The Prevalence of Celiac Disease in a Fracture Liaison Service Population.

Celiac disease (CD) is a known risk factor for osteoporosis and fractures. The prevalence of CD in patients with a recent fracture is unknown. We therefore systematically screened patients at a fracture liaison service (FLS) to study the prevalence of CD. Patients with a recent fracture aged ≥ 50 years were invited to VieCuri Medical Center's FLS. In FLS attendees, bone mineral density (BMD) and laboratory evaluation for metabolic bone disorders and serological screening for CD was systematically evaluated. If serologic testing for CD was positive, duodenal biopsies were performed to confirm the diagnosis CD. Data were collected in 1042 consecutive FLS attendees. Median age was 66 years (Interquartile range (IQR) 15), 27.6% had a major and 6.9% a hip fracture, 26.4% had osteoporosis and 50.8% osteopenia. Prevalent vertebral fractures were found in 29.1%. CD was already diagnosed in two patients (0.19%), one still had a positive serology. Three other patients (0.29%) had a positive serology for CD (one with gastro-intestinal complaints). In two of them, CD was confirmed by duodenal histology (0.19%) and one refused further evaluation. The prevalence of biopsy-proven CD was therefore 0.38% (4/1042) of which 0.19% (2/1042) was newly diagnosed. The prevalence of CD in patients with a recent fracture at the FLS was 0.38% and within the range of reported prevalences in the Western-European population (0.33-1.5%). Newly diagnosed CD was only found in 0.19%. Therefore, standard screening for CD in FLS patients is not recommended.

[Purulent peritonitis due to gonococcal infection]. / Purulente peritonitis door een gonokokkeninfectie.

BACKGROUND A Neisseria gonorrhoea infection is one of the most common sexually transmitted diseases and can present both urogenitally and extragenitally. CASE DESCRIPTION A 55-year-old woman presented at the emergency room with general malaise, abdominal pain and fever. Despite extensive surgical, gynaecological and radiological investigations no clear cause could initially be found. She was subsequently admitted to the surgical unit for observation. During the admission period the patient developed diffuse peritonitis and her infection parameters were rising. Diagnostic laparoscopy revealed extensive terminal ileitis with a reactive infiltrate of the uterine fundus and purulent peritonitis. A PCR test of the abdominal exudate was strongly positive for Neisseria gonorrhoeae, but cultures remained negative. Following an 8-day course of antibiotic treatment with intravenous ceftriaxone, the patient recovered from her symptoms. CONCLUSION Terminal ileitis with peritonitis is an unusual extragenital manifestation of a gonococcal infection. In order to make a diagnosis, surgical exploration with cultures is sometimes indicated.

Pertussis surveillance and control: exploring variations and delays in testing, laboratory diagnostics and public health service notifications, the Netherlands, 2010 to 2013.

Pertussis is most severe among unvaccinated infants (< 1 year of age), and still leads to several reported deaths in the Netherlands every year. In order to avoid pertussis-related infant morbidity and mortality, pertussis surveillance data are used to guide pertussis control measures. However, more insight into the accuracy of pertussis surveillance and control, and into the range of healthcare and public health-related factors that impede this are needed. We analysed a unique combination of data sources from one Dutch region of 1.1 million residents, including data from laboratory databases and local public health notifications between 2010 and 2013. This large study (n = 12,090 pertussis tests) reveals possible misdiagnoses, substantial under-notification (18%, 412/2,301 laboratory positive episodes) and a delay between patient symptoms and notification to the local public health services (median 34 days, interquartile range (IQR): 27-54). It is likely that the misdiagnoses, under-notification and overall delay in surveillance data are not unique to this area of the Netherlands, and are generalisable to other countries in Europe. In addition to preventive measures such as maternal immunisation, based on current findings, we further recommend greater adherence to testing guidelines, standardisation of test interpretation guidelines, use of automatic notification systems and earlier preventive measures.

Is a wound swab for microbiological analysis supportive in the clinical assessment of infection of a chronic wound?

AIM: To determine whether bacteriological analysis of a wound swab is supportive in the clinical assessment of infection of a chronic wound. METHODS: Patients attending an outpatient wound clinic who had endured a chronic wound for more than 3 weeks were clinically assessed for infection. In addition, standardized wound swabs were taken according to the Levine technique and the microbiological findings of the swabs compared with the clinical assessment of the wounds. RESULTS: There was no significant relationship between the clinical assessments of the chronic wounds and the qualitative or quantitative bacteriological results of the swabs. CONCLUSION: Microbiological analysis of wound swabs taken from chronic wounds to support clinical assessment of the wounds is waste of time and money. It may be preferable to assess chronic wounds clinically, however, validation studies of these signs and symptoms are needed.

Antimicrobial resistance and spread of multi drug resistant Escherichia coli isolates collected from nine urology services in the Euregion Meuse-Rhine.

We determined the prevalence and spread of antibiotic resistance and the characteristics of ESBL producing and/or multi drug resistant (MDR) Escherichia coli isolates collected from urine samples from urology services in the Euregio Meuse-Rhine, the border region of the Netherlands (n=176), Belgium (n=126) and Germany (n=119). Significant differences in resistance between the three regions were observed. Amoxicillin-clavulanic acid resistance ranged from 24% in the Netherlands to 39% in Belgium (p=0.018), from 20% to 40% (p<0.004) for the fluoroquinolones and from 20% to 40% (p=0.018) for the folate antagonists. Resistance to nitrofurantoin was less than 5%. The prevalence of ESBL producing isolates varied from 2% among the Dutch isolates to 8% among the German ones (p=0.012) and were mainly CTX-M 15. The prevalence of MDR isolates among the Dutch, German and Belgian isolates was 11%, 17% and 27%, respectively (p< =0.001 for the Belgian compared with the Dutch isolates). The majority of the MDR and ESBL producing isolates belonged to ST131. This study indicates that most antibiotics used as first choice oral empiric treatment for UTIs (amoxicillin-clavulanic acid, fluoroquinolones and folate antagonists) are not appropriate for this purpose and that MDR strains such as CTX-M producing ST131 have spread in the entire Euregion. Our data stress the importance of ward specific surveillance to optimize empiric treatment. Also, prudent use of antibiotics and further research to alternative agents are warranted.

Multiresistant Staphylococcus epidermidis in a neonatal care unit.

OBJECTIVE: To study the presence and diversity of types of Staphylococcus epidermidis in the neonatal intensive care unit of a university hospital. METHODS: During a period of 6 weeks, samples were taken from nose, external auditory canal, axilla, groin and umbilicus from consecutively admitted patients. Patients were sampled two times a week for up to 2 weeks. Isolates of S. epidermidis were characterized by antibiogram, plasmid pattern and biotype. RESULTS: Fifteen patients were included. Each patient was sampled in one to four successive surveys, depending on the admission period. A total of 128 isolates of S. epidermidis were obtained and allocated to seven antibiogram types, 36 plasmid types and 14 biotypes. One plasmid type found in 58 isolates (six patients) corresponded with one multiresistant antibiogram type. The number of isolates with these characteristics increased per neonate from the first survey to the fourth. Nineteen isolates from four patients were allocated to a second plasmid type and were of a common antibiogram type. The remaining 34 plasmid types were sporadic. No clear correspondence of biotypes with antibiogram or plasmid types was found. CONCLUSIONS: The present study revealed the increase in colonization of a multiresistant type of S. epidermidis in the compromised patients during admission to the ward. Further studies have to assess whether this type remains persistent in the ward.