Biomedical subjects

J E Degener

Publications and source records attributed to J E Degener.

At least 19 recordsLinked to original sources

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

[Health council report: "Antimicrobial growth promoters"].

The Health Council of the Netherlands has issued a report on the risk of development of resistance among bacteria as result of the use of antibiotics as growth promotors in livestock farming. The committee appointed by the Health Council conclude that the use of antimicrobial growth promotors contributes to the problem of resistance among human pathogens. The conclusions are based on evidence regarding the development of resistance in livestock as the result of the use of antimicrobial growth promotors, the possibility of colonisation/infection of humans with resistant bacteria from the intestinal flora of productive livestock, and the transfer of resistance genes from livestock bacteria to human pathogenic microorganisms. Effective measures for the limitation of the public health risk should focus on termination of the use of antimicrobial growth promotors that confer resistance to (related) antibiotics currently used (or which will be available) to treat patients suffering from bacterial infections. In addition, the committee advised ending the use of antimicrobial growth promotors in 3 years.

Animals↗

PubMed1999

Evaluation of the effects of storage in two different swab fabrics and under three different transport conditions on recovery of aerobic and anaerobic bacteria.

Recovery of six anaerobic and five aerobic pathogens from viscose swabs and polyurethane swabs (Culturette EZ) was evaluated quantitatively, and transport in aerobic dry tubes, aerobic Amies transport medium (Transwab), and anaerobic universal transport medium (Port-a-Cul) was compared. The Culturette EZ in aerobic dry tubes gave the highest recovery levels. Data obtained with clinical specimens confirmed these results.

Bacteria, Aerobic↗

PubMed1998

[Urinary antigen test as a screen for the diagnosis of beta-hemolytic streptococcal infections in newborn infants].

OBJECTIVE: To differentiate between neonates with high and low risk of infections caused by group B beta-haemolytic streptococci (GBS), by using the urinary group B streptococcal antigen test. DESIGN: Retrospective. SETTING: Medical Centre Leeuwarden and Public Health Laboratory, Friesland, the Netherlands. METHODS: In a period of two years clinical, haematological and microbiological (including urinary group B streptococcal antigen detection) data were collected in newborns and their mothers who met one or more of the following criteria: a previous affected child, prolonged (> or = 12 hrs) rupture of membranes, fever in labour, unexpected preterm delivery, unexplained perinatal asphyxia. On the basis of surveillance cultures a colonization rate was made. GBS infection was 'suspected' in an unwell infant with a 'high' colonization rate; infection with GBS was 'proved' by a positive blood culture with GBS. RESULTS: 6 of 342 neonates had an infection with GBS. Risk of invasive infection increased with higher colonization rates. Sensitivity of the antigen test to detect colonization was low, sensitivity to detect neonatal infection was high (51 versus 100%). The negative predictive value of urinary antigen testing was 100%. Prolonged rupture of membranes (1.5% risk of infection) and maternal fever (5%) were the most important risk factors. CONCLUSION: In healthy neonates with risk factors but with a negative antigen detection test the risk of GBS infection is extremely low. In children with a risk factor a positive test result can indicate heavy colonization or infection. These children should be carefully observed and examined.

Adult↗

PubMed1997

16S ribosomal RNA-targeted oligonucleotide probes for monitoring of intestinal tract bacteria.

BACKGROUND: The composition of a sample of faecal bacteria can be determined by culturing different dilutions on specific media. However, not all bacteria can be cultured and media are not always specific. With a culture-independent approach a more accurate picture of the composition of the intestinal flora may be obtained. METHODS: Fluorescently labelled oligonucleotide probes targeted at 16S ribosomal RNA sequences specific for a bacterial genus were designed and applied for fluorescence in situ hybridization (FISH) of bacteria in human faecal samples. RESULTS: The mean number of Bifidobacterium spp. and the total number of anaerobic bacteria per gram of faeces were determined by culturing and with the probe technique. Although in both cases the number of Bifidobacterium spp. was about the same, 2.38 x 10(9) and 2.45 x 10(9), it was found that the contribution of Bifidobacterium spp. to the total composition is overestimated due to the lower number of total anaerobic bacteria estimated by culturing. CONCLUSION: Genus-specific or group-specific fluorescent 16S rRNA probes may become an invaluable tool in gut ecology studies.

Bacteria, Anaerobic↗

PubMed1997

The relationship between the use of flucloxacillin, vancomycin, aminoglycosides and ciprofloxacin and the susceptibility patterns of coagulase-negative staphylococci recovered from blood cultures.

Antibiotic use is a cause of selection of multiresistant bacterial strains. Over three years (1990-1992) we studied the relation between the use of flucloxacillin, vancomycin, aminoglycosides and ciprofloxacin and the susceptibility of coagulase-negative staphylococci (CNS) recovered from blood cultures. Although there was no increase in the use of flucloxacillin, the susceptibility of CNS to this antibiotic decreased from 25% to 6%. No increase in aminoglycoside use was seen, though the use in the non-surgical intensive care unit was 40 times the average use in the hospital. The susceptibility to gentamicin declined from 36% to 15% for the rest of the hospital and to zero for the non-surgical intensive care unit. Vancomycin use did not change in the hospital as a whole, but the use in the haematological unit was about ten times that in the rest of the hospital. No single resistant strain (vancomycin MIC > or = 4 mg/L) was found. A three-fold increase in ciprofloxacin use was seen. After a decline in the susceptibility to ciprofloxacin from 72% to 58% in 1991, there was a small recovery to 62% in 1992. The use in the haematological unit was about 20 times that in the rest of the hospital. Ciprofloxacin susceptibility declined from 40% to 25% in that unit in 1991. In 1992 there was a small recovery to 29%.

Aminoglycosides↗

PubMed1995

Microbiology of chronic maxillary sinusitis in adults: isolated aerobic and anaerobic bacteria and their susceptibility to twenty antibiotics.

In a comparative study on the efficacy of two surgical treatment procedures, 90 patients diagnosed with chronic maxillary sinusitis received antimicrobial prophylaxis. Maxillary sinus fluid samples were taken from these 90 patients before the initiation of antimicrobial prophylaxis, and were cultured for aerobic and anaerobic bacteria. In 81% of all samples, bacterial growth was present. Anaerobic bacteria were present in 29% of the cases (5% pure anaerobic and 24% mixed aerobic and anaerobic). Predominant aerobic bacteria were staphylococci, in 42% of all samples (mainly coagulase-negative), and streptococci (32%). Predominant anaerobic bacteria were Propionibacterium species (18%) and Gram-negative rods (9%). The antimicrobial susceptibility was determined for 20 antibiotics, and the beta-lactamase production was investigated. The prevalence of beta-lactamase-producing bacteria was unexpectedly high (isolated from 36% of all patients). The findings in this study indicate that not all antimicrobial agents used against upper respiratory tract infections are suitable for treatment of this group of patients when the susceptibility of bacteria present in sinus fluid is taken into account. The high prevalence of beta-lactamase-producing bacteria could influence the course of the disease, due to the breakdown of antibiotics by such strains. Recommendations are given for criteria to use when choosing antimicrobial agents to treat bacterial infections it) patients with chronic maxillary sinusitis.

Adolescent↗

PubMed1994

Nosocomial infection by Staphylococcus haemolyticus and typing methods for epidemiological study.

A patient with chronic myelogenous leukemia became colonized with a Staphylococcus haemolyticus strain and experienced a septic episode caused by this strain during a cytostatic course. The strain was multiply resistant to antibiotics; the MIC and MBC of vancomycin were 2 and 4 mg/liter, and the MIC and MBC of teicoplanin were 4 and 16 mg/liter, respectively. We performed a surveillance study on the carriage of S. haemolyticus in medical and nursing staff of the hospital ward where the patient was treated. S. haemolyticus was isolated from 18 sites on 12 of the 39 people tested. A number of typing methods were performed in order to investigate the possible relationships among the isolates. Methods used were immunoblotting of staphylococcal peptides, plasmid analysis, restriction fragment length polymorphism of chromosomal DNA, and pulsed-field gel electrophoresis of total DNA. Compared with the immunoblotting technique, the molecular methods were more discriminative. The strain colonizing the patient showed a consistent pattern by all typing methods during isolation. When the immunoblot technique was used, similar patterns were found with isolates from hospital staff and isolates from unrelated sources. With the molecular techniques, no evidence of a local spread of the patient's strain was found. However, plasmid profiles and restriction fragment length polymorphism and pulsed-field gel electrophoresis patterns showed that S. haemolyticus isolates collected from hospital ward personnel were related, which was not the case with isolates collected from unrelated sources. Restriction fragment length polymorphism analysis was more discriminative when IS431 was used as a DNA probe instead of a probe based on the 16S rRNA gene. S. haemolyticus, as in this case, may develop resistance to vancomycin and teicoplanin. These antibiotics are considered the last-resort drugs for the therapy of nosocomial gram-positive infections. Thus, local spread of staphylococci resistant to these drugs is an important problem, which should be prevented by strict hygienic measures and antibiotic policy.

Base Sequence↗

PubMed1993

Optimizing antimicrobial prophylaxis in reconstructive vascular surgery.

The combinations of cefuroxime and metronidazole, and amoxycillin/clavulanate (Augmentin) are useful as prophylactic drugs during vascular surgery. In this study the pharmacokinetic profiles of different dosing regimens utilizing these drugs during reconstructive vascular procedures are presented. Three groups of patients, undergoing aortobifemoral or femoropopliteal prosthetic surgery, received one of the following regimens: Group I: 1500 mg metronidazole plus 1500 mg cefuroxime at premedication, Group II: 1500 mg metronidazole at premedication plus 1500 mg cefuroxime at the time of induction anaesthesia, followed by 750 mg of cefuroxime 2 h later, Group III: 2000 mg amoxycillin/200 mg clavulanate at time of induction anaesthesia, followed by 1000 mg amoxycillin/200 mg clavulanate, 3 h later. For determination of the antibiotic concentrations, arterial blood samples were obtained at 30-minute intervals during the entire procedure. An additional sample was collected at the time of inguinal graft site anastomosis. Cefuroxime concentrations in these additional samples were 29.3 +/- 11.2 mg/l in group I and 44.7 +/- 15.9 mg/l in group II. Metronidazole concentrations were satisfactorily high in all patients (38.4 +/- 4.5 mg/l). Amoxycillin/clavulanate concentrations were 35.1 +/- 21.5 mg/l and 4.4 +/- 3.7 mg/l respectively. We recommend a multiple dose administration scheme for prophylaxis in high-risk prosthetic vascular surgery, if the procedure takes more than 2-3 h and antimicrobial agents with a rapid elimination time are used. A multiple dosing scheme ensures sufficiently high antibiotic concentrations, exceeding the MIC of staphylococci and enterobacteria approximately twice, at the time of inguinal graft site anastomosis.

Aged↗

PubMed1993

Rupture of an aortic aneurysm caused by Haemophilus influenzae type B infection.

A patient was operated for a contained rupture of an aortic aneurysm that appeared to be infected with Haemophilus influenzae type b. Reports on this species as a cause of infection and rupturation of an atherosclerotic aneurysm are extremely rare and we therefore describe this case. Apparently the risk of bacteraemia and the possible effects of it in patients with an aneurysm should be considered in surgical decision-making and management.

Aged↗

PubMed1992

Pericarditis, pneumonia and brain abscess due to a combined Actinomyces--Actinobacillus actinomycetemcomitans infection.

A patient is described in whom there developed a pulmonary infiltrate and constrictive pericarditis caused by a combined Actinomyces and Actinobacillus actinomycetemcomitans infection, presumably originating from his poor dentition. The diagnosis was only made following repeated thoracotomy. After surgery, long-term treatment with antibiotics led to complete clinical recovery. None the less, some months later he was found to have a brain abscess which resolved during a further course of antibiotics. The variable clinical picture of actinomycosis is discussed, as well as the role of other bacteria frequently associated with actinomycotic infection, in particular Actinobacillus actinomycetemcomitans. The therapeutic implications are described.

Actinobacillus Infections↗

PubMed1990

[Altered sensitivity of Escherichia coli for antibiotics in the population].

Faecal carriage rates for antibiotic-resistant Escherichia coli were determined in a Dutch urban population during two periods with an interval of seven years. In the period 1978-1980 faecal samples were collected from 624 persons and in 1987 from 154 persons. E. coli was isolated from samples of 577 persons in the first period and from samples of 125 persons in the second period. The frequency of E. coli-carrying persons found with tetracycline-resistant E. coli decreased from 42% in 1978-1980 to 20% in 1987 (p less than 0.001). The frequency of persons with a predominantly tetracycline-resistant E. coli flora (greater than 50% of the E. coli flora resistant) decreased in the period 1978-1980 from 12% to 6% in 1987 (p less than 0.05). There was an increase in frequency of persons found with a predominantly ampicillin-resistant E. coli flora from 5% in 1978-1980 to 11% in 1987 (p less than 0.01). Antimicrobial resistance in the open population is a dynamic process. Data concerning an association with antibiotic consumption are mostly lacking. Further intervention studies on the influence of antibiotic policies are needed.

Adolescent↗

PubMed1990

Correlations between consumption of antibiotics and methicillin resistance in coagulase negative staphylococci.

The correlation between antibiotic consumption, expressed in defined daily doses (DDD), and antibiotic resistance rates was studied, using 976 isolates of coagulase negative staphylococci (CNS) from human pathological material. Data from four hospitals, including 14 participating departments, were analysed for this purpose. Susceptibility tests were performed according to Dutch national standards, except for methicillin, which for the majority of isolates was tested according to adapted NCCLS standards. Resistance to methicillin was most frequent in Staphylococcus epidermidis (29%) and S. haemolyticus (16%). Among the departments, thoracic surgery (29-47%), surgical intensive care (68%) and neonatology (32%) scored highest. Significant correlations were found between percentages of methicillin resistance in CNS and consumption (DDD/month/bed) of (flu)cloxacillin (P0.008), of cephalosporins (P0.01) and of gentamicin (P0.005). (Flu)cloxacillin was used mainly prophylactically, cephalosporins and gentamicin therapeutically. Results were similar for S. epidermidis (n = 639) alone. There was no significant correlation between consumption and resistance to trimethoprim, erythromycin (P0.08) or gentamicin (P0.09). Analysis of data from individual patients showed significant differences in proportions of methicillin resistance rates in CNS, between use and non-use of penicillinase resistant beta-lactams or gentamicin. It is concluded that clinical use of both (flu)cloxacillin and cephalosporins selects for methicillin resistant CNS.

Anti-Bacterial Agents↗

PubMed1990

Ecology of Pseudomonas aeruginosa in patients with cystic fibrosis.

The occurrence of various Pseudomonas aeruginosa strains in the sputum of 15 patients with cystic fibrosis (CF) was monitored over periods ranging from 2 to 60 months. Isolates of P. aeruginosa were typed by four different techniques, namely serotyping, active and passive pyocin typing, and phage typing. The maximum number of different serotypes found in the patients was three (one serotype in nine patients; two serotypes in five patients; three serotypes in one patient). Pyocin and phage typing showed no marked differences between strains of the same serotype in individual patients. Exacerbations of chronic respiratory infection were not associated with changes in the sputum flora, the composition of P. aeruginosa strains in which remains constant over long periods in patients with CF.

Adolescent↗

PubMed1990

In vitro activities of seven quinolone derivatives against Neisseria gonorrhoeae.

The in vitro activities of ciprofloxacin, enoxacin, fleroxacin, lomefloxacin, norfloxacin, ofloxacin, and pefloxacin against 10 penicillinase-producing N. gonorrhoeae strains (PPNG's), 10 non-PPNG's, 10 non-penicillinase-producing penicillin-resistant chromosomally mediated N. gonorrhoeae strains (CMRNG's) 3 N. gonorrhoeae strains with a decreased sensitivity against quinolones compounds and one tetracycline-resistant penicillinase-producing N. gonorrhoeae (TRNG/PPNG), strain were evaluated in this study. The non PPNG, PPNG, CMRNG and TRNG/PPNG strains showed good to excellent sensitivity to the quinolones tested. The N. gonorrhoeae strains with a decreased sensitivity against quinolones showed higher MIC (minimum inhibitory concentration) values.

4-Quinolones↗

PubMed1989

Complications from long-term indwelling central venous catheters in hematologic patients with special reference to infection.

Forty-three evaluable patients with hematologic malignancies, mainly acute leukemia, were prospectively randomized to receive a double lumen central venous catheter or a totally implantable venous access system. The mean catheter stay was 166 days (median, 104 days) for the 23 double lumen catheters and 164 days (median, 65 days) for implanted systems. Exit site infections were not encountered in double lumen catheters, but there were two proven infections around the injection port of implanted devices. Tunnel infections did not occur. Seven double lumen catheters and four implanted systems were removed because of infection. Staphylococcus epidermidis was the predominant microorganism cultured from these catheters. Five of nine patients with double lumen catheters and catheter-related S. epidermidis infection and the two patients with implanted systems in whom S. epidermidis was cultured were on selective gut decontamination. The pattern of infection did not seem to be influenced by this regimen. Totally implantable systems proved to be as safe as double lumen central venous lines.

Acute Disease↗

PubMed1989

The efficacy of the combination of teicoplanin or flucloxacillin with netilmicin in the treatment of Staphylococcus aureus bacteraemia.

Twenty one patients with serious Staphylococcus aureus infection and bacteraemia were randomized prospectively to receive either teicoplanin and netilmicin or flucloxacillin and netilmicin. After at least 48 h of treatment serum samples were collected for the determination of trough and peak antibiotic concentrations, the serum killing level and the serum bactericidal rate. With the help of a severity-of-disease scoring system (APACHE II) the clinical efficacy of antimicrobial therapy was assessed. Eighteen patients were evaluable. The clinical results and the results of the serum assays suggest that treatment with teicoplanin or flucloxacillin, combined with netilmicin, is a safe approach in patients with bacteraemia caused by S. aureus.

Adult↗

PubMed1989

Use of protein profiles to identify Acinetobacter calcoaceticus in a respiratory care unit.

The presence of acinetobacters in a respiratory care unit was prospectively studied because of an increase in the number of isolations of Acinetobacter calcoaceticus. Cell envelope protein electrophoresis was used to distinguish strains. Eleven protein patterns were observed in isolates from patients and their environment. One pattern (pattern 1) was seen in several patients and environmental samples. Another pattern (pattern 2) was identified repeatedly in samples from skin and mucous membranes of patients in the same ward. After thorough cleaning was undertaken throughout the unit, the pattern 1 strain was no longer cultivated from clinical samples. It is concluded that cell envelope protein electrophoresis is a useful method for tracing epidemic strains of A calcoaceticus.

Acinetobacter↗