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PubMed1999

Increased but low incidence and poor survival of malignant mesothelioma in the southeastern part of The Netherlands since 1970: a population-based study.

Changes in the incidence and survival rates for malignant mesothelioma in the southeastern part of The Netherlands since 1970 were investigated, using data from the Eindhoven Cancer Registry (ECR). The exposure to asbestos in this area is presumed to be limited. Most of the mesotheliomas occurred in the pleura, where there were 119 (88%) against 15 (11%) in the peritoneum and two in the tunica vaginalis testis. Compared to other European countries, the incidence rate for the southeastern part of The Netherlands was fairly low in the second half of the 1980s. Between 1975 and 1994 the age-adjusted incidence rates (ESR) for pleural mesothelioma increased twofold (from 10 to 19 per one million person-years among men and from 2.4 to 3.8 among women). The rate for peritoneal mesothelioma remained constant. The overall relative 0.5-, 1-, and 3-year survival rates remained 68, 42, and 8%, respectively. The fourfold higher incidence rate for men compared with women reflects the fact that mesothelioma is mainly an occupational disease. In view of presumed limited exposure to asbestos and small geographical variation, the incidence of mesothelioma in the southeastern part of The Netherlands will probably remain low, despite an increase in the past decades.

Adult↗
PubMed1997

The age-related incidences of oesophageal carcinoma in intellectually disabled individuals in institutes in The Netherlands.

OBJECTIVE: An increased age-related incidence of oesophageal cancer in people with intellectual disability has been suggested by studies in the Netherlands. Gastro-oesophageal reflux disease (GORD), as documented by pH testing, occurs frequently in the intellectually disabled population, being found in nearly 50% of those with an IQ less than 50, while Barrett's oesophagus is found in about 15-26%. DESIGN: We compared the age-related incidence of oesophageal cancer in institutionalized, intellectually disabled individuals in the Netherlands with the age-related incidence in the general Dutch population. METHODS: Data were provided by the Netherlands Cancer Registry. The patient's institute physician was asked to complete a questionnaire about the diagnosis, which was endoscopically and histologically confirmed. RESULTS: The incidence of oesophageal carcinoma was 20 in 168,000 person-years. The expected incidence for oesophageal cancer, based on age-related incidence in the general population, was 7.0, resulting in a standardized morbidity ratio in the population with intellectual disability of 2.9 (confidence limits, 1.8-4.1; P < 0.001). Endoscopic findings were as follows: in 18/20 intellectually disabled carcinoma patients an adenocarcinoma was found; the remaining two patients had a squamous cell carcinoma. Barrett's epithelium was observed in nine patients (45%), eight (42%) of whom showed a peptic stricture as well. In 15 (75%) cancer patients reflux oesophagitis was found, accompanied in 14 cases by a hiatal hernia. CONCLUSION: A standardized morbidity ratio for oesophageal carcinoma of 2.9 was found in the intellectually disabled population as compared to the general population. Early detection and treatment of GORD in the population with intellectual disability is of paramount importance to prevent the development of Barrett's dysplasia and carcinoma.

Adenocarcinoma↗
PubMed2004

A description of emergency department-related malpractice claims in The Netherlands: closed claims study 1993-2001.

BACKGROUND: The aim of this study was to assess the quality of care provided at emergency departments (ED) in the Netherlands by analysing medical liability insurance claims. METHODS: A retrospective study performed by reviewing records at MediRisk, presently the largest insurer for medical liability in the Netherlands. The following data were abstracted from the files available for analysis: medical discipline involved, physician involved (resident or consultant), nature and gravity of the complaint, and final claim disposition. RESULTS: Between 1993 and 2001 a total of 326 claims involving the ED were filed at MediRisk. Of these, 256 claims (79%) were closed and were available for analysis. Medical liability claims were filed primarily for alleged errors in diagnosis and treatment. The majority of claims involved minor surgical conditions: fractures, luxations (joint dislocations), wounds and tendon injuries (210/256, 82%). Residents were involved in 76% of the claims; resident supervision by a consultant was documented in only 15% of the medical records. Permanent patient disability resulting from improper ED treatment was alleged in 22% of the claims. Four per cent of the claims involved the death of a patient. Physicians accepted liability in 16% of the claims filed. Indemnity payments during the 8-year study period totalled Euros 504,000. CONCLUSION: The number of medical liability claims is low compared with the number of patients treated in ED in the Netherlands. Claims primarily concerned alleged mistakes in diagnosis and the treatment of minor trauma. Residents were involved in the majority of the claims. More resident supervision is needed, as are specific training programmes for emergency physicians.

Emergency Medicine↗
PubMedDate not supplied

The cost of illness of pressure ulcers in The Netherlands.

OBJECTIVE: To conduct a cost-of-illness study of pressure ulcers in the Netherlands for different care settings, including home care, nursing homes, general hospitals, and university hospitals. DESIGN: A cost-of-illness study was conducted based on prevalence figures and expert opinion. A differential cost study approach was used, distinguishing among the 4 stages of pressure ulcer severity and the different care settings. To obtain expert opinion, structured interviews were conducted with pressure ulcer experts who were chosen randomly from the membership of the Dutch Society of Pressure Ulcer Experts. Information was gathered on volume of care parameters for each pressure ulcer stage, including personnel, extra days of care, and use of special beds and medical materials. Experts were asked to estimate the percentage of patients for which each care parameter was considered relevant; low and high estimates of each figure were given to determine the range of the calculations. Cost estimates were obtained from Dutch guidelines for cost calculations in health care, then converted to US dollars. SETTING: Home care, nursing homes, general hospitals, and university hospitals in the Netherlands. PARTICIPANTS: Experts on pressure ulcer management working in the different care settings. MAIN OUTCOME MEASURE: Cost-of-illness of pressure ulcers, converted to US dollars. MAIN RESULTS: The cost-of-illness of pressure ulcers ranged from a low estimate of $362 million to a high estimate of $2.8 billion. The most conservative estimate is approximately 1% of the total Dutch health care budget. CONCLUSION: The cost-of-illness of pressure ulcers in the Netherlands is considerable.

Cost of Illness↗
PubMed2006

Prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands: The Amsterdam Health Monitor Survey.

OBJECTIVE: To assess ethnic differences in the prevalence and management of hypertension among Turkish, Moroccan and native Dutch ethnic groups in Amsterdam, the Netherlands. DESIGN: A cross-sectional survey. PARTICIPANTS: A random sample of 1304 adults aged 18 years and over. Of these, 39.2% were Dutch, 33.2% were Turkish and 27.6% were Moroccan. RESULTS: The prevalence of hypertension was lower in Turkish (men 25.8% and women 22.2%) and Moroccan (men 26.1% and women 19.6%) than in Dutch individuals (men 48.8% and women 35.0%). Except for Turkish women, these differences persisted after adjustment for age and body mass index: the odds ratios (95% confidence interval) for being hypertensive were 0.47 (0.30-0.74; P < 0.001) for Turkish men, 0.48 (0.30-0.76; P < 0.001) for Moroccan men and 0.51 (0.28-0.94; P = 0.03) for Moroccan women. Only Moroccan hypertensive women were less likely than Dutch women to be aware of their condition 0.31 (0.11-0.81; P < 0.01) and to be treated 0.32 (0.12-0.88; P < 0.01) for hypertension. There were no differences in hypertension control between the ethnic groups in both men and women. CONCLUSION: The lower prevalence of hypertension among Moroccan men may contribute to the low cardiovascular disease (CVD) mortality reported among this group in the Netherlands. The differential risks in CVD mortality between Moroccan men and women may partly result from the lower hypertension awareness and treatment rates in Moroccan women. Strategies aimed at improving the detection and treatment of hypertension among Moroccan women may improve the sex disparity in cardiovascular mortality between Moroccan men and women in the Netherlands.

Adolescent↗
PubMed2005

Risk of malignant transformation of congenital melanocytic nevi: a retrospective nationwide study from The Netherlands.

PURPOSE: Since the risk of malignant transformation is the most important reason to remove congenital melanocytic nevi, and data vary in the literature, we aimed to determine the incidence of malignant transformation in congenital melanocytic nevi in The Netherlands. METHODS: The Dutch nationwide pathology database, PALGA (Pathologisch Anatomisch Landelijk Geautomatiseerd Archief), provided anonymous pathology descriptions of all patients registered with congenital melanocytic nevi (giant or nongiant nevus) and of patients with a malignant melanoma within a congenital melanocytic nevus who were diagnosed between January 1, 1989, and December 31, 2000. A comparison was made between cancer incidence in our cohort of patients and the general population by applying the person-year distribution in the cohort to sex-, age- and calendar period-specific reference data obtained from The Netherlands Cancer Registry. Our cohort consisted of 3929 patients. RESULTS: After a median follow-up time of 4.7 years, a total of 15 cases of malignant melanoma were observed in 19,253 person-years, against 1.23 expected cases. The incidence rate of malignant melanoma was greater than expected on the basis of population rates, overall standardized incidence rate of 12.2 (95 percent confidence interval 9.6 to 15.3). Compared with the general population rates, we observed an increased risk for malignant melanoma, both in men (standardized incidence ratio = 6.4; 95 percent confidence interval 4.1 to 9.6) and women (standardized incidence ratio = 14.1; 95 percent confidence interval 10.5 to 18.7). This is comparable with the higher propensity of women to develop a malignant melanoma. Patients with a giant nevus had a 51.6 percent higher risk of developing a malignant melanoma compared with the general population rates. CONCLUSION: Our study shows that congenital melanocytic nevi have a significantly higher risk of developing a malignant melanoma compared with the age-, sex-, calendar-period-specific reference data from The Netherlands Cancer Registry.

Adult↗
PubMed2005

Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands.

OBJECTIVES: To evaluate the best available evidence on volume-outcome effect of pancreatic surgery by a systematic review of the existing data and to determine the impact of the ongoing plea for centralization in The Netherlands. SUMMARY BACKGROUND DATA: Centralization of pancreatic resection (PR) is still under debate. The reported impact of hospital volume on the mortality rate after PR varies. Since 1994, there has been a continuous plea for centralization of PR in The Netherlands, based on repetitive analysis of the volume-outcome effect. METHODS: A systematic search for studies comparing hospital mortality rates after PR between high- and low-volume hospitals was used. Studies were reviewed independently for design features, inclusion and exclusion criteria, cutoff values for high and low volume, and outcome. Primary outcome measure was hospital or 30-day mortality. Data were obtained from the Dutch nationwide registry on the outcome of PR from 1994 to 2004. Hospitals were divided into 4 volume categories based on the number of PRs performed per year. Interventions and their effect on mortality rates and centralization were analyzed. RESULTS: Twelve observational studies with a total of 19,688 patients were included. The studies were too heterogeneous to allow a meta-analysis; therefore, a qualitative analysis was performed. The relative risk of dying in a high-volume hospital compared with a low-volume hospital was between 0.07 and 0.76, and was inversely proportional to the volume cutoff values arbitrarily defined. In 5 evaluations within a decade, hospital mortality rates were between 13.8% and 16.5% in hospitals with less than 5 PRs per year, whereas hospital mortality rates were between 0% and 3.5% in hospitals with more than 24 PRs per year. Despite the repetitive plea for centralization, no effect was seen. During 2001, 2002, and 2003, 454 of 792 (57.3%) patients underwent surgery in hospitals with a volume of less than 10 PRs per year, compared with 280 of 428 (65.4%) patients between 1994 and 1996. CONCLUSIONS: The data on hospital volume and mortality after PR are too heterogeneous to perform a meta-analysis, but a systematic review shows convincing evidence of an inverse relation between hospital volume and mortality and enforces the plea for centralization. The 10-year lasting plea for centralization among the surgical community did not result in a reduction of the mortality rate after PR or change in the referral pattern in The Netherlands.

Chi-Square Distribution↗
PubMed2000

Evolutionary dynamics of declining melanism in the peppered moth in the Netherlands.

Populations of Biston betularia in the region of The Netherlands around Leiden and Rotterdam were resampled. A comparison of three sets of data for 1969-1973, 1988 and 1999 enabled a further examination of declines in melanism. Unlike parallel changes for the black carbonaria form of this species in urban regions of Britain, those inThe Netherlands involve substantial changes in frequencies of at least two of the intermediate insularia morphs as well as an increase in the non-melanic typica morph. The darkest of the three insularia morphs has shown a transitory pulse of increased frequency in The Netherlands. The dynamics are discussed in relation to the history of air pollution and to straightforward predictions about selection.

Adaptation, Physiological↗
PubMed2001

Modeled impacts of farming practices and structural agricultural changes on nitrogen fluxes in the Netherlands.

In the Netherlands, nutrient emissions from intensive animal husbandry have contributed to decreased species diversity in (semi) natural terrestrial and aquatic ecosystems, pollution of groundwater, and possibly global warming due to N2O emissions. This paper presents the results of a modelling study presenting the impacts of both structural measures and improved farming practices on major nitrogen (N) fluxes, including NH3 and N2O emission, uptake, leaching, and runoff, in the Netherlands, using input data for the year 2000. Average annual fluxes (Gg N year(-1)) for the year 2000 were estimated at 132 for NH3 emission (160 Gg NH 3 year(-1)), 28 for N2O emission, 50 for N inflow to groundwater, and 15 for N inflow to surface water at a total N input of 1046. At this input, nitrate (NO3) concentrations in groundwater often exceeded the target of 50 mg NO3 l(-1), specifically in well-drained sandy soils. The ammonia (NH3) emissions exceeded emission targets that were set to protect the biodiversity of nonagricultural land. Improved farming practices were calculated to lead to a significant reduction in NH3 emissions to the atmosphere and N leaching and runoff to groundwater and surface water, but these improvements were not enough to reach all the targets set for those fluxes. Only strong structural measures clearly improved the situation. The NH3 emission target of 30 Gg NH3 year(-1), suggested for the year 2030, could not be attained, however, unless pig and poultry farming is completely banned in the Netherlands and all cattle stay almost permanently in low emission stables.

Agriculture↗
PubMed2004

Rapid and continuous increases in incidence rates of basal cell carcinoma in the southeast Netherlands since 1973.

This study is aimed to determine the characteristics of the trends in incidence of basal cell carcinoma (BCC) in the Netherlands. We used incidence data of BCC from the Eindhoven Cancer Registry (Comprehensive Cancer Centre South) in the south of the Netherlands from 1973 to 2000. Data were age-adjusted and age-specific rates were calculated. Joinpoint and age-period-birth cohort modelling were applied. Between 1973 and 2000, age-adjusted incidence rates of BCC increased in both sexes, most markedly among (young) females. Recent increases were most marked on the trunk. The male data fitted age-drift models, suggesting a linear increase in rates over time, not attributable to either period- or cohort effects. In females, age-cohort-drift models described the data adequately, suggesting changes in intermittent UV exposures in subsequent cohorts. Incidence of BCC in the Netherlands is increasing rapidly, especially at body sites that are not chronically exposed to sunlight. The most likely explanation is an increased intermittent overexposure to UV radiation. This could have introduced an equal fractional increase in risk at all ages in all cohorts. There is no indication of an end to this trend in BCC.

Adult↗
PubMed2005

Dramatic change in prescribing of hormone replacement therapy in The Netherlands after publication of the Million Women Study: a follow-up study.

AIMS: To estimate the diffusion of new safety information concerning postmenopausal hormonal replacement therapy (HRT) into prescribing practice in The Netherlands and to assess the impact of revised guidelines on the long-term treatment of HRT. DESIGN: Cross-sectional study. SETTING: Community pharmacy dispensing data from a population of approximately 450,000 patients in the northern and eastern part of The Netherlands. POPULATION: Women aged 45-69 years to whom at least one HRT prescription was dispensed between 1 January 2000 and 1 January 2004. MAIN OUTCOME MEASURES: Annual and quarter prevalences of HRT and the proportion of new HRT users, switchers and continuous HRT users per quarter. RESULTS: The prevalence of HRT prescribing decreased significantly from 107/1000 [95% confidence interval (CI) 104, 110] in 2000 to 87/1000 (95% CI 84, 89) in 2003. The decreasing prevalence was especially evident among the younger age groups and was most pronounced among users of oestrogen/progestagen combinations. The publication of the Women Health Initiative Study (WHI) was followed by a modest decrease in prescribing of HRT, whereas prescribing of HRT declined dramatically after publication of the Million Women Study (MWS) in August 2003. Among the continuous HRT users in the 4th quarter of 2002, 55% used HRT longer than 3 years. This percentage was 53 in the 4th quarter of 2003. CONCLUSIONS: In contrast to the release of the WHI study results, publication of the MWS was followed by a dramatic fall in prescribing of HRT in The Netherlands. Despite the new recommendation that long-term HRT use should be discouraged, the proportion of long-term users did not change after the publication of the MWS.

Age Factors↗
PubMed1995

The costs of diabetes-related lower extremity amputations in the Netherlands.

Diabetes mellitus is a common problem in the Netherlands and in the rest of the world. A complication seen in association with diabetes is peripheral neuropathy which can lead to lower extremity amputation. The purpose of this study is to identify the duration of hospital stay and the direct costs associated with diabetes-related lower extremity amputations in the Netherlands in 1992. Total direct costs included costs associated with hospital stay and the average procedure specific costs (surgeons' fees, anaesthetists' fees, and operating room fees) for the specific level of amputation. In the Netherlands in 1992, 1575 hospitalizations for 1810 diabetes-related lower extremity amputations occurred. The total number of days in the hospital for the diabetic population was 65,778 days with a mean of 41.8 days per hospitalization. Mean costs associated with diabetes-related hospitalizations for amputation were pounds 10,531 (Dfl. 28,433) per hospitalization. Persons who underwent multiple amputations during their hospitalization stayed in the hospital longer and the costs associated with these hospitalizations were higher when compared to hospitalization with a single amputation. An increase in length of stay and costs with increasing age and higher level of amputation was identified.

Amputation, Surgical↗
PubMed2004

Epidemiology of restless legs in The Netherlands.

The prevalence of restless legs syndrome (RLS) in various regions in the world has been estimated between 2.5 and 29%. For The Netherlands these figures are not known. Our observational and cross-sectional study was performed to estimate the prevalence of RLS in The Netherlands. A cross-sectional survey by postal questionnaire was carried out through a general practice in a small town in which one general practice serves 93% of the population. All men and women aged 50 years and older were invited to fill out the questionnaire on leg movements, quality of sleep and daytime symptoms. A total of 1485 (88.2%) persons returned their questionnaire and 1437 (85.4%) patients answered the questions on leg movements. A total of 102 (7.1%) inhabitants answered positively to the questions on leg movements and probably have RLS. The prevalence was higher in women and increased with age. People who complain of RLS have significantly more complaints of disturbances in initiating and maintaining sleep, sleepiness, tiredness during the day and less refreshing sleep. RLS is common in The Netherlands with an estimated prevalence of 7.1% in the population over 50 years of age.

Adult↗
PubMed1990

Fertility adaptation of Turkish and Moroccan women in the Netherlands.

"After a short overview of fertility trends among Turkish and Moroccan immigrants in the Netherlands, based upon population and vital registration data, determinants of these trends are analysed using survey data on cumulative fertility as well as on desired fertility." The author concludes that although "a long time series of data is not yet available due to the fairly recent history of the migration of Turkish and Moroccan women to the Netherlands, it appears that their fertility level is declining. Migrant fertility levels are lower than in the countries of origin.... Factors in the decline of overall immigrant fertility are variables related to the country of destination: work and education, insofar as this education was received in the Netherlands." (SUMMARY IN FRE AND SPA)

Africa↗
PubMed2006

Burden of illness of bacterial cellulitis and erysipelas of the leg in the Netherlands.

BACKGROUND: Information on the prevalence of bacterial cellulitis (BC) and erysipelas (ER) of the leg (BCERL) is sparse and dependent on the definitions used. There is no information available on the number of hospitalized and non-hospitalized patients with BCERL, and related treatment costs. OBJECTIVE: The purpose of this study was to assess the burden of illness for BCERL in the Netherlands in 2001. METHODS: Data were obtained from different linked databases. Hospital information was obtained from the National Morbidity Registration (known in the Netherlands as the LMR), which includes all Dutch citizens, using ICD-9-CM codes. The number of patients not admitted to hospital was estimated using a subsample with data from general practitioners (GPs) (N = 50,000). These data were extrapolated using age/gender and disease-specific standardization. The subsample was used to assess the location of the infection. Reimbursement costs were available for all resources. RESULTS: In 2001, approximately 28,000 patients presented with either BC or ER of the leg. Of these patients, 2,200 were admitted to the hospital and 4-6% had two or more episodes of ER/BC in 2001. The average costs per hospitalization for BCERL were 5,346 euros, accumulating to more than 14 million euros in 2001. Although only 7% of all patients were hospitalized, 83% of the total treatment costs could be attributed to hospitalization. CONCLUSIONS: BCERL are common and serious infections in the Netherlands. Hospitalization occurs in only one in 14 patients but contributes more than 80% of the total costs, which accumulate to 17 million euros a year.

Bacterial Infections↗
PubMed2004

Treatment of nursing home residents with dementia and lower respiratory tract infection in the United States and The Netherlands: an ocean apart.

OBJECTIVES: To compare treatment of nursing home residents with dementia and lower respiratory tract infection (LRI) in Missouri and the Netherlands. DESIGN: Two separate but simultaneous prospective cohort studies. SETTING: Nursing homes in Missouri (n=36) and the Netherlands (n=61). PARTICIPANTS: Selected residents (701 from Missouri and 551 from the Netherlands) diagnosed with LRI and dementia. MEASUREMENTS: Treatment, dementia severity, symptoms and signs of LRI, and general health condition were recorded at the time of diagnosis of LRI. Death was monitored at follow-up. Treatment and mortality, stratified for dementia severity, are reported. RESULTS: Treatment of nursing home-acquired LRI in Missouri residents involved a larger number of antibiotics, more frequent hospitalization, and greater use of intravenous antibiotics and rehydration therapy than in Dutch residents of equal dementia severity. Furthermore, for Missouri residents, intensive interventions were more often provided irrespective of severe dementia. By contrast, in both countries, treatments to relieve symptoms of LRI were provided for only a minority of residents. Dutch mortality rates were higher overall. CONCLUSION: Care for U.S. nursing home residents with LRI and dementia is more aggressive than care for Dutch residents, particularly in residents with severe dementia. These results are relevant to the debate on optimal care in relation to curative or palliative treatment goals.

Aged↗
PubMed1999

Drug-associated acute pancreatitis: twenty-one years of spontaneous reporting in The Netherlands.

OBJECTIVE: Drugs are considered a rare cause of acute pancreatitis. We conducted a descriptive study to assess which drugs have been associated with acute pancreatitis in spontaneous adverse drug reaction reports in The Netherlands. METHODS: Our study is based on reports of drug-associated acute pancreatitis reported to the Netherlands Center for Monitoring of Adverse Reactions to Drugs and The Netherlands Pharmacovigilance Foundation LAREB between 1 January 1977 and 1 January 1998. We used an algorithm to validate the diagnosis and to assess the causal relationship between acute pancreatitis and use of the suspected drug. RESULTS: A total of 55 cases were available for review. We excluded 11 (20.0%) reports, as we could not confirm the diagnosis of acute pancreatitis. Another 10 (18%) cases were excluded, as the causal relationship with the suspected drug was unlikely. In the remaining 34 reports, acute pancreatitis was labeled as definite in 11 (32%) and as probable in 23 (68%). The age of the patients ranged from 17 to 84 yr with a median of 41; 24 (71%) patients were female. Of the 34 cases, 27 (79%) recovered, five (15%) died, and in two (6%) the outcome is unknown. Azathioprine, cimetidine, interferon-alpha, methyldopa, metronidazole, olsalazine, and oxyphenbutazon all had a definite causal relationship with acute pancreatitis. Doxycycline, enalapril, famotidine, ibuprofen, maprotiline, mesalazine, and sulindac had a probable causal relationship with acute pancreatitis. CONCLUSIONS: A variety of drugs was associated with acute pancreatitis in Dutch adverse drug reaction reports. Quantitative information about drug-induced pancreatitis is scanty. Epidemiological studies to assess the risk of drug-induced acute pancreas, therefore, are needed.

Acute Disease↗
PubMed2005

Antimicrobial profiles of periodontal pathogens isolated from periodontitis patients in The Netherlands and Spain.

BACKGROUND AND AIM: Antimicrobial resistance of periodontal pathogens towards currently used antibiotics in periodontics has been investigated in a previous study. Microbial resistance in the periodontal microflora was more frequently observed in Spanish patients in comparison with Dutch patients. The aim of the present study was to compare antimicrobial susceptibility profiles of five periodontal bacteria isolated from periodontitis patients in Spain and in The Netherlands. MATERIAL AND METHODS: Subgingival plaque samples from adult patients with periodontitis were collected and cultured on selective and non-selective plates. Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Fusobacterium nucleatum and Micromonas micros were isolated and used for minimal inhibitory concentration tests using the Epsilometer (E-test) technique. Eight different antibiotics were tested on all bacterial isolates. MIC50 and MIC90 values for each antibiotic and each species were determined and the percentage of resistant strains was calculated. RESULTS: Significantly higher MIC values were noted in Spanish strains of F. nucleatum for penicillin, ciprofloxacin, of P. intermedia for penicillin, amoxicillin and tetracycline, of M. micros for tetracycline, amoxicillin and azithromycin, and of P. gingivalis for tetracycline and ciprofloxacin. Based on breakpoint concentrations, a higher number of resistant strains in Spain were found in F. nucleatum for penicillin, amoxicillin and metronidazole, in Prevotella intermedia for tetracycline and amoxicillin, and in A. actinomycetemcomitans for amoxicillin and azithromycin. Resistance of P. gingivalis strains was not observed for any of the antibiotics tested both in Spain and The Netherlands. CONCLUSIONS: Differences exist in the susceptibility profiles of periodontal pathogens isolated from periodontitis patients in Spain and in The Netherlands. This implicates that antibiotic susceptibility testing is necessary to determine efficacy of antimicrobial agents. Also, clinical studies with antibiotics should take these differences into account. The information from the present study indicates that it may not be possible to develop uniform protocols for usage of antibiotics in the treatment of severe periodontitis in the European Union.

Adult↗