Cutaneous Brucellosis unmasked as Aureimonas altamirensis in a wound culture

Aureimonas altamirensis was isolated from a wound culture and initially misidentified as Brucella melitensis by the VITEK® 2 system. The VITEK-MS did not provide identification whereas the Bruker MALDI-ToF MS system and 16-S sequencing revealed a clear identification, which highlights the importance of inclusion of species in databases for accurate and fast identification of bacteria

Epidemiology of Extended-Spectrum beta-Lactamase-Producing E-coli and Vancomycin-Resistant Enterococci in the Northern Dutch-German Cross-Border Region

Objectives: To reveal the prevalence and epidemiology of extended-spectrum β-lactamase (ESBL)- and/or plasmid AmpC (pAmpC)- and carbapenemase (CP) producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) across the Northern Dutch–German border region.Methods: A point-prevalence study on ESBL/pAmpC/CP producing Enterobacteriaceae and VRE was carried out in hospitalized patients in the Northern Netherlands (n = 445, 2012–2013) and Germany (n = 242, 2012). Healthy individuals from the Dutch community (n = 400, 2010–2012) were also screened. In addition, a genome-wide gene-by-gene approach was applied to study the epidemiology of ESBL-Escherichia coli and VRE.Results: A total of 34 isolates from 27 patients (6.1%) admitted to Dutch hospitals were ESBL/pAmpC positive and 29 ESBL-E. coli, three pAmpC-E. coli, one ESBL-Enterobacter cloacae, and one pAmpC-Proteus mirabilis were found. In the German hospital, 18 isolates (16 E. coli and 2 Klebsiella pneumoniae) from 17 patients (7.7%) were ESBL positive. In isolates from the hospitalized patients CTX-M-15 was the most frequently detected ESBL-gene. In the Dutch community, 11 individuals (2.75%) were ESBL/pAmpC positive: 10 ESBL-E. coli (CTX-M-1 being the most prevalent gene) and one pAmpC E. coli. Six Dutch (1.3%) and four German (3.9%) hospitalized patients were colonized with VRE. Genetic relatedness by core genome multi-locus sequence typing (cgMLST) was found between two ESBL-E. coli isolates from Dutch and German cross-border hospitals and between VRE isolates from different hospitals within the same region.Conclusion: The prevalence of ESBL/pAmpC-Enterobacteriaceae was similar in hospitalized patients across the Dutch–German border region, whereas VRE prevalence was slightly higher on the German side. The overall prevalence of the studied pathogens was lower in the community than in hospitals in the Northern Netherlands. Cross-border transmission of ESBL-E. coli and VRE seems unlikely based on cgMLST analysis, however continuous monitoring is necessary to control their spread and stay informed about their epidemiology

Survival outcomes of patients with advanced mucosal melanoma diagnosed from 2013 to 2017 in the Netherlands - A nationwide population-based study

Background: Mucosal melanoma (MM) is rare and has a poor prognosis. Since 2011, new effective treatments are available for advanced melanoma. It is unclear whether patients with mucosal melanoma equally benefit from these new treatments compared with patients with cutaneous melanoma (CM). Methods: Patients with advanced MM and CM diagnosed between 2013 and 2017 were included from a nationwide population-based registry – the Dutch Melanoma Treatment Registry. Overall survival (OS) was estimated with the Kaplan-Meier method (also for a propensity score-matched cohort). A Cox model was used to analyse the association of possible prognostic factors with OS. Results: In total, 120 patients with MM and 2960 patients with CM were included. Median OS was 8.7 months and 14.5 months, respectively. Patients with MM were older (median age 70 versus 65 years) and more often female (60% versus 41%), compared with CM. In total, 77% and 2% of the MM patients were treated with first-line immunotherapy and targeted therapy, respectively, compared with 49% and 33% of the CM patients. In contrast to CM, OS for MM did not improve for patients diagnosed in 2015–2017, compared with 2013–2014. ECOG performance score ≥1 (HR = 1.99 [1.26–3.15; p = 0.003]) and elevated LDH level (HR = 1.63 [0.96–2.76]; p = 0.069) in MM were associated with worse survival. Conclusions: Within the era of immune and targeted therapies, prognosis for patients with advanced MM has not improved as much as for CM. Collaboration is necessary to enlarge sample size for research to improve immunotherapeutic strategies and identify targetable mutations

National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the

Prostitution in the Works of Marguerite Duras. Writing distance

Cette thèse propose d’analyser comment la prostitution dans l’oeuvre écrite de Marguerite Duras se décline sous différentes formes. En croisant histoire littéraire,philosophie et psychanalyse, ce travail montre que la prostitution, loin d’être un simple motif,participe à l’acte créateur. L’écriture de Duras, façonnée par l’écart, est constamment prise dans une tension productrice de sens : c’est depuis l’écart en effet que l’écrivain construit son oeuvre (écart par rapport à la doxa, par rapport à la langue), préférant subvertir la norme plutôt que de la suivre.Nous commencerons par envisager la prostitution d’un point de vue thématique : ce motif, prégnant dans l’oeuvre depuis les premiers textes, tisse une véritable fantasmatique et donne à voir une oeuvre qui, renversant l’axiologie, sacralise le profane et fait de l’écart son centre. La prostitution, véritable creuset de l’écrit, devient dès lors un enjeu poïétique (elle fonde l’écriture même). Mais au-delà de l’idéalisation d’un don de soi, il appert que la prostitution a un enjeu plus profond : un enjeu métaphysique. Nous montrerons ensuite comment le fait de s’offrir participe d’une quête infinie, celle de l’Absolu. Proposer son corps est un acte tendu entre désir et deuil et s’apparente à une recherche de l’Alèthéia (la vérité par le dévoilement) plus qu’à une simple transaction dépourvue d’érotisme. Dans tous les cas, se prostituer relève avant tout d’une mise en scène où la théâtralité domine ; c’est ce point que nous analyserons en dernière partie. À partir des années 1980 le rapport de la prostituée à la vérité évolue, et l’écart, plus que le rapprochement entre les êtres, est monnayé.This dissertation analyses the different meanings of prostitution in the writings of Marguerite Duras. Through the intersecting analytical lenses of literary history, philosophy and psychoanalysis, our research shows that prostitution, far from being a simple subject, is inherent to the creative art and act of the author. Writing, for Duras, is the product of a creative tension shaped by distance : the very margin (away from the doxa, the language itself) from which the author crafted her work is the creative force that informs her desire to diverge from the norm and effectively strive to overturn rather than follow it.We will first consider the thematic of prostitution – prevalent from her earliest texts – throughout Duras’s work and how it weaves a veritable fantasy matrix proposing a body of work that reverses the common axiology by sacralizing profanity and placing the margin at the center. Prostitution becomes a melting pot of the writing process and reveals the agenda of the potentialities within creation (it shapes writing itself). Nevertheless, beyond the idealization of giving oneself to another, prostitution runs deeper than the skin : it has ametaphysical sense. Indeed, we demonstrate how offering one’s body is linked to an infinite quest or thirst that only the Absolute of life can quench. Offering one’s body is a tense act situated between desire and mourning and that can be interpreted as the quest for Aletheia(truth through unveiling), rather than a simple transaction free of any eroticism. In any case,to prostitute oneself is above all, a staged performance deeply rooted in theatricality, and this point is analyzed in the last part of our work. After the 1980s the rapport between the prostitute and the truth changes and distance, far more than the rapprochement between bodies and beings, is then paid in cash

Characterising the gut microbiome of stranded harbour seals (Phoca vitulina) in rehabilitation.

Animal rehabilitation centres provide a unique opportunity to study the microbiome of wild animals because subjects will be handled for their treatment and can therefore be sampled longitudinally. However, rehabilitation may have unintended consequences on the animals' microbiome because of a less varied and suboptimal diet, possible medical treatment and exposure to a different environment and human handlers. Our study describes the gut microbiome of two large seal cohorts, 50 pups (0-30 days old at arrival) and 23 weaners (more than 60 days old at arrival) of stranded harbour seals admitted for rehabilitation at the Sealcentre Pieterburen in the Netherlands, and the effect of rehabilitation on it. Faecal samples were collected from all seals at arrival, two times during rehabilitation and before release. Only seals that did not receive antimicrobial treatment were included in the study. The average time in rehabilitation was 95 days for the pups and 63 days for the weaners. We observed that during rehabilitation, there was an increase in the relative abundance of some of the Campylobacterota spp and Actinobacteriota spp. The alpha diversity of the pups' microbiome increased significantly during their rehabilitation (p-value <0.05), while there were no significant changes in alpha diversity over time for weaners. We hypothesize that aging is the main reason for the observed changes in the pups' microbiome. At release, the sex of a seal pup was significantly associated with the microbiome's alpha (i.e., Shannon diversity was higher for male pups, p-value <0.001) and beta diversity (p-value 0.001). For weaners, variation in the microbiome composition (beta diversity) at release was partly explained by sex and age of the seal (p-values 0.002 and 0.003 respectively). We mainly observed variables known to change the gut microbiome composition (e.g., age and sex) and conclude that rehabilitation in itself had only minor effects on the gut microbiome of seal pups and seal weaners

Livestock-Associated meticillin-resistant Staphylococcus aureus in a young harbour seal (Phoca vitulina) with endocarditis

A five-month-old male harbour seal was admitted for rehabilitation to the Sealcentre Pieterburen on November 16, 2015. During initial veterinary examination parasitic pneumonia and secondary bacterial pneumonia were suspected. Therefore, the seal received antiparasitic and antimicrobial treatment and appeared to recover but died unexpectedly after several weeks. Postmortem examination revealed a perforation in the aortic wall and histopathological examination of the aorta revealed mural necrosis with haemorrhage and suppurative to mixed inflammation. Bacterial culture resulted in isolation of a meticillin-resistant Staphylococcus aureus (MRSA) from the pericardial effusion. Subsequent culture of rectal swabs collected at arrival and during rehabilitation showed that the animal was already colonised with MRSA when admitted to the Sealcentre. MRSA has been isolated from marine mammals before, however, to our knowledge this is the first report of MRSA-Associated endocarditis in seals and the first time that livestock-Associated MRSA is reported in seals

Recente behandelresultaten van uitgezaaid melanoom : Gegevens uit de Dutch Melanoma Treatment Registry

Doel Evaluatie van de behandelstrategieën en overleving van patiënten met irresectabel melanoom stadium IIIc of IV sinds de introductie van nieuwe geneesmiddelen in 2012 in Nederland. Opzet Prospectieve cohortstudie. Methode Wij analyseerden gegevens uit de Dutch Melanoma Treatment Registry (DMTR) van patiënten die in de periode 1 juli 2012-31 december 2015 waren gediagnosticeerd met irresectabel melanoom stadium IIIc of IV. We schatten de overlevingsduur met de Kaplan-Meier-methode. De relatie tussen jaar van diagnose en overleving werd geschat met Cox-regressieanalyse, gecorrigeerd voor leeftijd, ‘WHO performance status’, lactaatdehydrogenasewaarde, tumorstadium, hersenmetastasen en afstandsmetastasen. Resultaten Van de geregistreerde 2768 patiënten kreeg ongeveer driekwart systemische therapie; deze behandeling was elk jaar aan verandering onderhevig. De mediane overlevingsduur was 10,7 maanden (95%-BI: 9,6-13,2) in 2012 en 13,8 maanden (95%-BI: 11,8-15,6) in 2015; de mediane overlevingsduur voor systemisch behandelde patiënten was 17,1 maanden in 2015. De 2- jaarsoverleving nam in deze periode toe van 23 tot 40%. Patiënten gediagnosticeerd in 2015 hadden een betere overleving dan patiënten uit 2014 (hazardratio (HR): 0,82; 95%-BI: 0,73-0,93). Dit effect gold ook voor patiënten die werden behandeld met systemische therapie (HR: 0,79; 95%-BI: 0,69-0,91). Conclusie De snelle beschikbaarheid van nieuwe geneesmiddelen, die door de toenmalige minister van VWS en de beroepsgroep is geïnitieerd, heeft de behandeling van patiënten met irresectabel melanoom stadium IIIc of IV ingrijpend veranderd. De gegevens uit de DMTR duiden op een veilig gebruik van deze nieuwe geneesmiddelen in de dagelijkse praktijk en een verbetering van de overleving van patiënten met gevorderd melanoom in de afgelopen jaren