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Hendriks MMC, Schweren KSA, Kleij A, Berrevoets MAH, de Jong E, van Wijngaarden P, Ammerlaan HSM, Vos AN, van Assen S, Slieker K, Gisolf EH, Netea MG, Ten Oever J, Kouijzer IJE. Low-risk Staphylococcus aureus bacteremia patients do not require routine diagnostic imaging: A multicenter retrospective cohort study. Clin Infect Dis 2024:ciae187. [PMID: 38576380 DOI: 10.1093/cid/ciae187] [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: 12/21/2023] [Revised: 03/21/2024] [Accepted: 04/02/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Risk stratification to categorize patients with Staphylococcus aureus bacteremia (SAB) as low- or high-risk for metastatic infection may direct diagnostic evaluation and enable personalized management. We investigated the frequency of metastatic infections in low-risk SAB patients, their clinical relevance, and whether omission of routine imaging is associated with worse outcomes. METHODS We performed a retrospective cohort study in seven Dutch hospitals among adult patients with low-risk SAB, defined as hospital-acquired infection without treatment delay, absence of prosthetic material, short duration of bacteremia, and rapid defervescence. The primary outcome was the proportion of patients whose treatment plan changed due to detected metastatic infections, as evaluated by both the actual therapy administered and by linking a retrospectively adjudicated diagnosis to guideline-recommended treatment. Secondary outcomes were 90-day relapse-free survival, and factors associated with performing of diagnostic imaging. RESULTS Of 377 patients included, 298 (79%) underwent diagnostic imaging. In 15 of these 298 patients (5.0%) imaging findings during patient admission had been interpreted as metastatic infections that should extend duration of treatment. Using the final adjudicated diagnosis, 4 patients (1.3%) had clinically relevant metastatic infection. In a multilevel multivariable logistic regression analysis, 90-days relapse-free survival was similar between patients without imaging and those who underwent imaging (81.0% versus 83.6%; aOR 0.749 (95% CI 0.373-1.504). CONCLUSION Our study advocates risk stratification for the management of patients with SAB. Prerequisites are follow-up blood cultures, bedside ID consultation, along with critically reviewing disease evolution. Using this approach, routine imaging could be omitted in low-risk patients.
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Affiliation(s)
- M M C Hendriks
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - K S A Schweren
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - A Kleij
- Elisabeth-TweeSteden Hospital, Tilburg, the Netherlands
| | | | - E de Jong
- Amphia Hospital, Breda, the Netherlands
| | | | | | - A N Vos
- Treant, Emmen, the Netherlands
| | | | - K Slieker
- Bernhoven Hospital, Uden, the Netherlands
| | - E H Gisolf
- Rijnstate Hospital, Arnhem, the Netherlands
| | - M G Netea
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
- Department of Immunology and Metabolism, Life and Medical Sciences Institute, University of Bonn, Bonn, Germany
| | - J Ten Oever
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - I J E Kouijzer
- Department of Internal Medicine and Radboud center for infectious diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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Kouijzer IJE, Speijker LTD, Aarntzen EHJG, Rijnen WHC, Somford MP, Maat I, van Meer MPA, Oever JT, Gisolf EH. Clinically unsuspected orthopedic implants during S. aureus bacteremia do not require additional diagnostic work-up. Infection 2022; 51:743-747. [PMID: 36076049 DOI: 10.1007/s15010-022-01913-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/24/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To assess the likelihood of occult infection in patients with clinically unsuspected orthopedic implants during Staphylococcus aureus bacteremia (SAB). METHODS In a retrospective study in two Dutch hospitals, we included all patients with SAB between 2013 and 2020 with one or more orthopedic implants in whom [18F]FDG-PET/CT was performed. The primary outcome was the percentage of patients who had an orthopedic implant-related infection by S. aureus. We also compared clinical parameters in patients with clinically suspected and unsuspected implants. RESULTS Fifty-five of 191 (29%) orthopedic implants in 118 SAB patients included had clinical signs of infection. Of all 136 unsuspected implants, 5 (3%, all arthroplasties), showed increased [18F]FDG uptake around the prosthesis on [18F]FDG-PET/CT. The clinical course of these patients without clinically overt infection or relapse of bacteremia during follow-up of a median of 48 months (range 0-48), however, argued against prosthetic joint infection. CONCLUSION Although orthopedic implants are evidently a risk factor for metastatic infection during SAB, the absence of clinical symptoms obviate the need of additional investigations or prolonged antibiotic treatment.
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Affiliation(s)
- Ilse J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands.
| | - L T D Speijker
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, the Netherlands
| | - W H C Rijnen
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M P Somford
- Department of Orthopaedics, Rijnstate Hospital, Arnhem, the Netherlands
| | - I Maat
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - M P A van Meer
- Department of Medical Microbiology and Immunology, Rijnstate Hospital, Arnhem, the Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, the Netherlands
| | - E H Gisolf
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, the Netherlands
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3
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van den Heuvel FMA, Bos M, Geuzebroek GSC, Aarntzen EHJG, Maat I, Dieker HJ, Verkroost M, Rodwell L, Ten Oever J, van Crevel R, Habets J, Kouijzer IJE, Nijveldt R. The impact of implementing an endocarditis team in comparison to the classic heart team in a tertiary referral centre. BMC Cardiovasc Disord 2022; 22:114. [PMID: 35300594 PMCID: PMC8931961 DOI: 10.1186/s12872-022-02558-0] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/13/2022] [Indexed: 11/10/2022] Open
Abstract
Background Infective endocarditis (IE) is a complex disease for which the European Society of Cardiology guideline recommends a dedicated multidisciplinary endocarditis team (ET) approach since 2015. It is currently unknown whether this ET approach is beneficial compared to a classic heart team approach including bedside consultation by an infectious disease specialist in Western Europe. Methods This retrospective single centre, observational cohort study was conducted at the Radboudumc, a tertiary referral centre in the Netherlands. Consecutive patients treated for IE were included from September 2017 to September 2018 before implementation of a dedicated ET and from May 2019 to May 2020 afterwards. Results In total, 90 IE patients (45 patients before and 45 patients after the implementation of the ET) were included. No significant differences were found in diagnostic workup, surgical treatment (surgery performed 69% vs. 71%, p = 0.82), time to surgery because of an urgent indication (median 4 vs. 6 days, p = 0.82), in-hospital complications (53% vs. 67%, p = 0.20), and 6-month mortality (11% vs. 13%, p = 0.75) between IE patients treated before and after the implementation of the ET. Conclusion Formalization of the recommended multidisciplinary endocarditis team might not significantly improve the complication rate nor the short term outcome. Supplementary Information The online version contains supplementary material available at 10.1186/s12872-022-02558-0.
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Affiliation(s)
- F M A van den Heuvel
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands.
| | - M Bos
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
| | - G S C Geuzebroek
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - E H J G Aarntzen
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I Maat
- Department of Medical Microbiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H J Dieker
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
| | - M Verkroost
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - L Rodwell
- Department of Health Evidence, Section Biostatistics, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R van Crevel
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Habets
- Department of Medical Imaging, Radboud University Medical Center, Nijmegen, The Netherlands
| | - I J E Kouijzer
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - R Nijveldt
- Department of Cardiology, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6500 HB, Nijmegen, the Netherlands
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4
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Machiels JD, Ter Avest M, Ten Oever J, Kramers C. [Chloroquine for COVID-19: a hype or not?]. Ned Tijdschr Geneeskd 2020; 164:D5475. [PMID: 33332057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
In March the CEO of Tesla, Elon Musk, posted a Tweet about the possible effects of chloroquine for COVID-19. Celebrities and mainstream media joined the discussion and promoted (hydroxy-)chloroquine to a true hype and the miracle cure for COVID-19. Police surveillance was needed to protect the producer of chloroquine in the Netherlands. Was (hydroxy-)chloroquine just a hype? The first European study had many methodological issues, a misleading conclusion and was published without the peer review process. It took several weeks before better designed studies showed that (hydroxy-)chloroquine was not effective for COVID-19, after which the use of this medicine was no longer recommended. It is understandable that in a pandemic there is a high need for an effective cure, but physicians should have waited until effectiveness was demonstrated. In our opinion, the use of (hydroxy-)chloroquine for COVID-19 was indeed a hype.
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Affiliation(s)
- J D Machiels
- Radboudumc, afd. Medische Microbiologie,Nijmegen
| | - M Ter Avest
- Canisius-Wilhelmina Ziekenhuis, afd. Klinische Farmacie, Nijmegen
| | - J Ten Oever
- Radboudumc, afd. Interne Geneeskunde,Nijmegen
| | - C Kramers
- Radboudumc, afd. Farmacologie-Toxicologie,Nijmegen
- Contact: C. Kramers
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Jaeger M, Pinelli M, Borghi M, Constantini C, Dindo M, van Emst L, Puccetti M, Pariano M, Ricaño-Ponce I, Büll C, Gresnigt MS, Wang X, Gutierrez Achury J, Jacobs CWM, Xu N, Oosting M, Arts P, Joosten LAB, van de Veerdonk FL, Veltman JA, Ten Oever J, Kullberg BJ, Feng M, Adema GJ, Wijmenga C, Kumar V, Sobel J, Gilissen C, Romani L, Netea MG. A systems genomics approach identifies SIGLEC15 as a susceptibility factor in recurrent vulvovaginal candidiasis. Sci Transl Med 2020; 11:11/496/eaar3558. [PMID: 31189718 DOI: 10.1126/scitranslmed.aar3558] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 08/13/2018] [Accepted: 05/14/2019] [Indexed: 12/30/2022]
Abstract
Candida vaginitis is a frequent clinical diagnosis with up to 8% of women experiencing recurrent vulvovaginal candidiasis (RVVC) globally. RVVC is characterized by at least three episodes per year. Most patients with RVVC lack known risk factors, suggesting a role for genetic risk factors in this condition. Through integration of genomic approaches and immunological studies in two independent cohorts of patients with RVVC and healthy individuals, we identified genes and cellular processes that contribute to the pathogenesis of RVVC, including cellular morphogenesis and metabolism, and cellular adhesion. We further identified SIGLEC15, a lectin expressed by various immune cells that binds sialic acid-containing structures, as a candidate gene involved in RVVC susceptibility. Candida stimulation induced SIGLEC15 expression in human peripheral blood mononuclear cells (PBMCs) and a polymorphism in the SIGLEC15 gene that was associated with RVVC in the patient cohorts led to an altered cytokine profile after PBMC stimulation. The same polymorphism led to an increase in IL1B and NLRP3 expression after Candida stimulation in HeLa cells in vitro. Last, Siglec15 expression was induced by Candida at the vaginal surface of mice, where in vivo silencing of Siglec15 led to an increase in the fungal burden. Siglec15 silencing was additionally accompanied by an increase in polymorphonuclear leukocytes during the course of infection. Identification of these pathways and cellular processes contributes to a better understanding of RVVC and may open new therapeutic avenues.
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Affiliation(s)
- M Jaeger
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, 6525GA, Netherlands
| | - M Pinelli
- Telethon Institute of Genetics and Medicine (TIGEM), Pozzuoli, Naples, 80078, Italy.,Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands
| | - M Borghi
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - C Constantini
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - M Dindo
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - L van Emst
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - M Puccetti
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - M Pariano
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - I Ricaño-Ponce
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - C Büll
- Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6525GA, Netherlands
| | - M S Gresnigt
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands.,Radboud Institute for Molecular Life Sciences (RIMLS), Radboud University Nijmegen Medical Center (Radboudumc), Nijmegen, 6525GA, Netherlands.,Department of Microbial Pathogenicity Mechanisms, Leibniz Institute for Natural Product Research and Infection Biology-Hans Knöll Institute, Beutenbergstraße 11a, Jena, 07745, Germany
| | - X Wang
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands.,College of Computer, Qinghai Normal University, 810008 Xining, China
| | - J Gutierrez Achury
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - C W M Jacobs
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - N Xu
- BGI-Shenzhen, Shenzhen 518083, China
| | - M Oosting
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - P Arts
- Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands
| | - L A B Joosten
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - F L van de Veerdonk
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - J A Veltman
- Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, 6229HX, Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - B J Kullberg
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands
| | - M Feng
- BGI-Shenzhen, Shenzhen 518083, China
| | - G J Adema
- Department of Radiation Oncology, Radiotherapy & OncoImmunology Laboratory, Radboud Institute for Molecular Life Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 32, Nijmegen, 6525GA, Netherlands
| | - C Wijmenga
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - V Kumar
- University of Groningen, University Medical Centre Groningen, Department of Genetics, Groningen, 9713GZ, Netherlands
| | - J Sobel
- Infectious Diseases, Wayne State University School of Medicine, Detroit, MI 48201, USA
| | - C Gilissen
- Department of Human Genetics, Donders Center for Neuroscience, Radboud University Medical Center, Nijmegen, 6525HR, Netherlands
| | - L Romani
- Department of Experimental Medicine, University of Perugia, Polo Unico Sant'Andrea delle Fratte, Perugia, 06123, Italy
| | - M G Netea
- Department of Internal Medicine and Radboud Centre for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, 6525GA, Netherlands. .,Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, 200349
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6
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Lenkens M, de Wit H, Danser AH, Esselink AC, Horikx A, Ten Oever J, van de Veerdonk F, Kramers C. [Medication and comedication in COVID-19 patients]. Ned Tijdschr Geneeskd 2020; 164:D4995. [PMID: 32324352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
This paper discusses the possible effects of comedication on COVID-19 and the current treatment options for this infection. It is very doubtful that comedication has a disadvantageous effect on the course of the disease. NSAIDs should be avoided in any patient with a possible severe disease, because of potential side effects. Inhibitors of the renin-angiotensin aldosterone system should be continued when there is a solid indication, and stopped in case of hemodynamic problems. There is no preference for either ACE inhibitors or angiotensin II receptor inhibitors. Currently, chloroquine and remdesivir are possible treatment options. There is no sound evidence for either treatment. Chloroquine has side effects (nausea, QT prolongation) and there are several drug interactions. The treatment should be reconsidered in the event of side effects and when inferior medication for comorbidity must be prescribed because of possible interactions. Lopinavir/ritonavir is not effective. Supportive care is at present the mainstay of the treatment.
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Affiliation(s)
- M Lenkens
- CWZ, afd. Interne Geneeskunde, Nijmegen
| | - H de Wit
- CWZ, afd. Klinische Farmacie, Nijmegen
| | - A H Danser
- Erasmus MC, afd. Interne Geneeskunde, Rotterdam
| | | | - A Horikx
- Koninklijke Nederlandse Maatschappij ter bevordering der Pharmacie (KNMP), Den Haag
| | - J Ten Oever
- Radboudumc, afd. Interne Geneeskunde, Nijmegen
| | | | - C Kramers
- Radboudumc, afd. Interne Geneeskunde, Nijmegen
- Contact: C. Kramers
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7
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Kallen MC, Ten Oever J, Prins JM, Kullberg BJ, Schouten JA, Hulscher MEJL. A survey on antimicrobial stewardship prerequisites, objectives and improvement strategies: systematic development and nationwide assessment in Dutch acute care hospitals. J Antimicrob Chemother 2019; 73:3496-3504. [PMID: 30252063 DOI: 10.1093/jac/dky367] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 08/15/2018] [Indexed: 12/30/2022] Open
Abstract
Background Stewardship guidelines define three essential building blocks for successful hospital antimicrobial stewardship programmes (ASPs): stewardship prerequisites, stewardship objectives and improvement strategies. Objectives We systematically developed a survey, based on these building blocks, to evaluate the current state of antimicrobial stewardship in hospitals. We tested this survey in 64 Dutch acute care hospitals. Methods We performed a literature review on surveys of antimicrobial stewardship. After extraction and categorization of survey questions, five experts merged and rephrased questions during a consensus meeting. After a pilot study, the survey was sent to 80 Dutch hospitals. Results The final survey consisted of 46 questions, categorized into hospital characteristics, stewardship prerequisites, stewardship objectives and stewardship strategies. The response rate was 80% (n = 64). Ninety-four percent of hospitals had established an antimicrobial stewardship team, consisting of at least one hospital pharmacist and one clinical microbiologist. An infectious diseases specialist was present in 68% of the teams. Nine percent had dedicated IT support. Forty-one percent of the teams were financially supported, with a median of 0.6 full-time equivalents (FTE; 0.1-1.8). The majority of hospitals performed monitoring of restricted antibiotic agents (91%), dose optimization (65%), bedside consultation (56%) and intravenous-to-oral switch (53%). Fifty-eight percent of the hospitals provided education to residents and 28% to specialists. Conclusions The survey provides information on the progress that is being made in hospitals regarding the three building blocks of a successful ASP, and provides clear aims to strengthen ASPs. Ultimately, these data will be related to national data on antibiotic consumption and resistance.
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Affiliation(s)
- M C Kallen
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, The Netherlands
| | - J Ten Oever
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - J M Prins
- Department of Internal Medicine, Division of Infectious Diseases, Amsterdam UMC, Meibergdreef 9, 1105 AZ Amsterdam, Amsterdam, The Netherlands
| | - B J Kullberg
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - J A Schouten
- Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.,Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | - M E J L Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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8
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Wolbrink DRJ, Kolwijck E, Ten Oever J, Horvath KD, Bouwense SAW, Schouten JA. Management of infected pancreatic necrosis in the intensive care unit: a narrative review. Clin Microbiol Infect 2019; 26:18-25. [PMID: 31238118 DOI: 10.1016/j.cmi.2019.06.017] [Citation(s) in RCA: 10] [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: 03/24/2019] [Revised: 06/11/2019] [Accepted: 06/13/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Severe acute pancreatitis is marked by organ failure and (peri)pancreatic necrosis with local complications such as infected necrosis. Infection of these necrotic collections together with organ failure remain the major causes of admission to an intensive care unit (ICU) in acute pancreatitis. Appropriate treatment of infected necrosis is essential to reduce morbidity and mortality. Overall knowledge of the treatment options within a multidisciplinary team-with special attention to the appropriate use of antimicrobial therapy and invasive treatment techniques for source control-is essential in the treatment of this complex disease. OBJECTIVES To address the current state of microbiological diagnosis, antimicrobial treatment, and source control for infected pancreatic necrosis in the ICU. SOURCES A literature search was performed using the Medline and Cochrane libraries for articles subsequent to 2003 using the keywords: infected necrosis, pancreatitis, intensive care medicine, treatment, diagnosis and antibiotic(s). CONTENT This narrative review provides an overview of key elements of diagnosis and treatment of infected pancreatic necrosis in the ICU. IMPLICATIONS In pancreatic necrosis it is essential to continuously (re)evaluate the indication for antimicrobial treatment and invasive source control. Invasive diagnostics (e.g. through fine-needle aspiration, FNA), preferably prior to the start of broad-spectrum antimicrobial therapy, is advocated. Antimicrobial stewardship principles apply: paying attention to altered pharmacokinetics in the critically ill, de-escalation of broad-spectrum therapy once cultures become available, and early withdrawal of antibiotics once source control has been established. This is important to prevent the development of antimicrobial resistance, especially in a group of patients who may require repeated courses of antibiotics during the prolonged course of their illness.
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Affiliation(s)
- D R J Wolbrink
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands; Dutch Pancreatitis Study Group, the Netherlands(†)
| | - E Kolwijck
- Radboud Centre for Infectious Diseases, Department of Medical Microbiology, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud Centre for Infectious Diseases, Department of Internal Medicine, Nijmegen, the Netherlands
| | - K D Horvath
- University of Washington, Department of Surgery, Seattle, WA 98195, USA
| | - S A W Bouwense
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands; Dutch Pancreatitis Study Group, the Netherlands(†)
| | - J A Schouten
- Radboud Centre for Infectious Diseases, Department of Intensive Care, Nijmegen, the Netherlands.
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9
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Kallen MC, Binda F, Ten Oever J, Tebano G, Pulcini C, Murri R, Beovic B, Saje A, Prins JM, Hulscher MEJL, Schouten JA. Comparison of antimicrobial stewardship programmes in acute-care hospitals in four European countries: A cross-sectional survey. Int J Antimicrob Agents 2019; 54:338-345. [PMID: 31200022 DOI: 10.1016/j.ijantimicag.2019.06.005] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/20/2019] [Accepted: 06/02/2019] [Indexed: 12/17/2022]
Abstract
Antimicrobial stewardship programmes (ASPs) are designed to improve antibiotic use. A survey was systematically developed to assess ASP prerequisites, objectives and improvement strategies in hospitals. This study assessed the current state of ASPs in acute-care hospitals throughout Europe. A survey containing 46 questions was disseminated to acute-care hospitals: all Dutch (n = 80) and Slovenian (n = 29), 215 French (25%, random stratified sampling) and 62 Italian (49% of hospitals with an infectious diseases department, convenience sampling) acute-care hospitals, for a Europe-wide assessment. Response rates for the Netherlands (Nl), Slovenia (Slo), France (Fr) and Italy (It) were 80%, 86%, 45% and 66%. There was variation between countries in the prerequisites met and the objectives and improvement strategies chosen. A formal ASP was present mainly in the Netherlands (90%) and France (84%) compared with Slovenia (60%) and Italy (60%). Presence of an antimicrobial stewardship (AMS) team ranged from 42% (Fr) to 94% (Nl). Salary support for AMS teams was provided in 68% (Fr), 51% (Nl), 33% (Slo) and 12% (It) of surveyed hospitals. Quantity of antibiotic use was monitored in the majority of hospitals, ranging from 72% (Nl) to 100% (Slo and Fr) of acute-care hospitals. Participating countries varied substantially in the use of 'prospective monitoring and advice' as a strategy to improve AMS objectives. ASP prerequisites, objectives and improvement activities vary considerably across Europe, with room for improvement. Stimulating appropriate system prerequisites throughout Europe, e.g. by introducing staffing standards and financial support for ASPs, seems a first priority.
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Affiliation(s)
- M C Kallen
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands.
| | - F Binda
- Université de Lorraine, APEMAC, Nancy, France; University of Milan, Department of Biomedical and Clinical Sciences 'Luigi Sacco', Milan, Italy
| | - J Ten Oever
- Radboud University Medical Center, Department of Internal Medicine, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - G Tebano
- Department of Infectious Diseases, Pitié-Salpêtrière Hospital, AP-PH, Paris, France; Sorbonne University, UPMC Univ. Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
| | - C Pulcini
- Université de Lorraine, APEMAC, Nancy, France; Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, Nancy, France
| | - R Murri
- Institute of Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - B Beovic
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - A Saje
- Department of Infectious Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - J M Prins
- Amsterdam UMC, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Meibergdreef 9, Amsterdam, the Netherlands
| | - M E J L Hulscher
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands
| | - J A Schouten
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare), Geert Grooteplein Zuid 10, Nijmegen, the Netherlands; Radboud University Medical Center, Department of Intensive Care Medicine, Geert Grooteplein Zuid 10, Nijmegen, the Netherlands.
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10
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Kolwijck E, Seegers AEM, Tops SCM, van der Heijden AG, Sedelaar JPM, Ten Oever J. Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study. BMC Infect Dis 2019; 19:303. [PMID: 30943902 PMCID: PMC6448312 DOI: 10.1186/s12879-019-3932-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 11/19/2018] [Accepted: 03/21/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-operative infections are frequent after radical cystectomy with urinary diversion surgery (UDS). Reduction of post-operative infections necessitates appropriate peri-operative antimicrobial prophylaxis targeting causative bacteria. We assessed the incidence and microbiology of infections in the 30-day post-operative period after UDS and investigated effectiveness of the currently used peri-operative antibacterial prophylaxis. METHODS Retrospective cohort study of all patients undergoing UDS in a tertiary university medical center from January 2014 until September 2016. Antibiotic prophylaxis consisted of cefazolin plus metronidazol according to the Dutch national guideline. Primary outcome was the incidence of post-operative infections within 30 days. Risk factors for post-operative infections and antimicrobial susceptibility profiles of cultured bacteria were also assessed. RESULTS 147 patients were included. 69 patients (46.9%) had 82 post-operative infections, 27 of which were patients with bacteremia (18.4%). Highest incidence of infections was on day 4-5 and on day 8-10 postoperatively. The second peak was associated with ureteral stent removal. 4.8% of 147 study patients developed bacteremia 24 h after stent removal, which counted for 25.9% of all bacteremia episodes found in this study. Enterobacteriaceae were cultured in 67.9% of blood cultures and were only highly susceptible to ciprofloxacine, piperacillin-tazobactam (90%), meropenem and gentamicin (100%). Multivariate logistic regression analysis showed orthotopic Hautmann neobladder to be associated with increased infections complications: odds ratio 4.1 (95% confidence interval 1.6-10.5), p = 0.03. CONCLUSIONS The incidence of infections after radical cystectomy is high and particularly ureteral stent removal was associated with both bacteremia and complicated urinary tract infections. Based on the results of this study, antibiotic prophylaxis might need to be broadened for patients undergoing radical cystectomy. Further research is required to investigate whether current guidelines need to be altered concerning administration of antibiotic prophylaxis just before stent removal.
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Affiliation(s)
- E Kolwijck
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - A E M Seegers
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - S C M Tops
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - A G van der Heijden
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J P M Sedelaar
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
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11
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Kolwijck E, Seegers AEM, Tops SCM, van der Heijden AG, Sedelaar JPM, Ten Oever J. Incidence and microbiology of post-operative infections after radical cystectomy and ureteral stent removal; a retrospective cohort study. BMC Infect Dis 2019. [PMID: 30943902 DOI: 10.1186/s12879.019-3932-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Post-operative infections are frequent after radical cystectomy with urinary diversion surgery (UDS). Reduction of post-operative infections necessitates appropriate peri-operative antimicrobial prophylaxis targeting causative bacteria. We assessed the incidence and microbiology of infections in the 30-day post-operative period after UDS and investigated effectiveness of the currently used peri-operative antibacterial prophylaxis. METHODS Retrospective cohort study of all patients undergoing UDS in a tertiary university medical center from January 2014 until September 2016. Antibiotic prophylaxis consisted of cefazolin plus metronidazol according to the Dutch national guideline. Primary outcome was the incidence of post-operative infections within 30 days. Risk factors for post-operative infections and antimicrobial susceptibility profiles of cultured bacteria were also assessed. RESULTS 147 patients were included. 69 patients (46.9%) had 82 post-operative infections, 27 of which were patients with bacteremia (18.4%). Highest incidence of infections was on day 4-5 and on day 8-10 postoperatively. The second peak was associated with ureteral stent removal. 4.8% of 147 study patients developed bacteremia 24 h after stent removal, which counted for 25.9% of all bacteremia episodes found in this study. Enterobacteriaceae were cultured in 67.9% of blood cultures and were only highly susceptible to ciprofloxacine, piperacillin-tazobactam (90%), meropenem and gentamicin (100%). Multivariate logistic regression analysis showed orthotopic Hautmann neobladder to be associated with increased infections complications: odds ratio 4.1 (95% confidence interval 1.6-10.5), p = 0.03. CONCLUSIONS The incidence of infections after radical cystectomy is high and particularly ureteral stent removal was associated with both bacteremia and complicated urinary tract infections. Based on the results of this study, antibiotic prophylaxis might need to be broadened for patients undergoing radical cystectomy. Further research is required to investigate whether current guidelines need to be altered concerning administration of antibiotic prophylaxis just before stent removal.
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Affiliation(s)
- E Kolwijck
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands. .,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.
| | - A E M Seegers
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - S C M Tops
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of medical microbiology, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
| | - A G van der Heijden
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J P M Sedelaar
- Department of urology, Radboud university medical center, Nijmegen, the Netherlands
| | - J Ten Oever
- Radboud center for infectious diseases, Radboud university medical center, P.O. Box 9101, 6500, HB, Nijmegen, the Netherlands.,Department of internal medicine, Radboud university medical center, Nijmegen, the Netherlands
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12
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Ten Oever J, Harmsen M, Schouten J, Ouwens M, van der Linden PD, Verduin CM, Kullberg BJ, Prins JM, Hulscher MEJL. Human resources required for antimicrobial stewardship teams: a Dutch consensus report. Clin Microbiol Infect 2018; 24:1273-1279. [PMID: 30036665 DOI: 10.1016/j.cmi.2018.07.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 07/07/2018] [Accepted: 07/08/2018] [Indexed: 12/19/2022]
Abstract
SCOPE Antimicrobial stewardship teams are responsible for implementing antimicrobial stewardship programmes (ASP). However, in many countries, lack of funding challenges this obligation. A consensus procedure was performed to investigate which structural activities need to be performed by Dutch stewardship teams and how much time (and thus full-time equivalent (FTE) labor) is needed to perform these activities. METHODS In 2015, an electronic survey, based on a nonsystematic literature search and interviews with seven experienced stewardship teams, was sent to 21 stewardship teams that performed an ASP. This was followed by a semistructured face-to-face consensus meeting. Fourteen stewardship teams completed the survey (18% of Dutch acute-care hospitals), and 13 participated in the consensus meeting. RECOMMENDATIONS The hours needed each year are dependent on hospital size and number of stewardship objectives monitored. If all activities are performed at a minimal base (one stewardship objective; minimal staffing standard), time investment was estimated to be 1393 to 2680 hours annually in the early phase, corresponding with 0.87 (300 beds) to 1.68 FTE (1200 beds), with a further increase to minimally 1.25 to 3.18 FTE in the following years with three stewardship objectives monitored (optimal staffing standards during the first few years of implementing an ASP). This consensus on required human resources provides a directive for structural financial support of stewardship teams in the Dutch context. Some stewardship activities (and related time investments) might be specific to the Dutch context and hospital setting. To develop standards for other settings, our methodology could be applied.
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Affiliation(s)
- J Ten Oever
- Department of Internal Medicine, Radboud University Medical Center, The Netherlands; Radboud Center for Infectious Diseases, Nijmegen, The Netherlands.
| | - M Harmsen
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, The Netherlands
| | - J Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, The Netherlands; Department of Intensive Care Medicine, Radboud University Medical Center, The Netherlands; Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - M Ouwens
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, The Netherlands
| | - P D van der Linden
- Department of Clinical Pharmacy, Tergooi Hospital, Hilversum, The Netherlands
| | - C M Verduin
- Laboratory for Medical Microbiology, Stichting PAMM, Veldhoven, The Netherlands
| | - B J Kullberg
- Department of Internal Medicine, Radboud University Medical Center, The Netherlands; Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
| | - J M Prins
- Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - M E J L Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, The Netherlands; Radboud Center for Infectious Diseases, Nijmegen, The Netherlands
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13
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Mothapo KM, Ten Oever J, Koopmans P, Stelma FF, Burm S, Bajramovic J, Verbeek MM, Rikkert MGO, Netea MG, Koopman G, van der Ven AJ. Soluble TLR2 and 4 concentrations in cerebrospinal fluid in HIV/SIV-related neuropathological conditions. J Neurovirol 2016; 23:250-259. [PMID: 27882497 DOI: 10.1007/s13365-016-0495-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 08/11/2016] [Revised: 10/18/2016] [Accepted: 10/20/2016] [Indexed: 11/29/2022]
Abstract
HIV in the central nervous system (CNS) mainly infects microglial cells which are known to express toll-like receptors (TLRs). This paper aimed to study the role of soluble TLR2 (sTLR2), sTLR4, and other inflammatory markers in cerebrospinal fluid (CSF) in HIV/Simian immunodeficiency virus (SIV)-related neurological sequelae. We determined sTLR2 and sTLR4 levels in CSF and serum/plasma of SIV-infected rhesus macaques with and without neurological sequelae, as well as in HIV-infected patients with and without cognitive impairments and Alzheimer's disease (AD) patients and matched controls. CSF cytokines and chemokines levels were analyzed in macaques as markers of neuroinflammation, while neopterin and S100B CSF concentrations were measured in HIV-infected patients as microglial and astrocyte marker, respectively. We found detectable levels of sTLR2 and sTLR4 in CSF of macaques and humans. Furthermore, CSF sTLR2 and sTLR4 concentrations were higher in SIV-infected macaques with neurological sequelae compared to those without neurological complications (p = 0.0003 and p = 0.0006, respectively). CSF IL-8 and monocyte chemoattractant protein-1 (MCP-1) levels were elevated in macaques with neurological sequelae, and a positive correlation was found between CSF levels of sTLR2/4 and IL-8 and MCP-1. Also in humans, elevated CSF sTLR4 levels were found in HIV-infected patients with cognitive impairments compared to HIV-infected patients with normal cognition (p = 0.019). Unlike CSF S100B levels, neopterin correlated positively with sTLR2 and sTLR4. No difference was found in plasma and CSF sTLR2 and sTLR4 levels between AD patients and control subjects (p = 0.26). In conclusion, CSF sTLR2 and sTLR4 may play a role in HIV/SIV-related neuroinflammation and subsequent neuropathology.
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Affiliation(s)
- Khutso M Mothapo
- Department of Internal Medicine and Nijmegen Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.
| | - J Ten Oever
- Department of Internal Medicine and Nijmegen Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - P Koopmans
- Department of Internal Medicine and Nijmegen Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - F F Stelma
- Department of Medical Microbiology-Section Virology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - S Burm
- Alternatives Unit, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - J Bajramovic
- Alternatives Unit, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - M M Verbeek
- Departments of Neurology and Laboratory Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G Olde Rikkert
- Radboudumc Alzheimer Centre, Department of Geriatric Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - M G Netea
- Department of Internal Medicine and Nijmegen Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - G Koopman
- Department of Virology, Biomedical Primate Research Centre, Rijswijk, The Netherlands
| | - A J van der Ven
- Department of Internal Medicine and Nijmegen Institute for Health Sciences, Radboud University Medical Center, PO Box 9101, 6500 HB, Nijmegen, The Netherlands
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Ten Oever J, Kuijper PHM, Kuijpers ALA, Dercksen MW, Vreugdenhil G. Complete remission of MDS RAEB following immunosuppressive treatment in a patient with Sweet's syndrome. Neth J Med 2009; 67:347-350. [PMID: 19767665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report on a patient with myelodysplastic syndrome (MDS), classified as refractory anaemia with excess of blasts-2, and histiocytoid Sweet's syndrome. The skin lesions disappeared after initiation of corticosteroids and doxycycline. Remarkably, two months later a complete remission of the MDS occurred. Fourteen months later both the skin lesions and the MDS relapsed. Antileukaemic activity following reversion of the impaired cellular immunity due to an increased number of natural killer cells in his bone marrow may be responsible for this rare event. Inhibition of T-cell mediated myelosuppression by corticosteroids or a proapoptotic effect of doxycycline may have attributed as well.
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Affiliation(s)
- J Ten Oever
- Department of Internal Medicine, Máxima Medical Centre Veldhoven, Veldhoven, the Netherlands.
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