Background In Dutch hospitals a 6-point questionnaire is mandatory for risk-assessment to identif... more Background In Dutch hospitals a 6-point questionnaire is mandatory for risk-assessment to identify carriers of multidrug-resistant organisms (MDRO) at the time of hospitalization. Presence of one or more risk factors is followed by microbiological culturing and pre-emptive isolation. We evaluated the test characteristics of this screening tool in identifying new MDRO carriers. MethodsA cross-sectional study using routinely collected healthcare data was performed in a Dutch tertiary hospital between 1 January 2015 and 1 August 2019 including all admissions with an MDRO risk assessment performed on the day of admission. MDRO risk-assessment included: (1) known MDRO carriage, (2) previous hospitalization in another Dutch hospital during a known outbreak, (3) previous hospitalization in a foreign hospital, (4) living in an asylum centre, (5) professional exposure to livestock farming and (6) household membership of a methicillin-resistant Staphylococcus aureus (MRSA) carrier. Sensitivit...
To evaluate the effect of soluble CD14 (sCD14) on human neutrophil response to lipopolysaccharide... more To evaluate the effect of soluble CD14 (sCD14) on human neutrophil response to lipopolysaccharide (LPS), we developed an LPS-priming assay that measures the chemiluminescence response to N-formyl-methionyl-leucyl-phenylalanine stimulation. Priming by 1 ng/mL rough LPS occurred in the presence of either serum or recombinant LPS-binding protein (LBP) only. Priming was completely CD14-dependent because preincubation of the neutrophils with an anti-CD14 monoclonal antibody prevented priming. We hypothesize that sCD14 enhances LPS response in neutrophils, but this response is not as effective as LPS response via membrane CD14 (mCD14). In our experiments sCD14 is present in an excess compared with mCD14. Priming of neutrophils occurs with low LBP, supposedly via sCD14-LPS complexes. With high LBP, addition of sCD14 inhibited LPS-priming of neutrophils. In that case, LPS may be transported to sCD14, preventing a more effective response via mCD14. In this study we demonstrate that the effec...
To identify patients who benefit most from Staphylococcus aureus screening and decolonization tre... more To identify patients who benefit most from Staphylococcus aureus screening and decolonization treatment upon admission. S. aureus carriers are at increased risk of developing surgical-site infections with S. aureus. Previously, we demonstrated in a randomized, placebo-controlled trial (RCT) that these infections can largely be prevented by detection of carriage and decolonization treatment upon admission. In this study, we analyzed 1- and 3-year mortality rates in both treatment arms of the RCT to identify patient groups that should be targeted when implementing the screen-and-treat strategy. Three years after enrolment in the RCT, mortality dates of all surgical patients were checked. One- and 3-year mortality rates were calculated for all patients and for various subgroups. After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%) patients had died in the mupirocin/chlorhexidine and placebo groups, respectively. No significant differences in mortality rates were observed between the ...
During a large hospital outbreak of OXA-48 producing bacteria, most K. pneumoniaeOXA-48 isolates ... more During a large hospital outbreak of OXA-48 producing bacteria, most K. pneumoniaeOXA-48 isolates were phenotypically resistant to meropenem or imipenem, whereas most E. coliOXA-48 isolates were phenotypically susceptible to these antibiotics. In the absence of molecular gene-detection E. coliOXA-48 could remain undetected, facilitating cross-transmission and horizontal gene transfer of blaOXA-48. Based on 868 longitudinal molecular microbiological screening results from patients carrying K. pneumoniaeOXA-48 (n = 24), E. coliOXA-48 (n = 17), or both (n = 40) and mathematical modelling we determined mean durations of colonisation (278 and 225 days for K. pneumoniaeOXA-48 and E. coliOXA-48, respectively), and horizontal gene transfer rates (0.0091/day from K. pneumoniae to E. coli and 0.0015/day vice versa). Based on these findings the maximum effect of horizontal gene transfer of blaOXA-48 originating from E. coliOXA-48 on the basic reproduction number (R0) is 1.9%, and it is, therefo...
OBJECTIVE Manual surveillance of healthcare-associated infections is cumbersome and vulnerable to... more OBJECTIVE Manual surveillance of healthcare-associated infections is cumbersome and vulnerable to subjective interpretation. Automated systems are under development to improve efficiency and reliability of surveillance, for example by selecting high-risk patients requiring manual chart review. In this study, we aimed to validate a previously developed multivariable prediction modeling approach for detecting drain-related meningitis (DRM) in neurosurgical patients and to assess its merits compared to conventional methods of automated surveillance. METHODS Prospective cohort study in 3 hospitals assessing the accuracy and efficiency of 2 automated surveillance methods for detecting DRM, the multivariable prediction model and a classification algorithm, using manual chart review as the reference standard. All 3 methods of surveillance were performed independently. Patients receiving cerebrospinal fluid drains were included (2012-2013), except children, and patients deceased within 24 h...
Aan de hand van achttien vragen en antwoorden wordt het begrip MRSA (methicilline resistente Stap... more Aan de hand van achttien vragen en antwoorden wordt het begrip MRSA (methicilline resistente Staphylococcus aureus) in landbouwhuisdieren behandelt
A hospital-wide increase in the number of patients with aminoglycoside-resistant Enterobacter clo... more A hospital-wide increase in the number of patients with aminoglycoside-resistant Enterobacter cloacae (AREC) isolated from clinical cultures was detected in December 2002 using a classical surveillance system (CSS). CSS refers to a strategy based on the recognition of an increased incidence of a species with a particular antibiogram at certain wards in a limited period. Since clonal spread was suspected, hospital records were reviewed for E. cloacae culture-positive patients. Based upon genotyping of 139 clinical E. cloacae isolates from 80 patients, it was concluded that 53 patients had had clinical cultures with a single AREC clone since April 2001. Determinants for unnoticed spread were investigated retrospectively, as was the possibility that a computer-assisted surveillance method would have detected this outbreak at an earlier stage. Determinants associated with late detection of clonal spread were the following: (i) the absence of a hospital-wide increase in incidence of E. c...
A large outbreak with an aminoglycoside-resistant Enterobacter cloacae (AREC) clone occurred at t... more A large outbreak with an aminoglycoside-resistant Enterobacter cloacae (AREC) clone occurred at the University Medical Center Utrecht beginning in 2001 and continued up through the time that this study was completed. This clone (genotype I) contains a conjugative R plasmid carrying the qnrA1 , bla CTX-M-9 , and aadB genes, encoding resistance to quinolones, extended-spectrum β-lactamases, and aminoglycosides, respectively. The aim of this study was to determine whether this clone was more transmissible than other AREC strains. Therefore, the dissemination of this genotype and of other E. cloacae strains was studied. In addition, infection control measures taken were evaluated. Pulsed-field gel electrophoresis analysis divided the 191 AREC strains into 42 different genotypes, of which 5 (12%) involved at least three patients. Aside from this outbreak (133 patients), only two other small outbreaks occurred, showing that the infection control measures were successful for all strains bu...
Objectives: To determine incidence rates of hospital-acquired infections and to develop preventiv... more Objectives: To determine incidence rates of hospital-acquired infections and to develop preventive measures to reduce the risk of hospital-acquired infections. Methods: Prospective surveillance for hospital-acquired infections was performed during a 5-year period in the wards housing general and vascular, thoracic, orthopedic, and general gynecologic and gynecologic-oncologic surgery of the University Medical Center Utrecht, the Netherlands. Data were collected from patients with and without infections, using criteria of the Centers for Disease Control and Prevention. Results: The infection control team recorded 648 hospital-acquired infections affecting 550 (14%) of 3,845 patients. The incidence density was 17.8 per 1,000 patient-days. Patients with hospital-acquired infections were hospitalized for 19.8 days versus 7.7 days for patients without hospital-acquired infections. Prolongation of stay among patients with hospital-acquired infections may have resulted in 664 fewer admissi...
Infection Control & Hospital Epidemiology, 2000
We describe and compare the organization of infection control and some infection control practice... more We describe and compare the organization of infection control and some infection control practices in 10 hospitals in seven different European countries. Great differences were observed. By evaluating infection control and hygiene practices in different European centers, areas of prime importance for the development of a European infection control standard may be defined.
Background In Dutch hospitals a 6-point questionnaire is mandatory for risk-assessment to identif... more Background In Dutch hospitals a 6-point questionnaire is mandatory for risk-assessment to identify carriers of multidrug-resistant organisms (MDRO) at the time of hospitalization. Presence of one or more risk factors is followed by microbiological culturing and pre-emptive isolation. We evaluated the test characteristics of this screening tool in identifying new MDRO carriers. MethodsA cross-sectional study using routinely collected healthcare data was performed in a Dutch tertiary hospital between 1 January 2015 and 1 August 2019 including all admissions with an MDRO risk assessment performed on the day of admission. MDRO risk-assessment included: (1) known MDRO carriage, (2) previous hospitalization in another Dutch hospital during a known outbreak, (3) previous hospitalization in a foreign hospital, (4) living in an asylum centre, (5) professional exposure to livestock farming and (6) household membership of a methicillin-resistant Staphylococcus aureus (MRSA) carrier. Sensitivit...
To evaluate the effect of soluble CD14 (sCD14) on human neutrophil response to lipopolysaccharide... more To evaluate the effect of soluble CD14 (sCD14) on human neutrophil response to lipopolysaccharide (LPS), we developed an LPS-priming assay that measures the chemiluminescence response to N-formyl-methionyl-leucyl-phenylalanine stimulation. Priming by 1 ng/mL rough LPS occurred in the presence of either serum or recombinant LPS-binding protein (LBP) only. Priming was completely CD14-dependent because preincubation of the neutrophils with an anti-CD14 monoclonal antibody prevented priming. We hypothesize that sCD14 enhances LPS response in neutrophils, but this response is not as effective as LPS response via membrane CD14 (mCD14). In our experiments sCD14 is present in an excess compared with mCD14. Priming of neutrophils occurs with low LBP, supposedly via sCD14-LPS complexes. With high LBP, addition of sCD14 inhibited LPS-priming of neutrophils. In that case, LPS may be transported to sCD14, preventing a more effective response via mCD14. In this study we demonstrate that the effec...
To identify patients who benefit most from Staphylococcus aureus screening and decolonization tre... more To identify patients who benefit most from Staphylococcus aureus screening and decolonization treatment upon admission. S. aureus carriers are at increased risk of developing surgical-site infections with S. aureus. Previously, we demonstrated in a randomized, placebo-controlled trial (RCT) that these infections can largely be prevented by detection of carriage and decolonization treatment upon admission. In this study, we analyzed 1- and 3-year mortality rates in both treatment arms of the RCT to identify patient groups that should be targeted when implementing the screen-and-treat strategy. Three years after enrolment in the RCT, mortality dates of all surgical patients were checked. One- and 3-year mortality rates were calculated for all patients and for various subgroups. After 3 years, 44 of 431 (10.2%) and 43 of 362 (11.9%) patients had died in the mupirocin/chlorhexidine and placebo groups, respectively. No significant differences in mortality rates were observed between the ...
During a large hospital outbreak of OXA-48 producing bacteria, most K. pneumoniaeOXA-48 isolates ... more During a large hospital outbreak of OXA-48 producing bacteria, most K. pneumoniaeOXA-48 isolates were phenotypically resistant to meropenem or imipenem, whereas most E. coliOXA-48 isolates were phenotypically susceptible to these antibiotics. In the absence of molecular gene-detection E. coliOXA-48 could remain undetected, facilitating cross-transmission and horizontal gene transfer of blaOXA-48. Based on 868 longitudinal molecular microbiological screening results from patients carrying K. pneumoniaeOXA-48 (n = 24), E. coliOXA-48 (n = 17), or both (n = 40) and mathematical modelling we determined mean durations of colonisation (278 and 225 days for K. pneumoniaeOXA-48 and E. coliOXA-48, respectively), and horizontal gene transfer rates (0.0091/day from K. pneumoniae to E. coli and 0.0015/day vice versa). Based on these findings the maximum effect of horizontal gene transfer of blaOXA-48 originating from E. coliOXA-48 on the basic reproduction number (R0) is 1.9%, and it is, therefo...
OBJECTIVE Manual surveillance of healthcare-associated infections is cumbersome and vulnerable to... more OBJECTIVE Manual surveillance of healthcare-associated infections is cumbersome and vulnerable to subjective interpretation. Automated systems are under development to improve efficiency and reliability of surveillance, for example by selecting high-risk patients requiring manual chart review. In this study, we aimed to validate a previously developed multivariable prediction modeling approach for detecting drain-related meningitis (DRM) in neurosurgical patients and to assess its merits compared to conventional methods of automated surveillance. METHODS Prospective cohort study in 3 hospitals assessing the accuracy and efficiency of 2 automated surveillance methods for detecting DRM, the multivariable prediction model and a classification algorithm, using manual chart review as the reference standard. All 3 methods of surveillance were performed independently. Patients receiving cerebrospinal fluid drains were included (2012-2013), except children, and patients deceased within 24 h...
Aan de hand van achttien vragen en antwoorden wordt het begrip MRSA (methicilline resistente Stap... more Aan de hand van achttien vragen en antwoorden wordt het begrip MRSA (methicilline resistente Staphylococcus aureus) in landbouwhuisdieren behandelt
A hospital-wide increase in the number of patients with aminoglycoside-resistant Enterobacter clo... more A hospital-wide increase in the number of patients with aminoglycoside-resistant Enterobacter cloacae (AREC) isolated from clinical cultures was detected in December 2002 using a classical surveillance system (CSS). CSS refers to a strategy based on the recognition of an increased incidence of a species with a particular antibiogram at certain wards in a limited period. Since clonal spread was suspected, hospital records were reviewed for E. cloacae culture-positive patients. Based upon genotyping of 139 clinical E. cloacae isolates from 80 patients, it was concluded that 53 patients had had clinical cultures with a single AREC clone since April 2001. Determinants for unnoticed spread were investigated retrospectively, as was the possibility that a computer-assisted surveillance method would have detected this outbreak at an earlier stage. Determinants associated with late detection of clonal spread were the following: (i) the absence of a hospital-wide increase in incidence of E. c...
A large outbreak with an aminoglycoside-resistant Enterobacter cloacae (AREC) clone occurred at t... more A large outbreak with an aminoglycoside-resistant Enterobacter cloacae (AREC) clone occurred at the University Medical Center Utrecht beginning in 2001 and continued up through the time that this study was completed. This clone (genotype I) contains a conjugative R plasmid carrying the qnrA1 , bla CTX-M-9 , and aadB genes, encoding resistance to quinolones, extended-spectrum β-lactamases, and aminoglycosides, respectively. The aim of this study was to determine whether this clone was more transmissible than other AREC strains. Therefore, the dissemination of this genotype and of other E. cloacae strains was studied. In addition, infection control measures taken were evaluated. Pulsed-field gel electrophoresis analysis divided the 191 AREC strains into 42 different genotypes, of which 5 (12%) involved at least three patients. Aside from this outbreak (133 patients), only two other small outbreaks occurred, showing that the infection control measures were successful for all strains bu...
Objectives: To determine incidence rates of hospital-acquired infections and to develop preventiv... more Objectives: To determine incidence rates of hospital-acquired infections and to develop preventive measures to reduce the risk of hospital-acquired infections. Methods: Prospective surveillance for hospital-acquired infections was performed during a 5-year period in the wards housing general and vascular, thoracic, orthopedic, and general gynecologic and gynecologic-oncologic surgery of the University Medical Center Utrecht, the Netherlands. Data were collected from patients with and without infections, using criteria of the Centers for Disease Control and Prevention. Results: The infection control team recorded 648 hospital-acquired infections affecting 550 (14%) of 3,845 patients. The incidence density was 17.8 per 1,000 patient-days. Patients with hospital-acquired infections were hospitalized for 19.8 days versus 7.7 days for patients without hospital-acquired infections. Prolongation of stay among patients with hospital-acquired infections may have resulted in 664 fewer admissi...
Infection Control & Hospital Epidemiology, 2000
We describe and compare the organization of infection control and some infection control practice... more We describe and compare the organization of infection control and some infection control practices in 10 hospitals in seven different European countries. Great differences were observed. By evaluating infection control and hygiene practices in different European centers, areas of prime importance for the development of a European infection control standard may be defined.
Uploads
Papers by Annet Troelstra