Healthcare professionals challenged by 14 distinct carbapenemase-producing micro-organisms in a war-injured Ukrainian patient.

The Russia-Ukraine war lead to evacuation of patients across Europe. We present an unprecedented case of a severely injured Ukrainian soldier carrying 11 carbapenemase-producing Enterobacterales, two carbapenemase-producing Pseudomonas aeruginosa and one carbapenem-resistant Acinetobacter baumannii, together harboring six different carbapenemase genes and with evidence for in-patient transfer of resistance plasmids.

The power of interactive maps for communicating spatio-temporal data to health professionals.

While more and more health-related data is being produced and published every day, few of it is being prepared in a way that would be beneficial for daily use outside the scientific realm. Interactive visualizations that can slice and condense enormous amounts of multi-dimensional data into easy-to-digest portions are a promising tool that has been under-utilized for health-related topics. Here we present two case studies for how interactive maps can be utilized to make raw health data accessible to different target audiences: i) the European Notifiable Diseases Interactive Geovisualization (ENDIG) which aims to communicate the implementation status of disease surveillance systems across the European Union to public health experts and decision makers, and ii) the Zoonotic Infection Risk in Twente-Achterhoek Map (ZIRTA map), which aims to communicate information about zoonotic diseases and their regional occurrence to general practitioners and other healthcare providers tasked with diagnosing infectious diseases on a daily basis.

Positive effects of audit and feedback on antimicrobial use in hospitalized patients limited to audited patients.

Objective: Audit and feedback is an antimicrobial stewardship (AMS) strategy, with the potential to also optimize antimicrobial use in non-audited patients. This study aimed to determine whether audit and feedback reduce antimicrobial use in both audited and non-audited patients.

Design: Before-after trial with a 1-year intervention period and 2.

Low-Threshold Testing for SARS-CoV-2 (COVID-19) in Long-Term Care Facilities Early in the First Pandemic Wave, the Twente Region, the Netherlands: A Possible Factor in Reducing Morbidity and Mortality.

During the first wave of the COVID-19 pandemic, there was a shortage of SARS-CoV-2 diagnostic tests, and testing patients with mild symptoms (low-threshold testing) was not recommended in the Netherlands. Despite these guidelines, to protect those who were most at risk, low-threshold testing was advocated and offered to the majority of long-term care institutions in the region. In this manner, 144 healthcare workers and 96 residents tested SARS-CoV-2-positive and were isolated before the same service was provided nationwide by public health services.

Improving the Development and Implementation of Audit and Feedback Systems to Support Health Care Workers in Limiting Antimicrobial Resistance in the Hospital: Scoping Review.

Background: For eHealth technologies in general and audit and feedback (AF) systems specifically, integrating interdisciplinary theoretical underpinnings is essential, as it increases the likelihood of achieving desired outcomes by ensuring a fit among eHealth technology, stakeholders, and their context. In addition, reporting on the development and implementation process of AF systems, including substantiations of choices, enables the identification of best practices and accumulation of knowledge across studies but is often not elaborated on in publications.

Objective: This scoping review aims to provide insights into the development and implementation strategies for AF systems for a real-world problem that threatens modern health care-antimicrobial resistance-and provide an interdisciplinary conceptual framework that can serve as a checklist and guidance for making informed choices in the development and implementation of future AF systems.

Contact precautions in single-bed or multiple-bed rooms for patients with extended-spectrum β-lactamase-producing Enterobacteriaceae in Dutch hospitals: a cluster-randomised, crossover, non-inferiority study.

Background: Use of single-bed rooms for control of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is under debate; the added value when applying contact precautions has not been shown. We aimed to assess whether an isolation strategy of contact precautions in a multiple-bed room was non-inferior to a strategy of contact precautions in a single-bed room for preventing transmission of ESBL-producing Enterobacteriaceae.

Methods: We did a cluster-randomised, crossover, non-inferiority study on medical and surgical wards of 16 Dutch hospitals.

Prevalence of plasmid-mediated AmpC in Enterobacteriaceae isolated from humans and from retail meat in Zagazig, Egypt.

Background: The objective of this study was to determine the prevalence of plasmid-mediated AmpC (pAmpC) among Enterobacteriaceae isolated from humans and from retail meat in Egypt.

Methods: Enterobacteriaceae were isolated from patients with suspected bloodstream infection, human fecal samples, retail chicken meat samples and retail sheep meat samples. All group I Enterobacteriaceae were analyzed for presence of pAmpC genes by PCR.

Impact of single room design on the spread of multi-drug resistant bacteria in an intensive care unit.

Background: Cross-transmission of nosocomial pathogens occurs frequently in intensive care units (ICU). The aim of this study was to investigate whether the introduction of a single room policy resulted in a decrease in transmission of multidrug-resistant (MDR) bacteria in an ICU.

Methods: We performed a retrospective study covering two periods: between January 2002 and April 2009 (old-ICU) and between May 2009 and March 2013 (new-ICU, single-room).

Internal and External Validation of a Computer-Assisted Surveillance System for Hospital-Acquired Infections in a 754-Bed General Hospital in the Netherlands.

OBJECTIVE To evaluate a computer-assisted point-prevalence survey (CAPPS) for hospital-acquired infections (HAIs). DESIGN Validation cohort. SETTING A 754-bed teaching hospital in the Netherlands.

Genomic Characterization of Colistin Heteroresistance in Klebsiella pneumoniae during a Nosocomial Outbreak.

Klebsiella pneumoniae is emerging as an important nosocomial pathogen due to its rapidly increasing multidrug resistance, which has led to a renewed interest in polymyxin antibiotics, such as colistin, as antibiotics of last resort. However, heteroresistance (i.e.

Plasmid-mediated AmpC: prevalence in community-acquired isolates in Amsterdam, the Netherlands, and risk factors for carriage.

Objectives: The objective of this study was to determine the prevalence of pAmpC beta-lactamases in community-acquired Gram negative bacteria in the Netherlands, and to identify possible risk factors for carriage of these strains.

Methods: Fecal samples were obtained from community-dwelling volunteers. Participants also returned a questionnaire for analysis of risk factors.

Detection and occurrence of plasmid-mediated AmpC in highly resistant gram-negative rods.

Objectives: The aim of this study was to compare the current screening methods and to evaluate confirmation tests for phenotypic plasmidal AmpC (pAmpC) detection.

Methods: For this evaluation we used 503 Enterobacteriaceae from 18 Dutch hospitals and 21 isolates previously confirmed to be pAmpC positive. All isolates were divided into three groups: isolates with 1) reduced susceptibility to ceftazidime and/or cefotaxime; 2) reduced susceptibility to cefoxitin; 3) reduced susceptibility to ceftazidime and/or cefotaxime combined with reduced susceptibility to cefoxitin.

Emergence of colistin resistance in Enterobacteriaceae after the introduction of selective digestive tract decontamination in an intensive care unit.

Selective decontamination of the digestive tract (SDD) selectively eradicates aerobic Gram-negative bacteria (AGNB) by the enteral administration of oral nonabsorbable antimicrobial agents, i.e., colistin and tobramycin.

New diagnostic microarray (Check-KPC ESBL) for detection and identification of extended-spectrum beta-lactamases in highly resistant Enterobacteriaceae.

The performance of a microarray for the detection of extended-spectrum beta-lactamases was determined on a collection of 638 highly resistant members of the family Enterobacteriaceae collected from patients in 18 hospitals in The Netherlands. The microarray had a significantly higher specificity than the phenotypic assays. It also detects carbapenemases and characterizes the resistance genes, providing epidemiological insight.

Method for phenotypic detection of extended-spectrum beta-lactamases in enterobacter species in the routine clinical setting.

In 271 Enterobacter blood culture isolates from 12 hospitals, extended-spectrum beta-lactamase (ESBL) prevalence varied between 0% and 30% per hospital. High prevalence was associated with dissemination, indicating the potential relevance of infection control measures. Screening with cefepime or Vitek 2, followed by a cefepime/cefepime-clavulanate Etest, was an accurate strategy for ESBL detection in Enterobacter isolates (positive predictive value, 100%; negative predictive value, 99%).

Detection of an Ambler class D OXA-48-type β-lactamase in a Klebsiella pneumoniae strain in The Netherlands.

Traditionally, bacteria in The Netherlands have low levels of resistance to antibiotics. This report describes what is believed to be the first carbapenem-resistant Klebsiella pneumoniae producing an OXA-48 type β-lactamase in The Netherlands. The isolate co-produced a CTX-M-15 type β-lactamase and was recovered from a patient who was transferred from a hospital in India to an intensive care unit in The Netherlands.

[Fatal pneumonia caused by carbapenem resistant Klebsiella pneumoniae].

A 63-year-old Dutch man became colonized with a carbapenem resistant Klebsiella pneumoniae during a period of hospitalization in India. His recovery in the Netherlands was complicated by pneumonia due to this difficult-to-control multiresistant bacteria to which he eventually succumbed. Carbapenem resistance in Enterobacteriaceae, such as K.

Characterization of DIM-1, an integron-encoded metallo-beta-lactamase from a Pseudomonas stutzeri clinical isolate in the Netherlands.

A carbapenem-resistant Pseudomonas stutzeri strain isolated from a Dutch patient was analyzed in detail. This isolate produced a metallo-beta-lactamase (MBL) whose gene, with 43.5% GC content, was cloned and expressed in Escherichia coli.