-
[show abstract]
[hide abstract]
ABSTRACT: The concurrent presence of bla CTX-M-1 and bla TEM-52 genes on similar plasmids of Escherichia coli isolated from poultry, chicken meat and humans supports the occurrence of food-borne transmission of extended-spectrum beta-lactamase (ESBL) genes. ESBL-producing E. coli (ESBL-E. coli) are most frequently detected in hospitalised patients and are known to spread in healthcare settings. We hypothesised that poultry-associated (PA) ESBL genes are predominant in the community, where acquisition is fuelled by food contamination, whereas non-PA ESBL genes are predominant in hospitals, with acquisition fuelled by cross-transmission. Then, differences in antimicrobial selective pressure in hospitals and poultry would create differences in co-resistance between PA and non-PA ESBL-E. coli. We, therefore, determined the prevalence and co-resistance of PA and non-PA ESBL-E. coli in community-acquired and nosocomial urinary tract infections in humans and bla CTX-M-1 and bla TEM-52 isolates from poultry. A total of 134 human ESBL-E. coli urine isolates were included in this study. Isolates containing bla CTX-M-1 or bla TEM-52 were considered to be PA, with the remainder being non-PA. Also, 72 poultry ESBL-E. coli were included. Minimum inhibitory concentration (MIC) values were determined by broth microdilution. The prevalence of PA ESBL genes in isolates obtained in general practice and hospitals was 28 % versus 30 % (n.s.). Human PA ESBL-E. coli were more frequently susceptible to ciprofloxacin (51 % vs. 25 %; p = 0.0056), gentamicin (86 % vs. 63 %; p = .0.0082), tobramycin (91 % vs. 34 %; p = 0.0001) and amikacin (98 % vs. 67 %; p = 0.0001) compared to human non-PA ESBL-E. coli. PA ESBL-E. coli are not more prevalent in community acquired than nosocomial urine samples, but are more often susceptible to ciprofloxacin and aminoglycosides than non-PA ESBL-E. coli. This does not support the existence of different reservoirs of ESBL genes.
European Journal of Clinical Microbiology 03/2013; · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To determine the efficacy of a short course of oral glucocorticoids in adult patients with acute rhinosinusitis.
A double blind, placebo-controlled, randomized study conducted in 54 general practices in the Netherlands from December 2008 to March 2011 (NTR1295; http://www.trialregister.nl, search for 1295).
Adult patients with acute rhinosinusitis were randomly allocated to treatment with prednisolone 30 mg daily or placebo for 7 days. The primary outcome measure was the percentage of patients with resolution of facial pain or pressure on day 7. Secondary outcomes were time to recovery, median duration of symptoms, health-related quality of life, and reported side effects.
185 patients were randomized (prednisolone: n = 93; placebo: n = 92). Two participants withdrew from the study on day 1 and outcomes from 9 participants could not be included in the analysis because of incomplete data, leaving 174 patients (n = 88 and n = 86, respectively) eligible for intention-to-treat analyses. On day 7, 55/88 (62.5%) of patients in the prednisolone group and 48/86 (55.8%) in the placebo group had resolution of facial pain or pressure (difference: 6.7%; 95% CI: -7.9 to 21.2). There was no difference in the course of symptoms or health-related quality of life between groups. Side effects reported were mild and did not differ between groups.
A short course of oral glucocorticoids seemed to have no clinically relevant beneficial effects in adult patients with acute rhinosinusitis.
Nederlands tijdschrift voor geneeskunde 01/2013; 157(8):A5808.
-
[show abstract]
[hide abstract]
ABSTRACT: To determine costs and effects of selective digestive tract decontamination (SDD) and selective oropharyngeal decontamination (SOD) as compared with standard care (ie, no SDD/SOD (SC)) from a healthcare perspective in Dutch Intensive Care Units (ICUs).
A post hoc analysis of a previously performed cluster-randomised trial (NEJM 2009;360:20).
13 Dutch ICUs.
Patients with ICU-stay of >48 h that received SDD (n=2045), SOD (n=1904) or SC (n=1990).
SDD or SOD. PRIMARY AND SECONDARY OUTCOME MEASURES: Effects were based on hospital survival, expressed as crude Life Years Gained (cLYG). The incremental cost-effectiveness ratio (ICER) was calculated, with corresponding cost acceptability curves. Sensitivity analyses were performed for discount rates, costs of SDD, SOD and mechanical ventilation.
Total costs per patient were €41 941 for SC (95% CI €40 184 to €43 698), €40 433 for SOD (95% CI €38 838 to €42 029) and €41 183 for SOD (95% CI €39 408 to €42 958). SOD and SDD resulted in crude LYG of +0.04 and +0.25, respectively, as compared with SC, implying that both SDD and SOD are dominant (ie, cheaper and more beneficial) over SC. In cost-effectiveness acceptability curves probabilities for cost-effectiveness, compared with standard care, ranged from 89% to 93% for SOD and from 63% to 72% for SDD, for acceptable costs for 1 LYG ranging from €0 to €20 000. Sensitivity analysis for mechanical ventilation and discount rates did not change interpretation. Yet, if costs of the topical component of SDD and SOD would increase 40-fold to €400/day and €40/day (maximum values based on free market prices in 2012), the estimated ICER as compared with SC for SDD would be €21 590 per LYG. SOD would remain cost-saving.
SDD and SOD were both effective and cost-saving in Dutch ICUs.
BMJ open. 01/2013; 3(3).
-
[show abstract]
[hide abstract]
ABSTRACT: Community-acquired pneumonia (CAP) is an important cause of morbidity and mortality worldwide. This review summarises current trends and knowledge gaps in CAP management and prevention. Although Streptococcus pneumoniae is the most frequent cause of CAP, identification of the microbial cause of infection remains unsuccessful in most episodes, and little is known about the aetiology of CAP in immunocompromised patients. Urinary antigen testing has become standard care for diagnosing Legionella infection, and pneumococcal urinary antigen testing is now recommended in the Dutch guidelines to streamline antibiotic therapy in patients hospitalised with CAP. In primary care C-reactive protein determination is recommended to improve antibiotic prescription for lower respiratory tract infections. In patients hospitalised with CAP, three strategies are considered equally effective for choosing empirical antibiotic treatment. Yet, more (and better designed) studies are needed to determine the best strategy, as well as to determine optimal (which usually means the minimum) duration of antibiotic therapy and the role of adjuvant treatment with corticosteroids. The effectiveness of the 23-valent pneumococcal polysaccharide vaccine in preventing invasive pneumococcal disease and pneumococcal CAP remains debated, and whether the newer conjugate vaccines are more effective remains to be determined. Many of these questions are currently being addressed in large-scaled trials in the Netherlands, and their results may allow evidence-based decisions in CAP management and prevention.
The Netherlands Journal of Medicine 10/2012; 70(8):337-48. · 2.07 Impact Factor
-
Clinical Infectious Diseases 07/2012; 55(7):1028-9. · 9.15 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Hepatitis C virus infection is a serious health threat in today's society. Improved identification strategies have increased the number of patients undergoing the expensive treatment with ribavirin and peg-interferon, inducing a substantial economic burden.
In a retrospective cohort study in three treatment centres in the Netherlands, files of patients treated between 2001 and 2010 were systematically searched for all cost-inducing treatment details. Costs of treatment resulting in sustained viral response (SVR), relapse, non-response and the costs per cured patient were specified for genotype and treatment setting. Determinants of costs were determined by multivariate linear regression.
The mean 'real-life' treatment costs excluding side effects for genotype 1/4 and genotype 2/3 were approximately € 12,900 and € 9900 for all patients, € 15,500 and € 10,100 for treatment resulting in SVR and € 16,800 and € 12,100 for relapse, respectively. Costs per cured patient were € 28,500 and € 15,400 respectively. The costs of non-response were approximately € 8000 for all genotypes. Costs of side effects can be high and are mainly caused by incidental treatment for neutropenia. Medication is the main component of treatment costs. Treatment costs were higher in the academic setting due to longer duration and higher costs of side effects. Regression analysis confirms duration as the main determinant of treatment costs excluding side effects.
The 'real-life' costs of treatment are mainly determined by treatment duration, medication costs and costs of side effects. The costs of unsuccessful treatment are considerable as are the costs of side effects. Therefore, future research should aim at increasing SVR rates, reducing treatment duration and preventing side effects.
The Netherlands Journal of Medicine 04/2012; 70(3):145-53. · 2.07 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Selective digestive decontamination (SDD) and selective oropharyngeal decontamination (SOD) are effective in improving survival in patients under intensive care. In this study possible differential effects in surgical and non-surgical patients were investigated.
This was a post hoc subgroup analysis of data from a cluster-randomized multicentre trial comparing three groups (SDD, SOD or standard care) to quantify effects among surgical and non-surgical patients. The primary study outcome was 28-day mortality rate. Duration of mechanical ventilation, duration of intensive care unit (ICU) and hospital length of stay, and bacteraemia rates were secondary outcomes.
The subgroup analyses included a total of 2762 surgical and 3165 non-surgical patients. Compared with standard care, adjusted odds ratios (ORs) for mortality were comparable in SDD-treated surgical and non-surgical patients: 0·86 (95 per cent confidence interval 0·69 to 1·09; P = 0·220) and 0·85 (0·70 to 1·03; P = 0·095) respectively. However, duration of mechanical ventilation, ICU stay and hospital stay were significantly reduced in surgical patients who had SDD. SOD did not reduce mortality compared with standard treatment in surgical patients (adjusted OR 0·97, 0·77 to 1·22; P = 0·801); in non-surgical patients it reduced mortality (adjusted OR 0·77, 0·63 to 0·94; P = 0·009) by 16·6 per cent, representing an absolute mortality reduction of 5·5 per cent with number needed to treat of 18.
Subgroup analysis found similar effects of SDD in reducing mortality in surgical and non-surgical ICU patients, whereas SOD reduced mortality only in non-surgical patients. The hypothesis-generating findings mandate investigation into mechanisms between different ICU populations.
British Journal of Surgery 02/2012; 99(2):232-7. · 4.61 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: There have recently been 12 outbreaks of infection caused by vancomcyin-resistant enterococci (VRE) in Dutch hospitals. Although the first VRE outbreaks were reported almost 12 years ago, such outbreaks remained uncommon and the question is why they are occurring now. Based on molecular epidemiological studies we have learned that a subpopulation of Enterococcus faecium, resistant to amoxicillin but susceptible to vancomycin, has become highly endemic in Dutch hospitals in the past 12 years. Initial analyses suggest that several transposons containing vancomycin-resistance genes have been introduced into this population, followed by nosocomial spread. We recommend that hospitals without detected VRE outbreaks screen high-risk patients for the presence of VRE. If transmission has already occurred in many hospitals, it will be extremely difficult (and costly) to eradicate VRE.
Nederlands tijdschrift voor geneeskunde 01/2012; 156(38):A5233.
-
[show abstract]
[hide abstract]
ABSTRACT: Clin Microbiol Infect ABSTRACT: This study aimed to evaluate the routine setting performance of a guideline for phenotypic detection of extended spectrum β-lactamases (ESBLs) in Enterobacteriaceae, recommending ESBL confirmation with Etest or combination disc for isolates with a positive ESBL screen test (i.e. cefotaxime and/or ceftazidime MIC >1 mg/L or an automated system ESBL warning). Twenty laboratories submitted 443 Enterobacteriaceae with a positive ESBL screen test and their confirmation test result (74%Escherichia coli, 12%Enterobacter cloacae, 8%Klebsiella pneumoniae, 3%Proteus mirabilis, 2%Klebsiella oxytoca). Presence of ESBL genes was used as reference test. Accuracy of local phenotypic ESBL detection was 88%. The positive predictive value (PPV) of local screen tests was 70%, and differed per method (Vitek-2: 69%, Phoenix: 68%, disc diffusion: 92%), and species (95%K. pneumoniae-27%K. oxytoca). A low PPV (3%) was observed for isolates with automated system alarm but third-generation cephalosporin MICs <2 mg/L. Local ESBL confirmation had a PPV and negative predictive value (NPV) of 93% and 90%, respectively. Compared with centrally performed confirmation tests, 7% of local tests were misinterpreted. Combination disc was more specific than Etest (91% versus 61%). Confirmation tests were not reliable for P. mirabilis and K. oxytoca (PPV 33% and 38%, respectively, although NPVs were 100%). In conclusion, performance of Etests could be enhanced by education of technicians to improve their interpretation, by genotypic ESBL confirmation of P. mirabilis and K. oxytoca isolates with positive phenotypic ESBL confirmation, and by interpreting isolates with a positive ESBL alarm but an MIC <2 mg/L for cefotaxime and ceftazidime as ESBL-negative.
Clinical Microbiology and Infection 11/2011; · 4.54 Impact Factor
-
M W M Wassenberg,
J A J W Kluytmans,
R W Bosboom,
A G M Buiting,
E P M van Elzakker,
W J G Melchers,
S F T Thijsen,
A Troelstra,
C M J E Vandenbroucke-Grauls,
C E Visser,
A Voss,
P F G Wolffs,
M W H Wulf,
A A van Zwet,
G A de Wit, M J M Bonten
[show abstract]
[hide abstract]
ABSTRACT: Multiple body site screening and pre-emptive isolation of patients at risk for methicillin-resistant Staphylococcus aureus (MRSA) carriage are considered essential for control of nosocomial spread. The relative importance of extranasal screening when using rapid diagnostic testing (RDT) is unknown. Using data from a multicentre study evaluating BD GeneOhm™ MRSA PCR (IDI), Xpert MRSA (GeneXpert) and chromogenic agar, added to conventional cultures, we determined cost-effectiveness assuming isolation measures would have been based on RDT results of different hypothetical screening regimes. Costs per isolation day avoided were calculated for regimes with single or less extensive multiple site RDT, regimes without conventional back-up cultures and when PCR would have been performed with pooling of swabs. Among 1764 patients at risk, MRSA prevalence was 3.3% (n = 59). In all scenarios the negative predictive value is above 98.4%. With back-up cultures of all sites as a reference, the costs per isolation day avoided were €15.19, €30.83 and €45.37 with 'nares only' screening using chromogenic agar, IDI and GeneXpert, respectively, as compared with €19.95, €95.77 and €125.43 per isolation day avoided when all body sites had been screened. Without back-up cultures costs per isolation day avoided using chromogenic agar would range from €9.24 to €76.18 when costs per false-negative RDT range from €5000 up to €50 000; costs for molecular screening methods would be higher in all scenarios evaluated. In conclusion, in a low endemic setting chromogenic agar screening added to multiple site conventional cultures is the most cost-effective MRSA screening strategy.
Clinical Microbiology and Infection 03/2011; 17(11):1704-10. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Studies suggest that infection with highly prevalent Pseudomonas aeruginosa clones in cystic fibrosis (CF) is associated with an unfavourable clinical outcome. We studied the clinical characteristics of patients infected with a recently described, highly prevalent P. aeruginosa clone (ST406) in two CF centres in The Netherlands. Multilocus sequence typing data were available for 219 patients, of whom 40 (18.3%) were infected with ST406 and 179 with other sequence types. ST406 infection was independently associated with age, having a sibling with ST406 infection and use of inhaled antibiotics, but not with unfavourable clinical outcome, suggesting that high transmissibility is not necessarily associated with high virulence.
Clinical Microbiology and Infection 03/2011; 17(3):382-5. · 4.54 Impact Factor
-
M A Leverstein-van Hall,
C M Dierikx,
J Cohen Stuart,
G M Voets,
M P van den Munckhof,
A van Essen-Zandbergen,
T Platteel,
A C Fluit,
N van de Sande-Bruinsma,
J Scharinga, M J M Bonten,
D J Mevius
[show abstract]
[hide abstract]
ABSTRACT: Intestinal carriage of extended-spectrum beta-lactamase (ESBL) -producing bacteria in food-producing animals and contamination of retail meat may contribute to increased incidences of infections with ESBL-producing bacteria in humans. Therefore, distribution of ESBL genes, plasmids and strain genotypes in Escherichia coli obtained from poultry and retail chicken meat in the Netherlands was determined and defined as 'poultry-associated' (PA). Subsequently, the proportion of E. coli isolates with PA ESBL genes, plasmids and strains was quantified in a representative sample of clinical isolates. The E. coli were derived from 98 retail chicken meat samples, a prevalence survey among poultry, and 516 human clinical samples from 31 laboratories collected during a 3-month period in 2009. Isolates were analysed using an ESBL-specific microarray, sequencing of ESBL genes, PCR-based replicon typing of plasmids, plasmid multi-locus sequence typing (pMLST) and strain genotyping (MLST). Six ESBL genes were defined as PA (bla(CTX-M-1) , bla(CTX-M-2) , bla(SHV-2) , bla(SHV-12) , bla(TEM-20) , bla(TEM-52) ): 35% of the human isolates contained PA ESBL genes and 19% contained PA ESBL genes located on IncI1 plasmids that were genetically indistinguishable from those obtained from poultry (meat). Of these ESBL genes, 86% were bla(CTX-M-1) and bla(TEM-52) genes, which were also the predominant genes in poultry (78%) and retail chicken meat (75%). Of the retail meat samples, 94% contained ESBL-producing isolates of which 39% belonged to E. coli genotypes also present in human samples. These findings are suggestive for transmission of ESBL genes, plasmids and E. coli isolates from poultry to humans, most likely through the food chain.
Clinical Microbiology and Infection 02/2011; 17(6):873-80. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: On account of the serious complications of hepatitis C virus (HCV) infection and the improved treatment possibilities, the need to improve HCV awareness and case-finding is increasingly recognized. To optimize a future national campaign with this objective, three pilot campaigns were executed in three regions in The Netherlands. One campaign was aimed at the general population, a second (similar) campaign was extended with a support programme for primary care and a third campaign was specifically aimed at hard-drug users. Data from the pilot campaigns were used to build a mathematical model to estimate the incremental cost-effectiveness ratio of the different campaigns. The campaign aimed at the general public without support for primary care did not improve case-finding and was therefore not cost-effective. The similar campaign accompanied by additional support for primary care and the campaign aimed at hard-drug users emerged as cost-effective interventions for identification of HCV carriers.
Epidemiology and Infection 02/2011; 140(1):58-69. · 2.84 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The increasing incidence of coagulase-negative staphylococci (CoNS) in hospital-acquired infections underlines the need for an accurate and simple identification of Staphylococcus isolates at the species level. Sequencing of the tuf gene has been shown to be the most accurate for the species identification of CoNS. We determined the species of 62 consecutive clinical and 31 reference CoNS isolates by tuf gene sequencing and matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF-MS). Species assignment by MALDI-TOF-MS and tuf sequencing was congruent in all cases. We conclude that MALDI-TOF-MS is accurate for identifying CoNS in routine clinical practice. The study also identified an unexpectedly high number of cases of Staphylococcus capitis infections among 62 consecutive CoNS isolates in 2009 at the University Medical Center Utrecht, the Netherlands.
European Journal of Clinical Microbiology 02/2011; 30(10):1169-72. · 2.86 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: We quantified nosocomial transmission rates of sequence type (ST) 398 methicillin-resistant Staphylococcus aureus (MRSA) (an emerging livestock-associated MRSA clone) and non-ST398 MRSA isolates in patients hospitalized without infection control measures in 51 Dutch hospitals. Identification of 174 index patients initiated 139 post-exposure screenings of 9925 persons. There were 65 genotype-confirmed secondary cases (three and 62 for ST398 and non-ST398 MRSA, respectively), yielding a relative transmission risk for ST398 MRSA of 0.28 (95% CI 0.09-0.90), which was not sensitive to adjustment for duration of hospitalization at time of detection. Nosocomial transmission of ST398 MRSA is 72% less likely than that of non-ST398 MRSA strains.
Clinical Microbiology and Infection 05/2010; 17(2):316-9. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Unintended negative effects, such as anxiety and depression, have been demonstrated in patients subjected to infection control strategies, such as isolation for long periods. Yet isolation precautions are mostly short-term. We therefore determined levels of anxiety, depression and quality of life in patients exposed to short-term isolation. In a cross-sectional matched cohort study, performed in a single university hospital, patients isolated for infection control were evaluated with the Hospital Anxiety and Depression Scale [HADS-A (Anxiety) and HADS-D (Depression)], Visual Analogue Scale of EQ-5D (EQ VAS) and an isolation evaluation questionnaire within 24-48 h after start of isolation. Two matched controls were selected for each isolated patient. Isolated patients (N=42) and control patients (N=84) had comparable HADS-A (4.5 vs 5.0), HADS-D (4.0 vs 5.0) and EQ VAS (65 vs 62) scores. In multiple regression analysis comorbidity was associated with EQ VAS outcome (P=0.005), whereas all other variables, including being in isolation, were unrelated to HADS and EQ VAS scores. Patients reported positive associations with isolation measures. The quality of care provided by physicians and nurses, as perceived by isolated patients, was not negatively affected in 74% and 71% of patients, respectively. In conclusion, short-term infection control measures do not influence hospitalised patients' levels of anxiety and depression and quality of life. Isolated patients had a positive attitude towards the precautions taken.
The Journal of hospital infection 04/2010; 75(2):124-7. · 3.01 Impact Factor
-
M W M Wassenberg,
J A J W Kluytmans,
A T A Box,
R W Bosboom,
A G M Buiting,
E P M van Elzakker,
W J G Melchers,
M M L van Rijen,
S F T Thijsen,
A Troelstra,
C M J E Vandenbroucke-Grauls,
C E Visser,
A Voss,
P F G Wolffs,
M W H Wulf,
A A van Zwet,
G A de Wit, M J M Bonten
[show abstract]
[hide abstract]
ABSTRACT: Pre-emptive isolation of suspected methicillin-resistant Staphylococcus aureus (MRSA) carriers is considered essential for controlling the spread of MRSA, but noncolonized patients will be isolated unnecessarily as a result of a delay in diagnosis of 3-5 days with conventional cultures. We determined costs per isolation day avoided, and incremental costs of rapid MRSA screening tests when added to conventional screening, but with decisions on isolation measures based on PCR results. A prospective multicentre study evaluating BD GeneOhm MRSA PCR (`IDI') (BD Diagnostics, San Diego, CA, USA), Xpert MRSA (`GeneXpert') (Cepheid, Sunnyvale, CA, USA) and chromogenic agar (MRSA-ID) (bioMérieux, Marcy-l'Etoile, France) was performed in 14 Dutch hospitals. Among 1764 patients at risk, MRSA prevalence was 3.3% (n=59). Duration of isolation was 19.7 and 16.1 h with IDI and GeneXpert, respectively, and would have been 30.0 and 76.2 h when based on chromogenic agar and conventional cultures, respectively. Negative predictive values (at a patient level) were 99.5%, 99.1% and 99.5% for IDI, GeneXpert and chromogenic agar, respectively. Numbers of isolation days were reduced by 60% and 47% with PCR-based and chromogenic agar-based screening, respectively. The cost per test was €56.22 for IDI, €69.62 for GeneXpert and €2.08 for chromogenic agar, and additional costs per extra isolation day were €26.34. Costs per isolation day avoided were €95.77 (IDI) and €125.43 (GeneXpert). PCR-based decision-making added €153.64 (IDI) and €193.84 (GeneXpert) per patient to overall costs and chromogenic testing would have saved €30.79 per patient. Rapid diagnostic testing safely reduces the number of unnecessary isolation days, but only chromogenic screening, and not PCR-based screening, can be considered as cost saving.
Clinical Microbiology and Infection 03/2010; 16(12):1754-61. · 4.54 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Antibiotic resistance poses a serious threat to the successful treatment of hospitalized patients. Micro-organisms that produce carbapenamases, such as Klebsiella pneumoniae carbapenamases (KPCs) represent the next step in the continuously emerging problem of antibiotic resistance. Restrictions on antibiotic use plus optimal adherence to infection control measures will be crucial to limit the spread of KPC in hospitals in the Netherlands in the coming years.
Nederlands tijdschrift voor geneeskunde 01/2010; 154:A1947.
-
[show abstract]
[hide abstract]
ABSTRACT: In this evidence-based case report we studied the clinical question: Does intranasal corticosteroid (INCS) monotherapy reduce time to recovery in adults with acute noncomplicated rhinosinusitis? The search yielded 490 papers, of which only two were relevant and had a high validity regarding our clinical question. (copyright) 2010 American Academy of Otolaryngology-Head and Neck Surgery Foundation
Otolaryngology - Head and Neck Surgery. 01/2010; 142(6).
-
[show abstract]
[hide abstract]
ABSTRACT: Nosocomial, or hospital-acquired
, infections are an important cause of morbidity and mortality in health-care settings. Within hospitals, we find a gathering
of patients with a weakened immune system, who receive all kinds of treatment that may even further weaken host defense mechanisms
and that may break natural barriers against pathogens by surgery or by inserting intravascular lines. In such circumstances,
even microorganisms that are generally considered harmless may cause fulminate infections.
12/2009: pages 395-407;
