Background: We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The... Show moreBackground: We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage. Methods: A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008. Results: Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7-43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)]. Conclusions: Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success. Show less
Background: Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we... Show moreBackground: Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure. Methods: A multivariate logistic regression model was performed with subgroup analyses for uncomplicated and complicated MRSA carriage (the latter including MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and for those treated according to the guideline (i.e. mupirocin nasal ointment and chlorhexidine soap solution for uncomplicated carriage, in combination with two oral antibiotics for complicated carriage). Results: Six hundred and thirteen MRSA carriers were included, of whom 333 (54%) had complicated carriage; 327 of 530 patients (62%) with known complexity of carriage were treated according to the guideline with an absolute increase in treatment success of 20% (95% confidence interval 12%-28%). Among those with uncomplicated carriage, guideline adherence [adjusted odds ratio (OR alpha) 7.4 (1.7-31.7)], chronic pulmonary disease [OR alpha 44 (2.9-668)], throat carriage [OR alpha 2.9 (1.4-6.1)], perineal carriage [OR alpha 2.2 (1.1-4.4)] and carriage among household contacts [OR alpha 5.6 (1.2-26)] were associated with treatment failure. Among those with complicated carriage, guideline adherence was associated with treatment success [OR alpha 0.2 (0.1-0.3)], whereas throat carriage [OR alpha 4.4 (2.3-8.3)] and dependence in activities of daily living [OR alpha 3.6 (1.4-8.9)] were associated with failure. Conclusions: Guideline adherence, especially among those with complicated MRSA carriage, was associated with treatment success. Adding patients with extranasal carriage or dependence in daily self-care activities to the definition of complicated carriage, and treating them likewise, may further increase treatment success. Show less
The general objective of this thesis was to test the effectiveness of an early intervention program aimed at reducing externalizing problems in 1- to 3-year-old children by enhancing parental... Show moreThe general objective of this thesis was to test the effectiveness of an early intervention program aimed at reducing externalizing problems in 1- to 3-year-old children by enhancing parental sensitivity and adequate discipline strategies. A new intervention was designed for this study: the Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) The study consisted of a screening phase in a general population sample (N = 2408) and a randomized case-control intervention phase in a selected subsample of children with high levels of externalizing behavior problems (n = 237). The results of this thesis show that externalizing problems occur in children as young as 1 year of age and are moderately predictive of externalizing problems one year later. Furthermore, child temperament appears to be a moderator in the association between maternal discipline strategies and externalizing problems. Children with difficult temperaments are more susceptible to both negative discipline (i.e., showing more externalizing problems) and positive discipline (i.e., showing less externalizing problems) compared to children with relatively easy temperaments. Finally, the VIPP-SD intervention was effective in improving maternal attitudes towards sensitivity and sensitive discipline, enhancing actual maternal sensitive discipline practices, and decreasing the children's level of overactive behaviors. Show less
Alink, L.R.A.; Mesman, J.; Zeijl, J. van; Stolk, M.N.; Juffer, F.; Koot, H.M.; ... ; IJzendoorn, M.H. van 2006
