and Pericarditis: Towards Identification of Risk Factors. Glob Heart 2023; 18:39. [PMID: 38533475 PMCID: PMC10964799 DOI: 10.5334/gh.1252] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/27/2023] [Indexed: 03/28/2024] Open
Affiliation(s)
- Laura C. Zwiers
- Julius Clinical, Zeist, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - David S. Y. Ong
- Julius Clinical, Zeist, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Diederick E. Grobbee
- Julius Clinical, Zeist, The Netherlands
- Julius Global Health, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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7
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Ong DSY, de Man P, Verhagen T, Doejaaren G, Dallinga MA, Alibux E, Janssen ML, Wils EJ. Airborne virus shedding of the alpha, delta, omicron SARS-CoV-2 variants and influenza virus in hospitalized patients. J Med Virol 2023; 95:e28748. [PMID: 37185846 DOI: 10.1002/jmv.28748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
Airborne transmission is an important transmission route for the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological data indicate that certain SARS-CoV-2 variants, like the omicron variant, are associated with higher transmissibility. We compared virus detection in air samples between hospitalized patients infected with different SARS-CoV-2 variants or influenza virus. The study was performed during three separate time periods in which subsequently the alpha, delta, and omicron SARS-CoV-2 variants were predominant. In total, 79 patients with coronavirus disease 2019 (COVID-19) and 22 patients with influenza A virus infection were included. Collected air samples were positive in 55% of patients infected with the omicron variant in comparison to 15% of those infected with the delta variant (p < 0.01). In multivariable analysis, the SARS-CoV-2 omicron BA.1/BA.2 variant (as compared to the delta variant) and the viral load in nasopharynx were both independently associated with air sample positivity, but the alpha variant and COVID-19 vaccination were not. The proportion of positive air samples patients infected with the influenza A virus was 18%. In conclusion, the higher air sample positivity rate of the omicron variant compared to previous SARS-CoV-2 variants may partially explain the higher transmission rates seen in epidemiological trends.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Verhagen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Gerda Doejaaren
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Marloes A Dallinga
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Esmee Alibux
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Matthijs L Janssen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
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8
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Fragkou PC, Moschopoulos CD, Dimopoulou D, Ong DSY, Dimopoulou K, Nelson PP, Schweitzer VA, Janocha H, Karofylakis E, Papathanasiou KA, Tsiordras S, De Angelis G, Thölken C, Sanguinetti M, Chung HR, Skevaki C. Performance of point-of care molecular and antigen-based tests for SARS-CoV-2: a living systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:291-301. [PMID: 36336237 PMCID: PMC9660861 DOI: 10.1016/j.cmi.2022.10.028] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 10/05/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Molecular and antigen point-of-care tests (POCTs) have augmented our ability to rapidly identify and manage SARS-CoV-2 infection. However, their clinical performance varies among individual studies. OBJECTIVES The evaluation of the performance of molecular and antigen-based POCTs in confirmed, suspected, or probable COVID-19 cases compared with that of laboratory-based RT-PCR in real-life settings. DATA SOURCES MEDLINE/PubMed, Scopus, Embase, Web of Science, Cochrane Library, Cochrane COVID-19 study register, and COVID-19 Living Evidence Database from the University of Bern. STUDY ELIGIBILITY CRITERIA Peer-reviewed or preprint observational studies or randomized controlled trials that evaluated any type of commercially available antigen and/or molecular POCTs for SARS-CoV-2, including multiplex PCR panels, approved by the United States Food and Drug Administration, with Emergency Use Authorization, and/or marked with Conformitè Europëenne from European Commission/European Union. PARTICIPANTS Close contacts and/or patients with symptomatic and/or asymptomatic confirmed, suspected, or probable COVID-19 infection of any age. TEST/S Molecular and/or antigen-based SARS-CoV-2 POCTs. REFERENCE STANDARD Laboratory-based SARS-CoV-2 RT-PCR. ASSESSMENT OF RISK OF BIAS Eligible studies were subjected to quality-control and risk-of-bias assessment using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. METHODS OF DATA SYNTHESIS Summary sensitivities and specificities with their 95% CIs were estimated using a bivariate model. Subgroup analysis was performed when at least three studies informed the outcome. RESULTS A total of 123 eligible publications (97 and 26 studies assessing antigen-based and molecular POCTs, respectively) were retrieved from 4674 initial records. The pooled sensitivity and specificity for 13 molecular-based POCTs were 92.8% (95% CI, 88.9-95.4%) and 97.6% (95% CI, 96.6-98.3%), respectively. The sensitivity of antigen-based POCTs pooled from 138 individual evaluations was considerably lower than that of molecular POCTs; the pooled sensitivity and specificity rates were 70.6% (95% CI, 67.2-73.8%) and 98.9% (95% CI, 98.5-99.2%), respectively. DISCUSSION Further studies are needed to evaluate the performance of molecular and antigen-based POCTs in underrepresented patient subgroups and different respiratory samples.
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Affiliation(s)
- Paraskevi C Fragkou
- First Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland
| | - Charalampos D Moschopoulos
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitra Dimopoulou
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Second Department of Paediatrics, 'Panagiotis and Aglaia Kyriakou' Children's Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - David S Y Ong
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | | | - Philipp P Nelson
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany
| | - Valentijn A Schweitzer
- Department of Medical Microbiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hannah Janocha
- Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany
| | - Emmanouil Karofylakis
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos A Papathanasiou
- Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Sotirios Tsiordras
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Fourth Department of Internal Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Giulia De Angelis
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Clemens Thölken
- Center for Synthetic Microbiology, Philipps-Universität, Marburg, Germany
| | - Maurizio Sanguinetti
- Dipartimento di Scienze biotecnologiche di base, cliniche intensivologiche e perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy; Dipartimento di Scienze di Laboratorio e Infettivologiche, Fondazione Policlinico Universitario A. Gemelli Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy
| | - Ho-Ryun Chung
- Institut für Medizinische Bioinformatik und Biostatistik, Philipps-Universität Marburg, Marburg, Germany
| | - Chrysanthi Skevaki
- The European Society of Clinical Microbiology and Infection Study Group for Respiratory Viruses, Basel, Switzerland; Institute of Laboratory Medicine, Universities of Giessen and Marburg Lung Center, Philipps University Marburg, German Center for Lung Research (DZL) Marburg, Marburg, Germany.
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9
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Michels EHA, Butler JM, Reijnders TDY, Cremer OL, Scicluna BP, Uhel F, Peters-Sengers H, Schultz MJ, Knight JC, van Vught LA, van der Poll T, Bos LDJ, Glas GJ, Hoogendijk AJ, van Hooijdonk RTM, Horn J, Huson MA, Schouten LRA, Straat M, Wieske L, Wiewel MA, Witteveen E, Bonten MJM, Cremer OM, Ong DSY, Frencken JF, Klouwenberg PMCK, Koster‐Brouwer ME, van de Groep K, Verboom DM. Association between age and the host response in critically ill patients with sepsis. Crit Care 2022; 26:385. [PMID: 36514130 PMCID: PMC9747080 DOI: 10.1186/s13054-022-04266-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The association of ageing with increased sepsis mortality is well established. Nonetheless, current investigations on the influence of age on host response aberrations are largely limited to plasma cytokine levels while neglecting other pathophysiological sepsis domains like endothelial cell activation and function, and coagulation activation. The primary objective of this study was to gain insight into the association of ageing with aberrations in key host response pathways and blood transcriptomes in sepsis. METHODS We analysed the clinical outcome (n = 1952), 16 plasma biomarkers providing insight in deregulation of specific pathophysiological domains (n = 899), and blood leukocyte transcriptomes (n = 488) of sepsis patients stratified according to age decades. Blood transcriptome results were validated in an independent sepsis cohort and compared with healthy individuals. RESULTS Older age was associated with increased mortality independent of comorbidities and disease severity. Ageing was associated with lower endothelial cell activation and dysfunction, and similar inflammation and coagulation activation, despite higher disease severity scores. Blood leukocytes of patients ≥ 70 years, compared to patients < 50 years, showed decreased expression of genes involved in cytokine signaling, and innate and adaptive immunity, and increased expression of genes involved in hemostasis and endothelial cell activation. The diminished expression of gene pathways related to innate immunity and cytokine signaling in subjects ≥ 70 years was sepsis-induced, as healthy subjects ≥ 70 years showed enhanced expression of these pathways compared to healthy individuals < 50 years. CONCLUSIONS This study provides novel evidence that older age is associated with relatively mitigated sepsis-induced endothelial cell activation and dysfunction, and a blood leukocyte transcriptome signature indicating impaired innate immune and cytokine signaling. These data suggest that age should be considered in patient selection in future sepsis trials targeting the immune system and/or the endothelial cell response.
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Affiliation(s)
- Erik H. A. Michels
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Joe M. Butler
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Tom D. Y. Reijnders
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Olaf L. Cremer
- grid.7692.a0000000090126352Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Brendon P. Scicluna
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,grid.4462.40000 0001 2176 9482Department of Applied Biomedical Science, Faculty of Health Sciences, Mater Dei Hospital, University of Malta, Msida, Malta ,grid.4462.40000 0001 2176 9482Centre for Molecular Medicine and Biobanking, University of Malta, Msida, Malta
| | - Fabrice Uhel
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Hessel Peters-Sengers
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Marcus J. Schultz
- grid.7177.60000000084992262Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands ,grid.10223.320000 0004 1937 0490Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand ,grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Julian C. Knight
- grid.4991.50000 0004 1936 8948Nuffield Department of Medicine, University of Oxford, Oxford, UK ,grid.4991.50000 0004 1936 8948Wellcome Centre for Human Genetics, University of Oxford, Oxford, UK
| | - Lonneke A. van Vught
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- grid.7177.60000000084992262Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands ,grid.7177.60000000084992262Division of Infectious Diseases, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands
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Ong DSY, Chong GLM, Chemaly RF, Cremer OL. Comparative clinical manifestations and immune effects of cytomegalovirus infections following distinct types of immunosuppression. Clin Microbiol Infect 2022; 28:1335-1344. [PMID: 35709902 DOI: 10.1016/j.cmi.2022.05.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 02/28/2022] [Revised: 05/23/2022] [Accepted: 05/30/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is a well-recognized complication of solid organ and hematopoietic cell transplantation. However, CMV infection also occurs in patients with human immunodeficiency virus (HIV) infection, previously immunocompetent intensive care unit (ICU) patients, and individuals on immunosuppressive medications for various underlying diseases. OBJECTIVES This review describes the comparative effects of CMV infection in distinct types of acquired immunosuppression. SOURCES Selected peer-reviewed publications on CMV infections published until December 2021. CONTENT CMV infection affects various organ systems through direct cytolytic mechanisms, but may also exert indirect effects by promoting pro-inflammatory and immunosuppressive responses. This has been well studied in transplant recipients, for whom antiviral prophylaxis and pre-emptive therapy have now become standard practice. These strategies not only prevent direct CMV disease manifestations, but also mitigate various immunopathological processes to reduce graft-versus-host disease, graft rejection, and the occurrence of secondary bacterial and fungal infections. The efficacy of neither prophylactic nor pre-emptive treatment of CMV infection has been demonstrated for patients with critical illness- or medication-induced immunosuppression. Many observational studies have shown an independent association between CMV reactivation and a prolonged duration of mechanical ventilation or increased mortality in the ICU. Furthermore, data suggest that CMV reactivation may increase pulmonary inflammation and prolong the duration of mechanical ventilation. IMPLICATIONS A large number of observational and experimental studies suggest attributable morbidity and mortality related to CMV infection, not only in transplant recipients and patients with HIV infection but also in patients with critically illness- or medication-induced immunosuppression. Adequately powered randomized controlled trials investigating the efficacy of prophylaxis or pre-emptive treatment of CMV infection in these patients are lacking, with a notable exception for transplant recipients.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Ga-Lai M Chong
- Erasmus University Medical Center, Department of Medical Microbiology & Infectious Diseases, Rotterdam, the Netherlands
| | - Roy F Chemaly
- Department of Infectious Diseases, Infection Control, & Employee Health, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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11
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Mak WA, Koeleman JGM, Ong DSY. Comparison between an in-house SARS-CoV-2 ELISpot and the T-Spot® Discovery SARS-CoV-2 for the assessment of T cell responses in prior SARS-CoV-2 infected individuals. J Clin Virol 2022; 150-151:105158. [PMID: 35447515 PMCID: PMC9005222 DOI: 10.1016/j.jcv.2022.105158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/28/2022] [Accepted: 04/09/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Willem A Mak
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands.
| | - Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis en Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
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12
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Carrara E, Ong DSY, Hussein K, Keske S, Johansson AF, Presterl E, Tsioutis C, Tschudin-Sutter S, Tacconelli E. ESCMID guidelines on testing for SARS-CoV-2 in asymptomatic individuals to prevent transmission in the healthcare setting. Clin Microbiol Infect 2022; 28:672-680. [PMID: 35124258 PMCID: PMC8812094 DOI: 10.1016/j.cmi.2022.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/14/2022] [Accepted: 01/16/2022] [Indexed: 12/20/2022]
Abstract
Scope This guideline addresses the indications for direct testing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in asymptomatic individuals in health care facilities, with the aim to prevent SARS-CoV-2 transmissions in these settings. The benefit of testing asymptomatic individuals to create a safe environment for patients and health care workers must be weighed against potential unintended consequences, including delaying necessary treatments owing to false positive results and lower quality of care owing to strict isolation measures. Methods A total of nine PICOs (population, intervention, comparison, outcome) on the topic of testing asymptomatic individuals was selected by the panel members. Subsequently, a literature search for existing guidelines and systematic reviews was performed on PubMed, Epistemonikos, and RecMap using relevant filters available in each database. Data on article/recommendation type, setting, target population, intervention, and quality of the evidence were extracted. Credibility of the systematic reviews was evaluated using the AMSTAR tool, and level of agreement with available recommendation was evaluated with the AGREE II score. Because the evidence available from systematic reviews was deemed insufficiently updated to formulate relevant recommendations, an additional search targeting relevant guidance documents from major public health institutions and original studies was performed. Provisional recommendations were discussed via web conferences until agreement was reached, and final recommendations were formulated according to the GRADE approach. Recommendations Recommendations were formulated regarding systematic testing in asymptomatic individuals upon admission to a health care setting, during hospital stay, before elective procedures, and before scheduled nonsurgical procedures. Moreover, recommendations regarding testing of asymptomatic visitors, personal caregivers, and health care workers in health care facilities were presented. Recommendations also were given on contact tracing in asymptomatic patients or health care workers and the possibility of a negative screening test to shorten the quarantine period. Furthermore, if applicable, recommendations were specified to transmission rate and vaccination coverage.
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Affiliation(s)
- Elena Carrara
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland.
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands; ESCMID Study Group for Respiratory Viruses (ESGREV), Basel, Switzerland
| | - Khetam Hussein
- European Committee on Infection Control (EUCIC), Basel, Switzerland; The Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; Infection Control Unit, Rambam Health Care Campus, Haifa, Israel
| | - Siran Keske
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infectious Diseases and Clinical Microbiology, Koç University School of Medicine, Istanbul, Turkey
| | - Anders F Johansson
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Clinical Microbiology and the Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Elisabeth Presterl
- European Committee on Infection Control (EUCIC), Basel, Switzerland; Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Constantinos Tsioutis
- European Committee on Infection Control (EUCIC), Basel, Switzerland; School of Medicine, European University Cyprus, Nicosia, Cyprus
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Evelina Tacconelli
- Division of Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy; European Committee on Infection Control (EUCIC), Basel, Switzerland
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13
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Rotee ILM, Ong DSY, Koeleman JGM, Vos ERA, Tramper-Stranders GA. Trends in SARS-CoV-2 seroprevalence amongst urban paediatric patients compared with a nationwide cohort in the Netherlands. J Clin Virol Plus 2021; 1:100045. [PMID: 35262026 PMCID: PMC8501184 DOI: 10.1016/j.jcvp.2021.100045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 09/24/2021] [Accepted: 10/02/2021] [Indexed: 11/27/2022] Open
Abstract
Objectives The extent of SARS-CoV-2 infection amongst children and their role in transmission remains unclear. Therefore, we aimed to estimate the SARS-CoV-2 antibody seroprevalence amongst children who presented to our hospital for non-COVID-19-related morbidity during the first and second epidemic wave in 2020 and compared these to the general Dutch paediatric population. Methods We collected residual plasma samples from all paediatric patients (1 month-17 years of age) visiting our clinic or emergency room, who had blood drawing for various medical reasons. Samples were analysed for the presence of total antibodies against SARS-CoV-2 by Wantai ELISA. The seroprevalence in two separate periods (July-Sep 2020, and Oct-Dec 2020) was compared to regional and national data (PIENTER-Corona study, September 2020), and associations with co-morbidities were assessed. Results A total of 209 samples in period 1 and 240 samples in period 2 were collected (median age 7.1 years, IQR 1.5–13.5). SARS-CoV-2 antibodies were detected in 4.1% and 13.8%, respectively (p< 0.001). Seroprevalence was higher compared to national paediatric data, but did not differ with regional estimates. Most children with SARS-CoV-2 antibodies were seen in the outpatient clinic for general paediatric problems with no differences in medical reasons for presentation between the two periods. Conclusions These data confirm a rapid three-fold increase in SARS-CoV-2 seroprevalence in paediatric patients in the second half of 2020 with a trend towards a higher seroprevalence compared to randomly-selected children in a nationwide study. Underlying morbidity in children might not play an important role in acquiring SARS-CoV-2 infection.
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Affiliation(s)
- I L M Rotee
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Netherlands
| | - D S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Netherlands.,Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - J G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Netherlands
| | - E R A Vos
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - G A Tramper-Stranders
- Department of Pediatrics, Franciscus Gasthuis & Vlietland, Netherlands.,Department of Neonatology, Sophia Children's Hospital, Erasmus Medical Center Rotterdam, Netherlands
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14
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de Man P, Ortiz M, Bluyssen PM, de Man SJ, Rentmeester MJ, van der Vliet M, Wils EJ, Ong DSY. Airborne SARS-CoV-2 in home- and hospital environment investigated with a high-powered air sampler. J Hosp Infect 2021; 119:126-131. [PMID: 34752804 PMCID: PMC8572039 DOI: 10.1016/j.jhin.2021.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 12/14/2022]
Abstract
Background The initial aim was to study the effects of face masks worn by recently infected individuals on the airborne spread of SARS-CoV-2, but findings motivated us to proceed with comparing the presence of SARS-CoV-2 in air samples near infected individuals at home with those near infected intensive care unit (ICU) patients. Aim To assess the presence of SARS-CoV-2 in the air of homes of infected individuals and in ICU rooms of critically ill patients with COVID-19 who were undergoing different forms of potential aerosol-generating medical procedures. Methods A high-volume air sampler method was developed that used a household vacuum cleaner with surgical face masks serving as sample filters. SARS-CoV-2 RNA was harvested from these filters and analysed by polymerase chain reaction. Fog experiments were performed to visualize the airflow around the air sampler. Air samples were acquired in close proximity of infected individuals, with or without wearing face masks, in their homes. Environmental air samples remote from these infected individuals were also obtained, plus samples near patients in the ICU undergoing potential aerosol-generating medical procedures. Findings Wearing a face mask resulted in a delayed and reduced flow of the fog into the air sampler. Face masks worn by infected individuals were found to contain SARS-CoV-2 RNA in 71% of cases. SARS-CoV-2 was detected in air samples regardless of mask experiments. The proportion of positive air samples was higher in the homes (29/41; 70.7%) than in the ICU (4/17; 23.5%) (P < 0.01). Conclusion SARS-CoV-2 RNA could be detected in air samples by using a vacuum cleaner based air sampler method. Air samples in the home environment of recently infected individuals contained SARS-CoV-2 RNA nearly three times more frequently by comparison with those obtained in ICU rooms during potential aerosol-generating medical procedures.
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Affiliation(s)
- Peter de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Marco Ortiz
- Indoor Environment, Faculty of Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands
| | - Philomena M Bluyssen
- Indoor Environment, Faculty of Architecture and the Built Environment, Delft University of Technology, Delft, The Netherlands
| | - Stijn J de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Marie-Jozé Rentmeester
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Marijke van der Vliet
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
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15
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Koeleman JGM, Brand H, de Man SJ, Ong DSY. Clinical evaluation of rapid point-of-care antigen tests for diagnosis of SARS-CoV-2 infection. Eur J Clin Microbiol Infect Dis 2021; 40:1975-1981. [PMID: 34021840 PMCID: PMC8140309 DOI: 10.1007/s10096-021-04274-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/06/2021] [Indexed: 10/25/2022]
Abstract
The RT-qPCR in respiratory specimens is the gold standard for diagnosing acute COVID-19 infections. However, this test takes considerable time before test results become available, thereby delaying patients from being diagnosed, treated, and isolated immediately. Rapid antigen tests could overcome this problem. In the first study, clinical performances of five rapid antigen tests were compared to RT-qPCR in upper respiratory specimens from 40 patients with positive and 40 with negative RTq-PCR results. In the second study, the rapid antigen test with one of the best test characteristics (Romed) was evaluated in a large prospective collection of upper respiratory specimens from 900 different COVID-19-suspected patients (300 emergency room patients, 300 nursing home patients, and 300 health care workers). Test specificities ranged from 87.5 to 100.0%, and test sensitivities from 55.0 to 80.0%. The clinical specificity of the Romed test was 99.8% (95% CI 98.9-100). Overall clinical sensitivity in the study population was 73.3% (95% CI 67.9-78.2), whereas sensitivity in the different patient groups varied from 65.3 to 86.7%. Sensitivity was 83.0 to 86.7% in patients with short duration of symptoms. In a population with a COVID-19 prevalence of 1%, the negative predictive value in all patients was 99.7%. There is a large variability in diagnostic performance between rapid antigen tests. The Romed rapid antigen test showed a good clinical performance in patients with high viral loads (RT-qPCR cycle threshold ≤30), which makes this antigen test suitable for rapid identification of COVID-19-infected health care workers and patients.
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Affiliation(s)
- Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Henk Brand
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - Stijn J de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands.
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
- , Rotterdam, The Netherlands.
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16
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Heijnen NFL, Hagens LA, Smit MR, Cremer OL, Ong DSY, van der Poll T, van Vught LA, Scicluna BP, Schnabel RM, van der Horst ICC, Schultz MJ, Bergmans DCJJ, Bos LDJ. Biological Subphenotypes of Acute Respiratory Distress Syndrome Show Prognostic Enrichment in Mechanically Ventilated Patients without Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2021; 203:1503-1511. [PMID: 33465019 DOI: 10.1164/rccm.202006-2522oc] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Rationale: Recent studies showed that biological subphenotypes in acute respiratory distress syndrome (ARDS) provide prognostic enrichment and show potential for predictive enrichment. Objectives: To determine whether these subphenotypes and their prognostic and potential for predictive enrichment could be extended to other patients in the ICU, irrespective of fulfilling the definition of ARDS. Methods: This is a secondary analysis of a prospective observational study of adult patients admitted to the ICU. We tested the prognostic enrichment of both cluster-derived and latent-class analysis (LCA)-derived biological ARDS subphenotypes by evaluating the association with clinical outcome (ICU-day, 30-day mortality, and ventilator-free days) using logistic regression and Cox regression analysis. We performed a principal component analysis to compare blood leukocyte gene expression profiles between subphenotypes and the presence of ARDS. Measurements and Main Results: We included 2,499 mechanically ventilated patients (674 with and 1,825 without ARDS). The cluster-derived "reactive" subphenotype was, independently of ARDS, significantly associated with a higher probability of ICU mortality, higher 30-day mortality, and a lower probability of successful extubation while alive compared with the "uninflamed" subphenotype. The blood leukocyte gene expression profiles of individual subphenotypes were similar for patients with and without ARDS. LCA-derived subphenotypes also showed similar profiles. Conclusions: The prognostic and potential for predictive enrichment of biological ARDS subphenotypes may be extended to mechanically ventilated critically ill patients without ARDS. Using the concept of biological subphenotypes for splitting cohorts of critically ill patients could add to improving future precision-based trial strategies and lead to identifying treatable traits for all critically ill patients.
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Affiliation(s)
- Nanon F L Heijnen
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | | | | | | | - David S Y Ong
- Division of Infectious Diseases.,Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Infection and Immunity
| | - Tom van der Poll
- Laboratory of Experimental Intensive Care and Anesthesiology, and.,Department of Respiratory Medicine, Amsterdam University Medical Centers, location Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | | | - Brendon P Scicluna
- Laboratory of Experimental Intensive Care and Anesthesiology, and.,Department of Intensive Care Medicine and
| | - Ronny M Schnabel
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Iwan C C van der Horst
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Marcus J Schultz
- Department of Intensive Care Medicine.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Department of Medical Microbiology and Infection Control, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Bangkok, Thailand; and
| | - Dennis C J J Bergmans
- Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands
| | - Lieuwe D J Bos
- Department of Intensive Care Medicine.,Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
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de Man P, Paltansing S, Ong DSY, Vaessen N, van Nielen G, Koeleman JGM. Outbreak of Coronavirus Disease 2019 (COVID-19) in a Nursing Home Associated With Aerosol Transmission as a Result of Inadequate Ventilation. Clin Infect Dis 2021; 73:170-171. [PMID: 32857130 PMCID: PMC7499506 DOI: 10.1093/cid/ciaa1270] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Peter de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Sunita Paltansing
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Norbert Vaessen
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Gerard van Nielen
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
| | - Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, The Netherlands
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18
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Maraolo AE, Barac A, Cremer OL, Ong DSY. Editorial: Viral Infections in the Intensive Care Unit. Front Med (Lausanne) 2021; 8:716824. [PMID: 34277675 PMCID: PMC8277976 DOI: 10.3389/fmed.2021.716824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/07/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
- Alberto E Maraolo
- First Division of Infectious Diseases, Cotugno Hospital, Naples, Italy
| | - Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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19
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Ong DSY, Keuren F, van der Vliet M, Boxma-de Klerk BM, Koeleman JGM. SARS-CoV-2 antibody response dynamics and heterogeneous diagnostic performance of four serological tests and a neutralization test in symptomatic healthcare workers with non-severe COVID-19. J Clin Virol 2021; 141:104904. [PMID: 34229209 PMCID: PMC8236075 DOI: 10.1016/j.jcv.2021.104904] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 12/24/2022]
Abstract
Background Most COVID-19 patients experience non-severe illness. The presence of SARS-CoV-2 antibodies suggest possible protection against re-infections in prior SARS-CoV-2 infected individuals. Objectives The aims of this prospective observational study were to longitudinally assess the antibody response during the first 4–6 months after polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection, and to study the diagnostic performance of four different enzyme-linked immunosorbent assays (ELISAs) and a surrogate virus neutralization test (sVNT) in symptomatic healthcare workers (HCWs) with non-severe COVID-19. Study design HCWs in a teaching hospital were included between March 8 and June 15, 2020, when they had a PCR-confirmed SARS-CoV-2 infection in the past 3 months. The performances of four ELISAs (Wantai, Bio-Rad Platelia, BioTrading Immy clarus, and Euroimmun) were evaluated in serum samples obtained at the moment of study inclusion and subsequently at 1, 2 and 3 months thereafter. Furthermore, in the last available serum sample sVNT by GenScript was performed. Results 309 samples from 80 positive HCWs were included of whom 70 (88%) were SARS-CoV-2 seropositive. The detection rates of SARS-CoV-2 antibodies by the different ELISAs were heterogenous ranging from 64% for the Euroimmun ELISA to 88% for the Wantai ELISA. The Wantai ELISA had the highest and almost perfect agreement with sVNT (96%, Cohen's kappa 0.83). Conclusion SARS-CoV-2 (neutralizing) antibodies were detectable in most symptomatic individuals with non-severe COVID-19. The presence of antibodies remained stable up to six months after initial infection. There is large variability in diagnostic test performance between ELISA tests.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Frans Keuren
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Marijke van der Vliet
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Bianca M Boxma-de Klerk
- Department of Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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20
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Ong DSY, Koeleman JGM, Vaessen N, Breijer S, Paltansing S, de Man P. Rapid screening method for the detection of SARS-CoV-2 variants of concern. J Clin Virol 2021; 141:104903. [PMID: 34182300 PMCID: PMC8213512 DOI: 10.1016/j.jcv.2021.104903] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/10/2021] [Accepted: 06/14/2021] [Indexed: 11/18/2022]
Abstract
Background Comprehensive and up-to-date monitoring of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern (VOC) is crucial as these are characterized by their increased transmissibility, immune evasion and virulence. Objectives To describe the wide-scale implementation of a reverse transcriptase polymerase chain reaction (RT-PCR) multiple variants assay with melting curve analysis as a routine procedure. Study design We prospectively performed multiple variants RT-PCR on consecutive SARS-CoV-2 RT-PCR positive samples from patients, healthcare workers and nursing home residents from our hospital catchment area. This technique was implemented in our automated Roche FLOW system with a turn-around time of 6 h. Results Between February 1 and May 2, 2021, 989 samples were tested by the variant RT-PCR. Our method was validated by comparison of variant RT-PCR to whole genome sequencing testing. We observed an increase over time in the proportion of UK variant that became the dominant variant, and the concurrent emergence of the South-African and Brazilian variants. Prompt public health responses for infection control were possible because of this rapid screening method, resulting in early detection and reduction of unnoticed spread of VOC as early as possible. Conclusion A variant RT-PCR with additional melting curve analyses is a feasible, rapid and efficient screening strategy that can be implemented in routine microbiological laboratories.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Johannes G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Norbert Vaessen
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Simone Breijer
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Sunita Paltansing
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Peter de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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21
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Elderman JH, Ong DSY, van der Voort PHJ, Wils EJ. Anti-infectious decontamination strategies in Dutch intensive care units: A survey study on contemporary practice and heterogeneity. J Crit Care 2021; 64:262-269. [PMID: 34052572 DOI: 10.1016/j.jcrc.2021.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/29/2022]
Abstract
PURPOSE Despite increasing evidence and updated national guidelines, practice of anti-infectious strategies appears to vary in the Netherlands. This study aimed to determine the variation of current practices of anti-infectious strategies in Dutch ICUs. MATERIALS AND METHODS In 2018 and 2019 an online survey of all Dutch ICUs was conducted with detailed questions on their anti-infectious strategies. RESULTS 89% (63 of 71) of the Dutch ICUs responded to the online survey. The remaining ICUs were contacted by telephone. 47 (66%) of the Dutch ICUs used SDD, 14 (20%) used SOD and 10 (14%) used neither SDD nor SOD. Within these strategies considerable heterogeneity was observed in the start criteria of SDD/SOD, the regimen adjustments based on microbiological surveillance and the monitoring of the interventions. CONCLUSIONS The proportion of Dutch ICUs applying SDD or SOD increased over time. Considerable heterogeneity in the regimens was reported. The impact of the observed differences within SDD and SOD practices on clinical outcome remains to be explored.
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Affiliation(s)
- J H Elderman
- Department of Intensive Care, IJsselland Hospital, Capelle aan den IJssel, the Netherlands; Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands.
| | - D S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - P H J van der Voort
- Department of Critical Care, University Medical Center Groningen, Groningen, the Netherlands
| | - E-J Wils
- Department of Intensive Care, Erasmus Medical Center, Rotterdam, the Netherlands; Department of Intensive Care, Franciscus Gasthuis & Vlietland Hospital, Rotterdam, the Netherlands
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22
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Barac A, Poljak M, Ong DSY. Editorial: Innovative Approaches in Diagnosis of Emerging/Re-emerging Infectious Diseases. Front Microbiol 2020; 11:619498. [PMID: 33343557 PMCID: PMC7744347 DOI: 10.3389/fmicb.2020.619498] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 11/11/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
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23
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Simonis FD, Schouten LRA, Cremer OL, Ong DSY, Amoruso G, Cinella G, Schultz MJ, Bos LD. Prognostic classification based on P/F and PEEP in invasively ventilated ICU patients with hypoxemia-insights from the MARS study. Intensive Care Med Exp 2020; 8:43. [PMID: 33336322 PMCID: PMC7746417 DOI: 10.1186/s40635-020-00334-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/15/2022] Open
Abstract
Background Outcome prediction in patients with acute respiratory distress syndrome (ARDS) greatly improves when patients are reclassified based on predefined arterial oxygen partial pressure to fractional inspired oxygen ratios (PaO2/FiO2) and positive end–expiratory pressure (PEEP) cutoffs 24 h after the initial ARDS diagnosis. The aim of this study was to test whether outcome prediction improves when patients are reclassified based on predefined PaO2/FiO2 and PEEP cutoffs 24 h after development of mild hypoxemia while not having ARDS. Methods Post hoc analysis of a large prospective, multicenter, observational study that ran in the ICUs of two academic hospitals in the Netherlands between January 2011 and December 2013. Patients were classified into four groups using predefined cutoffs for PaO2/FiO2 (250 mmHg) and PEEP (5 cm H2O), both at onset of hypoxemia and after 24 h: PaO2/FiO2 ≥ 250 mmHg and PEEP < 6 cm H2O (group I), PaO2/FiO2 ≥ 250 mmHg and PEEP ≥ 6 cm H2O (group II), PaO2/FiO2 < 250 mmHg and PEEP < 6 cm H2O (group III), and PaO2/FiO2 < 250 mmHg and PEEP ≥ 6 cm H2O (group IV), to look for trend association with all-cause in-hospital mortality, the primary outcome. Secondary outcome were ICU- and 90-day mortality, and the number of ventilator-free days or ICU-free days and alive at day 28. Results The analysis included 689 consecutive patients. All-cause in-hospital mortality was 35%. There was minimal variation in mortality between the four groups at onset of hypoxemia (33, 36, 38, and 34% in groups I to IV, respectively; P = 0.65). Reclassification after 24 h resulted in a strong trend with increasing mortality from group I to group IV (31, 31, 37, and 48% in groups I to IV, respectively; P < 0.01). Similar trends were found for the secondary endpoints. Conclusions Reclassification using PaO2/FiO2 and PEEP cutoffs after 24 h improved classification for outcome in invasively ventilated ICU patients with hypoxemia not explained by ARDS, compared to classification at onset of hypoxemia. Trial registration ClinicalTrials.gov identifier: NCT01905033. Registered on July 11, 2013. Retrospectively registered.
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Affiliation(s)
- Fabienne D Simonis
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.
| | - Laura R A Schouten
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David S Y Ong
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Gabriele Amoruso
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Gilda Cinella
- Department of Anesthesia and Intensive Care, University of Foggia, Foggia, Italy
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care & Anesthesiology (L·E·I·C·A), Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands.,Mahidol-Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand.,Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Lieuwe D Bos
- Department of Intensive Care, Amsterdam University Medical Centers, location AMC, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam, The Netherlands.,Department of Pulmonology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
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24
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Sharp SP, Mackenzie DG, Ong DSY, Mountziaris PM, Logghe HJ, Ferrada P, Wexner SD. Factors Influencing the Dissemination of Tweets at the American College of Surgeons Clinical Congress 2018. Am Surg 2020; 87:520-526. [PMID: 33106021 DOI: 10.1177/0003134820950680] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Social media is increasingly used in surgery, facilitating the dissemination of knowledge. Social media can potentially aid networking, education, and information exchange. This study explored the impact of tweet components and tweeter characteristics during a large surgical congress to inform recommendations for optimizing social media use at future surgical conferences. METHODS Twitter activity was monitored during the American College of Surgeons Clinical Congress 2018 using NodeXL to extract tweets containing the conference hashtag #ACSCC18 (or #ACSCC2018). Multivariable logistic regression analysis was performed to identify independent predictors of retweet activity, also testing for multicollinearity and interactions among variables. RESULTS There were 4386 tweets that contained #ACSCC18 (or #ACSCC2018) posted from 1023 Twitter accounts. A larger group of Twitter accounts just retweeted. Other Twitter accounts with a stake in the conference neither tweeted nor retweeted. In a multivariable analysis of original tweets, the following were all independently associated with retweets, in decreasing order of effect size: mention of other tweeters, multimedia, inclusion of other hashtags, and the number of followers. In contrast with other conferences, the inclusion of a weblink (URL)-for example, link to paper or blog-was not associated with retweets. DISCUSSION This study helps understand social media impact at surgical conferences. Engage by tweeting and retweeting. Mention other tweeters, add multimedia, include congress hashtags and topic-specific hashtags, and build your followers. Although not associated with retweet activity in this study, the inclusion of URLs can still contribute in substantiating the disseminated content based on findings at other conferences.
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Affiliation(s)
- Stephen P Sharp
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
| | - Douglas G Mackenzie
- Department of General Practice, NHS Education for Scotland, Edinburgh, Midlothian, UK
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Paschalia M Mountziaris
- Department of Plastic Surgery, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Heather J Logghe
- Department of Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Paula Ferrada
- 72054 Department of Surgery and Trauma, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven D Wexner
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA
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25
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Ong DSY, Altorf-van der Kuil W, Vlek ALM, Schouls LM, Schoffelen AF. Routinely available antimicrobial susceptibility information can be used to increase the efficiency of screening for carbapenemase-producing Enterobacteriaceae. J Med Microbiol 2020; 69:1235-1239. [PMID: 32924918 DOI: 10.1099/jmm.0.001251] [Citation(s) in RCA: 0] [Impact Index Per Article: 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] [Indexed: 11/18/2022] Open
Abstract
Introduction. Increased carbapenem resistance is often caused by carbapenemase production.Aim. The objective of our study was to assess which antibiotic susceptibility patterns, as tested by automated systems, are highly associated with the absence of carbapenemase production in Enterobacteriaceae isolates, and could therefore be used as a screening tool.Methodology. Routine antibiotic susceptibility testing data from 42 medical microbiology laboratories in the Netherlands in the period between January 2011 and June 2017 were obtained from the national antimicrobial resistance surveillance programme. Data on Enterobacteriaceae isolates that had an elevated minimum inhibitory concentration (MIC) for carbapenems (meropenem >0.25 mg l-1 or imipenem >1.0 mg l-1) were selected and subjected to phenotypic or genotypic carbapenemase production testing. Routinely available amoxicillin/clavulanic acid, piperacillin/tazobactam, cefuroxime and ceftriaxone/cefotaxime susceptibilities were studied in relation to carbapenemase production by calculating the negative predictive value.Results. No evidence for carbapenemase-producing Enterobacteriaceae (CPE) was found in 767 of 1007 (76 %) isolates. The negative predictive value was highest for amoxicillin/clavulanic acid (99.6 %) and piperacillin/tazobactam (98.8 %).Conclusion. Enterobacteriaceae isolates with elevated carbapenem MICs that are susceptible to amoxicillin/clavulanic acid or piperacillin/tazobactam are unlikely to be carbapenemase producers. Preselection based on this susceptibility pattern may lead to increased laboratory efficiency and reduction of costs. Whether this is also true for countries with a different distribution of CPE species and types or a higher prevalence of CPE needs to be studied.
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Affiliation(s)
- David S Y Ong
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Medical Microbiology and Infection Control, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands
| | - Wieke Altorf-van der Kuil
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Anne L M Vlek
- Department of Medical Microbiology and Immunology, Diakonessenhuis, Utrecht, Netherlands
| | - Leo M Schouls
- Centre for Infectious Diseases Research, Diagnostics and laboratory Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
| | - Annelot F Schoffelen
- Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute for Public Health and the Environment (RIVM), Bilthoven, Netherlands
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26
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Ong DSY, Claas ECJ, Breijer S, Vaessen N. Comparison of the GeneFinder TM COVID-19 Plus RealAmp Kit on the sample-to-result Platform ELITe InGenius to the national reference method: An added value of N gene target detection? J Clin Virol 2020; 132:104632. [PMID: 32932152 PMCID: PMC7475767 DOI: 10.1016/j.jcv.2020.104632] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 01/08/2023]
Abstract
The InGenius platform for SARS-CoV-2 detection has excellent sensitivity. The InGenius platform for SARS-CoV-2 detection has low hands-on-time and is easy to use. The time window for the detection of N gene is increased in comparison to E and RdRp genes. The inclusion of the N gene may increase sensitivity for the diagnosis of COVID-19.
Background Due to the emergence of the coronavirus disease 2019 (COVID-19) pandemic there is an urgent need for rapid and accurate testing on the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objectives The aim of this study was to assess the diagnostic performance of the GeneFinderTMCOVID-19 Plus RealAmp Kit on the ELITe InGenius sample-to-result platform, which is a commercial nucleic acid amplification test (NAT) targeting genes of SARS-CoV-2. Study design Patients were eligible between March 18 and May 27, 2020, when they had respiratory symptoms that were suspected for COVID-19. The InGenius platform was compared to routine in-house NAT that was validated according to the national reference. Results Of 128 randomly selected patients, 58 (45 %) tested positive and 55 (43 %) tested negative in both platforms. Sensitivity of the InGenius platform was 100 % (95 % confidence interval 94–100). In the remaining 15 (12 %) cases E and RdRp genes were not detected in both platforms but the nucleoprotein (N) gene was tested positive by the InGenius platform. All solitary N gene positive cases were confirmed by a N-gene specific in-house validated NAT, and most of these patients could also be considered positive based on other recently available COVID-19 positive respiratory samples or highly suspected radiological findings. Conclusion The InGenius platform for SARS-CoV-2 detection has excellent sensitivity, is easy to use and provides fast results. The inclusion of the N gene as a third gene target may further increase sensitivity for the diagnosis of COVID-19 in comparison to the national reference method.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Eric C J Claas
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Simone Breijer
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Norbert Vaessen
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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27
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Hermans JJR, Groen J, Zwets E, Boxma-De Klerk BM, Van Werkhoven JM, Ong DSY, Hanselaar WEJJ, Waals-Prinzen L, Brown V. Chest CT for triage during COVID-19 on the emergency department: myth or truth? Emerg Radiol 2020; 27:641-651. [PMID: 32691211 PMCID: PMC7369539 DOI: 10.1007/s10140-020-01821-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 07/09/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE We aimed to investigate the diagnostic performance of chest CT compared with first RT-PCR results in adult patients suspected of COVID-19 infection in an ED setting. We also constructed a predictive machine learning model based on chest CT and additional data to improve the diagnostic accuracy of chest CT. METHODS This study's cohort consisted of 319 patients who underwent chest CT and RT-PCR testing at the ED. Patient characteristics, demographics, symptoms, vital signs, laboratory tests, and chest CT results (CO-RADS) were collected. With first RT-PCR as reference standard, the diagnostic performance of chest CT using the CO-RADS score was assessed. Additionally, a predictive machine learning model was constructed using logistic regression. RESULTS Chest CT, with first RT-PCR as a reference, had a sensitivity, specificity, PPV, and NPV of 90.2%, 88.2%, 84.5%, and 92.7%, respectively. The prediction model with CO-RADS, ferritin, leucocyte count, CK, days of complaints, and diarrhea as predictors had a sensitivity, specificity, PPV, and NPV of 89.3%, 93.4%, 90.8%, and 92.3%, respectively. CONCLUSION Chest CT, using the CO-RADS scoring system, is a sensitive and specific method that can aid in the diagnosis of COVID-19, especially if RT-PCR tests are scarce during an outbreak. Combining a predictive machine learning model could further improve the accuracy of diagnostic chest CT for COVID-19. Further candidate predictors should be analyzed to improve our model. However, RT-PCR should remain the primary standard of testing as up to 9% of RT-PCR positive patients are not diagnosed by chest CT or our machine learning model.
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Affiliation(s)
- Joep J R Hermans
- Department of Emergency Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
| | - Joost Groen
- Department of Clinical Chemistry, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Egon Zwets
- Department of Emergency Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Bianca M Boxma-De Klerk
- Department of Statistics and Education, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Jacob M Van Werkhoven
- Department of Radiology, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Lenneke Waals-Prinzen
- Department of Clinical Chemistry, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Vanessa Brown
- Department of Emergency Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
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Ong DSY, de Man SJ, Lindeboom FA, Koeleman JGM. Comparison of diagnostic accuracies of rapid serological tests and ELISA to molecular diagnostics in patients with suspected coronavirus disease 2019 presenting to the hospital. Clin Microbiol Infect 2020; 26:1094.e7-1094.e10. [PMID: 32502646 PMCID: PMC7265854 DOI: 10.1016/j.cmi.2020.05.028] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/21/2020] [Accepted: 05/22/2020] [Indexed: 01/23/2023]
Abstract
Objectives To assess the diagnostic performance of rapid lateral flow immunochromatographic assays (LFAs) compared with an ELISA and nucleic acid amplification tests (NATs) in individuals with suspected coronavirus disease 2019 (COVID-19). Methods Patients presenting to a Dutch teaching hospital were eligible between 17 March and 10 April 2020, when they had respiratory symptoms that were suspected for COVID-19. The performances of six different LFAs were evaluated in plasma samples obtained on corresponding respiratory sample dates of NATs testing. Subsequently, the best performing LFA was evaluated in 228 patients and in 50 sera of a historical patient control group. Results In the pilot analysis, sensitivity characteristics of LFA were heterogeneous, ranging from 2/20 (10%; 95% CI 0%–23%) to 11/20 (55%; 95% CI 33%–77%). In the total cohort, Orient Gene Biotech COVID-19 IgG/IgM Rapid Test LFA had a sensitivity of 43/99 (43%; 95% CI 34%–53%) and specificity of 126/129 (98%; 95% CI 95%–100%). Sensitivity increased to 31/52 (60%; 95% CI 46%–73%) in patients with at least 7 days of symptoms, and to 21/33 (64%; 95% CI 47%–80%) in patients with C-reactive protein (CRP) ≥100 mg/L. Sensitivity and specificity of Wantai SARS-CoV-2 Ab ELISA was 59/95 (62%; 95% CI 52%–72%) and 125/128 (98%; 95% CI 95%–100%) in all patients, respectively, but sensitivity increased to 38/48 (79%; 95% CI 68%–91%) in patients with at least 7 days of symptoms. Conclusions There is large variability in diagnostic test performance between rapid LFAs, but overall limited sensitivity and high specificity in acutely admitted patients. Sensitivity improved in patients with longer existing symptoms or high CRP. LFAs should only be considered as additional triage tools when these may lead to the improvement of hospital logistics.
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Affiliation(s)
- D S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - S J de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - F A Lindeboom
- Department of Clinical Chemistry and Haematology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - J G M Koeleman
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
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29
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Bos LDJ, Scicluna BP, Ong DSY, Cremer O, van der Poll T, Schultz MJ. Understanding Heterogeneity in Biologic Phenotypes of Acute Respiratory Distress Syndrome by Leukocyte Expression Profiles. Am J Respir Crit Care Med 2020; 200:42-50. [PMID: 30645145 DOI: 10.1164/rccm.201809-1808oc] [Citation(s) in RCA: 77] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Rationale: Two biologic phenotypes of acute respiratory distress syndrome (ARDS) have been identified based on plasma protein markers in four previous studies. Objectives: To determine if blood leukocyte gene expression is different between the "reactive" and "uninflamed" phenotype. Methods: This is a new study adding blood leukocyte transcriptomics and bioinformatics analysis to an existing patient cohort of ARDS in patients with sepsis admitted to two ICUs during a 1.5-year period. Canonical pathway analysis was performed. Measurements and Main Results: A total of 210 patients with sepsis and ARDS were included, of whom 128 had a reactive and 82 an uninflamed phenotype. A total of 3,332/11,443 (29%) transcripts were significantly different between the phenotypes. Canonical pathway analysis showed upregulation of oxidative phosphorylation genes indicative of mitochondrial dysfunction (52% of genes in pathway). The uninflamed phenotype was characterized by upregulation of mitogen-activated protein kinase pathways. Conclusions: A third of genes are differentially expressed between biologic phenotypes of ARDS supporting the observation that the subgroups of ARDS are incomparable in terms of pathophysiology. These data provide additional support for biologic heterogeneity in patients with ARDS and suggests that a personalized approach to intervention focusing on oxidative phosphorylation is pivotal in this condition.
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Affiliation(s)
- Lieuwe D J Bos
- 1 Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology.,2 Department of Respiratory Medicine
| | - Brendon P Scicluna
- 3 Center of Experimental Molecular Medicine, and.,4 Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Infection and Immunity, Amsterdam University Medical Center, location Academic Medical Center, Amsterdam, the Netherlands
| | - David S Y Ong
- 5 Department of Microbiology, Julius Center for Health Sciences and Primary Care.,6 Department of Epidemiology, Julius Center for Health Sciences and Primary Care, and
| | - Olaf Cremer
- 7 Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands; and
| | | | - Marcus J Schultz
- 1 Intensive Care, Laboratory of Experimental Intensive Care and Anesthesiology.,8 Mahidol Oxford Tropical Medicine Research Unit, Bangkok, Thailand
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30
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Cevik M, Russell CD, Ong DSY. Challenges of Interpreting Cytomegalovirus DNAemia and Its Potential Association With Chronic Lung Disease in Children and Adolescents With Perinatally Acquired Human Immunodeficiency Virus Infection. Clin Infect Dis 2020; 70:989-990. [PMID: 31247099 DOI: 10.1093/cid/ciz521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews.,Regional Infectious Diseases Unit, Western General Hospital, NHS Lothian.,Department of Laboratory Medicine, Royal Infirmary of Edinburgh
| | - Clark D Russell
- Regional Infectious Diseases Unit, Western General Hospital, NHS Lothian.,University of Edinburgh Centre for Inflammation Research, Queen's Medical Research Institute, Edinburgh BioQuarter, United Kingdom
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, the Netherlands
| | - Marc J M Bonten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, the Netherlands
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Del Puente F, Giacobbe DR, Salsano A, Maraolo AE, Ong DSY, Yusuf E, Tutino S, Marchese A, Santini F, Viscoli C. Epidemiology and outcome of Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-KP) infections in cardiac surgery patients: a brief narrative review. J Chemother 2019; 31:359-366. [PMID: 31701842 DOI: 10.1080/1120009x.2019.1685794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Klebsiella pneumoniae carbapenemase-producing Klebsiella pneumoniae (KPC-KP) is a difficult-to-treat pathogen due to its multidrug-resistant phenotype. Cardiac surgery patients are at increased risk of developing KPC-KP infections compared to other populations, with previous KPC-KP colonization being a critical factor in influencing the risk of subsequent infection. Two different pieces of information are essential to comprehensively assess the local characteristics of KPC-KP colonization in cardiac surgery patients: (i) the local prevalence of colonization; (ii) the timing of colonization. Treatment of KPC-KP infections in cardiac surgery patients is a complex task, but more effective treatment options have recently become available. Nonetheless, implementation and full adherence to infection-control measures remain of pivotal importance for reducing the burden of KPC-KP infections in this peculiar population. The aim of this narrative review is to summarize the available literature on the epidemiology and outcome of KPC-KP infections in cardiac surgery patients.
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Affiliation(s)
- Filippo Del Puente
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Daniele R Giacobbe
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Antonio Salsano
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Alberto E Maraolo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.,Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
| | - Erlangga Yusuf
- Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Stefania Tutino
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Anna Marchese
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Microbiology Unit, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Francesco Santini
- Dipartimento di Scienze Chirurgiche e Diagnostiche Integrate (DISC), University of Genoa, Genoa, Italy.,Division of Cardiac Surgery, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Claudio Viscoli
- Department of Health Sciences, University of Genoa, Genoa, Italy.,Clinica Malattie Infettive, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
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Ong DSY, Poljak M. Smartphones as mobile microbiological laboratories. Clin Microbiol Infect 2019; 26:421-424. [PMID: 31610301 DOI: 10.1016/j.cmi.2019.09.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 08/13/2019] [Revised: 09/24/2019] [Accepted: 09/29/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Point-of-care (POC) tests provide an alternative to traditional laboratory-based diagnostics due to reduced turnaround times, portability and no need for highly trained laboratory staff. Smartphones can be integrated into POC platforms because of their multifunctionality, enabled by high-quality digital cameras, computer processors, touchscreen interface and wireless data transfer. It is predicted that by 2020 about 80% of the world population will use smartphones. OBJECTIVES This review summarizes the current state of the art regarding smartphones as part of a mobile microbiological laboratory. SOURCES Selected peer-reviewed publications on smartphone-based microbiological testing published between January 2015 and August 2019. CONTENT Smartphones can be used as instrumental interfaces, dongles, microscopes or test result readers (brightfield, colorimetric and fluorescent measurements), or combined with amplification methods such as loop-mediated isothermal amplification (LAMP) tests in portable POC test platforms. Smartphone-based tests offer opportunities for microbiological diagnostics in remote areas and both resource-limited and resource-rich settings. Wireless connectivity may facilitate epidemiological studies and creation of spatiotemporal disease prevalence maps. However, the current analytical performance of many smartphone-based POC tests must be improved and carefully validated in clinical settings by comparison with current diagnostic standards. IMPLICATIONS Recent developments in smartphone-based POC tests for infectious diseases are promising, as evidenced by results from many proof-of-concept studies. Further progress will foster large-scale implementation of smartphone-based POC as mobile microbiological laboratories in the near future.
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Affiliation(s)
- D S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Verboom DM, Frencken JF, Ong DSY, Horn J, van der Poll T, Bonten MJM, Cremer OL, Klein Klouwenberg PMC. Robustness of sepsis-3 criteria in critically ill patients. J Intensive Care 2019; 7:46. [PMID: 31489199 PMCID: PMC6716896 DOI: 10.1186/s40560-019-0400-6] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/15/2019] [Indexed: 12/13/2022] Open
Abstract
Background Early recognition of sepsis is challenging, and diagnostic criteria have changed repeatedly. We assessed the robustness of sepsis-3 criteria in intensive care unit (ICU) patients. Methods We studied the apparent incidence and associated mortality of sepsis-3 among patients who were prospectively enrolled in the Molecular Diagnosis and Risk Stratification of Sepsis (MARS) cohort in the Netherlands, and explored the effects of minor variations in the precise definition and timing of diagnostic criteria for organ failure. Results Among 1081 patients with suspected infection upon ICU admission, 648 (60%) were considered to have sepsis according to prospective adjudication in the MARS study, whereas 976 (90%) met sepsis-3 criteria, yielding only 64% agreement at the individual patient level. Among 501 subjects developing ICU-acquired infection, these rates were 270 (54%) and 260 (52%), respectively (yielding 58% agreement). Hospital mortality was 234 (36%) vs 277 (28%) for those meeting MARS-sepsis or sepsis-3 criteria upon presentation (p < 0.001), and 121 (45%) vs 103 (40%) for those having sepsis onset in the ICU (p < 0.001). Minor variations in timing and interpretation of organ failure criteria had a considerable effect on the apparent prevalence of sepsis-3, which ranged from 68 to 96% among those with infection at admission, and from 22 to 99% among ICU-acquired cases. Conclusion The sepsis-3 definition lacks robustness as well as discriminatory ability, since nearly all patients presenting to ICU with suspected infection fulfill its criteria. These should therefore be specified in greater detail, and applied more consistently, during future sepsis studies. Trial registration The MARS study is registered at ClinicalTrials.gov (identifier NCT 01905033). Electronic supplementary material The online version of this article (10.1186/s40560-019-0400-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Diana M Verboom
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jos F Frencken
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - David S Y Ong
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,3Department of Medical Microbiology and Infection Control, Franciscus Gasthuis and Vlietland, Rotterdam, the Netherlands
| | - Janneke Horn
- 4Department of Intensive Care Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Tom van der Poll
- 5Center for Experimental and Molecular Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,6Division of Infectious Diseases, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Marc J M Bonten
- 1Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,7Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Olaf L Cremer
- 2Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Frencken JF, Donker DW, Spitoni C, Koster-Brouwer ME, Soliman IW, Ong DSY, Horn J, van der Poll T, van Klei WA, Bonten MJM, Cremer OL. Myocardial Injury in Patients With Sepsis and Its Association With Long-Term Outcome. Circ Cardiovasc Qual Outcomes 2019; 11:e004040. [PMID: 29378734 DOI: 10.1161/circoutcomes.117.004040] [Citation(s) in RCA: 73] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 11/30/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sepsis is frequently complicated by the release of cardiac troponin, but the clinical significance of this myocardial injury remains unclear. We studied the associations between troponin release during sepsis and 1-year outcomes. METHODS AND RESULTS We enrolled consecutive patients with sepsis in 2 Dutch intensive care units between 2011 and 2013. Subjects with a clinically apparent cause of troponin release were excluded. High-sensitivity cardiac troponin I (hs-cTnI) concentration in plasma was measured daily during the first 4 intensive care unit days, and multivariable Cox regression analysis was used to model its association with 1-year mortality while adjusting for confounding. In addition, we studied cardiovascular morbidity occurring during the first year after hospital discharge. Among 1258 patients presenting with sepsis, 1124 (89%) were eligible for study inclusion. Hs-cTnI concentrations were elevated in 673 (60%) subjects on day 1, and 755 (67%) ever had elevated levels in the first 4 days. Cox regression analysis revealed that high hs-cTnI concentrations were associated with increased death rates during the first 14 days (adjusted hazard ratio, 1.72; 95% confidence interval, 1.14-2.59 and hazard ratio, 1.70; 95% confidence interval, 1.10-2.62 for hs-cTnI concentrations of 100-500 and >500 ng/L, respectively) but not thereafter. Furthermore, elevated hs-cTnI levels were associated with the development of cardiovascular disease among 200 hospital survivors who were analyzed for this end point (adjusted subdistribution hazard ratio, 1.25; 95% confidence interval, 1.04-1.50). CONCLUSIONS Myocardial injury occurs in the majority of patients with sepsis and is independently associated with early-but not late-mortality, as well as postdischarge cardiovascular morbidity.
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Affiliation(s)
- Jos F Frencken
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands.
| | - Dirk W Donker
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Cristian Spitoni
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Marlies E Koster-Brouwer
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Ivo W Soliman
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - David S Y Ong
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Janneke Horn
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Tom van der Poll
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Wilton A van Klei
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Marc J M Bonten
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
| | - Olaf L Cremer
- From the Department of Epidemiology, Julius Center for Health Sciences and Primary Care (J.F.F., C.S., M.E.K.-B., M.J.M.B.), Department of Intensive Care Medicine (J.F.F., D.W.D., M.E.K.-B., I.W.S., D.S.Y.O., O.L.C.), Department of Medical Microbiology (D.S.Y.O., M.J.M.B.), and Department of Anesthesiology (W.A.v.K.), University Medical Center Utrecht, The Netherlands; Department of Mathematics, Utrecht University, The Netherlands (C.S.); Department of Intensive Care, Academic Medical Center, University of Amsterdam, The Netherlands (J.H.); and Center for Experimental and Molecular Medicine (T.v.d.P.) and Division of Infectious Diseases (T.v.d.P.), Academic Medical Center, Amsterdam, The Netherlands
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van de Groep K, Bos MP, Varkila MRJ, Savelkoul PHM, Ong DSY, Derde LPG, Juffermans NP, van der Poll T, Bonten MJM, Cremer OL. Moderate positive predictive value of a multiplex real-time PCR on whole blood for pathogen detection in critically ill patients with sepsis. Eur J Clin Microbiol Infect Dis 2019; 38:1829-1836. [PMID: 31243596 PMCID: PMC6778535 DOI: 10.1007/s10096-019-03616-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Accepted: 06/12/2019] [Indexed: 12/26/2022]
Abstract
A novel multiplex real-time PCR for bloodstream infections (BSI-PCR) detects pathogens directly in blood. This study aimed at determining the positive predictive value (PPV) of BSI-PCR in critically ill patients with sepsis. We included consecutive patients with presumed sepsis upon admission to the intensive care unit (ICU). The multiplexed BSI-PCR included 17 individual PCRs for a broad panel of species- and genus-specific DNA targets. BSI-PCR results were compared with a reference diagnosis for which plausibility of infection and causative pathogen(s) had been prospectively assessed by trained observers, based on available clinical and microbiological evidence. PPV and false positive proportion (FPP) were calculated. Clinical plausibility of discordant positive results was adjudicated by an expert panel. Among 325 patients, infection likelihood was categorized as confirmed, uncertain, and ruled out in 210 (65%), 88 (27%), and 27 (8%) subjects, respectively. BSI-PCR identified one or more microorganisms in 169 (52%) patients, of whom 104 (61%) had at least one detection in accordance with the reference diagnosis. Discordant positive PCR results were observed in 95 patients, including 30 subjects categorized as having an "unknown" pathogen. Based on 5525 individual PCRs yielding 295 positive results, PPV was 167/295 (57%) and FPP was 128/5525 (2%). Expert adjudication of the 128 discordant PCR findings resulted in an adjusted PPV of 68% and FPP of 2%. BSI-PCR was all-negative in 156 patients, including 79 (51%) patients in whom infection was considered ruled out. BSI-PCR may complement conventional cultures and expedite the microbiological diagnosis of sepsis in ICU patients, but improvements in positive predictive value of the test are warranted before its implementation in clinical practice can be considered.
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Affiliation(s)
- Kirsten van de Groep
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. .,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
| | | | - Meri R J Varkila
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Paul H M Savelkoul
- Microbiome, Amsterdam, The Netherlands.,Department of Medical Microbiology & Infection Control, Amsterdam University Medical Centers, VU, Amsterdam, The Netherlands.,Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - David S Y Ong
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Lennie P G Derde
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Division of Infectious Diseases, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc J M Bonten
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht,, Utrecht University, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Ong DSY, Zapf TC, Cevik M, Palacios-Baena ZR, Barać A, Cimen C, Maraolo AE, Rönnberg C, Cambau E, Poljak M. Current mentorship practices in the training of the next generation of clinical microbiology and infectious disease specialists: an international cross-sectional survey. Eur J Clin Microbiol Infect Dis 2019; 38:659-665. [PMID: 30783890 PMCID: PMC6424943 DOI: 10.1007/s10096-019-03509-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 02/02/2019] [Indexed: 12/11/2022]
Abstract
The purpose of this study was to describe the current practice of mentorship in clinical microbiology (CM) and infectious diseases (ID) training, to identify possible areas for improvement and to assess the factors that are associated with satisfactory mentorship. An international cross-sectional survey containing 35 questions was answered by 317 trainees or specialists who recently completed clinical training. Overall, 179/317 (56%) trainees were satisfied with their mentors, ranging from 7/9 (78%) in non-European countries, 39/53 (74%) in Northern Europe, 13/22 (59%) in Eastern Europe, 61/110 (56%) in Western Europe, 37/76 (49%) in South-Western Europe to 22/47 (47%) in South-Eastern Europe. However, only 115/317 (36%) respondents stated that they were assigned an official mentor during their training. In multivariable logistic regression analysis, the satisfaction of trainees was significantly associated with having a mentor who was a career model (OR 6.4, 95%CI 3.5–11.7), gave constructive feedback on work performance (OR 3.3, 95%CI 1.8–6.2), and knew the family structure of the mentee (OR 5.5, 95%CI 3.0–10.1). If trainees felt overburdened, 70/317 (22%) felt that they could not talk to their mentors. Moreover, 67/317 (21%) stated that they could not talk to their mentor when unfairly treated and 59/317 (19%) felt uncertain. Training boards and authorities responsible for developing and monitoring CM&ID training programmes should invest in the development of high-quality mentorship programmes for trainees in order to contribute to the careers of the next generation of professionals.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands.
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Thea Christine Zapf
- Department of Medical Microbiology and Infection Prevention, University Hospital of Marburg, Marburg, Germany
| | - Muge Cevik
- Division of Infection and Global Health Research, School of Medicine, University of St Andrews, St Andrews, UK
- Regional Infectious Diseases Unit, Western General Hospital, Edinburgh, UK
- Department of Laboratory Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Zaira R Palacios-Baena
- Unidad de Gestión Clínica de Enfermedades Infecciosas y Microbiología / Instituto de Biomedicina de Sevilla (IBIS), Hospital Universitario Virgen Macarena / Universidad de Sevilla, Seville, Spain
| | - Aleksandra Barać
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Cansu Cimen
- Infectious Diseases and Clinical Microbiology Clinic, Ministry of Health Ardahan Public Hospital, Ardahan, Turkey
| | - Alberto E Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Naples, Italy
| | - Caroline Rönnberg
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Emmanuelle Cambau
- Clinical Microbiology Laboratory, APHP-Lariboisiere Hospital, Paris, France
- School of Medicine, University of Paris Diderot, UMR1137 IAME, Paris, France
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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van de Groep K, Nierkens S, Cremer OL, Peelen LM, Klein Klouwenberg PMC, Schultz MJ, Hack CE, van der Poll T, Bonten MJM, Ong DSY. Effect of cytomegalovirus reactivation on the time course of systemic host response biomarkers in previously immunocompetent critically ill patients with sepsis: a matched cohort study. Crit Care 2018; 22:348. [PMID: 30563551 PMCID: PMC6299562 DOI: 10.1186/s13054-018-2261-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 10/05/2018] [Accepted: 11/12/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) reactivation in previously immunocompetent critically ill patients is associated with increased mortality, which has been hypothesized to result from virus-induced immunomodulation. Therefore, we studied the effects of CMV reactivation on the temporal course of host response biomarkers in patients with sepsis. METHODS In this matched cohort study, each sepsis patient developing CMV reactivation between day 3 and 17 (CMV+) was compared with one CMV seropositive patient without reactivation (CMVs+) and one CMV seronegative patient (CMVs-). CMV serostatus and plasma loads were determined by enzyme-linked immunoassays and real-time polymerase chain reaction, respectively. Systemic interleukin-6 (IL-6), IL-8, IL-18, interferon-gamma-induced protein-10 (IP-10), neutrophilic elastase, IL-1 receptor antagonist (RA), and IL-10 were measured at five time points by multiplex immunoassay. The effects of CMV reactivation on sequential concentrations of these biomarkers were assessed in multivariable mixed models. RESULTS Among 64 CMV+ patients, 45 could be matched to CMVs+ or CMVs- controls or both. The two baseline characteristics and host response biomarker levels at viremia onset were similar between groups. CMV+ patients had increased IP-10 on day 7 after viremia onset (symmetric percentage difference +44% versus -15% when compared with CMVs+ and +37% versus +4% when compared with CMVs-) and decreased IL-1RA (-41% versus 0% and -49% versus +10%, respectively). However, multivariable analyses did not show an independent association between CMV reactivation and time trends of IL-6, IP-10, IL-10, or IL-1RA. CONCLUSION CMV reactivation was not independently associated with changes in the temporal trends of host response biomarkers in comparison with non-reactivating patients. Therefore, these markers should not be used as surrogate clinical endpoints for interventional studies evaluating anti-CMV therapy.
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Affiliation(s)
- Kirsten van de Groep
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands. .,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands.
| | - Stefan Nierkens
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Linda M Peelen
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Peter M C Klein Klouwenberg
- Division of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ , Amsterdam, the Netherlands
| | - C Erik Hack
- Laboratory of Translational Immunology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands.,Division of Infectious Diseases, Amsterdam University Medical Centers, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Marc J M Bonten
- Division of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX, Utrecht, the Netherlands
| | - David S Y Ong
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, P.O. Box 85500, 3508 GA, Utrecht, the Netherlands.,Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands
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van de Groep K, Bos MP, Savelkoul PHM, Rubenjan A, Gazenbeek C, Melchers WJG, van der Poll T, Juffermans NP, Ong DSY, Bonten MJM, Cremer OL. Development and first evaluation of a novel multiplex real-time PCR on whole blood samples for rapid pathogen identification in critically ill patients with sepsis. Eur J Clin Microbiol Infect Dis 2018; 37:1333-1344. [PMID: 29700761 PMCID: PMC6015113 DOI: 10.1007/s10096-018-3255-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 04/06/2018] [Indexed: 12/19/2022]
Abstract
Molecular tests may enable early adjustment of antimicrobial therapy and be complementary to blood culture (BC) which has imperfect sensitivity in critically ill patients. We evaluated a novel multiplex real-time PCR assay to diagnose bloodstream pathogens directly in whole blood samples (BSI-PCR). BSI-PCR included 11 species- and four genus-specific PCRs, a molecular Gram-stain PCR, and two antibiotic resistance markers. We collected 5 mL blood from critically ill patients simultaneously with clinically indicated BC. Microbial DNA was isolated using the Polaris method followed by automated DNA extraction. Sensitivity and specificity were calculated using BC as reference. BSI-PCR was evaluated in 347 BC-positive samples (representing up to 50 instances of each pathogen covered by the test) and 200 BC-negative samples. Bacterial species-specific PCR sensitivities ranged from 65 to 100%. Sensitivity was 26% for the Gram-positive PCR, 32% for the Gram-negative PCR, and ranged 0 to 7% for yeast PCRs. Yeast detection was improved to 40% in a smaller set-up. There was no overall association between BSI-PCR sensitivity and time-to-positivity of BC (which was highly variable), yet Ct-values were lower for true-positive versus false-positive PCR results. False-positive results were observed in 84 (4%) of the 2200 species-specific PCRs in 200 culture-negative samples, and ranged from 0 to 6% for generic PCRs. Sensitivity of BSI-PCR was promising for individual bacterial pathogens, but still insufficient for yeasts and generic PCRs. Further development of BSI-PCR will focus on improving sensitivity by increasing input volumes and on subsequent implementation as a bedside test.
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Affiliation(s)
- Kirsten van de Groep
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands. .,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Room F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.
| | | | - Paul H M Savelkoul
- Microbiome, Amsterdam, the Netherlands.,Department of Medical Microbiology & Infection Control, VU University Medical Center, Amsterdam, the Netherlands.,Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | | | - Willem J G Melchers
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.,Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Nicole P Juffermans
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - David S Y Ong
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Room F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Marc J M Bonten
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Room F06.149, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands
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Barac A, Ong DSY, Jovancevic L, Peric A, Surda P, Tomic Spiric V, Rubino S. Fungi-Induced Upper and Lower Respiratory Tract Allergic Diseases: One Entity. Front Microbiol 2018; 9:583. [PMID: 29666610 PMCID: PMC5891636 DOI: 10.3389/fmicb.2018.00583] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 03/14/2018] [Indexed: 02/06/2023] Open
Abstract
Introduction:Aspergillus can cause different allergic diseases including allergic bronchopulmonary aspergillosis (ABPA) and allergic fungal rhinosinusitis (AFRS). ABPA is allergic pulmonary disease against Aspergillus antigens. AFRS is a type of chronic rhinosinusitis (CRS) presented as hypersensitivity reactions to the fungal presence in sinuses. The aim of the present study was to clarify if ABPA and AFRS could be considered as a common disease entity. Methodology: The prospective cohort study included 75 patients with ABPA. Patients were divided into two groups and compared with each other: (i) patients with CT confirmation of rhinosinusitis and presence of fungi in sinuses (ABPA+AFRS group) and (ii) patients without CT or without mycological evidence of AFRS (ABPA group). Results: Findings of this study were: (i) AFRS was confirmed in 80% of patients with ABPA; (ii) all ABPA+AFRS patients had allergic mucin while fungal hyphae were present in 60% sinonasal aspirate; (iii) ABPA+AFRS patients had more often complicated CRS with (nasal polyps) NP (p < 0.001) and more severe forms of CRS; (iv) culture of sinonasal aspirate revealed fungal presence in 97% patients with ABPA+AFRS; (v) patients with ABPA+AFRS had more common positive skin prick test (SPT) for A. fumigatus (p = 0.037), while patients without AFRS had more common positive SPT for Alternaria alternata and Penicillium notatum (p = 0.04 and p = 0.03, respectively); (vi) 67% of ABPA patients had Aspergillus induced AFRS; (vii) larger number of fungi was isolated from the air-samples obtained from homes of patients with ABPA+AFRS than from the homes of patients without AFRS, while the most predominant species were A. fumigatus and A. niger isolated from almost 50% of the air-samples. Conclusion: The pathogenesis of ABPA and AFRS is similar, and AFRS can be considered as the upper airway counterpart of ABPA. Fungi-induced upper and lower respiratory tract allergic diseases present common entity. Next studies should clarify the mechanism by which fungi turn from “normal flora” into trigger of immunological reactions, resulting in ABPA or AFRS as well as to find new approaches for its' diagnosis and treatment.
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Affiliation(s)
- Aleksandra Barac
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - David S Y Ong
- Department of Medical Microbiology and Infection Prevention, Franciscus Gasthuis and Vlietland, Rotterdam, Netherlands.,Department of Epidemiology, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Ljiljana Jovancevic
- Department of Otorhinolaryngology, Clinical Centre of Vojvodina, Novi Sad, Serbia.,Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Aleksandar Peric
- Department of Otorhinolaryngology, Military Medical Academy, Belgrade, Serbia
| | - Pavol Surda
- Department of Otorhinolaryngology, Guy's and St Thomas' University Hospital, London, United Kingdom
| | - Vesna Tomic Spiric
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia.,Clinic for Allergology and Immunology, Clinical Centre of Serbia, Belgrade, Serbia
| | - Salvatore Rubino
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
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Ong DSY, Frencken JF, Klein Klouwenberg PMC, Juffermans N, van der Poll T, Bonten MJM, Cremer OL. Short-Course Adjunctive Gentamicin as Empirical Therapy in Patients With Severe Sepsis and Septic Shock: A Prospective Observational Cohort Study. Clin Infect Dis 2018; 64:1731-1736. [PMID: 28329088 DOI: 10.1093/cid/cix186] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [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: 11/23/2016] [Accepted: 02/25/2017] [Indexed: 12/30/2022] Open
Abstract
Background. Metaanalyses failed to demonstrate clinical benefits of beta lactam plus aminoglycoside combination therapy compared to beta lactam monotherapy in patients with sepsis. However, few data exist on the effects of short-course adjunctive aminoglycoside therapy in sepsis patients with organ failure or shock. Methods. We prospectively enrolled consecutive patients with severe sepsis or septic shock in 2 intensive care units in the Netherlands from 2011 to 2015. Local antibiotic protocols recommended empirical gentamicin add-on therapy in only 1 of the units. We used logistic regression analyses to determine the association between gentamicin use and the number of days alive and free of renal failure, shock, and death, all on day 14. Results. Of 648 patients enrolled, 245 received gentamicin (222 of 309 [72%] in hospital A and 23 of 339 [7%] in hospital B) for a median duration of 2 days (interquartile range, 1-3). The adjusted odds ratios associated with gentamicin use were 1.39 (95% confidence interval [CI], 1.00-1.94) for renal failure, 1.34 (95% CI, 0.96-1.86) for shock duration, and 1.41 (95% CI, 0.94-2.12) for day-14 mortality. Based on in vitro susceptibilities, inappropriate (initial) gram-negative coverage was given in 9 of 245 (4%) and 18 of 403 (4%) patients treated and not treated with gentamicin, respectively (P = .62). Conclusions. Short-course empirical gentamicin use in patients with sepsis was associated with an increased incidence of renal failure but not with faster reversal of shock or improved survival in a setting with low prevalence of antimicrobial resistance.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology.,Department of Intensive Care Medicine, and
| | - Jos F Frencken
- Department of Intensive Care Medicine, and.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
| | | | - Nicole Juffermans
- Department of Intensive Care, Academic Medical Center, University of Amsterdam, and
| | - Tom van der Poll
- Center of Experimental and Molecular Medicine & Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Marc J M Bonten
- Department of Medical Microbiology.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht
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Ong DSY, Bonten MJM, Cremer OL. Reply to Lipcsey. Clin Infect Dis 2018; 66:482. [DOI: 10.1093/cid/cix782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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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Ong DSY, Bonten MJM, Spitoni C, Verduyn Lunel FM, Frencken JF, Horn J, Schultz MJ, van der Poll T, Klein Klouwenberg PMC, Cremer OL. Epidemiology of Multiple Herpes Viremia in Previously Immunocompetent Patients With Septic Shock. Clin Infect Dis 2018; 64:1204-1210. [PMID: 28158551 DOI: 10.1093/cid/cix120] [Citation(s) in RCA: 84] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Accepted: 02/01/2017] [Indexed: 01/12/2023] Open
Abstract
Background Systemic reactivations of herpesviruses may occur in intensive care unit (ICU) patients, even in those without prior immune deficiency. However, the clinical relevance of these events is uncertain. Methods In this study we selected patients admitted with septic shock and treated for more than 4 days from a prospectively enrolled cohort of consecutive adults in the mixed ICUs of 2 tertiary care hospitals in the Netherlands. We excluded patients who had received antiviral treatment in the week before ICU admission and those with known immunodeficiency. We studied viremia episodes with cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), herpes simplex virus types 1 (HSV-1) and 2 (HSV-2), and varicella zoster virus (VZV) by weekly polymerase chain reaction in plasma. Results Among 329 patients, we observed 399 viremia episodes in 223 (68%) patients. Viremia with CMV, EBV, HHV-6, HSV-1, HSV-2, and VZV was detected in 60 (18%), 157 (48%), 80 (24%), 87 (26%), 13 (4%), and 2 (0.6%) patients, respectively; 112 (34%) patients had multiple concurrent viremia events. Crude mortality in the ICU was 36% in this latter group compared to 19% in remaining patients (P < .01). After adjustment for potential confounders, time-dependent bias, and competing risks, only concurrent CMV and EBV reactivations remained independently associated with increased mortality (adjusted subdistribution hazard ratio, 3.17; 95% confidence interval, 1.41-7.13). Conclusions Herpesvirus reactivations were documented in 68% of septic shock patients without prior immunodeficiency and frequently occurred simultaneously. Concurrent reactivations could be independently associated with mortality. Clinical Trials Registration NCT01905033.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marc J M Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Cristian Spitoni
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Mathematics, Utrecht University, The Netherlands
| | - Frans M Verduyn Lunel
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jos F Frencken
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Janneke Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands
| | - Tom van der Poll
- Division of Infectious Diseases & Center of Experimental and Molecular Medicine Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Center for Infection and Immunity Amsterdam, Academic Medical Center, University of Amsterdam, The Netherlands
| | - Peter M C Klein Klouwenberg
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
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Simonis FD, de Iudicibus G, Cremer OL, Ong DSY, van der Poll T, Bos LD, Schultz MJ. Macrolide therapy is associated with reduced mortality in acute respiratory distress syndrome (ARDS) patients. Ann Transl Med 2018; 6:24. [PMID: 29430441 DOI: 10.21037/atm.2017.12.25] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background Macrolides have been associated with favorable immunological effects in various inflammatory disease states. We investigated the association between macrolide therapy and mortality in patients with the acute respiratory distress syndrome (ARDS). Methods This was an unplanned secondary analysis of patients with ARDS within a large prospective observational study of critically ill patients in the intensive care units (ICUs) of two university-affiliated hospitals in the Netherlands. The exposure of interest was low-dose macrolide use prescribed for another reason than infection; we excluded patients who received high-dose macrolides for an infection. The primary endpoint was 30-day mortality. The association between macrolide therapy and mortality was determined in the whole cohort, as well as in a propensity score matched cohort; the association was compared between pulmonary versus non-pulmonary ARDS, and between two biological phenotypes based on plasma levels of 20 biomarkers. Results In total, 873 patients with ARDS were analyzed, of whom 158 patients (18%) received macrolide therapy during stay in ICU for a median duration of 3 (interquartile range, 1-4) days. Erythromycin was the most frequent prescribed macrolide (97%). Macrolide therapy was associated with reduced 30-day mortality in the whole cohort [22.8% vs. 31.6%; crude odds ratio (OR), 0.64 (interquartile range, 0.43-0.96), P=0.03]. The association in the propensity score matched cohort remained significant [22.8% vs. 32.9%; OR, 0.62 (interquartile range, 0.39-0.96), P=0.03]. Propensity matched associations with mortality were different in patients with non-pulmonary ARDS vs. pulmonary ARDS and also varied by biological phenotype. Conclusions These data together show that low-dose macrolide therapy prescribed for another reason than infection is associated with decreased mortality in patients with ARDS.
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Affiliation(s)
- Fabienne D Simonis
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, The Netherlands
| | | | - Olaf L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David S Y Ong
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom van der Poll
- Center for Experimental and Molecular Medicine (C.E.M.M.), Academic Medical Center, Amsterdam, The Netherlands.,Division of Infectious Diseases, Academic Medical Center, Amsterdam, The Netherlands
| | - Lieuwe D Bos
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, The Netherlands.,Department of Pulmonology, Academic Medical Center, Amsterdam, The Netherlands
| | - Marcus J Schultz
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory for Experimental Intensive Care and Anesthesiology (L.E.I.C.A.), Academic Medical Center, Amsterdam, The Netherlands.,Mahidol Oxford Research Unit (MORU), Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Ong DSY, van Werkhoven CH, Cremer OL, Thwaites GE, Bonten MJM. Is a randomized trial of a short course of aminoglycoside added to β-lactam antibiotics for empirical treatment in critically ill patients with sepsis justified? Clin Microbiol Infect 2017; 24:95-96. [PMID: 28989114 DOI: 10.1016/j.cmi.2017.09.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/23/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Affiliation(s)
- D S Y Ong
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - C H van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - O L Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - G E Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom
| | - M J M Bonten
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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Ong DSY, Bonten MJM, Cremer OL. Reply to Cobussen et al. Clin Infect Dis 2017; 65:874. [PMID: 29017276 DOI: 10.1093/cid/cix448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- David S Y Ong
- Departments of Medical Microbiology, University Medical Center Utrecht, The Netherlands.,Intensive Care Medicine, University Medical Center Utrecht, The Netherlands
| | - Marc J M Bonten
- Departments of Medical Microbiology, University Medical Center Utrecht, The Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Olaf L Cremer
- Intensive Care Medicine, University Medical Center Utrecht, The Netherlands
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Bos LD, Schouten LR, van Vught LA, Wiewel MA, Ong DSY, Cremer O, Artigas A, Martin-Loeches I, Hoogendijk AJ, van der Poll T, Horn J, Juffermans N, Calfee CS, Schultz MJ. Identification and validation of distinct biological phenotypes in patients with acute respiratory distress syndrome by cluster analysis. Thorax 2017; 72:876-883. [PMID: 28450529 DOI: 10.1136/thoraxjnl-2016-209719] [Citation(s) in RCA: 174] [Impact Index Per Article: 24.9] [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: 11/12/2016] [Revised: 03/27/2017] [Accepted: 03/28/2017] [Indexed: 12/11/2022]
Abstract
RATIONALE We hypothesised that patients with acute respiratory distress syndrome (ARDS) can be clustered based on concentrations of plasma biomarkers and that the thereby identified biological phenotypes are associated with mortality. METHODS Consecutive patients with ARDS were included in this prospective observational cohort study. Cluster analysis of 20 biomarkers of inflammation, coagulation and endothelial activation provided the phenotypes in a training cohort, not taking any outcome data into account. Logistic regression with backward selection was used to select the most predictive biomarkers, and these predicted phenotypes were validated in a separate cohort. Multivariable logistic regression was used to quantify the independent association with mortality. RESULTS Two phenotypes were identified in 454 patients, which we named 'uninflamed' (N=218) and 'reactive' (N=236). A selection of four biomarkers (interleukin-6, interferon gamma, angiopoietin 1/2 and plasminogen activator inhibitor-1) could be used to accurately predict the phenotype in the training cohort (area under the receiver operating characteristics curve: 0.98, 95% CI 0.97 to 0.99). Mortality rates were 15.6% and 36.4% (p<0.001) in the training cohort and 13.6% and 37.5% (p<0.001) in the validation cohort (N=207). The 'reactive phenotype' was independent from confounders associated with intensive care unit mortality (training cohort: OR 1.13, 95% CI 1.04 to 1.23; validation cohort: OR 1.18, 95% CI 1.06 to 1.31). CONCLUSIONS Patients with ARDS can be clustered into two biological phenotypes, with different mortality rates. Four biomarkers can be used to predict the phenotype with high accuracy. The phenotypes were very similar to those found in cohorts derived from randomised controlled trials, and these results may improve patient selection for future clinical trials targeting host response in patients with ARDS.
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Affiliation(s)
- L D Bos
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Department of Respiratory Medicine, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, The Netherlands
| | - L R Schouten
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, The Netherlands
| | - L A van Vught
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, The Netherlands
| | - M A Wiewel
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, The Netherlands
| | - D S Y Ong
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.,Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - O Cremer
- Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Artigas
- CIBER enfermedades respiratorias (CIBERES), Critical Care Center, Sabadell Hospital, Corporación Sanitaria Universitaria Parc Taulí, Universitat Autonoma de Barcelona, Sabadell, Spain
| | - I Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), Department of Clinical Medicine, Trinity Centre for Health Sciences, Dublin, Ireland
| | - A J Hoogendijk
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, The Netherlands
| | - T van der Poll
- Center for Experimental and Molecular Medicine (CEMM), Academic Medical Center, Amsterdam, The Netherlands
| | - J Horn
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, The Netherlands
| | - N Juffermans
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, The Netherlands
| | - C S Calfee
- Departments of Medicine and Anesthesia, Cardiovascular Research Institute, University of California San Francisco, San Francisco, California, USA
| | - M J Schultz
- Department of Intensive Care, Academic Medical Center, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology (L.E.I.C.A), Academic Medical Center, Amsterdam, The Netherlands
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Maraolo AE, Ong DSY, Cortez J, Dedić K, Dušek D, Martin-Quiros A, Maver PJ, Skevaki C, Yusuf E, Poljak M, Sanguinetti M, Tacconelli E. Personal life and working conditions of trainees and young specialists in clinical microbiology and infectious diseases in Europe: a questionnaire survey. Eur J Clin Microbiol Infect Dis 2017; 36:1287-1295. [PMID: 28233138 PMCID: PMC5495844 DOI: 10.1007/s10096-017-2937-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 02/01/2017] [Indexed: 11/25/2022]
Abstract
The purpose of this investigation was to assess the balance between the personal and professional lives of trainees and young European specialists in clinical microbiology (CM) and infectious diseases (ID), and determine differences according to gender, country of training, workplace and specialty. The Steering Committee of the Trainee Association of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) devised a questionnaire survey consisting, beyond the demographic questions, of nine yes/no questions, 11 Likert scale self-evaluations and one open-response item on parenthood, working conditions, quality of life, alcohol consumption and burnout. This anonymous survey in English was held between April and July 2015 among European CM/ID trainees and young specialists (<3 years after training completion). Responses from 416 participants with a mean age of 32 years [standard deviation (SD) 5 years] were analysed. Females and physicians from Northern/Western Europe (NWE) benefit more from paternity/maternity leaves even during training than their counterparts. Among all respondents, only half of breastfeeding mothers enjoyed the benefit of working hours flexibility. Only two-thirds of respondents found their working environment stimulating. In comparison to colleagues from other parts of Europe, trainees and young specialists from Southern/Eastern Europe (SEE) had less frequent regular meetings with mentors/supervisors and head of departments where trainees’ issues are discussed. Also, physicians from SEE were more frequently victims of workplace mobbing/bullying in comparison to those from other regions. Finally, multivariate analysis showed that female gender, SEE region and ID specialty were associated with burnout feelings. Female gender and country of work from SEE largely determine satisfactory working conditions, the possibility of parenthood leaves, amount of leisure time, mobbing experiences and burnout feelings among European CM/ID trainees and young specialists.
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Affiliation(s)
- A E Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - D S Y Ong
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - J Cortez
- Infectious Diseases Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- CISA, Health Research Centre of Angola, Caxito, Angola
| | - K Dedić
- Microbiology Department, Cantonal Hospital "Dr. Irfan Ljubijankic", Bihac, Bosnia and Herzegovina
| | - D Dušek
- University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb, Croatia
| | - A Martin-Quiros
- Emergency Department, Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - P J Maver
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - C Skevaki
- University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany
| | - E Yusuf
- Department of Medical Microbiology, Universitair Ziekenhuis Antwerpen, University of Antwerp, Edegem, Belgium
| | - M Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Sanguinetti
- Institute of Microbiology, Università Cattolica del Sacro Cuore, Rome, Italy
| | - E Tacconelli
- Infectious Diseases, University Hospital Tübingen, DZIF Center, Tübingen, Germany
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Klein Klouwenberg PMC, Frencken JF, Kuipers S, Ong DSY, Peelen LM, van Vught LA, Schultz MJ, van der Poll T, Bonten MJ, Cremer OL. Incidence, Predictors, and Outcomes of New-Onset Atrial Fibrillation in Critically Ill Patients with Sepsis. A Cohort Study. Am J Respir Crit Care Med 2017; 195:205-211. [DOI: 10.1164/rccm.201603-0618oc] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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50
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Yusuf E, Ong DSY, Martin-Quiros A, Skevaki C, Cortez J, Dedić K, Maraolo AE, Dušek D, Maver PJ, Sanguinetti M, Tacconelli E. A large survey among European trainees in clinical microbiology and infectious disease on training systems and training adequacy: identifying the gaps and suggesting improvements. Eur J Clin Microbiol Infect Dis 2016; 36:233-242. [PMID: 27704297 PMCID: PMC5253151 DOI: 10.1007/s10096-016-2791-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [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: 09/04/2016] [Accepted: 09/04/2016] [Indexed: 11/26/2022]
Abstract
The purpose of this investigation was to perform a survey among European clinical microbiology (CM) and infectious disease (ID) trainees on training satisfaction, training tools, and competency assessment. An online, anonymous survey in the English language was carried out between April and July 2015. There were 25 questions: seven in a 5-point Likert scale (1: worst scenario, 5: best scenario) and the remainder as closed multiple-choice questions in five areas (satisfaction, adequacy, system, mentorship, and evaluation of training). Included were 419 respondents (215 CM, 159 ID, and 45 combined CM/ID) from 31 European countries [mean age (standard deviation) 32.4 (5.3) years, 65.9 % women]. Regarding satisfaction on the training scheme, CM and ID scored 3.6 (0.9) and 3.2 (1.0), respectively. These scores varied between countries, ranging from 2.5 (1.0) for Italian ID to 4.3 (0.8) for Danish CM trainees. The majority of respondents considered training in management and health economics inadequate and e-learning and continuing medical education programs insufficient. Many trainees (65.3 % of CM and 62.9 % of ID) would like to have more opportunities to spend a part of their training abroad and expected their mentor to be more involved in helping with future career plans (63.5 % of CM and 53.4 % of ID) and practical skills (53.0 % of CM and 61.2 % of ID). Two-thirds of the respondents across the specialties agreed that a European exam should be developed, but half of them thought it should not be made mandatory. This survey shows high heterogeneity in training conditions in European countries, identifies perceived gaps in training, and suggests areas for improvements.
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Affiliation(s)
- E Yusuf
- Department of Medical Microbiology and Infection Prevention, Universitair Ziekenhuis Brussel, Brussels, Belgium. .,Department of Medical Microbiology, Universitair Ziekenhuis Antwerpen, University of Antwerp, Edegem, Belgium.
| | - D S Y Ong
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - A Martin-Quiros
- Emergency Department, Hospital Universitario La Paz-Instituto de Investigación del Hospital Universitario La Paz, Madrid, Spain
| | - C Skevaki
- University Hospital Giessen and Marburg GmbH, Philipps University, Marburg, Germany
| | - J Cortez
- Infectious Diseases Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,CISA, Health Research Centre of Angola, Caxito, Angola
| | - K Dedić
- Microbiology Department, Cantonal Hospital "Dr. Irfan Ljubijankic", Bihac, Bosnia and Herzegovina
| | - A E Maraolo
- Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples "Federico II", Naples, Italy
| | - D Dušek
- University Hospital for Infectious Diseases "Dr. Fran Mihaljevic", Zagreb, Croatia
| | - P J Maver
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - M Sanguinetti
- l'Istituto di Microbiologia, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - E Tacconelli
- Infectious Diseases, University Hospital Tübingen, DZIF Center, Tübingen, Germany
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