5 november, 2018
Diagnostisch stewardship of diagnostisch stewardshipprogramma (DSP) is een trending topic in het veld van de medische microbiologie en daarbuiten. Maar waar gaat dit concept nu over, is het echt zo nieuw en hoe wordt het ingelijfd in infectiemanagement? De term ‘diagnostic stewardship’ werd gebruikt in een opiniestuk van Dik et al., waarin verschillende facetten van infectiemanagement beschreven werden, het zogeheten ‘integrated stewardship’. Wij belichten de diagnostische kant van dit model en beschrijven het concept ervan: diagnostiek als multidisciplinair geheel van opname tot ontslag.
Schijnbare thyreotoxicose door gebruik van biotine in hoge dosis. Verstoring van TSH- en T4-bepaling door biotine.
19 juli, 2018
Het is belangrijk dat clinici zich bewust zijn van de mogelijke interferentie van biotine bij immunoassays, zoals die van de schildklierfunctie, maar ook bij andere immunochemische bepalingen. Overleg met laboratoriumspecialisten bij onbegrepen uitslagen is aan te bevelen. Door volledig te vertrouwen op deze laboratoriumuitslagen ligt het gevaar van een onterechte behandeling op de loer.
4 juni, 2018
QuantiFERON (QFT) results near the cut-off are subject to debate. We aimed to investigate which borderline QFT results were due to Mycobacterium tuberculosis (Mtb)-specific responses or to test variability.
Defining Multidrug Resistance of Gram-Negative Bacteria in the Dutch–German Border Region—Impact of National Guidelines
26 januari, 2018
We willen graag met z’n allen (multi)resistentie van bacteriën tegen gaan, zodat we als we later
groot en sterk oud en afgetakeld zijn ook nog met antibiotica behandeld kunnen worden. Maar wanneer noem je iets nu ‘multiresistent’? Die definitie is per land verschillend en daarom hebben we gekeken naar het verschil tussen Nederland en Duitsland. Wij noemen deze bacteriën BRMO (bijzonder resistente micro-organismen) en Duitsland noemt een deel van deze bacteriën MRGN (Multiresistente gramnegative Stäbchen). Hoe is het voor medewerkers van een Infectiepreventie in de grensregio; kunnen zij deze verschillen van definities hanteren?
Gepubliceerd op: http://www.mdpi.com/2076-2607/6/1/11/htm
3 september, 2017
Objectives: The aim of this verification study was to compare the QuantiFERON®-TB Gold Plus (QFT-Plus) to the QuantiFERON®-TB Gold In Tube (QFT-GIT). The new QFT-Plus test contains an extra antigen tube which, according
to the manufacturer additionally elicits a CD8+ T-cell response above the CD4+ T-cell response. We assessed the value of this tube in detecting recent latent tuberculosis infections. Methods: Between May 2015 and December 2016, 1031 subjects underwent QFT-Plus and QFT-GIT test. Overall agreement between both tests and performance for different test indications and/or immune states was assessed. A difference of>0.6 IU/mL interferon-γ release between the two antigen tubes of the QFT-Plus assay was considered a true difference and used as estimation for CD8+ T-cell response. Results: Analysis of the QuantiFERON tests resulted in an overall agreement between assays of 95%. Subjects considered to be recently exposed to tuberculosis had significantly more often a true difference in interferon-γ release compared to all other subjects (p = 0.029). Conclusion: Results of QFT-Plus are highly comparable to QFT-GIT. Although there is an indication that a true
difference in interferon-γ release between the antigen tubes is associated with recent latent tuberculosis infection, the QFT-Plus could not be used to exclude recent exposure.
Extensive colonization with carbapenemase-producing microorganisms in Romanian burn patients: infectious consequences from the Colectiv fire disaster
29 augustus, 2017
Abstract Health care of severe burn patients is highly specialized and may require international patient transfer. Burn
patients have an increased risk of developing infections. Patients that have been hospitalized in countries where carbapenemase-producing microorganisms (CPMO) are endemic
may develop infections that are difficult to treat. In addition, there is a risk on outbreaks with CPMOs in burn centers. This study underlines that burn patients may extensively be colonized with CPMOs, and it provides best practice
recommendations regarding clinical microbiology and infection control. We evaluated CPMO-carriage and wound colonization in a burn patient initially treated in Romania, and transported to the Netherlands. The sequence types and acquired
beta-lactamase genes of highly-resistant microorganisms were derived from next generation sequencing data. Next, we searched literature for reports on CPMOs in burn patients. Five different carbapenemase-producing isolates
were cultured: two unrelated OXA-48-producing Klebsiella pneumoniae isolates, OXA-23-producing Acinetobacter baumanii, OXA-48-producing Enterobacter cloacae, and NDM-1-producing Providencia stuartii. Also, multi-drug resistant
Pseudomonas aeruginosa isolates were detected. Among the sampling sites, there was high variety in CPMOs. We found 46 reports on CPMOs in burn patients. We listed the epidemiology of CPMOs by country of initial
treatment, and summarized recommendations for care of these
patients based on these reports and our study.
Published in Eur J Clin Microbiol Infect Dis
Asymptomatic bacteriuria and urinary tract infection in pregnant women with and without diabetes: Cohort study
3 mei, 2017
Objective: To compare the prevalence of asymptomatic bacteriuria (ASB) and the incidence of urinary tract infection (UTI) in pregnant women with and without diabetes mellitus (DM) or gestational DM (GDM).
Study design: We performed a cohort study in five hospitals and two midwifery clinics in the Netherlands. Pregnant women with and without DM or GDM were screened for the presence of ASB around 12 and 32
weeks’ gestation. Characteristics of participants as well as outcome data were collected from questionnaires and medical records. ASB was defined as the growth of at least 10e5 cfu/ml isolated from the urine of a woman without UTI complaints. UTI was considered to be present when a treating physician had diagnosed UTI and prescribed antibiotics. Results: We studied 202 women with and 272 women without DM or GDM. Of all women 31.7% with and 94.9% without DM or GDM provided a week 12 sample. The prevalence of ASB was comparable in women with and without DM or GDM (12 weeks’ n = 322; 4.7% and 2.3%; relative risk (RR) 2.02; 95% confidence interval (CI) 0.52–7.84; 32 weeks’ n = 422; 3.2% and 3.0%; RR 1.06; 95% CI 0.36–3.09), as was the incidence of UTI (16.8% and 12.9%; RR 1.31; 95% CI 0.85–2.02). Neither ASB nor UTI were associated with preterm birth or babies being small for gestational age.
Conclusion: In pregnant women with and women without DM or GDM, the overall prevalence of ASB was low. Neither ASB nor UTI did differ significantly between the groups. Our data discourage a routine ASB screen and treat policy in pregnant women with DM or GDM.
4 april, 2017
Current molecular diagnostics of human pathogens provide limited information that is often not sufficient for outbreak and transmission investigation. Next generation sequencing (NGS) determines the DNA sequence of a complete bacterial genome in a single sequence run, and from these data, information on resistance and virulence, as well as information for typing is obtained, useful for outbreak investigation. The obtained genome data can be further used for the development of an outbreak-specific screening test. In this review, a general introduction to NGS is presented, including the library preparation and the major characteristics of the most common NGS platforms, such as the MiSeq (Illumina) and the Ion PGM™ (ThermoFisher). An overview of the software used for NGS data analyses used at the medical microbiology diagnostic laboratory in the University Medical Center Groningen in The Netherlands is given. Furthermore, applications of NGS in the clinical setting are described, such as outbreak management, molecular case finding, characterization and surveillance of pathogens, rapid identification of bacteria using the 16S-23S rRNA region, taxonomy, metagenomics approaches on clinical samples, and the determination of the transmission of zoonotic micro-organisms from animals to humans. Finally, we share our vision on the use of NGS in personalised microbiology in the near future, pointing out specific requirements.
11 augustus, 2016
In de 1e-lijn zijn urines 24 uur of langer onderweg voordat onderzoek mogelijk is. Kan de Vacuette CCM urinebuis (Greiner) deze urines conserveren en blijft meting op de Sysmex UF500i voor algemeen urineonderzoek, kweekscreening en kweken mogelijk?
15 april, 2016
There is an increasing awareness to counteract problems due to incorrect antimicrobialuse.Interventions that are implemented are often part of an Antimicrobial Stewardship Program (ASPs). Studies publishing results from these interventions are increasing, including reports on the economical effects of ASPs.This review will look at the economical sections of these studies and themethods that were used.