Tongue necrosis by giant cell arteritis and fatal pacemaker embolism.
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Aged↗
Biomedical subjects
W E Peetermans
Publications and source records attributed to W E Peetermans.
Recurrent Listeria monocytogenes bacteraemia in a liver transplant patient.
We report a case of a recurrent Listeria monocytogenes bacteraemia in a 46 year-old liver transplant patient. Serotyping revealed that the two episodes of bacteraemia were caused by different strains. The possibility of a recrudescence of a persisting infection was rejected. We concluded that the recurrent bacteraemia in this predisposed patient was due to re-infection, and that antibiotic treatment (amoxicillin plus an aminoglycoside) resulted in a complete eradication of the infective microorganism. Therefore long-term suppressive antibiotic treatment was not indicated. The source of these L. monocytogenes infections was not found.
Anti-Bacterial Agents↗
Bioprosthetic valve endocarditis caused by Neisseria elongata subspecies nitroreducens.
A new case of Neisseria elongata ssp. nitroreducens bacteremia and endocarditis in a 74-year-old woman who had undergone aortic valve replacement in 1992 is reported in detail. N. elongata ssp. nitroreducens differs from the other subspecies of N. elongata in the additional reduction of nitrate without gas formation. Like most Neisseria spp. except Neisseria meningitidis and Neisseria gonorrhoeae, this N. elongata ssp. nitroreducens is usually classified in the group of "non-pathogenic" Neisseria spp. This case report indicates that the presence of subspecies of this group is significant when isolated from normally sterile sites and can cause severe disease in susceptible individuals.
Aged↗
Double prosthetic valve endocarditis caused by Streptococcus pneumoniae.
Infective endocarditis (IE) caused by Streptococcus pneumoniae is a rare disease. Only eight cases of pneumococcal prosthetic valve endocarditis have been described in the literature. In this report we describe the first case of pneumococcal endocarditis involving two prosthetic heart valves. The patient had pneumonia as the probable portal of entry but no predisposing conditions for invasive pneumococcal disease. Our case also illustrates the importance of transesophageal echocardiography (TEE) for the early diagnosis of IE and a timely decision for cardiac surgery.
Echocardiography, Transesophageal↗
The antimicrobial resistance crisis in hospitals calls for multidisciplinary mobilization.
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Anti-Bacterial Agents↗
New insights in the pathogenesis of foreign body infections with coagulase negative staphylococci.
Foreign body infections by coagulase negative Staphylococci are an important and growing problem in our hospitals. Only recently have we started to get some data on the specific virulence factors that permit the otherwise non-pathogenic Coagulase Negative Staphylococci (CNS) to be so successful in causing foreign body infections. Adherence of the Coagulase Negative Staphylococci to the foreign body is a first and crucial step. Several genes and gene-products have been identified that enhance staphylococcal adherence to biomaterials. Adherence is followed by accumulation; in this phase the Coagulase negative Staphylococci organise themselves into a complex multilayer of cells covered with polysaccharide. This we call the biofilm. Finally coagulase negative Staphylococci undergo complex and as yet non-defined metabolic changes that in combination with biofilm formation allow them to persist on the foreign body and become less susceptible to antibiotics. Few data are available on the factors involved in the accumulation and persistence phase.
Bacterial Adhesion↗
The use of polyclonal intravenous immunoglobulins in the prevention and treatment of infectious diseases.
In this review we discuss the prevention and treatment of infectious diseases with intravenous immunoglobulins (IVIG). IVIG can be used to prevent infections in primary as well as in certain secondary immunodeficiencies. We also discuss the use of IVIG in the prevention of CMV-disease after organ or bone marrow transplantation. Besides their use in prevention, IVIG can also be used as an additional therapy in sepsis in neonates, in streptococcal toxic shock syndrome and in CMV-disease after bone marrow or solid organ transplantation. We briefly discuss the different preparations of IVIG that are available in Belgium.
Belgium↗
The antibiotic and anti-inflammatory treatment of bacterial meningitis in adults: do we have to change our strategies in an era of increasing antibiotic resistance?
Community acquired bacterial meningitis remains a feared infection because of its high morbidity and mortality. During the last decade, the incidence and the microbial resistance patterns of pathogens causing bacterial meningitis have changed considerably. A sharp increase in meningococcal disease has been observed and meningitis caused by penicillin resistant Streptococcus pneumoniae emerged as a matter of major concern. Since pneumococcal resistance in Belgium to third generation cephalosporins remains rare and low level, addition of vancomycin to the initial empirical therapy including third generation cephalosporins is not yet necessary. However, the evolution of the resistance patterns of invasive S. pneumoniae should be followed very carefully. The emergence of penicillin resistant pneumococci also raises concern about the safety of adjuvant anti-inflammatory therapy with dexamethasone. Although there is a growing evidence suggesting a decrease of neurological complications after administration of adjuvant dexamethasone, this therapy may lower the already borderline penetration through the blood-brain barrier of the currently used antibiotics. This may result in therapeutic failure. We therefore presently do not advocate the routine use of dexamethasone in the therapy of adult bacterial meningitis.
Adult↗
Implementation of pretravel advice: good for malaria, bad for diarrhoea.
Pretravel immunizations and health advice can substantially reduce the incidence of travel-related diseases. The aim of this study was to evaluate the implementation of pretravel advice among a homogenous group of students, who received similar written information on vaccination requirements and health advice. They were referred to the travel clinic (50%) or a general practitioner (50%) for vaccination, counselling and prescriptions. Eighty-four out of 110 students (76%) returned the questionnaire. Insect repellent was used by all and only 10 used the repellent for less than 75% of the time spent in malaria endemic areas. Malaria chemoprophylaxis was taken by all but one: chloroquine plus proquanil by 12 and mefloquine by 71. Reported compliance with the dosing regimen was optimal in 64 students, 9 missed one dose and 10 stopped too early. Side effects due to antimalarials were reported by 25 (30%). Diarrhoea during travel occurred in 43 students (51%). Loperamide was used by 34 students with diarrhoea (79%), but only 2 out of 27 students with moderate to severe diarrhoea used the recommended self-treatment with a fluoroquinolone antibiotic. In conclusion, the recommendations of malaria prophylaxis were well implemented by most travellers despite a high incidence of self-reported side effects to antimalarials. The incidence of traveller's diarrhoea was high and the recommendation for early self-treatment of moderate to severe diarrhoea with a fluoroquinolone antibiotic in combination with loperamide was not put into practice.
Adult↗
Antibiotic susceptibility and serotype distribution of 240 Streptococcus pneumoniae causing meningitis in Belgium 1997-2000.
Cerebrospinal fluid isolates of Streptococcus pneumoniae, collected during the years 1997-2000 at more than 100 Belgian laboratories were studied. The 10 most common serotypes-serogroups representing 76% of the isolates were 14, 6, 9, 19, 23, 18, 4, 10, 8 and 12 (in order of frequency). Thirty-six percent of strains were isolated in children < 5 years old. In this age group the number of serogroups was more limited and 81.4% are included in the 7-valent conjugate vaccine. Decreased susceptibility to penicillin was observed in 13.9% of 237 strains (MIC > 0.06 mg/L), with only 2.1% resistant strains (MIC > 1 mg/L). Twelve strains showed reduced susceptibility to cefotaxime (MIC > 0.5 mg/L). Only three of the 237 strains were intermediately susceptible to meropenem. All strains were susceptible to vancomycin and moxifloxacin. In Belgium, high doses of third generation cephalosporins remain effective for the treatment of pneumococcal meningitis. The new fluoroquinolones seem the most promising agents for the treatment of pneumococcal meningitis in the future.
Adolescent↗
Recommendations for the use of the 23-valent polysaccharide pneumococcal vaccine in adults: a Belgian consensus report.
A multidisciplinary expert panel, appointed by the High Council for Public Health, evaluated the scientific evidence on which the recommendations for the appropriate use of the pneumococcal vaccine was based and reviewed the studies that became available since previous reports. The conclusions of the working group, presented in this manuscript, resulted in an update of the Belgian recommendations for pneumococcal vaccination.
Adult↗
Recommendations for antibiotic prophylaxis before ERCP: can we come to workable conclusions after review of the literature?
Infectious complications after endoscopic retrograde cholangiopancreatography (ERCP) are rare and can mainly be divided into endocarditis and sepsis/cholangitis. There still remains uncertainty about the indications, antibiotic regimens, and timing for antibiotic prophylaxis. Several guidelines for antibiotic prophylaxis have been published. It is the purpose of the present paper to make an extensive review of the literature and to yield general recommendations on antibiotic prophylaxis before ERCP. Antibiotic prophylaxis is recommended for patients at high risk for endocarditis, as well as for patients with a vascular graft less than 1 year old. For sepsis/cholangitis, prophylaxis is mostly recommended for patients with a bile duct obstruction or with a pancreatic pseudocyst. For other conditions, a case-by-case evaluation by the physician/endoscopist is still inevitable.
Antibiotic Prophylaxis↗
Implementation of antibiotic management teams in Belgian hospitals.
In 2002-03, the Belgian government subsidized in part the activities of local Antibiotic Managers (AMs) in 36 hospitals selected based on the presence of an operational multidisciplinary Antibiotic Management Team (AMT). AMs were trained as Internists (28), Microbiologists (13) and Hospital Pharmacists (13). The hospitals were representative of Belgian hospitals in affiliation, regional origin and size. The financing scheme allowed the implementation of 175 antibiotic management interventions, with a mean of 5 interventions/hospital. The activities reported in the first 9-month progress reports were analyzed according to national guidelines for AMTs. All hospitals irrespective of size or affiliation had undertaken a wide range of measures: review of formulary (29), implementation of new clinical guidelines (24), restricted access to selected antibiotics (25), improvement of antibiotic susceptibility testing methods (12), development of antibiotic consumption database (35) and analysis of antibacterial susceptibility data (31). Advertisement type categorization of communication methods showed that education of prescribers was based on multimodal communication. All hospitals used at least one passive method, 39% at least one active method and 55% at least one personalized method. The quality of communication was higher in hospitals with teaching affiliation. In conclusion, hospitals that received a financial incentive under theAMT pilot phase have developed multimodal antibiotic policy interventions independently of the hospital size and teaching status. Extension to all Belgian hospitals appears warranted. The impact of AMTs and AMs on the quality of use of antibiotics and trends of antibiotic resistance and cost will be monitored based on standardized indicators.
Anti-Bacterial Agents↗