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Objectives Among patients with haematological malignancy, bacteraemia is a common complication during chemotherapy-induced neutropenia. Resistance of gram-negative pathogens to third-generation cephalosporins is increasing. We aimed to assess the distribution of pathogens causing bacteraemia in patients with haematological malignancy, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization. Methods Using 11 years of data (2008–2018) from the Dutch national antimicrobial resistance surveillance system, we assessed the prevalence of third-generation cephalosporin resistant Gram-negative bacteria (3GC-R GNB) in episodes of bacteraemia, and the proportion of 3GC-R GNB bacteraemia that was preceded by 3GC-R GNB colonization (identified using surveillance cultures) in the year before. Results We included 3,887 patients, representing 4,142 episodes of bacteraemia. GNB were identified in 715/4,142 (17.3%), of which 221 (30.9%) were 3GC-R GNB. In (106/139) 76.2% of patients with a 3GC-R GNB bacteraemia and available GNB surveillance cultures in the preceding year, 3GC-R GNB colonization had been previously identified. Conclusions This multi-centre study shows that in patients with haematological malignancy, the majority of 3GC-R GNB bacteraemia is preceded by 3GC-R GNB colonization. Prospective clinical studies are needed to assess the safety and benefits of surveillance-culture guided empirical therapy to restrict the empirical use of carbapenems in this population.

Additional file 1. Electronic medication registration prescription format.

Additional file 2. Microbiological tests and identified bacterial pathogens within 72 h of admission.

Additional file 1. Parameters used by the expert panel to categorize patients as having unlikely, possible or probable community-acquired bacterial co-infection.

Additional file 3. Description of criteria present in patients with a possible or probable co-infection.

We describe two cases of prosthetic joint infection (PJI) of the hip due to Salmonella. The first patient presented with an early infection 5 d after being discharged following a total hip replacement and the second patient presented at the emergency ward with a late infection, thirteen years following a total hip replacement. Both cases occurred within one month of each other at our institution and both were successfully treated with a one-stage revision. PJI caused by Salmonella species is very rare: so far only 20 Salmonella PJIs of the hip have been described. Therefore, full consensus on the best treatment approach has not yet been reached. An aggressive two-stage approach is advised because of the virulence of Salmonella, although a limited number of successful one-stage approaches have been described as well. According to the latest guidelines, one-stage revision has comparable success rates and less morbidity compared to two-stage treatment, when selecting the right patients. In our opinion, PJI caused by Salmonella should be treated just as PJI caused by other bacteria, with consideration of the selection criteria as mentioned in several treatment guidelines. As illustrated by these two cases, one-stage revision can be successful in both early and late Salmonella PJI of the hip.

Antimicrobial resistance (AMR) poses a growing threat to human health around the world. As more bacteria become resistant to antibiotics, mortality due to antibiotic-resistant infections increases. The main driver of AMR is antimicrobial consumption. Therefore, strategies to reduce antimicrobial consumption are necessary. In this thesis, we propose a strategy to measure and develop interventions to reduce antimicrobial consumption and antibiotic related adverse events using local data. This strategy comprises a collaborative approach in which the Antimicrobial stewardship team (A-team) and prescribers together define knowledge gaps and/or barriers that preclude appropriate antibiotic use. After the joint formulation of research questions, the appropriate (local) data is collected and analysed. The research results are discussed and antimicrobial treatment policies are amended if necessary. After implementation of the intervention, the local antibiotic policy can be re-evaluated with regards to adherence and relevant clinical outcome measures. This cyclical process is referred to as “data-driven antimicrobial stewardship”. The availability of large amounts of data (i.e. electronic patient record, prescription, microbiological and diagnostic data) allows us to form a better picture of the epidemiology, aetiology and outcome of infectious diseases. These data can help us weigh the benefit of adequate empirical therapy and the harm of excessive (broad-spectrum) antibiotic use. Thus, we can optimise our antibiotic policies without compromising treatment effectiveness. In this thesis we show several examples of how the analysis of local data, together with all those involved in the treatment, can be used to reduce antibiotic use and prevent antibiotic related adverse events.