Overall, it was concluded that none of the test methods is suitable as an alternative to agar dilution in the routine laboratory.

Transanal TME procedures are associated with positive cultures in more than one-third of the patients. In these patients, postoperative locoregional infectious complications are more common.

The optimal surgical approach and timing for patients with tetralogy of Fallot remain controversial. There are two options in current practice: a two-stage repair (an initial palliative aortopulmonary shunt at an early age followed by complete repair at an older age) or primary complete repair. There has been a trend towards primary repair at a young age, which can be attributed to advances in anesthetic and cardiac surgical techniques. Primary repair has several advantages. The correction can be done in one operation and shunt complications are avoided. Progressive right ventricular fibrosis, ventricular hypertrophy, and chronic hypoxia are avoided, which may reduce the incidence of late ventricular arrhythmias. However, surgical correction at a young age is associated with an increased incidence of transannular patching and consequent pulmonary regurgitation. Progressive pulmonary regurgitation is associated with late ventricular arrhythmias and sudden death. These consequences may be prevented by timely pulmonary valve replacement. Palliative procedures include an aortopulmonary shunt, balloon dilation of the right ventricular tract, and stent placement. Of these measures, the aortopulmonary shunt is preferred, as it results in a more predictable outcome. Complications associated with shunt placement include shunt occlusion, pulmonary artery distortion, and occasionally, volume overloading of the left ventricle and pulmonary circulation. Institutional and surgeon preferences exist for either surgical strategy, and ultimately are justifiable when they produce the best outcomes for the individual patient. The optimal surgical strategy has to be determined by large prospective randomized studies that compare the functional status of the pulmonary valve and the need for reoperation at long-term follow-up.

Purpose In the Netherlands, patients with a risk factor for methicillin-resistant Staphylococcus aureus (MRSA) carriage, such as foreign hospital stay and contact with livestock (pigs, veal calves and/or broilers) are actively screened upon hospital admission. This study aimed to give insight in the geographical clustering patterns of MRSA carriage among these patients in a livestock-dense region. Methods A retrospective study was performed using medical records and laboratory results of MRSA screened patients admitted to seven hospitals in the provinces of Gelderland and Noord-Brabant, covering the period from 01/2011 to 02/2017. SaTScan spatial scanning identified cluster areas with an increased MRSA carriage risk in postal codes compared to the surrounding areas. Results 15 546 patients were included, among which 10.0% (n=1499) were MRSA carriers. Four significant, typically highly pig-dense MRSA carriage hotspots were identified, where the relative risk of carriage ranged from 2.1 to 3.4 compared to the surrounding area. Conclusion MRSA carriage risk clustered in certain areas, suggesting an association between livestock density (mainly pigs) and the MRSA carriage risk for the screened population at hospital admission. It needs to be explored when proximity (not contact) to livestock should be considered a risk factor. Considering analytical difficulties we encountered it is recommended to harmonize culture methods and data acquisition across hospitals to facilitate analysis for improving MRSA screening policy.