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Dequeker S, Callies M, Catteau L, Int Panis L, Islamaj E, Klamer S, Latour K, Pauwels M, Vernemmen C, Mahieu R, Masson H, Savsin M, De Clercq E, Thomas M, Catry B, Vandael E. COVID-19 Clusters in Belgian Nursing Homes: Impact of Facility Characteristics and Vaccination on Cluster Occurrence, Duration and Severity. Viruses 2023; 15:232. [PMID: 36680272 PMCID: PMC9867491 DOI: 10.3390/v15010232] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/06/2023] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
COVID-19 severely affected nursing home residents from March 2020 onwards in Belgium. This study aimed to model the impact of vaccination and facility characteristics on cluster occurrence, duration and severity in this setting. Possible clusters were identified between June 2020 and January 2022, based on the Belgian COVID-19 surveillance in nursing homes. Median attack rates (AR) among residents and staff, case hospitalization rates (CHR) and case fatality rates (CFR) were calculated. A negative binomial model was used to identify the association between nursing home characteristics and the number of cases, hospital admissions and deaths and the duration of the cluster. A total of 2239 clusters were detected in more than 80% of nursing homes. Most of these (62%) occurred before the start of COVID-19 vaccination (end of December 2020). After vaccination, the number of clusters, the AR among residents and staff, the CHR and the CFR dropped. Previous cluster(s) and vaccination decreased the number of cases, hospital admissions and deaths among residents. Previous cluster experience and having started vaccination were protective factors. We recommend continued implementation of targeted interventions such as vaccination, large-scale screening and immediate implementation of additional infection prevention and control measures.
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Affiliation(s)
- Sara Dequeker
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Milena Callies
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Lucy Catteau
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Laura Int Panis
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Esma Islamaj
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Sofieke Klamer
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Katrien Latour
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Marijke Pauwels
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Catharina Vernemmen
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
| | - Romain Mahieu
- Department of Infectious Disease Prevention and Control, Common Community Commission, Brussels-Capital Region, 1040 Brussels, Belgium
| | - Hanna Masson
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, 1000 Brussels, Belgium
| | - Muhammet Savsin
- Direction de la Recherche, de la Statistique et de la Veille des Politiques, AVIQ, 6061 Charleroi, Belgium
| | - Etienne De Clercq
- Iriscare, Brussels Public Agency for Health and Social Care, 1040 Brussels, Belgium
| | - Mireille Thomas
- Cellule des Maladies Infectieuses, Département Santé et Personnes Âgées, Ministère de la Communauté Germanophone, 4700 Eupen, Belgium
| | - Boudewijn Catry
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
- Faculty of Medecine, Université Libre de Bruxelles (ULB), 1050 Brussels, Belgium
| | - Eline Vandael
- Department of Epidemiology and Public Health, Sciensano, 1050 Brussels, Belgium
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Vandael E, Latour K, Islamaj E, Panis LI, Callies M, Haarhuis F, Proesmans K, Devleesschauwer B, Rebolledo Gonzalez J, Hannecart A, Mahieu R, de Viron L, De Clercq E, Kongs A, Hammami N, François JM, Dubourg D, Henz S, Catry B, Dequeker S. COVID-19 cases, hospitalizations and deaths in Belgian nursing homes: results of a surveillance conducted between April and December 2020. Arch Public Health 2022; 80:45. [PMID: 35093169 PMCID: PMC8799977 DOI: 10.1186/s13690-022-00794-6] [Citation(s) in RCA: 5] [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: 10/18/2021] [Accepted: 01/07/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND In Belgium, the first COVID-19 death was reported on 10 March 2020. Nursing home (NH) residents are particularly vulnerable for COVID-19, making it essential to follow-up the spread of COVID-19 in this setting. This manuscript describes the methodology of surveillance and epidemiology of COVID-19 cases, hospitalizations and deaths in Belgian NHs. METHODS A COVID-19 surveillance in all Belgian NHs (n = 1542) was set up by the regional health authorities and Sciensano. Aggregated data on possible/confirmed COVID-19 cases and hospitalizations and case-based data on deaths were reported by NHs at least once a week. The study period covered April-December 2020. Weekly incidence/prevalence data were calculated per 1000 residents or staff members. RESULTS This surveillance has been launched within 14 days after the first COVID-19 death in Belgium. Automatic data cleaning was installed using different validation rules. More than 99% of NHs participated at least once, with a median weekly participation rate of 95%. The cumulative incidence of possible/confirmed COVID-19 cases among residents was 206/1000 in the first wave and 367/1000 in the second wave. Most NHs (82%) reported cases in both waves and 74% registered ≥10 possible/confirmed cases among residents at one point in time. In 51% of NHs, at least 10% of staff was absent due to COVID-19 at one point. Between 11 March 2020 and 3 January 2021, 11,329 COVID-19 deaths among NH residents were reported, comprising 57% of all COVID-19 deaths in Belgium in that period. CONCLUSIONS This surveillance was crucial in mapping COVID-19 in this vulnerable setting and guiding public health interventions, despite limitations of aggregated data and necessary changes in protocol over time. Belgian NHs were severely hit by COVID-19 with many fatal cases. The measure of not allowing visitors, implemented in the beginning of the pandemic, could not avoid the spread of SARS-CoV-2 in the NHs during the first wave. The virus was probably often introduced by staff. Once the virus was introduced, it was difficult to prevent healthcare-associated outbreaks. Although, in contrast to the first wave, personal protective equipment was available in the second wave, again a high number of cases were reported.
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Affiliation(s)
- Eline Vandael
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Katrien Latour
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Esma Islamaj
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Laura Int Panis
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Milena Callies
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Freek Haarhuis
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | | | - Brecht Devleesschauwer
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium ,grid.5342.00000 0001 2069 7798Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | | | - Alice Hannecart
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
| | - Romain Mahieu
- grid.508182.6Department of Infectious Disease Prevention and Control, Common Community Commission, Brussels-Capital Region, Brussels, Belgium
| | - Louise de Viron
- grid.508182.6Department of Infectious Disease Prevention and Control, Common Community Commission, Brussels-Capital Region, Brussels, Belgium
| | - Etienne De Clercq
- Iriscare - Brussels public agency for health and social care, Brussels, Belgium
| | - Anne Kongs
- Department of Welfare, Public Health and Family, Government of Flanders, Brussels, Belgium
| | - Naïma Hammami
- Agency for Care and Health, Infection Prevention and Control, Government of Flanders, Brussels, Belgium
| | - Jean-Marc François
- Direction de la recherche, de la statistique et de la veille des politiques, Agence pour une Vie de Qualité (AVIQ), Charleroi, Belgium
| | - Dominique Dubourg
- Direction de la recherche, de la statistique et de la veille des politiques, Agence pour une Vie de Qualité (AVIQ), Charleroi, Belgium
| | - Sarah Henz
- grid.494275.9Ministerium der Deutschsprachigen Gemeinschaft, Eupen, Belgium
| | - Boudewijn Catry
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium ,grid.4989.c0000 0001 2348 0746Faculty of Medicine, Université libre de Bruxelles (ULB), Brussels, Belgium
| | - Sara Dequeker
- Department of Epidemiology and public health, Sciensano, Brussels, Belgium
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Renard F, Scohy A, Van der Heyden J, Peeters I, Dequeker S, Vandael E, Van Goethem N, Dubourg D, De Viron L, Kongs A, Hammami N, Devleesschauwer B, Sasse A, Rebolledo Gonzalez J, Bustos Sierra N. Establishing an ad hoc COVID-19 mortality surveillance during the first epidemic wave in Belgium, 1 March to 21 June 2020. Euro Surveill 2021; 26:2001402. [PMID: 34857066 PMCID: PMC8641068 DOI: 10.2807/1560-7917.es.2021.26.48.2001402] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/17/2020] [Accepted: 02/16/2021] [Indexed: 12/28/2022] Open
Abstract
BackgroundCOVID-19-related mortality in Belgium has drawn attention for two reasons: its high level, and a good completeness in reporting of deaths. An ad hoc surveillance was established to register COVID-19 death numbers in hospitals, long-term care facilities (LTCF) and the community. Belgium adopted broad inclusion criteria for the COVID-19 death notifications, also including possible cases, resulting in a robust correlation between COVID-19 and all-cause mortality.AimTo document and assess the COVID-19 mortality surveillance in Belgium.MethodsWe described the content and data flows of the registration and we assessed the situation as of 21 June 2020, 103 days after the first death attributable to COVID-19 in Belgium. We calculated the participation rate, the notification delay, the percentage of error detected, and the results of additional investigations.ResultsThe participation rate was 100% for hospitals and 83% for nursing homes. Of all deaths, 85% were recorded within 2 calendar days: 11% within the same day, 41% after 1 day and 33% after 2 days, with a quicker notification in hospitals than in LTCF. Corrections of detected errors reduced the death toll by 5%.ConclusionBelgium implemented a rather complete surveillance of COVID-19 mortality, on account of a rapid investment of the hospitals and LTCF. LTCF could build on past experience of previous surveys and surveillance activities. The adoption of an extended definition of 'COVID-19-related deaths' in a context of limited testing capacity has provided timely information about the severity of the epidemic.
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Affiliation(s)
- Françoise Renard
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Aline Scohy
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Ilse Peeters
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Sara Dequeker
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Eline Vandael
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Nina Van Goethem
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | | | - Louise De Viron
- Commission Communautaire Commune de la Région de Bruxelles-Capitale (COCOM), Brussels, Belgium
| | - Anne Kongs
- Agentschap Zorg en Gezondheid (AZG), Vlaanderen, Brussels, Belgium
| | - Naïma Hammami
- Agentschap Zorg en Gezondheid (AZG), Vlaanderen, Brussels, Belgium
| | - Brecht Devleesschauwer
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Veterinary Public Health and Food Safety, Ghent University, Merelbeke, Belgium
| | - André Sasse
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Bruyndonckx R, Coenen S, Hens N, Vandael E, Catry B, Goossens H. Antibiotic use and resistance in Belgium: the impact of two decades of multi-faceted campaigning. Acta Clin Belg 2021; 76:280-288. [PMID: 32024450 DOI: 10.1080/17843286.2020.1721135] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: To present an overview of almost two decades of multi-faceted campaigning by the Belgian Antibiotic Policy Coordination Committee (BAPCOC) and partners, and its impact on public and prescribers' awareness, outpatient antibiotic use, its cost and antimicrobial resistance in Belgium.Methods: Awareness of both public and prescribers was assessed through pre- and post-campaign interviews and surveys. Outpatient antibiotic use was evaluated using national reimbursement data expressed in number of defined daily doses and packages (a good proxy for treatments) per 1000 inhabitants per day (DID and PID, respectively) from July 1997 to June 2018. Its cost was studied using the same data expressed in number of euros per 1000 inhabitants per day. Antimicrobial resistance was evaluated between 1986 and 2017 using national data on the proportion of Streptococcus pneumoniae isolates not susceptible to penicillins, macrolides and tetracyclines.Results: Antibiotic awareness improved significantly, with general practitioners preferred by 87.5% of respondents as source of information. The Belgian outpatient antibiotic use has decreased by 12.8% in DID and by 42.8% in PID in the 2017-2018 winter compared to the winter before the start of its public awareness campaigns (1999-2000). This evolution coincided with decreasing costs for antibiotics and decreasing antimicrobial resistance. Despite multi-faceted campaigning, outpatient antibiotic use and use of broad-spectrum antibiotics, especially fluoroquinolones and amoxicillin with clavulanic acid, are still high in Belgium.Conclusion: Almost two decades of multi-faceted campaigning coincide with improvements in antibiotic awareness among the public and prescribers, outpatient antibiotic use and resistance. Nevertheless, additional efforts are needed to reach the targets set in BAPCOC's national action plan 2014-2019. Therefore, a new national action plan was developed for 2020-2024 using a One Health approach.
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Affiliation(s)
- R. Bruyndonckx
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-biostat), Hasselt University, Hasselt, Belgium
| | - S. Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- Department of Primary and Interdisciplinary Care (ELIZA), University of Antwerp, Antwerp, Belgium
- Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium
| | - N. Hens
- Interuniversity Institute for Biostatistics and Statistical Bioinformatics (I-biostat), Hasselt University, Hasselt, Belgium
- Department of Epidemiology and Social Medicine (ESOC), University of Antwerp, Antwerp, Belgium
- Centre for Health Economic Research and Modelling Infectious Diseases (CHERMID), Vaccine & Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - E. Vandael
- Healthcare-associated Infection & Antimicrobial Resistance (NSIH), Scientific Directorate Epidemiology and Public Health, Brussels, Belgium
| | - B. Catry
- Healthcare-associated Infection & Antimicrobial Resistance (NSIH), Scientific Directorate Epidemiology and Public Health, Brussels, Belgium
- Faculty of Medicine, Université Libre De Bruxelles (ULB), Brussels, Belgium
| | - H. Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Diseases Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
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Vandael E, Magerman K, Coenen S, Goossens H, Catry B. Antibiotic consumption in Belgian acute care hospitals: analysis of the surveillance methodology, consumption evolution 2003 to 2016 and future perspectives. ACTA ACUST UNITED AC 2020; 24. [PMID: 31771707 PMCID: PMC6864973 DOI: 10.2807/1560-7917.es.2019.24.46.1900098] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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] [Indexed: 11/20/2022]
Abstract
BackgroundStudies have demonstrated the link between antimicrobial consumption and the development of antimicrobial resistance. Surveillance of antimicrobial consumption is an action point of the European Commission's 'One Health Action Plan Against Antimicrobial Resistance'.AimThis study aims to compare two methodologies for antibiotic consumption surveillance, investigate the 14-year evolution of antibiotic consumption in Belgian acute care hospitals and discuss future perspectives.MethodsWe compared self-reported data (old methodology) and reimbursement data (new methodology) of national antibiotic consumption surveillance in hospitals. Descriptive analyses were performed on the reimbursement data collected per year and per trimester (2003-2016), per hospital and per unit. Antibiotic consumption was compared with European Surveillance of Antimicrobial Consumption Network (ESAC-Net) results.ResultsThe median differences for defined daily doses (DDDs)/1,000 patient days and DDDs/1,000 admissions were 3.09% and 3.94% when comparing the old vs new methodology. Based on reimbursement data, the median antibiotic consumption in 2016 in 102 Belgian acute care hospitals was 577.1 DDDs/1,000 patient days and 3,890.3 DDDs/1,000 admissions with high variation between hospitals (interquartile ranges (IQR): 511.3-655.0 and 3,450.0-4,400.5, respectively), and similar to 2015. Based on DDDs/1,000 patient days, the magnitude of consumption is comparable with the Netherlands, Denmark and Sweden, but is higher when based on DDDs/1,000 admissions.ConclusionAntibiotic consumption in Belgian acute care hospitals has remained overall stable over time. However, the high variation across hospitals should be further investigated. This surveillance data could be used for benchmarking and assessing interventions to improve antibiotic consumption in these hospitals.
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Affiliation(s)
- Eline Vandael
- Healthcare-associated infections and antimicrobial resistance, Sciensano, Brussels, Belgium
| | - Koen Magerman
- Department of Microbiology, UHasselt, Hasselt, Belgium.,Jessa Hospital, Hasselt, Belgium.,Belgian Antibiotic Policy Coordination Committee (BAPCOC), Brussels, Belgium
| | - Samuel Coenen
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Belgian Antibiotic Policy Coordination Committee (BAPCOC), Brussels, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium.,Belgian Antibiotic Policy Coordination Committee (BAPCOC), Brussels, Belgium
| | - Boudewijn Catry
- Faculty of Medicine, Université libre de Bruxelles (ULB), Brussels, Belgium.,Healthcare-associated infections and antimicrobial resistance, Sciensano, Brussels, Belgium
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Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, O'Donnell J, Hauge SH, Dequeker S, Vandael E, Van der Heyden J, Renard F, Sierra NB, Ricchizzi E, Schweickert B, Schmidt N, Abu Sin M, Eckmanns T, Paiva JA, Schneider E. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. ACTA ACUST UNITED AC 2020; 25. [PMID: 32524949 PMCID: PMC7336111 DOI: 10.2807/1560-7917.es.2020.25.22.2000956] [Citation(s) in RCA: 113] [Impact Index Per Article: 28.3] [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] [Indexed: 11/20/2022]
Abstract
Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30–60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.
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Affiliation(s)
| | - Kostas Danis
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Laure Fonteneau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Scarlett Georges
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Côme Daniau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | | | - Lisa Domegan
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland.,European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | - Enrico Ricchizzi
- Regional Health and Social Agency - Emilia Romagna, Bologna, Italy
| | | | | | | | | | | | - Elke Schneider
- European Agency for Safety and Health at Work, Bilbao, Spain
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7
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Danis K, Fonteneau L, Georges S, Daniau C, Bernard-Stoecklin S, Domegan L, O'Donnell J, Hauge SH, Dequeker S, Vandael E, Van der Heyden J, Renard F, Sierra NB, Ricchizzi E, Schweickert B, Schmidt N, Abu Sin M, Eckmanns T, Paiva JA, Schneider E. High impact of COVID-19 in long-term care facilities, suggestion for monitoring in the EU/EEA, May 2020. Euro Surveill 2020. [PMID: 32524949 DOI: 10.2807/1560-7917.es.2020.25.22.200095] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023] Open
Abstract
Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30-60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.
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Affiliation(s)
- Kostas Danis
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Laure Fonteneau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Scarlett Georges
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | - Côme Daniau
- Santé Publique France (SpFrance), the French National Public Health Agency, St Maurice, France
| | | | - Lisa Domegan
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | - Joan O'Donnell
- Health Service Executive-Health Protection Surveillance Centre, Dublin, Ireland
| | | | | | | | | | | | | | - Enrico Ricchizzi
- Regional Health and Social Agency - Emilia Romagna, Bologna, Italy
| | | | | | | | | | | | - Elke Schneider
- European Agency for Safety and Health at Work, Bilbao, Spain
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8
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Vandael E, Latour K, Goossens H, Magerman K, Drapier N, Catry B, Versporten A. Point prevalence survey of antimicrobial use and healthcare-associated infections in Belgian acute care hospitals: results of the Global-PPS and ECDC-PPS 2017. Antimicrob Resist Infect Control 2020; 9:13. [PMID: 31956402 PMCID: PMC6958935 DOI: 10.1186/s13756-019-0663-7] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022] Open
Abstract
Background The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017. Methods Belgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September-December 2017. All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS. Results Overall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5-27.6%) was found. The most frequently reported indications were pneumonia (23.2%), urinary tract infections (15.2%) and skin and soft tissue infections (11.9%). The reason for antimicrobial use was recorded for 81.9% of the prescriptions, a stop/review date for 40.8% and compliance with local antibiotic guidelines for 76.6%. In the ECDC-PPS, the crude prevalence of patients with at least one HAI was 7.3% (95%CI 6.8-7.7%). Most frequently reported HAIs were pneumonia (21.6%) and urinary tract infections (21.3%). Conclusions HAI and antimicrobial use prevalence remained stable in comparison with the previous PPS (7.1% and 27.4% in 2011 and 2015, respectively). Belgian hospitals should be further stimulated to set local targets to improve antibiotic prescribing and reduce HAI.
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Affiliation(s)
- Eline Vandael
- Healthcare-associated infections and antimicrobial resistance, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Katrien Latour
- Healthcare-associated infections and antimicrobial resistance, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Herman Goossens
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Koen Magerman
- Belgian Antibiotic Policy Coordination Commission (BAPCOC), Direction General Healthcare, Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
- Department of Microbiology, University of Hasselt, Hasselt, Belgium
| | - Nico Drapier
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
| | - Boudewijn Catry
- Healthcare-associated infections and antimicrobial resistance, Sciensano, Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
- Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, University of Antwerp, Antwerp, Belgium
- Belgian Antibiotic Policy Coordination Commission (BAPCOC), Direction General Healthcare, Federal Public Service Health, Food Chain Safety and Environment, Brussels, Belgium
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9
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Strauven G, Anrys P, Vandael E, Henrard S, De Lepeleire J, Spinewine A, Foulon V. Cluster-Controlled Trial of an Intervention to Improve Prescribing in Nursing Homes Study. J Am Med Dir Assoc 2019; 20:1404-1411. [DOI: 10.1016/j.jamda.2019.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 05/13/2019] [Accepted: 06/02/2019] [Indexed: 01/25/2023]
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10
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Vandenberk B, Siau C, Vandael E, Puype L, Branders J, Dewolf P, Foulon V, Willems R, Verelst S. A prolonged QTc-interval at the emergency department: Should we always be prepared for the worst? J Cardiovasc Electrophysiol 2019; 30:2041-2050. [PMID: 31402492 DOI: 10.1111/jce.14114] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 08/06/2019] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION QTc-interval prolongation is associated with ventricular arrhythmias and mortality in a general population. Bazett's correction formula (QTcB) is routinely used despite its overcorrection at high heart rates. Recently, we proposed a patient-specific QT correcting algorithm (QTcA) resulting in improved rate correction and predictive value in a general population. We hypothesize risk stratification at the Emergency Department (ED) could be improved using QTcA. METHODS AND RESULTS A retrospective case-control study including a randomized age- and sex-matched control population was performed at a tertiary care ED. A total of 1930 patients were included in the analysis (63.0% males, age 71.5 ± 15.6 years). Patient characteristics, history, and test results at the time of the electrocardiogram were collected. QTc was dichotomized as prolonged (>450 millisecond for men, >470 millisecond for women) or severely prolonged (>500 millisecond). Implementation of QTcA would reduce the number of patients considered to have a prolonged QTc by 65.2%, for severely prolonged QTc 79.6%. Multivariate regression was performed for in-hospital mortality, cardiovascular endpoints, and hospital admission. Neither a prolonged QTcB (HR 1.04; 95% CI, 0.64-1.69) nor QTcA (HR 0.76; 95% CI, 0.42-1.38) was an independent predictor of in-hospital mortality. A severely prolonged QTcA (OR, 2.54; 95% CI, 1.04-6.23) was an independent predictor of cardiovascular events. Both a prolonged QTcA (OR, 1.52; 95% CI, 1.06-2.18) and a prolonged QTcB (OR, 1.37; 95% CI, 1.05-1.79) were associated with higher hospitalization rates. CONCLUSIONS QTcA reduced the number of patients considered at risk. Neither QTcB nor QTcA were predictors of in-hospital mortality. A severely prolonged QTcA was associated with cardiovascular events.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Caroline Siau
- Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Belgium
| | - Laura Puype
- Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Jordi Branders
- Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Philippe Dewolf
- Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Sandra Verelst
- Emergency Medicine, University Hospital of Leuven, Leuven, Belgium
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Struyf T, Vandael E, Leroy R, Mertens K, Catry B. Antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 to 2016. Int Dent J 2019; 69:480-487. [PMID: 31376156 DOI: 10.1111/idj.12512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe antimicrobial prescribing by Belgian dentists in ambulatory care, from 2010 until 2016. MATERIALS AND METHODS Reimbursement data from the Belgian National Institute for Health and Disability Insurance were analysed to evaluate antimicrobial prescribing (WHO ATC-codes J01/P01AB). Utilisation was expressed in defined daily doses (DDDs), and in DDDs and packages per 1000 inhabitants per day (DID and PID, respectively). Additionally, the number of DDD and packages per prescriber was calculated. RESULTS In 2016, the dentistry-related prescribing rate of 'Antibacterials for systemic use' (J01) and 'Antiprotozoals' (P01AB) was 1.607 and 0.014 DID, respectively. From 2010 to 2016, the DID rate of J01 increased by 6.3%, while the PID rate declined by 6.7%. Amoxicillin and amoxicillin with an enzyme inhibitor were the most often prescribed products, followed by clindamycin, clarithromycin, doxycycline, azithromycin and metronidazole. The proportion of amoxicillin relative to amoxicillin with an enzyme inhibitor was low. The narrow-spectrum antibiotic penicillin V was almost never prescribed. CONCLUSIONS Antibiotics typically classified as broad- or extended-spectrum were prescribed most often by Belgian dentists during the period 2000-2016. Although the DID rate of all 'Antibacterials for systemic use' (J01) increased over the years, the number of prescriptions per dentist decreased since 2013. The high prescription level of amoxicillin with an enzyme inhibitor is particularly worrying. It indicates that there is a need for comprehensive clinical practice guidelines for Belgian dentists.
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Affiliation(s)
- Thomas Struyf
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium
| | - Eline Vandael
- Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium
| | - Roos Leroy
- Belgian Health Care Knowledge Centre (KCE), Brussels, Belgium
| | - Karl Mertens
- Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium
| | - Boudewijn Catry
- Sciensano, Healthcare-associated Infections & Antimicrobial Resistance, Brussels, Belgium.,Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Goemaere B, Lagrou K, Spriet I, Hendrickx M, Vandael E, Becker P, Catry B. Systemic antifungal drug use in Belgium—One of the biggest antifungal consumers in Europe. Mycoses 2019; 62:542-550. [DOI: 10.1111/myc.12912] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/28/2019] [Accepted: 03/14/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Berdieke Goemaere
- BCCM/IHEM Fungal Collection Service of Mycology and Aerobiology Sciensano Brussels Belgium
| | - Katrien Lagrou
- Department of Microbiology and Immunology KU Leuven Leuven Belgium
- Clinical Department of Laboratory Medicine National Reference Centre for Mycosis University Hospitals Leuven Leuven Belgium
| | - Isabel Spriet
- Department of Pharmaceutical and Pharmacological Sciences KU Leuven Leuven Belgium
- Pharmacy Department University Hospitals Leuven Leuven Belgium
| | - Marijke Hendrickx
- BCCM/IHEM Fungal Collection Service of Mycology and Aerobiology Sciensano Brussels Belgium
| | - Eline Vandael
- Healthcare‐Associated Infections and Antimicrobial Resistance Sciensano Brussels Belgium
| | - Pierre Becker
- BCCM/IHEM Fungal Collection Service of Mycology and Aerobiology Sciensano Brussels Belgium
| | - Boudewijn Catry
- Healthcare‐Associated Infections and Antimicrobial Resistance Sciensano Brussels Belgium
- Faculty of Medicine Université Libre de Bruxelles (ULB) Brussels Belgium
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Vandael E, Vandenberk B, Vandenberghe J, Van den Bosch B, Willems R, Foulon V. A smart algorithm for the prevention and risk management of QTc prolongation based on the optimized RISQ-PATH model. Br J Clin Pharmacol 2018; 84:2824-2835. [PMID: 30112769 PMCID: PMC6255989 DOI: 10.1111/bcp.13740] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 02/16/2018] [Revised: 07/31/2018] [Accepted: 08/05/2018] [Indexed: 12/31/2022] Open
Abstract
AIMS QTc prolongation is a complex problem linked with multiple risk factors. The RISQ-PATH score was previously developed to identify high-risk patients for QTc prolongation. The aim of this study was to optimize and validate this risk score in a large patient cohort, and to propose an algorithm to generate smart QT signals in the electronic medical record. METHODS A retrospective study was performed in the Nexus hospital network (n = 17) in Belgium. All electrocardiograms performed in 2015 in both ambulatory and hospitalized patients were collected together with risk factors for QTc prolongation (training database). Multiple logistic regression was performed to obtain the optimal prediction (RISQ-PATH) model. The model was tested in a validation database (electrocardiograms between January and April 2016). RESULTS In total, 60 208 patients (52.8% males, mean age 63 ± 18 years) were included; 3543 patients (5.9%) had a QTc ≥ 450(♂)/470(♀) ms and 453 (0.8%) a QTc ≥ 500 ms. The optimized RISQ-PATH model has an area under the ROC-curve of 0.772 [95% CI 0.763-0.780] to predict QTc ≥ 450(♂)/470(♀)ms. A predicted probability of ≥0.035 was set as cutoff for a high risk of QTc prolongation. This cutoff resulted in a sensitivity of 87.4% [95% CI 86.2-88.5] and a specificity of 46.2% [95% CI 45.8-46.6]. These results could be confirmed for QTc ≥ 500 ms and in the validation database (n = 28 400). CONCLUSIONS The RISQ-PATH model, with a cutoff probability of 0.035, predicted a prolonged QTc interval ≥ 450/470 ms or ≥500 ms with a sensitivity of ±87% and a specificity of ±45%. This RISQ-PATH model can be used in clinical decision support systems to create smart QT alerts.
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Affiliation(s)
- Eline Vandael
- Department of Pharmaceutical and Pharmacological SciencesKU Leuven3000LeuvenBelgium
- Sciensano, Public Health and Surveillance1050BrusselsBelgium
| | - Bert Vandenberk
- Department of Cardiovascular SciencesKU Leuven3000LeuvenBelgium
- CardiologyUniversity Hospitals Leuven3000LeuvenBelgium
| | - Joris Vandenberghe
- Department of NeurosciencesKU Leuven3000LeuvenBelgium
- PsychiatryUniversity Hospitals Leuven3000LeuvenBelgium
| | | | - Rik Willems
- Department of Cardiovascular SciencesKU Leuven3000LeuvenBelgium
- CardiologyUniversity Hospitals Leuven3000LeuvenBelgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological SciencesKU Leuven3000LeuvenBelgium
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Vandenberk B, Vandael E, Robyns T, Vandenberghe J, Garweg C, Foulon V, Ector J, Willems R. QT correction across the heart rate spectrum, in atrial fibrillation and ventricular conduction defects. Pacing Clin Electrophysiol 2018; 41:1101-1108. [DOI: 10.1111/pace.13423] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 05/16/2018] [Accepted: 06/10/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences; University of Leuven; Leuven Belgium
| | - Tomas Robyns
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | | | - Christophe Garweg
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences; University of Leuven; Leuven Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences; University of Leuven; Leuven Belgium
- Department of Cardiology; University Hospitals Leuven; Leuven Belgium
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Vandael E, Vandenberk B, Vandenberghe J, Willems R, Foulon V. Cases of drug-induced Torsade de Pointes: a review of Belgian cases in the EudraVigilance database. Acta Clin Belg 2017; 72:385-390. [PMID: 28335691 DOI: 10.1080/17843286.2017.1300217] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 10/19/2022]
Abstract
OBJECTIVES Post-marketing surveillance is very important, especially for rare adverse drug reactions like QTc-prolongation and Torsade de Pointes (TdP). The objective of this study was to investigate the characteristics of Belgian cases of drug-related TdP reported in the EudraVigilance database. METHODS The EudraVigilance database was searched for Belgian post-marketing cases of TdP reported between December 2001-April 2015. These cases were identified with MedDRA preferred terms. Duplicate reports were excluded. Each included case report was reviewed to collect data about age, gender, seriousness, suspected drug, concomitant drugs, causality, and other known risk factors for QTc-prolongation. RESULTS Between 2001 and 2015, only 31 cases coded as TdP were identified; 16 cases were also coded as 'prolonged QT' and 2 patients died. In total, 21 suspected drugs were implicated and most of them (N = 11) were part of list 1 of CredibleMeds. The most common suspected drugs were citalopram (N = 4) and amiodarone (N = 3). In 18 cases, a pharmacodynamic drug-drug interaction with risk of QTc-prolongation was present. Most patients (N = 25) had ≥2 other risk factors for QTc-prolongation. CONCLUSION Over 15 years, only a low number of Belgian cases of TdP were identified in the EudraVigilance database. In most case reports, multiple risk factors for QTc-prolongation could be detected. This illustrates that there is a clear underreporting of QTc-prolongation and TdP in Belgium. Initiatives are needed to improve the awareness and knowledge of health care professionals regarding the risk of QTc-prolongation and TdP, both to prevent cases of TdP and to stimulate the reporting of these cases.
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Affiliation(s)
- Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven – University of Leuven, Leuven, Belgium
| | - Bert Vandenberk
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Experimental Cardiology – UZ Leuven, Leuven, Belgium
| | - Joris Vandenberghe
- Department of Neurosciences, KU Leuven – University of Leuven, Leuven, Belgium
- Liaison Psychiatry, KU Leuven – University of Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven – University of Leuven, Leuven, Belgium
- Cardiology – UZ Leuven, Leuven, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven – University of Leuven, Leuven, Belgium
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Vandenberk B, Vandael E, Robyns T, Vandenberghe J, Garweg C, Foulon V, Ector J, Willems R. P475QT correction and predictive value of QTc in atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux141.198] [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: 11/12/2022] Open
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Vandael E, Vandenberk B, Vandenberghe J, Pincé H, Willems R, Foulon V. Incidence of Torsade de Pointes in a tertiary hospital population. Int J Cardiol 2017; 243:511-515. [PMID: 28576628 DOI: 10.1016/j.ijcard.2017.05.072] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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: 02/10/2017] [Revised: 05/11/2017] [Accepted: 05/17/2017] [Indexed: 12/18/2022]
Abstract
BACKGROUND Multiple risk factors play a role in the development of QTc-prolongation and Torsade de Pointes (TdP). Cases of TdP are underreported and data on the incidence of TdP is scarce. The aim of this study was to investigate the incidence of TdP in a Belgian university hospital and describe the characteristics of TdP-cases using a risk score. METHODS All cases from 2011 till 2013 coded with the ICD-9 code 427.1 in the University Hospitals of Leuven were selected. The medical files were reviewed and demographical, medical, medication and electrocardiographic data were collected. We focused on TdP-cases that were probably caused by the acquired long QT-syndrome. The RISQ-PATH score was used to quantify the risk in these cases (≥10 points as high risk for QTc-prolongation/TdP). RESULTS Over three years, 41 TdP-cases were identified of which 19 cases were secondary to the acquired long QT-syndrome (52.6% females, mean age of 74±12years). This corresponds with an incidence of 0.16‰/year in a hospital population. Most of the patients (N=17) were treated with at least one QTc-prolonging drug (most frequently amiodarone, sotalol and furosemide) of whom 12 patients with ≥1 QTc-prolonging drug of list 1 of CredibleMeds. Fifteen patients had an electrocardiogram in a 24-hours interval before the TdP with a prolonged QTc-interval (≥450/470ms). All the patients had a RISQ-PATH score≥10. CONCLUSIONS Although the incidence of 0.16‰/year might seem low, this means that approximately 173 possibly lethal TdP-cases can be expected in Belgian hospitals each year. All TdP-cases were associated with a high RISQ-PATH score.
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Affiliation(s)
- Eline Vandael
- KU Leuven - University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000 Leuven, Belgium.
| | - Bert Vandenberk
- KU Leuven - University of Leuven, Department of Cardiovascular Sciences, 3000 Leuven, Belgium; University Hospitals Leuven, Cardiology, 3000 Leuven, Belgium
| | - Joris Vandenberghe
- KU Leuven - University of Leuven, Department of Neurosciences, 3000 Leuven, Belgium; University Hospitals Leuven, Psychiatry, 3000 Leuven, Belgium
| | - Hilde Pincé
- KU Leuven - University of Leuven, Leuven Institute for Healthcare Policy, 3000 Leuven, Belgium; University Hospitals Leuven, Medical Coding Department and Management Information Reporting, 3000 Leuven, Belgium
| | - Rik Willems
- KU Leuven - University of Leuven, Department of Cardiovascular Sciences, 3000 Leuven, Belgium; University Hospitals Leuven, Cardiology, 3000 Leuven, Belgium
| | - Veerle Foulon
- KU Leuven - University of Leuven, Department of Pharmaceutical and Pharmacological Sciences, 3000 Leuven, Belgium
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Vandael E, De WuLf I, Foulon V. [Drug-drug interactions with risk of QT-prolongation. A epidemiological study in Belgian community pharmacies]. J Pharm Belg 2016:14-23. [PMID: 30281244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Introduction Community pharmacists have an important role in the management of drug-drug interactions (DD). One of the interactions that can lead to serious adverse drug events, more specifically Torsade de Pointes and sudden cardiac death, are DDI with risk of CT-prolongation. Many drugs from different therapeutic classes have been linked with the risk of QT-prolongation (as listed in the QT-drug lists of CredibleMeds]. Moreover, patient-specific risk factors should be taken into account. This leads to a complex risk estimation of QT-prolongation for each patient. Aim The aim of this study is to investigate the prevalence of DDI and the management of these interactions in community pharmacies, with special attention for DDI with a risk of QT-prolongation. Method This epidemiological study is based on data of an interuniversity, observational study in 534 Belgian community pharmacies with a last-year pharmacy student (November 2012 - March 2013), in which all drug-related problems (DRP) and associated interventions of the pharmacist were registered for drugs on prescription. In this study, all DRP that were registered as a DDI were selected. The evidence for these DD was verified in four information sources (DelphiCare, Medscape, Drugs.com, handbook 'Commentaren Medicatiebewaking'). Finally, an in-depth analysis was performed for DDI with risk of QT-prolongation. QT-prolonging drugs were identified with the QT-drug lists of CredibleMeds. Results In total, 64.962 prescriptions and 15.952 DRP were registered in the interuniversity study, of which 1858 DRP (11.6%) described as a DDI that was confirmed in at least one of the information sources. Of these interactions, 223 [12.0%] were linked with a risk of QT- prolongation. The majority of the concerned drugs are situated in list 1 of CredibleMeds (known risk of Torsade de Pointes). In 69 CT-prolonging DDI, two drugs of list 1 were involved. The most frequent QT-prolonging DDI was between escitalopram and quetiapine (N=11J. In 69.5% of the QT-prolonging DDI, an intervention was performed by the community pharmacist. In 47.8% of these interventions, the DDI was discussed with the patient. In 28.3% of the QT-prolonging DDI, the pharmacist contacted the physician. However, the proposed intervention was often considered unnecessary by the physician (42.9%). In only 4.5% of the interventions, the involved CT-prolonging drug was replaced by an alternative. Conclusion DDI represent an important part of the DRP in community pharmacies, including DDI with a risk of CT-prolongation (12% of the interactions). In the majority of the QT-prolonging DDI, at least one QT-prolonging drug of list 1 of CredibleMeds [known risk of Torsade de Pointes) was involved. In only 4.5% of the interventions, the involved QT-prolonging drug was replaced by an alternative.
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Vandenberk B, Vandael E, Garweg C, Foulon V, Ector J, Willems R. Which Correction Formula for the Qt-interval Should Be Implemented In A Computer Based Hospital Wide Qt-monitoring System? J Electrocardiol 2016. [DOI: 10.1016/j.jelectrocard.2016.09.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
Background Drug safety precautions recommend monitoring of the corrected QT interval. To determine which QT correction formula to use in an automated QT‐monitoring algorithm in our electronic medical record, we studied rate correction performance of different QT correction formulae and their impact on risk assessment for mortality. Methods and Results All electrocardiograms (ECGs) in patients >18 years with sinus rhythm, normal QRS duration and rate <90 beats per minute (bpm) in the University Hospitals of Leuven (Leuven, Belgium) during a 2‐month period were included. QT correction was performed with Bazett, Fridericia, Framingham, Hodges, and Rautaharju formulae. In total, 6609 patients were included (age, 59.8±16.2 years; 53.6% male and heart rate 68.8±10.6 bpm). Optimal rate correction was observed using Fridericia and Framingham; Bazett performed worst. A healthy subset showed 99% upper limits of normal for Bazett above current clinical standards: men 472 ms (95% CI, 464–478 ms) and women 482 ms (95% CI 474–490 ms). Multivariate Cox regression, including age, heart rate, and prolonged QTc, identified Framingham (hazard ratio [HR], 7.31; 95% CI, 4.10–13.05) and Fridericia (HR, 5.95; 95% CI, 3.34–10.60) as significantly better predictors of 30‐day all‐cause mortality than Bazett (HR, 4.49; 95% CI, 2.31–8.74). In a point‐prevalence study with haloperidol, the number of patients classified to be at risk for possibly harmful QT prolongation could be reduced by 50% using optimal QT rate correction. Conclusions Fridericia and Framingham correction formulae showed the best rate correction and significantly improved prediction of 30‐day and 1‐year mortality. With current clinical standards, Bazett overestimated the number of patients with potential dangerous QTc prolongation, which could lead to unnecessary safety measurements as withholding the patient of first‐choice medication.
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Affiliation(s)
- Bert Vandenberk
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Belgium
| | - Tomas Robyns
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Christophe Garweg
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, University of Leuven, Belgium
| | - Joris Ector
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, University of Leuven, Belgium Department of Cardiology, University Hospitals Leuven, Leuven, Belgium
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Vandael E, Marynissen T, Reyntens J, Spriet I, Vandenberghe J, Willems R, Foulon V. Frequency of use of QT-interval prolonging drugs in psychiatry in Belgium. Int J Clin Pharm 2014; 36:757-65. [PMID: 24805801 DOI: 10.1007/s11096-014-9953-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/19/2014] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Drug-induced QT-prolongation is an established risk factor for Torsade de pointes and sudden cardiac death. The list of QT-prolonging drugs is extensive and includes many drugs commonly used in psychiatry. AIM In this study we performed a cross-sectional analysis of medication profiles to assess the prevalence of drug interactions potentially leading to QT-prolongation. SETTING 6 psychiatric hospitals in Flanders, Belgium. METHODS For each patient, the full medication list was screened for the presence of interactions, with special attention to those with an increased risk for QT-prolongation. Current practice on QT monitoring and prevention of drug-induced arrhythmia was assessed. MAIN OUTCOME MEASURE Number of drug interactions with risk of QT-prolongation. RESULTS 592 patients (46 % female; mean age 55.7 ± 17.1 years) were included in the analysis. 113 QT-prolonging interactions were identified in 43 patients (7.3 %). QT-prolonging interactions occurred most frequently with antidepressants (n = 102) and antipsychotics (n = 100). The precautions and follow-up provided by the different institutions when combining QT-prolonging drugs were very diverse. CONCLUSION Drug combinations that are associated with QT-prolongation are frequently used in the chronic psychiatric setting. Persistent efforts should be undertaken to provide caregivers with clear guidelines on how to use these drugs in a responsible and safe way.
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Affiliation(s)
- Eline Vandael
- Department of Pharmaceutical and Pharmacological Sciences, Clinical Pharmacology and Pharmacotherapy, KU Leuven - University of Leuven, Herestraat 49, Box 521, 3000, Leuven, Belgium,
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Liekens S, Vandael E, Roter D, Larson S, Smits T, Laekeman G, Foulon V. Impact of training on pharmacists' counseling of patients starting antidepressant therapy. Patient Educ Couns 2014; 94:110-115. [PMID: 24169022 DOI: 10.1016/j.pec.2013.09.023] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Revised: 09/16/2013] [Accepted: 09/27/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To measure the impact of a one-day depression-related training program on pharmacists' counseling of unannounced "mystery shoppers" (MS) starting antidepressant therapy. METHODS Clustered RCT pharmacies; intervention group pharmacists received communication skills training related to depression (n=21); control pharmacists did not (n=19). Eight months after training, the 40 community pharmacies were visited by MS with a first prescription for antidepressants. The pharmacy interactions were recorded and analyzed using the Roter Interaction Analysis System (RIAS). Mann-Whitney U tests were used to evaluate the impact of training on pharmacy interactions and MS evaluations of the pharmacists' skills and attitudes. RESULTS Interactions of intervention group pharmacists were significantly longer and consisted of more education and counseling statements about lifestyle and psychosocial concerns. Intervention group pharmacists asked more questions about medical condition and therapeutic regimen, as well as socioemotional concerns. MS gave more socioemotional information to intervention group pharmacists and were more positive in their assessment of these pharmacists' skills and attitudes (p values<0.05). CONCLUSION Pharmacist training in depression care can positively affect the quality of patient care. PRACTICE IMPLICATIONS Postgraduate training in depression related services is a worthwhile approach to improve the quality of pharmaceutical care.
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Affiliation(s)
- Sophie Liekens
- Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Leuven, Belgium.
| | - Eline Vandael
- Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Debra Roter
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Susan Larson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, USA
| | - Tim Smits
- Institute for Mediastudies, KU Leuven, Leuven, Belgium; Marketing Management, Lessius University College, Belgium
| | - Gert Laekeman
- Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Veerle Foulon
- Department of Pharmaceutical & Pharmacological Sciences, KU Leuven, Leuven, Belgium
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