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Candida spp is responsible for 70-90% of invasive fungal infections. Invasive candidiasis is usually diagnosed by blood culture; other microbiological methods such as PCR, beta-D-glucans and mannans/anti-mannans are available in addition to clinical scores such as the Candida score. Management includes antifungal therapy, removal of catheters and source control, follow-up blood cultures and fundus examination, one possible complication being endophthalmitis. Candida albicans is the most common species in Switzerland and is generally susceptible to all antifungal agents. One concern is the spread of Candida auris, due to multi-resistant strains and the propensity to spread within and between hospitals, which is difficult to control., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Tularaemia is a highly infectious, zoonotic disease caused by Francisella tularensis , which has become increasingly prevalent over the past decade. Depending on the route of infection, different clinical manifestations can be observed. We report a case of typhoidal tularaemia presenting as a febrile illness with gastrointestinal symptoms in a patient in her mid-80s. During the acute illness phase and in the context of alcohol-related liver cirrhosis, the patient developed progressive ascites. During paracentesis, spontaneous bacterial peritonitis was consistently reported. Blood culture revealed Gram-negative bacilli identified as F. tularensis upon microscopic examination. Immediate clinical improvement was observed after adaptation to a pathogen-specific antibiotic regime. Typhoidal tularaemia presents general, non-specific symptoms without the local manifestations seen in other forms of the disease, thus representing a diagnostic challenge. In the case of protracted fever and if the epidemiological context as well as possible exposure are compatible, tularaemia should be considered in the differential diagnosis., Competing Interests: Competing interests: None declared., (© BMJ Publishing Group Limited 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

I study the effect of parental leave duration on maternal health in the short- to medium-run leveraging variation in parental leave duration induced by an Austrian policy reform in the year 2000. Using rich administrative data and a regression discontinuity framework, I find that long parental leave of 2.5 years instead of 1.5 years deteriorates maternal health. Worse mental health mainly drives this effect. Alternative channels such as differential fertility, long-term employment effects, a change in disposable income or alternative mode of childcare are unlikely to be of main importance. There is substantial heterogeneity with longer leave spells being less harmful for mothers with unhealthy babies proxied by low birth weight., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier B.V. All rights reserved.)

Aortitis may be an incidental finding at imaging. It refers to inflammation of the aortic wall and sometimes may be hard to differentiate with the periaortitis, inflammation of tissues around the vessel. Their clinical presentation is as varied as their etiologies. Appropriate early management is essential for improving patient prognosis, as the diagnostic approach remains challenging., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Hantaviruses are enveloped zoonotic RNA viruses hosted by rodents and responsible in the Americas for hantavirus pulmonary syndrome. In Europe, they cause hemorrhagic fever with renal syndrome and its milder form, nephropathia epidemica. The disease begins abruptly with high fever, chills, headache, back pain and abdominal pain associated with nausea and vomiting. Diagnosis is primarily made by serology. There is currently no specific medication or preventive available in Europe. Treatment is symptomatic., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

In 2021, the European and American Infectious Diseases Societies published new guidelines for the treatment of Clostridiodes difficile colitis. They have opted for a change in practice with fidaxomicin being recommended as the first line of treatment, and vancomycin as a second choice. Metronidazole remains recommended only in cases where other treatments are not available. These choices have not been endorsed by the Swiss Infectious Diseases Society, which still proposes metronidazole as first-line treatment. As a matter of fact, this inexpensive treatment still presents a satisfactory efficacy on the strains of Clostridoides difficile found in Switzerland in the context of patients without risk factors and with low probability of relapse., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Since the introduction of antibiotics, successive waves of Staphylococcus aureus clones occurred, each one having characteristic susceptibility pattern to antibiotics and virulence factors. We report here the results of a molecular epidemiological surveillance of methicillin-resistant S. aureus (MRSA) in French-speaking Switzerland between 2006 and 2020 showing the emergence and disappearance of clones known for their international dissemination, and the sporadic appearance of other international clones. Since 2012, a marked decrease in the incidence of cases attributable to the biology of the clones and to the control measures taken in the hospitals has been observed. These results highlight the importance of continuous surveillance in order to better assess the burden of this multi-resistant pathogen in our region., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

This paper studies the effect of birth allowances (so-called baby bonus) on fertility, newborn health, and birth-scheduling in Switzerland. Switzerland provides an optimal quasi-experiment: 11 out of 26 cantons introduced a baby bonus during the last 50 years at different points in time. To identify the effect of changes in the baby bonus, we employ an event study with control groups using several administrative data sets on births, stillbirths, and infant deaths in Switzerland from 1969 to 2017. While there is no evidence for birth-scheduling, we find, however, a sizable but only temporary increase in the fertility rate of 5.5% and a permanent but diminishing increase in the birth weight of 2.8%. The latter effect is particularly strong at the lower end of the birth weight distribution. Furthermore, we document substantial heterogeneity by citizenship of mothers., (© 2021 The Authors. Health Economics published by John Wiley & Sons Ltd.)

Parental leave policies across the globe have become much more generous than they used to be. This is also true for prenatal maternal leave. While this may be costly in the short run, little is known about the effect of maternal employment during pregnancy on newborn health. In this paper, I exploit three sharp policy changes on the duration of paid parental leave in Austria that strongly affected the share of mothers who work up to the 32nd week of pregnancy. I use administrative data from Austria on the working history of women linked to the full Austrian birth register and coupled with a regression discontinuity framework to identify the effect of prenatal employment on their offspring. Maternal employment during pregnancy with the second child reacts strongly to these policy changes. The share of employed mothers sharply declined in 1990 by 19.1 percentage points, increased in 1996 by 6.9 percentage points and declined again by 6.4 percentage points in 2000. None of these changes in prenatal employment translated into effects on newborn health measured via birth weight, gestational length, and Apgar scores. This result holds true for mothers of different socioeconomic backgrounds and across industries. The effect is precisely estimated, which suggests that prenatal employment prior to the 32nd week of pregnancy does not causally affect the fetus for measures visible at birth., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Background: Since its first description in December 2019, coronavirus disease 19 (COVID-19) has spread worldwide. There is limited information about presenting characteristics and outcomes of Swiss patients requiring hospitalisation. Furthermore, outcomes 30 days after onset of symptoms and after hospital discharge have not been described., Aims: To describe the clinical characteristics, outcomes 30 days after onset of symptoms and in-hospital mortality of a cohort of patients hospitalised for COVID-19 in a Swiss area., Methods: In this retrospective cohort study, we included all inpatients hospitalised with microbiologically confirmed COVID-19 between 1 March and 12 April 2020 in the public hospital network of a Swiss area (Fribourg). Demographic data, comorbidities and outcomes were recorded. Rate of potential hospital-acquired infection, outcomes 30 days after onset of symptoms and in-hospital mortality are reported., Results: One hundred ninety-six patients were included in the study. In our population, 119 (61%) were male and the median age was 70 years. Forty-nine patients (25%) were admitted to the intensive care unit (ICU). The rate of potential hospital-acquired infection was 7%. Overall, 30 days after onset of symptoms 117 patients (60%) had returned home, 23 patients (12%) were in a rehabilitation facility, 18 patients (9%) in a medical ward, 6 patients (3%) in ICU and 32 (16%) patients had died. Among patients who returned home within 30 days, 73 patients (63%) reported persistent symptoms. The overall in-hospital mortality was 17%., Conclusion: We report the first cohort of Swiss patients hospitalised with COVID-19. Thirty days after onset of the symptoms, 60% had returned home. Among them, 63% still presented symptoms. Studies with longer follow-up are needed to document long-term outcomes in patients hospitalised with COVID-19.

Actinomycosis is a chronic bacterial infection, caused by the genus Actinomyces, commensal of the digestive and genital tract. The most common presentation of the disease affects the cervicofacial region, but other anatomical sites in the abdomen, thorax and central nervous system may be involved. Differential diagnosis includes neoplasia. Prolonged culture of deep samples in an anaerobic environment is the gold standard of the diagnosis. The treatment of choice is intravenous penicillin G followed by oral amoxicillin for a total duration of 6 to 12 months. However, depending on the location and response to antibiotics, shorter therapy may be considered., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Back pain is a frequent reason for consultation. Although commonplace most of the time, back pain can sometimes be the only symptom of vertebral osteomyelitis, an infection that usually affects an intervertebral disc and the two adjacent vertebrae. Microbiology varies with the host's risk factors and local epidemiology. MRI is the preferred radiologic modality. Nevertheless, the definitive diagnosis is based on microbiological and histopathological elements. Antibiotic therapy alone may in some cases lead to cure, while in other cases the use of surgery is necessary. If it isn't diagnosed in time, vertebral osteomyelitis can have serious consequences. Thus, the physician must be familiar with the anamnestic, clinical and paraclinical elements that will bring him to actively look for this disease., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Legionellosis refers to the two clinical syndromes caused by Legionella : Pontiac fever, a benign febrile illness and Legionnaires'disease (or pneumonia). Clinically and radiologically, Legionnaires'disease presents itself as a « typical » pneumonia caused by Streptococcus pneumonia. Diagnosis is usually made by using urinary antigen testing. Culture and PCR are also helpful. Legionella is resistant to betalactam antibiotics, and is treated by quinolones or macrolides., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Listeria monocytogenes infections are caused by food ingestion. They are not only transmitted by animal products, but also by secondarily contaminated fruits and vegetables. They preferentially affect pregnant women, patients of extreme ages and the immu-nocompromised, and manifest as a gastroenteritis, bacteremia, meningo-encephalitis or maternal-fetal infection. Diagnosis is achieved by culture of usually sterile sites. The preferred treatment is amoxicillin with or without gentamicin. For patients at risk, prevention is based on avoiding at-risk food or cooking it when possible., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Several outbreaks have made the news in 2016 : Ebola has come at an end, Zika is booming and a resurgence of yellow fever takes place in Africa. In Switzerland, two hospital outbreaks have been reported, caused by Mycobacterium chimerae and Burkholderia cepacia. A major new article has consolidated the notion that prolonged antibiotic therapy is unnecessary in Lyme disease. As multiresistant bacteria are increasing in frequency, innovative therapeutic approaches are under development. For lung infections, sensitive and specific methods are in need to refine their etiological diagnosis. In pneumonia, therapy can be shortened without risk compared with usual practice. Finally, the epidemiology of bacterial meningitis has changed in the last 10 years, with a decrease of incidence., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Purpose: The frequency of bacteremia and the array of microorganisms involved in cellulitis vary greatly among studies. Although current guidelines do not recommend routine blood culture in uncomplicated cellulitis, their implementation in clinical practice remains challenging. We therefore aimed to assess the frequency, determinants and microbiology of bacteremia in hospitalized patients with uncomplicated cellulitis., Methods: We retrospectively reviewed the medical records of all adult patients admitted at a primary-care hospital with a diagnosis of community-acquired uncomplicated cellulitis during a 4-year period. We looked at the factors associated with blood cultures sampling and at the incidence, determinants and microbiology of bacteremia in this population., Results: Among the 476 patients hospitalized with a diagnosis of cellulitis, 250 (52.5%) had blood cultures. Fever, high C-reactive protein and lymphatic insufficiency were significantly associated with the sampling of blood cultures. Twelve (4.8%) patients had bacteremia. Alcoholism and duration of hospitalization were associated with bacteremia in multivariate analysis. Among the 12 patients with bacteremia, 9 had Streptococcus sp. and 3 had Staphylococcus aureus infection., Conclusion: In our study population with uncomplicated cellulitis, representative of unselected population admitted at primary-care hospitals, bacteremia was uncommon and not associated with discriminant patient characteristics, except for alcohol abuse. Episodes of bacteremia were exclusively due to gram-positive cocci susceptible to co-amoxicilin, a common first-line empirical therapy. In accordance with existing guidelines, we do not recommend to collect blood for cultures in uncomplicated cellulitis. Clinicians' awareness of guidelines and of the poor yield of blood cultures could reduce useless investigation., (Copyright © 2016 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.)

Background: Assessment of early response to treatment is crucial for the management of community-acquired pneumonia (CAP)., Objective: To describe the predictors and the outcomes of early clinical stability., Methods: We did a secondary analysis of a multicentre randomized controlled trial on CAP treatment in which 580 patients hospitalized for moderately severe CAP were included. The association between demographic, clinical and biological variables available at inclusion and early clinical stability (stabilization of vital signs within 72 hours with predetermined cut-offs) was assessed by multivariate logistic regression. The association between early clinical stability and mortality, severe adverse events, and length of stay was also tested., Results: Younger age (OR 0.98, 95% CI 0.96-0.99), lower platelet count (OR per 10 G/L increment 0.96, 95% CI 0.94-0.98), lower respiratory rate (OR 0.94, 95% CI 0.90-0.97), absence of hypoxemia (OR 0.58, 95% CI 0.40-0.85), lower numbers of co-morbid conditions (OR 0.82, 95% CI 0.69-0.98) and signs or symptoms (OR 0.78, 95% CI 0.68-0.90) were significantly associated with early clinical stability. Patients with early clinical stability had lower 90-days mortality (3.4% vs. 11.9%, p<0.001), fewer admissions to the intensive care unit (2.7% vs. 8.0%, p = 0.005) and a shorter length of stay (6.0 days, IQR 4.0-10.0 vs. 10.0 days, IQR 7.0-15.0, p<0.001)., Conclusions: Patients with younger age, less co-morbidity, fewer signs or symptoms, less respiratory compromise, and a lower platelet count are more likely to reach early clinical stability. Patients without early clinical stability have a worse prognosis and warrant close scrutiny.

Background: In hemodialysis patients, post-dialysis treatment with intravenous antibiotics permits even severe infections to be managed on an outpatient basis. Cefepime is a fourth-generation cephalosporin with a broad spectrum of action in monotherapy. We report on the pharmacokinetics of cefepime in post-dialysis therapy., Methods: Since June 2012, twelve infections were treated with post-dialysis cefepime in 9 patients on high-flux hemodialysis. The initial post-dialysis dose of cefepime was approximately 15 mg/kg. The following doses were adapted according to the trough serum levels obtained before the subsequent dialysis in order to be above the EUCAST breakpoints for susceptible organisms and above the MIC90. Residual plasma concentrations were determined before (n = 30) and after (n = 17) dialysis by liquid chromatography-mass spectrometry., Results: Overall, the mean ± SD dose of cefepime was 920 ± 270 mg (14.5 ± 5.1 mg/kg), but it was significantly lower before the 48 h interval (775 ± 210 mg or 12.7 ± 4.5 mg/kg) compared to the 72 h interval (1125 ± 225 mg or 17.2 ± 4.9 mg/kg) (p < 0.05). The mean trough pre-dialysis concentrations were 10.7 ± 3.9 mg/l and 11.3 ± 5.6 mg/l at 48 and 72 h, respectively. These levels always largely exceeded the EUCAST susceptibility breakpoints for all the targeted bacteria (>1 mg/l) with the exception of Pseudomonas aeruginosa (>8 mg/l). Cefepime concentrations were higher in anuric patients compared to those with preserved diuresis (15.6 ± 3.5 vs 9.25 ± 3.6 mg/l; p < 0.001) and decreased on average by 81 % during dialysis (from 10.5 ± 3.7 to 1.96 ± 1.2 mg/l; p < 0.001). The clinical outcome of all patients was good., Conclusions: Outpatient treatment with cefepime administered post-dialysis three-times-weekly was effective and well-tolerated in our patients. According to our data, in patients infected by highly susceptible pathogens a fixed dose of cefepime of 1 g before every 48-h interval and of 1.5 g before every 72-h interval should be recommended, without need of routine monitoring of the cefepime blood levels. In patients having an infection with less susceptibles pathogens as P. aeruginosa, and particularly in those among them exhibiting residual renal function, higher initial doses are necessary (1.5 g before a 48-h interval and 2.0 g before a 72-h interval) with adaption according to the subsequent pre-dialysis trough serum levels.

The clinical microbiology laboratory plays an essential role in the management of Clostri- dium difficile infections, showing an increase in frequency and severity. Many tests (culture, EIA, PCR), detecting bacteria or their antigens, toxin genes or free toxins, allow the microbio- logist to provide the clinician and the infection control specialist with a reliable diagnosis as- sistance, which meet essential criteria for ra- pidity, sensitivity and specificity. This review presents the diagnostic algorithms currently used.

Pharyngitis is a common cause of consultation in ambulatory medicine. Although it is benign in most cases, serious complications may happen and must be recognized quickly. Lemierre's syndrome is one of them. It consists in the association of thrombosis of the internal jugular vein and septic emboli that generally involve the lungs and is classically associated with Fusobacterium necrophorum. It is usually found in young and healthy adults and has an estimated mortality of 5%. Diagnosis relies essentially on the characteristic presentation of the disease. Therapy consists of surgical drainage of purulent collections and necrotic tissues associated with a prolonged course of antibiotics. Some authors also recommend a anticoagulation.

CSF lactate measurement is recommended when nosocomial meningitis is suspected, but its value in community-acquired bacterial meningitis is controversial. We evaluated the diagnostic performance of lactate and other CSF parameters in a prospective cohort of adult patients with acute meningitis. Diagnostic accuracy of lactate and other CSF parameters in patients with microbiologically documented episodes was assessed by receiver operating characteristic (ROC) curves. The cut-offs with the best diagnostic performance were determined. Forty-five of 61 patients (74%) had a documented bacterial (n = 18; S. pneumoniae, 11; N. meningitidis, 5; other, 2) or viral (n = 27 enterovirus, 21; VZV, 3; other, 3) etiology. CSF parameters were significantly different in bacterial vs. viral meningitis, respectively (p < 0.001 for all comparisons): white cell count (median 1333 vs. 143/mm(3)), proteins (median 4115 vs. 829 mg/l), CSF/blood glucose ratio (median 0.1 vs. 0.52), lactate (median 13 vs. 2.3 mmol/l). ROC curve analysis showed that CSF lactate had the highest accuracy for discriminating bacterial from viral meningitis, with a cutoff set at 3.5 mmol/l providing 100% sensitivity, specificity, PPV, NPV, and efficiency. CSF lactate had the best accuracy for discriminating bacterial from viral meningitis and should be included in the initial diagnostic workup of this condition.

Importance: The clinical benefit of adding a macrolide to a β-lactam for empirical treatment of moderately severe community-acquired pneumonia remains controversial., Objective: To test noninferiority of a β-lactam alone compared with a β-lactam and macrolide combination in moderately severe community-acquired pneumonia., Design, Setting, and Participants: Open-label, multicenter, noninferiority, randomized trial conducted from January 13, 2009, through January 31, 2013, in 580 immunocompetent adult patients hospitalized in 6 acute care hospitals in Switzerland for moderately severe community-acquired pneumonia. Follow-up extended to 90 days. Outcome assessors were masked to treatment allocation., Interventions: Patients were treated with a β-lactam and a macrolide (combination arm) or with a β-lactam alone (monotherapy arm). Legionella pneumophila infection was systematically searched and treated by addition of a macrolide to the monotherapy arm., Main Outcomes and Measures: Proportion of patients not reaching clinical stability (heart rate <100/min, systolic blood pressure >90 mm Hg, temperature <38.0°C, respiratory rate <24/min, and oxygen saturation >90% on room air) at day 7., Results: After 7 days of treatment, 120 of 291 patients (41.2%) in the monotherapy arm vs 97 of 289 (33.6%) in the combination arm had not reached clinical stability (7.6% difference, P = .07). The upper limit of the 1-sided 90% CI was 13.0%, exceeding the predefined noninferiority boundary of 8%. Patients infected with atypical pathogens (hazard ratio [HR], 0.33; 95% CI, 0.13-0.85) or with Pneumonia Severity Index (PSI) category IV pneumonia (HR, 0.81; 95% CI, 0.59-1.10) were less likely to reach clinical stability with monotherapy, whereas patients not infected with atypical pathogens (HR, 0.99; 95% CI, 0.80-1.22) or with PSI category I to III pneumonia (HR, 1.06; 95% CI, 0.82-1.36) had equivalent outcomes in the 2 arms. There were more 30-day readmissions in the monotherapy arm (7.9% vs 3.1%, P = .01). Mortality, intensive care unit admission, complications, length of stay, and recurrence of pneumonia within 90 days did not differ between the 2 arms., Conclusions and Relevance: We did not find noninferiority of β-lactam monotherapy in patients hospitalized for moderately severe community-acquired pneumonia. Patients infected with atypical pathogens or with PSI category IV pneumonia had delayed clinical stability with monotherapy., Trial Registration: clinicaltrials.gov Identifier: NCT00818610.

Accurate diagnosis of orthopedic device-associated infections can be challenging. Culture of tissue biopsy specimens is often considered the gold standard; however, there is currently no consensus on the ideal incubation time for specimens. The aim of our study was to assess the yield of a 14-day incubation protocol for tissue biopsy specimens from revision surgery (joint replacements and internal fixation devices) in a general orthopedic and trauma surgery setting. Medical records were reviewed retrospectively in order to identify cases of infection according to predefined diagnostic criteria. From August 2009 to March 2012, 499 tissue biopsy specimens were sampled from 117 cases. In 70 cases (59.8%), at least one sample showed microbiological growth. Among them, 58 cases (82.9%) were considered infections and 12 cases (17.1%) were classified as contaminations. The median time to positivity in the cases of infection was 1 day (range, 1 to 10 days), compared to 6 days (range, 1 to 11 days) in the cases of contamination (P < 0.001). Fifty-six (96.6%) of the infection cases were diagnosed within 7 days of incubation. In conclusion, the results of our study show that the incubation of tissue biopsy specimens beyond 7 days is not productive in a general orthopedic and trauma surgery setting. Prolonged 14-day incubation might be of interest in particular situations, however, in which the prevalence of slow-growing microorganisms and anaerobes is higher.

Tularemia is an infection caused by Francisella tularensis. This zoonose is transmitted to human through contact with infected animals or by vectors such as ticks. It has been a rare disease in Switzerland until recently, but its incidence is increasing. The clinical manifestations of tularemia are diverse and the ulcero-glandular disease is the most common form. It presents with an ulcerative lesion at the site of inoculation and regional lymphadenopathy which can be massive. Diagnosis is based on culture, PCR or serology with antibody titer rise approximately 2 weeks after the onset of illness. Antibiotics with clinical efficacy include doxycycline, fluoroquinolones and aminoglycosides.

We describe the case of a 35-year-old female patient who suffered from fulminant tick-borne encephalitis and subsequently died. Remarkable about this case was that the woman was not living in an endemic area and that the disease occurred outside the usual season. Furthermore, this indicates that an increase in transmission of tick-borne encephalitis can be expected outside the classical endemic areas in higher altitudes, possibly as a consequence of climate changes.

According to molecular epidemiology theory, two isolates belong to the same chain of transmission if they are similar according to a highly discriminatory molecular typing method. This has been demonstrated in outbreaks, but is rarely studied in endemic situations. Person-to-person transmission cannot be established when isolates of meticillin-resistant Staphylococcus aureus (MRSA) belong to endemically predominant genotypes. By contrast, isolates of infrequent genotypes might be more suitable for epidemiological tracking. The objective of the present study was to determine, in newly identified patients harbouring non-predominant MRSA genotypes, whether putative epidemiological links inferred from molecular typing could replace classical epidemiology in the context of a regional surveillance programme. MRSA genotypes were defined using double-locus sequence typing (DLST) combining clfB and spa genes. A total of 1,268 non-repetitive MRSA isolates recovered between 2005 and 2006 in Western Switzerland were typed: 897 isolates (71%) belonged to four predominant genotypes, 231 (18%) to 55 non-predominant genotypes, and 140 (11%) were unique. Obvious epidemiological links were found in only 106/231 (46%) patients carrying isolates with non-predominant genotypes suggesting that molecular surveillance identified twice as many clusters as those that may have been suspected with classical epidemiological links. However, not all of these molecular clusters represented person-to-person transmission. Thus, molecular typing cannot replace classical epidemiology but is complementary. A prospective surveillance of MRSA genotypes could help to target epidemiological tracking in order to recognise new risk factors in hospital and community settings, or emergence of new epidemic clones., (Copyright © 2011 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Infections acquired by exposure to water are common. The evolution of these infections found in our region is benign. However, some acquired in our regions or during travel abroad, may have a severe clinical course that requires early diagnosis. This article proposes a non-exhaustive review of the most common infections encountered in our regions or acquired abroad. The review excludes gastrointestinal infections acquired after ingestion of contaminated water.

Diagnosis of nontuberculous mycobacterial infection, which most often cause pulmonary disease, are increasing. Only a few of the numerous mycobacteria species are clearly pathogenic. Patients, either immunocompetent or immunocompromised, with orwithout underlying disease, are contaminated from the environment. Diagnosis, according to standardized criteria, is based on clinical picture, radiological exams and positive microbiological samples, usually on more than one occasion (slow growing culture and PCR). There are several typical presentations, such as tuberculosis-like disease and lung nodules associated with bronchiectasis. Treatment combines several antimicrobials, is long (occasionally more than one year) and is not always successful.

Background: Missed appointments are known to interfere with appropriate care and to misspend medical and administrative resources. The aim of this study was to test the effectiveness of a sequential intervention reminding patients of their upcoming appointment and to identify the profile of patients missing their appointments., Methods: We conducted a randomised controlled study in an urban primary care clinic at the Geneva University Hospitals serving a majority of vulnerable patients. All patients booked in a primary care or HIV clinic at the Geneva University Hospitals were sent a reminder 48 hrs prior to their appointment according to the following sequential intervention: 1. Phone call (fixed or mobile) reminder; 2. If no phone response: a Short Message Service (SMS) reminder; 3. If no available mobile phone number: a postal reminder. The rate of missed appointment, the cost of the intervention, and the profile of patients missing their appointment were recorded., Results: 2123 patients were included: 1052 in the intervention group, 1071 in the control group. Only 61.7% patients had a mobile phone recorded at the clinic. The sequential intervention significantly reduced the rate of missed appointments: 11.4% (n = 122) in the control group and 7.8% (n = 82) in the intervention group (p < 0.005), and allowed to reallocate 28% of cancelled appointments. It also proved to be cost effective in providing a total net benefit of 1846. - EUR/3 months. A satisfaction survey conducted with 241 patients showed that 93% of them were not bothered by the reminders and 78% considered them to be useful. By multivariate analysis, the following characteristics were significant predictors of missed appointments: younger age (OR per additional decade 0.82; CI 0.71-0.94), male gender (OR 1.72; CI 1.18-2.50), follow-up appointment >1 year (OR 2.2; CI: 1.15-4.2), substance abuse (2.09, CI 1.21-3.61), and being an asylum seeker (OR 2.73: CI 1.22-6.09)., Conclusion: A practical reminder system can significantly increase patient attendance at medical outpatient clinics. An intervention focused on specific patient characteristics could further increase the effectiveness of appointment reminders.

Background/aims: Treatment of chronic HCV infection has become a priority in HIV+ patients, given the faster progression to end-stage liver disease. The primary endpoint of this study was to evaluate and compare antiviral efficacy of Peginterferon alpha 2a plus ribavirin in HIV-HCV co-infected and HCV mono-infected patients, and to examine whether 6 months of therapy would have the same efficacy in HIV patients with favourable genotypes 2 and 3 as in mono-infected patients, to minimise HCV-therapy-related toxicities. Secondary endpoints were to evaluate predictors of sustained virological response (SVR) and frequency of side-effects., Methods: Patients with genotypes 1 and 4 were treated for 48 weeks with Pegasys 180 microg/week plus Copegus 1000-1200 mg/day according to body weight; patients with genotypes 2 and 3 for 24 weeks with Pegasys 180 microg/week plus Copegus 800 mg/day., Results: 132 patients were enrolled in the study: 85 HCV mono-infected (38: genotypes 1 and 4; 47: genotypes 2 and 3), 47 HIV-HCV co-infected patients (23: genotypes 1 and 4; 24: genotypes 2 and 3). In an intention-to-treat analysis, SVR for genotypes 1 and 4 was observed in 58% of HCV mono-infected and in 13% of HIV-HCV co-infected patients (P = 0.001). For genotypes 2 and 3, SVR was observed in 70% of HCV mono-infected and in 67% of HIV-HCV co-infected patients (P = 0.973). Undetectable HCV-RNA at week 4 had a positive predictive value for SVR for mono-infected patients with genotypes 1 and 4 of 0.78 (95% CI: 0.54-0.93) and of 0.81 (95% CI: 0.64-0.92) for genotypes 2 and 3. For co-infected patients with genotypes 2 and 3, the positive predictive value of SVR of undetectable HCV-RNA at week 4 was 0.76 (95%CI, 0.50-0.93). Study not completed by 22 patients (36%): genotypes 1 and 4 and by 12 patients (17%): genotypes 2 and 3., Conclusion: Genotypes 2 or 3 predict the likelihood of SVR in HCV mono-infected and in HIV-HCV co-infected patients. A 6-month treatment with Peginterferon alpha 2a plus ribavirin has the same efficacy in HIV-HCV co-infected patients with genotypes 2 and 3 as in mono-infected patients. HCV-RNA negativity at 4 weeks has a positive predictive value for SVR. Aggressive treatment of adverse effects to avoid dose reduction, consent withdrawal or drop-out is crucial to increase the rate of SVR, especially when duration of treatment is 48 weeks. Sixty-one percent of HIV-HCV co-infected patients with genotypes 1 and 4 did not complete the study against 4% with genotypes 2 and 3.

Pet-related infections in humans are diverse, rather infrequent considering the high number of pets in households and often unrecognized. This article briefly covers a couple of them, caused by bacteria (salmonellosis and campylobacteriosis, cat-scratch disease, fish tank granuloma, psittacosis), fungi (dermatophytosis), viruses (lymphocytic choriomeningitis) and parasites (toxoplasmosis, toxocariasis, cutaneous larva migrans, echinococcosis) and describes their epidemiology and clinical presentation. Widening of public tastes in this area opens doors for emerging diseases (e.g. Cowpox virus with rats).

HCV infection has a severe course of disease in HIV/HCV co-infection and in liver transplant recipients. However, the mechanisms involved remain unclear. Here, we evaluated functional profiles of HCV-specific T-cell responses in 86 HCV mono-infected patients, 48 HIV/HCV co-infected patients and 42 liver transplant recipients. IFN-gamma and IL-2 production and ability of CD4 and CD8 T cells to proliferate were assessed after stimulation with HCV-derived peptides. We observed that HCV-specific T-cell responses were polyfunctional in HCV mono-infected patients, with presence of proliferating single IL-2-, dual IL-2/IFN-gamma and single IFN-gamma-producing CD4+ and dual IL-2/IFN-gamma and single IFN-gamma-producing CD8+ cells. In contrast, HCV-specific T-cell responses had an effector profile in HIV/HCV co-infected individuals and liver transplant recipients with absence of single IL-2-producing HCV-specific CD4+ and dual IL-2/IFN-gamma-producing CD8+ T cells. In addition, HCV-specific proliferation of CD4+ and CD8+ T cells was severely impaired in HIV/HCV co-infected patients and liver transplant recipients. Importantly, "only effector" T-cell responses were associated with significantly higher HCV viral load and more severe liver fibrosis scores. Therefore, the present results suggest that immune-based mechanisms may contribute to explain the accelerated course of HCV infection in conditions of HIV-1 co-infection and liver transplantation.

Head pediculosis is a benign and common disease, particularly in children. It is usually asymptomatic and a definite diagnosis is not always easy. When a case is discovered, overdiagnosis and unwarranted therapies may be a consequence of patient follow-up and contact investigation. As a general rule, topical pediculicides--mainly permethrin and malathion--give good results despite the emergence of resistance in some countries. Pediculosis of the body affects populations with very poor sanitation conditions; simple hygiene measures are the cornerstone of therapy. Phtirius pubis is sexually transmitted, easily diagnosed and treated with topical pediculicides.

It is not always easy to choose the right microbiology test to order. Which pathogens to look for? What is the best-fitted method: microscopy, culture, tests for antigens, antibodies, genes or toxins? How to sample and transport the specimen? This article brings some answers to the questions the physician often asks when prescribing microbiology exams on stools, deep respiratory tract secretions, blood and wounds. By selecting the appropriate tests and respecting the guidelines for sampling and transporting specimens, the physician greatly contributes to the quality of results.

In the last decade, community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) have emerged in young, individuals without risk factors for MRSA acquisition. They mainly present with skin and soft tissue infections. CA-MRSA are genotypically and phenotypically differents from HA-MRSA. In case of recurrent or severe soft tissue infections, search for CA-MRSA should be performed. Treatment consists of incision and drainage of abscesses and furuncles. If antibiotics are needed, trimethoprim-sulfamethoxazole is the first choice. A specialist in infection control is advised for contact screening implementation of hygienic precautions and decolonization therapy.

We report the case of a 62-year-old man without prodromal symptoms who developed a hemolytic-uremic syndrome (HUS) one week after the diagnosis of an acute bacteremic urinary infection (UTI). In this patient, the E. coli isolated in blood cultures was a non-O157:H7 Shigatoxin-producing strain that could subsequently be identified as O138:H-. This is a strain that is normally found in pigs and that has never been isolated in humans previously. UTI-related HUS is a rare event, as until now, only 14 pediatric and 3 adult cases have been reported. Indeed, this new case, besides its interesting microbiological aspects, should heighten our awareness of UTI-related HUS as a rare but real condition, not only in young children but also in adult patients. This should emphasize the necessity to search actively for other sources of Shigatoxin-producing E. coli in patients presenting with HUS without gastrointestinal symptoms.

Health care workers are often victims of occupational injuries by contaminated sharps or projection of contaminated fluids to mucous membranes and are therefore at risk for transmission of HIV, HBV and HCV. Every technical and organisation-related measure useful to prevent injuries should be implemented and personal protection equipment must be made available to workers. Promotion of hepatitis B immunization is a key issue. Immediate evaluation of injured employee is necessary to assess the risk related to exposure and the indication for post-exposure prophylaxis (anti-retroviral therapy for HIV, immunoglobulins and vaccination for hepatitis B). When a health care worker has been exposed to one of the blood-born viruses, thorough information and follow-up should be offered by a specialist.

Blood culture negative endocarditis (BCNE) account for about 5% of all cases of endocarditis. Diagnosis and initiation of antimicrobial therapy may be delayed, with a negative impact on clinical outcome. The most common cause of BCNE is antimicrobial drug therapy before blood sampling. Other common causes include slow growing and non cultivable organisms. Identification of the etiologic agent is critical in the management of BCNE and molecular tools such as broad range 16SrRNA PCR technique followed by direct automated sequencing and microorganism-specific PCR are promising. Some authors have proposed to include these techniques among major Duke's criteria for the diagnosis of BCNE.

Several authors, mainly from the United States, have reported on the microbiology and interpretation of positive blood cultures. We conducted a retrospective study over a 2 years period to address this issue in a medium-size swiss hospital: two hundred and thirty-two episodes of positive blood culture were recorded, with 403 microorganisms; Escherichia coli (22%), Staphylococcus aureus (21%) and coagulase-negative staphylococci (110%) were the most frequent isolates. The latter were considered as contaminants in 38% of cases. Half the episodes were nosocomial, 23% originated from the urinary tract and 18% were linked to a vascular catheter. Attributable mortality of bacteremia/fungemia was 9%, significantly higher for fungi (36%) than for bacteria (8%; p 0.009).