88 research outputs found
Methodiek arbeidsmarktprognoses en -indicatoren 1997-2002
In dit werkdocument wordt een overzicht gegeven van de methodiek die is gehanteerd bij het opstellen van de arbeidsmarktprognoses naar opleiding en beroep tot 2002 en de bijbehorende arbeidsmarktindicatoren ten behoeve van het rapport De arbeidsmarkt naar opleiding en beroep tot 2002 en de bijbehorende Statistische Bijlage. Het ROA brengt deze arbeidsmarktinformatie uit in het kader van het Project Onderwijs - Arbeidsmarkt (POA). De gegevens – die een beeld geven van de arbeidsmarktpositie van opleidingen en beroepen – zijn ook gebruikt door het LDC Expertisecentrum voor loopbaanvraagstukken (LDC), onder andere in de publicatie Kansen op werk 2002 en de op CD-ROM verkrijgbare Traject-reeks.education, training and the labour market;
Clostridium difficile beyond stools : dog nasal discharge as a possible new vector of bacterial transmission
Zoonotic transmission of Clostridium difficile has been largely hypothesised to occur after direct or indirect contact with contaminated animal faeces. Recent studies have reported the presence of the bacterium in the natural environment, including in soils and rivers. If C. difficile spores are scattered in the environment, they can easily enter the respiratory tract of dogs, and therefore, dog nasal discharge could be a direct route of transmission not previously investigated. This study reports for the first time the presence of C. difficile in the respiratory tracts of dogs. The bacterium was isolated from 6 (17.1%) out of 35 nasal samples, with a total of 4 positive dogs (19%). C. difficile was recovered from both proximal and distal nasal cavities. All isolates were toxigenic and belonged to PCR- ribotype 014, which is one of the most predominant types in animals and in community- acquired C. difficile infections in recent years. The findings of this study demonstrate that the nasal cavity of dogs is contaminated with toxigenic C. difficile, and therefore, its secretions could be considered as a new route by which bacteria are spread and transmitted.Peer reviewe
Diagnosing Clostridioides difficile infections with molecular diagnostics: multicenter evaluation of revogene C. difficile assay
Clostridioides difficile infections are a significant threat to our healthcare system, and rapid and accurate diagnostics are crucial to implement the necessary infection prevention and control measurements. Nucleic acid amplification tests are such reliable diagnostic tools for the detection of toxigenic Clostridioides difficile strains directly from stool specimens. In this multicenter evaluation, we determined the performance of the revogene C. difficile assay. The analysis was conducted on prospective stool specimens collected from six different sites in Europe. The performance of the revogene C. difficile assay was compared to the different routine diagnostic methods and, for a subset of the specimens, against toxigenic culture. In total, 2621 valid stool specimens were tested, and the revogene C. difficile assay displayed a sensitivity/specificity of 97.1% [93.3-99.0] and 98.9% [98.5-99.3] for identification of Clostridioides difficile infection. Discrepancy analysis using additional methods improved this performance to 98.8% [95.8-99.9] and 99.6% [99.2-99.8], respectively. In comparison to toxigenic culture, the revogene C. difficile assay displayed a sensitivity/specificity of 93.0% [86.1-97.1] and 99.5% [98.7-99.9], respectively. These results indicate that the revogene C. difficile assay is a robust and reliable aid in the diagnosis of Clostridioides difficile infections.This article is freely available via Open Access. Click on the Publisher URL to access it via the publisher's site.This study was supported by grants from GenePOC, now part of Meridian Biosciences.published version, accepted versio
a pilot study, 2013
Introduction After recognition of European outbreaks of Clostridium difficile
infections (CDIs) associated with the emergence of PCR ribotype 027/NAP1 in
2005, CDI surveillance at country level was encouraged by the European Centre
for Disease Prevention and Control (ECDC) [1]. In 2008, an ECDC-supported
European CDI survey (ECDIS) identified large intercountry variations in
incidence rates and distribution of prevalent PCR ribotypes, with the
outbreak-related PCR ribotype 027 being detected in 5% (range: 0–26) of the
characterised isolates [2]. The surveillance period was limited to one month
and the representation of European hospitals was incomplete; however, this has
been the only European (comprising European Union (EU)/European Economic Area
(EEA) and EU candidate countries) CDI surveillance study. The authors
highlighted the need for national and European surveillance to control CDI.
Yet, European countries were found to have limited capacity for diagnostic
testing, particularly in terms of standard use of optimal methods and absence
of surveillance protocols and a fully validated, standardised and exchangeable
typing system for surveillance and/or outbreak investigation. As of 2011, 14
European countries had implemented national CDI surveillance, with various
methodologies [3]. National surveillance systems have since reported a
decrease in CDI incidence rate and/or prevalence of PCR ribotype 027 in some
European countries [4-8]. However, CDI generally remains poorly controlled in
Europe [9], and PCR ribotype 027 continues to spread in eastern Europe [10-12]
and globally [13]. In 2010, ECDC launched a new project, the European C.
difficile Infection Surveillance Network (ECDIS-Net), to enhance surveillance
of CDI and laboratory capacity to test for CDI in Europe. The goal of ECDIS-
Net was to establish a standardised CDI surveillance protocol suitable for
application all over Europe in order to: (i) estimate the incidence rate and
total infection rate of CDI (including recurrent CDI cases) in European acute
care hospitals; (ii) provide participating hospitals with a standardised tool
to measure and compare their own incidence rates with those observed in other
participating hospitals; (iii) assess adverse outcomes of CDI such as
complications and death; and (iv) describe the epidemiology of CDI concerning
antibiotic susceptibility, PCR ribotypes, presence of tcdA, tcdB and binary
toxins and detect new emerging types at local, national and European level.
The primary objectives of the present study were to: (i) test the pilot
protocol for the surveillance of CDI in European acute care hospitals
developed by ECDIS-Net (methodology, variables and indicators); (ii) assess
the feasibility and workload of collecting the required hospital data, case-
based epidemiological and microbiological data; and (iii) evaluate the quality
of data collected, whether in the presence or absence of existing national CDI
surveillance activities. A secondary aim was to assess the relationship
between patient and microbiological characteristics and in-hospital outcome of
CDI to confirm the added value of collecting detailed epidemiological and
microbiological data on CDI at European level
Bezlotoxumab for Prevention of Recurrent Clostridium difficile Infection
BACKGROUND Clostridium difficile is the most common cause of infectious diarrhea in hospitalized patients. Recurrences are common after antibiotic therapy. Actoxumab and bezlotoxumab are human monoclonal antibodies against C. difficile toxins A and B, respectively. METHODS We conducted two double-blind, randomized, placebo-controlled, phase 3 trials, MODIFY I and MODIFY II, involving 2655 adults receiving oral standard-of-care antibiotics for primary or recurrent C. difficile infection. Participants received an infusion of bezlotoxumab (10 mg per kilogram of body weight), actoxumab plus bezlotoxumab (10 mg per kilogram each), or placebo; actoxumab alone (10 mg per kilogram) was given in MODIFY I but discontinued after a planned interim analysis. The primary end point was recurrent infection (new episode after initial clinical cure) within 12 weeks after infusion in the modified intention-to-treat population. RESULTS In both trials, the rate of recurrent C. difficile infection was significantly lower with bezlotoxumab alone than with placebo (MODIFY I: 17% [67 of 386] vs. 28% [109 of 395]; adjusted difference, −10.1 percentage points; 95% confidence interval [CI], −15.9 to −4.3; P<0.001; MODIFY II: 16% [62 of 395] vs. 26% [97 of 378]; adjusted difference, −9.9 percentage points; 95% CI, −15.5 to −4.3; P<0.001) and was significantly lower with actoxumab plus bezlotoxumab than with placebo (MODIFY I: 16% [61 of 383] vs. 28% [109 of 395]; adjusted difference, −11.6 percentage points; 95% CI, −17.4 to −5.9; P<0.001; MODIFY II: 15% [58 of 390] vs. 26% [97 of 378]; adjusted difference, −10.7 percentage points; 95% CI, −16.4 to −5.1; P<0.001). In prespecified subgroup analyses (combined data set), rates of recurrent infection were lower in both groups that received bezlotoxumab than in the placebo group in subpopulations at high risk for recurrent infection or for an adverse outcome. The rates of initial clinical cure were 80% with bezlotoxumab alone, 73% with actoxumab plus bezlotoxumab, and 80% with placebo; the rates of sustained cure (initial clinical cure without recurrent infection in 12 weeks) were 64%, 58%, and 54%, respectively. The rates of adverse events were similar among these groups; the most common events were diarrhea and nausea. CONCLUSIONS Among participants receiving antibiotic treatment for primary or recurrent C. difficile infection, bezlotoxumab was associated with a substantially lower rate of recurrent infection than placebo and had a safety profile similar to that of placebo. The addition of actoxumab did not improve efficacy. (Funded by Merck; MODIFY I and MODIFY II ClinicalTrials.gov numbers, NCT01241552 and NCT01513239.
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