Luc Niclaes - Academia.edu (original) (raw)

Papers by Luc Niclaes

Journal of the American Geriatrics Society, Dec 1, 2006

To assess the effect of methicillin-resistant Staphylococcus aureus (MRSA) colonization on morbid... more To assess the effect of methicillin-resistant Staphylococcus aureus (MRSA) colonization on morbidity and mortality of nursing home residents. Three-year cohort study from 2000 to 2003. Twenty-three nursing homes of all types and regions in the northern part of Belgium (Flanders). Two thousand eight hundred fourteen nursing home residents. The consequences of MRSA colonization on mortality and hospitalization were studied, adjusting for potential confounders. Dates and cause of death and hospitalization were collected every 6 months during 3 years of follow-up. After adjustment for age, sex, and Charlson comorbidity index, the risk for 36-month mortality remained significantly higher in MRSA carriers (hazard ratio (HR) = 1.4, 95% confidence interval (CI) = 1.1-1.8) than in noncarriers. The effect of MRSA on mortality was dependent on the degree of cognitive impairment, with the highest effect in patients with severe cognitive impairment (adjusted HR = 1.8, 95% CI = 1.1-2.8) and absence of effect in residents with good mental status (adjusted HR = 0.8, 95% CI = 0.43-1.62). Deaths were more frequently reported to be infection-related in MRSA carriers. No association was found between MRSA colonization and hospitalization for any reason, but during follow-up, MRSA carriers were twice as frequently hospitalized for respiratory tract infections. Colonization of MRSA in Belgian nursing home residents was associated with higher mortality. This excess mortality was restricted to residents with impaired cognitive function, probably reflecting differences in therapeutic approaches, in delay of diagnosis of pneumonia and other acute disorders in these patients, or in both.

Carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) in a Belgia... more Carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) in a Belgian home care facility: are they a threat? M. Ntoumpanaki, V. Saegeman*, L. Niclaes, A. Schuermans (Leuven, GR; Leuven, BE) Objectives: Carbapenemase producing Enterobacteriaceae (CPE) and vancomycine resistant enterococci (VRE) increase all over the world. The role of the community, including long-term-care facilities, remains unclear. We aimed to evaluate the prevalence of rectal colonization with CPE and VRE among residents of a long-term care facility in Leuven (Belgium) with frequent contacts with the tertiary care University Hospitals Leuven. Methods: In this observational study, 150 residents with debilitating conditions were examined in the summer of 2012. Rectal Eswabs (Copan, Italy) were taken after informed consent and transported within 4 hrs to UHLeuven. They were immediately inoculated onto 5 different CPE screening agars (Brilliance CRE (Oxoid), Brilliance ESBL (Oxoid), CHROMagar KPC (Chromagar), in-house made MacConkey with meropenem 0.5µg/mL, and a MacConkey with ertapenem (10µg, Neo-Sensitabs) and temocillin (30µg, Neo-Sensitabs) discs) and 2 VRE screening agars (chromID VRE (bioMérieux) and a selective agar for gram positive cocci with nalidixic acid/colistin sulphate and a vancomycin disc (30µg,Neo-Sensitabs)). Plates were incubated for 24 and 48 hrs. All strains growing on every agar or within restricted diameters of the discs were identified with Maldi-TOF MS (Bruker Daltonics). For CPE, each Enterobacteriaceae was tested with Modified Hodge Test (MHT) and antimicrobial susceptibility was tested with Vitek2 (bioMérieux). In case MHT was not negative or the strain was not meropenem and temocillin susceptible, Etests for the non-susceptible antibiotic(s) and a KPC/Metallo-B-Lactamase (MBL) Confirmation test (Rosco diagnostica) were performed. In case of increased MIC or a non-negative MBL test, a real-time PCR (Checkpoints-MDRCarba) was performed for the detection of carbapenemase genes. In case Enterococcus spp. was isolated from the VRE screening plates, confirmation was performed with Etest vancomycin. Results: Neither CPE nor VRE were found in the total population of 150 residents. Special attention was given to detect OXA-48, which is prevalent in Belgium and sometimes difficult to detect because of its possible low meropenem MIC values. Conclusion: The prevalence of CPE and VRE in this population of residents revealed to be zero. However, outbreaks of both CPE and VRE in some Belgian hospitals make us alert of unknown reservoirs. This study was additionally conducted to optimize the detection of OXA-48 strains that are particularly difficult to identify.

Acta Clinica Belgica, Feb 1, 2014

Médecine et maladies infectieuses xxx (2013) xxx-xxx General review Carbapenemase-producing Enter... more Médecine et maladies infectieuses xxx (2013) xxx-xxx General review Carbapenemase-producing Enterobacteriaceae: Overview of a major public health challenge Entérobactéries et carbapénémases : bilan et enjeux d'un problème de santé publique majeur

European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology, Jan 21, 2015

Over the last several years, carbapenemase-producing Enterobacteriaceae (CPE) have been increasin... more Over the last several years, carbapenemase-producing Enterobacteriaceae (CPE) have been increasingly detected not only among patients in acute care hospitals, but also in long-term care facilities. In this point prevalence survey, residents from three nursing homes and patients in one rehabilitation center were screened for asymptomatic intestinal carriage of CPE by rectal swabs. The first objective was to evaluate the hypothesis of the establishment of a CPE reservoir in a geriatric/chronic care population. Secondly, we evaluated the comparative performances of different culture methods (chromID(®) CARBA, chromID(®) OXA-48, MacConkey with temocillin/meropenem, ertapenem enrichment broth) and a commercial molecular assay (Check-Direct CPE). From the 257 included residents, only one had evidence for CPE carriage. From the rectal swabs of this resident, an OXA-48-producing Klebsiella pneumoniae could be isolated and was confirmed by a molecular assay both on the strain and on the rect...

Infection Control and Hospital Epidemiology, Sep 1, 2002

A cross-sectional study of methicillin-resistantStaphylococcus aureuscarriage in 2,857 nursing ho... more A cross-sectional study of methicillin-resistantStaphylococcus aureuscarriage in 2,857 nursing home residents showed an overall prevalence of 4.9%. The three clones identified by genetic analysis were identical to those in the acute care facilities; only their relative prevalence differed. Clone 2 took epidemic proportions in five of these nursing homes.

Acta Clinica Belgica, 2014

ABSTRACT Prevalence of carbapenemase-producing Enterobacteriaceae (CPE) is increasing both in hos... more ABSTRACT Prevalence of carbapenemase-producing Enterobacteriaceae (CPE) is increasing both in hospitals and in the community. In this point prevalence study, rectal CPE colonization was investigated among 150 nursing home residents. No CPE were detected. Epidemiological data directly linked with CPE colonization in community and nursing home settings are currently lacking. Further research will show whether the preventive measures taken, including a strong focus on standard precautions, a dedicated isolation policy, and antibiotic restriction will retain CPE to invade nursing homes.

european congres of clinical microbiology and infectious diseases, Apr 27, 2013

publication only) Carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci... more publication only) Carbapenemase-producing Enterobacteriaceae and vancomycin-resistant enterococci (VRE) in a Belgian home care facility: are they a threat? M. Ntoumpanaki, V. Saegeman*, L. Niclaes, A. Schuermans (Leuven, GR; Leuven, BE) Objectives: Carbapenemase producing Enterobacteriaceae (CPE) and vancomycine resistant enterococci (VRE) increase all over the world. The role of the community, including long-term-care facilities, remains unclear. We aimed to evaluate the prevalence of rectal colonization with CPE and VRE among residents of a long-term care facility in Leuven (Belgium) with frequent contacts with the tertiary care University Hospitals Leuven. Methods: In this observational study, 150 residents with debilitating conditions were examined in the summer of 2012. Rectal Eswabs (Copan, Italy) were taken after informed consent and transported within 4 hrs to UHLeuven. They were immediately inoculated onto 5 different CPE screening agars (Brilliance CRE (Oxoid), Brilliance ...

Journal of the American Geriatrics Society, 2006

Infection Control and Hospital Epidemiology, 2002

Infection control and hospital epidemiology, 2002

A cross-sectional study of methicillin-resistant Staphylococcus aureus carriage in 2,857 nursing ... more A cross-sectional study of methicillin-resistant Staphylococcus aureus carriage in 2,857 nursing home residents showed an overall prevalence of 4.9%. The three clones identified by genetic analysis were identical to those in the acute care facilities; only their relative prevalence differed. Clone 2 took epidemic proportions in five of these nursing homes.

Journal of The American Geriatrics Society, 2006

Journal of the American Geriatrics Society, 2000

Journal of Clinical Epidemiology, 2002

The object of this article was to validate the predictive value of Charlson's comorbidity index f... more The object of this article was to validate the predictive value of Charlson's comorbidity index for the prediction of short-term mortality or morbidity in elderly people. The design was a cohort study comparing survival and hospitalization in institutionalized elderly people with different levels of comorbidity at baseline. The setting was 16 Flemish nursing homes for the elderly. The subjects were 2,727 inhabitants of which full data were available for 2,624. The outcome measures were hazard ratios resulting from Cox regression analysis, comparing 6 months survival in patients with moderate and a high level to low level of comorbidity. Odds ratios resulting from multiple logistic regression analysis comparing the occurrence of at least one hospitalization during the follow-up period in surviving patients of the same groups. Mortality adjusted for age group was significantly increased in patients with a moderate (HR ϭ 2.00) and even more in those with a high level (HR ϭ 3.62) of comorbidity. Hospitalization was more frequent in both groups (OR ϭ 1.54 and 2.19, respectively), with statistical significance only being reached for the highest group. Adjustment for age, gender, mobility status, and disorientation did not change the general picture. Charlson's comorbidity index is a predictor of short-term mortality in institutionalized elderly patients and, to a lesser extend, also of hospitalization. These results support its use as a measure for introducing comorbidity as a covariable in longitudinal studies with a geriatric population.

Infectious Disease Clinics of North America, 2007

Epidemiology and Infection, 1999

A prospective cohort study with 1 year follow-up evaluated the relation between MRSA carriage and... more A prospective cohort study with 1 year follow-up evaluated the relation between MRSA carriage and mortality, likelihood of hospitalization and functional status in residents of a nursing home for the elderly. Included were all 447 residents living in the home in early June 1994. From all patients, swabs were taken from nose, throat and perineum. Additional swabs (sputum, urine or wounds) were taken when indicated. The relative risk (RR) of dying within 6 months in MRSA carriers compared to non-carriers was 2n29 (95 % CI l 1n04-5n04). This RR remained stable (1n57-2n40) after adjustment for co-variables using Mantel-Haenszel stratified analysis. After 1 year, the RR was reduced to 1n30 (95 % CI l 0n65-2n58). Univariate survival analysis confirmed a difference in survival between carriers and non-carriers after 6 months (log-rank P l 0n04) and no difference after 1 year. Cox regression analysis resulted in a hazard ratio for dying within 6 months of 1n73 (95 % CI l 0n72-4n17). No relation was found between carriage and either likelihood of hospitalization or indicators of functional status. These results are compatible with a possible relation between 6 months mortality and MRSA carriage in nursing home patients. It calls for a large scale, multicentre cohort study in order to either confirm or refute these findings.