Melioidosis in travelers: An analysis of Dutch melioidosis registry data 1985–2018

Background: Melioidosis, caused by the Gram-negative bacterium Burkholderia pseudomallei, is an opportunistic infection across the tropics. Here, we provide a systematic overview of imported human cases in a non-endemic country over a 25-year period. Methods: All 5

Monitoring therapy success of urogenital Chlamydia trachomatis infections in women: A prospective observational cohort study.

The use of a nucleic acid amplification test (NAAT) as a test of cure after treatment is subject to discussion, as the presence of C. trachomatis nucleic acids after treatment may be prolonged and intermittent without presence of infectious bacteria. We used cell culture to assess if a positive RNA- or DNA-based NAAT after treatment indicates the presence of viable C. trachomatis.We included women with asymptomatic urogenital C. trachomatis infection visiting the Amsterdam STI clinic from September 2015 through June 2016. Endocervical swabs were collected prior to treatment with azithromycin, and during three follow-up visits 7, 21 and 49 days after treatment. Collected swabs were subjected to C. trachomatis culture and a RNA- and DNA-based NAAT. High-resolution multilocus sequence typing (hr-MLST) was used to further differentiate potential re-infections.We included 90 women with a positive RNA-test prior to receiving treatment of whom 81 (90%) were also DNA-positive, and 69 (76.7%) culture-positive. Prolonged and intermittent positive RNA and DNA results over time were observed. Three women had culture positive results at the second visit, but all were negative at the third visit. Five women had NAAT-positive results at the fourth visit of whom three women were also culture-positive indicating a viable infection. All five women reported unprotected sexual contact since the first visit. From 2, hr-MLST sequence types were obtained. One had a different sequence type indicating a new infection the other was identical to the previously found indicating a potentially persisting infection.Most RNA- or DNA-positive results after treatment of urogenital C. trachomatis may be caused by non-viable molecular remnants since they cannot be confirmed by culture. In a minority viable C. trachomatis was found in culture at the second visit, indicating that patients may remain infectious at least 7 days after treatment

Characteristics of 90 NAAT-positive women according to their <i>C</i>. <i>trachomatis</i> culture result.

<p>Amsterdam STI clinic, 2015–2016.</p

Characteristics of 107 women according to their NAAT result at inclusion.

<p>Amsterdam STI clinic, 2015–2016.</p

Overview of women tested DNA, RNA or Culture positive at the fourth visit.

<p><i>Chlamydia trachomatis</i> RNA and DNA-based NAAT test results, sexual contact and culture result per visit for 5 women with positive results at the fourth visit. Red: DNA- and RNA-positive; green: RNA-positive and DNA-negative; blue, DNA-positive and RNA-negative; White: RNA- and DNA-negative; C+: culture positive; C- culture negative; S: unprotected sexual contact reported after the previous visit.</p

The number of women that tested positive for <i>Chlamydia trachomatis</i> per test visit.

<p>Graph showing the total number of women that tested positive for <i>C</i>. <i>trachomatis</i> RNA, DNA or culture. Lines indicate the total number of women included at each visit.</p

Behaviour of women after inclusion and clearance of <i>Chlamydia trachomatis</i> infection based on testing by RNA, DNA and culture.

<p>Behaviour of women after inclusion and clearance of <i>Chlamydia trachomatis</i> infection based on testing by RNA, DNA and culture.</p

Time to clearance of <i>Chlamydia trachomatis</i> RNA, DNA and culture.

<p>(A) Time to clearance of <i>Chlamydia trachomatis</i> RNA (n = 78), (B) time to clearance of <i>Chlamydia trachomatis</i> DNA (n = 70) and (C) time to clearance of <i>Chlamydia trachomatis</i> culture (n = 58) with 95% confidence interval (CI).</p

High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands.

Introduction The aim of this study was to determine the rate of asymptomatic carriage and spread of multidrug- resistant micro-organisms (MDRO) and to identify risk factors for extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in 12 long term care facilities (LTCFs) in Amsterdam, the Netherlands. Materials and methods From November 2014 to August 2015, feces and nasal swabs from residents from LTCFs in Amsterdam, the Netherlands were collected and analyzed for presence of multidrug-resistant Gram-negative bacteria (MDRGN), including ESBL-E, carbapenemase-producing Enterobacteriaceae (CPE), colistin-resistant Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Logistic regression analysis was performed to assess associations between variables and ESBLcarriage. Results In total, 385 residents from 12 LTCFs (range 15-48 residents per LTCF) were enrolled. The prevalence of carriage of MDRGN was 18.2% (range among LTCFs 0-47%) and the prevalence of ESBL-E alone was 14.5% (range among LTCFs: 0-34%). Of 63 MDRGN positive residents, 50 (79%) were ESBL-E positive of which 43 (86%) produced CTX-M. Among 44 residents with ESBL-E positive fecal samples of whom data on contact precautions were available at the time of sampling, only 9 (20%) were already known as ESBL-E carriers. The prevalence for carriage of MRSA was 0.8% (range per LTCF: 0-7%) and VRE 0%. One CPE colonized resident was found. All fecal samples tested negative for presence of plasmid mediated resistance for colistin (MCR-1). Typing of isolates by Amplified Fragment Length Polymorphism (AFLP) showed five MDRGN clusters, of which one was found in multiple LTCFs and four were found in single LTCFs, suggesting transmission within and between LTCFs. In multivariate analysis only the presence of MDRO in the preceding year remained a risk factor for ESBL-E carriage. Conclusions The ESBL-carriage rate of residents in LTCFs is nearly two times higher than in the general population but varies considerably among LTCFs in Amsterdam, whereas carriage of MRSA and VRE is low. The majority (80%) of ESBL-E positive residents had not been detected by routine culture of clinical specimens at time of sampling. Current infection control practices in LTCFs in Amsterdam do not prevent transmission. Both improvement of basic hygiene, and funding for laboratory screening, should allow LTCFs in Amsterdam to develop standards of care to prevent transmission of ESBL-E