Biomedical subjects

J A J W Kluytmans

Publications and source records attributed to J A J W Kluytmans.

10 recordsLinked to original sources

PubMed2006

How many infection control staff do we need in hospitals?

During a one-day workshop experienced infection control practitioners (ICPs) and medical microbiologists debated how much time was needed for the delivery of infection control activities in a model hospital. They agreed a standard of one full-time equivalent (FTE) ICP per 178 hospital beds and one FTE medical microbiologist per 806 hospital beds. This is 40% and 24% more than the usual standard, respectively. Now that official numbers of hospital beds have become an inadequate parameter for work delivered by hospitals, a new standard is proposed, with the number of admissions as the denominator. This is one FTE ICP per 5000 admissions and one medical microbiologist or epidemiologist per 25000 admissions.

Humans↗

PubMed2006

Evaluation of S. aureus ID, a chromogenic agar medium for the detection of Staphylococcus aureus.

BACKGROUND: Screening for staphylococci among various patient populations has become important for appropriate therapeutic management and for control of nosocomial infections. The purpose of this study is to evaluate the in vitro sensitivity and specificity of a chromogenic agar medium, S. aureus ID (bioMérieux, France), for the identification of Staphylococcus aureus. MATERIALS AND METHODS: A well-defined collection of S. aureus and coagulase-negative staphylococci (CNS) was used. The methicillin-resistant S. aureus (MRSA) isolates were collected in The Netherlands and all had a unique typing pattern. The methicillin-susceptible S. aureus (MSSA) and CNS were isolated from cultures of blood. The isolates were inoculated on Columbia agar plates with 5% sheep blood and incubated for 24 h at 35 degrees C. From the resulting cultures, a suspension of 0.5 McFarland was made and subsequently 10 mul was streaked on a S. aureus ID plate using a sterile loop. The results were read after 24 h and 48 h of incubation at 35 degrees C. Growth of colonies showing green coloration was considered to be positive (indicating S. aureus). RESULTS: A total of 519 S. aureus strains were tested (249 MSSA, 270 MRSA). The sensitivity to detect S. aureus was 96.5% (501/519) after 24 h and 97.5% (506/519) after 48 h. A total of 478 CNS were tested. The specificity was 98.5% (471/478) after 24 h and 98.3% (470/478) after 48 h. The differences between 24 h and 48 h incubation were not statistically significant. CONCLUSION: S. aureus ID is highly sensitive and specific to differentiate between S. aureus and CNS in vitro. Since the performance does not significantly differ between 24 h or 48 h of incubation, samples need only 1 day of incubation before optimal results can be obtained.

Agar↗

PubMed2006

Community-acquired methicillin-resistant Staphylococcus aureus: current perspectives.

Methicillin-resistant Staphylococcus aureus (MRSA) has become a worldwide problem, although its prevalence varies considerably among countries. The epidemiology of MRSA is now changing; infections are no longer confined to the hospital setting, but also appear in healthy community-dwelling individuals without established risk factors for the acquisition of MRSA. Reported prevalence rates of community-acquired MRSA (CA-MRSA) vary widely among studies-largely because of the different definitions employed and different settings in which the studies have been performed. At present, molecular epidemiological definitions, based on staphylococcal cassette chromosome mec (SCCmec) typing and phylogenetic analyses of the MRSA isolates, are considered the most reliable means by which to distinguish between hospital-acquired MRSA (HA-MRSA) and CA-MRSA. CA-MRSA has been isolated predominantly from skin and soft tissue infections, such as abscesses, cellulitis, folliculitis and impetigo. Although CA-MRSA infections are usually mild, they may also be severe, and can result in hospitalisation and even death. CA-MRSA strains differ from the major pandemic clones of MRSA that account for the majority of epidemic HA-MRSA strains. Differences are found in SCCmec types, bacterial growth rate, and the distribution of antibiotic resistance genes and toxin genes. Mathematical models have shown that CA-MRSA has a high potential to become endemic in the community, and this will impact significantly on the control of MRSA in the hospital setting. Well-designed, community-based studies with adequate risk factor analysis are required to further elucidate the epidemiology of CA-MRSA and to improve strategies to control MRSA in both the community and hospital settings.

Community-Acquired Infections↗

PubMed2005

The emergence of infections with community-associated methicillin resistant Staphylococcus aureus.

Recently there have been reports indicating an increased incidence of MRSA infections, afflicting individuals with no apparent risk factors for hospital acquisition. Patients with community-associated (CA) MRSA are significantly younger and had different distributions of clinical infections compared with HA-MRSA patients. CA-MRSA infections have mostly been associated with staphylococcal strains bearing the SCCmec type IV element and PVL genes. These strains are more frequently susceptible to a variety of non-beta-lactam antibiotics. Clinicians must be aware of the wide and, in some cases, unique spectrum of disease caused by CA-MRSA. Continued emergence of MRSA in the community is a public-health problem that warrants increased vigilance in the diagnosis and management of suspected and confirmed staphylococcal infections.

Communicable Diseases, Emerging↗

PubMed2005

[Optimising patient isolation due to methicllin-resistant Staphylococcus aureus].

Isolation of patients is used to control the spread of certain microorganisms in the hospital, e.g. meticillin-resistant Staphylococcus aureus (MRSA). Recent investigations have shown that the quality of care for patients in isolation is affected significantly. However, this is not accompanied by an effect on the morbidity or mortality. The successful Dutch policy on MRSA is based largely on strict isolation of patients colonised with MRSA. If MRSA becomes endemic, this is accompanied by increases in morbidity and mortality as well as costs. The disadvantages of isolation are recognised and should be prevented as far as possible. New diagnostic and therapeutic developments can shorten the duration of isolation significantly, which will further improve the quality of care.

Cross Infection↗

PubMed2005

Nasal carriage of Staphylococcus aureus and prevention of nosocomial infections.

This review summarizes the clinically relevant aspects of nasal carriage of Staphylococcus aureus. The epidemiology, associated risk, and the effects of eradication are discussed. The main conclusions are that nasal carriage of S. aureus is a well-defined risk factor for subsequent infection in nearly all categories of hospitalized patients that have been studied. However, studies that have been performed to evaluate the effect of eradication of carriage using mupirocin nasal ointment have been inconclusive so far in most subgroups. Only in patients on hemodialysis or chronic ambulatory peritoneal dialysis (CAPD) was a significant reduction of the infection rate found. But prolonged treatment in these groups carries a risk for the development of resistance. In surgical patients two randomized studies have found an effect on the surgical site infection rate in carriers that, when those studies are combined, was close to being statistically significant (p = 0.06). In non-surgical patients a significant delay in the onset of infection was found but the overall infection rate was not significantly different. When the results of all well-designed studies that have been performed are combined, a significant reduction of the nosocomial S. aureus infections in carriers is found (approximately 50% lower). Future studies should focus on treating carriers only and consider other treatment regimens.

Anti-Bacterial Agents↗

PubMed2005

Dutch guideline for preventing nosocomial transmission of highly resistant microorganisms (HRMO).

Hospitals are faced with the increasingly rapid emergence and dissemination of antimicrobial-resistant microorganisms. US and European guidelines on the prevention of antimicrobial resistance in hospitals were, until recently, mainly directed at methicillin-resistant Staphylococcus aureus (MRSA). In 2004, the Dutch Working Party on Infection Prevention issued a guideline on the prevention of nosocomial transmission of highly resistant microorganisms (HRMO), in order to fulfill the growing need for additional guidance on the control of other pathogens with acquired resistance and the potential to spread within hospitals (such as glycopeptide-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, extendedspectrum beta-lactamase producing Enterobacteriaceae, and other (multi)drug-resistant gram-negatives). In addition to providing criteria for defining HRMO, the Dutch guideline provides recommendations on isolation of patients, active surveillance, and contact tracing. The guideline will enable the comparison of HRMO rates between hospitals, and may be used to evaluate the efficacy of programs to control antibiotic use and/or nosocomial transmission of resistant pathogens. The eventual success of nationwide implementation of this guideline remains to be established in the coming years.

Cross Infection↗

PubMed2004

Low prevalence of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission in the Netherlands: the value of search and destroy and restrictive antibiotic use.

In the Netherlands, less than 1% of clinical isolates of Staphylococcus aureus are methicillin-resistant (MRSA). A national search and destroy policy prevents MRSA from becoming endemic. Some MRSA outbreaks cannot be related to patients at risk for MRSA carriage. This study was designed to measure the prevalence of MRSA among patients without risk factors for MRSA carriage at the time of admission to the hospital. In four Dutch hospitals, patients admitted to non-surgical departments in the period 1999-2000 were screened for MRSA nasal carriage. Nasal swabs were streaked on 5% sheep blood agar (BA), submerged in a selective broth, and incubated for two to three days at 35 degrees C. Colonies suspected of being S. aureus were identified with an agglutination test. Susceptibility testing was performed by an automated system and additional oxacillin disk diffusion. Methicillin resistance was confirmed by a DNA hybridization test and mecA PCR. MRSA strains were genotyped by pulsed-field gel electrophoresis (PFGE). Twenty-four percent (2332/9859) of the patients were S. aureus nasal carriers. Only three (0.03%) patients were MRSA carriers. These patients were not repatriated, nor known to be MRSA carriers before screening. Genotyping revealed that the strains were not clonally related and were not related to MRSA outbreaks in the hospital where the patients were admitted. We conclude that at routine admission to a Dutch hospital (excluding high-risk foreign admissions) the MRSA prevalence is low (0.03%), due to the Dutch search and destroy policy and restrictive antibiotic prescribing.

Carrier State↗

PubMed2003

Extraction of Chlamydia pneumoniae DNA from vascular tissue for use in PCR: an evaluation of four procedures.

The objective of this study was to compare four procedures for Chlamydia pneumoniae DNA extraction from vascular tissue. The NucliSens Kit, the QIAamp tissue DNA MiniKit, buffer-saturated phenol and the Geneclean II Kit were evaluated, based on the yield of recovered DNA, using PCR to detect C. pneumoniae in vascular tissue. The QIAamp tissue procedure had the highest detection level (0.004 inclusion-forming units/sample). All methods, except NucliSens (70 min), had a short handling time (30-40 min). Costs varied from 0.5 to 3.2 Euro.

Chlamydia Infections↗

PubMed2002

Surgical site infections in orthopedic surgery: the effect of mupirocin nasal ointment in a double-blind, randomized, placebo-controlled study.

The objective of this study was to determine whether use of mupirocin nasal ointment for perioperative eradication of Staphylococcus aureus nasal carriage is effective in preventing the development of surgical site infections (SSIs). A randomized, double-blind, placebo-controlled design was used. Either mupirocin or placebo nasal ointment was applied twice daily to 614 assessable patients from the day of admission to the hospital until the day of surgery. A total of 315 and 299 patients were randomized to receive mupirocin and placebo, respectively. Eradication of nasal carriage was significantly more effective in the mupirocin group (eradication rate, 83.5% versus 27.8%). In the mupirocin group, the rate of endogenous S. aureus infections was 5 times lower than in the placebo group (0.3% and 1.7%, respectively; relative risk, 0.19; 95% confidence interval, 0.02-1.62). Mupirocin nasal ointment did not reduce the SSI rate (by S. aureus) or the duration of hospital stay.

Anti-Bacterial Agents↗