Thema: Diabetes mellitus en infectieziekten Het ... - NVMM

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Prevalence in the Netherlands of OXA-48 producingE. coli and K. pneumoniae with meropenem MICsbelow the screenbreakpoint of the Dutchcarbapenemase guidelineK. van Dijk 1,2 , J. Scharringa 2 , A.C. Fluit 2 , J.M. Ossewaarde 3 ,A. van der Zee 3 , M. A. Leverstein-Van Hall 4,5 , H.A.Bijlmer 4 , M.J.M. Bonten 2 , J.W.T. Cohen Stuart 21Department of Medical Microbiology, Academic MedicalCenter, Amsterdam, 2 Department of Medical Microbiology,University Medical Center Utrecht, Utrecht, 3 Department ofMedical Microbiology, Maasstad Hospital, Rotterdam, 4 Centrefor Infectious Disease Control, National Institute for PublicHealth and the Environment (RIVM), Bilthoven, 5 Departmentof Medical Microbiology, Bronovo Hospital, the HagueIn a recent outbreak of OXA-48 producingEnterobacteriaceae, 56% of E. coli and 25% of K.pneumoniae were screen negative according to theDutch detection guideline (meropenem ≤ 0.25 mg/Land imipenem ≤ 1 mg/L). All isolates had ertapenemMICs ≥ 0.5 mg/L. Aim of this study was to estimate theprevalence in the Netherlands of screen negative OXA-48producing E. coli and K. pneumoniae in non-outbreaksettings.All 9 Dutch laboratories using Phoenix TM systems wereasked to send E. coli and K. pneumoniae isolates withmeropenem MICs ≤ 0.5 mg/L and ertapenem MICs≥ 0.5 mg/L collected between January 1st 2011 andMarch 1st 2012. Species identification was confirmed byMaldi-ToF, and OXA-48 PCR was performed in isolateswith ertapenem MIC ≥ 0.5 mg/L, confirmed by Etest.In total, 448 isolates matched the inclusion criteria. Ofthese, 97 were available. Twenty-one isolates were excludedbecause of contamination or species misidentification,leaving 76 isolates (13 K. pneumoniae and 63 E. coli), inwhich ertapenem MIC ≥ 0.5 mg/L was confirmed in 16. Ofthese, 2 E. coli isolates produced OXA-48 plus an ESBL, andmeropenem MICs were ≤ 0.25 mg/L by Etest. Both patientshad recently traveled to the Mediterranean basin. By extrapolationusing ISIS-AR data, 29 (95%-CI: 18-40) OXA-48producing E. coli and no K. pneumoniae would have beenmissed in 2011 in the Netherlands (1 per 1-2 laboratories).In conclusion, with the current carbapenemase detectionguideline, the estimated number of undetected OXA-48producing E.coli and K. pneumoniae is around 29 per yearin the Netherlands.Negative rtPCR of sputum and oropharyngealwash specimens cannot rule out diagnosis ofPneumocystis jirovecii pneumoniaJ. van Ingen 1 , T. Arens 1 , J. Hopman 1 , P.D.J. Sturm 11 Department of Medical Microbiology, Radboud UniversityNijmegen Medical Centre, NijmegenPneumocystis jirovecii pneumonia (PJP) is a potentially fatalopportunistic infection that requires invasive samplingof the lower airways by broncho-alveolar lavage (BAL)and detection of Pneumocystis jirovecii for diagnosis. Anoninvasive rule-out test to be performed in upper airwayspecimens would be clinically useful.To assess their potential as rule-out tests for PJP, weperformed real-time PCR (rtPCR) analysis of pairedsamples of sputum and/or oropharyngeal wash fluid andBAL fluid of 47 patients with a high clinical suspicion ofPJP, evaluated between January 2009 and January 2011.A positive rtPCR in BAL was used as a gold standard fordisease.Seventeen patients had a positive rtPCR for Pneumocystisjirovecii in BAL fluid. rtPCR of sputum samples (n = 17)showed a sensitivity of 88%, specificity of 78%, positivepredictive value (PPV) of 78% and negative predictive value(NPV) of 88%. rtPCR of oropharyngeal wash fluid (n = 34)revealed a sensitivity of 57%, specificity of 90%, PPV of57% and NPV of 75%.Three out of six rtPCR-positive BAL samples of patientswith rtPCR-negative oropharyngeal wash samples werepositive by immunofluorescence. The sole rtPCR-positiveBAL sample of which the paired sputum sample wasnegative was negative by immunofluorescence.In conclusion, the NPVs are insufficient to use rtPCR ofsputum or oropharyngeal wash samples as a rule-out testin the clinical diagnosis of PJP, using the current goldstandard. Applying stricter criteria for diagnosis, includingpositive immunofluorescence, rtPCR of sputum may be ofvalue as a rule-out test.As of yet unexplained supraregional emergence ofcryptosporidiosis in the NetherlandsP.C. Wever 1 , I.T.M.A Overdevest 2 , B. Mulder 3 , T.G. Mank 4 ,M.H.A. Hermans 5 , J. Roelfsema 6 , J.G. Kusters 7 , J.W.Dorigo-Zetsma 8 , M. Deege 9 , L.M. Kortbeek 61 Department of Medical Microbiology and Infection Control,Jeroen Bosch Hospital, ’s-Hertogenbosch, 2 Laboratory forMedical Microbiology and Immunology, St. ElisabethHospital, Tilburg, 3 Laboratory of Medical MicrobiologyTwente Achterhoek, Enschede, 4 Regional Laboratory forMedical Microbiology & Public Health, Haarlem, 5 MolecularDiagnostics, Jeroen Bosch Hospital, ’s-Hertogenbosch, 6 Centerfor Infectious Disease Control Netherlands, Laboratoryfor Infectious Diseases and Perinatal Screening, RIVM,Bilthoven, 7 Department of Medical Microbiology, UniversityMedical Center Utrecht, Utrecht, 8 Department of MedicalMicrobiology, Tergooiziekenhuizen, Hilversum/Almere,9 SALTRO, Primary Health Care Laboratory, UtrechtCryptosporidiosis is a seasonal gastrointestinal illnesscaused by protozoa of the genus Cryptosporidium. FromNed Tijdschr Med Microbiol 2012;20:nr4186
week 31 onwards an increase in the number of cryptosporidiosiscases was observed in the ’s-Hertogenboscharea. In a 7-week period (weeks 31-37), 43 patientswere identified with stools that were PCR positive forCryptosporidium spp. (median Ct value 28.1, range19.1-37.5). In 2011, 3 patients with positive stools weredetected in the same period. Of the 43 patients, 63.4% werefemale, while 39.5% of patients were aged 0-5 years, 11.6%6-10 years, 7.0% 11-18 years, 41.9% 19-65 years and 0.0%> 65 years. Although there were 6 groups of ≥ 2 patientswith identical four digit postal codes, geographic clusteringwas not apparent. Stool diagnostics of 37 patients wererequested by 30 family physicians and the remainderby hospital pediatricians. Significant co-infections wereidentified in 20.1% of patients (Giardia lamblia (6x),Campylobacter lari, Salmonella spp., human parechovirus/enterovirus). A recent visit abroad was listed for 14.0%of patients. Similar signals were subsequently receivedfrom Tilburg/Breda/Roosendaal (5.8% and 7.8% of stoolsamples Cryptosporidium positive in August and September2012 versus 1.5% and 1.4% in August and September 2011),Hilversum/Almere, Utrecht, Enschede, Groningen andFriesland. Ninety-one positive stools referred to the RIVMfrom ’s-Hertogenbosch, Hilversum/Almere, Utrecht,Haarlem and Enschede were subtypable using GP60analysis and identified as containing Cryptosporidiumhominis IbA10G2 in 75 (82.4%) of cases. C. hominis existsonly in a human-to-human transmission cycle. As of yet, acause for this increase has not been identified.The diagnostic value of real-time PCR in thediagnosis of acute Q fever infectionsC.C.H. Wielders 1,2 , P.C.A. Wijnbergen 1,3 , J.J.A. Schellekens 4 ,P.M. Schneeberger 1 , P.C. Wever 1 , M.H.A. Hermans 41 Department of Medical Microbiology and Infection Control,Jeroen Bosch Hospital, ’s-Hertogenbosch, 2 Centre for InfectiousDisease Control, National Institute for Public Health andthe Environment, Bilthoven, 3 University of Western Ontario,London, Ontario, Canada, 4 Molecular Diagnostics, JeroenBosch Hospital, ’s-HertogenboschPCR is very effective in diagnosing acute Q fever at theearly stages of infection, when the bacterium is presentin the bloodstream but antibodies have not yet developed.PCR starts to become negative as IgM phase II antibodiesappear (approximately 14 days after onset of symptoms),at which point serology becomes a more useful diagnostictool. The objective of this study was to determine thediagnostic value of real-time PCR in diagnosing acute Qfever. In 2009, 3043 patients had PCR for Coxiella burnetiiDNA performed on at least one serum sample at the JeroenBosch Hospital. After excluding requests from externallaboratories and PCR tests to check for chronic infection,2715 patients remained. A positive/low positive/ambiguousPCR result (defined as positive) was found in 385 patients,while 2330 patients tested negative. To calculate sensitivity,specificity, positive predictive value (PPV) and negativepredictive value (NPV), we analysed patients with anegative PCR and a follow-up sample within 14 days (n =316), and PCR positive patients with at least one follow-upsample (n = 372). Based on immunofluorescence assayresults we assessed whether the PCR result was correct orincorrect. Sensitivity was 92.3%, specificity 99.0%, PPV99.2%, and NPV 90.2%. When Ct values during acuteinfection were investigated, we found that 5/7 patients wholater developed possible/probable/proven chronic Q feverinfection were observed among the 10 lowest Ct valuesduring the acute infection. Thus, PCR is a valuable tool inthe diagnosis of acute Q fever.Evaluation of the EUCAST guidelines 2011 on amoxicillin-clavulanatesusceptibility testing in Escherichiacoli in the routine clinical settingM.A. Leversteijn-van Hall, K. Waar, J. Muilwijk, J. CohenStuart on behalf of the ISIS-AR study groupFor susceptibility testing of Enterobacteriaceae toamoxicillin-clavulanate (amoxi-clav) with broth microdilution,CLSI recommends to use a fixed 2:1 ratio ofamoxi-clav, while the new EUCAST guidline recommendsa fixed 2 mg/L clavulanate concentration with increasingamoxicillin concentrations. For 3 Dutch laboratoriespreviously using CLSI guidelines, a change to EUCASTguidelines resulted in an 58% increase (19.5% in 2010;30.8% in 2011) of amoxi-clav non-susceptible rates forclinical E. coli isolates. The increased amoxi-clav resistancewas a direct consequence of EUCAST implementationsince 1) for the same strains no amoxicillin MIC increasewas observed, 2) in the same period, no increase wasobserved of amoxi-clav resistance rates in 17 laboratoriesstill using CLSI, 3) the same degree of increasein resistance rate was observed in all 3 laboratories thatimplemented the new method.Of 319 clinical E. coli isolates that were resistant toamoxi-clav based on automated microdilution (Phoenixusing EUCAST compliant UNMIC-85 card), 43% testedamoxi-clav susceptible using the EUCAST disc diffusionmethod, and 37% tested susceptible with Etest. However,the evaluation of the clinical outcome of 89 patients withE. coli sepsis in relation with the susceptibility resultsshowed that the EUCAST method of testing had a bettercorrelation between clinical response and measured MICsthan the CLSI method based Etest. Clinical failure wasassociated with the occurrence of major errors by the Etest(Etest susceptible and Phoenix resistant (N)/ all isolates(N)) in the test result (20% (7/34) vs 5%(3/55); p = 0.04).Ned Tijdschr Med Microbiol 2012;20:nr4187
Page 7 and 8: Wereldwijd geleken de meeste A(H1N1
Page 9 and 10: Tabel 5. Antigene analyse van Neder
Page 11 and 12: ARTIKELDe toekomst van infectieprev
Page 13 and 14: geleerd. De huidige opleiding biedt
Page 15 and 16: A R T I K E LDiabetes en darmfloraE
Page 17 and 18: EnterotypesRecent is in het tijdsch
Page 19 and 20: ARTIKELDe diabetische voetWaarom lo
Page 21 and 22: leerd met de hoogte van het geglyce
Page 23 and 24: Tabel 2. Duur van antibiotische beh
Page 25 and 26: ARTIKELRisicofactoren voor chronisc
Page 27 and 28: Tabel 1. Nederlandse consensusricht
Page 29 and 30: A R T I K E LAsymptomatische bacter
Page 31 and 32: de urine van vrouwen met DM en ASB.
Page 33 and 34: Referenties1. Muller LM, Gorter KJ,
Page 35 and 36: Sensorische neuropathie gaat gepaar
Page 37 and 38: Hart- en vaatziektenAls gevolg van
Page 39 and 40: wondgenezing. Dit verschaft micro-o
Page 41 and 42: 10. Jun HS, Yoon JW. Role of Viruse
Page 43 and 44: VERENIGINGSNIEUWSAbstracts Najaarsv
Page 45 and 46: of Medical Microbiology and Infecti
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Page 51 and 52: ORATIESAFSCHEIDSREDES21 september 2

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