M C Vos

Erasmus MC, Rotterdam, South Holland, Netherlands

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Publications (98)445.05 Total impact

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    ABSTRACT: We compared the standard procedure of three MRSA follow-up culture sets to six to determine the number of recurrences detected between the third and sixth follow-up culture-set, and studied possible risk factors for MRSA recurrence. A retrospective carrier cohort (2005-2010) was studied. Data was collected on MRSA culture-sets, follow-up, risk factors and outcome (recurrences during follow-up). We compared outcome between three and six follow-up MRSA culture sets, between HCWs and patients groups for complicated or uncomplicated carriers, and between nose-throat carriers and other carriers. Of 406 MRSA carriers, 179 had received eradication therapy and had a negative first follow-up MRSA culture-set. Between the third and sixth follow-up culture-set 54% (35/65) of total recurrences occurred. Over 88% of all recurrences were detected within two months. Combined nose and throat carriage OR 25.5 (1.6-419.1)) and intravascular lines (OR 13.6 (1.2-156.2)) were risk factors for early recurrence. We recommend five culture-sets till one year after successful eradication therapy with a distinction between those at risk for early recurrence and HCWs who require frequent culturing in the beginning and those not at risk for early recurrence. This recommendation is a balance between the need for swift detection of MRSA recurrence and the patients' burden. Copyright © 2015. Published by Elsevier Ltd.
    Journal of Infection 01/2015; DOI:10.1016/j.jinf.2015.01.006 · 4.02 Impact Factor
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    ABSTRACT: The objective of this review was to provide an up-to-date account of the interventions used to prevent the introduction of meticillin-resistant Staphylococcus aureus (MRSA) from the expanding community and livestock reservoirs into hospitals in the USA, Denmark, The Netherlands and Western Australia. A review of existing literature and local guidelines for the management of MRSA in hospitals was performed. In Denmark, The Netherlands and Western Australia, where the prevalence of MRSA is relatively low, targeted admission screening and isolation of predefined high-risk populations have been used for several decades to successfully control MRSA in the hospital. Furthermore, in Denmark and The Netherlands, all identified MRSA carriers undergo routine decolonisation, whereas only carriers of particularly transmissible or virulent MRSA clones are subjected to decolonisation in Western Australia. In the USA, which continues to be a high-prevalence MRSA country, policies vary by state and even by hospital, and whilst guidelines from professional organisations provide a framework for infection control practices, these guidelines lack the authority of a legislative mandate. In conclusion, the changing epidemiology of MRSA, exemplified by the recent emergence of MRSA in the community and in food animals, makes it increasingly difficult to accurately identify specific high-risk groups to screen for MRSA carriage. Understanding the changing epidemiology of MRSA in a local as well as global context is fundamental to prevent the introduction of MRSA into hospitals.
    12/2014; DOI:10.1016/j.jgar.2014.09.003
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    ABSTRACT: Surveillance of hospital-acquired infections can be approximated by repeated surveys that are performed in a standardized, cost-effective manner. We developed an integrated software system for serial electronic hospital-wide point prevalence surveys using algorithms that proved highly sensitive and specific over a 5-year period in a large university medical center.
    Infection Control and Hospital Epidemiology 07/2014; 35(7):888-890. DOI:10.1086/676869 · 3.94 Impact Factor
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    ABSTRACT: In this pilot study, we evaluate an algorithm that uses predictive clinical and laboratory parameters to differentiate between patients with hospital-acquired infection (HAI) and patients without HAI. Seventy-four percent of the studied population of surgical patients could be reliably (negative predictive value of 98%) excluded from detailed assessment by the infection control practitioner.
    Infection Control and Hospital Epidemiology 07/2014; 35(7):886-887. DOI:10.1086/676868 · 3.94 Impact Factor
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    ABSTRACT: A systematic review and meta-analyses were performed to identify the risk factors associated with carbapenem-resistant Pseudomonas aeruginosa and to identify sources and reservoirs for the pathogen. A systematic search of PubMed and EMBASE from January 1(st) 1987 until January 27(th) 2012 identified 1662 articles, 53 of which were included in a systematic review, and 38 in a random effects meta-analyses study. The use of carbapenem, use of fluoroquinolones, use of vancomycin, use of other antibiotics, having medical devices, ICU admission, having underlying diseases, patient characteristics and length of hospital stay were significant risk factors using multivariate analyses. The meta-analyses showed that carbapenem use (OR= 7.09, 95%CI= 5.43-9.25) and medical devices (OR= 5.11, 95%CI= 3.55-7.37) generated the highest pooled estimates. Cumulative meta-analyses showed that the pooled estimate of carbapenem use was stable, and that the pooled estimate of the risk factor medical devices increased with time. We conclude that our results highlight the importance of antibiotic stewardship and the thoughtful use of medical devices in helping prevent outbreaks of carbapenem-resistant P. aeruginosa.
    Antimicrobial Agents and Chemotherapy 02/2014; DOI:10.1128/AAC.01758-13 · 4.57 Impact Factor
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    ABSTRACT: The Dutch Health Care Inspectorate investigated the preparedness of Dutch hospitals for the emergence of antibiotic resistance, and concluded that hospitals are not well prepared and are insufficiently aware that infection prevention is a prerequisite for patient safety. These conclusions are based on observations of process indicators of current practice guidelines, without including the available outcome indicators that demonstrate the persistently low incidence of infections with antibiotic resistant bacteria in Dutch hospitals. The conclusions may have negative effects on the quality of infection prevention in Dutch hospitals. Therefore, it is advisable to use outcome indicators rather than process indicators to evaluate the quality of infection prevention.
    Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7395.
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    ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) has rapidly emerged worldwide, affecting both healthcare and community settings, and intensive livestock industry. The efficient control of MRSA strongly depends on its adequate laboratory detection. This guideline provides recommendations on the appropriate use of currently available diagnostic laboratory methods for the timely and accurate detection of MRSA in patients and healthcare workers. Herewith, it aims to standardise and improve the diagnostic laboratory procedures that are used for the detection of MRSA in Dutch medical microbiology laboratories.
    European Journal of Clinical Microbiology 07/2013; DOI:10.1007/s10096-013-1933-6 · 3.02 Impact Factor
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    06/2013; 2(1). DOI:10.1186/2047-2994-2-S1-O55
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    ABSTRACT: Typing of MRSA remains necessary in order to assess whether transmission of MRSA occurred and to what extend infection prevention measures need to be taken. Raman spectroscopy (SpectraCellRA [SCRA], RiverD International, Rotterdam, The Netherlands) is a recently developed tool for bacterial typing. In this study, the performance (typeability, discriminatory power, reproducibility, workflow and costs) of the SCRA system was evaluated for typing of MRSA strains isolated from patients who were infected with or colonized by MRSA and their household members.We analyzed a well-documented collection of 113 MRSA strains, collected from 54 households. The epidemiological relationship between the MRSA strains within one household was used as the "gold standard". PFGE was used for discrepancy analysis.Results of SCRA analysis on the strain level corresponded with epidemiological data for 108 of 113 strains; a concordance of 95.6%. When results were analyzed at the household level, results of SCRA were correct for 49 out of 54 households; a concordance of 90.7%. Concordance on strain level with epidemiological data for PFGE was 93.6% (103/110 isolates typed). Concordance on household level with epidemiological data for PFGE was 93.5% (49/53 households analyzed). When PFGE is regarded as the reference standard, Raman spectroscopy would come to identical conclusions in 100 of 105 cases (95.2%).Reproducibility of SCRA was found to be 100%.We conclude that the SpectraCellRA system is a fast, easy to use and highly reproducible typing platform for outbreak analysis that can compete with the currently used typing techniques.
    Journal of clinical microbiology 02/2013; DOI:10.1128/JCM.02101-12 · 4.23 Impact Factor
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    ABSTRACT: BACKGROUND: Comparing and ranking hospitals based on health outcomes is becoming increasingly popular, although case-mix differences between hospitals and random variation are known to distort interpretation. The aim of this study was to explore whether surgical-site infection (SSI) rates are suitable for comparing hospitals, taking into account case-mix differences and random variation. METHODS: Data from the national surveillance network in the Netherlands, on the eight most frequently registered types of surgery for the year 2009, were used to calculate SSI rates. The variation in SSI rate between hospitals was estimated with multivariable fixed- and random-effects logistic regression models to account for random variation and case mix. 'Rankability' (as the reliability of ranking) of the SSI rates was calculated by relating within-hospital variation to between-hospital variation. RESULTS: Thirty-four hospitals reported on 13 629 patients, with overall SSI rates per surgical procedure varying between 0 and 15·1 per cent. Statistically significant differences in SSI rate between hospitals were found for colonic resection, caesarean section and for all operations combined. Rankability was 80 per cent for colonic resection but 0 per cent for caesarean section. Rankability was 8 per cent in all operations combined, as the differences in SSI rates were explained mainly by case mix. CONCLUSION: When comparing SSI rates in all operations, differences between hospitals were explained by case mix. For individual types of surgery, case mix varied less between hospitals, and differences were explained largely by random variation. Although SSI rates may be used for monitoring quality improvement within hospitals, they should not be used for ranking hospitals. Copyright © 2013 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
    British Journal of Surgery 01/2013; 100(5). DOI:10.1002/bjs.9039 · 4.84 Impact Factor
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    Infection Control and Hospital Epidemiology 01/2013; 34(1):102-103. DOI:10.1086/668772 · 4.02 Impact Factor
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    ABSTRACT: There is evidence that MRSA ST398 of animal origin is only capable of temporarily occupying the human nose, and it is therefore, often considered a poor human colonizer.We inoculated 16 healthy human volunteers with a mixture of the human MSSA strain 1036 (ST931, CC8) and the bovine MSSA strain 5062 (ST398, CC398), 7 weeks after a treatment with mupirocin and chlorhexidine-containing soap. Bacterial survival was studied by follow-up cultures over 21 days. The human strain 1036 was eliminated faster (median 14 days; range 2-21 days) than the bovine strain 5062 (median 21 days; range 7-21 days) but this difference was not significant (p = 0.065). The bacterial loads were significantly higher for the bovine strain on day 7 and day 21. 4/14 volunteers (28.6%) showed elimination of both strains within 21 days. Of the 10 remaining volunteers, 5 showed no differences in bacterial counts between both strains, and in the other 5 the ST398 strain far outnumbered the human S. aureus strain. Within the 21 days of follow-up, neither human strain 1036 nor bovine strain 5062 appeared to acquire or lose any mobile genetic elements. In conclusion, S. aureus ST398 strain 5062 is capable of adequately competing for a niche with a human strain and survives in the human nose for at least 21 days.
    PLoS ONE 11/2012; 7(11):e48896. DOI:10.1371/journal.pone.0048896 · 3.53 Impact Factor
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    ABSTRACT: A multi centre double-blind randomised-controlled trial (M-RCT), carried out in the Netherlands in 2005-2007, showed that hospitalised patients with S. aureus nasal carriage who were treated prophylactically with mupirocin nasal ointment and chlorhexidine gluconate medicated soap (MUP-CHX), had a significantly lower risk of health-care associated S. aureus infections than patients receiving placebo (3.4% vs. 7.7%, RR 0.42, 95% CI 0.23-0.75). The objective of the present study was to determine whether treatment of patients undergoing elective cardiothoracic or orthopaedic surgery with MUP-CHX (screen-and-treat strategy) affected the costs of patient care. We compared hospital costs of patients undergoing cardiothoracic or orthopaedic surgery (n=415) in one of the participating centres of the M-RCT. Data from the 'Planning and Control' department were used to calculate total hospital costs of the patients. Total costs were calculated including nursing days, costs of surgery, costs for laboratory and radiological tests, functional assessments and other costs. Costs for personnel, materials and overhead were also included. Mean costs in the two treatment arms were compared using the t-test for equality of means (two-tailed). Subgroup analysis was performed for cardiothoracic and orthopaedic patients. An investigator-blinded analysis revealed that costs of care in the treatment arm (MUP-CHX, n=210) were on average €1911 lower per patient than costs of care in the placebo arm (n=205) (€8602 vs. €10513, p=0.01). Subgroup analysis showed that MUP-CHX treated cardiothoracic patients cost €2841 less (n=280, €9628 vs €12469, p=0.006) and orthopaedic patients €955 less than non-treated patients (n=135, €6097 vs €7052, p=0.05). In conclusion, in patients undergoing cardiothoracic or orthopaedic surgery, screening for S. aureus nasal carriage and treating carriers with MUP-CHX results in a substantial reduction of hospital costs.
    PLoS ONE 08/2012; 7(8):e43065. DOI:10.1371/journal.pone.0043065 · 3.53 Impact Factor
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    ABSTRACT: In a prospective observational study of bacteremic patients we ascertained the influence of different parts of culture results on the correctness of empirical antibiotic therapy. Ninety-three bacteremic patients requiring antibiotic treatment were included. Patients who had consultations with an infectious disease consultation service before they became bacteremic received microbiologically correct empirical antibiotic therapy more often than those who did not have such consultations (75% versus 53%; P = 0.03). As a direct result of Gram staining, 92% of all patients received microbiologically correct antibiotic therapy.
    Journal of clinical microbiology 03/2012; 50(6):2066-8. DOI:10.1128/JCM.06051-11 · 4.23 Impact Factor
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  • The Journal of hospital infection 12/2011; 80(2):182-3; author reply 183-4. DOI:10.1016/j.jhin.2011.05.030 · 3.01 Impact Factor
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    ABSTRACT: Public health authorities have recognized lack of hand hygiene in hospitals as one of the important causes of preventable mortality and morbidity at population level. The implementation strategy ACCOMPLISH (Actively Creating COMPLIance Saving Health) targets both individual and environmental determinants of hand hygiene. This study aims to evaluate the cost-effectiveness of a multicomponent implementation strategy aimed at the reduction of healthcare associated infections in Dutch hospital care, by promotion of hand hygiene. The ACCOMPLISH package will be evaluated in a two-arm cluster randomised trial in 16 hospitals in the Netherlands, in one intensive care unit and one surgical ward per hospital. A multicomponent package, including e-learning, team training, introduction of electronic alcohol based hand rub dispensers and performance feedback. The primary outcome measure will be the observed hand hygiene compliance rate, measured at baseline and after 6, 12 and 18 months; as a secondary outcome measure the prevalence of healthcare associated infections will be measured at the same time points. Process indicators of the intervention will be collected pre and post intervention. An ex-post economic evaluation of the ACCOMPLISH package from a healthcare perspective will be performed. Multilevel analysis, using mixed linear modelling techniques will be conducted to assess the effect of the intervention strategy on the overall compliance rate among healthcare workers and on prevalence of healthcare associated infections. Questionnaires on process indicators will be analysed with multivariable linear regression, and will include both behavioural determinants and determinants of innovation. Cost-effectiveness will be assessed by calculating the incremental cost-effectiveness ratio, defined here as the costs for the intervention divided by the difference in prevalence of healthcare associated infections between the intervention and control group. This study is the first RCT to investigate the effects of a hand hygiene intervention programme on the number of healthcare associated infections, and the first to investigate the cost-effectiveness of such an intervention. In addition, if the ACCOMPLISH package proves successful in improving hand hygiene compliance and lowering the prevalence of healthcare associated infections, the package could be disseminated at (inter)national level. NTR2448.
    BMC Public Health 09/2011; 11:721. DOI:10.1186/1471-2458-11-721 · 2.32 Impact Factor
    This article is viewable in ResearchGate's enriched format
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    ABSTRACT: The Netherlands is known for its low methicillin-resistant Staphylococcus aureus (MRSA) prevalence. Yet MRSA with no link to established Dutch risk factors for acquisition, MRSA of unknown origin (MUO), has now emerged and hampers early detection and control by active screening upon hospital admittance. We assessed the magnitude of the problem and determined the differences between MUO and MRSA of known origin (MKO) for CC398 and non-CC398. National MRSA Surveillance data (2008-2009) were analysed for epidemiological determinants and genotypic characteristics (Panton-Valentine leukocidin, spa). A quarter (24%) of the 5545 MRSA isolates registered were MUO, i.e. not from defined risk groups. There are two genotypic MUO groups: CC398 MUO (352; 26%) and non-CC398 MUO (998; 74%). CC398 MUO needs further investigation because it could suggest spread, not by direct contact with livestock (pigs, veal calves), but through the community. Non-CC398 MUO is less likely to be from a nursing home than non-CC398 MKO (relative risk 0.55; 95% CI 0.42-0.72) and Panton-Valentine leukocidin positivity was more frequent in non-CC398 MUO than MKO (relative risk 1.19; 95% CI 1.11-1.29). Exact transmission routes and risk factors for non-CC398 as CC398 MUO remain undefined.
    Clinical Microbiology and Infection 08/2011; 18(7):656-61. DOI:10.1111/j.1469-0691.2011.03662.x · 4.58 Impact Factor
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    ABSTRACT: The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) carriage at hospital admission in The Netherlands was 0.03% in 1999-2000. The aim of the present study was to assess whether the prevalence of MRSA carriage in The Netherlands has changed over the last few years. In five Dutch hospitals, 6496 unique patients were screened for nasal S. aureus carriage at hospital admission by microbiological culture between 1 October 2005 and 7 June 2007. In total, 2036 of 6496 (31.3%) patients carried S. aureus in their nose, and seven of 6496 (0.11%) patients were nasal carriers of MRSA. Compared with 1999-2000, the prevalence of MRSA carriage in the Dutch population at hospital admission has increased more than three fold; however, this increase was not significant (P=0.06, Fisher's exact test). This prevalence is still among the lowest in the world, probably as a result of the stringent Dutch infection control policy, and the restrictive use of antibiotics in The Netherlands.
    The Journal of hospital infection 07/2011; 79(3):198-201. DOI:10.1016/j.jhin.2011.05.009 · 3.01 Impact Factor
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    ABSTRACT: The objectives of this study were to determine the incidence density and the occurrence of horizontal spread of highly resistant gram-negative rods (HR-GNRs) in Dutch hospitals. The factors that influence these outcome measures were also investigated. All patients with HR-GNRs, as determined by sample testing, who were hospitalized in 1 of 18 hospitals during a 6-month period (April through October 2007) were included in this study. For all available isolates, the species was identified, susceptibility was determined (including the presence of extended-spectrum β-lactamases [ESBLs]), and molecular typing was performed. On the basis of a combination of species identification, molecular typing, and epidemiological data, the occurrence of nosocomial transmission was determined. The mean incidence density of patients with HR-GNRs was 55 per 100,000 patient-days (cumulative incidence, 39 per 10,000 patients admitted). A facility being a university hospital was a statistically significant (P = .03) independent determinant of a higher incidence of patients with HR-GNRs. The majority of HR-GNR isolates were ESBL producers. The adjusted transmission index-the ratio between secondary and primary cases-in the participating hospitals ranged from 0.0 to 0.2. The overall adjusted transmission index of HR-GNRs was 0.07. No determinants for a higher transmission index were identified. The nosocomial transmission rate of HR-GNRs was relatively low in all hospitals where well-established transmission-based precautions were used. The incidence density of patients with HR-GNRs was higher in university hospitals, probably due to the patient population and the complexity of the care provided.
    Infection Control and Hospital Epidemiology 04/2011; 32(4):333-41. DOI:10.1086/658941 · 4.02 Impact Factor

Publication Stats

3k Citations
445.05 Total Impact Points

Institutions

  • 2003–2015
    • Erasmus MC
      • • Department of Medical Microbiology and Infectious Diseases
      • • Department of Dermatology
      Rotterdam, South Holland, Netherlands
  • 2013
    • Delft University Of Technology
      • Faculty of Industrial Design Engineering
      Delft, South Holland, Netherlands
  • 2012
    • Amphia Ziekenhui
      Breda, North Brabant, Netherlands
  • 1991–2012
    • Erasmus Universiteit Rotterdam
      • • Department of Medical Microbiology and Infectious Diseases
      • • Department of Internal Medicine
      Rotterdam, South Holland, Netherlands
  • 2009
    • Maastricht Universitair Medisch Centrum
      Maestricht, Limburg, Netherlands
  • 1999
    • Hannover Medical School
      Hanover, Lower Saxony, Germany