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E E Stobberingh

Publications and source records attributed to E E Stobberingh.

At least 19 recordsLinked to original sources
PubMed2000

[Optimizing antibiotics policy in the Netherlands. V. SWAB guidelines for perioperative antibiotic prophylaxis. Foundation Antibiotics Policy Team].

The Stichting Werkgroep Antibioticabeleid (SWAB, Foundation Antibiotics Policy Team) has issued guidelines for perioperative antibiotic prophylaxis in Dutch hospitals. Antibiotic prophylaxis is generally recommended for surgical procedures with relatively high postoperative infection rates and those in which consequences of infection are really serious. Studies have revealed that prophylaxis given within two hours before incision is most effective. Short-term, preferably single-dose prophylaxis, is as effective as multiple-dose prophylaxis in most procedures. For reasons of cost effectiveness and prevention of induction of resistance, single-dose prophylaxis is recommended. The antimicrobial agent of choice for perioperative prophylaxis should not be widely used as a therapeutic agent, should be selectively active against micro-organisms most frequently isolated from surgical site infections, and should have a plasma-half-life that makes single-dosing possible for most operations. Therefore cefazoline is an agent that is widely used for perioperative prophylaxis.

Antibiotic Prophylaxis↗
PubMed2000

Epidemiology of resistance to antibiotics. Links between animals and humans.

An inevitable side effect of the use of antibiotics is the emergence and dissemination of resistant bacteria. Most retrospective and prospective studies show that after the introduction of an antibiotic not only the level of resistance of pathogenic bacteria, but also of commensal bacteria increases. Commensal bacteria constitute a reservior of resistance genes for (potentially) pathogenic bacteria. Their level of resistance is considered to be a good indicator for selection pressure by antibiotic use and for resistance problems to be expected in pathogens. Resistant commensal bacteria of food animals might contaminate, like zoonotic bacteria, meat (products) and so reach the intestinal tract of humans. Monitoring the prevalence of resistance in indicator bacteria such as faecal Escherichia coli and enterococci in different populations, animals, patients and healthy humans, makes it feasible to compare the prevalence of resistance and to detect transfer of resistant bacteria or resistance genes from animals to humans and vice versa. Only in countries that use or used avoparcin (a glycopeptide antibiotic, like vancomycin) as antimicrobial growth promoter (AMGP), is vancomycin resistance common in intestinal enterococci, not only in exposed animals, but also in the human population outside hospitals. Resistance genes against antibiotics, that are or have only been used in animals, i.e. nourseothricin, apramycin etc. were found soon after their introduction, not only in animal bacteria but also in the commensal flora of humans, in zoonotic pathogens like salmonellae, but also in strictly human pathogens, like shigellae. This makes it clear that not only clonal spread of resistant strains occurs, but also transfer of resistance genes between human and animal bacteria. Moreover, since the EU ban of avoparcin, a significant decrease has been observed in several European countries in the prevalence of vancomycin resistant enterococci in meat (products), in faecal samples of food animals and healthy humans, which underlines the role of antimicrobial usage in food animals in the selection of bacterial resistance and the transport of these resistances via the food chain to humans. To safeguard public health, the selection and dissemination of resistant bacteria from animals should be controlled. This can only be achieved by reducing the amounts of antibiotics used in animals. Discontinuing the practice of routinely adding AMGP to animal feeds would reduce the amounts of antibiotics used for animals in the EU by a minimum of 30% and in some member states even by 50%.

Animal Feed↗
PubMed2000

Antimicrobial resistance in pig faecal samples from the Netherlands (five abattoirs) and Sweden.

The prevalence and degree of antibiotic resistance of faecal indicator bacteria, Escherichia coli and enteroccoci, were determined in 1321 faecal samples collected from pigs at five abattoirs in The Netherlands and in 100 samples from Swedish pigs. In the Dutch samples a high prevalence of resistance was observed in E. coli for three commonly used antibiotics in pig medicine, amoxycillin (70-94%), oxytetracycline (78-98%) and trimethoprim (62-96%). Also, the prevalence for chloramphenicol (55-67%) and neomycin (38-67%) was relatively high. For the other compounds tested the prevalence was less than 10%. The percentage of samples with a high degree of resistant E. coli showed the same tendency in all Dutch abattoirs although significant differences between the abattoirs were observed. The percentage of Swedish samples with a high degree of resistant E. coli was significantly lower for all antibiotics except nitrofurantoin, gentamicin, flumequin and ciprofloxacin. All enterococci were susceptible to amoxycillin and high-level resistance to gentamicin was observed in 4-6% of the Dutch samples. A high prevalence of resistance and a high degree of resistance was found for erythromycin and oxytetracycline. The prevalence of resistance to dalfopristin-quinupristin ranged from 6 to 8% and for vancomycin from 24 to 46%. Significant differences between the abattoirs were found for all compounds tested except amoxycillin. In the Swedish population both the prevalence and degree of resistance in enterococci were significantly lower except for amoxycillin and gentamicin. This point prevalence study showed that the prevalence and degree of antibiotic resistance in indicator bacteria, E. coli and enterococci, in faecal samples from pigs differed between two countries and reflected differences in antibiotic usage in pigs. To analyse the differences observed between the slaughterhouses, additional information about the farms of origin and antibiotic consumption is necessary.

Abattoirs↗
PubMed2000

Selective digestive decontamination in patients in intensive care. The Dutch Working Group on Antibiotic Policy.

Selective digestive decontamination (SDD) is the most extensively studied method for the prevention of infection in patients in intensive care units (ICUs). Despite 27 prospective randomized studies and six meta-analyses, routine use of SDD is still controversial. In this review, we summarize the available scientific information on effectiveness of SDD in ICU patients. The effects of SDD have been studied in different combinations of the concept, using different antibiotics. Comparison of the individual studies, therefore, is difficult. In most studies, SDD resulted in significant reductions in the number of diagnoses of ventilator-associated pneumonia. However, incidences of ventilator-associated pneumonia in control groups ranged from 5% to 85%. Moreover, these reductions in incidences of ventilator-associated pneumonia in individual studies were not associated with improved patient survival, reductions of duration of ventilation or ICU stay, or reductions in antibiotic use. The numbers of patients studied are too small to determine effects on patient survival. Although two meta-analyses suggested a 20% mortality reduction when using the full concept of SDD (topical and systemic prophylaxis) these results should be interpreted with caution. Formal cost-benefit analyses of SDD have not been performed. SDD is associated with the selection of microorganisms that are intrinsically resistant to the antibiotics used. However, the studies are too small and too short to investigate whether SDD will lead to development of antibiotic resistance. As long as the benefits of SDD (better patient survival, reduction in antibiotic use or improved cost-effectiveness) have not been firmly established, the routine use of SDD for mechanically ventilated patients is not advised.

Antibiotic Prophylaxis↗
PubMed2000

Management of acute uncomplicated urinary tract infections in general practice in the south of The Netherlands.

There is debate about the ideal diagnostic procedure for urinary tract infections (UTIs) in general practice. The aim of this study was to evaluate nitrite and leucocyte esterase strip test procedures in general practice patients, and to relate the results to the decision of the general practitioner to prescribe antibiotic therapy. A total of 292 female patients from eight general practices in the Maastricht area, who were aged 12 years or over with complaints suggesting UTI, were included in the study. All eight practices tested fresh urine samples using the nitrite strip test, and seven also used the leucocyte esterase strip test. The positive predictive value of the nitrite test was greater than the leucocyte test. Antibiotic therapy was nearly always prescribed when either or both of these tests were positive. Bacterial culture was positive in 159 (59%) cases, although treatment was started in 70 (27%) cases where there was an absence of significant bacteruria. It was found that the choice of agent used to treat the patient was related to the antibiotic susceptibility of the uropathogens that were isolated.

Adolescent↗
PubMed1999

[European strategy for control of resistance to antibiotics].

The problem of international spread of bacterial resistance requires development of a strategy at worldwide or at least at European level. Clinically relevant monitoring systems for resistance and use of antibiotics have to be implemented to support the guidelines on prescription of antibiotics. Every hospital should establish an 'antibiotics team' controlling the prescription of antimicrobials and the observance of local formulary agreements. Veterinary use of growth promoting antimicrobials related to substances used in human medicine should be terminated. Future research should be aimed at resolving the problem of resistance to antimicrobials.

Animals↗
PubMed1999

[Ventilator-associated pneumonia; controversies with respect to diagnosis, pathogenesis, therapy and prevention].

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection among intensive care patients; it is associated with increased morbidity and mortality. VAP is always preceded by colonization of the upper respiratory tract with potentially pathogenic micro-organisms. Oropharyngeal colonization is pivotal in the pathogenesis of VAP, while gastric and intestinal colonization appear to be less important than generally believed. The diagnosis is difficult and usually relies on a combination of clinical, microbiological and radiographic criteria. This combination of criteria may have a high sensitivity for VAP, but specificity is low. As a result, many patients receive antibiotics unnecessarily. Bronchoscopic sampling of lower airways can increase specificity, but whether these relatively expensive techniques are cost-effective remains to be established. The best antibiotic therapy for VAP is unknown. General infection control measures remain the cornerstone of infection prevention in each intensive care unit (ICU). Selective digestive decontamination (SDD) was associated with a reduction in the incidence of VAP, but mortality rates remained largely unaffected, and selection of antibiotic-resistant pathogens remains a potential disadvantage. Routine SDD in ICU is discouraged. Decontamination of the oropharynx appears to be equally effective.

Antibiotic Prophylaxis↗
PubMed1999

[Optimizing the antibiotics policy in the Netherlands. IV. SWAB- guidelines for antimicrobial therapy of adults with sepsis in hospitals. Foundation Antibiotics Policy Work Group].

The Stichting Werkgroep Antibioticabeleid (SWAB, Foundation Antibiotic Policy Team) issued guidelines for empirical antimicrobial therapy in the hospital of sepsis in adults. A distinction is made between sepsis in patients with and patients without neutropenia. Patients without neutropenia are subdivided according to the setting where they contracted sepsis: at home, in the hospital or in the intensive-care unit. Because of the diversity in antibiotic spectrum of the different classes of cephalosporins, they can be used in all the categories of sepsis. The use of antibiotics with a very broad spectrum, like carbapenems and piperacillin-tazobactam, or antibiotics which can be applied in infections with microorganisms difficult to treat, like quinolones and glycopeptides, is limited in the empirical treatment of sepsis in order to combat development of resistance. It is crucial to streamline antibiotic therapy as soon as the causative agent of the sepsis is known; this includes choosing an antibiotic with the narrowest possible spectrum.

Adult↗
PubMed1999

Antimicrobial resistance patterns in urinary isolates from nursing home residents. Fifteen years of data reviewed.

The antibiotic resistance patterns of gram-negative bacteria isolated from nursing home patients between 1983 and 1997 were analysed. Escherichia coli was the most prevalent isolate (48%) followed by Proteus spp. (26%) and other Enterobacteriaceae (20%). During the study period, the susceptibility of E. coli decreased for co-trimoxazole (79% to 62%), increased for nitrofurantoin (79% to 91%) and remained unchanged for amoxycillin (41%). Susceptibility to norfloxacin, available from 1990, decreased from 87% to 71%. Similar trends were observed when the susceptibilities of all gram-negative urinary pathogens were combined. The changes in susceptibility can probably be attributed to the empirical prescribing practices in the nursing homes studied.

Anti-Bacterial Agents↗
PubMed1999

Application of different genotyping methods for Pseudomonas aeruginosa in a setting of endemicity in an intensive care unit.

Colonization with Pseudomonas aeruginosa was studied by taking serial swab specimens from the oropharynges and anuses and tracheal and gastric aspirates from patients in an intensive care unit during a 10-month period in a setting of endemicity. Nineteen (10%) of the 192 patients included in the study were colonized on admission, while another 30 (16%) patients acquired P. aeruginosa while in the hospital. Typing of 353 isolates was performed by random amplified polymorphic DNA (RAPD) analysis, and 56 strains were selected for further typing by RAPD analysis, pulsed-field gel electrophoresis (PFGE), and amplified fragment length polymorphism (AFLP) analysis. By these methods, 42, 44, and 44 genotypes were found, respectively. Computer-aided cluster analysis indicated that similar groups of related isolates were obtained by each method. By taking admission periods into account, analysis of the typing results suggested cross-acquisition of P. aeruginosa for five patient pairs. The small number of transfers and the large number of genotypes found indicate that most P. aeruginosa strains were derived from the patients themselves. The numbers of observed typing patterns and band differences between related isolates were counted for each typing method. AFLP analysis with primers without a selective base proved to be the most discriminatory method, followed by PFGE, AFLP analysis (with one selective base), and RAPD analysis. On the basis of a comparison with established strain differentiation criteria for PFGE, the criteria for differentiation of P. aeruginosa by AFLP analysis are presented.

Bacterial Typing Techniques↗
PubMed1999

Characteristics of polyclonal endemicity of Pseudomonas aeruginosa colonization in intensive care units. Implications for infection control.

We investigated the endemicity of Pseudomonas aeruginosa in intensive care units (ICUs) through analyses of surveillance cultures (from the rectum, stomach, oropharynx, and trachea; n = 1,089), and clinical cultures (n = 2,393) from 297 consecutive patients. Multiple isolates of P. aeruginosa (n = 353) were genotyped. Variables associated with acquisition of respiratory tract colonization (RTC) were tested in a risk factor analysis. The mean daily prevalence of colonization was 34%. On admission, 22 patients had intestinal colonization and 13 had RTC. Twenty patients acquired colonization in the intestinal and 24 in the respiratory tract. Forty-four different genotypes were found; 38 (86%) were isolated from individual patients only. In all, 37 patients had RTC with a total of 38 genotypes: 13 (34%) were colonized on admission, 9 (24%) acquired RTC with a novel genotype during a stay in the ICU, five (13%) acquired colonization from their intestinal tract and three (8%) were colonized via cross-acquisition. In eight patients (21%), no route could be demonstrated for colonization. Antibiotics providing P. aeruginosa with a selective growth advantage were associated with acquired RTC. Endemicity of colonization with P. aeruginosa is characterized by polyclonality, and seems to be maintained by continuous admittance of colonized patients and selection pressure from antibiotics rather than by cross-acquisition.

APACHE↗
PubMed1999

Antibiotic usage in animals: impact on bacterial resistance and public health.

Antibiotic use whether for therapy or prevention of bacterial diseases, or as performance enhancers will result in antibiotic resistant micro-organisms, not only among pathogens but also among bacteria of the endogenous microflora of animals. The extent to which antibiotic use in animals will contribute to the antibiotic resistance in humans is still under much debate. In addition to the veterinary use of antibiotics, the use of these agents as antimicrobial growth promoters (AGP) greatly influences the prevalence of resistance in animal bacteria and a poses risk factor for the emergence of antibiotic resistance in human pathogens. Antibiotic resistant bacteria such as Escherichia coli, Salmonella spp., Campylobacter spp. and enterococci from animals can colonise or infect the human population via contact (occupational exposure) or via the food chain. Moreover, resistance genes can be transferred from bacteria of animals to human pathogens in the intestinal flora of humans. In humans, the control of resistance is based on hygienic measures: prevention of cross contamination and a decrease in the usage of antibiotics. In food animals housed closely together, hygienic measures, such as prevention of oral-faecal contact, are not feasible. Therefore, diminishing the need for antibiotics is the only possible way of controlling resistance in large groups of animals. This can be achieved by improvement of animal husbandry systems, feed composition and eradication of or vaccination against infectious diseases. Moreover, abolishing the use of antibiotics as feed additives for growth promotion in animals bred as a food source for humans would decrease the use of antibiotics in animals on a worldwide scale by nearly 50%. This would not only diminish the public health risk of dissemination of resistant bacteria or resistant genes from animals to humans, but would also be of major importance in maintaining the efficacy of antibiotics in veterinary medicine.

Animal Husbandry↗
PubMed1998

[Optimizing of antibiotics policy in the Netherlands. III. SWAB guidelines for antimicrobial therapy in adults hospitalized with bronchitis. Foundation Antibiotics Policy Work Group].

The Stichting Werkgroep Antibioticabeleid (SWAB, Foundation Antibiotics Policy Team) has issued guidelines for empirical antimicrobial therapy of adult patients with bronchitis in hospital. Acute bronchitis is rarely caused by bacteria: therefore antibiotic treatment is not indicated in most cases. In an exacerbation of asthma or chronic obstructive pulmonary disease (COPD), the primary treatment aims at combating the inflammatory reaction and the bronchospasm. In case of increasing dyspnoea, (increase of) sputum production and (increase of) purulence of the sputum, antibiotic treatment may lead to shortening of the symptoms and sickness duration. Doxycycline is to be preferred because of its spectrum, easy dosage and favourable price. If the patient has not had antibiotics earlier, amoxicillin also is a good choice. Macrolide antibiotics are no preparations of first choice because large-scale use readily leads to resistance.

Adult↗
PubMed1998

[Optimizing antibiotics use policy in the Netherlands. I. The Netherlands Antibiotics Policy Foundation (SWAB)].

The worldwide problem of antibiotic resistance of bacteria is a point of concern in the Netherlands as well. Responsible use of existing antibiotics was the incentive to establish a foundation, with the acronym SWAB, the primary goal of which is to optimize the use of antibiotics in the Netherlands in order to diminish the development of antibiotic resistance. One of the SWAB projects is the development of national guidelines for the use of antibiotics in hospitals. These guidelines are prepared by a committee of experts and reviewed by external consultants: infectious disease specialists, medical microbiologists and pharmacists. The revised version of the guidelines is submitted for publication in this journal. The SWAB hopes that these guidelines will make the prevention of antibiotic resistance a major factor in the choice of the antibiotic. Streamlining antibiotic therapy is an important tool in this respect.

Anti-Bacterial Agents↗
PubMed1998

[Optimization of the antibiotics policy in the Netherlands. II. SWAB guidelines for the antimicrobial therapy of pneumonia in patients at home and as nosocomial infections. The Netherlands Antibiotic Policy Foundation].

The Netherlands Antibiotic Policy Foundation issued guidelines for empirical antimicrobial therapy of adult pneumonia patients in hospitals. A distinction is made between pneumonia contracted at home or in hospital because of the differences in micro-organisms and resistance patterns. These two categories are subdivided further with an empirical antibiotic treatment being chosen on the basis of the causative agents to be expected. For instance, pneumonia contracted at home is mostly caused by Streptococcus pneumoniae, to be treated with benzylpenicillin or amoxicillin. With regard to nosocomial pneumonia, treatment varies according to whether a pneumonia has or has not been contracted in the intensive care unit. Combating development of resistance is alloted an important place. Emphasis is laid on 'streamlining' the therapy, i.e. its adjustment (including choosing an antibiotic with the narrowest possible spectrum) once the causative agent is known.

Adult↗