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Årdal C, Baraldi E, Busse R, Castro R, Ciabuschi F, Cisneros JM, Gyssens IC, Harbarth S, Kostyanev T, Lacotte Y, Magrini N, McDonnell A, Monnier AA, Moon S, Mossialos E, Peñalva G, Ploy MC, Radulović M, Ruiz AA, Røttingen JA, Sharland M, Tacconelli E, Theuretzbacher U, Vogler S, Sönksen UW, Åkerfeldt K, Cars O, O'Neill J. Transferable exclusivity voucher: a flawed incentive to stimulate antibiotic innovation. Lancet 2024; 403:e2-e4. [PMID: 36774936 DOI: 10.1016/s0140-6736(23)00282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo 0213, Norway.
| | - Enrico Baraldi
- Department of Engineering Sciences, Industrial Engineering and Management, Uppsala University, Uppsala, Sweden
| | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Rosa Castro
- European Public Health Alliance, Brussels, Belgium
| | | | - José Miguel Cisneros
- Department of Infectious Diseases, University Hospital Virgen del Rocio, IBiS, CIBERINFEC, Seville, Spain
| | - Inge C Gyssens
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Yohann Lacotte
- University of Limoges, INSERM, CHU Limoges, RESINFIT, Limoges, France
| | | | | | - Annelie A Monnier
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suerie Moon
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Elias Mossialos
- London School of Economics and Political Science, London, UK
| | - Germán Peñalva
- Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Marie-Cécile Ploy
- University of Limoges, INSERM, CHU Limoges, RESINFIT, Limoges, France
| | - Momir Radulović
- Agency for Medicinal Products and Medical Devices of the Republic of Slovenia, Ljubljana, Slovenia
| | - Adrián Alonso Ruiz
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Michael Sharland
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | | | | | - Sabine Vogler
- Austrian National Public Health Institute, Vienna, Austria; Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | | | | | - Otto Cars
- ReAct Europe, Uppsala University, Uppsala, Sweden
| | - Jim O'Neill
- The Review on Antimicrobial Resistance, London, UK
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2
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D'Onofrio V, Cartuyvels R, Messiaen PEA, Barišić I, Gyssens IC. Virulence Factor Genes in Invasive Escherichia coli Are Associated with Clinical Outcomes and Disease Severity in Patients with Sepsis: A Prospective Observational Cohort Study. Microorganisms 2023; 11:1827. [PMID: 37512999 PMCID: PMC10386379 DOI: 10.3390/microorganisms11071827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 06/26/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
BACKGROUND Escherichia coli harbours virulence factors that facilitate the development of bloodstream infections. Studies determining virulence factors in clinical isolates often have limited access to clinical data and lack associations with patient outcome. The goal of this study was to correlate sepsis outcome and virulence factors of clinical E. coli isolates in a large cohort. METHODS Patients presenting at the emergency department whose blood cultures were positive for E. coli were prospectively included. Clinical and laboratory parameters were collected at admission. SOFA-score was calculated to determine disease severity. Patient outcomes were in-hospital mortality and ICU admission. Whole genome sequencing was performed for E. coli isolates and virulence genes were detected using the VirulenceFinder database. RESULTS In total, 103 E. coli blood isolates were sequenced. Isolates had six to 41 virulence genes present. One virulence gene, kpsMII_K23, a K1 capsule group 2 of E. coli type K23, was significantly more present in isolates of patients who died. kpsMII_K23 and cvaC (Microcin C) were significantly more frequent in isolates of patients who were admitted to the ICU. Fourteen virulence genes (mchB, mchC, papA_fsiA_F16, sat, senB, iucC, iutA, iha, sfaD, cnf1, focG, vat, cldB, and mcmA) significantly differed between patients with and without sepsis. CONCLUSIONS Microcins, toxins, and fimbriae were associated with disease severity. Adhesins and iron uptake proteins seemed to be protective. Two genes were associated with worse clinical outcome. These findings contribute to a better understanding of host-pathogen interactions and could help identifying patients most at risk for a worse outcome.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- Department of Infectious Diseases and Immunity, Jessa Hospital, 3500 Hasselt, Belgium
- Department of Internal Medicine and Radboud, Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
| | | | - Peter E A Messiaen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- Department of Infectious Diseases and Immunity, Jessa Hospital, 3500 Hasselt, Belgium
| | - Ivan Barišić
- Austrian Institute of Technology, 1210 Vienna, Austria
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500 Hasselt, Belgium
- Department of Internal Medicine and Radboud, Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands
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3
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Peeters T, Houben B, Cools P, Thys Y, D'Onofrio V, Martens S, Jaeger M, Doppenberg-Oosting M, Netea MG, Gyssens IC. An observational study on lifestyle and environmental risk factors in patients with acute appendicitis. Heliyon 2023; 9:e15131. [PMID: 37128345 PMCID: PMC10147974 DOI: 10.1016/j.heliyon.2023.e15131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 03/21/2023] [Accepted: 03/27/2023] [Indexed: 04/04/2023] Open
Abstract
Purpose Acute appendicitis is a common abdominal emergency worldwide. This study aimed at characterizing environmental risk factors influencing the development and severity of acute appendicitis. Methods Patients from a Belgian acute appendicitis cohort (n = 374) and healthy controls from the 500 functional genomics (500FG) cohort (n = 513) were compared. Individuals with a history of appendectomy (n = 1067) and without a history of appendectomy (n = 8656) were available from the Nijmegen Biomedical Study (NBS). Questionnaires on demographics, lifestyle and environment were available. Binary logistic regression was used for prediction models. Results Fifteen risk factors for developing acute appendicitis were identified. Binary logistic regression showed that 7 were independent risk factors: family history of acute appendicitis, having grown up in a rural environment, having a lower education, probiotic use as well as antibiotic use increased the risk of developing appendicitis. Fruit and fiber-rich vegetable consumption decreased the risk. Findings on vegetable consumption, smoking and level of education were replicated in the NBS population. Independent risk factors for complicated appendicitis were being male, higher age, and a delay to diagnosis of more than 48 h. Conclusions Environmental exposures influence the risk of developing appendicitis. Further research into these factors is needed.
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Monnier AA, D'Onofrio V, Willemsen I, Kluytmans-van den Bergh MFQ, Kluytmans JAJW, Schuermans A, Leroux-Roels I, Gyssens IC. Practice testing of generic quality indicators for responsible antibiotic use in 9 hospitals in the Dutch-Belgian border area. J Hosp Infect 2022; 129:153-161. [PMID: 35998836 DOI: 10.1016/j.jhin.2022.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/29/2022] [Accepted: 07/30/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Inpatient quality indicators (IQIs) were previously developed to assess responsible antibiotic use. The aim of this study was the practice testing of these QIs in the hospital setting. METHOD This study was performed within a Dutch-Belgian border network of hospitals implementing the Infection Risk Scan (IRIS) point prevalence survey (PPS) as part of the I-4-1-Health project. Twenty out of 51 DRIVE-AB IQIs, including 13 structure and 7 process IQIs, were tested. Data on structure IQIs were obtained through a web-based questionnaire sent to the hospital medical microbiologists. PPS data from October-December 2018 were used to calculate performance scores for the process QIs. RESULTS Nine hospitals participated. Regarding structure IQIs: the lowest performance scores were observed for recommendations for microbiological investigations in the guidelines and the use of an approval system for restricted antibiotics. In addition, most hospitals reported that some antibiotics were out of stock due to shortages. Regarding process IQIs: 697 systemic antibiotic prescriptions were used to calculate performance scores. The lowest score was observed for documentation of an antibiotic plan in the medical file (58.8%). Performance scores for IQIs on guideline compliance varied between 74.1% and 82.3% for different aspects of the antibiotic regimen (duration, choice, route, timing). CONCLUSION This multicentre practice testing of IQIs identified improvement targets for stewardship efforts for both structure and process aspects of antibiotic care (approval system for restricted antibiotics, documentation of antibiotic plan). These results can guide the design of future PPS studies and a more extensive evaluation of the clinimetric properties of the IQIs.
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Affiliation(s)
- Annelie A Monnier
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine, And Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine, And Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ina Willemsen
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Contrain infectiepreventiecoach, Breda, the Netherlands
| | - Marjolein F Q Kluytmans-van den Bergh
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Amphia Academy Infectious Disease Foundation, Amphia Hospital Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands
| | - Jan A J W Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands; Microvida Laboratory for Medical Microbiology, Amphia Hospital, Breda, the Netherlands
| | - Annette Schuermans
- Department of Infection Control and epidemiology, University Hospitals Leuven, KULeuven, Leuven, Belgium
| | | | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine, And Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
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5
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Ricaño-Ponce I, Peeters T, Matzaraki V, Houben B, Achten R, Cools P, Netea MG, Gyssens IC, Kumar V. Impact of Human Genetic Variation on C-Reactive Protein Concentrations and Acute Appendicitis. Front Immunol 2022; 13:862742. [PMID: 35693796 PMCID: PMC9174512 DOI: 10.3389/fimmu.2022.862742] [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: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/16/2022] Open
Abstract
Background Acute appendicitis is one of the most common abdominal emergencies worldwide. Both environmental and genetic factors contribute to the disease. C-reactive protein (CRP) is an important biomarker in the diagnosis of acute appendicitis. CRP concentrations are significantly affected by genetic variation. However, whether such genetic variation is causally related to appendicitis risk remains unclear. In this study, the causal relationship between single-nucleotide polymorphisms (SNPs) associated with circulating CRP concentrations and the risk and severity of acute appendicitis was investigated. Methods CRP concentrations in serum of appendicitis patients (n = 325) were measured. Appendicitis was categorized as complicated/uncomplicated and gangrenous/non-gangrenous. Imputed SNP data (n = 287) were generated. A genome-wide association study (GWAS) on CRP concentrations and appendicitis severity was performed. Intersection and colocalization of the GWAS results were performed with appendicitis and CRP-associated loci from the Pan-UKBB cohort. A functional-genomics approach to prioritize genes was employed. Results Thirteen percent of significant CRP quantitative trait loci (QTLs) that were previously identified in a large cohort of healthy individuals were replicated in our small patient cohort. Significant enrichment of CRP-QTLs in association with appendicitis was observed. Among these shared loci, the two top loci at chromosomes 1q41 and 8p23.1 were characterized. The top SNP at chromosome 1q41 is located within the promoter of H2.0 Like Homeobox (HLX) gene, which is involved in blood cell differentiation, and liver and gut organogeneses. The expression of HLX is increased in the appendix of appendicitis patients compared to controls. The locus at 8p23.1 contains multiple genes, including cathepsin B (CTSB), which is overexpressed in appendix tissue from appendicitis patients. The risk allele of the top SNP in this locus also increases CTSB expression in the sigmoid colon of healthy individuals. CTSB is involved in collagen degradation, MHC class II antigen presentation, and neutrophil degranulation. Conclusions The results of this study prioritize HLX and CTSB as potential causal genes for appendicitis and suggest a shared genetic mechanism between appendicitis and CRP concentrations.
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Affiliation(s)
- Isis Ricaño-Ponce
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Toon Peeters
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Infectious Diseases & Immunity, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Vasiliki Matzaraki
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Bert Houben
- Department of General and Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Ruth Achten
- Department of General and Abdominal Surgery, Jessa Hospital, Hasselt, Belgium
| | - Peter Cools
- Department of Abdominal Surgery, GZA Hospital, Antwerpen, Belgium
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.,Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania
| | - Inge C Gyssens
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Infectious Diseases & Immunity, Jessa Hospital, Hasselt, Belgium.,Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Vinod Kumar
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Nitte (Deemed to be University), Nitte University Centre for Science Education and Research (NUCSER), Deralakatte, Mangalore, India
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6
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D'Onofrio V, Heylen D, Pusparum M, Grondman I, Vanwalleghem J, Meersman A, Cartuyvels R, Messiaen P, Joosten LAB, Netea MG, Valkenborg D, Ertaylan G, Gyssens IC. A prospective observational cohort study to identify inflammatory biomarkers for the diagnosis and prognosis of patients with sepsis. J Intensive Care 2022; 10:13. [PMID: 35264246 PMCID: PMC8905560 DOI: 10.1186/s40560-022-00602-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 02/21/2022] [Indexed: 11/24/2022] Open
Abstract
Background Sepsis is a life-threatening organ dysfunction. A fast diagnosis is crucial for patient management. Proteins that are synthesized during the inflammatory response can be used as biomarkers, helping in a rapid clinical assessment or an early diagnosis of infection. The aim of this study was to identify biomarkers of inflammation for the diagnosis and prognosis of infection in patients with suspected sepsis. Methods In total 406 episodes were included in a prospective cohort study. Plasma was collected from all patients with suspected sepsis, for whom blood cultures were drawn, in the emergency department (ED), the department of infectious diseases, or the haemodialysis unit on the first day of a new episode. Samples were analysed using a 92-plex proteomic panel based on a proximity extension assay with oligonucleotide-labelled antibody probe pairs (OLink, Uppsala, Sweden). Supervised and unsupervised differential expression analyses and pathway enrichment analyses were performed to search for inflammatory proteins that were different between patients with viral or bacterial sepsis and between patients with worse or less severe outcome. Results Supervised differential expression analysis revealed 21 proteins that were significantly lower in circulation of patients with viral infections compared to patients with bacterial infections. More strongly, higher expression levels were observed for 38 proteins in patients with high SOFA scores (> 4), and for 21 proteins in patients with worse outcome. These proteins are mostly involved in pathways known to be activated early in the inflammatory response. Unsupervised, hierarchical clustering confirmed that inflammatory response was more strongly related to disease severity than to aetiology. Conclusion Several differentially expressed inflammatory proteins were identified that could be used as biomarkers for sepsis. These proteins are mostly related to disease severity. Within the setting of an emergency department, they could be used for outcome prediction, patient monitoring, and directing diagnostics. Trail registration number: clinicaltrial.gov identifier NCT03841162. Supplementary Information The online version contains supplementary material available at 10.1186/s40560-022-00602-x.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium. .,Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium. .,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Dries Heylen
- Unit Health, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Murih Pusparum
- Unit Health, Flemish Institute for Technological Research (VITO), Mol, Belgium.,Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Inge Grondman
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | | | | | | | - Peter Messiaen
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium.,Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.,Human Genomics Laboratory, Craiova University of Medicine and Pharmacy, Craiova, Romania
| | - Dirk Valkenborg
- Data Science Institute, Hasselt University, Hasselt, Belgium
| | - Gökhan Ertaylan
- Unit Health, Flemish Institute for Technological Research (VITO), Mol, Belgium
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Martelarenlaan 42, 3500, Hasselt, Belgium. .,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
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7
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Franceschini E, Cozzi-Lepri A, Santoro A, Bacca E, Lancellotti G, Menozzi M, Gennari W, Meschiari M, Bedini A, Orlando G, Puzzolante C, Digaetano M, Milic J, Codeluppi M, Pecorari M, Carli F, Cuomo G, Alfano G, Corradi L, Tonelli R, De Maria N, Busani S, Biagioni E, Coloretti I, Guaraldi G, Sarti M, Luppi M, Clini E, Girardis M, Gyssens IC, Mussini C. Herpes Simplex Virus Re-Activation in Patients with SARS-CoV-2 Pneumonia: A Prospective, Observational Study. Microorganisms 2021; 9:microorganisms9091896. [PMID: 34576791 PMCID: PMC8465957 DOI: 10.3390/microorganisms9091896] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/15/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Herpes simplex 1 co-infections in patients with COVID-19 are considered relatively uncommon; some reports on re-activations in patients in intensive-care units were published. The aim of the study was to analyze herpetic re-activations and their clinical manifestations in hospitalized COVID-19 patients, performing HSV-1 PCR on plasma twice a week. Methods: we conducted a prospective, observational, single-center study involving 70 consecutive patients with severe/critical SARS-CoV-2 pneumonia tested for HSV-1 hospitalized at Azienda Ospedaliero-Universitaria of Modena. Results: of these 70 patients, 21 (30.0%) showed detectable viremia and 13 (62%) had clinically relevant manifestations of HSV-1 infection corresponding to 15 events (4 pneumonia, 5 herpes labialis, 3 gingivostomatitis, one encephalitis and two hepatitis). HSV-1 positive patients were more frequently treated with steroids than HSV-1 negative patients (76.2% vs. 49.0%, p = 0.036) and more often underwent mechanical ventilation (IMV) (57.1% vs. 22.4%, p = 0.005). In the unadjusted logistic regression analysis, steroid treatment, IMV, and higher LDH were significantly associated with an increased risk of HSV1 re-activation (odds ratio 3.33, 4.61, and 16.9, respectively). The association with the use of steroids was even stronger after controlling for previous use of both tocilizumab and IMV (OR = 5.13, 95% CI:1.36–19.32, p = 0.016). The effect size was larger when restricting to participants who were treated with high doses of steroids while there was no evidence to support an association with the use of tocilizumab Conclusions: our study shows a high incidence of HSV-1 re-activation both virologically and clinically in patients with SARS-CoV-2 severe pneumonia, especially in those treated with steroids.
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Affiliation(s)
- Erica Franceschini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
- Correspondence: (E.F.); (C.M.)
| | - Alessandro Cozzi-Lepri
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London, London NW3 2PF, UK;
| | - Antonella Santoro
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Erica Bacca
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Guido Lancellotti
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Marianna Menozzi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - William Gennari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Marianna Meschiari
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Andrea Bedini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gabriella Orlando
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Cinzia Puzzolante
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Margherita Digaetano
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Jovana Milic
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Mauro Codeluppi
- Infectious Diseases Unit, G. da Saliceto Hospital, 29121 Piacenza, Italy;
| | - Monica Pecorari
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Federica Carli
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gianluca Cuomo
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Gaetano Alfano
- Nephrology, Dialysis and Transplant Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy;
| | - Luca Corradi
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
| | - Roberto Tonelli
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.T.); (E.C.)
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy;
| | - Stefano Busani
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Emanuela Biagioni
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Irene Coloretti
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Giovanni Guaraldi
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
| | - Mario Sarti
- Microbiology and Virology Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (W.G.); (M.P.); (M.S.)
| | - Mario Luppi
- Hematology Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy;
| | - Enrico Clini
- Respiratory Diseases Unit, University of Modena and Reggio Emilia, 41124 Modena, Italy; (R.T.); (E.C.)
| | - Massimo Girardis
- Intensive Care Unit, Department of Anaesthesia, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (S.B.); (E.B.); (I.C.); (M.G.)
| | - Inge C. Gyssens
- Radboud Center for Infectious Diseases, Department of Internal Medicine, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands;
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Cristina Mussini
- Infectious Diseases Unit, Azienda Ospedaliero-Universitaria Policlinico, 41124 Modena, Italy; (A.S.); (M.M.); (M.M.); (A.B.); (G.O.); (C.P.); (M.D.); (F.C.); (G.C.); (L.C.)
- Department of Infectious Diseases, University of Modena and Reggio Emilia, 41124 Modena, Italy; (E.B.); (G.L.); (J.M.); (G.G.)
- Correspondence: (E.F.); (C.M.)
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8
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Meschiari M, Lòpez-Lozano JM, Di Pilato V, Gimenez-Esparza C, Vecchi E, Bacca E, Orlando G, Franceschini E, Sarti M, Pecorari M, Grottola A, Venturelli C, Busani S, Serio L, Girardis M, Rossolini GM, Gyssens IC, Monnet DL, Mussini C. A five-component infection control bundle to permanently eliminate a carbapenem-resistant Acinetobacter baumannii spreading in an intensive care unit. Antimicrob Resist Infect Control 2021; 10:123. [PMID: 34412693 PMCID: PMC8376111 DOI: 10.1186/s13756-021-00990-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/07/2021] [Indexed: 12/18/2022] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii (CRAB) infection outbreaks are difficult to control and sometimes require cohorting of CRAB-positive patients or temporary ward closure for environmental cleaning. We aimed at controlling the deadly 2018 CRAB outbreak in a 12 bed- intensive care unit (ICU) including 9 beds in a 220 m2 open space. We implemented a new multimodal approach without ward closure, cohorting or temporarily limiting admissions. Methods A five-component bundle was introduced in 2018 including reinforcement of hand hygiene and sample extension of screening, application of contact precautions to all patients, enhanced environmental sampling and the one-time application of a cycling radical environmental cleaning and disinfection procedure of the entire ICU. The ICU-CRAB incidence density (ID), ICU alcohol-based hand rub consumption and antibiotic use were calculated over a period of 6 years and intervention time series analysis was performed. Whole genome sequencing analysis (WGS) was done on clinical and environmental isolates in the study period. Results From January 2013, nosocomial ICU-CRAB ID decreased from 30.4 CRAB cases per 1000 patients-days to zero cases per 1000 patients-days. Our intervention showed a significant impact (-2.9 nosocomial ICU-CRAB cases per 1000 bed-days), while no influence was observed for antibiotic and alcohol-based hand rub (AHR) consumption. WGS demonstrated that CRAB strains were clonally related to an environmental reservoir which confirms the primary role of the environment in CRAB ICU spreading. Conclusion A five-component bundle of continuous hand hygiene improvement, extended sampling at screening including the environment, universal contact precautions and a novel cycling radical environmental cleaning and disinfection procedure proved to be effective for permanently eliminating CRAB spreading within the ICU. Cohorting, admission restriction or ICU closure were avoided. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-021-00990-z.
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Affiliation(s)
- Marianna Meschiari
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy.
| | | | - Vincenzo Di Pilato
- Department of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy
| | | | - Elena Vecchi
- Hospital Hygiene and Infection Control, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Erica Bacca
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
| | - Gabriella Orlando
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
| | - Erica Franceschini
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
| | - Mario Sarti
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Monica Pecorari
- Laboratory of Virology and Molecular Biology, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Antonella Grottola
- Laboratory of Virology and Molecular Biology, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Claudia Venturelli
- Clinical Microbiology Laboratory, Azienda Ospedaliero-Universitaria Policlinico of Modena, Modena, Italy
| | - Stefano Busani
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
| | - Lucia Serio
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
| | - Massimo Girardis
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
| | - Gian Maria Rossolini
- Clinical Microbiology and Virology Unit, Florence Careggi University Hospital, Florence, Italy.,IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Inge C Gyssens
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Dominique L Monnet
- European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Cristina Mussini
- Infectious Disease Clinic, Azienda Ospedaliero-Universitaria Policlinico and University of Modena and Reggio Emilia, Modena, Italy
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9
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D'Onofrio V, Meersman A, Magerman K, Waumans L, van Halem K, Cox JA, van der Hilst JC, Cartuyvels R, Messiaen P, Gyssens IC. Audit of empirical antibiotic therapy for sepsis and the impact of early multidisciplinary consultation on patient outcomes. Int J Antimicrob Agents 2021; 58:106379. [PMID: 34161787 DOI: 10.1016/j.ijantimicag.2021.106379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 04/04/2021] [Accepted: 06/13/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To perform an audit of empirical antibiotic therapy (EAT) of sepsis at the emergency department and to analyse the impact of an antimicrobial stewardship (AMS) programme on process and patient outcomes. PATIENTS AND METHODS A prospective, single-centre cohort study including patients with sequential organ failure assessment (SOFA) score ≥2 from whom blood cultures were taken was conducted between February 2019 and April 2020. EAT was assessed using eight applicable inpatient quality indicators (IQIs) for responsible antibiotic use. Patient outcomes were hospital length-of-stay (LOS), ICU admission, ICU LOS, and in-hospital mortality. RESULTS The audit included 900 sepsis episodes in 803 patients. Full guideline adherence regarding choice and dosing was 45.9%; adherence regarding choice alone was 68.1%. EAT was active against all likely pathogens in 665/787 (84.5%) episodes. In the guideline non-adherent group, choice of EAT was inappropriate in 122/251 (48.6%) episodes. Changes within 3 days occurred in 335/900 (37.2%) episodes. Treating physicians changed administration route more often, whereas microbiological/infectious disease (ID)/AMS consultant advice resulted in de-escalation and discontinuation (P = 0.000). Guideline-adherent choice was associated with significantly shorter LOS (6 (4-11) vs. 8 (5-15) days). Full adherence was associated with significantly lower mortality (23 (6.4%) vs. 48 (11.3%)) and shorter LOS (6 (4-10) vs. 8 (5-14) days). CONCLUSION Five global quality indicators of EAT were measurable in routine clinical practice. Full adherence to guidelines was only moderate. Adherence to guidelines was associated with better patient outcomes.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Koen Magerman
- Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
| | - Luc Waumans
- Department of Clinical Biology, Jessa Hospital, Hasselt, Belgium
| | - Karlijn van Halem
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Janneke A Cox
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Jeroen C van der Hilst
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | | | - Peter Messiaen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium; Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.
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10
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D'Onofrio V, Meersman A, Vijgen S, Cartuyvels R, Messiaen P, Gyssens IC. Risk Factors for Mortality, Intensive Care Unit Admission, and Bacteremia in Patients Suspected of Sepsis at the Emergency Department: A Prospective Cohort Study. Open Forum Infect Dis 2020; 8:ofaa594. [PMID: 33511231 PMCID: PMC7813192 DOI: 10.1093/ofid/ofaa594] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/03/2020] [Indexed: 12/31/2022] Open
Abstract
Background There is a clear need for a better assessment of independent risk factors for in-hospital mortality, intensive care unit admission, and bacteremia in patients presenting with suspected sepsis at the emergency department. Methods A prospective observational cohort study including 1690 patients was performed. Two multivariable logistic regression models were used to identify independent risk factors. Results Sequential organ failure assessment (SOFA) score of ≥2 and serum lactate of ≥2mmol/L were associated with all outcomes. Other independent risk factors were individual SOFA variables and systemic inflammatory response syndrome variables but varied per outcome. Mean arterial pressure <70 mmHg negatively impacted all outcomes. Conclusions These readily available measurements can help with early risk stratification and prediction of prognosis.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | | | - Sara Vijgen
- Clinical Laboratory, Jessa Hospital, Hasselt, Belgium
| | | | - Peter Messiaen
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Affiliation(s)
- Inge C. Gyssens
- Department of Internal Medicine and Radboud Center for Infectious Diseases, Nijmegen, Netherlands
- Faculty of Medicine and Health Sciences, Hasselt University, Hasselt, Belgium
| | - Heiman F. Wertheim
- Department of Medical Microbiology and Radboud Center for Infectious Diseases, Nijmegen, Netherlands
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12
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Santoro A, Franceschini E, Meschiari M, Menozzi M, Zona S, Venturelli C, Digaetano M, Rogati C, Guaraldi G, Paul M, Gyssens IC, Mussini C. Epidemiology and Risk Factors Associated With Mortality in Consecutive Patients With Bacterial Bloodstream Infection: Impact of MDR and XDR Bacteria. Open Forum Infect Dis 2020; 7:ofaa461. [PMID: 33209951 PMCID: PMC7652098 DOI: 10.1093/ofid/ofaa461] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [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: 06/17/2020] [Accepted: 09/25/2020] [Indexed: 12/31/2022] Open
Abstract
Background Mortality related to bloodstream infections (BSIs) is high. The epidemiology of BSIs is changing due to the increase in multidrug resistance, and it is unclear whether the presence of multidrug-resistant (MDR) organisms, per se, is an independent risk factor for mortality. Our objectives were, first, to describe the epidemiology and outcome of BSIs and, second, to determine the risk factors associated with mortality among patients with BSI. Methods This research used a single-center retrospective observational study design. Patients were identified through microbiological reports. Data on medical history, clinical condition, bacteria, antimicrobial therapy, and mortality were collected. The primary outcome was crude mortality at 30 days. The relationships between mortality and demographic, clinical, and microbiological variables were analyzed by multivariate analysis. Results A total of 1049 inpatients were included. MDR bacteria were isolated in 27.83% of patients, where 2.14% corresponded to an extremely drug-resistant (XDR) isolate. The crude mortality rates at days 7, 30, and 90 were 12.11%, 25.17%, and 36.13%, respectively. Pitt score >2, lung and abdomen as site of infection, and XDR Pseudomonas aeruginosa were independent risk factors for 7-, 30-, and 90-day mortality. Charlson score >4, carbapenem-resistant Klebsiella pneumoniae, and XDR Acinetobacter baumannii were independent risk factors for 30- and 90-day mortality. Infection by XDR gram-negative bacteria, Charlson score >4, and immunosuppression were independent risk factors for mortality in patients who were stable at the time of BSI. Conclusions BSI is an event with an extreme impact on mortality. Patients with severe clinical condition are at higher risk of death. The presence of XDR gram-negative bacteria in blood is strongly and independently associated with patient death.
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Affiliation(s)
- Antonella Santoro
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Erica Franceschini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Marianna Meschiari
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Marianna Menozzi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Stefano Zona
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Claudia Venturelli
- Department of Microbiology, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Margherita Digaetano
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Carlotta Rogati
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Giovanni Guaraldi
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
| | - Mical Paul
- Rambam Medical Center, Infectious Diseases Department, Haifa, Israel
| | - Inge C Gyssens
- Radboud University Medical Center and Radboud Center for Infectious Diseases (RCI), Nijmegen, the Netherlands
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero-Universitaria "Policlinico of Modena," Modena, Italy
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13
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D'Onofrio V, Salimans L, Bedenić B, Cartuyvels R, Barišić I, Gyssens IC. The Clinical Impact of Rapid Molecular Microbiological Diagnostics for Pathogen and Resistance Gene Identification in Patients With Sepsis: A Systematic Review. Open Forum Infect Dis 2020; 7:ofaa352. [PMID: 33033730 PMCID: PMC7528559 DOI: 10.1093/ofid/ofaa352] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 08/10/2020] [Indexed: 12/12/2022] Open
Abstract
Fast microbiological diagnostics (MDx) are needed to ensure early targeted antimicrobial treatment in sepsis. This systematic review focuses on the impact on antimicrobial management and patient outcomes of MDx for pathogen and resistance gene identification compared with blood cultures. PubMed was searched for clinical studies using either whole blood directly or after short-term incubation. Twenty-five articles were retrieved describing the outcomes of 8 different MDx. Three interventional studies showed a significant increase in appropriateness of antimicrobial therapy and a nonsignificant change in time to appropriate therapy. Impact on mortality was conflicting. Length of stay was significantly lower in 2 studies. A significant decrease in antimicrobial cost was demonstrated in 6 studies. The limitations of this systematic review include the low number and observed heterogeneity of clinical studies. In conclusion, potential benefits of MDx regarding antimicrobial management and some patient outcomes were reported. More rigorous intervention studies are needed focusing on the direct benefits for patients.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lene Salimans
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium
| | - Branka Bedenić
- Department of Microbiology, School of Medicine, University of Zagreb, Zagreb, Croatia
| | | | - Ivan Barišić
- Molecular diagnostics, Austrian Institute of Technology, Vienna, Austria
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, Hasselt, Belgium.,Department of Internal Medicine and Radboud Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, the Netherlands
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14
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Monnier AA, Schouten J, Tebano G, Zanichelli V, Huttner BD, Pulcini C, Årdal C, Harbarth S, Hulscher ME, Gyssens IC. Ensuring Antibiotic Development, Equitable Availability, and Responsible Use of Effective Antibiotics: Recommendations for Multisectoral Action. Clin Infect Dis 2020; 68:1952-1959. [PMID: 30256927 DOI: 10.1093/cid/ciy824] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 09/20/2018] [Indexed: 12/13/2022] Open
Abstract
Antibiotic resistance is a growing threat to global public health. The World Health Organization's Global Action Plan on Antimicrobial Resistance recommends engaging multisectoral stakeholders to tackle the issue. However, so far, few studies have addressed barriers to antibiotic development, equitable availability, and responsible antibiotic use from the perspective of stakeholders outside healthcare facilities or patient communities: the so-called third-party stakeholders. Third-party stakeholders include, inter alia, governments, regulatory agencies, and professionals working in antibiotic research and development and medical ethics. This viewpoint provides an overview of barriers to antibiotic development, equitable availability of effective antibiotics, and the responsible use of antibiotics. The barriers were identified in an exploratory, qualitative interview study with an illustrative sample of 12 third-party stakeholders. Recommendations to lift these barriers are presented, together with examples of recently-made progress. The recommendations should guide future antibiotic policies and multisectoral policy action.
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Affiliation(s)
- Annelie A Monnier
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Belgium
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Benedikt D Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Céline Pulcini
- Université de Lorraine, APEMAC, Nancy, France.,Université de Lorraine, CHRU-Nancy (Centre Hospitalier Régional Universitaire de Nancy), Infectious Diseases Department, France
| | | | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Switzerland.,Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Belgium
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15
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Monnier AA, Tacconelli E, Årdal C, Cavaleri M, Gyssens IC. A case study on Staphylococcus aureus bacteraemia: available treatment options, antibiotic R&D and responsible antibiotic-use strategies. JAC Antimicrob Resist 2020; 2:dlaa034. [PMID: 34222996 PMCID: PMC8210125 DOI: 10.1093/jacamr/dlaa034] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives This case study addresses: (i) antibiotic treatment options for Staphylococcus aureus bacteraemia (SAB), for both empirical and targeted therapy; (ii) the current status of and priorities for the antibiotic pipeline to ensure access of effective antibiotics for SAB; and (iii) strategies for responsible antibiotic use relevant to the clinical management of SAB. Methods Evidence to address the aims was extracted from the following information sources: (i) EUCAST and CLSI recommendations, summaries of product characteristics (SPCs), antibiotic treatment guidelines and the textbook Kucers’ The Use of Antibiotics; (ii) the www.clinicaltrial.gov database; and (iii) quality indicators for responsible antibiotic use. Results Current monotherapy treatment options for SAB include only three drug classes (β-lactams, glycopeptides and lipopeptides), of which two also cover MRSA bacteraemia (glycopeptides and lipopeptides). The analysis of the antibiotic pipeline and ongoing clinical trials revealed that several new antibiotics with S. aureus (including MRSA) coverage were developed in the past decade (2009–19). However, none belonged to a new antibiotic class or had superior effectiveness and their added clinical value for SAB remains to be proven. Responsible antibiotic use for the treatment of SAB was illustrated using 11 quality indicators. Conclusions Awareness of the problem of a limited antibiotic arsenal, together with incentives (e.g. push incentives), is needed to steer the R&D landscape towards the development of novel and effective antibiotics for treating SAB. In the meantime, responsible antibiotic use guided by quality indicators should preserve the effectiveness of currently available antibiotics for treating SAB.
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Affiliation(s)
- Annelie A Monnier
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Verona, Italy
| | - Christine Årdal
- Norwegian Institute of Public Health, Antimicrobial Resistance Centre, Oslo, Norway
| | | | - Inge C Gyssens
- Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands.,Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
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16
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D'Onofrio V, Conzemius R, Varda-Brkić D, Bogdan M, Grisold A, Gyssens IC, Bedenić B, Barišić I. Epidemiology of colistin-resistant, carbapenemase-producing Enterobacteriaceae and Acinetobacter baumannii in Croatia. Infect Genet Evol 2020; 81:104263. [PMID: 32105865 DOI: 10.1016/j.meegid.2020.104263] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/19/2020] [Accepted: 02/21/2020] [Indexed: 10/24/2022]
Abstract
Colistin is a last-resort antibiotic for the treatment of infections caused by multidrug and carbapenem-resistant Gram-negative bacteria. Colistin resistance has been emerging and multiple outbreaks have been reported in Europe and elsewhere. It has been most frequently reported in carbapenem-resistant K. pneumoniae. In this study, 24 multidrug and colistin-resistant clinical isolates (14 K. pneumoniae, one E. aerogenes, one E. cloacae, and eight A. baumannii) were collected from four hospitals in Croatia from 2013 to 2018, in order to analyse the molecular epidemiology and mechanisms of antibiotic resistance. β-lactamase and carbapenemase genes were detected by PCR. Genotyping was done on selected isolates by rep-PCR. Whole genome sequencing (WGS) was performed to discover possible molecular mechanisms for the observed colistin resistance. All isolates, except two K. pneumoniae isolates, were extensively drug resistant. Ten out of 16 (63%) K. pneumoniae isolates possessed blaOXA-48, which is the most common carbapenem resistance gene in Croatia and in other parts of Europe. All A. baumannii isolates possessed the OXA-23-like carbapenem hydrolysing oxacillinase and five turned out to be pandrug-resistant. Colistin resistance was most likely chromosomally mediated. After sequence analysis, none of the isolates were found to possess any of the mcr gene variants. Several previously reported mutations were found in PmrB, PhoP, PhoQ, and MgrB, which are associated with colistin resistance. In the global phylogenetic analysis, DNA mutations causing mutations in the MgrB protein were present mostly in lineages comprising colistin resistant isolates, and the second most prevalent mutation (K3X) was also encountered in our isolates. In addition, based on genotyping by rep-PCR, the spread of colistin resistance is most likely to be clonal. Most importantly, the presence of colistin resistance together with carbapenemase genes in extensively drug resistant isolates poses real threats in the use of carbapenems and colistin to fight infections.
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Affiliation(s)
- Valentino D'Onofrio
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium.; Department of Infectious Diseases and Immunity, Jessa Hospital, 3500 Hasselt, Belgium; Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, 6663 Nijmegen, The Netherlands
| | - Rick Conzemius
- AIT, Austrian Institute for Technology, 1210 Vienna, Austria
| | | | - Maja Bogdan
- Public Health Institute of Osijek-Baranja County, 31000 Osijek, Croatia; School of Medicine, University of Osijek, 31000 Osijek, Croatia
| | - Andrea Grisold
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, Graz, Austria
| | - Inge C Gyssens
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium.; Department of Internal Medicine and Center for Infectious Diseases, Radboud University Medical Center, 6663 Nijmegen, The Netherlands
| | - Branka Bedenić
- University Hospital Center Zagreb, 10000 Zagreb, Croatia; School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Ivan Barišić
- AIT, Austrian Institute for Technology, 1210 Vienna, Austria.
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17
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Dyar OJ, Nathwani D, Monnet DL, Gyssens IC, Stålsby Lundborg C, Pulcini C. Do medical students feel prepared to prescribe antibiotics responsibly? Results from a cross-sectional survey in 29 European countries. J Antimicrob Chemother 2019; 73:2236-2242. [PMID: 29746647 DOI: 10.1093/jac/dky150] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 03/27/2018] [Indexed: 11/12/2022] Open
Abstract
Background In an era of antibiotic resistance, medical students must be prepared to prescribe antibiotics responsibly. Objectives To assess self-reported preparedness among final-year medical students at European universities, using a comprehensive set of topics related to prudent antibiotic use. Methods We conducted a cross-sectional, multicentre, web-based survey. All medical-degree students in their final year of studies at European universities were eligible to participate. A preparedness score was calculated for each student and mean scores were compared at medical school and country levels. Comparisons were made with national-level data on resistance among four common bacterial pathogens. Results In total, 7328 responses were included from 179/296 eligible medical schools in 29/29 countries. Students felt at least sufficiently prepared on a mean of 71.2% of topics assessed, ranging from 54.8% (Portugal) to 84.8% (Latvia). The proportion of students wanting more education on prudent antibiotic use or general antibiotic use ranged from 20.3% (Sweden) to 94.3% (Slovakia), with a mean of 66.1%, and was strongly inversely correlated with preparedness scores (Spearman's ρ = -0.72, n = 29, P < 0.001). Higher prevalence rates of antibiotic-non-susceptible bacteria were associated with lower preparedness scores and higher self-reported needs for further education (P < 0.01). Conclusions Most final-year European medical students feel they still need more education on antibiotic use for their future practice as junior doctors. Patterns of preparedness on specific topics were identified, were highly consistent across countries, and correlated with both perceived need for further education and levels of antibiotic resistance among common bacteria.
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Affiliation(s)
- Oliver J Dyar
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Inge C Gyssens
- Radboud University Medical Center, Nijmegen, The Netherlands.,Hasselt University, Hasselt, Belgium
| | - Cecilia Stålsby Lundborg
- Global Health - Health Systems and Policy, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Céline Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France.,CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
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18
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Abstract
Vaccines are applied to large populations, but only recently has research into immunologic responses and mechanisms started to increase exponentially. Some live vaccines, such as the tuberculosis vaccine bacillus Calmette-Guérin, protect against other infections nonspecifically by eliciting complex immune responses which are not specific antibody related. These heterologous effects are explained by the concept of trained immunity. This editorial introduces five narrative reviews offering recent insights on innate and adaptive immune memory towards a variety of pathogens.
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Affiliation(s)
- I C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium.
| | - M G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, the Netherlands; Department for Immunology & Metabolism, Life and Medical Sciences Institute (LIMES), University of Bonn, Bonn, Germany
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19
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Affiliation(s)
- I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium; CMI Editorial Office, UK.
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20
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Peeters T, Penders J, Smeekens SP, Galazzo G, Houben B, Netea MG, Savelkoul PHM, Gyssens IC. The fecal and mucosal microbiome in acute appendicitis patients: an observational study. Future Microbiol 2019; 14:111-127. [DOI: 10.2217/fmb-2018-0203] [Citation(s) in RCA: 20] [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: 01/08/2023] Open
Abstract
Aim: We aimed to study the mucosal microbiota of the appendix in a prospective appendicitis cohort and to compare the fecal microbiota of patients and controls. We hypothesized that the microbiota may be associated with susceptibility to appendicitis. Patients & methods: The fecal microbiota of 99 patients and 106 controls were characterized using 16S–23S intergenic spacer profiling. Richness, diversity and community structure were compared. The appendiceal microbiota from 90 patients was analyzed according to the severity of appendicitis. Results: Overall fecal microbial richness and diversity were similar in patients and controls, yet richness and diversity within the group of Firmicutes, Actinobacteria, Fusobacteria and Verrucomicrobia phyla were lower in patients. Discriminant analyses could correctly classify patients and controls with fair accuracy. No differences were found according to severity in appendiceal or fecal microbiota. Conclusion: This study demonstrates differences in the composition of intestinal microbiota of appendicitis patients and healthy individuals.
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Affiliation(s)
- Toon Peeters
- Department of Infectious Diseases & Immunity, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - John Penders
- School of Nutrition & Translational Research in Metabolism (NUTRIM) & School for Public Health & Primary Care (CAPHRI), Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Sanne P Smeekens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gianluca Galazzo
- School of Nutrition & Translational Research in Metabolism (NUTRIM) & School for Public Health & Primary Care (CAPHRI), Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bert Houben
- Department of Abdominal & Oncological Surgery, Jessa Hospital, Hasselt, Belgium
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul HM Savelkoul
- School of Nutrition & Translational Research in Metabolism (NUTRIM) & School for Public Health & Primary Care (CAPHRI), Department of Medical Microbiology, Maastricht University Medical Center+, Maastricht, The Netherlands
- Department of Medical Microbiology & Infection Control, VU University Medical Center, Amsterdam, The Netherlands
| | - Inge C Gyssens
- Department of Infectious Diseases & Immunity, Jessa Hospital, Hasselt, Belgium
- Faculty of Medicine & Life Sciences, Hasselt University, Hasselt, Belgium
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Radboudumc Center for Infectious Diseases (RCI), Radboud University Medical Center, Nijmegen, The Netherlands
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21
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Abstract
The ability to treat infectious diseases with antimicrobials is an essential component of medical management. Antimicrobial therapy is based on the characteristics of the patient, drug, microorganisms causing the infection, and colonizing flora. Prudent antibiotic use is the only option to delay the emergence of resistance. Training in infectious diseases and knowledge of the principles of responsible antibiotic prescribing and uses must be improved. To change practice, health care professionals should be educated at all levels of their training.
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Affiliation(s)
- Inge C Gyssens
- Department of Medicine, Radboud University Medical Center, AIG 463, PO Box 9101, Nijmegen 6500 HB, The Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Martelarenlaan 42, BE 3500, Hasselt, Belgium.
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22
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van Mechelen M, van der Hilst J, Gyssens IC, Messiaen P. Mycobacterial skin and soft tissue infections: TB or not TB? Neth J Med 2018; 76:269-274. [PMID: 30152403] [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: 06/08/2023]
Abstract
Non-tuberculous mycobacteria are a known cause of skin and soft tissue infections. However, only too often it takes inordinately long to arrive at the appropriate diagnosis and start treatment. Actively searching for predilection factors, exposure risks and specific clinical clues may speed up the diagnostic process. Deep tissue biopsy cultures are indispensable to determine the species and strain of mycobacterium, with important consequences for treatment. Less well known as a causative agent of prolonged tenosynovitis is Mycobacterium tuberculosis. We present a case series and performed a literature search concerning mycobacterial tenosynovitis.
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Affiliation(s)
- M van Mechelen
- Department of Infectious Diseases & Immunity, Jessa hospital, Hasselt, Belgium
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23
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Versporten A, Gyssens IC, Pulcini C, Monnier AA, Schouten J, Milanič R, Stanić Benić M, Tebano G, Le Maréchal M, Zanichelli V, Huttner B, Vlahović-Palčevski V, Goossens H, Hulscher ME, Adriaenssens N. Metrics to assess the quantity of antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi59-vi66. [PMID: 29878220 PMCID: PMC5989614 DOI: 10.1093/jac/dky119] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background The international Innovative Medicines Initiative (IMI) project DRIVE-AB (Driving Reinvestment in Research and Development and Responsible Antibiotic Use) aims to develop a global definition of 'responsible' antibiotic use. Objectives To identify consensually validated quantity metrics for antibiotic use in the outpatient setting. Methods First, outpatient quantity metrics (OQMs) were identified by a systematic search of literature and web sites published until 12 December 2014. Identified OQMs were evaluated by a multidisciplinary, international stakeholder panel using a RAND-modified Delphi procedure. Two online questionnaires and a face-to-face meeting between them were conducted to assess OQM relevance for measuring the quantity of antibiotic use on a nine-point Likert scale, to add comments or to propose new metrics. Results A total of 597 articles were screened, 177 studies met criteria for full-text screening and 138 were finally included. Twenty different OQMs were identified and appraised by 23 stakeholders. During the first survey, 14 OQMs were excluded and 6 qualified for discussion. During the face-to-face meeting, 10 stakeholders retained five OQMs and suggestions were made considering context and combination of metrics. The final set of metrics included defined daily doses, treatments/courses and prescriptions per defined population, treatments/courses and prescriptions per defined number of physician contacts and seasonal variation of total antibiotic use. Conclusions A small set of consensually validated metrics to assess the quantity of antibiotic use in the outpatient setting was obtained, enabling (inter)national comparisons. The OQMs will help build a global conceptual framework for responsible antibiotic use.
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Affiliation(s)
- Ann Versporten
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000 Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Romina Milanič
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | | | | | - Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Herman Goossens
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Niels Adriaenssens
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
- University of Antwerp, Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Antwerp, Belgium
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24
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Le Maréchal M, Tebano G, Monnier AA, Adriaenssens N, Gyssens IC, Huttner B, Milanič R, Schouten J, Stanić Benić M, Versporten A, Vlahović-Palčevski V, Zanichelli V, Hulscher ME, Pulcini C. Quality indicators assessing antibiotic use in the outpatient setting: a systematic review followed by an international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi40-vi49. [PMID: 29878218 PMCID: PMC5989608 DOI: 10.1093/jac/dky117] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Objectives Quality indicators (QIs) assessing the appropriateness of antibiotic use are essential to identify targets for improvement and guide antibiotic stewardship interventions. The aim of this study was to develop a set of QIs for the outpatient setting from a global perspective. Methods A systematic literature review was performed by searching MEDLINE and relevant web sites in order to retrieve a list of QIs. These indicators were extracted from published trials, guidelines, literature reviews or consensus procedures. This evidence-based set of QIs was evaluated by a multidisciplinary, international group of stakeholders using a RAND-modified Delphi procedure, using two online questionnaires and a face-to-face meeting between them. Stakeholders appraised the QIs' relevance using a nine-point Likert scale. This work is part of the DRIVE-AB project. Results The systematic literature review identified 43 unique QIs, from 54 studies and seven web sites. Twenty-five stakeholders from 14 countries participated in the consensus procedure. Ultimately, 32 QIs were retained, with a high level of agreement. The set of QIs included structure, process and outcome indicators, targeting both high- and middle- to low-income settings. Most indicators focused on general practice, addressing the common indications for antibiotic use in the community (particularly urinary and respiratory tract infections), and the organization of healthcare facilities. Twelve indicators specifically addressed outpatient parenteral antimicrobial therapy (OPAT). Conclusions We identified a set of 32 outpatient QIs to measure the appropriateness of antibiotic use. These QIs can be used to identify targets for improvement and to evaluate the effects of antibiotic stewardship interventions.
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Affiliation(s)
| | | | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
- University of Antwerp, Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Antwerp, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Romina Milanič
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000 Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
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25
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Zanichelli V, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Pulcini C, Le Maréchal M, Tebano G, Vlahović-Palčevski V, Stanić Benić M, Milanič R, Harbarth S, Hulscher ME, Huttner B. Variation in antibiotic use among and within different settings: a systematic review. J Antimicrob Chemother 2018; 73:vi17-vi29. [PMID: 29878219 PMCID: PMC5989604 DOI: 10.1093/jac/dky115] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Variation in antibiotic use may reflect inappropriate use. We aimed to systematically describe the variation in measures for antibiotic use among settings or providers. This study was conducted as part of the innovative medicines initiative (IMI)-funded international project DRIVE-AB. Methods We searched for studies published in MEDLINE from January 2004 to January 2015 reporting variation in measures for systemic antibiotic use (e.g. DDDs) in inpatient and outpatient settings. The ratio between a study's reported maximum and minimum values of a given measure [maximum:minimum ratio (MMR)] was calculated as a measure of variation. Similar measures were grouped into categories and when possible the overall median ratio and IQR were calculated. Results One hundred and forty-three studies were included, of which 85 (59.4%) were conducted in Europe and 12 (8.4%) in low- to middle-income countries. Most studies described the variation in the quantity of antibiotic use in the inpatient setting (81/143, 56.6%), especially among hospitals (41/81, 50.6%). The most frequent measure was DDDs with different denominators, reported in 23/81 (28.4%) inpatient studies and in 28/62 (45.2%) outpatient studies. For this measure, we found a median MMR of 3.7 (IQR 2.6-5.0) in 4 studies reporting antibiotic use in ICUs in DDDs/1000 patient-days and a median MMR of 2.3 (IQR 1.5-3.2) in 18 studies reporting outpatient antibiotic use in DDDs/1000 inhabitant-days. Substantial variation was also identified in other measures. Conclusions Our review confirms the large variation in antibiotic use even across similar settings and providers. Data from low- and middle-income countries are under-represented. Further studies should try to better elucidate reasons for the observed variation to facilitate interventions that reduce unwarranted practice variation. In addition, the heterogeneity of reported measures clearly shows that there is need for standardization.
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Affiliation(s)
- Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Céline Pulcini
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
- Université de Lorraine, APEMAC, F-54000 Nancy, France
| | | | | | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | | | - Stephan Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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26
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Monnier AA, Schouten J, Le Maréchal M, Tebano G, Pulcini C, Stanic Benic M, Vlahovic-Palcevski V, Milanic R, Adriaenssens N, Versporten A, Huttner B, Zanichelli V, Hulscher ME, Gyssens IC. Quality indicators for responsible antibiotic use in the inpatient setting: a systematic review followed by an international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi30-vi39. [PMID: 29878221 PMCID: PMC5989598 DOI: 10.1093/jac/dky116] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background This study was conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project and aimed to develop generic quality indicators (QIs) for responsible antibiotic use in the inpatient setting. Methods A RAND-modified Delphi method was applied. First, QIs were identified by a systematic review. A complementary search was performed on web sites of relevant organizations. Duplicates were removed and disease and patient-specific QIs were combined into generic indicators. The relevance of these QIs was appraised by a multidisciplinary international stakeholder panel through two questionnaires and an in-between consensus meeting. Results The systematic review retrieved 70 potential generic QIs. The QIs were appraised by 25 international stakeholders with diverse backgrounds (medical community, public health, patients, antibiotic research and development, regulators, governments). Ultimately, 51 QIs were selected in consensus. QIs with the highest relevance score included: (i) an antibiotic plan should be documented in the medical record at the start of the antibiotic treatment; (ii) the results of bacteriological susceptibility testing should be documented in the medical record; (iii) the local guidelines should correspond to the national guidelines but should be adapted based on local resistance patterns; (iv) an antibiotic stewardship programme should be in place at the healthcare facility; and (v) allergy status should be taken into account when antibiotics are prescribed. Conclusions This systematic and stepwise method combining evidence from literature and stakeholder opinion led to multidisciplinary international consensus on generic inpatient QIs that can be used globally to assess the quality of antibiotic use.
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Affiliation(s)
- Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000, Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Mirjana Stanic Benic
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Vera Vlahovic-Palcevski
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Romina Milanic
- Department of Clinical Pharmacology, University Hospital Rijeka and Medical Faculty, University of Rijeka, Rijeka, Croatia
| | - Niels Adriaenssens
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Ann Versporten
- Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute (VAXINFECTIO), University of Antwerp, Antwerp, Belgium
| | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
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27
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Stanić Benić M, Milanič R, Monnier AA, Gyssens IC, Adriaenssens N, Versporten A, Zanichelli V, Le Maréchal M, Huttner B, Tebano G, Hulscher ME, Pulcini C, Schouten J, Vlahović-Palčevski V. Metrics for quantifying antibiotic use in the hospital setting: results from a systematic review and international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi50-vi58. [PMID: 29878222 PMCID: PMC5989607 DOI: 10.1093/jac/dky118] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Quantifying antibiotic use is an essential element of antibiotic stewardship since it allows comparison between different settings and time windows, and measurement of the impact of interventions. However, quantity metrics (QMs) and methods have not been standardized. Objectives To propose a set of QMs for antibiotic use in inpatients (IQMs) that are accepted globally by professionals in a range of disciplines. The study was conducted within the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project. Methods A systematic literature review using MEDLINE identified articles on measuring inpatient antibiotic use, published up to 29 January 2015. A consensually selected list of national and international web sites was screened for additional IQMs. IQMs were classified according to the type of numerator used and presented to a multidisciplinary panel of stakeholders. A RAND-modified Delphi consensus procedure, which consisted of two online questionnaires and a face-to-face meeting, was performed. Results The systematic literature review and web site search identified 168 eligible articles from which an initial list of 20 IQMs, composed of 20 different numerators and associated denominators was developed. The consensus procedure resulted in a final set of 12 IQMs. Among this final set, DDDs per 100(0) patient-days and days of therapy per patient-days were most frequently found in the review. The panel recommended that antibiotic use should be expressed in at least two metrics simultaneously. Conclusions Our consensus procedure identified a set of IQMs that we propose as an evidence-based global standard.
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Affiliation(s)
- Mirjana Stanić Benić
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka Medical Faculty, Rijeka, Croatia
| | | | - Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - Niels Adriaenssens
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
- University of Antwerp, Department of Primary and Interdisciplinary Care (ELIZA), Centre for General Practice, Antwerp, Belgium
| | - Ann Versporten
- University of Antwerp, Vaccine & Infectious Disease Institute (VAXINFECTIO), Laboratory of Medical Microbiology, Antwerp, Belgium
| | - Veronica Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Benedikt Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Céline Pulcini
- Université de Lorraine, APEMAC, F-54000 Nancy, France
- Université de Lorraine, CHRU-Nancy, Infectious Diseases Department, F-54000 Nancy, France
| | - Jeroen Schouten
- Scientific Center for Quality of Healthcare, IQ Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Vera Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
- University of Rijeka Medical Faculty, Rijeka, Croatia
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Monnier AA, Eisenstein BI, Hulscher ME, Gyssens IC. Towards a global definition of responsible antibiotic use: results of an international multidisciplinary consensus procedure. J Antimicrob Chemother 2018; 73:vi3-vi16. [PMID: 29878216 PMCID: PMC5989615 DOI: 10.1093/jac/dky114] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background Conducted as part of the Driving Reinvestment in Research and Development and Responsible Antibiotic Use (DRIVE-AB) project, this study aimed to identify key elements for a global definition of responsible antibiotic use based on diverse stakeholder input. Methods A three-step RAND-modified Delphi method was applied. First, a systematic review of antibiotic stewardship literature and relevant organization web sites identified definitions and synonyms of responsible use. Identified elements of definitions were presented by questionnaire to a multidisciplinary international stakeholder panel for appraisal of their relevance. Finally, questionnaire results were discussed in a consensus meeting. Results The systematic review and the web site search identified 17 synonyms (e.g. appropriate, correct) and 22 potential elements to include in a definition of responsible use. Elements were grouped into patient-level (e.g. Indication, Documentation) or societal-level elements (e.g. Education, Future Effectiveness). Forty-eight stakeholders with diverse backgrounds [medical community, public health, patients, antibiotic research and development (R&D), regulators, governments] from 18 countries across all continents participated in the questionnaire. Based on relevance scores, 21 elements were retained, 9 were rephrased and 1 was added. Together, the 22 elements and associated best-practice descriptions comprise an exhaustive list of elements to be considered when defining responsible use. Conclusions Combination of concepts from the literature and stakeholder opinion led to an international multidisciplinary consensus on a global definition of responsible antibiotic use. The widely diverging perspectives of stakeholders providing input should ensure the comprehensiveness and relevance of the definition for both individual patients and society. An aspirational goal would be to address all elements.
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Affiliation(s)
- Annelie A Monnier
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | | | - Marlies E Hulscher
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
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Zanichelli V, Tebano G, Gyssens IC, Vlahović-Palčevski V, Monnier AA, Stanic Benic M, Harbarth S, Hulscher M, Pulcini C, Huttner BD. Patient-related determinants of antibiotic use: a systematic review. Clin Microbiol Infect 2018; 25:48-53. [PMID: 29777927 DOI: 10.1016/j.cmi.2018.04.031] [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: 11/27/2017] [Revised: 04/17/2018] [Accepted: 04/28/2018] [Indexed: 01/16/2023]
Abstract
OBJECTIVES We aimed to assess patient-related determinants potentially influencing antibiotic use. METHODS Studies published in MEDLINE until 30 September 2015 were searched. We included: qualitative studies describing patients' self-reported determinants of antibiotic use; and quantitative studies on either self-reported or objectively assessed determinants associated with antibiotic use. Whenever possible, reported determinants were categorized as 'barriers' or 'facilitators' of responsible antibiotic use. RESULTS A total of 87 studies from 33 countries were included. Seventy-five (86.2%) were quantitative and described self-reported (45/75, 60.0%), objectively assessed (20/75, 26.7%) or self-reported and objectively assessed (10/75, 13.3%) patient-related determinants. Twelve (12/87, 13.8%) were qualitative studies or had a qualitative and quantitative component. Eighty-six of the studies (98.8%) concerned the outpatient setting. We identified seven broad categories of determinants having an impact on different aspects of antibiotic use (in descending order of frequency): demographic and socio-economic characteristics, patient-doctor interactions (e.g. counselling), treatment characteristics (e.g. administration frequency), attitudes (e.g. expecting antibiotics), access to treatment (e.g. patients' direct costs), characteristics of the condition for which the antibiotic was prescribed (e.g. duration of symptoms), knowledge (e.g. regarding indications for treatment). Most determinants were classified as 'barriers' to responsible antibiotic use. CONCLUSION A large variety of patient-related determinants impact antibiotic use. The most easily 'modifiable' determinants concern patient-doctor interactions, treatment characteristics and knowledge. Data from the inpatient setting and low- and middle-income countries were underrepresented. Further studies should develop and test interventions that take these determinants into account with the ultimate aim of improving responsible use of antibiotics.
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Affiliation(s)
- V Zanichelli
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - G Tebano
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - V Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia; University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - A A Monnier
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium; Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - M Stanic Benic
- Department of Clinical Pharmacology, University Hospital Rijeka, Rijeka, Croatia
| | - S Harbarth
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Hulscher
- Scientific Centre for Quality of Healthcare (IQ Healthcare), Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - B D Huttner
- Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Zanichelli V, Monnier AA, Tebano G, Stanić BM, Gyssens IC, Pulcini C, Vlahović-Palčevski V, Schindler M, Harbarth S, Hulscher M, Huttner BD. Views and experiences with regard to antibiotic use of hospitalized patients in five European countries: a qualitative descriptive study. Clin Microbiol Infect 2018; 25:249.e7-249.e12. [PMID: 29777924 DOI: 10.1016/j.cmi.2018.04.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 04/17/2018] [Accepted: 04/28/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To explore inpatients experiences and views with regard to antibiotics in five European hospitals. METHODS Qualitative study where a patient-centred framework was used to explore inpatients' experiences concerning antibiotic treatment. A purposeful sample of inpatients treated with antibiotics in five hospitals participated in interviews (all centres) and focus groups (Switzerland only). RESULTS A total of 31 interviews (five in Belgium, ten in Croatia, nine in France, five in the Netherlands and two in Switzerland) and three focus groups (in Switzerland, 11 participants) were performed. The median age of participants was 61 years (range 33-86 years). The following main themes emerged: (a) patients trust doctors to take the best decisions for them even though communication concerning different antibiotic-related aspects is often insufficient, (b) patients feel that doctors do not prioritize communication due to time constraints and do not seem to adapt information based on patients' preferences, (c) patients differ in their wish to be informed but overall want to be informed on the main aspects in an understandable way, (d) patients often find reassurance in sharing information about their antibiotic treatment with close family, (e) professionals should explore patients' preferences to be involved or not in shared decision making for antibiotic treatment. CONCLUSION Inpatients often doubt their ability to understand medical information and trust their physicians to take the best decisions for them. Tailored strategies that inform hospitalized patients, acknowledging their concerns and preferences, may be useful to promote patient involvement and to improve communication regarding antibiotic use.
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Affiliation(s)
- V Zanichelli
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - A A Monnier
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Scientific Centre for Quality of Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - G Tebano
- Université de Lorraine, EA 4360 APEMAC, Nancy, France
| | - B M Stanić
- Department of Clinical Pharmacology, University Hospital Rijeka, Croatia
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands; Faculty of Medicine, Research Group of Immunology and Biochemistry, Hasselt University, Hasselt, Belgium
| | - C Pulcini
- Université de Lorraine, EA 4360 APEMAC, Nancy, France; CHRU de Nancy, Service de Maladies Infectieuses et Tropicales, Nancy, France
| | - V Vlahović-Palčevski
- Department of Clinical Pharmacology, University Hospital Rijeka, Croatia; University of Rijeka, Medical Faculty, Rijeka, Croatia
| | - M Schindler
- Sociology Department, University of Geneva, Geneva, Switzerland
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - M Hulscher
- Scientific Centre for Quality of Healthcare, IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - B D Huttner
- Infection Control Programme, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland; Division of Infectious Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
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Averbuch D, Orasch C, Mikulska M, Livermore DM, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, Akova M, Calandra T, Cordonnier C. Re: "Comparison of antipseudomonal betalactams for febrile neutropenia empiric therapy: systematic review and network metaanalysis" by Horita et al. Clin Microbiol Infect 2018; 24:662-663. [PMID: 29410224 DOI: 10.1016/j.cmi.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 01/08/2018] [Accepted: 01/10/2018] [Indexed: 11/27/2022]
Affiliation(s)
- D Averbuch
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel.
| | - C Orasch
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (CHUV, Centre Hospitalier Universitaire Vaudois), Lausanne, Switzerland; Division for Infectious Diseases and Hospital Epidemiology, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - M Mikulska
- Infectious Disease Unit, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
| | - D M Livermore
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, NR4 7TJ, UK
| | - C Viscoli
- Infectious Disease Unit, University of Genova (DISSAL) and Ospedale Policlinico San Martino, Genova, Italy
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands; Hasselt University, Hasselt, Belgium
| | - W V Kern
- Division of Infectious Diseases, University Hospital and Medical Centre, Freiburg, Germany
| | - G Klyasova
- Department of Clinical Microbiology, Mycology and Antimicrobial Treatment, National Research Centre for Haematology, Moscow, Russia
| | - O Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, CH-1011 Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la CÔte, CH-1110 Morges, Switzerland
| | - D Engelhard
- Hadassah-Hebrew University Medical Centre, Jerusalem, Israel
| | - M Akova
- Hacettepe University School of Medicine, Department of Infectious Diseases, Ankara, 06100 Turkey
| | - T Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - C Cordonnier
- Assistance Publique-Hôpitaux de Paris (APHP) - Henri Mondor, Haematology Department and University Paris-Est Créteil, F-94010, Créteil, France
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Baecke C, Gyssens IC, Decoutere L, van der Hilst JCH, Messiaen P. Prevalence of drug-drug interactions in the era of HIV integrase inhibitors: a retrospective clinical study. Neth J Med 2017; 75:235-240. [PMID: 28741582] [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: 06/07/2023]
Abstract
BACKGROUND Antiretroviral agents pose a high risk for drug-drug interactions (DDIs), mainly but not limited to being a substrate, inducer or inhibitor of P450 cytochrome enzymes. In part metabolised by other pathways, integrase inhibitors might show a more favourable profile. The aim of this study was to investigate the prevalence of DDIs in daily clinical practice for patients starting different antiretroviral treatment (ART) regimens. METHODS All patients starting ART in our centre from January 2009 to April 2016 were included. All prescribed co-medications since the start of ART were recorded retrospectively from the medical files and screened for DDIs using the Liverpool HIV drug interaction database. Only DDIs between antiretroviral and non-antiretroviral drugs were considered. RESULTS We included 145 patients, of which 42% were on an integrase inhibitor-based regimen, mainly dolutegravir and elvitegravir. Of the patients, 78% (n = 113) took co-medication. Potential DDIs were seen in 63% of the patients with co-medication; contraindicated prescriptions were detected in 1%. Protease inhibitor-based ART was a risk factor for DDI (odds ratio (OR) 2.57; 95% confidence interval (CI) 1.06-6.19), in contrast to non-nucleoside reverse transcriptase inhibitor-based ART (OR 0.77; 95% CI 0.32-1.84). Concerning integrase inhibitors, a significantly lower risk was seen with dolutegravir-based treatment (OR 0.35; 95% CI 0.15-0.82), though not for elvitegravir-based ART (OR 2.51; 95% CI 0.66-9.58). CONCLUSIONS ART regimens pose a dissimilar risk for drug-drug interactions in clinical practice. Regarding the use of integrase inhibitors, a significantly lower risk was seen with dolutegravir-based treatment.
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Affiliation(s)
- C Baecke
- Department of Infectious Diseases & Immunity, Jessa Hospital, Hasselt, Belgium
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Messiaen P, Forier A, Vanderschueren S, Theunissen C, Nijs J, Van Esbroeck M, Bottieau E, De Schrijver K, Gyssens IC, Cartuyvels R, Dorny P, van der Hilst J, Blockmans D. Outbreak of trichinellosis related to eating imported wild boar meat, Belgium, 2014. ACTA ACUST UNITED AC 2017; 21:30341. [PMID: 27684098 PMCID: PMC5032856 DOI: 10.2807/1560-7917.es.2016.21.37.30341] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/04/2016] [Indexed: 11/20/2022]
Abstract
Trichinellosis is a rare parasitic zoonosis caused by Trichinella following ingestion of raw or undercooked meat containing Trichinella larvae. In the past five years, there has been a sharp decrease in human trichinellosis incidence rates in the European Union due to better practices in rearing domestic animals and control measures in slaughterhouses. In November 2014, a large outbreak of trichinellosis occurred in Belgium, related to the consumption of imported wild boar meat. After a swift local public health response, 16 cases were identified and diagnosed with trichinellosis. Of the 16 cases, six were female. The diagnosis was confirmed by serology or the presence of larvae in the patients' muscle biopsies by histology and/or PCR. The ensuing investigation traced the wild boar meat back to Spain. Several batches of imported wild boar meat were recalled but tested negative. The public health investigation allowed us to identify clustered undiagnosed cases. Early warning alerts and a coordinated response remain indispensable at a European level.
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Affiliation(s)
- Peter Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
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Gyssens IC. Introduction to the supplement on 'Vaccines for mutual protection'. Clin Microbiol Infect 2016; 22 Suppl 5:S83-S84. [PMID: 27890456 DOI: 10.1016/j.cmi.2016.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 11/28/2022]
Affiliation(s)
- I C Gyssens
- Radboud University Medical Centre Nijmegen, The Netherlands; Hasselt University, Hasselt, Belgium.
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Bedini A, De Maria N, Del Buono M, Bianchini M, Mancini M, Binda C, Brasacchio A, Orlando G, Franceschini E, Meschiari M, Sartini A, Zona S, Paioli S, Villa E, Gyssens IC, Mussini C. Antimicrobial stewardship in a Gastroenterology Department: Impact on antimicrobial consumption, antimicrobial resistance and clinical outcome. Dig Liver Dis 2016; 48:1142-7. [PMID: 27453168 DOI: 10.1016/j.dld.2016.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [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: 05/04/2016] [Revised: 06/04/2016] [Accepted: 06/20/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND A major cause of the increase in antimicrobial resistance is the inappropriate use of antimicrobials. AIMS To evaluate the impact on antimicrobial consumption and clinical outcome of an antimicrobial stewardship program in an Italian Gastroenterology Department. METHODS Between October 2014 and September 2015 (period B), a specialist in infectious diseases (ID) controlled all antimicrobial prescriptions and decided about the therapy in agreement with gastroenterologists. The defined daily doses of antimicrobials (DDDs), incidence of MDR-infections, mean length of stay and overall in-hospital mortality rate were compared with those of the same period in the previous 12-months (period A). RESULTS During period B, the ID specialist performed 304 consultations: antimicrobials were continued in 44.4% of the cases, discontinued in 13.8%, not recommended in 12.1%, de-escalated 9.9%, escalated in 7.9%, and started in 4.0%. Comparing the 2 periods, we observed a decreased of antibiotics consumption (from 109.81 to 78.45 DDDs/100 patient-days, p=0.0005), antifungals (from 41.28 to 24.75 DDDs/100pd, p=0.0004), carbapenems (from 15.99 to 6.80 DDDsx100pd, p=0.0032), quinolones (from 35.79 to 17.82 DDDsx100pd, p=0.0079). No differences were observed in incidence of MDR-infections, length of hospital stay (LOS), and mortality rate. CONCLUSIONS ASP program had a positive impact on reducing the consumption of antimicrobials, without an increase in LOS and mortality.
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Affiliation(s)
- Andrea Bedini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy.
| | - Nicola De Maria
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Mariagrazia Del Buono
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Marcello Bianchini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Mauro Mancini
- Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Cecilia Binda
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Andrea Brasacchio
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Gabriella Orlando
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Erica Franceschini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Marianna Meschiari
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Alessandro Sartini
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Stefano Zona
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Serena Paioli
- Pharmaceutical Department, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Erica Villa
- Gastroenterology Unit, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
| | - Inge C Gyssens
- Department of Infectious Diseases, Hasselt University, Belgium
| | - Cristina Mussini
- Clinic of Infectious Diseases, Azienda Ospedaliero-Universitaria, Policlinico di Modena, Italy
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Manniën J, van Kasteren MEE, Nagelkerke NJ, Gyssens IC, Kullberg BJ, Wille JC, de Boer AS. Effect of Optimized Antibiotic Prophylaxis on the Incidence of Surgical Site Infection. Infect Control Hosp Epidemiol 2016; 27:1340-6. [PMID: 17152032 DOI: 10.1086/509842] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 06/21/2005] [Accepted: 12/05/2005] [Indexed: 02/06/2023]
Abstract
Objective.To compare the rate of surgical site infection (SSI) before and after an intervention period in which an optimized policy for antibiotic prophylaxis was implemented. To demonstrate that a more prudent, restrictive policy would not have a detrimental effect on patient outcomes.Design.Before-after trial with prospective SSI surveillance in the Dutch nosocomial surveillance network (Preventie Ziekenhuisinfecties door Surveillance [PREZIES]), using the criteria of the Centers for Disease Control, including postdischarge surveillance for up to 1 year.Methods.During a preintervention period and a postintervention period (both 6-13 months), 12 Dutch hospitals collected data on antimicrobial prophylaxis and SSI rates. The study was limited to commonly performed surgical procedures in 4 specialties: vascular, intestinal, gynecological and orthopedic surgery. Selected risk factors for analysis were sex, age, American Society of Anesthesiologists classification, wound contamination class, duration of surgery, length of hospital stay before surgery, and urgency of surgery (elective or acute).Results.A total of 3,621 procedures were included in the study, of which 1,668 were performed before the intervention and 1,953 after. The overall SSI rate decreased from 5.4% to 4.5% (P = .22). Among the procedures included in the study, the largest proportion (55%) were total hip arthroplasty, and the smallest proportion (2%) were replacement of the head of the femur. SSI rates varied from 0% for vaginal hysterectomy to 21.1% for femoropopliteal or femorotibial bypass surgery. Crude and adjusted odds ratios showed that there were no significant changes in procedure-specific SSI rates after the intervention (P>.1).Conclusions.An optimized and restrictive antibiotic prophylaxis policy had no detrimental effect on the outcome of clean and clean contaminated surgery, as measured by SSI rate.
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Affiliation(s)
- Judith Manniën
- National Institute for Public Health and the Environment, Center for Infectious Disease Epidemiology, Bilthoven, The Netherlands.
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Jaeger M, Stappers MHT, Joosten LAB, Gyssens IC, Netea MG. Genetic variation in pattern recognition receptors: functional consequences and susceptibility to infectious disease. Future Microbiol 2016; 10:989-1008. [PMID: 26059622 DOI: 10.2217/fmb.15.37] [Citation(s) in RCA: 19] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Cells of the innate immune system are equipped with surface and cytoplasmic receptors for microorganisms called pattern recognition receptors (PRRs). PRRs recognize specific pathogen-associated molecular patterns and as such are crucial for the activation of the immune system. Currently, five different classes of PRRs have been described: Toll-like receptors, C-type lectin receptors, nucleotide-binding oligomerization domain-like receptors, retinoic acid-inducible gene I-like receptors and absent in melanoma 2-like receptors. Following their discovery, many sequence variants in PRR genes have been uncovered and shown to be implicated in human infectious diseases. In this review, we will discuss the effect of genetic variation in PRRs and their signaling pathways on susceptibility to infectious diseases in humans.
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Affiliation(s)
- Martin Jaeger
- Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Mark H T Stappers
- Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.,Department of Medical Microbiology & Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Faculty of Medicine, Research group of Immunology & Biochemistry, Hasselt University, Hasselt, Belgium
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands.,Department of Medical Microbiology & Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands.,Faculty of Medicine, Research group of Immunology & Biochemistry, Hasselt University, Hasselt, Belgium
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
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Messiaen PEA, Peeters K, van Esbroeck MJA, Bijnens EJL, Wouters KK, Gyssens IC, van der Hilst JCH. A 47-year-old woman with fever and periorbital oedema. Trichinellosis. Neth J Med 2016; 74:96-97. [PMID: 26951358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- P E A Messiaen
- Department of Infectious Diseases and Immunity, Jessa Hospital, Hasselt, Belgium
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Ghathian K, Calum H, Gyssens IC, Frimodt-Møller N. Temocillin in vitro activity against recent clinical isolates of Neisseria gonorrhoeae compared with penicillin, ceftriaxone and ciprofloxacin. J Antimicrob Chemother 2016; 71:1122-3. [PMID: 26747100 DOI: 10.1093/jac/dkv434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Affiliation(s)
- K Ghathian
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - H Calum
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - I C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - N Frimodt-Møller
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
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Stappers MHT, Hagen F, Reimnitz P, Mouton JW, Meis JF, Gyssens IC. Bacteroides fragilis in biopsies of patients with major abscesses and diabetic foot infections: direct molecular versus culture-based detection. Diagn Microbiol Infect Dis 2015; 85:263-5. [PMID: 27112830 DOI: 10.1016/j.diagmicrobio.2015.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/31/2015] [Accepted: 12/22/2015] [Indexed: 10/22/2022]
Abstract
Direct determination by pathogen-specific real-time PCR assay for Bacteroides fragilis was compared to culture in major abscess and diabetic foot infection biopsy samples. Real-time PCR resulted in an increased detection rate of 12% for B. fragilis and could improve the detection of B. fragilis in clinical samples.
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Affiliation(s)
- Mark H T Stappers
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Hasselt University, Martelarenlaan 42, BE3500, Hasselt, Belgium
| | - Ferry Hagen
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands
| | - Peter Reimnitz
- Bayer Healthcare Pharmaceuticals, Friedrich-Ebert-Straße 475, 42117, Wuppertal, Germany
| | - Johan W Mouton
- Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Jacques F Meis
- Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Department of Medical Microbiology, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Erasmus MC, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Geert Grooteplein-Zuid 10, 6525 GA, Nijmegen, The Netherlands; Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Weg door Jonkerbos 100, 6532 SZ, Nijmegen, The Netherlands; Hasselt University, Martelarenlaan 42, BE3500, Hasselt, Belgium.
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Stappers MHT, Oosting M, Ioana M, Reimnitz P, Mouton JW, Netea MG, Gyssens IC, Joosten LAB. Genetic Variation in TLR10, an Inhibitory Toll-Like Receptor, Influences Susceptibility to Complicated Skin and Skin Structure Infections. J Infect Dis 2015; 212:1491-9. [PMID: 25895985 DOI: 10.1093/infdis/jiv229] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [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: 10/29/2014] [Accepted: 04/07/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Toll-like receptors (TLRs) play a central role in the innate immune response to complicated skin and skin structure infections (cSSSIs), with TLR10 being the first family member known to have an inhibitory function. This study assessed the role of TLR10 in recognition of cSSSI-related pathogens and whether genetic variation in TLR10 influences susceptibility to cSSSIs. METHODS Human peripheral blood mononuclear cells (PBMCs) preincubated with anti-TLR10 antibody and HEK-293 cells overexpressing TLRs were exposed to cSSSI pathogens, and cytokine secretion was determined by enzyme-linked immunosorbent assay. A total of 318 patients with cSSSI and 328 healthy controls were genotyped for 4 nonsynonymous single-nucleotide polymorphisms in TLR10, and functional consequences of the TLR10 SNPs were assessed via in vitro stimulation assays. RESULTS PBMC stimulation with cSSSI pathogens in the presence of TLR10 neutralizing antibody significantly increased interleukin 6 secretion. Overexpression of TLR10 completely abrogated TLR2-induced interleukin 8 secretion by HEK-293 cells in response to cSSSI pathogens. Three polymorphisms in TLR10, I775L, I369L, and N241H, were associated with reduced susceptibility to cSSSIs. The presence of the TLR10 alleles 775L, 369L, or 241H increased interleukin 6 secretion by PBMCs in response to cSSSI pathogens. CONCLUSIONS TLR10 is a modulatory receptor of innate immune responses to cSSSI-related pathogens, and genetic variants in TLR10 are associated with protection against cSSSIs.
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Affiliation(s)
- Mark H T Stappers
- Department of Internal Medicine, Radboud University Medical Center Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen Hasselt University, Belgium
| | - Marije Oosting
- Department of Internal Medicine, Radboud University Medical Center
| | - Mihai Ioana
- Department of Internal Medicine, Radboud University Medical Center
| | | | - Johan W Mouton
- Department of Medical Microbiology, Radboud University Medical Center Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen Department of Medical Microbiology and Infectious Diseases, Erasmus MC, Rotterdam, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Hospital, Nijmegen Hasselt University, Belgium
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center
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Ten Oever J, van de Veerdonk FL, Joosten LAB, Simon A, van Crevel R, Kullberg BJ, Gyssens IC, van der Meer JWM, van Deuren M, Netea MG. Cytokine production assays reveal discriminatory immune defects in adults with recurrent infections and noninfectious inflammation. Clin Vaccine Immunol 2014; 21:1061-9. [PMID: 24872512 PMCID: PMC4135925 DOI: 10.1128/cvi.00152-14] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Accepted: 05/20/2014] [Indexed: 11/20/2022]
Abstract
Cytokine production assays have been primarily used in research settings studying novel immunodeficiencies. We sought to determine the diagnostic value of cytokine production assays in patients with recurrent and/or severe infectious diseases (IDs) without known immunodeficiencies and unclassified noninfectious inflammatory disorders (NIIDs). We retrospectively examined cytokine production in whole-blood and peripheral blood mononuclear cell samples from 157 adult patients. A cytokine production rate of <5% of that of healthy controls was considered defective. While monocyte-derived cytokine (tumor necrosis factor alpha [TNF-α], interleukin-1β [IL-1β], and IL-6) production was rarely affected, 30% of all included patients had deficient production of interferon gamma (IFN-γ), IL-17A, or IL-22. Twenty-five percent of the NIID patients displayed defective IFN-γ production, whereas IL-17A production was generally unaffected. In the group of ID patients, defective IFN-γ production was found in 19% and 14% of the patients with viral and bacterial infections, respectively, and in 38%, 24%, and 50% of patients with mycobacterial, mucocutaneous, and invasive fungal infections, respectively. Defective IL-17A and IL-22 production was mainly confined to ID patients with mucocutaneous fungal infections. In conclusion, cytokine production assays frequently detect defective Th1 responses in patients with mycobacterial or fungal infections, in contrast to patients with respiratory tract infections or isolated bacterial infections. Defective IL-17A and IL-22 production was primarily found in patients with fungal infections, while monocyte-derived cytokine production was unaffected. Thus, lymphocyte-derived cytokine production assays are helpful in the diagnostic workup of patients with recurrent infections and suspected immunodeficiencies and have the potential to reveal immune defects that might guide adjunctive immunomodulatory therapy.
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Affiliation(s)
- Jaap Ten Oever
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Frank L van de Veerdonk
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Leo A B Joosten
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anna Simon
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Reinout van Crevel
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bart-Jan Kullberg
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands Hasselt University, Diepenbeek, Belgium
| | - Jos W M van der Meer
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marcel van Deuren
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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Averbuch D, Orasch C, Cordonnier C, Livermore DM, Mikulska M, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, Akova M. European guidelines for empirical antibacterial therapy for febrile neutropenic patients in the era of growing resistance: summary of the 2011 4th European Conference on Infections in Leukemia. Haematologica 2014; 98:1826-35. [PMID: 24323983 DOI: 10.3324/haematol.2013.091025] [Citation(s) in RCA: 370] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Owing to increasing resistance and the limited arsenal of new antibiotics, especially against Gram-negative pathogens, carefully designed antibiotic regimens are obligatory for febrile neutropenic patients, along with effective infection control. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for initial empirical therapy in febrile neutropenic patients, based on: i) the local resistance epidemiology; and ii) the patient's risk factors for resistant bacteria and for a complicated clinical course. An 'escalation' approach, avoiding empirical carbapenems and combinations, should be employed in patients without particular risk factors. A 'de-escalation' approach, with initial broad-spectrum antibiotics or combinations, should be used only in those patients with: i) known prior colonization or infection with resistant pathogens; or ii) complicated presentation; or iii) in centers where resistant pathogens are prevalent at the onset of febrile neutropenia. In the latter case, infection control and antibiotic stewardship also need urgent review. Modification of the initial regimen at 72-96 h should be based on the patient's clinical course and the microbiological results. Discontinuation of antibiotics after 72 h or later should be considered in neutropenic patients with fever of unknown origin who are hemodynamically stable since presentation and afebrile for at least 48 h, irrespective of neutrophil count and expected duration of neutropenia. This strategy aims to minimize the collateral damage associated with antibiotic overuse, and the further selection of resistance.
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Gyssens IC, Kern WV, Livermore DM. The role of antibiotic stewardship in limiting antibacterial resistance among hematology patients. Haematologica 2014; 98:1821-5. [PMID: 24323982 DOI: 10.3324/haematol.2013.091769] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
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van den Bosch CMA, Hulscher MEJL, Natsch S, Gyssens IC, Prins JM, Geerlings SE. Development of quality indicators for antimicrobial treatment in adults with sepsis. BMC Infect Dis 2014; 14:345. [PMID: 24950718 PMCID: PMC4078010 DOI: 10.1186/1471-2334-14-345] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Accepted: 06/09/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Outcomes in patients with sepsis are better if initial empirical antimicrobial use is appropriate. Several studies have shown that adherence to guidelines dictating appropriate antimicrobial use positively influences clinical outcome, shortens length of hospital stay and contributes to the containment of antibiotic resistance.Quality indicators (QIs) can be systematically developed from these guidelines to define and measure appropriate antimicrobial use. We describe the development of a concise set of QIs to assess the appropriateness of antimicrobial use in adult patients with sepsis on a general medical ward or Intensive Care Unit (ICU). METHODS A RAND-modified, five step Delphi procedure was used. A multidisciplinary panel of 14 experts appraised and prioritized 40 key recommendations from within the Dutch national guideline on antimicrobial use for adult hospitalized patients with sepsis (http://www.swab.nl/guidelines). A procedure to select QIs relevant to clinical outcome, antimicrobial resistance and costs was performed using two rounds of questionnaires with a face-to-face consensus meeting between the rounds over a period of three months. RESULTS The procedure resulted in the selection of a final set of five QIs, namely: obtain cultures; prescribe empirical antimicrobial therapy according to the national guideline; start intravenous drug therapy; start antimicrobial treatment within one hour; and streamline antimicrobial therapy. CONCLUSION This systematic, stepwise method, which combined evidence and expert opinion, led to a concise and therefore feasible set of QIs for optimal antimicrobial use in hospitalized adult patients with sepsis. The next step will entail subjecting these quality indicators to an applicability test for their clinimetric properties and ultimately, using these QIs in quality-improvement projects. This information is crucial for antimicrobial stewardship teams to help set priorities and to focus improvement.
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Affiliation(s)
- Caroline MA van den Bosch
- Department of Internal Medicine, division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) Academic Medical Center, Meibergdreef 9, 1105, AZ Amsterdam Zuidoost, The Netherlands
| | - Marlies EJL Hulscher
- Scientific Institute for Quality of Healthcare (IQ healthcare), Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stephanie Natsch
- Department of Clinical Pharmacy, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Inge C Gyssens
- Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Medical Microbiology and Infectious Diseases, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands
- Hasselt University, Hasselt, Belgium
| | - Jan M Prins
- Department of Internal Medicine, division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) Academic Medical Center, Meibergdreef 9, 1105, AZ Amsterdam Zuidoost, The Netherlands
| | - Suzanne E Geerlings
- Department of Internal Medicine, division of Infectious Diseases, Center for Infection and Immunity Amsterdam (CINIMA) Academic Medical Center, Meibergdreef 9, 1105, AZ Amsterdam Zuidoost, The Netherlands
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Pulcini C, Bush K, Craig WA, Frimodt-Møller N, Grayson ML, Mouton JW, Turnidge J, Harbarth S, Gyssens IC. Forgotten antibiotics: an inventory in Europe, the United States, Canada, and Australia. Clin Infect Dis 2014; 54:268-74. [PMID: 22198992 DOI: 10.1093/cid/cir838] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In view of the alarming spread of antimicrobial resistance in the absence of new antibiotics, this study aimed at assessing the availability of potentially useful older antibiotics. A survey was performed in 38 countries among experts including hospital pharmacists, microbiologists, and infectious disease specialists in Europe, the United States, Canada, and Australia. An international expert panel selected systemic antibacterial drugs for their potential to treat infections caused by resistant bacteria or their unique value for specific criteria. Twenty-two of the 33 selected antibiotics were available in fewer than 20 of 38 countries. Economic motives were the major cause for discontinuation of marketing of these antibiotics. Fourteen of 33 antibiotics are potentially active against either resistant Gram-positive or Gram-negative bacteria. Urgent measures are then needed to ensure better availability of these antibiotics on a global scale.
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Affiliation(s)
- Céline Pulcini
- Centre Hospitalier Universitaire de Nice, Service d'Infectiologie and Université de Nice Sophia-Antipolis, Faculté de Médecine, France
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Averbuch D, Cordonnier C, Livermore DM, Mikulska M, Orasch C, Viscoli C, Gyssens IC, Kern WV, Klyasova G, Marchetti O, Engelhard D, Akova M. Targeted therapy against multi-resistant bacteria in leukemic and hematopoietic stem cell transplant recipients: guidelines of the 4th European Conference on Infections in Leukemia (ECIL-4, 2011). Haematologica 2013; 98:1836-47. [PMID: 24323984 PMCID: PMC3856958 DOI: 10.3324/haematol.2013.091330] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [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: 05/24/2013] [Accepted: 10/14/2013] [Indexed: 01/19/2023] Open
Abstract
The detection of multi-resistant bacterial pathogens, particularly those to carbapenemases, in leukemic and stem cell transplant patients forces the use of old or non-conventional agents as the only remaining treatment options. These include colistin/polymyxin B, tigecycline, fosfomycin and various anti-gram-positive agents. Data on the use of these agents in leukemic patients are scanty, with only linezolid subjected to formal trials. The Expert Group of the 4(th) European Conference on Infections in Leukemia has developed guidelines for their use in these patient populations. Targeted therapy should be based on (i) in vitro susceptibility data, (ii) knowledge of the best treatment option against the particular species or phenotype of bacteria, (iii) pharmacokinetic/pharmacodynamic data, and (iv) careful assessment of the risk-benefit balance. For infections due to resistant Gram-negative bacteria, these agents should be preferably used in combination with other agents that remain active in vitro, because of suboptimal efficacy (e.g., tigecycline) and the risk of emergent resistance (e.g., fosfomycin). The paucity of new antibacterial drugs in the near future should lead us to limit the use of these drugs to situations where no alternative exists.
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Abstract
Widespread antimicrobial use has compromised its value, leading to a crisis of antimicrobial resistance. A major cause of misuse is insufficient knowledge of prescribing of antimicrobials in many categories of professionals. An important principle of antimicrobial stewardship is avoiding selection pressure in the patient, both on pathogen and commensal by avoiding unnecessary use, choosing the least broad-spectrum antibiotic, adequate doses, a good timing and the shortest possible duration. Up to now, most educational efforts have been targeted at professionals (mostly medical doctors) after their training and at the adult public. In the past few years, progress has been made in educating children. It is now crucial that academia and ministries of Health and Education jointly focus on an adapted undergraduate medical/professional curriculum that teaches all necessary principles of microbiology, infectious diseases and clinical pharmacology, with emphasis on the principles of prudent prescribing.
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Schaper NC, Dryden M, Kujath P, Nathwani D, Arvis P, Reimnitz P, Alder J, Gyssens IC. Efficacy and safety of IV/PO moxifloxacin and IV piperacillin/tazobactam followed by PO amoxicillin/clavulanic acid in the treatment of diabetic foot infections: results of the RELIEF study. Infection 2012. [PMID: 23180507 PMCID: PMC3566391 DOI: 10.1007/s15010-012-0367-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim was to compare the efficacy and safety of two antibiotic regimens in patients with diabetic foot infections (DFIs). METHODS Data of a subset of patients enrolled in the RELIEF trial with DFIs requiring surgery and antibiotics were evaluated retrospectively. DFI was diagnosed on the basis of the modified Wagner, University of Texas, and PEDIS classification systems. Patients were randomized to receive either intravenous/oral moxifloxacin (MXF, N = 110) 400 mg q.d. or intravenous piperacillin/tazobactam 4.0/0.5 g t.d.s. followed by oral amoxicillin/clavulanate 875/125 mg b.d. (PIP/TAZ-AMC, N = 96), for 7-21 days until the end of treatment (EOT). The primary endpoint was clinical cure rates in the per-protocol (PP) population at the test-of-cure visit (TOC, 14-28 days after EOT). RESULTS There were no significant differences between the demographic characteristics of PP patients in either treatment group. At TOC, MXF and PIP/TAZ-AMC had similar efficacy in both the PP and intent-to-treat (ITT) populations: MXF: 76.4 % versus PIP/TAZ-AMC: 78.1 %; 95 % confidence interval (CI) -14.5 %, 9.0 % in the PP population; MXF: 69.9 % versus PIP/TAZ-AMC: 69.1 %; 95 % CI -12.4 %, 12.1 % in the ITT population. The overall bacteriological success rates were similar in both treatment groups (MXF: 71.7 % versus PIP/TAZ-AMC: 71.8 %; 95 % CI -16.9 %, 10.7 %). A similar proportion of patients (ITT population) experienced any adverse events in both treatment groups (MXF: 30.9 % versus PIP/TAZ-AMC: 31.8 %, respectively). Death occurred in three MXF-treated patients and one PIP/TAZ-AMC-treated patient; these were unrelated to the study drugs. CONCLUSION Moxifloxacin has shown favorable safety and efficacy profiles in DFI patients and could be an alternative antibiotic therapy in the management of DFI. CLINICAL TRIAL NCT00402727.
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Affiliation(s)
- N C Schaper
- Department of Internal Medicine, Division of Endocrinology, CARIM and CAPHRI Institute, Maastricht University Medical Center+, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands.
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Stappers MHT, Janssen NAF, Oosting M, Plantinga TS, Arvis P, Mouton JW, Joosten LAB, Netea MG, Gyssens IC. A role for TLR1, TLR2 and NOD2 in cytokine induction by Bacteroides fragilis. Cytokine 2012; 60:861-9. [PMID: 22998942 DOI: 10.1016/j.cyto.2012.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 05/30/2012] [Revised: 08/15/2012] [Accepted: 08/18/2012] [Indexed: 01/01/2023]
Abstract
Bacteroides fragilis, an intestinal flora commensal microorganism, is frequently isolated from abscesses and soft tissue infections. This study aimed to identify pattern recognition receptors (PRRs) involved in B. fragilis recognition and to characterize the induced cytokine profile. Human PBMCs were stimulated with heat-killed B. fragilis and cytokine levels were determined by ELISA. Roles of individual PRRs were assessed using specific blockers of receptor signaling pathways and PBMCs carrying single nucleotide polymorphisms of PRR genes. Cell lines expressing human TLR2 or TLR4 were employed to assess TLR-specificity of B. fragilis. TLR1, TLR2 and NOD2 were the main PRRs responsible for recognition of B. fragilis, while TLR4, TLR6, NOD1 and Dectin-1 were not involved. B. fragilis induced strong IL-6 and IL-8, moderate IL-1β and TNF-α, and poor IL-10, IL-17, IL-23 and IFN-γ production. This study identifies the receptor pathways of the innate immune response to B. fragilis, and thus provides new insights in the host defense against B. fragilis.
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Affiliation(s)
- Mark H T Stappers
- Department of Medicine, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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