| 1. |
- van de Sande-Bruinsma, Nienke, et al.
(author)
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Antimicrobial drug use and resistance in Europe
- 2008
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In: Emerging Infectious Diseases. - : Centers for Disease Control and Prevention (CDC). - 1080-6040 .- 1080-6059. ; 14:11, s. 1722-30
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Journal article (peer-reviewed)abstract
- Our study confronts the use of antimicrobial agents in ambulatory care with the resistance trends of 2 major pathogens, Streptococcus pneumoniae and Escherichia coli, in 21 European countries in 2000-2005 and explores whether the notion that antimicrobial drug use determines resistance can be supported by surveillance data at national aggregation levels. The data obtained from the European Surveillance of Antimicrobial Consumption and the European Antimicrobial Resistance Surveillance System suggest that variation of consumption coincides with the occurrence of resistance at the country level. Linear regression analysis showed that the association between antimicrobial drug use and resistance was specific and robust for 2 of 3 compound pathogen combinations, stable over time, but not sensitive enough to explain all of the observed variations. Ecologic studies based on routine surveillance data indicate a relation between use and resistance and support interventions designed to reduce antimicrobial drug consumption at a national level in Europe.
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| 2. |
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| 3. |
- Aerts, Olivier, et al.
(author)
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Isobornyl Acrylate
- 2020
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In: Dermatitis. - 1710-3568. ; 31:1, s. 4-12
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Journal article (peer-reviewed)abstract
- Multidisciplinary collaboration between several European dermatology departments has identified isobornyl acrylate (IBOA; CAS 5888-33-5), once deemed a low-risk sensitizer, as a major culprit contact allergen in glucose sensors and insulin pumps, medical devices used by diabetes patients worldwide. Although the patch test modalities of IBOA have been fairly well characterized, intriguing questions remain. For example, its cross-reactive profile to other acrylates remains to be determined, and the striking occurrence of concomitant positive patch test reactions to sesquiterpene lactones needs to be further elucidated. Importantly, the path to its discovery as a contact sensitizer in diabetes devices and the difficulties that were associated with this quest illustrate that apparent difficulties in obtaining sufficient cooperation from the medical device industry may seriously hamper the correct workup of cases of allergic contact dermatitis. The IBOA saga will convince companies to lend more cooperation to dermatologists and policymakers to side with patients and physicians when it comes to updating medical device regulations, including the compulsory labeling of medical devices in general and of diabetes devices in particular.
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| 4. |
- Anguille, Sébastien, et al.
(author)
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Dendritic cell vaccination as postremission treatment to prevent or delay relapse in acute myeloid leukemia
- 2017
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In: Blood. - : American Society of Hematology. - 0006-4971 .- 1528-0020. ; 130:15, s. 1713-1721
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Journal article (peer-reviewed)abstract
- Relapse is a major problem in acute myeloid leukemia (AML) and adversely affects survival. In this phase 2 study, we investigated the effect of vaccination with dendritic cells (DCs) electroporated with Wilms’ tumor 1 (WT1) messenger RNA (mRNA) as postremission treatment in 30 patients with AML at very high risk of relapse. There was a demonstrable antileukemic response in 13 patients. Nine patients achieved molecular remission as demonstrated by normalization of WT1 transcript levels, 5 of which were sustained after a median follow-up of 109.4 months. Disease stabilization was achieved in 4 other patients. Five-year overall survival (OS) was higher in responders than in nonresponders (53.8% vs 25.0%; P 5 .01). In patients receiving DCs in first complete remission (CR1), there was a vaccine-induced relapse reduction rate of 25%, and 5-year relapse-free survival was higher in responders than in nonresponders (50% vs 7.7%; P < .0001). In patients age £65 and >65 years who received DCs in CR1, 5-year OS was 69.2% and 30.8% respectively, as compared with 51.7% and 18% in the Swedish Acute Leukemia Registry. Long-term clinical response was correlated with increased circulating frequencies of polyepitope WT1-specific CD81 T cells. Long-term OS was correlated with interferon-g1 and tumor necrosis factor-a1 WT1-specific responses in delayed-type hypersensitivity-infiltrating CD81 T lymphocytes. In conclusion, vaccination of patients with AML with WT1 mRNA-electroporated DCs can be an effective strategy to prevent or delay relapse after standard chemotherapy, translating into improved OS rates, which are correlated with the induction of WT1-specific CD81 T-cell response. This trial was registered at www.clinicaltrials.gov as #NCT00965224.
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| 5. |
- Bachmann, Till T., et al.
(author)
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Expert guidance on target product profile development for AMR diagnostic tests
- 2023
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In: BMJ Global Health. - : BMJ Publishing Group. - 2059-7908. ; 8:12
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Journal article (peer-reviewed)abstract
- Diagnostics are widely considered crucial in the fight against antimicrobial resistance (AMR), which is expected to kill 10 million people annually by 2030. Nevertheless, there remains a substantial gap between the need for AMR diagnostics versus their development and implementation. To help address this problem, target product profiles (TPP) have been developed to focus developers’ attention on the key aspects of AMR diagnostic tests. However, during discussion between a multisectoral working group of 51 international experts from industry, academia and healthcare, it was noted that specific AMR-related TPPs could be extended by incorporating the interdependencies between the key characteristics associated with the development of such TPPs. Subsequently, the working group identified 46 characteristics associated with six main categories (ie, Intended Use, Diagnostic Question, Test Description, Assay Protocol, Performance and Commercial). The interdependencies of these characteristics were then identified and mapped against each other to generate new insights for use by stakeholders. Specifically, it may not be possible for diagnostics developers to achieve all of the recommendations in every category of a TPP and this publication indicates how prioritising specific TPP characteristics during diagnostics development may influence (or not) a range of other TPP characteristics associated with the diagnostic. The use of such guidance, in conjunction with specific TPPs, could lead to more efficient AMR diagnostics development.
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| 6. |
- Becker, Holger, et al.
(author)
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Microfluidic system for the identification of bacterial pathogens causing urinary tract infections
- 2015
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In: Microfluidics, BioMEMS, and Medical Microsystems XIII. - : SPIE - International Society for Optical Engineering. - 9781628414103
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Conference paper (peer-reviewed)abstract
- Urinary tract infections (UTIs) are among the most common bacterial infections and pose a significant healthcare burden. The growing trend in antibiotic resistance makes it mandatory to develop diagnostic kits which allow not only the determination of a pathogen but also the antibiotic resistances. We have developed a microfluidic cartridge which takes a direct urine sample, extracts the DNA, performs an amplification using batch-PCR and flows the sample over a microarray which is printed into a microchannel for fluorescence detection. The cartridge is injection-molded out of COP and contains a set of two-component injection-molded rotary valves to switch between input and to isolate the PCR chamber during thermocycling. The hybridization probes were spotted directly onto a functionalized section of the outlet microchannel. We have been able to successfully perform PCR of E. coli in urine in this chip and perform a fluorescence detection of PCR products. An upgraded design of the cartridge contains the buffers and reagents in blisters stored on the chip.
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| 7. |
- Butler, Christopher, et al.
(author)
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Antibiotica voor acute hoest: het voorschrijfgedrag van huisartsen in dertien Europese landen [Antibiotics in case of acute cough: Prescribing habits of general practitioners in 13 European countries]
- 2009
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In: Huisarts en Wetenschap. - 0018-7070 .- 1876-5912. ; 52:12, s. 571-575
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Journal article (peer-reviewed)abstract
- Doel Ons doel was in kaart te brengen hoe vaak huisartsen in verschillende Europese landen antibiotica voorschrijven voor acute hoest, en welk effect dit heeft op het ziektebeloop.Methode Wij verrichtten een cross-sectioneel prospectief observationeel onderzoek onder volwassen patiënten in 13 Europese landen die met een nieuwe of verergerende hoest bij de huisarts kwamen of bij wie de huisarts een infectie van de lage luchtwegen vermoedde. De huisartsen noteerden bij presentatie de symptomen en welk beleid zij volgden, de patiënten hielden 28 dagen een symptoomdagboek bij. Onze primaire uitkomstmaten waren het voorschrijven van antibiotica en het beloop van de symptomen in de tijd.Resultaten Aan het onderzoek namen 384 huisartsen deel, die 3402 patiënten includeerden. Van 3296 (97%) patiënten ontvingen de onderzoekers een volledig registratieformulier en van 2560 (75%) patiënten een compleet symptoomdagboek. De ernst van de symptomen bij presentatie (gescoord door de huisarts op een schaal van 0 tot 100) varieerde van 19 in Spanje en Italië tot 38 in Zweden. In gemiddeld 53% van de episoden schreven de artsen antibiotica voor, maar dit varieerde per land van 20% tot bijna 90% (België 25,9%, Nederland 41,5%). Ook na correctie voor klinische presentatie en demografische kenmerken bleven de verschillen aanzienlijk. Noorse huisartsen schreven het minst vaak antibiotica voor (OR 0,18; 95%-BI 0,11 tot 0,30), Slowaakse het vaakst (OR 11,2; 95%-BI 6,20 tot 20,27). Ook het soort antibioticum varieerde sterk. Amoxicilline, het meest voorgeschreven middel, werd in Noorwegen het minst vaak gegeven (3% van de voorgeschreven antibiotica), in Engeland het vaakst (83%). Fluorochinolonen werden in sommige landen helemaal niet voorgeschreven, maar in Italië aan 18% van de patiënten. Patiënten die geen antibiotica kregen, herstelden nagenoeg even snel als patiënten die wel antibiotica kregen.Conclusie De variatie in de klinische presentatie biedt geen verklaring voor de grote verschillen in het voorschrijven van antibiotica bij lageluchtweginfecties en/of hoest in Europa. Antibiotica hebben nauwelijks invloed op het herstel van de hoestklachten.
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| 8. |
- Butler, Christopher C, et al.
(author)
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Treatment of acute cough/lower respiratory tract infection by antibiotic class and associated outcomes: a 13 European country observational study in primary care
- 2010
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In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. - : Oxford University Press. - 0305-7453 .- 1460-2091. ; 65:11, s. 2472-2478
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Journal article (peer-reviewed)abstract
- Acute cough/lower respiratory tract infection (LRTI) is one of the commonest reasons for consulting and antibiotic prescribing. There are theoretical reasons why treatment with particular antibiotic classes may aid recovery more than others, but empirical, pragmatic evidence is lacking. We investigated whether treatment with a particular antibiotic class (amoxicillin) was more strongly associated with symptom score resolution and time to patients reporting recovery than each of eight other antibiotic classes or no antibiotic treatment for acute cough/LRTI. Clinicians recorded history, examination findings, symptom severity and antibiotic treatment for 3402 patients in a 13 country prospective observational study of adults presenting in 14 primary care research networks with acute cough/LRTI. 2714 patients completed a symptom score daily for up to 28 days and recorded the day on which they felt recovered. A three-level autoregressive moving average model (1,1) model investigated logged daily symptom scores to analyse symptom resolution. A two-level survival model analysed time to reported recovery. Clinical presentation was controlled for using clinician-recorded symptoms, sputum colour, temperature, age, co-morbidities, smoking status and duration of illness prior to consultation. Compared with amoxicillin, no antibiotic class (and no antibiotic treatment) was associated with clinically relevant improved symptom resolution (all coefficients in the range -0.02 to 0.01 and all P values greater than 0.12). No antibiotic class (and no antibiotic treatment) was associated with faster time to recovery than amoxicillin. Treatment by antibiotic class was not associated with symptom resolution or time to recovery in adults presenting to primary care with acute cough/LRTI.
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| 9. |
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| 10. |
- Fokkens, Wytske J., et al.
(author)
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EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists
- 2012
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In: Rhinology. - 0300-0729. ; 50:1, s. 1-12
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Journal article (peer-reviewed)abstract
- The European Position Paper on Rhinosinusitis and Nasal Polyps 2012 is the update of similar evidence based position papers published in 2005 and 2007. The document contains chapters on definitions and classification, we now also propose definitions for 'difficult to treat' rhinosinusitis, control of disease and better definitions for rhinosinusitis in children. More emphasis is placed on the diagnosis and treatment of acute rhinosinusitis. Throughout the document the terms chronic rhinosinusitis without nasal polyps (CRSsNP) and chronic rhinosinusitis with nasal polyps (CRSwNP) are used to further point out differences in pathophysiology and treatment of these two entities. There are extensive chapters on epidemiology and predisposing factors, inflammatory mechanisms, (differential) diagnosis of facial pain, genetics, cystic fibrosis, aspirin exacerbated respiratory disease, immunodeficiencies, allergic fungal rhinosinusitis and the relationship between the upper and lower airways. The chapters on paediatric acute and chronic rhinosinusitis are totally rewritten. Last but not least all available evidence for management of acute rhinosinusitis and chronic rhinosinusitis with or without nasal polyps in adults and children is analyzed and presented and management schemes based on the evidence are proposed. This executive summary for otorhinolaryngologists focuses on the most important changes and issues for otorhinolaryngologists.
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| 11. |
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| 12. |
- Herman, Anne, et al.
(author)
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Allergic contact dermatitis caused by isobornyl acrylate in Freestyle® Libre, a newly introduced glucose sensor
- 2017
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In: Contact Dermatitis. - : Wiley. - 0105-1873. ; 77:6, s. 367-373
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Journal article (peer-reviewed)abstract
- Background: Glucose sensors, such as FreeStyle® Libre, are innovative medical devices developed for diabetes patients as a replacement for classic glucose meters, ensuring continuous glucose monitoring without the disadvantage of regular skin finger pricks. Objectives: To report several cases of allergic contact dermatitis caused by FreeStyle® Libre, and to report on isobornyl acrylate as a culprit allergen. Patients and Methods: Fifteen patients presented with allergic contact dermatitis caused by FreeStyle® Libre. All but 1 were patch tested with a baseline series, and with pieces and/or ultrasonic bath extracts of (the adhesive part of) the glucose sensor. Isobornyl acrylate was patch tested, in various concentrations and vehicles, in 13 patients. Gas chromatography–mass spectrometry (GC-MS) of the sensors was performed. Results: All patients reacted to the adhesive part of the sensor, and 12 patients were shown to be sensitized to isobornyl acrylate. Simultaneous reactions to other allergens were rarely observed. GC-MS showed the presence of isobornyl acrylate in the sensors. Conclusions: Cases of allergic contact dermatitis caused by FreeStyle® Libre are increasingly being observed, and isobornyl acrylate is a relevant culprit allergen. Cross-reactivity to other acrylates was infrequently observed, but other, hitherto unidentified, contact allergens may still be present in the device.
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| 13. |
- Herman, Anne, et al.
(author)
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Allergic contact dermatitis caused by isobornyl acrylate in the Enlite glucose sensor and the Paradigm MiniMed Quick-set insulin infusion set
- 2019
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In: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 81:6, s. 432-437
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Journal article (peer-reviewed)abstract
- Background: The FreeStyle Libre glucose sensor has caused many cases of allergic contact dermatitis, and isobornyl acrylate (IBOA) in this sensor has been identified as one of the culprit allergens. Objectives: To report on the presence of IBOA in devices produced by Medtronic, namely, Enlite sensor and insulin infusion set Paradigm MiniMed Quick-set. Patients and Methods: Five patients reacting to the glucose sensor Enlite and/or the insulin infusion set Paradigm MiniMed Quick-set observed in three clinics (two Belgian and one Swedish) were patch tested with the baseline and other series, as well as with IBOA; four of them also with pieces of adhesive patches from the devices, and two with a thin layer chromatogram of Enlite glucose sensor extracts. Gas chromatography-mass spectrometry (GC-MS) analyses were performed. Results: Four patients reacted to IBOA and one to colophonium, a known allergen in Enlite, and three to the adhesive part of the sensor or the insulin infusion set. IBOA was identified in the sensor by GC-MS, and its presence was indicated in the infusion set. Conclusions: IBOA is a contact allergen in Enlite glucose sensor, and likely also in the infusion set. Therefore, these devices are not suitable alternatives for patients sensitized to the FreeStyle Libre sensor.
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| 14. |
- Herman, Anne, et al.
(author)
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The preservative 2-(thiocyanomethylthio)benzothiazole : A potential allergen in leather products
- 2019
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In: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 81:4, s. 262-265
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Journal article (peer-reviewed)abstract
- Background: Allergic contact dermatitis caused by leather is common, and several responsible allergens, such as tanning agents, glues, mercaptobenzothiazole derivatives, and dyes, but also antimicrobials and antifungals, are involved. Material and methods: Three female patients were referred to the Departments of Dermatology in a Belgian university hospital following skin reactions caused by leather products (shoes, belt, and car seats). They were patch tested with the European baseline series and samples of suspected leather products, and additionally with 2-(thiocyanomethylthio)benzothiazole (TCMTB), an antifungal agent previously reported to be a contact allergen in footwear. Chromatographic analyses of samples of all the leather materials tested were performed at the Department of Occupational and Environmental Dermatology in Malmö, Sweden. Results: The patients reacting to the leather samples were shown to be sensitized to TCMTB, the presence of which could be confirmed by chemical analyses of samples obtained from the patients. Conclusion: Patch tests with TCMTB should be considered in patients with contact dermatitis caused by leather items.
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| 15. |
- Herman, Anne, et al.
(author)
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Unexpected positive patch test reactions to sesquiterpene lactones in patients sensitized to the glucose sensor FreeStyle Libre
- 2019
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In: Contact Dermatitis. - : Wiley. - 0105-1873 .- 1600-0536. ; 81:5, s. 354-367
-
Journal article (peer-reviewed)abstract
- Background: Most diabetic patients sensitized to FreeStyle Libre react to isobornyl acrylate (IBOA), with a considerable number of them also showing unexpected positive patch test reactions to sesquiterpene lactone (SL) mix (SLM) tested in the baseline series. Objectives: To compile patch test results of subjects affected, and provide potential explanations for this association. Patients and Methods: Fifty-three Freestyle Libre-allergic patients were patch tested with IBOA and/or SLM, and several were also patch tested with the components of SLM. Chromatographic analyses were performed on the glucose sensor, IBOA, and the components of SLM. Results: Thirty-three patients reacted positively to the components of SLM, and 11 of 27 patients reacted positively to alantolactone, in particular. Gas chromatography-mass spectrometry (GC-MS) analyses did not detect these chemicals in the different parts of the glucose sensor, or in IBOA. Conclusion: Significant co-sensitizations between SLs on the one hand and the glucose sensor FreeStyle Libre and/or isobornyl acrylate on the other hand exist, without evidence of the presence of SLs via GC-MS analysis. Cross-reactions between them seem improbable. As a possible hypothesis, a common precursor for both, such as camphene, may exist. Highlights: Of the diabetic patients sensitized to the glucose sensor FreeStyle Libre and/or IBOA, 62.3% reacted positively to SLM. Cross-reactions between IBOA and the three components of SLM (alantolactone, costunolide, and dehydrocostus lactone) seem unlikely, because of their different spatial structures. Co-sensitization between IBOA and SLS can be explained by the fact that there is a common precursor, such as camphene, between these two molecules.
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| 16. |
- Iseri, Emre, et al.
(author)
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Digital dipstick: miniaturized bacteria detection and digital quantification for the point-of-care
- 2020
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In: Lab on a Chip. - : Royal Society of Chemistry (RSC). - 1473-0197 .- 1473-0189. ; 20:23, s. 4349-4356
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Journal article (peer-reviewed)abstract
- Established digital bioassay formats, digital PCR and digital ELISA, show extreme limits of detection, absolute quantification and high multiplexing capabilities. However, they often require complex instrumentation, and extensive off-chip sample preparation. In this study, we present a dipstick-format digital biosensor (digital dipstick) that detects bacteria directly from the sample liquid with a minimal number of steps: dip, culture, and count. We demonstrate the quantitative detection of Escherichia coli (E. coli) in urine in the clinically relevant range of 102 –105 CFU ml−1 for urinary tract infections. Our format shows 89% sensitivity to detect E. coli in clinical urine samples (n = 28) when it is compared to plate culturing (gold standard). The significance and uniqueness of this diagnostic test format is that it allows a non-trained operator to detect urinary tract infections in the clinically relevant range in the home setting.
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| 17. |
- Karlsson, J. Mikael, 1982-, et al.
(author)
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Active liquid degassing in microfluidic systems
- 2013
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In: Lab on a Chip. - : RSC Publishing. - 1473-0197 .- 1473-0189. ; 13:22, s. 4366-4373
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Journal article (peer-reviewed)abstract
- We present a method for efficient air bubble removal in microfluidic applications. Air bubbles are extracted from a liquid chamber into a vacuum chamber through a semipermeable membrane, consisting of PDMS coated with amorphous Teflon (R) AF 1600. Whereas air is efficiently extracted through the membrane, water loss is greatly reduced by the Teflon even at elevated temperatures. We present the water loss and permeability change with the amount of added Teflon AF to the membrane. Also, we demonstrate bubble-free, multiplex DNA amplification using PCR in a PDMS microfluidic device.
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| 18. |
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| 19. |
- Laxminarayan, Ramanan, et al.
(author)
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Antibiotic resistance-the need for global solutions
- 2013
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In: The Lancet - Infectious diseases. - 1473-3099 .- 1474-4457. ; 13:12, s. 1057-1098
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Journal article (peer-reviewed)abstract
- The causes of antibiotic resistance are complex and include human behaviour at many levels of society; the consequences affect everybody in the world. Similarities with climate change are evident. Many efforts have been made to describe the many different facets of antibiotic resistance and the interventions needed to meet the challenge. However, coordinated action is largely absent, especially at the political level, both nationally and internationally. Antibiotics paved the way for unprecedented medical and societal developments, and are today indispensible in all health systems. Achievements in modern medicine, such as major surgery, organ transplantation, treatment of preterm babies, and cancer chemotherapy, which we today take for granted, would not be possible without access to effective treatment for bacterial infections. Within just a few years, we might be faced with dire setbacks, medically, socially, and economically, unless real and unprecedented global coordinated actions are immediately taken. Here, we describe the global situation of antibiotic resistance, its major causes and consequences, and identify key areas in which action is urgently needed.
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| 20. |
- Little, Paul, et al.
(author)
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Amoxicillin for acute lower-respiratory-tract infection in primary care when pneumonia is not suspected: a 12-country, randomised, placebo-controlled trial
- 2013
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In: The Lancet - Infectious diseases. - : Elsevier: Lancet. - 1473-3099 .- 1474-4457. ; 13:2, s. 123-129
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Journal article (peer-reviewed)abstract
- Background Lower-respiratory-tract infection is one of the most common acute illnesses managed in primary care. Few placebo-controlled studies of antibiotics have been done, and overall effectiveness (particularly in subgroups such as older people) is debated. We aimed to compare the benefits and harms of amoxicillin for acute lower-respiratory-tract infection with those of placebo both overall and in patients aged 60 years or older. less thanbrgreater than less thanbrgreater thanMethods Patients older than 18 years with acute lower-respiratory-tract infections (cough of andlt;= 28 days duration) in whom pneumonia was not suspected were randomly assigned (1:1) to either amoxicillin (1 g three times daily for 7 days) or placebo by computer-generated random numbers. Our primary outcome was duration of symptoms rated "moderately bad" or worse. Secondary outcomes were symptom severity in days 2-4 and new or worsening symptoms. Investigators and patients were masked to treatment allocation. This trial is registered with EudraCT (2007-001586-15), UKCRN Portfolio (ID 4175), ISRCTN (52261229), and FWO (G.0274.08N). less thanbrgreater than less thanbrgreater thanFindings 1038 patients were assigned to the amoxicillin group and 1023 to the placebo group. Neither duration of symptoms rated "moderately bad" or worse (hazard ratio 1.06, 95% CI 0.96-1.18; p=0.229) nor mean symptom severity (1.69 with placebo vs 1.62 with amoxicillin; difference 0.07 [95% CI -0.15 to 0.007]; p=0.074) differed significantly between groups. New or worsening symptoms were significantly less common in the amoxicillin group than in the placebo group (162 [15.9%] of 1021 patients vs 194 [19.3%] of 1006; p=0-043; number needed to treat 30). Cases of nausea, rash, or diarrhoea were significantly more common in the amoxidllin group than in the placebo group (number needed to harm 21,95% CI 11-174; p=0.025), and one case of anaphylaxis was noted with amoxicillin. Two patients in the placebo group and one in the ammdcillin group needed to be admitted to hospital; no study-related deaths were noted. We noted no evidence of selective benefit in patients aged 60 years or older (n=595). less thanbrgreater than less thanbrgreater thanInterpretation When pneumonia is not suspected clinically, amoxicillin provides little benefit for acute lower-respiratory-tract infection in primary care both overall and in patients aged 60 years or more, and causes slight harms. less thanbrgreater than less thanbrgreater thanFunding European Commission Framework Programme 6, UK National Institute for Health Research, Barcelona Ciberde Enfermedades Respiratorias, and Research Foundation Flanders.
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| 21. |
- Morel, Chantal M., et al.
(author)
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A one health framework to estimate the cost of antimicrobial resistance
- 2020
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In: Antimicrobial Resistance and Infection Control. - : Springer Science and Business Media LLC. - 2047-2994. ; 9:1
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Journal article (peer-reviewed)abstract
- Objectives/purpose: The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a hospital perspective, primarily from high-income countries. The Global Antimicrobial Resistance Platform for ONE-Burden Estimates (GAP-ONeuro) network has developed a framework to help guide AMR costing exercises in any part of the world as a first step towards more comprehensive analyses for comparing AMR interventions at the local level as well as more harmonized analyses for quantifying the full economic burden attributable to AMR at the global level.Methods: GAP-ONeuro (funded under the JPIAMR 8th call (Virtual Research Institute) is composed of 19 international networks and institutions active in the field of AMR. For this project, the Network operated by means of Delphi rounds, teleconferences and face-to-face meetings. The resulting costing framework takes a bottom-up approach to incorporate all relevant costs imposed by an AMR bacterial microbe in a patient, in an animal, or in the environment up through to the societal level.Results: The framework itemizes the epidemiological data as well as the direct and indirect cost components needed to build a realistic cost picture for AMR. While the framework lists a large number of relevant pathogens for which this framework could be used to explore the costs, the framework is sufficiently generic to facilitate the costing of other resistant pathogens, including those of other aetiologies.Conclusion: In order to conduct cost-effectiveness analyses to choose amongst different AMR-related interventions at local level, the costing of AMR should be done according to local epidemiological priorities and local health service norms. Yet the use of a common framework across settings allows for the results of such studies to contribute to cumulative estimates that can serve as the basis of broader policy decisions at the international level such as how to steer R&D funding and how to prioritize AMR amongst other issues. Indeed, it is only by building a realistic cost picture that we can make informed decisions on how best to tackle major health threats.
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| 22. |
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| 23. |
- van der Wijngaart, Wouter, et al.
(author)
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Electrostatic sampling of patient breath for pathogen detection : a pilot study
- 2020
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In: Frontiers in Mechanical Engineering. - : Frontiers Media SA. - 2297-3079. ; 6
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Journal article (peer-reviewed)abstract
- Collecting samples for diagnosis of respiratory infections can be invasive and highly uncomfortable for patients; with sampling techniques ranging from nasal or throat swabs to bronchoalveolar lavage. In this work, we explore the electrostatic capture of exhaled pathogens as a non-invasive sampling method for rapid diagnosis in a primary care setting. A pilot study at primary care centers in Belgium enrolled 20 patients presenting with flu-like symptoms whose diagnosis was determined by nasopharyngeal (NP) swabs. We collected exhaled aerosol particles from infected patients using a breath electrostatic sampler (BESS) and using filters, following an extremely light procedure consisting of five normal exhales. All samples were analyzed using a commercial multiplex q-RT-PCR panel assay. Staphylococcus aureus (S. aureus) was detected from BESS samples of 7 patients; 3 of whom were in agreement with their corresponding diagnoses. The BESS method was negative for exhaled viruses. We detected viruses, but no bacteria, with the filters, but the results showed no correlation with the corresponding diagnosis. Our results indicate that electrostatic sampling of exhaled breath is a technique and approach potentially suited for the primary care setting, where it might constitute a helpful diagnostic device.
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