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1.
Euro Surveill ; 29(7)2024 Feb.
Article in English | MEDLINE | ID: mdl-38362626

ABSTRACT

BackgroundAntimicrobial resistance (AMR) of Mycoplasma genitalium (MG) is a growing concern worldwide and surveillance is needed. In Belgium, samples are sent to the National Reference Centre of Sexually Transmitted Infections (NRC-STI) on a voluntary basis and representative or robust national AMR data are lacking.AimWe aimed to estimate the occurrence of resistant MG in Belgium.MethodsBetween July and November 2022, frozen remnants of MG-positive samples from 21 Belgian laboratories were analysed at the NRC-STI. Macrolide and fluoroquinolone resistance-associated mutations (RAMs) were assessed using Sanger sequencing of the 23SrRNA and parC gene. Differences in resistance patterns were correlated with surveillance methodology, socio-demographic and behavioural variables via Fisher's exact test and logistic regression analysis.ResultsOf the 244 MG-positive samples received, 232 could be sequenced for macrolide and fluoroquinolone RAMs. Over half of the sequenced samples (55.2%) were resistant to macrolides. All sequenced samples from men who have sex with men (MSM) (24/24) were macrolide-resistant. Fluoroquinolone RAMs were found in 25.9% of the samples and occurrence did not differ between socio-demographic and sexual behaviour characteristics.ConclusionAlthough limited in sample size, our data suggest no additional benefit of testing MG retrieved from MSM for macrolide resistance in Belgium, when making treatment decisions. The lower occurrence of macrolide resistance in other population groups, combined with emergence of fluoroquinolone RAMs support macrolide-resistance testing in these groups. Continued surveillance of resistance in MG in different population groups will be crucial to confirm our findings and to guide national testing and treatment strategies.


Subject(s)
Mycoplasma Infections , Mycoplasma genitalium , Sexual and Gender Minorities , Sexually Transmitted Diseases , Male , Humans , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Homosexuality, Male , Mycoplasma genitalium/genetics , Belgium/epidemiology , Macrolides/pharmacology , Drug Resistance, Bacterial/genetics , Mycoplasma Infections/drug therapy , Mycoplasma Infections/epidemiology , Mutation , RNA, Ribosomal, 23S/genetics , Fluoroquinolones/pharmacology
2.
Eur J Clin Microbiol Infect Dis ; 41(3): 349-362, 2022 Mar.
Article in English | MEDLINE | ID: mdl-35048278

ABSTRACT

Chlorhexidine digluconate (CHG) is an antiseptic frequently used in hospitals to prevent healthcare-related infections. It is used in different formulations for skin antisepsis, oral care, patient bathing, and hand hygiene. Also, CHG impregnated vascular catheters and wound dressings contribute to increased exposure of hospital germs to this biocide. In the last decade, concerns are rising about decreasing susceptibility of microorganisms to CHG and its potential cross-resistance with antibiotics. This study reviewed the published data regarding the evidence of reduced CHG susceptibility, the cross-resistance with antibiotics, and the implications for infection control for S. aureus, coagulase-negative staphylococci, E. coli, K. pneumoniae, and P. aeruginosa. Despite incongruity in definitions of "resistance," increased CHG minimal inhibitory values of these pathogens have been described, and different mutations encoding for CHG efflux pumps have been identified. Clinical relevance of species with reduced susceptibility to CHG is debatable and cross-resistance with antibiotics remains controversial. However, some studies link the increased usage of CHG to multidrug resistance, and the potential cross-resistance with colistin for K. pneumoniae is of major concern. More research in this matter is necessary. For infection control, it is advisable to use CHG applications only for indications with a clear patient benefit. It is important to follow manufacturer's instructions, and exposure of microorganisms to sub-lethal CHG concentrations should be avoided.


Subject(s)
Anti-Infective Agents, Local , Cross Infection , Anti-Infective Agents, Local/pharmacology , Chlorhexidine/pharmacology , Cross Infection/prevention & control , Delivery of Health Care , Escherichia coli , Humans , Staphylococcus aureus
3.
Eur J Clin Microbiol Infect Dis ; 41(2): 187-202, 2022 Feb.
Article in English | MEDLINE | ID: mdl-34799754

ABSTRACT

Multiplexed respiratory viral panels (MRVP) have recently been added to the diagnostic work-up of respiratory infections. This review provides a summary of the main literature of MRVP for patients with regard to 3 different topics. Can the results of MRVP reduce the inappropriate use of antibiotics, can they guide the use of appropriate antiviral therapy and do they have an added value with respect to infection control measures? Literature was searched for based on a defined search string using both the PubMed and Embase database. Twenty-five articles report on the impact of MRVP on antibiotic therapy. In all the articles where active antimicrobial stewardship was performed (e.g., education/advice on interpreting results of MRVP) (N = 9), a reduction in antibiotic therapy was shown (with exception of 2 studies). Three studies evaluating the effect of MRVP on antimicrobial use in a population that is not suspected of having bacterial pneumonia (e.g., absence of radiology suggestive for bacterial infection or low PCT) found a positive impact on antibiotic therapy. Eight studies with a short TAT (< 7 h) had a positive impact on use of antibiotic therapy. Eleven studies focused on the impact of MRVP on antiviral use. In contrast to antibiotic reduction, all studies systematically objectified improved antiviral use as a consequence of MRVP results. With regard to the impact of MRVP on infection control, eleven articles were withheld. All these studies led to a more accurate use of infection control measures by detecting unidentified pathogens or stopping isolation precautions in case of a negative MRVP result. MRVP don't reduce antibiotic therapy in all populations. Reduction seems more likely if the following factors are present: active antimicrobial stewardship, low likelihood of a bacterial infection, and a short turnaround time to result. With respect to antiviral therapy, all studies have an impact but the targeted use of antivirals is so far not that evidence based for all viral respiratory pathogens. Regarding infection control measures, the potential impact of MRVP is high because of the need of additional isolation precautions for many respiratory viruses, although logistical problems can occur.


Subject(s)
Antimicrobial Stewardship/methods , Infection Control/methods , Respiratory Tract Infections/diagnosis , Respiratory Tract Infections/prevention & control , Viruses , Anti-Bacterial Agents/therapeutic use , Anti-Infective Agents/therapeutic use , Antiviral Agents/therapeutic use , Databases, Factual , Humans , Pneumonia, Bacterial/drug therapy , Respiratory Tract Infections/virology
4.
BMC Infect Dis ; 22(1): 756, 2022 Sep 28.
Article in English | MEDLINE | ID: mdl-36171561

ABSTRACT

BACKGROUND: Patients with Lyme borreliosis (LB) may report persisting non-specific symptoms such as fatigue, widespread musculoskeletal pain or cognitive difficulties. When present for more than 6 months and causing a reduction in daily activities, this is often referred to as post-treatment Lyme disease syndrome (PTLDS). This study aimed to compare the occurrence of symptoms between LB patients and controls, to estimate the proportion of LB patients developing PTLDS and to identify risk factors. METHODS: A prospective cohort study was set up including three subpopulations: patients with an erythema migrans (EM) (i) or disseminated/late LB (ii) and a non-LB control group (iii). At 6- and 12-months follow-up, the occurrence of several symptoms, including six symptoms used to define PTLDS, i.e. muscle pain, joint pain, fatigue, memory problems, difficulties concentrating and problems finding words, and impact on daily activities, was compared between LB patients and controls. Finally, the proportion of LB patients developing PTLDS as defined by the Infectious Disease Society of America was estimated, including a time frame for symptoms to be present. RESULTS: Although the risk of presenting PTLDS-related symptoms was significantly higher in EM patients (n = 120) compared to controls (n = 128) at 6 months follow-up, the risk of presenting at least one of these symptoms combined with impact on daily activities was not significantly higher in EM patients, at either 6- or 12-months follow-up. A significant association was found between disseminated/late LB (n = 15) and the occurrence of any PTLDS-symptom with an impact on daily activities at both time points. The proportion of patients with PTLDS was estimated at 5.9% (95% CI 2.7-12.9) in EM patients and 20.9% (95% CI 6.8-64.4) in patients with disseminated/late LB (RR = 3.53, 95% CI 0.98-12.68, p = 0.053). No significant risk factors were identified, which may be explained by small sample sizes. CONCLUSIONS: In our study, PTLDS was present in both LB cohorts, yet with a higher percentage in disseminated/late LB patients. Additional research is needed into risk factors for and causes of this syndrome. In addition, development and validation of standardized methods to assess the PTLDS case definition, easily applicable in practice, is of great importance.


Subject(s)
Erythema Chronicum Migrans , Lyme Disease , Post-Lyme Disease Syndrome , Belgium , Erythema Chronicum Migrans/epidemiology , Fatigue/epidemiology , Fatigue/etiology , Humans , Lyme Disease/complications , Lyme Disease/drug therapy , Lyme Disease/epidemiology , Post-Lyme Disease Syndrome/complications , Prospective Studies
5.
Forensic Sci Med Pathol ; 17(1): 87-100, 2021 Mar.
Article in English | MEDLINE | ID: mdl-33464531

ABSTRACT

This manuscript aims to: 1) provide specific guidelines on PMM techniques in the setting of minimally invasive autopsy (MIA), both for pathologists collecting samples and for microbiologists advising pathologists and interpreting the results and 2) introduce standardization in PMM sampling at MIA. Post-mortem microbiology (PMM) is crucial to identify the causative organism in deaths due to infection. MIA including the use of post-mortem (PM) computed tomography (CT) and PM magnetic resonance imaging (MRI), is increasingly carried out as a complement or replacement for the traditional PM. In this setting, mirroring the traditional autopsy, PMM aims to: detect infectious organisms causing sudden unexpected deaths; confirm clinically suspected but unproven infection; evaluate the efficacy of antimicrobial therapy; identify emergent pathogens; and recognize medical diagnostic errors. Meaningful interpretation of PMM results requires careful evaluation in the context of the clinical history, macroscopic and microscopic findings. These guidelines were developed by a multidisciplinary team with experts in various fields of microbiology and pathology on behalf of the ESGFOR (ESCMID - European Society of Clinical Microbiology and Infectious Diseases - Study Group of Forensic and Post-mortem Microbiology, in collaboration with the ESP -European Society of Pathology-) based on a literature search and the author's expertise. Microbiological sampling methods for MIA are presented for various scenarios: adults, children, developed and developing countries. Concordance between MIA and conventional invasive autopsy is substantial for children and adults and moderate for neonates and maternal deaths. Networking and closer collaboration among microbiologists and pathologists is vital to maximize the yield of PMM in MIA.


Subject(s)
Autopsy/methods , Infections/diagnosis , Microbiological Techniques , Specimen Handling/methods , Forensic Medicine , Humans , Infection Control , Personal Protective Equipment
6.
Transpl Infect Dis ; 21(2): e13046, 2019 Apr.
Article in English | MEDLINE | ID: mdl-30597699

ABSTRACT

Pulmonary Mycobacterium abscessus infection in cystic fibrosis (CF) patients is difficult to treat and considered a contra-indication for lung transplantation in most centers. We present four CF patients with chronic pulmonary M abscessus infection, in whom lung transplantation was performed. Through intensive treatment before transplantation, we achieved control of the infection in all but one patient. After a mean of 16 months of follow up, 3 patients are doing well, without evidence of local or disseminated recurrence. One patient died early post-transplant due to an unrelated cause. These findings support the possibility of lung transplantation with favorable outcome in CF patients with M abscessus infection.


Subject(s)
Cystic Fibrosis/microbiology , Lung Transplantation , Lung/microbiology , Mycobacterium Infections, Nontuberculous/drug therapy , Adult , Anti-Bacterial Agents/therapeutic use , Chronic Disease , Cystic Fibrosis/complications , Cystic Fibrosis/surgery , Female , Humans , Male , Nontuberculous Mycobacteria/drug effects , Young Adult
7.
BMC Public Health ; 19(1): 597, 2019 May 17.
Article in English | MEDLINE | ID: mdl-31101034

ABSTRACT

BACKGROUND: Serological surveillance, based on the measurement of the presence of specific antibodies in a given population, can be used in addition to traditional and routine disease surveillance methods. The added value of this has been largely documented for vaccine-preventable diseases, but to a lesser extent for vector-borne diseases. This study aimed to evaluate the utility of seroprevalence data as additional source of information on the epidemiology of Lyme borreliosis in Belgium. METHODS: In total, 3215 residual blood samples collected in 2013-2015 were analysed with Liaison® Borrelia IgG kit (DiaSorin S.p.A, Saluggia, Italy). Positive and equivocal results were further examined with immunoblotting (recomLine Borrelia IgG kit, Mikrogen, Neuried, Germany). Crude prevalence estimates of equivocal and seropositive results were calculated and further adjusted accounting for clustered sampling and standardized for age, sex and population per province, according to the Belgian population structure in 2014. The effect of age, sex and region on seropositivity was assessed using log-binomial regression. RESULTS: The overall weighted national seroprevalence for Borrelia burgdorferi sensu lato, adjusted for clustered sampling, age, sex and province was 1.06% (95%CI 0.67-1.67). Although not statistically significant, the highest prevalences were observed in men and in those younger than 15 years or older than 59 years of age. At provincial level, the seroprevalence estimates do not follow the geographical distribution of tick bites and diagnoses of Lyme borreliosis as detected through other surveillance systems. CONCLUSIONS: Although the use of residual samples for seroprevalence estimates has several advantages, it seems to be a limited tool for serological surveillance of Lyme borreliosis in Belgium, other than follow-up of trends if repeated over time. A population-based sampling strategy might provide a more representative nationwide sample, but would be very time intensive and expensive. Seroprevalence studies within risk groups or risk areas in Belgium could provide a useful alternative approach to complement routine surveillance data of Lyme borreliosis.


Subject(s)
Lyme Disease/epidemiology , Population Surveillance/methods , Adult , Belgium/epidemiology , Borrelia burgdorferi , Female , Humans , Male , Middle Aged , Prevalence , Risk Factors , Seroepidemiologic Studies , Tick Bites/epidemiology , Young Adult
8.
Eur J Clin Microbiol Infect Dis ; 37(8): 1503-1510, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29770901

ABSTRACT

Vancomycin pharmacokinetic (PK) and pharmacodynamic (PD) data in neonates are based on total concentrations. However, only unbound vancomycin is pharmacologically active. The objective was to determine vancomycin protein binding and the covariates impacting unbound vancomycin concentration in neonates and young infants. In neonates and young infants to whom vancomycin was administered intermittently for medical indications, total and unbound vancomycin plasma concentrations were determined using LC-MS/MS. Sampling occurred randomly during vancomycin exposure, covering a broad range of concentrations. Impact of covariates on unbound vancomycin concentration was determined using linear regression. Significant results of the univariate regressions were entered in a stepwise multiple regression. Passing-Bablok regression and Bland-Altman were used to assess the difference between measured and calculated unbound vancomycin concentration. Thirty-seven samples in 33 patients (median (interquartile range) gestational age 35 (29-39) weeks) were collected. Median total and unbound vancomycin concentrations were 14.2 (7.4-20.6) and 13.6 (7.2-22.5) mg/L, respectively. Median unbound fraction was 0.90 (0.77-0.98). Multiple regression revealed total vancomycin concentration (ß = 0.884, p < 0.001) and albumin (ß = - 0.323, p = 0.007) as most important covariates of unbound vancomycin concentrations, with an R2 adjusted of 0.953 (p < 0.0001). Mean absolute difference between calculated and measured unbound vancomycin was - 0.008 (95% CI - 0.92-0.91) mg/L. The unbound vancomycin fraction in neonates is higher compared to that in children and adults, and total vancomycin concentration and albumin were the most important covariates of unbound vancomycin concentration. Integration of protein binding in future PK/PD analyses is appropriate to optimize vancomycin dosing and to determine population-specific vancomycin PD targets for neonates.


Subject(s)
Anti-Bacterial Agents/pharmacokinetics , Vancomycin/pharmacokinetics , Age Factors , Anti-Bacterial Agents/administration & dosage , Biomarkers , Chromatography, Liquid , Drug Monitoring , Female , Gestational Age , Humans , Infant , Infant, Newborn , Male , Protein Binding , Risk Factors , Tandem Mass Spectrometry , Vancomycin/administration & dosage
9.
J Antimicrob Chemother ; 72(9): 2469-2477, 2017 09 01.
Article in English | MEDLINE | ID: mdl-28859446

ABSTRACT

Objectives: To describe a novel plasmid-borne class D carbapenemase (CHDL) named OXA-427 identified in several Enterobacteriaceae clinical isolates from nine patients in one Belgian hospital. Methods: OXA-427-producing isolates were analysed by an electrochemical imipenem hydrolysis method (BYG Carba test), Carba NP test, conventional phenotypic assays and by molecular methods (PCR, whole sequencing of the OXA-427-encoding plasmid and cloning). The antimicrobial resistance profile of OXA-427 was analysed by expression of the cloned gene in Escherichia coli DH10B and J53. Results: Eleven OXA-427-producing Enterobacteriaceae isolates of various species were identified from clinical specimens of nine patients between March 2012 and June 2014. OXA-427 shares only 22%-29% amino acid identity with OXA-48-like enzymes and other acquired CHDL (e.g. OXA-23, -24/40 and -58 of Acinetobacter spp.). Conversely, it appeared closely related to the chromosomal class D ß-lactamase of Aeromonas media, Aeromonas hydrophila and Aeromonas sobria (99%, 89% and 77% of identity, respectively). When expressed in E. coli, OXA-427 hydrolysed imipenem and conferred resistance to extended-spectrum cephalosporins (mostly ceftazidime), penicillins including temocillin, and reduced susceptibility to carbapenems. The blaOXA-427 gene was located in a 45 kb resistance island on a 177 kb IncA/C plasmid. Conclusions: OXA-427 is a novel CHDL most closely related to chromosomal class D ß-lactamase of A. media WS. It confers resistance to penicillins, ceftazidime and aztreonam and in some instances to carbapenems. OXA-427, which is not detectable by classical molecular tests, caused a protracted outbreak in one university hospital over a 2 year period.


Subject(s)
Anti-Bacterial Agents/metabolism , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Carbapenems/metabolism , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/enzymology , Plasmids/genetics , beta-Lactamases/genetics , beta-Lactamases/metabolism , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/isolation & purification , Belgium/epidemiology , Carbapenems/pharmacology , Cloning, Molecular , Drug Resistance, Multiple, Bacterial/genetics , Enterobacteriaceae Infections/epidemiology , Escherichia coli/drug effects , Escherichia coli/genetics , High-Throughput Nucleotide Sequencing , Humans , Hydrolysis , Male , Microbial Sensitivity Tests , Middle Aged , beta-Lactamases/isolation & purification
10.
Eur J Pediatr ; 175(5): 651-7, 2016 May.
Article in English | MEDLINE | ID: mdl-26782094

ABSTRACT

UNLABELLED: Many hospitals opt for early postnatal discharge of newborns with a potential risk of readmission for neonatal hyperbilirubinemia. Assays/algorithms with the possibility to improve prediction of significant neonatal hyperbilirubinemia are needed to optimize screening protocols and safe discharge of neonates. This study investigated the predictive value of umbilical cord blood (UCB) testing for significant hyperbilirubinemia. Neonatal UCB bilirubin, UCB direct antiglobulin test (DAT), and blood group were determined, as well as the maternal blood group and the red blood cell antibody status. Moreover, in newborns with clinically apparent jaundice after visual assessment, plasma total bilirubin (TB) was measured. Clinical factors positively associated with UCB bilirubin were ABO incompatibility, positive DAT, presence of maternal red cell antibodies, alarming visual assessment and significant hyperbilirubinemia in the first 6 days of life. UCB bilirubin performed clinically well with an area under the receiver-operating characteristic curve (AUC) of 0.82 (95 % CI 0.80-0.84). The combined UCB bilirubin, DAT, and blood group analysis outperformed results of these parameters considered separately to detect significant hyperbilirubinemia and correlated exponentially with hyperbilirubinemia post-test probability. CONCLUSION: Post-test probabilities for neonatal hyperbilirubinemia can be calculated using exponential functions defined by UCB bilirubin, DAT, and ABO compatibility results. WHAT IS KNOWN: • The diagnostic value of the triad umbilical cord blood bilirubin measurement, direct antiglobulin testing and blood group analysis for neonatal hyperbilirubinemia remains unclear in literature. • Currently no guideline recommends screening for hyperbilirubinemia using umbilical cord blood. What is New: • Post-test probability for hyperbilirubinemia correlated exponentially with umbilical cord blood bilirubin in different risk groups defined by direct antiglobulin test and ABO blood group compatibility results. • Exponential functions can be used to calculate hyperbilirubinemia probability.


Subject(s)
ABO Blood-Group System/analysis , Bilirubin/blood , Fetal Blood/chemistry , Hyperbilirubinemia, Neonatal/blood , Coombs Test , Female , Follow-Up Studies , Humans , Hyperbilirubinemia, Neonatal/diagnosis , Infant, Newborn , Male , Predictive Value of Tests , ROC Curve , Retrospective Studies , Time Factors
11.
J Clin Microbiol ; 52(2): 678-80, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24478512

ABSTRACT

We evaluated the performance of the ChromID MRSA/ChromID S. aureus biplate for the simultaneous detection of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) in preoperative screening samples. The sensitivity and specificity were 94.2% and 93.6%, respectively, for the S. aureus compartment and 92.9% and 99.7% for the MRSA compartment after 48 h incubation.


Subject(s)
Bacteriological Techniques/methods , Carrier State/diagnosis , Culture Media/chemistry , Nasal Mucosa/microbiology , Preoperative Care/methods , Staphylococcal Infections/diagnosis , Staphylococcus aureus/isolation & purification , Carrier State/microbiology , Humans , Mass Screening/methods , Methicillin Resistance , Sensitivity and Specificity , Staphylococcal Infections/microbiology , Staphylococcus aureus/classification , Time
12.
Curr Ther Res Clin Exp ; 76: 51-7, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25061483

ABSTRACT

BACKGROUND: Although vancomycin is frequently used to treat neonatal late-onset sepsis, there is no consensus on the optimal dosing regimen. Because many neonates needed dosing adaptation due to suboptimal trough values, the vancomycin dosing regimen in our neonatal department was changed during 2012. OBJECTIVE: We aimed to document the need for validation of neonatal vancomycin dosing by exploring serum trough levels achieved using 2 published dosing regimens (previous regimen: based on postmenstrual age and serum creatinine and new regimen: based on postmenstrual age and postnatal age) and to identify covariates associated with suboptimal vancomycin trough levels (<10 mg/L). METHODS: Routine therapeutic drug monitoring serum trough levels quantified after initiation of intravenous vancomycin therapy and clinical covariates were retrospectively collected. Median vancomycin trough levels of both dosing regimens were compared using the Mann-Whitney U test. The influence of continuous and dichotomous covariates on achieving a suboptimal trough level was explored using the Van Elteren test (stratified Mann-Whitney U test) and Mantel-Haenszel test (stratified χ(2) test), respectively. Covariates significant in monovariate analysis were subsequently included in a logistic regression analysis. RESULTS: In total, 294 observations (median current weight 1870 g [range = 420-4863 g] and median postmenstrual age 35.07 weeks [range = 25.14-56.00 weeks]) were included. Using the previous and new dosing regimens, 66.3% and 76.2% of trough levels, respectively, were below 10 mg/L. Overall, suboptimal vancomycin trough values were significantly associated with lower weight (birth weight and current weight) and age (gestational age and postmenstrual age). CONCLUSIONS: The majority of vancomycin trough levels in neonates achieved using 2 published dosing regimens did not reach the target of 10 mg/L. This illustrates the urgent need for prospective validation of neonatal vancomycin dosing regimens. We anticipate that dosing regimens integrating covariates reflecting general physiological maturation and renal maturation, as well as disease characteristics, could improve vancomycin exposure in neonates.

13.
J Appl Lab Med ; 9(4): 776-788, 2024 Jul 01.
Article in English | MEDLINE | ID: mdl-38642405

ABSTRACT

BACKGROUND: This paper presents a data-driven strategy for establishing the reportable interval in clinical laboratory testing. The reportable interval defines the range of laboratory result values beyond which reporting should be withheld. The lack of clear guidelines and methodology for determining the reportable interval has led to potential errors in reporting and patient risk. METHODS: To address this gap, the study developed an integrated strategy that combines statistical analysis, expert review, and hypothetical outlier calculations. A large data set from an accredited clinical laboratory was utilized, analyzing over 124 million laboratory test records from 916 distinct tests. The Dixon test was applied to identify outliers and establish the highest and lowest non-outlier result values for each test, which were validated by clinical pathology experts. The methodology also included matching the reportable intervals with relevant Logical Observation Identifiers Names and Codes (LOINC) and Unified Code for Units of Measure (UCUM)-valid units for broader applicability. RESULTS: Upon establishing the reportable interval for 135 routine laboratory tests (493 LOINC codes), we applied these to a primary care laboratory data set of 23 million records, demonstrating their efficacy with over 1% of result records identified as implausible. CONCLUSIONS: We developed and tested a data-driven strategy for establishing reportable intervals utilizing large electronic medical record (EMR) data sets. Implementing the established interval in clinical laboratory settings can improve autoverification systems, enhance data reliability, and reduce errors in patient care. Ongoing refinement and reporting of cases exceeding the reportable limits will contribute to continuous improvement in laboratory result management and patient safety.


Subject(s)
Electronic Health Records , Humans , Electronic Health Records/statistics & numerical data , Retrospective Studies , Clinical Laboratory Techniques/standards , Clinical Laboratory Techniques/statistics & numerical data , Clinical Laboratory Techniques/methods , Laboratories, Clinical/statistics & numerical data , Diagnostic Tests, Routine/standards , Diagnostic Tests, Routine/statistics & numerical data , Diagnostic Tests, Routine/methods , Logical Observation Identifiers Names and Codes
14.
Microorganisms ; 12(5)2024 May 14.
Article in English | MEDLINE | ID: mdl-38792818

ABSTRACT

Forensic microbiology is a relatively new discipline, born in part thanks to the development of advanced methodologies for the detection, identification and characterization of microorganisms, and also in relation to the growing impact of infectious diseases of iatrogenic origin. Indeed, the increased application of medical practices, such as transplants, which require immunosuppressive treatments, and the growing demand for prosthetic installations, associated with an increasing threat of antimicrobial resistance, have led to a rise in the number of infections of iatrogenic origin, which entails important medico-legal issues. On the other hand, the possibility of detecting minimal amounts of microorganisms, even in the form of residual traces (e.g., their nucleic acids), and of obtaining gene and genomic sequences at contained costs, has made it possible to ask new questions of whether cases of death or illness might have a microbiological origin, with the possibility of also tracing the origin of the microorganisms involved and reconstructing the chain of contagion. In addition to the more obvious applications, such as those mentioned above related to the origin of iatrogenic infections, or to possible cases of infections not properly diagnosed and treated, a less obvious application of forensic microbiology concerns its use in cases of violence or violent death, where the characterization of the microorganisms can contribute to the reconstruction of the case. Finally, paleomicrobiology, e.g., the reconstruction and characterization of microorganisms in historical or even archaeological remnants, can be considered as a sister discipline of forensic microbiology. In this article, we will review these different aspects and applications of forensic microbiology.

15.
Acta Clin Belg ; 78(1): 36-43, 2023 Feb.
Article in English | MEDLINE | ID: mdl-35373719

ABSTRACT

OBJECTIVES: Hospital point prevalence surveys (PPS) are shown to help identifying determinants for inappropriate antimicrobial therapy (AMT) and create feedback opportunities to optimize AMT. METHODS: PPS were performed at the AZNikolaas hospital, on four wards with high consumption rates of three alert antibiotics (AB) to judge their appropriateness. The impact of a multidisciplinary interaction between a medical microbiologist, a clinical pharmacist and the prescriber on inappropriate AMT, hospital costs and intravenous AMT days, was analyzed. RESULTS: During this survey, 7,39% of hospitalized patients in the selected wards received one or more of three alert antibiotics. Out of 78 prescriptions, 35.90% were judged appropriate, 39.74% inappropriate and 24.36% had insufficient data for judgment. Only the oncology ward was associated with more frequent appropriate use of alert AB. In case of an unknown infection focus or a catheter-related infection, the relative risk of inappropriate use was the highest. Multidisciplinary interaction improved inappropriate AMT in 59% of cases. It resulted in a 2478€ healthcare AMT cost saving and a reduction of 30 intravenous AMT days. CONCLUSIONS: This survey shows high consumption rates and a high rate of inappropriate use of three alert AB in the observed wards. It revealed the lack of a local guideline concerning treatment of neutropenic fever of unknown origin and the need for more diagnostic information in electronical medical records. The survey demonstrated that direct feedback on inappropriate AMT to clinicians can be of added value, cost-saving and reducing length of intravenous AMT days. However, more studies are needed to confirm this.


Subject(s)
Anti-Bacterial Agents , Anti-Infective Agents , Humans , Anti-Bacterial Agents/therapeutic use , Prevalence , Feedback , Anti-Infective Agents/therapeutic use , Hospitals
16.
Microorganisms ; 11(10)2023 Oct 07.
Article in English | MEDLINE | ID: mdl-37894167

ABSTRACT

The relevance of postmortem microbiological examinations has been controversial for decades, but the boom in advanced sequencing techniques over the last decade is increasingly demonstrating their usefulness, namely for the estimation of the postmortem interval. This comprehensive review aims to present the current knowledge about the human postmortem microbiome (the necrobiome), highlighting the main factors influencing this complex process and discussing the principal applications in the field of forensic sciences. Several limitations still hindering the implementation of forensic microbiology, such as small-scale studies, the lack of a universal/harmonized workflow for DNA extraction and sequencing technology, variability in the human microbiome, and limited access to human cadavers, are discussed. Future research in the field should focus on identifying stable biomarkers within the dominant Bacillota and Pseudomonadota phyla, which are prevalent during postmortem periods and for which standardization, method consolidation, and establishment of a forensic microbial bank are crucial for consistency and comparability. Given the complexity of identifying unique postmortem microbial signatures for robust databases, a promising future approach may involve deepening our understanding of specific bacterial species/strains that can serve as reliable postmortem interval indicators during the process of body decomposition. Microorganisms might have the potential to complement routine forensic tests in judicial processes, requiring robust investigations and machine-learning models to bridge knowledge gaps and adhere to Locard's principle of trace evidence.

18.
Ann Transl Med ; 10(11): 644, 2022 Jun.
Article in English | MEDLINE | ID: mdl-35813341

ABSTRACT

Background and Objective: A thorough understanding of the pathogenic mechanisms elicited by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) still requires further research. Until recently, only a restricted number of autopsies have been performed, therefore limiting the accurate knowledge of the lung injury associated with SARS-CoV-2. A multidisciplinary European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group of Forensic and Post-mortem Microbiology-ESGFOR team conducted a non-systematic narrative literature review among coronavirus 2019 disease (COVID-19) pneumonia cases assessing the histopathological (HP) effects of positive airways pressure. HP lung features were recorded and compared between mechanically ventilated (>24 hours) and control (ventilation <24 hours) patients. A logistic regression analysis was performed to identify associations between mechanical ventilation (MV) and HP findings. Methods: A PubMed and MEDLINE search was conducted in order to identify studies published between March 1st 2020 and June 30th 2021. Key Content and Findings: Seventy patients (median age: 69 years) from 24 studies were analysed, among whom 38 (54.2%) underwent MV longer than 24 hours. Overall, main HP features were: diffuse alveolar damage (DAD) in 53 (75.7%), fibrosis (interstitial/intra-alveolar) in 43 (61.4%), vascular damage-including thrombosis/emboli- in 41 (58.5%), and endotheliitis in only 8 (11.4%) patients. Association of DAD, fibrosis and vascular damage was detected in 30 (42.8%) patients. Multivariate analysis, adjusted by age and gender, identified MV >24 hours as an independent variable associated with DAD (OR =5.40, 95% CI: 1.48-19.62), fibrosis (OR =3.88, 95% CI: 1.25-12.08), vascular damage (OR =5.49, 95% CI: 1.78-16.95) and association of DAD plus fibrosis plus vascular damage (OR =6.99, 95% CI: 2.04-23.97). Conclusions: We identified that patients mechanically ventilated >24 hours had a significantly higher rate of pulmonary injury on histopathology independently of age and gender. Our findings emphasize the importance of maintaining a protective ventilator strategy when subjects with COVID-19 pneumonia undergo intubation.

19.
Antimicrob Resist Infect Control ; 11(1): 43, 2022 02 28.
Article in English | MEDLINE | ID: mdl-35227333

ABSTRACT

BACKGROUND: A tool, the Infection Risk Scan has been developed to measure the quality of infection control and antimicrobial use. This tool measures various patient-, ward- and care-related variables in a standardized way. We describe the implementation of this tool in nine hospitals in the Dutch/Belgian border area and the obtained results. METHODS: The IRIS consists of a set of objective and reproducible measurements: patient comorbidities, (appropriate) use of indwelling medical devices, (appropriate) use of antimicrobial therapy, rectal carriage of Extended-spectrum beta-lactamase producing Enterobacterales and their clonal relatedness, environmental contamination, hand hygiene performance, personal hygiene of health care workers and presence of infection prevention preconditions. The Infection Risk Scan was implemented by an expert team. In each setting, local infection control practitioners were trained to achieve a standardized implementation of the tool and an unambiguous assessment of data. RESULTS: The IRIS was implemented in 34 wards in six Dutch and three Belgian hospitals. The tool provided ward specific results and revealed differences between wards and countries. There were significant differences in the prevalence of ESBL-E carriage between countries (Belgium: 15% versus The Netherlands: 9.6%), environmental contamination (median adenosine triphosphate (ATP) level Belgium: 431 versus median ATP level The Netherlands: 793) and calculated hand hygiene actions based on alcohol based handrub consumption (Belgium: 12.5/day versus The Netherlands: 6.3/day) were found. CONCLUSION: The Infection risk Scan was successfully implemented in multiple hospitals in a large cross-border project and provided data that made the quality of infection control and antimicrobial use more transparent. The observed differences provide potential targets for improvement of the quality of care.


Subject(s)
Cross Infection , Hand Hygiene , Belgium/epidemiology , Cross Infection/epidemiology , Cross Infection/prevention & control , Hospitals , Humans , Infection Control/methods
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