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Jansen SJ, Broer SDL, Hemels MAC, Visser DH, Antonius TAJ, Heijting IE, Bergman KA, Termote JUM, Hütten MC, van der Sluijs JPF, d'Haens EJ, Kornelisse RF, Lopriore E, Bekker V. Central-line-associated bloodstream infection burden among Dutch neonatal intensive care units. J Hosp Infect 2024; 144:20-27. [PMID: 38103692 DOI: 10.1016/j.jhin.2023.11.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 11/18/2023] [Accepted: 11/25/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND The establishment of an epidemiological overview provides valuable insights needed for the (future) dissemination of infection-prevention initiatives. AIM To describe the nationwide epidemiology of central-line-associated bloodstream infections (CLABSI) among Dutch Neonatal Intensive Care Units (NICUs). METHODS Data from 2935 neonates born at <32 weeks' gestation and/or with a birth weight <1500 g admitted to all nine Dutch NICUs over a two-year surveillance period (2019-2020) were analysed. Variations in baseline characteristics, CLABSI incidence per 1000 central-line days, pathogen distribution and CLABSI care bundles were evaluated. Multi-variable logistic mixed-modelling was used to identify significant predictors for CLABSI. RESULTS A total of 1699 (58%) neonates received a central line, in which 160 CLABSI episodes were recorded. Coagulase-negative staphylococci were the most common infecting organisms of all CLABSI episodes (N=100, 63%). An almost six-fold difference in the CLABSI incidence between participating units was found (2.91-16.14 per 1000 line-days). Logistic mixed-modelling revealed longer central line dwell-time (adjusted odds ratio (aOR):1.08, P<0.001), umbilical lines (aOR:1.85, P=0.03) and single rooms (aOR:3.63, P=0.02) to be significant predictors of CLABSI. Variations in bundle elements included intravenous tubing care and antibiotic prophylaxis. CONCLUSIONS CLABSI remains a common problem in preterm infants in The Netherlands, with substantial variation in incidence between centres. Being the largest collection of data on the burden of neonatal CLABSI in The Netherlands, this epidemiological overview provides a solid foundation for the development of a collaborative platform for continuous surveillance, ideally leading to refinement of national evidence-based guidelines. Future efforts should focus on ensuring availability and extraction of routine patient data in aggregated formats.
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Affiliation(s)
- S J Jansen
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands.
| | - S D L Broer
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - M A C Hemels
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - D H Visser
- Emma Children's Hospital, Department of Paediatrics, Division of Neonatology, Amsterdam University Medical Centre (AUMC), Location AMC, Amsterdam, The Netherlands
| | - T A J Antonius
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - I E Heijting
- Amalia Children's Hospital, Department of Paediatrics, Division of Neonatology, Radboud University Medical Centre (Radboud UMC), Nijmegen, The Netherlands
| | - K A Bergman
- Beatrix Children's Hospital, Department of Paediatrics, Division of Neonatology, University Medical Centre Groningen (UMCG), Groningen, The Netherlands
| | - J U M Termote
- Wilhelmina Children's Hospital, Department of Neonatology, Division of Mother and Child, University Medical Centre Utrecht (UMCU), Utrecht, The Netherlands
| | - M C Hütten
- Department of Paediatrics, Division of Neonatology, Maastricht University Medical Centre (MUMC), Maastricht, The Netherlands
| | - J P F van der Sluijs
- Department Paediatrics, Division of Neonatology, Máxima Medical Centre (MMC), Veldhoven, The Netherlands
| | - E J d'Haens
- Department of Neonatology, Isala, Zwolle, The Netherlands
| | - R F Kornelisse
- Erasmus MC - Sophia Children's Hospital, Department of Neonatal and Pediatric Intensive Care, Division of Neonatology, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - E Lopriore
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
| | - V Bekker
- Willem-Alexander Children's Hospital, Department of Paediatrics, Division of Neonatology, Leiden University Medical Centre, The Netherlands
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Dierikx TH, Visser DH, Benninga MA, van Kaam AHLC, de Boer NKH, de Vries R, van Limbergen J, de Meij TGJ. The influence of prenatal and intrapartum antibiotics on intestinal microbiota colonisation in infants: A systematic review. J Infect 2020; 81:190-204. [PMID: 32389786 DOI: 10.1016/j.jinf.2020.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/10/2020] [Accepted: 05/02/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The intestinal microbiota develops in early infancy and is essential for health status early and later in life. In this review we focus on the effect of prenatal and intrapartum maternally administered antibiotics on the infant intestinal microbiota. METHODS A systematic literature search was conducted in PubMed and EMBASE. All studies reporting effect on diversity or microbiota profiles were included. RESULTS A total of 4.030 records were encountered. A total of 24 articles were included in the final analysis. Infants from mothers exposed to antibiotics during delivery showed a decreased microbial diversity compared to non-exposed infants. The microbiota of infants exposed to antibiotics was characterised by a decreased abundance of Bacteriodetes and Bifidobacteria, with a concurrent increase of Proteobacteria. These effects were most pronounced in term vaginally born infants. CONCLUSION Maternal administration of antibiotics seems to have profound effects on the infant gut microbiota colonisation. Interpretation of microbiota aberrations in specific populations, such as preterm and caesarean born infants, is complicated by multiple confounding factors and by lack of high quality studies and high heterogeneity in study design. Further research is needed to investigate the potential short- and long-term clinical consequences of these microbial alterations.
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Affiliation(s)
- T H Dierikx
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, VU University medical centre, 1081 HV, Amsterdam, The Netherlands; Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands.
| | - D H Visser
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - M A Benninga
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - A H L C van Kaam
- Department of Neonatology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - N K H de Boer
- Department of Gastroenterology and Hepatology, Amsterdam UMC, Vrije Universiteit Amsterdam, AG&M institute, Amsterdam, The Netherlands
| | - R de Vries
- Medical Library, Vrije Universiteit, Amsterdam, The Netherlands
| | - J van Limbergen
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
| | - T G J de Meij
- Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, VU University medical centre, 1081 HV, Amsterdam, The Netherlands; Department of Paediatric Gastroenterology, Emma Children's Hospital, Amsterdam UMC, Academic Medical Centre, 1105 AZ, Amsterdam, The Netherlands
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Solomons RS, Visser DH, Marais BJ, Schoeman JF, van Furth AM. Diagnostic accuracy of a uniform research case definition for TBM in children: a prospective study. Int J Tuberc Lung Dis 2018; 20:903-8. [PMID: 27287642 DOI: 10.5588/ijtld.15.0509] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bacteriological confirmation of tuberculous meningitis (TBM) is problematic, and rarely guides initial clinical management. A uniform TBM case definition has been proposed for research purposes. METHODS We prospectively enrolled patients aged 3 months to 13 years with meningitis confirmed using cerebrospinal fluid analysis at Tygerberg Hospital, Cape Town, South Africa. Criteria that differentiated TBM from other causes were explored and the accuracy of a probable TBM score assessed by comparing bacteriologically confirmed cases to 'non-TBM' controls. RESULTS Of 139 meningitis patients, 79 were diagnosed with TBM (35 bacteriologically confirmed), 10 with bacterial meningitis and 50 with viral meningitis. Among those with bacteriologically confirmed TBM, 15 were Mycobacterium tuberculosis culture-positive and 20 were culture-negative but positive on GenoType(®) MTBDRplus or Xpert(®) MTB/RIF; 18 were positive on only a single commercial nucleic acid amplification test. A probable TBM score provided a sensitivity of 74% (95%CI 57-88) and a specificity of 97% (95%CI 86-99) compared to bacteriologically confirmed TBM. CONCLUSION A probable TBM score demonstrated excellent specificity compared to bacteriological confirmation. However, 26% of children with TBM would be missed due to the limited accuracy of the case definition. Further prospective testing of an algorithm-based approach to TBM is advisable before recommendation for general clinical practice.
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Affiliation(s)
- R S Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - D H Visser
- Department of Pediatric Infectious Diseases and Immunology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
| | - B J Marais
- Marie Bashir Infectious Diseases and Biosecurity Institute and The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - J F Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - A M van Furth
- Department of Pediatric Infectious Diseases and Immunology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
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Solomons RS, Visser DH, Friedrich SO, Diacon AH, Hoek KGP, Marais BJ, Schoeman JF, van Furth AM. Improved diagnosis of childhood tuberculous meningitis using more than one nucleic acid amplification test. Int J Tuberc Lung Dis 2015; 19:74-80. [PMID: 25519794 DOI: 10.5588/ijtld.14.0394] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Early treatment is critical to reducing tuberculous meningitis (TBM) related morbidity and mortality. Diagnosis based on cerebrospinal fluid (CSF) culture is impractical due to slow turnaround times, while microscopy has poor sensitivity. Enhanced detection methods are essential to guide early treatment initiation, especially in vulnerable young children. METHODS We assessed the diagnostic accuracy of the GenoType(®) MTBDRplus and Xpert(®) MTB/RIF assays on CSF collected from paediatric meningitis suspects prospectively enrolled at Tygerberg Hospital, Cape Town, South Africa. Fluorescent auramine-O microscopy, liquid culture for Mycobacterium tuberculosis, GenoType and Xpert assays were performed on all CSF samples. RESULTS Of 101 meningitis suspects, 55 were diagnosed with TBM and 46 served as non-TBM controls. Using a pre-defined TBM case definition as reference standard, sensitivities and specificities were 4% and 100% for fluorescent microscopy, 22% and 100% for culture, 33% and 98% for GenoType, 26% and 100% for Xpert, 22% and 100% for microscopy and culture combined and 49% and 98% for GenoType and Xpert combined. Culture, GenoType and Xpert combined performed best, with 56% sensitivity and 98% specificity. CONCLUSION Although commercial nucleic-acid amplification tests performed on CSF revealed incrementally improved diagnostic accuracy, providing rapid microbiological confirmation, they cannot serve as a rule-out test.
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Affiliation(s)
- R S Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - D H Visser
- Department of Paediatric Infectious Diseases and Immunology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
| | - S O Friedrich
- Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A H Diacon
- Division of Medical Physiology, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K G P Hoek
- Division of Medical Microbiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute, The Children's Hospital at Westmead, The University of Sydney, Sydney, New South Wales, Australia
| | - J F Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - A M van Furth
- Department of Paediatric Infectious Diseases and Immunology, Vrije Universiteit University Medical Center, Amsterdam, The Netherlands
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Solomons RS, Goussard P, Visser DH, Marais BJ, Gie RP, Schoeman JF, van Furth AM. Chest radiograph findings in children with tuberculous meningitis. Int J Tuberc Lung Dis 2015; 19:200-4. [PMID: 25574919 DOI: 10.5588/ijtld.14.0634] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculous meningitis (TBM) is diagnosed based on a combination of clinical, laboratory and radiological findings, including signs suggestive of tuberculosis (TB) on a standard chest X-ray (CXR). METHODS We describe the radiological features suggestive of intrathoracic TB in children diagnosed with TBM during a prospective evaluation of TBM suspects seen at Tygerberg Children's Hospital, Cape Town, South Africa. RESULTS Of 84 children treated for TBM, 31 (37%) had 'definite' TBM, 45 (55%) 'probable' TBM and 8 (9%) 'possible' TBM. In total, 37 (44%) TBM patients had CXR findings suggestive of TB, 9 (11%) with disseminated (miliary) TB. Only 1 in 4.39 children aged ≤3 years with TBM had suggestive CXR findings. The presence of complicated intrathoracic lymph node disease was significantly higher in children aged ≤3 years (OR 21.69, 95%CI 2.73-172.67, P < 0.01). Among 6 human immunodeficiency virus infected children, 3 (50%) had intrathoracic lymphadenopathy. CONCLUSION The majority of the children with TBM, including the very young, did not have signs suggestive of TB on CXR.
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Affiliation(s)
- R S Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - P Goussard
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - D H Visser
- Department of Paediatric Infectious Diseases and Immunology, Vrije University Medical Centre, Amsterdam, The Netherlands
| | - B J Marais
- Marie Bashir Institute for Infectious Diseases and Biosecurity Institute and The Children's Hospital at Westmead, The University of Sydney, Sydney, Victoria, Australia
| | - R P Gie
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - J F Schoeman
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, South Africa
| | - A M van Furth
- Department of Paediatric Infectious Diseases and Immunology, Vrije University Medical Centre, Amsterdam, The Netherlands
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Solomons RS, Visser DH, Donald PR, Marais BJ, Schoeman JF, van Furth AM. The diagnostic value of cerebrospinal fluid chemistry results in childhood tuberculous meningitis. Childs Nerv Syst 2015; 31:1335-40. [PMID: 25976864 DOI: 10.1007/s00381-015-2745-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 05/05/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Cerebrospinal fluid (CSF) hypoglycorrhachia and elevated protein is well-described in bacterial meningitis, but evidence for its differential diagnostic value in tuberculous meningitis (TBM) is lacking. We aimed to assess the diagnostic utility of CSF glucose, CSF to serum glucose ratio and CSF protein in children with suspected TBM. METHODS We describe CSF glucose and protein values as well as CSF to serum glucose ratios in a prospective evaluation of TBM suspects seen at Tygerberg Children's Hospital, Cape Town, South Africa, from January 1985 to January 2014. RESULTS Of 615 TBM suspects, 88 (14%) had microbiologically confirmed TBM, 381 (62%) 'probable' TBM and 146 (24%) 'non-TBM'. Mean absolute CSF glucose concentration was significantly lower in the microbiologically confirmed (1.87 ± 1.15 mmol/L) and 'probable' TBM (1.82 ± 1.19 mmol/L) groups compared to non-TBM (3.66 ± 0.88 mmol/L). A CSF glucose concentration of <2.2 mmol/L diagnosed TBM with sensitivity 0.68 and specificity 0.96. Sensitivity using a CSF to serum glucose ratio of <0.5 was 0.90. Mean CSF protein was significantly elevated in the microbiologically confirmed TBM (1.91 ± 1.44 g/L) and 'probable' TBM (2.01 ± 1.49 g/L) groups compared to the non-TBM (0.31 ± 0.31 g/L). A CSF protein >1 g/L diagnosed TBM with sensitivity 0.78 and specificity 0.94. CONCLUSION Absolute CSF glucose values of <2.2 mmol/L and protein values of >1 g/L differentiated between TBM and non-bacterial meningitis with good specificity, although sensitivity was poor. A CSF to serum glucose ratio is more informative than the absolute value.
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Affiliation(s)
- R S Solomons
- Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, PO Box 19063, Tygerberg, 7505, Cape Town, South Africa,
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Blok N, Visser DH, Solomons R, Van Elsland SL, den Hertog AL, van Furth AM. Lipoarabinomannan enzyme-linked immunosorbent assay for early diagnosis of childhood tuberculous meningitis. Int J Tuberc Lung Dis 2014; 18:205-10. [PMID: 24429314 DOI: 10.5588/ijtld.13.0526] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING Tuberculous meningitis (TBM) is a severe complication of tuberculosis (TB) predominantly affecting young children. Early initiation of treatment is important to prevent morbidity and mortality associated with TBM, emphasising the importance of early diagnosis. Among the most promising new methods for diagnosing TB are antigen-detection assays based on the detection of lipoarabinomannan (LAM). OBJECTIVE To evaluate the diagnostic value of a commercial, antigen-capture enzyme-linked immunosorbent assay (ELISA) test based on the detection of LAM in urine for the early diagnosis of TBM in children. METHOD A cross-sectional study in which urine samples from paediatric patients with suspected TBM attending the Tygerberg Children's Hospital, Cape Town, South Africa, were tested for LAM. RESULTS Complete data were available for 50 of 56 patients with suspected TBM. TBM was diagnosed in 21 (42%) patients and excluded in 29 (58%). The LAM ELISA had a sensitivity of 4.8% and a specificity of 93.1%. Serial measurements in the first 2 weeks after treatment initiation did not improve test performance. CONCLUSION We have shown that urinary LAM detection was of little value for the diagnosis of TBM in a cohort of paediatric patients with suspected TBM.
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Affiliation(s)
- N Blok
- Department of Paediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - D H Visser
- Department of Paediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands
| | - R Solomons
- Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - S L Van Elsland
- Department of Paediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands; Department of Paediatrics and Child Health, Stellenbosch University, Cape Town, South Africa
| | - A L den Hertog
- KIT Biochemical Research, Royal Tropical Institute, Amsterdam, The Netherlands
| | - A M van Furth
- Department of Paediatric Infectious Diseases and Immunology, VU University Medical Center, Amsterdam, The Netherlands
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