INTRODUCTION. Invasive aspergillosis (IA) is a fungal infection particularly affecting immunocomp... more INTRODUCTION. Invasive aspergillosis (IA) is a fungal infection particularly affecting immunocompromized hosts. Recently, several reports indicate an important occurrence rate of IA in ICU patients; however few data are available on epidemiology and outcome of patients with IA in this setting.OBJECTIVES. We report data from the AspICU project, a multicenter (n=30) observational study including all patients with a positive Aspergillus culture, from November 2006 to January 2011. IA was defined according to a clinical and validated algorithm that discriminates Aspergillus colonization from putative or proven IA in ICU patients (1).METHODS. We report data from the AspICU project, a multicenter (n=30) observational study including all patients with a positive Aspergillus culture, from November 2006 to January 2011. IA was defined according to a clinical and validated algorithm that discriminates Aspergillus colonization from putative or proven IA in ICU patients (1).RESULTS. A total of ...
PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text ... more PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcome
European Journal of Clinical Microbiology & Infectious Diseases, 2020
Purpose Broth microdilution (BMD) stays as the reference testing method for determination of anti... more Purpose Broth microdilution (BMD) stays as the reference testing method for determination of antimicrobial susceptibility testing (AST) to colistin and is considered essential for patient management and for monitoring of colistin resistance. This multicenter study aimed to evaluate the performance of automated systems for colistin AST among Enterobacterales as an alternative for BMD since the majority of laboratories use automated systems as first-line method. Methods Twenty colistin resistant (COL-R) including 10 MCR producers and 10 colistin-susceptible (COL-S) Enterobacterales isolates were blindly tested for colistin susceptibility with the routine automated AST systems used by 8 laboratories (3 with BD Phoenix, 3 with Vitek2 and 2 with MicroScan). Additionally, 3 reference strains (E. coli ATCC 25922, E. coli NCTC 13846, and one COL-R mcr-negative K. pneumoniae M/14750) were tested in triplicate by each laboratory. Results and conclusion Results were compared with BMD performed at the reference laboratory. BD Phoenix and MicroScan automated AST systems provide accurate and reproducible categorical results for the testing of colistin in Enterobacterales. However, Vitek2 system showed poor performance for the detection of COL-R isolates especially those with MICs close to the susceptibility breakpoint (categorical agreement of 88% and precision categorical agreement of 81%).
ObjectivesThe WHO Access, Watch and Reserve (AWaRe) classification has been developed to support ... more ObjectivesThe WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population.MethodsThe Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed.ResultsRegional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) ...
Antimicrobial Resistance & Infection Control, 2020
Background The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobi... more Background The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017. Methods Belgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September–December 2017. All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS. Results Overall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5–27.6...
Urbanization strongly affects biodiversity, altering natural communities and often leading to a r... more Urbanization strongly affects biodiversity, altering natural communities and often leading to a reduced species richness. Yet, despite its increasingly recognized importance, how urbanization impacts on the health of individual animals, wildlife populations and on disease ecology remains poorly understood. To test whether, and how, urbanization-driven ecosystem alterations influence pathogen dynamics and avian health, we use house sparrows (Passer domesticus) and Yersinia spp. (pathogenic for passerines) as a case study. Sparrows are granivorous urban exploiters, whose western European populations have declined over the past decades, especially in highly urbanized areas. We sampled 329 house sparrows originating from 36 populations along an urbanization gradient across Flanders (Belgium), and used isolation combined with 'matrix-assisted laser desorption ionization-time of flight mass spectrometry' (MALDI-TOF MS) and PCR methods for detecting the presence of different Yersinia species. Yersinia spp. were recovered from 57.43% of the sampled house sparrows, of which 4.06%, 53.30% and 69.54% were identified as Y. pseudotuberculosis, Y. enterocolitica and other Yersinia species, respectively. Presence of Yersinia was related to the degree of urbanization, average daily temperatures and the community of granivorous birds present at sparrow capture locations. Body condition of suburban house sparrows was found to be higher compared to urban and rural house sparrows, but no relationships between sparrows' body condition and presence of Yersinia spp. were found. We conclude that two determinants of pathogen infection dynamics, body condition and pathogen occurrence, vary along an urbanization gradient, potentially mediating the impact of urbanization on avian health.
Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD? To the... more Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD? To the Editor: Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection, mainly affecting immunocompromised patients, particularly those with prolonged neutropenia [1]. Several reports have shown that Aspergillus spp. can also cause IPA in patients with a priori less severe immune dysfunction, such as those in intensive care units (ICUs) [2-5] or with chronic obstructive pulmonary disease (COPD) [5-8]. In these patients, diagnosis of IPA remains a challenge, because the reference diagnostic criteria (defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG)) were developed for research in high-risk patients and not specifically for patients in the ICU or patients with COPD [9]. Two alternative algorithms have been proposed for this setting: the COPD algorithm for patients with COPD [6] and the Clinical algorithm for patients in the ICU [10]. We compared the three algorithms to evaluate which of them is the most accurate for classifying critically ill patients with COPD and Aspergillus-positive cultures. This study was part of the AspICU project [11], focusing on patients with COPD and Aspergillus-positive lower airway cultures. Collected data included demographics, clinical features, cultures, radiological findings (suggestive of IPA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage [12]. Using the COPD [6], Clinical [10] and EORTC/MSG [9] algorithms, patients were classified as having proven IPA, putative/probable IPA or colonisation. None of the patients could be classified as having "possible" IPA (as defined by the COPD and EORTC/MSG algorithms) because this requires negative cultures and all the patients in AspICU had at least one positive culture.
International Journal of Antimicrobial Agents, 2017
• Initiation of AFT does not seem to significantly alter the prognosis. Better diagnostic 69 tool... more • Initiation of AFT does not seem to significantly alter the prognosis. Better diagnostic 69 tools and strategies are needed.
Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affectin... more Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated...
Four Arcobacter species have been associated with human disease, and based on current knowledge, ... more Four Arcobacter species have been associated with human disease, and based on current knowledge, these Gram negative bacteria are considered as potential food and waterborne zoonotic pathogens. At present, only the genome of the species Arcobacter butzleri has been analysed, and still little is known about their physiology and genetics. The species Arcobacter thereius has first been isolated from tissue of aborted piglets, duck and pig faeces, and recently from stool of human patients with enteritis. In the present study, the complete genome and analysis of the A. thereius type strain LMG24486T, as well as the comparative genome analysis with 8 other A. thereius strains are presented. Genome analysis revealed metabolic pathways for the utilization of amino acids, which represent the main source of energy, together with the presence of genes encoding for respiration-associated and chemotaxis proteins. Comparative genome analysis with the A. butzleri type strain RM4018 revealed a larg...
Objectives: To evaluate the feasibility of different methods for susceptibility testing of human ... more Objectives: To evaluate the feasibility of different methods for susceptibility testing of human Arcobacter isolates, to assess susceptibility to antibiotics commonly used to treat diarrhoeal illness and to obtain MIC distribution data. Methods: One-hundred-and-six unique Arcobacter strains were collected during an epidemiological study on pathogens in gastroenteritis. Strains were identified by multiplex PCR and PCR-RFLP, and characterized by PFGE. Susceptibility to ampicillin, erythromycin, tetracycline, doxycycline, gentamicin and ciprofloxacin was determined using gradient strip and disc diffusion methodology. Optimal conditions for growth and incubation were tested. Azithromycin was tested with gradient strip diffusion on a subset of 40 strains. Sequence analysis of the quinolone resistance-determining region of gyrA was performed for a subset of 18 strains. Results: Based on gradient diffusion results, most Arcobacter strains were susceptible to gentamicin (99%) and tetracycline (89%). Erythromycin (78%), ciprofloxacin (72%) and doxycycline (76%) retained moderate activity against Arcobacter spp. Only 9% of the strains were susceptible to ampicillin. Most Arcobacter butzleri strains were susceptible to ciprofloxacin (87%), whereas half of the Arcobacter cryaerophilus isolates (51%) showed high-level resistance (MIC .32 mg/L). MIC 50 values were comparable for both macrolide antibiotics. Ciprofloxacin-resistant strains possessed an identical mutation in gyrA. Overall, categorical agreement between gradient and disc diffusion results was 60%. Gradient diffusion showed superior readability. Conclusions: Gradient diffusion methodology is preferred for routine susceptibility testing. Acquired resistance to fluoroquinolones was observed in A. cryaerophilus. Macrolides are not first-choice empirical antibiotics for Arcobacter infections. Tetracyclines can be suggested for treatment of documented Arcobacter-related gastrointestinal infections.
Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunoco... more Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. Methods An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Results A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incid...
We examined fecal samples from 6,774 patients with enteritis in Belgium, 2008-2013. Members of th... more We examined fecal samples from 6,774 patients with enteritis in Belgium, 2008-2013. Members of the genus Arcobacter were the fourth most common pathogen group isolated, and the isolation rate was higher than previously reported. Culturing Arcobacter in a microbiology laboratory is feasible and should thus be tested for in cases of diarrheal disease. C ampylobacteriosis is the most frequently reported zoonosis in industrialized countries with an increasing incidence during 2007-2011 (1). In this study, bacteria of the Arcobacter genus, which is closely related to the Campylobacter genus, comprised the fourth most common pathogenic group isolated from stool specimens of patients with acute enteritis in Ghent, Belgium. Bacteria species of the genus Arcobacter were first isolated from aborted bovine and porcine fetuses in 1977 (2). Based on similar phenotypic characteristics, they were originally classified as aerotolerant Campylobacter spp., until a separate genus was introduced in 1991 (2). Since then, 18 species have been identified and new species are pending. Members of the genus Arcobacter are aerotolerant gram-negative bacteria and able to grow at temperatures <30°C, which differentiate them from the Campylobacter species. The species A. butzleri, A. cryaerophilus, A. skirrowii, A. cibarius, A. thereius, and A. trophiarum have been identified in livestock worldwide and have been isolated from food of animal origin. Though these species have been associated with illness in farm animals, they are also known to colonize healthy animals (3). Arcobacter have been classified as emergent pathogens by the International Commission on Microbial Specifications for Foods (4). Currently, 3 species have been reported to infect humans. Contaminated drinking water
The objective of this study was to evaluate an automated blood culture system for the isolation o... more The objective of this study was to evaluate an automated blood culture system for the isolation of microorganisms from infected equine synovial fluid (SF). Samples were collected from 220 severely inflamed synovial joints and classified as either presumably infected (group A: n = 149) or not infected (group B: n = 71), based on a combination of clinical history, clinical signs and cytological analysis of the SF. Samples were inoculated into blood culture bottles and after incubation were subcultured onto agar media to confirm the results and to facilitate full bacterial identification. Microorganisms were isolated from 107 group A samples (71.8%) and from three group B samples (4.2%). Overall, the detection system identified 117 bottles as positive and 103 as negative, including nine instrument-false-positives and two instrument-false-negatives. The median time-to-detection for Gram-positive bacteria, Gram-negative bacteria, and for fungi was 14.3 (interquartile range [I.R.] 10.0) h, 8.8 (I.R. 12.8) h, and 72.0 (range 60.8-74.8) h, respectively. It was concluded that culture of infected SF using the automated system combines the advantages of enrichment in specialised medium with the rapid detection of bacterial growth.
In this study, we report the screening of four Arcobacter species for the presence of small and l... more In this study, we report the screening of four Arcobacter species for the presence of small and large plasmids. Plasmids were present in 9.9% of the 273 examined strains. One Arcobacter cryaerophilus and four Arcobacter butzleri plasmids were selected for further sequencing. The size of three small plasmids isolated from A. butzleri and the one from A. cryaerophilus strains ranged between 4.8 and 5.1 kb, and the size of the large plasmid, isolated from A. butzleri, was 27.4 kbp. The G+C content of all plasmids ranged between 25.4% and 26.2%. A total of 95% of the large plasmid sequence represents coding information, which contrasts to the 20 to 30% for the small plasmids. Some of the open reading frames showed a high homology to putative conserved domains found in other related organisms, such as replication, mobilization and genes involved in type IV secretion system. The large plasmid carried 35 coding sequences, including seven genes in a contiguous region of 11.6 kbp that encodes an orthologous type IV secretion system found in the Wolinella succinogenes genome, Helicobacter pylori and Campylobacter jejuni plasmids, which makes this plasmid interesting for further exploration.
INTRODUCTION. Invasive aspergillosis (IA) is a fungal infection particularly affecting immunocomp... more INTRODUCTION. Invasive aspergillosis (IA) is a fungal infection particularly affecting immunocompromized hosts. Recently, several reports indicate an important occurrence rate of IA in ICU patients; however few data are available on epidemiology and outcome of patients with IA in this setting.OBJECTIVES. We report data from the AspICU project, a multicenter (n=30) observational study including all patients with a positive Aspergillus culture, from November 2006 to January 2011. IA was defined according to a clinical and validated algorithm that discriminates Aspergillus colonization from putative or proven IA in ICU patients (1).METHODS. We report data from the AspICU project, a multicenter (n=30) observational study including all patients with a positive Aspergillus culture, from November 2006 to January 2011. IA was defined according to a clinical and validated algorithm that discriminates Aspergillus colonization from putative or proven IA in ICU patients (1).RESULTS. A total of ...
PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text ... more PDF corresponds to the article as it appeared upon acceptance. Fully formatted PDF and full text (HTML) versions will be made available soon. Epidemiology of invasive aspergillosis in critically ill patients: clinical presentation, underlying conditions, and outcome
European Journal of Clinical Microbiology & Infectious Diseases, 2020
Purpose Broth microdilution (BMD) stays as the reference testing method for determination of anti... more Purpose Broth microdilution (BMD) stays as the reference testing method for determination of antimicrobial susceptibility testing (AST) to colistin and is considered essential for patient management and for monitoring of colistin resistance. This multicenter study aimed to evaluate the performance of automated systems for colistin AST among Enterobacterales as an alternative for BMD since the majority of laboratories use automated systems as first-line method. Methods Twenty colistin resistant (COL-R) including 10 MCR producers and 10 colistin-susceptible (COL-S) Enterobacterales isolates were blindly tested for colistin susceptibility with the routine automated AST systems used by 8 laboratories (3 with BD Phoenix, 3 with Vitek2 and 2 with MicroScan). Additionally, 3 reference strains (E. coli ATCC 25922, E. coli NCTC 13846, and one COL-R mcr-negative K. pneumoniae M/14750) were tested in triplicate by each laboratory. Results and conclusion Results were compared with BMD performed at the reference laboratory. BD Phoenix and MicroScan automated AST systems provide accurate and reproducible categorical results for the testing of colistin in Enterobacterales. However, Vitek2 system showed poor performance for the detection of COL-R isolates especially those with MICs close to the susceptibility breakpoint (categorical agreement of 88% and precision categorical agreement of 81%).
ObjectivesThe WHO Access, Watch and Reserve (AWaRe) classification has been developed to support ... more ObjectivesThe WHO Access, Watch and Reserve (AWaRe) classification has been developed to support countries and hospitals in promoting rational use of antibiotics while improving access to these essential medicines. We aimed to describe patterns of worldwide antibiotic use according to the AWaRe classification in the adult inpatient population.MethodsThe Global Point Prevalence Survey on Antimicrobial Consumption and Resistance (Global-PPS) collects hospital antibiotic use data using a standardized PPS methodology. Global-PPS 2015, 2017 and 2018 data, collected by 664 hospitals in 69 countries, were categorized into AWaRe groups to calculate proportional AWaRe use, Access-to-Watch ratios and the most common indications for treatment with selected Watch antibiotics. Only prescriptions for systemic antibiotics on adult inpatient wards were analysed.ResultsRegional Access use ranged from 28.4% in West and Central Asia to 57.7% in Oceania, whereas Watch use was lowest in Oceania (41.3%) ...
Antimicrobial Resistance & Infection Control, 2020
Background The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobi... more Background The point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017. Methods Belgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September–December 2017. All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS. Results Overall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5–27.6...
Urbanization strongly affects biodiversity, altering natural communities and often leading to a r... more Urbanization strongly affects biodiversity, altering natural communities and often leading to a reduced species richness. Yet, despite its increasingly recognized importance, how urbanization impacts on the health of individual animals, wildlife populations and on disease ecology remains poorly understood. To test whether, and how, urbanization-driven ecosystem alterations influence pathogen dynamics and avian health, we use house sparrows (Passer domesticus) and Yersinia spp. (pathogenic for passerines) as a case study. Sparrows are granivorous urban exploiters, whose western European populations have declined over the past decades, especially in highly urbanized areas. We sampled 329 house sparrows originating from 36 populations along an urbanization gradient across Flanders (Belgium), and used isolation combined with 'matrix-assisted laser desorption ionization-time of flight mass spectrometry' (MALDI-TOF MS) and PCR methods for detecting the presence of different Yersinia species. Yersinia spp. were recovered from 57.43% of the sampled house sparrows, of which 4.06%, 53.30% and 69.54% were identified as Y. pseudotuberculosis, Y. enterocolitica and other Yersinia species, respectively. Presence of Yersinia was related to the degree of urbanization, average daily temperatures and the community of granivorous birds present at sparrow capture locations. Body condition of suburban house sparrows was found to be higher compared to urban and rural house sparrows, but no relationships between sparrows' body condition and presence of Yersinia spp. were found. We conclude that two determinants of pathogen infection dynamics, body condition and pathogen occurrence, vary along an urbanization gradient, potentially mediating the impact of urbanization on avian health.
Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD? To the... more Which algorithm diagnoses invasive pulmonary aspergillosis best in ICU patients with COPD? To the Editor: Invasive pulmonary aspergillosis (IPA) is a potentially lethal opportunistic infection, mainly affecting immunocompromised patients, particularly those with prolonged neutropenia [1]. Several reports have shown that Aspergillus spp. can also cause IPA in patients with a priori less severe immune dysfunction, such as those in intensive care units (ICUs) [2-5] or with chronic obstructive pulmonary disease (COPD) [5-8]. In these patients, diagnosis of IPA remains a challenge, because the reference diagnostic criteria (defined by the European Organization for Research and Treatment of Cancer/Mycosis Study Group (EORTC/MSG)) were developed for research in high-risk patients and not specifically for patients in the ICU or patients with COPD [9]. Two alternative algorithms have been proposed for this setting: the COPD algorithm for patients with COPD [6] and the Clinical algorithm for patients in the ICU [10]. We compared the three algorithms to evaluate which of them is the most accurate for classifying critically ill patients with COPD and Aspergillus-positive cultures. This study was part of the AspICU project [11], focusing on patients with COPD and Aspergillus-positive lower airway cultures. Collected data included demographics, clinical features, cultures, radiological findings (suggestive of IPA) and Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage [12]. Using the COPD [6], Clinical [10] and EORTC/MSG [9] algorithms, patients were classified as having proven IPA, putative/probable IPA or colonisation. None of the patients could be classified as having "possible" IPA (as defined by the COPD and EORTC/MSG algorithms) because this requires negative cultures and all the patients in AspICU had at least one positive culture.
International Journal of Antimicrobial Agents, 2017
• Initiation of AFT does not seem to significantly alter the prognosis. Better diagnostic 69 tool... more • Initiation of AFT does not seem to significantly alter the prognosis. Better diagnostic 69 tools and strategies are needed.
Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affectin... more Invasive aspergillosis(IA) is a potentially lethal complication of Aspergillus infection affecting mainly immunocompromised hosts; however, during the last two decades its incidence was increasingly observed in critically ill immunocompetent patients. The objective of this study is to describe the clinical characteristics of histologically proven endomyocardial and pericardial invasion, in the context of IA, in critically ill patients. Eight critically ill patients with histopathological confirmation of endomyocardial/pericardial aspergillosis were evaluated. Risk factors, clinical and laboratory characteristics, treatment, histopathological characteristics and mortality were recorded. Signs and symptoms of cardiac dysfunction were not observed in any of the patients. Therapy was administered to six of them shortly after the first positive culture. The observed histopathological lesions included haemorrhagic lesions, small vessels with central thrombosis and surrounding consolidated...
Four Arcobacter species have been associated with human disease, and based on current knowledge, ... more Four Arcobacter species have been associated with human disease, and based on current knowledge, these Gram negative bacteria are considered as potential food and waterborne zoonotic pathogens. At present, only the genome of the species Arcobacter butzleri has been analysed, and still little is known about their physiology and genetics. The species Arcobacter thereius has first been isolated from tissue of aborted piglets, duck and pig faeces, and recently from stool of human patients with enteritis. In the present study, the complete genome and analysis of the A. thereius type strain LMG24486T, as well as the comparative genome analysis with 8 other A. thereius strains are presented. Genome analysis revealed metabolic pathways for the utilization of amino acids, which represent the main source of energy, together with the presence of genes encoding for respiration-associated and chemotaxis proteins. Comparative genome analysis with the A. butzleri type strain RM4018 revealed a larg...
Objectives: To evaluate the feasibility of different methods for susceptibility testing of human ... more Objectives: To evaluate the feasibility of different methods for susceptibility testing of human Arcobacter isolates, to assess susceptibility to antibiotics commonly used to treat diarrhoeal illness and to obtain MIC distribution data. Methods: One-hundred-and-six unique Arcobacter strains were collected during an epidemiological study on pathogens in gastroenteritis. Strains were identified by multiplex PCR and PCR-RFLP, and characterized by PFGE. Susceptibility to ampicillin, erythromycin, tetracycline, doxycycline, gentamicin and ciprofloxacin was determined using gradient strip and disc diffusion methodology. Optimal conditions for growth and incubation were tested. Azithromycin was tested with gradient strip diffusion on a subset of 40 strains. Sequence analysis of the quinolone resistance-determining region of gyrA was performed for a subset of 18 strains. Results: Based on gradient diffusion results, most Arcobacter strains were susceptible to gentamicin (99%) and tetracycline (89%). Erythromycin (78%), ciprofloxacin (72%) and doxycycline (76%) retained moderate activity against Arcobacter spp. Only 9% of the strains were susceptible to ampicillin. Most Arcobacter butzleri strains were susceptible to ciprofloxacin (87%), whereas half of the Arcobacter cryaerophilus isolates (51%) showed high-level resistance (MIC .32 mg/L). MIC 50 values were comparable for both macrolide antibiotics. Ciprofloxacin-resistant strains possessed an identical mutation in gyrA. Overall, categorical agreement between gradient and disc diffusion results was 60%. Gradient diffusion showed superior readability. Conclusions: Gradient diffusion methodology is preferred for routine susceptibility testing. Acquired resistance to fluoroquinolones was observed in A. cryaerophilus. Macrolides are not first-choice empirical antibiotics for Arcobacter infections. Tetracyclines can be suggested for treatment of documented Arcobacter-related gastrointestinal infections.
Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunoco... more Introduction Invasive aspergillosis (IA) is a fungal infection that particularly affects immunocompromised hosts. Recently, several studies have indicated a high incidence of IA in intensive care unit (ICU) patients. However, few data are available on the epidemiology and outcome of patients with IA in this setting. Methods An observational study including all patients with a positive Aspergillus culture during ICU stay was performed in 30 ICUs in 8 countries. Cases were classified as proven IA, putative IA or Aspergillus colonization according to recently validated criteria. Demographic, microbiologic and diagnostic data were collected. Outcome was recorded 12 weeks after Aspergillus isolation. Results A total of 563 patients were included, of whom 266 were colonized (47%), 203 had putative IA (36%) and 94 had proven IA (17%). The lung was the most frequent site of infection (94%), and Aspergillus fumigatus the most commonly isolated species (92%). Patients with IA had higher incid...
We examined fecal samples from 6,774 patients with enteritis in Belgium, 2008-2013. Members of th... more We examined fecal samples from 6,774 patients with enteritis in Belgium, 2008-2013. Members of the genus Arcobacter were the fourth most common pathogen group isolated, and the isolation rate was higher than previously reported. Culturing Arcobacter in a microbiology laboratory is feasible and should thus be tested for in cases of diarrheal disease. C ampylobacteriosis is the most frequently reported zoonosis in industrialized countries with an increasing incidence during 2007-2011 (1). In this study, bacteria of the Arcobacter genus, which is closely related to the Campylobacter genus, comprised the fourth most common pathogenic group isolated from stool specimens of patients with acute enteritis in Ghent, Belgium. Bacteria species of the genus Arcobacter were first isolated from aborted bovine and porcine fetuses in 1977 (2). Based on similar phenotypic characteristics, they were originally classified as aerotolerant Campylobacter spp., until a separate genus was introduced in 1991 (2). Since then, 18 species have been identified and new species are pending. Members of the genus Arcobacter are aerotolerant gram-negative bacteria and able to grow at temperatures <30°C, which differentiate them from the Campylobacter species. The species A. butzleri, A. cryaerophilus, A. skirrowii, A. cibarius, A. thereius, and A. trophiarum have been identified in livestock worldwide and have been isolated from food of animal origin. Though these species have been associated with illness in farm animals, they are also known to colonize healthy animals (3). Arcobacter have been classified as emergent pathogens by the International Commission on Microbial Specifications for Foods (4). Currently, 3 species have been reported to infect humans. Contaminated drinking water
The objective of this study was to evaluate an automated blood culture system for the isolation o... more The objective of this study was to evaluate an automated blood culture system for the isolation of microorganisms from infected equine synovial fluid (SF). Samples were collected from 220 severely inflamed synovial joints and classified as either presumably infected (group A: n = 149) or not infected (group B: n = 71), based on a combination of clinical history, clinical signs and cytological analysis of the SF. Samples were inoculated into blood culture bottles and after incubation were subcultured onto agar media to confirm the results and to facilitate full bacterial identification. Microorganisms were isolated from 107 group A samples (71.8%) and from three group B samples (4.2%). Overall, the detection system identified 117 bottles as positive and 103 as negative, including nine instrument-false-positives and two instrument-false-negatives. The median time-to-detection for Gram-positive bacteria, Gram-negative bacteria, and for fungi was 14.3 (interquartile range [I.R.] 10.0) h, 8.8 (I.R. 12.8) h, and 72.0 (range 60.8-74.8) h, respectively. It was concluded that culture of infected SF using the automated system combines the advantages of enrichment in specialised medium with the rapid detection of bacterial growth.
In this study, we report the screening of four Arcobacter species for the presence of small and l... more In this study, we report the screening of four Arcobacter species for the presence of small and large plasmids. Plasmids were present in 9.9% of the 273 examined strains. One Arcobacter cryaerophilus and four Arcobacter butzleri plasmids were selected for further sequencing. The size of three small plasmids isolated from A. butzleri and the one from A. cryaerophilus strains ranged between 4.8 and 5.1 kb, and the size of the large plasmid, isolated from A. butzleri, was 27.4 kbp. The G+C content of all plasmids ranged between 25.4% and 26.2%. A total of 95% of the large plasmid sequence represents coding information, which contrasts to the 20 to 30% for the small plasmids. Some of the open reading frames showed a high homology to putative conserved domains found in other related organisms, such as replication, mobilization and genes involved in type IV secretion system. The large plasmid carried 35 coding sequences, including seven genes in a contiguous region of 11.6 kbp that encodes an orthologous type IV secretion system found in the Wolinella succinogenes genome, Helicobacter pylori and Campylobacter jejuni plasmids, which makes this plasmid interesting for further exploration.
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Papers by Anne Marie Van Den Abeele