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5. The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults

Author

Sieswerda, Elske, Bax, Hannelore I., Hoogerwerf, Jacobien J., de Boer, Mark G. J., Boermeester, Marja, Bonten, Marc J. M., Dekker, Douwe, van Wijk, Roy Gerth, Juffermans, Nicole P., Kuindersma, Marnix, van der Linden, Paul D., Melles, Damian C., Pickkers, Peter, Schouten, Jeroen A., Rebel, Jasper R., van Zanten, Arthur R. H., Prins, Jan M., and Wiersinga, W. Joost

Published
2022
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6. Pooled Population Pharmacokinetic Analysis and Dose Recommendations for Ciprofloxacin in Intensive Care Unit Patients with Obesity.

Author

van Rhee, Koen P., Brüggemann, Roger J.M., Roberts, Jason A., Sjövall, Fredrik, van Hest, Reinier M., Elbers, Paul W.G., Abdulla, Alan, van der Linden, Paul D., and Knibbe, Catherijne A.J.

Subjects
KIDNEY physiology, CIPROFLOXACIN, BARIATRIC surgery, PHARMACEUTICAL arithmetic, CRITICALLY ill, PATIENTS, BODY mass index, BODY weight, DESCRIPTIVE statistics, INTRAVENOUS therapy, CHRONIC kidney failure, INTENSIVE care units, OVERWEIGHT persons, OBESITY, GLOMERULAR filtration rate, PHARMACODYNAMICS
Abstract

Recent studies have explored the influence of obesity and critical illness on ciprofloxacin pharmacokinetics. However, variation across the subpopulation of individuals with obesity admitted to the intensive care unit (ICU) with varying renal function remains unexamined. This study aims to characterize ciprofloxacin pharmacokinetics in ICU patients with obesity and provide dose recommendations for this special population. Individual patient data of 34 ICU patients with obesity (BMI >30 kg/m2) from four studies evaluating ciprofloxacin pharmacokinetics in ICU patients were pooled and combined with data from a study involving 10 individuals with obesity undergoing bariatric surgery. All samples were collected after intravenous administration. Non‐linear mixed effects modeling and simulation were used to develop a population pharmacokinetic model and describe ciprofloxacin exposure in plasma. Model‐based dose evaluations were performed using a pharmacokinetic/pharmacodynamic target of AUC/MIC >125. The data from patients with BMI ranging from 30.2 to 58.1 were best described by a two‐compartment model with first‐order elimination and a proportional error model. The inclusion of Chronic Kidney Disease Epidemiology Collaboration (CKD‐EPI) as a covariate on clearance reduced inter‐individual variability from 57.3% to 38.5% (P <.001). Neither body weight nor ICU admission significantly influenced clearance or volume of distribution. Renal function is a viable predictor for ciprofloxacin clearance in ICU patients with obesity, while critical illness and body weight do not significantly alter clearance. As such, body weight and critical illness do not need to be accounted for when dosing ciprofloxacin in ICU patients with obesity. Individuals with CKD‐EPI >60 mL/min/1.73 m2 may require higher dosages for the treatment of pathogens with minimal inhibitory concentration ≥0.25 mg/L. [ABSTRACT FROM AUTHOR]

Published
2024
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7. Performance of ChatGPT on Factual Knowledge Questions Regarding Clinical Pharmacy.

Author

van Nuland, Merel, Erdogan, Abdullah, Aςar, Cenkay, Contrucci, Ramon, Hilbrants, Sven, Maanach, Lamyae, Egberts, Toine, and van der Linden, Paul D.

Subjects
GENERATIVE artificial intelligence, PHARMACY education, RESEARCH evaluation, REFERENCE books, EDUCATIONAL tests & measurements, PROFESSIONS
Abstract

ChatGPT is a language model that was trained on a large dataset including medical literature. Several studies have described the performance of ChatGPT on medical exams. In this study, we examine its performance in answering factual knowledge questions regarding clinical pharmacy. Questions were obtained from a Dutch application that features multiple‐choice questions to maintain a basic knowledge level for clinical pharmacists. In total, 264 clinical pharmacy‐related questions were presented to ChatGPT and responses were evaluated for accuracy, concordance, quality of the substantiation, and reproducibility. Accuracy was defined as the correctness of the answer, and results were compared to the overall score by pharmacists over 2022. Responses were marked concordant if no contradictions were present. The quality of the substantiation was graded by two independent pharmacists using a 4‐point scale. Reproducibility was established by presenting questions multiple times and on various days. ChatGPT yielded accurate responses for 79% of the questions, surpassing pharmacists' accuracy of 66%. Concordance was 95%, and the quality of the substantiation was deemed good or excellent for 73% of the questions. Reproducibility was consistently high, both within day and between days (>92%), as well as across different users. ChatGPT demonstrated a higher accuracy and reproducibility to factual knowledge questions related to clinical pharmacy practice than pharmacists. Consequently, we posit that ChatGPT could serve as a valuable resource to pharmacists. We hope the technology will further improve, which may lead to enhanced future performance. [ABSTRACT FROM AUTHOR]

Published
2024
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8. Narrow-spectrum antibiotics for community-acquired pneumonia in Dutch adults (CAP-PACT): a cross-sectional, stepped-wedge, cluster-randomised, non-inferiority, antimicrobial stewardship intervention trial

Author

Schweitzer, Valentijn A, van Heijl, Inger, Boersma, Wim G, Rozemeijer, Wouter, Verduin, Kees, Grootenboers, Marco J, Sankatsing, Sanjay U C, van der Bij, Akke K, de Bruijn, Winnie, Ammerlaan, Heidi S M, Overdevest, Ilse, Roorda-van der Vegt, J M Milena, Engel-Dettmers, Elske M, Ayuketah-Ekokobe, Florence E, Haeseker, Michiel B, Dorigo-Zetsma, J Wendelien, van der Linden, Paul D, Boel, C H Edwin, Oosterheert, Jan J, van Werkhoven, Cornelis H, and Bonten, Marc J M

Published
2022
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10. Poor performance of ChatGPT in clinical rule-guided dose interventions in hospitalized patients with renal dysfunction

Author

Apotheek Onderzoek, Infection & Immunity, Regenerative Medicine and Stem Cells, van Nuland, Merel, Snoep, JaapJan D, Egberts, Toine, Erdogan, Abdullah, Wassink, Ricky, van der Linden, Paul D, Apotheek Onderzoek, Infection & Immunity, Regenerative Medicine and Stem Cells, van Nuland, Merel, Snoep, JaapJan D, Egberts, Toine, Erdogan, Abdullah, Wassink, Ricky, and van der Linden, Paul D

Published
2024

11. Assessing accuracy of ChatGPT in response to questions from day to day pharmaceutical care in hospitals

Author

Apotheek Klinische Farmacie, Apotheek O&O&O, Apotheek Opleiding, Apotheek Onderzoek, Infection & Immunity, Regenerative Medicine and Stem Cells, Epi Infectieziekten Team 1, van Nuland, Merel, Lobbezoo, Anne Fleur H., van de Garde, Ewoudt M.W., Herbrink, Maikel, van Heijl, Inger, Bognàr, Tim, Houwen, Jeroen P.A., Dekens, Marloes, Wannet, Demi, Egberts, Toine, van der Linden, Paul D., Apotheek Klinische Farmacie, Apotheek O&O&O, Apotheek Opleiding, Apotheek Onderzoek, Infection & Immunity, Regenerative Medicine and Stem Cells, Epi Infectieziekten Team 1, van Nuland, Merel, Lobbezoo, Anne Fleur H., van de Garde, Ewoudt M.W., Herbrink, Maikel, van Heijl, Inger, Bognàr, Tim, Houwen, Jeroen P.A., Dekens, Marloes, Wannet, Demi, Egberts, Toine, and van der Linden, Paul D.

Published
2024

12. Diagnosis-linked antibiotic prescribing quality indicators: demonstrating feasibility using practice-based routine primary care data, reliability, validity and their potential in antimicrobial stewardship

Author

Infection & Immunity, Epi Infectieziekten Team 1, HAG Infectieziekten, JC onderzoeksprogramma Infectieziekten, van den Eijnde, Sharon E J D, van der Linden, Paul D, van der Velden, Alike W, Infection & Immunity, Epi Infectieziekten Team 1, HAG Infectieziekten, JC onderzoeksprogramma Infectieziekten, van den Eijnde, Sharon E J D, van der Linden, Paul D, and van der Velden, Alike W

Published
2024

13. Sulfamethoxazole-Trimethoprim-Induced Hyperkalemia in Hospitalized Patients Using Potassium-Sparing Drugs: An Observational Study.

Author

Butterhoff, Madelon H., Derijks, Hieronymus J., Hermens, Walter, and van der Linden, Paul D.

Subjects
HOSPITAL patients, HYPERKALEMIA, RENIN-angiotensin system, SCIENTIFIC observation, RESEARCH personnel
Abstract

The objective of this analysis is to investigate the risk of hyperkalemia in hospitalized patients using sulfamethoxazole-trimethoprim (Co-trimoxazole) and a potassium-sparing drug (potassium-sparing diuretic or renin-angiotensin system [RAS]-inhibitor). Researchers conducted a nested case control study within a cohort of hospitalized patients using a potassium-sparing diuretic and/or a RAS-inhibitor from the PHARMO Database Network. Researchers estimated the odds ratios (ORs) and 95% confidence intervals (CI) for the risk of hyperkalemia in patients receiving both Co-trimoxazole and a potassium-sparing drug compared with patients only receiving a potassium-sparing drug. Among a cohort of 25,849 patients, researchers identified 2054 cases of hyperkalemia during hospitalization in patients also using a potassium-sparing drug. Using Co-trimoxazole in addition to a potassium-sparing drug was associated with an increased risk of hyperkalemia in hospitalized patients (ORadj = 1.65, 95% CI 1.26-2.16) compared with using only a potassium-sparing drug. There was a trend of a more pronounced association between hyperkalemia and the co-use of Co-trimoxazole and potassium-sparing drugs in patients with an estimated GFR of 15-29 mL/min (ORadj = 3.15, 95% CI 1.29-7.70). The number needed to harm for hyperkalemia induced by adding Cotrimoxazole to patients receiving a potassium-sparing drug is 19.5. Using the combination of Co-trimoxazole with a potassium-sparing drug in hospitalized patients increases the risk of hyperkalemia compared with using only a potassium-sparing drug. Physicians and other prescribers should be aware of hyperkalemia and routinely monitor serum potassium levels in hospitalized patients using this combination of drugs. [ABSTRACT FROM AUTHOR]

Published
2024
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15. Women on diuretics have a higher risk of hospital admission because of hyponatremia than men

Author

Hendriksen, Linda C., van der Linden, Paul D., Herings, Ron M.C., Stricker, Bruno H., Visser, Loes E., Hendriksen, Linda C., van der Linden, Paul D., Herings, Ron M.C., Stricker, Bruno H., and Visser, Loes E.

Abstract

Purpose: Recent studies suggest that women are more susceptible to diuretic-induced hyponatremia resulting in hospital admission than men. The aim of this study was to confirm whether these sex differences in hyponatremia-related hospital admissions in diuretic users remain after adjusting for several confounding variables such as age, dose, and concurrent medication. Methods: In a case–control design nested in diuretic users, cases of hyponatremia associated hospital admissions between 2005 and 2017 were identified from the PHARMO Data Network. Cases were 1:10 matched to diuretic users as controls. Odds ratios (OR) with 95%CIs were calculated for women versus men and adjusted for potential confounders (age, number of diuretics, other hyponatremia-inducing drugs, chronic disease score) using unconditional logistic regression analysis. A subgroup analysis was performed for specific diuretic groups (thiazides, loop diuretics and aldosterone antagonists). Results: Women had a statistically significantly higher risk of a hospital admission associated with hyponatremia than men while using diuretics (OR 1.86, 95%CI 1.64–2.11). Adjusting for the potential confounders resulted in an increased risk for women compared to men (ORadj 2.65, 95% CI 2.31–3.04). This higher risk in women was also seen in the three subgroup analyses after adjustment. Conclusion: Our findings show a higher risk of hyponatremia-related hospital admission in women than men while using diuretics. Further research is needed to understand the underlying mechanism of this sex difference to be able to provide sex-specific recommendations.

Published
2023

22. The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults

Author

MMB Medische Staf, Epi Infectieziekten, Infection & Immunity, Epidemiology of Sepsis & Inflammation in Critically Ill Patients, JC onderzoeksprogramma Infectieziekten, Medische Staf Spoedeisende Hulp, Epi Infectieziekten Team 1, Sieswerda, Elske, Bax, Hannelore I, Hoogerwerf, Jacobien J, de Boer, Mark G J, Boermeester, Marja, Bonten, Marc J M, Dekker, Douwe, van Wijk, Roy Gerth, Juffermans, Nicole P, Kuindersma, Marnix, van der Linden, Paul D, Melles, Damian C, Pickkers, Peter, Schouten, Jeroen A, Rebel, Jasper R, van Zanten, Arthur R H, Prins, Jan M, Wiersinga, W Joost, MMB Medische Staf, Epi Infectieziekten, Infection & Immunity, Epidemiology of Sepsis & Inflammation in Critically Ill Patients, JC onderzoeksprogramma Infectieziekten, Medische Staf Spoedeisende Hulp, Epi Infectieziekten Team 1, Sieswerda, Elske, Bax, Hannelore I, Hoogerwerf, Jacobien J, de Boer, Mark G J, Boermeester, Marja, Bonten, Marc J M, Dekker, Douwe, van Wijk, Roy Gerth, Juffermans, Nicole P, Kuindersma, Marnix, van der Linden, Paul D, Melles, Damian C, Pickkers, Peter, Schouten, Jeroen A, Rebel, Jasper R, van Zanten, Arthur R H, Prins, Jan M, and Wiersinga, W Joost

Published
2022

23. Antibiotic stewardship in the real world - Authors' reply

Author

Epi Infectieziekten Team 1, Infection & Immunity, MMB opleiding Arts microbioloog, JC onderzoeksprogramma Infectieziekten, Epi Infectieziekten, van Heijl, Inger, Schweitzer, Valentijn A, van der Linden, Paul D, van Werkhoven, Cornelis H, Bonten, Marc J M, Epi Infectieziekten Team 1, Infection & Immunity, MMB opleiding Arts microbioloog, JC onderzoeksprogramma Infectieziekten, Epi Infectieziekten, van Heijl, Inger, Schweitzer, Valentijn A, van der Linden, Paul D, van Werkhoven, Cornelis H, and Bonten, Marc J M

Published
2022

26. Additional file 1 of The 2021 Dutch Working Party on Antibiotic Policy (SWAB) guidelines for empirical antibacterial therapy of sepsis in adults

Author

Sieswerda, Elske, Bax, Hannelore I., Hoogerwerf, Jacobien J., de Boer, Mark G. J., Boermeester, Marja, Bonten, Marc J. M., Dekker, Douwe, van Wijk, Roy Gerth, Juffermans, Nicole P., Kuindersma, Marnix, van der Linden, Paul D., Melles, Damian C., Pickkers, Peter, Schouten, Jeroen A., Rebel, Jasper R., van Zanten, Arthur R. H., Prins, Jan M., and Wiersinga, W. Joost

Abstract

Additional file 1. sTable 1. Alternative empirical treatment strategies in sepsis and low estimated risk of involvement of 3GCR-E. sTable 2. Alternative empirical treatment strategies in sepsis and increased or high estimated risk of involvement of 3GCR-E. sTable 3. Recommended iv doses of empirical antibacterial treatment for sepsis.

Published
2022
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27. Discontinuation of Antihypertensive Medications on the Outcome of Hospitalized Patients With Severe Acute Respiratory Syndrome-Coronavirus 2

Author

Singh, Sandeep, primary, Offringa-Hup, Annette K., additional, Logtenberg, Susan J.J., additional, Van der Linden, Paul D., additional, Janssen, Wilbert M.T., additional, Klein, Hubertina, additional, Waanders, Femke, additional, Simsek, Suat, additional, de Jager, Cornelis P.C., additional, Smits, Paul, additional, van der Feltz, Machteld, additional, Jan Beumer, Gerrit, additional, Widrich, Christine, additional, Nap, Martijn, additional, and Pinto-Sietsma, Sara-Joan, additional

Published
2021
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28. Women are started on a lower daily dose of metoprolol than men irrespective of dose recommendations::A potential source of confounding by contraindication in pharmacoepidemiology

Author

Hendriksen, Linda C., Verhamme, Katia M. C., Van der Linden, Paul D., Stricker, Bruno H., Visser, Loes E., Hendriksen, Linda C., Verhamme, Katia M. C., Van der Linden, Paul D., Stricker, Bruno H., and Visser, Loes E.

Abstract

Purpose: Current guidelines have no sex-specific dosage advice for metoprolol. To evalu-ate whether women and men are prescribed the same dose a cohort analysis was per-formed in the population-based Rotterdam Study (RS). Results were replicated in theIntegrated Primary Care Information (IPCI) database of automated general practice data.Methods: The mean daily starting doses of metoprolol in both sexes were comparedwith independent-samples t-tests and a linear regression analysis was used to adjustin the RS for co-variables, notably, cardiovascular comorbidity, migraine, age, SBP,DBP, BMI, socioeconomic status, use of other antihypertensive drugs, smoking, andalcohol. In the IPCI-database, adjustment was for age only.Results: The mean daily starting dose was statistically significantly lower in womenthan in men in both the RS and IPCI database, with a mean difference of 4.8 mg (95%CI −7.8, −1.8) and 4.6 mg (95%CI −5.3,-4.0), respectively. Statistical significanceremained after adjustment in both databases.Conclusions: Women received lower starting doses of metoprolol than men in twoindependent data collections despite non-sex specific cardiovascular guideline rec-ommendations. This example of real-life pharmacotherapy can lead to a form of con-founding by contraindication in pharmacoepidemiology

Published
2021

29. Attributable mortality of antibiotic resistance in Gram-negative infections in the Netherlands: a parallel matched cohort study

Author

Epi Infectieziekten Team 1, Epidemiology & Health Economics, Epi Infectieziekten, MMB, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Rottier, Wouter C, Deelen, J W Timotëus, Caruana, Giorgia, Buiting, Anton G M, Dorigo-Zetsma, J Wendelien, Kluytmans, Jan A J W, van der Linden, Paul D, Thijsen, Steven F T, Vlaminckx, Bart J M, Weersink, Annemarie J L, Ammerlaan, Heidi S M, Bonten, Marc J M, Epi Infectieziekten Team 1, Epidemiology & Health Economics, Epi Infectieziekten, MMB, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Rottier, Wouter C, Deelen, J W Timotëus, Caruana, Giorgia, Buiting, Anton G M, Dorigo-Zetsma, J Wendelien, Kluytmans, Jan A J W, van der Linden, Paul D, Thijsen, Steven F T, Vlaminckx, Bart J M, Weersink, Annemarie J L, Ammerlaan, Heidi S M, and Bonten, Marc J M

Published
2021

30. Short-course aminoglycosides as adjunctive empirical therapy in patients with Gram-negative bloodstream infection, a cohort study

Author

JC onderzoeksprogramma Infectieziekten, Infection & Immunity, Epi Infectieziekten Team 1, MMB, Epidemiology & Health Economics, Epi Infectieziekten, Deelen, J W Timotëus, Rottier, Wouter C, Buiting, Anton G M, Dorigo-Zetsma, J Wendelien, Kluytmans, Jan A J W, van der Linden, Paul D, Thijsen, Steven F T, Vlaminckx, Bart J M, Weersink, Annemarie J L, Ammerlaan, Heidi S M, Bonten, Marc J M, van Werkhoven, Cornelis H, JC onderzoeksprogramma Infectieziekten, Infection & Immunity, Epi Infectieziekten Team 1, MMB, Epidemiology & Health Economics, Epi Infectieziekten, Deelen, J W Timotëus, Rottier, Wouter C, Buiting, Anton G M, Dorigo-Zetsma, J Wendelien, Kluytmans, Jan A J W, van der Linden, Paul D, Thijsen, Steven F T, Vlaminckx, Bart J M, Weersink, Annemarie J L, Ammerlaan, Heidi S M, Bonten, Marc J M, and van Werkhoven, Cornelis H

Published
2021

32. The burden of bacteremic and non-bacteremic Gram-negative infections: a prospective multicenter cohort study in a low-resistance country

Author

Epi Infectieziekten Team 1, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, MMB, MMB KAM, Epi Infectieziekten, Deelen, J W Timotëus, Rottier, Wouter C, van Werkhoven, Cornelis H, Woudt, Sjoukje H S, Buiting, Anton G M, Dorigo-Zetsma, J Wendelien, Kluytmans, Jan A J W, van der Linden, Paul D, Thijsen, Steven F T, Vlaminckx, Bart J M, Weersink, Annemarie J L, Ammerlaan, Heidi S M, Bonten, Marc J M, Epi Infectieziekten Team 1, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, MMB, MMB KAM, Epi Infectieziekten, Deelen, J W Timotëus, Rottier, Wouter C, van Werkhoven, Cornelis H, Woudt, Sjoukje H S, Buiting, Anton G M, Dorigo-Zetsma, J Wendelien, Kluytmans, Jan A J W, van der Linden, Paul D, Thijsen, Steven F T, Vlaminckx, Bart J M, Weersink, Annemarie J L, Ammerlaan, Heidi S M, and Bonten, Marc J M

Published
2020

33. Impact of antimicrobial de-escalation on mortality: a literature review of study methodology and recommendations for observational studies

Author

Epi Infectieziekten Team 1, Infection & Immunity, MMB opleiding Arts microbioloog, Epi Infectieziekten, MMB, JC onderzoeksprogramma Infectieziekten, Van Heijl, Inger, Schweitzer, Valentijn A., van der Linden, Paul D., Bonten, Marc J. M., Van Werkhoven, Cornelis H., Epi Infectieziekten Team 1, Infection & Immunity, MMB opleiding Arts microbioloog, Epi Infectieziekten, MMB, JC onderzoeksprogramma Infectieziekten, Van Heijl, Inger, Schweitzer, Valentijn A., van der Linden, Paul D., Bonten, Marc J. M., and Van Werkhoven, Cornelis H.

Published
2020

34. The burden of bacteremic and non-bacteremic Gram-negative infections: A prospective multicenter cohort study in a low-resistance country

Author

Deelen, J.W. Timotëus, primary, Rottier, Wouter C., additional, van Werkhoven, Cornelis H., additional, Woudt, Sjoukje H.S., additional, Buiting, Anton G.M., additional, Dorigo-Zetsma, J. Wendelien, additional, Kluytmans, Jan A.J.W., additional, van der Linden, Paul D., additional, Thijsen, Steven F.T., additional, Vlaminckx, Bart J.M., additional, Weersink, Annemarie J.L., additional, Ammerlaan, Heidi S.M., additional, and Bonten, Marc J.M., additional

Published
2020
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38. Nieuwe antibiotica: Een overzicht

Author

Lemkes, Bregtje A., Richel, Olivier, Bonten, Marc J., van der Linden, Paul D., Wiersinga, W. Joost, Infectious diseases, ACS - Amsterdam Cardiovascular Sciences, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Center of Experimental and Molecular Medicine, AII - Infectious diseases, and AII - Cancer immunology

Subjects
Medicine(all), biochemical phenomena, metabolism, and nutrition
Abstract

The worldwide rapid increase in antibiotic resistance means that new therapeutic measures are urgently needed. Older antibiotics, such as colistin, fosfomycin, minocycline, mecillinam and temocillin, which had fallen from grace due to the development of more effective and less toxic drugs are now of renewed interest in the treatment of infections caused by multiresistant bacteria. Two new glycopeptides (oritavancin and dalbavancin) and a new oxazolidinone (tedizolid) are now registered for the treatment of acute skin and soft-tissue infections. In the treatment of infections caused by Gram-negative bacteria, cephalosporins are combined with beta-lactamase inhibitors which protect them from various beta-lactamases and also make them effective against extended spectrum beta-lactamase-producing bacteria. Examples of these are ceftolozane-tazobactam, ceftazidime-avibactam and meropenem-vaborbactam. Results of preclinical research on the effectiveness of new antibiotics are hopeful. There has been a great increase in investment in the development of new antimicrobials. Also, regulatory agencies have accelerated their assessment of these new - and urgently needed - drugs.

Published
2019

39. Development of diagnostic prediction tools for bacteraemia caused by 3rd generation cephalosporin-resistant Enterobacteriaceae in suspected bacterial infections: a nested case-control study

Author

Rottier, Wouter C, van Werkhoven, Cornelis H., Bamberg, Yara R P, Dorigo-Zetsma, J Wendelien, van de Garde, Ewoudt M, van Hees, Babette C, Kluytmans, Jan A J W, Kuck, Emile M, Van Der Linden, Paul D., Prins, Jan M., Thijsen, Steven F T, Verbon, Annelies, Vlaminckx, Bart J.M., Ammerlaan, Heidi S M, Bonten, Marc J M, Afd Pharmacoepi & Clinical Pharmacology, and Pharmacoepidemiology and Clinical Pharmacology

Subjects
Risk factors, Enterobacteria, Clinical prediction models, Taverne, Scoring systems, Extended-spectrum β-lactamases, Empirical antibiotic therapy
Abstract

OBJECTIVES: Current guidelines for empiric antibiotic treatment poorly predict the presence of 3rd generation cephalosporin-resistant Enterobacteriaceae bacteraemia (3GCR-E-Bac) as a cause of infection, thereby increasing unnecessary carbapenem use. We aimed to develop diagnostic scoring systems to better predict the presence of 3GCR-E-Bac. METHODS: A retrospective nested case-control study was performed that included patients ≥18 years from eight Dutch hospitals in whom blood cultures were obtained and intravenous antibiotics were initiated. Each patient with 3GCR-E-Bac was matched to four control infection episodes within the same hospital, based on blood culture date and onset location (community or hospital). Starting from 32 commonly described clinical risk factors available at infection onset, selection strategies were used to derive scoring systems for the probability of community- and hospital-onset 3GCR-E-Bac. RESULTS: 3GCR-E-Bac occurred in 90 of 22,506 (0.4%) community-onset and in 82 of 8,110 (1.0%) hospital-onset infections, and these cases were matched to 360 community-onset and 328 hospital-onset control episodes. The derived community-onset and hospital-onset scoring systems consisted of 6 and 9 predictors, respectively. With selected score cutoffs, the models identified 3GCR-E-Bac with equal sensitivity as existing guidelines (community-onset: 54.3%; hospital-onset: 81.5%). Yet, they reduced the proportion of patients classified as at risk for 3GCR-E-Bac (i.e. eligible for empiric carbapenem therapy) with 40% (95% confidence interval 21-56%) and 49% (95% confidence interval 39-58%) in, respectively, community-onset and hospital-onset infection. CONCLUSIONS: These prediction scores for 3GCR-E-Bac, specifically geared towards the initiation of empiric antibiotic treatment, may improve the balance between inappropriate antibiotics and carbapenem overuse.

Published
2018

40. Confounding by indication of the safety of de-escalation in community-acquired pneumonia : A simulation study embedded in a prospective cohort

Author

van Heijl, Inger, Schweitzer, Valentijn A, Boel, C H Edwin, Oosterheert, Jan Jelrik, Huijts, Susanne M, Dorigo-Zetsma, Wendelien, van der Linden, Paul D, Bonten, Marc J M, van Werkhoven, Cornelis H, van Heijl, Inger, Schweitzer, Valentijn A, Boel, C H Edwin, Oosterheert, Jan Jelrik, Huijts, Susanne M, Dorigo-Zetsma, Wendelien, van der Linden, Paul D, Bonten, Marc J M, and van Werkhoven, Cornelis H

Published
2019

41. Confounding by indication of the safety of de-escalation in community-acquired pneumonia: A simulation study embedded in a prospective cohort

Author

Epi Infectieziekten Team 1, Infection & Immunity, MMB opleiding Arts microbioloog, MMB Medische Staf, MS Interne Geneeskunde, Arts Assistenten Longziekten, Epi Infectieziekten, MMB, JC onderzoeksprogramma Infectieziekten, van Heijl, Inger, Schweitzer, Valentijn A, Boel, C H Edwin, Oosterheert, Jan Jelrik, Huijts, Susanne M, Dorigo-Zetsma, Wendelien, van der Linden, Paul D, Bonten, Marc J M, van Werkhoven, Cornelis H, Epi Infectieziekten Team 1, Infection & Immunity, MMB opleiding Arts microbioloog, MMB Medische Staf, MS Interne Geneeskunde, Arts Assistenten Longziekten, Epi Infectieziekten, MMB, JC onderzoeksprogramma Infectieziekten, van Heijl, Inger, Schweitzer, Valentijn A, Boel, C H Edwin, Oosterheert, Jan Jelrik, Huijts, Susanne M, Dorigo-Zetsma, Wendelien, van der Linden, Paul D, Bonten, Marc J M, and van Werkhoven, Cornelis H

Published
2019

42. Nieuwe antibiotica: een overzicht

Author

UMC Utrecht, Epi Infectieziekten, MMB, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Lemkes, Bregtje A., Richel, Olivier, Bonten, Marc J., van der Linden, Paul D., Wiersinga, W. Joost, UMC Utrecht, Epi Infectieziekten, MMB, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Lemkes, Bregtje A., Richel, Olivier, Bonten, Marc J., van der Linden, Paul D., and Wiersinga, W. Joost

Published
2019

47. Confounding by indication of the safety of de-escalation in community-acquired pneumonia: A simulation study embedded in a prospective cohort

Author

van Heijl, Inger, primary, Schweitzer, Valentijn A., additional, Boel, C. H. Edwin, additional, Oosterheert, Jan Jelrik, additional, Huijts, Susanne M., additional, Dorigo-Zetsma, Wendelien, additional, van der Linden, Paul D., additional, Bonten, Marc J. M., additional, and van Werkhoven, Cornelis H., additional

Published
2019
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49. Glucose variability during delirium in diabetic and non-diabetic intensive care unit patients: A prospective cohort study

Author

van Keulen, Kris, Knol, Wilma, Belitser, Svetlana V, Zaal, Irene J, van der Linden, Paul D, Heerdink, Eibert R, Egberts, Toine C G, Slooter, Arjen J C, van Keulen, Kris, Knol, Wilma, Belitser, Svetlana V, Zaal, Irene J, van der Linden, Paul D, Heerdink, Eibert R, Egberts, Toine C G, and Slooter, Arjen J C

Abstract

PURPOSE: To determine whether glucose variability is altered during delirium days compared to non-delirious days in critically ill patients with and without diabetes in the intensive care unit (ICU).MATERIALS AND METHODS: Critically ill patients with delirious and non-delirious days during ICU stay were included from a prospective cohort study which was conducted from January 2011- June 2013. Glucose variability was measured each observation day using various definitions (change in mean glucose, standard deviation, mean absolute glucose, daily delta and occurrence of hypo- and hyperglycemia). Mixed-effects models and generalized mixed-effects models with logit link function were performed to study the association between delirium and glucose variability, adjusting for potential confounders.RESULTS: With the exception of the risk of hypoglycemia, delirium was not linked to higher glucose variability using the various definitions of this estimate. For hypoglycemia, we did find an association with delirium in diabetic patients (OR adj.: 2.78; 95% CI: 1.71-6.32, p = 0.005), but not in non-diabetic patients (OR adj.: 1.16; 95% CI: 0.58-2.28, p = 0.689).CONCLUSIONS: Despite the positive association between delirium and hypoglycemia in critically ill patients with diabetes, delirium was not associated with more pronounced glucose variability. Our findings suggest that glucose levels should be monitored more closely in diabetic patients during delirium at the ICU to prevent hypoglycemia.

Published
2018

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