<metaname="description"content="This is the integral PhD thesis ‘A New Instrument for Microbial Epidemiology’ (DOI 10.33612/diss.177417131) by Matthijs S. Berends, which was defended publicly at the University of Groningen, the Netherlands, on 25 August 2021."/>
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<metaproperty="og:description"content="This is the integral PhD thesis ‘A New Instrument for Microbial Epidemiology’ (DOI 10.33612/diss.177417131) by Matthijs S. Berends, which was defended publicly at the University of Groningen, the Netherlands, on 25 August 2021."/>
<metaname="twitter:description"content="This is the integral PhD thesis ‘A New Instrument for Microbial Epidemiology’ (DOI 10.33612/diss.177417131) by Matthijs S. Berends, which was defended publicly at the University of Groningen, the Netherlands, on 25 August 2021."/>
<liclass="chapter"data-level="1"data-path="ch01-introduction.html"><ahref="ch01-introduction.html"><iclass="fa fa-check"></i><b>1</b> General Introduction</a>
<liclass="chapter"data-level="1.2.2"data-path="ch01-introduction.html"><ahref="ch01-introduction.html#interpretation-of-raw-results"><iclass="fa fa-check"></i><b>1.2.2</b> Interpretation of raw results</a></li>
<liclass="chapter"data-level="1.3"data-path="ch01-introduction.html"><ahref="ch01-introduction.html#data-analysis-using-r"><iclass="fa fa-check"></i><b>1.3</b> Data analysis using R</a></li>
<liclass="chapter"data-level="1.4"data-path="ch01-introduction.html"><ahref="ch01-introduction.html#setting-for-this-thesis"><iclass="fa fa-check"></i><b>1.4</b> Setting for this thesis</a></li>
<liclass="chapter"data-level="1.5"data-path="ch01-introduction.html"><ahref="ch01-introduction.html#aim-of-this-thesis-and-introduction-to-its-chapters"><iclass="fa fa-check"></i><b>1.5</b> Aim of this thesis and introduction to its chapters</a></li>
<liclass="chapter"data-level="2"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html"><iclass="fa fa-check"></i><b>2</b> Diagnostic Stewardship: Sense or Nonsense?!</a>
<liclass="chapter"data-level="2.1.1"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html#case-1"><iclass="fa fa-check"></i><b>2.1.1</b> Case 1</a></li>
<liclass="chapter"data-level="2.1.2"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html#case-2"><iclass="fa fa-check"></i><b>2.1.2</b> Case 2</a></li>
<liclass="chapter"data-level="2.2"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html#the-general-concept"><iclass="fa fa-check"></i><b>2.2</b> The general concept</a>
<liclass="chapter"data-level="2.2.2"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html#dsp-in-the-microbiological-laboratory"><iclass="fa fa-check"></i><b>2.2.2</b> DSP in the microbiological laboratory</a></li>
<liclass="chapter"data-level="2.2.3"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html#dsp-as-process-optimisation"><iclass="fa fa-check"></i><b>2.2.3</b> DSP as process optimisation</a></li>
<liclass="chapter"data-level="2.2.4"data-path="ch02-diagnostic-stewardship.html"><ahref="ch02-diagnostic-stewardship.html#multidisciplinary-aspects-of-dsp-and-infection-management"><iclass="fa fa-check"></i><b>2.2.4</b> Multidisciplinary aspects of DSP and infection management</a></li>
<liclass="chapter"data-level="3"data-path="ch03-introducing-new-method.html"><ahref="ch03-introducing-new-method.html"><iclass="fa fa-check"></i><b>3</b> Introducing a New, Free, and Independent Method for Standardised, Reproducible and Reliable Analyses of Antimicrobial Resistance Data</a>
<liclass="chapter"data-level="3.2"data-path="ch03-introducing-new-method.html"><ahref="ch03-introducing-new-method.html#standardising-amr-data-analysis"><iclass="fa fa-check"></i><b>3.2</b> Standardising AMR data analysis</a></li>
<liclass="chapter"data-level="3.3"data-path="ch03-introducing-new-method.html"><ahref="ch03-introducing-new-method.html#comparison-with-existing-software-methods"><iclass="fa fa-check"></i><b>3.3</b> Comparison with existing software methods</a></li>
<liclass="chapter"data-level="3.4"data-path="ch03-introducing-new-method.html"><ahref="ch03-introducing-new-method.html#user-feedback"><iclass="fa fa-check"></i><b>3.4</b> User feedback</a></li>
<liclass="chapter"data-level="4"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html"><iclass="fa fa-check"></i><b>4</b><code>AMR</code> - An <code>R</code> Package for Working with Antimicrobial Resistance Data</a>
<liclass="chapter"data-level="4.3.1"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#working-with-taxonomically-valid-microorganism-names"><iclass="fa fa-check"></i><b>4.3.1</b> Working with taxonomically valid microorganism names</a></li>
<liclass="chapter"data-level="4.3.2"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#working-with-antimicrobial-names-or-codes"><iclass="fa fa-check"></i><b>4.3.2</b> Working with antimicrobial names or codes</a></li>
<liclass="chapter"data-level="4.3.3"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#working-with-antimicrobial-susceptibility-test-results"><iclass="fa fa-check"></i><b>4.3.3</b> Working with antimicrobial susceptibility test results</a></li>
<liclass="chapter"data-level="4.3.4"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#interpretative-rules-by-eucast"><iclass="fa fa-check"></i><b>4.3.4</b> Interpretative rules by EUCAST</a></li>
<liclass="chapter"data-level="4.3.5"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#working-with-defined-daily-doses-ddd"><iclass="fa fa-check"></i><b>4.3.5</b> Working with defined daily doses (DDD)</a></li>
<liclass="chapter"data-level="4.4.1"data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#determining-first-isolates"><iclass="fa fa-check"></i><b>4.4.1</b> Determining first isolates</a></li>
<liclass="chapter"data-level=""data-path="ch04-amr-r-package.html"><ahref="ch04-amr-r-package.html#appendix-a-included-data-sets"><iclass="fa fa-check"></i>Appendix A: Included Data Sets</a></li>
</ul></li>
<liclass="chapter"data-level="5"data-path="ch05-radar.html"><ahref="ch05-radar.html"><iclass="fa fa-check"></i><b>5</b> Rapid Analysis of Diagnostic and Antimicrobial Patterns in R (RadaR): Interactive Open-Source Software App for Infection Management and Antimicrobial Stewardship</a>
<liclass="chapter"data-level="5.3.3"data-path="ch05-radar.html"><ahref="ch05-radar.html#development-process"><iclass="fa fa-check"></i><b>5.3.3</b> Development Process</a></li>
<liclass="chapter"data-level="5.4.1"data-path="ch05-radar.html"><ahref="ch05-radar.html#principal-findings"><iclass="fa fa-check"></i><b>5.4.1</b> Principal Findings</a></li>
<liclass="chapter"data-level=""data-path="ch05-radar.html"><ahref="ch05-radar.html#conflicts-of-interests"><iclass="fa fa-check"></i>Conflicts of interests</a></li>
<liclass="chapter"data-level="6"data-path="ch06-radar2.html"><ahref="ch06-radar2.html"><iclass="fa fa-check"></i><b>6</b> Better Antimicrobial Resistance Data Analysis and Reporting in Less Time</a>
<liclass="chapter"data-level="6.2.1"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#study-setup"><iclass="fa fa-check"></i><b>6.2.1</b> Study setup</a></li>
<liclass="chapter"data-level="6.2.2"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#amr-data"><iclass="fa fa-check"></i><b>6.2.2</b> AMR data</a></li>
<liclass="chapter"data-level="6.2.3"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#amr-data-analysis-and-reporting"><iclass="fa fa-check"></i><b>6.2.3</b> AMR data analysis and reporting</a></li>
<liclass="chapter"data-level="6.2.4"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#study-participants"><iclass="fa fa-check"></i><b>6.2.4</b> Study participants</a></li>
<liclass="chapter"data-level="6.2.5"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#study-execution-and-data"><iclass="fa fa-check"></i><b>6.2.5</b> Study execution and data</a></li>
<liclass="chapter"data-level="6.2.6"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#evaluation-and-study-data-analysis"><iclass="fa fa-check"></i><b>6.2.6</b> Evaluation and study data analysis</a></li>
<liclass="chapter"data-level="6.3.1"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#study-participants-1"><iclass="fa fa-check"></i><b>6.3.1</b> Study participants</a></li>
<liclass="chapter"data-level="6.3.2"data-path="ch06-radar2.html"><ahref="ch06-radar2.html#effectiveness-and-accuracy"><iclass="fa fa-check"></i><b>6.3.2</b> Effectiveness and accuracy</a></li>
<liclass="chapter"data-level=""data-path="ch06-radar2.html"><ahref="ch06-radar2.html#conflict-of-interest"><iclass="fa fa-check"></i>Conflict of interest</a></li>
<liclass="chapter"data-level="7"data-path="ch07-cons.html"><ahref="ch07-cons.html"><iclass="fa fa-check"></i><b>7</b> Trends in Occurrence and Phenotypic Resistance of Coagulase-Negative Staphylococci (CoNS) Found in Blood in the Northern Netherlands between 2013 and 2019</a>
<liclass="chapter"data-level="7.3"data-path="ch07-cons.html"><ahref="ch07-cons.html#materials-methods"><iclass="fa fa-check"></i><b>7.3</b> Materials & methods</a>
<ul>
<liclass="chapter"data-level="7.3.1"data-path="ch07-cons.html"><ahref="ch07-cons.html#study-setting-and-patient-cohort"><iclass="fa fa-check"></i><b>7.3.1</b> Study setting and patient cohort</a></li>
<liclass="chapter"data-level="7.3.2"data-path="ch07-cons.html"><ahref="ch07-cons.html#microbiological-and-demographic-data"><iclass="fa fa-check"></i><b>7.3.2</b> Microbiological and demographic data</a></li>
<liclass="chapter"data-level="7.3.3"data-path="ch07-cons.html"><ahref="ch07-cons.html#species-determination-and-antibiotic-susceptibility-testing-ast"><iclass="fa fa-check"></i><b>7.3.3</b> Species determination and antibiotic susceptibility testing (AST)</a></li>
<liclass="chapter"data-level="7.3.4"data-path="ch07-cons.html"><ahref="ch07-cons.html#selection-of-bacterial-isolates"><iclass="fa fa-check"></i><b>7.3.4</b> Selection of bacterial isolates</a></li>
<liclass="chapter"data-level="7.3.5"data-path="ch07-cons.html"><ahref="ch07-cons.html#eucast-rules-and-antibiotic-resistance-analysis"><iclass="fa fa-check"></i><b>7.3.5</b> EUCAST rules and antibiotic resistance analysis</a></li>
<liclass="chapter"data-level="7.4.1"data-path="ch07-cons.html"><ahref="ch07-cons.html#patients-and-included-isolates"><iclass="fa fa-check"></i><b>7.4.1</b> Patients and included isolates</a></li>
<liclass="chapter"data-level="7.4.2"data-path="ch07-cons.html"><ahref="ch07-cons.html#occurrence-of-cons-species"><iclass="fa fa-check"></i><b>7.4.2</b> Occurrence of CoNS species</a></li>
<liclass="chapter"data-level="7.4.3"data-path="ch07-cons.html"><ahref="ch07-cons.html#definition-of-cons-persistence"><iclass="fa fa-check"></i><b>7.4.3</b> Definition of CoNS persistence</a></li>
<liclass="chapter"data-level="8"data-path="ch08-defining-mdr.html"><ahref="ch08-defining-mdr.html"><iclass="fa fa-check"></i><b>8</b> Defining Multidrug Resistance of Gram-Negative Bacteria in the Dutch-German Border Region: Impact of National Guidelines</a>
<liclass="chapter"data-level="8.3.1"data-path="ch08-defining-mdr.html"><ahref="ch08-defining-mdr.html#number-of-antibiograms-and-patients"><iclass="fa fa-check"></i><b>8.3.1</b> Number of Antibiograms and Patients</a></li>
<liclass="chapter"data-level="8.3.2"data-path="ch08-defining-mdr.html"><ahref="ch08-defining-mdr.html#results-of-mrgn-and-brmo-classification"><iclass="fa fa-check"></i><b>8.3.2</b> Results of MRGN and BRMO Classification</a></li>
<liclass="chapter"data-level=""data-path="ch08-defining-mdr.html"><ahref="ch08-defining-mdr.html#conflicts-of-interest"><iclass="fa fa-check"></i>Conflicts of interest</a></li>
<liclass="chapter"data-level="9"data-path="ch09-changing-epidemiology.html"><ahref="ch09-changing-epidemiology.html"><iclass="fa fa-check"></i><b>9</b> Changing Epidemiology of Methicillin-Resistant <em>Staphylococcus aureus</em> in 42 Hospitals in the Dutch-German Border Region, 2012 to 2016: Results of the Search-and-Follow Policy</a>
<liclass="chapter"data-level="9.2.2"data-path="ch09-changing-epidemiology.html"><ahref="ch09-changing-epidemiology.html#guidelines-for-patients-at-risk-for-mrsa-and-infection-prevention-and-control-measures"><iclass="fa fa-check"></i><b>9.2.2</b> Guidelines for patients at risk for MRSA and infection prevention and control measures</a></li>
<liclass="chapter"data-level="9.2.3"data-path="ch09-changing-epidemiology.html"><ahref="ch09-changing-epidemiology.html#data-collection"><iclass="fa fa-check"></i><b>9.2.3</b> Data collection</a></li>
<liclass="chapter"data-level="9.2.5"data-path="ch09-changing-epidemiology.html"><ahref="ch09-changing-epidemiology.html#data-analysis"><iclass="fa fa-check"></i><b>9.2.5</b> Data analysis</a></li>
<liclass="chapter"data-level="9.3.1"data-path="ch09-changing-epidemiology.html"><ahref="ch09-changing-epidemiology.html#trend-and-cross-border-comparison-of-mrsa-rates"><iclass="fa fa-check"></i><b>9.3.1</b> Trend and cross-border comparison of MRSA rates</a></li>
<liclass="chapter"data-level="9.3.2"data-path="ch09-changing-epidemiology.html"><ahref="ch09-changing-epidemiology.html#cross-border-comparison-of-healthcare-utilisation"><iclass="fa fa-check"></i><b>9.3.2</b> Cross-border comparison of healthcare utilisation</a></li>
<p>Cover design: Matthijs Berends (images used with permission)<br/>
Layout: Matthijs Berends<br/>
Printing: Gildeprint – www.gildeprint.nl</p>
<p>The work described within this thesis was supported by (1) the Certe Medical Diagnostics and Advice Foundation, (2) the INTERREG V A (202085) funded project EurHealth-1Health (<ahref="http://www.eurhealth1health.eu"class="uri">http://www.eurhealth1health.eu</a>), part of a Dutch-German cross-border network supported by the European Commission, the Dutch Ministry of Health, Welfare and Sport, the Ministry of Economy, Innovation, Digitalisation and Energy of the German Federal State of North Rhine-Westphalia, and the Ministry for National and European Affairs and Regional Development of the German Federal State of Lower Saxony, (3) the European Union’s Horizon 2020 Research and Innovation Programme under the Marie Skłodowska-Curie Grant Agreement 713660 (MSCA-COFUND-2015-DP “Pronkjewail”), and (4) the European Society for Clinical Microbiology and Infectious Diseases (ESCMID) through the ESCMID Study Group for Antimicrobial Stewardship (ESGAP).</p>
<p>Printing of this thesis was financially supported by the Certe Medical Diagnostics and Advice Foundation. This support is greatly appreciated.</p>