Risk of dementia: The Rotterdam Study

Dementia is a frequent disorder in the elderly. It is also a distressing condition both for the patient and caregiver. Dementia puts a high claim on health care costs. In the Netherlands about one tenth of the yearly health budget is spent on nursing homes. Dementia is the. main diagnosis in 40% of nursing home patients and coexisting dementia may be the underlying. motive for admittance to a nursing home in patients with other diseases. 1•2 The need for dementia care will probably grow since the elderly population is increasing both in percentage and in absolute number. J,4 Reliable estimates of the frequency of dementia are important. Prevalence figures are used by health planners to determine the demand for disease-specific services. The incidence rate is morc informative when etiologic questions are addressed. For assessment of prevalence and incidence of dementia one cannot rely on medical registers; the disease is rarely reported on death celiificates and usually mild cases are not recognised. Therefore we studied the prevalence (chapter 2.1) and incidence (chapter 2.2) of dementia in a population-based study by active screening of participants. This study formed p31i of the Rotterdam Study, a prospective cohort study on medical disorders in the elderly.s Previous epidemiologic studies suggested that not all social layers are equally affected by dementia.6 Especially lower educated people might be more susceptible. Therefore, we examined the association between education and prevalent dementia (chapter 2.1) and also assessed if lower educated were at higher risk of incident dementia (chapter 2.3). The lack of knowledge on Causes of dementia, especially Alzheimer's disease, motivated the second pm of this thesis.7 We mainly studied associations with other COlfunon disorders of old age that have vascular implications

High rates of anorectal chlamydia in women:Cross-sectional study in general practice

BACKGROUND: Genital and anorectal Chlamydia trachomatis frequently present together in sexually transmitted infection clinics. AIM: This study aimed to investigate the prevalence of co-occurrent genital and anorectal chlamydia infection, and to study whether sexual behavior is associated with anorectal infection. DESIGN & SETTING: A cross-sectional study in general practices in the north of the Netherlands. METHOD: Women attending general practice with an indication for genital chlamydia testing were included and asked to complete a structured questionnaire on sexual behaviour. Anorectal infection prevalence was compared according to testing indications: standard vs experimental (ie, based on questionnaire answers). Variables associated with anorectal chlamydia were analysed by univariate and multivariate logistic regression analyses. RESULTS: Data could be analysed for 497 of 515 included women. Overall, 17.8% (87/490) were positive for C. trachomatis; of these, 72.4% (63/87) had co-occurrent genital and anorectal infection, 13.8% (12/87) had genital infection only, and 12.6% (11/87) had anorectal infection only. Rectal infection was missed in 69.3% of cases using the standard indication alone, while adding the sexual history still missed 20.0%. Age was the only variable significantly associated with anorectal infection. CONCLUSIONS: The prevalence of anorectal disease is high among women who visit their general practitioner with an indication for genital C. trachomatis testing. Many anorectal infections are missed despite taking comprehensive sexual histories, meaning that standard treatment of genital infection with azithromycin may result in rectal persistence. Performing anorectal testing in all women with an indication for genital C. trachomatis testing is therefore recommended

High prevalence of MRSA and ESBL among asylum seekers in the Netherlands

Migration is one of the risk factors for the spread of multidrug-resistant organisms (MDRO). The increasing influx of migrants challenges local health care systems. To provide evidence for both hospital hygiene measure and empirical antibiotic therapy, we analysed all cultures performed in asylum seekers between January 1 st 2014 and December 31 st 2015 for methicillin resistant Staphylococcus aureus (MRSA) and for multidrugresistant Enterobacteriaceae (MDRE). We compared these with cultures from the Dutch patient population with risk factors for carriage of MDRO. A total of 7181 patients were screened for MRSA. 7357 S. aureus were isolated in clinical cultures. Of 898 screened asylum seekers, almost 10% were MRSA positive. Of 118 asylum seekers with S. aureus in clinical cultures almost 19% were MRSA positive. The general patient population had a 1.3% rate of MRSA in S. aureus isolates. A higher rate of Panton-Valentine leukocidin (PVL) positive strains (RR: 2.4; 95% CI: 1.6-3.4) was found in asylum seekers compared to the general patient population. In 33475 patients one or more Enterobacteriaceae were obtained. More than 21% of the asylum seekers were carrier of MDRE, most of them producing extended spectrum beta-lactamases (20.3%). 5.1% of the general patient population was MDRE carrier. It can be concluded that asylum seekers present with higher rate of MDRO compared to the general patient population. These results justify continued screening of asylum seekers to anticipate multidrug-resistant organisms during hospital care of patients

Trends in Occurrence and Phenotypic Resistance of Coagulase-Negative Staphylococci (CoNS) Found in Human Blood in the Northern Netherlands between 2013 and 2019

Background: For years, coagulase-negative staphylococci (CoNS) were not considered a cause of bloodstream infections (BSIs) and were often regarded as contamination. However, the association of CoNS with nosocomial infections is increasingly recognized. The identification of more than 40 different CoNS species has been driven by the introduction of matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry. Yet, treatment guidelines consider CoNS as a whole group, despite increasing antibiotic resistance (ABR) in CoNS. This retrospective study provides an in-depth data analysis of CoNS isolates found in human blood culture isolates between 2013 and 2019 in the entire region of the Northern Netherlands. Methods: In total, 10,796 patients were included that were hospitalized in one of the 15 hospitals in the region, leading to 14,992 CoNS isolates for (ABR) data analysis. CoNS accounted for 27.6% of all available 71,632 blood culture isolates. EUCAST Expert rules were applied to correct for errors in antibiotic test results. Results: A total of 27 different CoNS species were found. Major differences were observed in occurrence and ABR profiles. The top five species covered 97.1% of all included isolates: S. epidermidis, S. hominis, S. capitis, S. haemolyticus, and S. warneri. Regarding ABR, methicillin resistance was most frequently detected in S. haemolyticus (72%), S. cohnii (65%), and S. epidermidis (62%). S. epidermidis and S. haemolyticus showed 50–80% resistance to teicoplanin and macrolides while resistance to these agents remained lower than 10% in most other CoNS species. Conclusion: These differences are often neglected in national guideline development, prompting a focus on ‘ABR-safe’ agents such as glycopeptides. In conclusion, this multi-year, full-region approach to extensively assess the trends in both the occurrence and phenotypic resistance of CoNS species could be used for evaluating treatment policies and understanding more about these important but still too often neglected pathogens