Comparative genomics of ESBL-producing Escherichia coli (ESBL-Ec) reveals a similar distribution of the 10 most prevalent ESBL-Ec clones and ESBL genes among human community faecal and extra-intestinal infection isolates in the Netherlands (2014-17).

INTRODUCTION: The human gut microbiota is an important reservoir of ESBL-producing Escherichia coli (ESBL-Ec). Community surveillance studies of ESBL-Ec to monitor circulating clones and ESBL genes are logistically challenging and costly. OBJECTIVES: To evaluate if isolates obtained in routine clinical practice can be used as an alternative to monitor the distribution of clones and ESBL genes circulating in the community. METHODS: WGS was performed on 451 Dutch ESBL-Ec isolates (2014-17), including 162 community faeces and 289 urine and blood isolates. We compared proportions of 10 most frequently identified STs, PopPUNK-based sequence clusters (SCs) and ESBL gene subtypes and the degree of similarity using Czekanowski's proportional similarity index (PSI). RESULTS: Nine out of 10 most prevalent STs and SCs and 8/10 most prevalent ESBL genes in clinical ESBL-Ec were also the most common types in community faeces. The proportions of ST131 (39% versus 23%) and SC131 (40% versus 25%) were higher in clinical isolates than in community faeces (P < 0.01). Within ST131, H30Rx (C2) subclade was more prevalent among clinical isolates (55% versus 26%, P < 0.01). The proportion of ESBL gene blaCTX-M-1 was lower in clinical isolates (5% versus 18%, P < 0.01). Czekanowski's PSI confirmed that the differences in ESBL-Ec from community faeces and clinical isolates were limited. CONCLUSIONS: Distributions of the 10 most prevalent clones and ESBL genes from ESBL-Ec community gut colonization and extra-intestinal infection overlapped in majority, indicating that isolates from routine clinical practice could be used to monitor ESBL-Ec clones and ESBL genes in the community.

Universal risk assessment upon hospital admission for screening of carriage with multidrug-resistant micro-organisms in a Dutch tertiary care centre.

BACKGROUND: In Dutch hospitals a six-point questionnaire is currently mandatory for risk assessment to identify carriers of multidrug-resistant organisms (MDROs) at the time of hospitalization. Presence of one or more risk factors is followed by pre-emptive isolation and microbiological culturing. AIM: To evaluate the yield of the universal risk assessment in identifying MDRO carriers upon hospitalization. METHODS: A cross-sectional study was performed using routine healthcare data in a Dutch tertiary hospital between January 1st, 2015 and August 1st, 2019. MDRO risk assessment upon hospitalization included assessment of: known MDRO carriage, previous hospitalization in another Dutch hospital during an outbreak or a foreign hospital, living in an asylum centre, exposure to livestock farming, and household membership of a meticillin-resistant Staphylococcus aureus carrier. FINDINGS: In total, 144,051 admissions of 84,485 unique patients were included; 4480 (3.1%) admissions had a positive MDRO risk assessment. In 1516 (34%) admissions microbiological screening was performed, of which 341 (23%) yielded MDRO. Eighty-one patients were categorized as new MDRO carriers, as identified through MDRO risk assessment, reflecting 0.06% (95% confidence interval: 0.04-0.07) of all admissions and 1.8% (1.4-2.2) of those with positive risk assessment. As a result, the number of 'MDRO risk assessments needed to perform' and individual 'MDRO questions needed to ask' to detect one new MDRO carrier upon hospitalization were 1778 and 10,420, respectively. CONCLUSION: The yield of the current strategy of MDRO risk assessment upon hospitalization is limited and it needs thorough reconsideration.

Antimicrobial approaches in the prevention of Staphylococcus aureus infections: a review.

Background: The prophylactic application of antimicrobials that are active against Staphylococcus aureus can prevent infections. However, implementation in clinical practice is limited. We have reviewed antimicrobial approaches for the prevention of S. aureus infections. Methods: We searched the Cochrane Central Register of Controlled Trials, PubMed/MEDLINE and EMBASE databases and trial registries using synonyms for S. aureus, infections and prevention as search terms. We included randomized controlled trials and systematic reviews only. Results: Most studies were conducted with mupirocin. Mupirocin is effective in preventing S. aureus infections in patients receiving dialysis treatment and in surgical patients, particularly if the patients are carriers of S. aureus. The combination of mupirocin and chlorhexidine, but not chlorhexidine alone, is also effective against S. aureus infections. So far, vaccines have not proven successful in protecting against S. aureus infections. Regarding prophylactic povidone-iodine and systemic antibiotics, there is limited evidence supporting their effectiveness against S. aureus infections. Antimicrobial honey has not been proven to be more effective or non-inferior to mupirocin in protecting against S. aureus infections. Conclusions: The current evidence supports the use of mupirocin as prophylaxis for preventing infections with S. aureus, particularly in carriers and in the surgical setting or in patients receiving dialysis treatment. Other antimicrobial agents have not been sufficiently proven to be effective so far, or have been proven ineffective. New trials with vaccines and anti-staphylococcal peptides are currently underway and may lead to new preventive strategies in the future.

Cognitive decision strategies adopted by consumers in reminder difference tests: Influence of the authenticity test.

Discrimination tests are used in food companies to quantify small differences between products. Within the diversity of methods available, some are quicker to conduct, whereas others are more sensitive or statistically powerful. One class of methods includes the reminder tasks in which the reference product is given before tasting the actual test stimuli. During the task, such a 'reminder' can be compared directly to each test stimulus, or alternatively, only serve to prime the memory of the judge without being taken into account in decision-making. Previous research with trained judges provided evidence for the latter process while research with untrained consumers has provided some evidence for the former process. Two studies were conducted with untrained consumers using the A Not-AR and 2-AFCR reminder tasks. Objectives were to determine the decision strategies used in, and the relative sensitivity of the tasks. In addition, the use of an "authenticity test" was explored to see if this has a positive effect on test performance. In the first study, mayonnaise and ice tea with small stimulus differences (d'<1) were used in A Not-AR and 2-AFCR. Results were compared to those from A Not-A and 2-AFC tasks, with and without an authenticity test. It was difficult to draw clear conclusions on the decision strategy used, though the use of an authenticity test increased the sensitivity for these small differences, as it improved the performance of 6 out of 8 tests. In the second study, ice teas with larger stimulus differences (at two levels) were tested using the A Not-AR and 2-AFCR tasks, in comparison to the same-different task. The results showed that consumers use the less optimal strategies and that the authenticity test decreases performance, which is contradictory to the results of the first study. It seems that for very small stimulus differences the authenticity test can improve performance, but with larger differences the authenticity test decreases performance; it seems to confuse the judges.

[Abdominal pain caused by herniation of the small intestine through the ligamentum latum uteri]. / Buikpijn als gevolg van dunnedarmherniatie door het ligamentum latum uteri.

A 47-year-old woman had experienced paroxysmal pain in the lower abdomen, nausea and vomiting for the last 12 hours. Laparoscopy revealed a 60-cm hernia of ileum through the ligamentum latum, which had led to ileal necrosis. After resection of a portion of the small intestine, the patient recovered. Defects in the ligamentum latum can arise from congenital or acquired causes. The most common congenital cause is the rupture of a cystic structure in the ligamentum latum. Acquired causes include surgical intervention, pelvic inflammatory disease and traumatic injury sustained during gravidity or parturition. These causes all lead to local weakening of or direct damage to the ligamentum latum.