146 results on '"Buetti N"'
Search Results
2. Epidemiology of bloodstream infections caused by extended-spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae in Switzerland, 2015–2022: secular trends and association with the COVID-19 pandemic
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Damonti, L., Gasser, M., Kronenberg, A., and Buetti, N.
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- 2024
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3. Risk of catheter-associated bloodstream infection by catheter type in a neonatal intensive care unit: a large cohort study of more than 1100 intravascular catheters
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Catho, G., Rosa Mangeret, F., Sauvan, V., Chraïti, M.-N., Pfister, R., Baud, O., Harbarth, S., and Buetti, N.
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- 2023
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4. Targeted mupirocin-based decolonization for Staphylococcus aureus carriers and the subsequent risk of mupirocin resistance in haemodialysis patients – a longitudinal study over 20 years
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Hassoun-Kheir, N., Buetti, N., Olivier, V., Perez, M., Frossard, J., Renzi, G., Schrenzel, J., Saudan, P., and Harbarth, S.
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- 2023
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5. Pronostic de l’intubation tardive dans l’insuffisance respiratoire aiguë hypoxémique liée au SARS-COV 2
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Phillips-Houlbracq, M., primary, Mathilde, N., additional, Bitar, K., additional, Siami, S., additional, Cohen, Y., additional, Laurent, V., additional, Mourvillier, B., additional, Reigner, J., additional, Goldgran-Toledano, D., additional, Schwebel, C., additional, Ruckly, S., additional, de Montmollin, E., additional, Buetti, N., additional, Cerf, C., additional, Timsit, J.-F., additional, and Dupuis, C., additional
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- 2024
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6. Validity of surrogate endpoints assessing central venous catheter-related infection: evidence from individual- and study-level analyses
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de Grooth, H.J., Timsit, J.-F., Mermel, L., Mimoz, O., Buetti, N., du Cheyron, D., Oudemans-van Straaten, H.M., and Parienti, J.-J.
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- 2020
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7. Cefepime neurotoxicity: thresholds and risk factors. A retrospective cohort study
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Boschung-Pasquier, L., Atkinson, A., Kastner, L.K., Banholzer, S., Haschke, M., Buetti, N., Furrer, D.I., Hauser, C., Jent, P., Que, Y.A., Furrer, H., and Babouee Flury, B.
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- 2020
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8. Hämoptyse mit seltener Ursache
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Taha-Mehlitz, S., Heising, E.-M., Benz, A., Buetti, N., and Leiser, A.
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- 2018
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9. Patterns and trends of pediatric bloodstream infections: a 7-year surveillance study
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Buetti, N., Atkinson, A., Kottanattu, L., Bielicki, J., Marschall, J., Kronenberg, A., Auckenthaler, R., Cherkaoui, A., Dolina, M., Dubuis, O., Frei, R., Koch, D., Kronenberg, A., Leib, S., Luyet, S., Nordmann, P., Perreten, V., Piffaretti, J. -C., Prod’hom, G., Schrenzel, J., Widmer, A. F., and the Swiss Centre for Antibiotic resistance (ANRESIS)
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- 2017
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10. Concentration of chlorhexidine gluconate-alcohol for skin antisepsis at the intravascular catheter insertion site
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Zhou, H.Y., primary, de Kraker, M.E.A., additional, Mimoz, O., additional, Boisson, M., additional, Harbarth, S., additional, and Buetti, N., additional
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- 2021
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11. Prevalence and significance of bacterial contamination of autologous stem cell products
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Damonti, L., primary, Buetti, N., additional, Droz, S., additional, Bacher, U., additional, Pabst, T., additional, Taleghani, B.M., additional, Baerlocher, G.M., additional, and Marschall, J., additional
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- 2021
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12. Corrigendum to 'Personal protective equipment and intensive care unit healthcare worker safety in the COVID-19 Era (PPE-SAFE): An international survey' [Journal of Critical Care, Volume 59, October 2020, Pages 70–75] (Journal of Critical Care (2020) 59 (70–75), (S088394412030592X), (10.1016/j.jcrc.2020.06.005))
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Tabah, A., Ramanan, M., Laupland, K. B., Buetti, N., Cortegiani, A., Mellinghoff, J., Conway Morris, A., Camporota, L., Zappella, N., Elhadi, M., Povoa, P., Amrein, K., Vidal, G., Derde, L., Francois, G., Bassetti, M., Ssi Yan Kai, N., and De Waele, J. J.
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- 2020
13. Successful management of a Clostridioides difficile ribotype 027 outbreak with a lean intervention bundle
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Kuenzli, A.B., primary, Burri, S., additional, Casanova, C., additional, Sommerstein, R., additional, Buetti, N., additional, Seth-Smith, H.M.B., additional, Bodmer, T., additional, Egli, A., additional, and Marschall, J., additional
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- 2020
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14. VRE in Switzerland: from first case to the national spread
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Buetti, N and Marschall, J
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ddc: 610 ,biochemical phenomena, metabolism, and nutrition ,610 Medical sciences ,Medicine ,bacterial infections and mycoses - Abstract
Background: Vancomycin-resistant enterococci (VRE) are multi-drug resistant microorganisms that cause healthcare-associated infections and are associated with an increased risk of mortality and length of hospital stay. In Switzerland, VRE incidence has not been monitored for infection control purposes[for full text, please go to the a.m. URL], Bad Honnef-Symposium 2019
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- 2019
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15. Isopropanol at 60% and at 70% are effective against ‘isopropanol-tolerant’ Enterococcus faecium
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Gebel, J., primary, Gemein, S., additional, Kampf, G., additional, Pidot, S.J., additional, Buetti, N., additional, and Exner, M., additional
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- 2019
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16. Low incidence of subsequent bacteraemia or fungaemia after removal of a colonized intravascular catheter tip
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Buetti, N., primary, Lo Priore, E., additional, Atkinson, A., additional, Kronenberg, A., additional, Marschall, J., additional, Burnens, A., additional, Cherkaoui, A., additional, Gaia, V., additional, Dubuis, O., additional, Viollier, A.G., additional, Egli, A., additional, Koch, D., additional, Luyet, S., additional, Nordmann, P., additional, Perreten, V., additional, Piffaretti, J.-C., additional, Prod'hom, G., additional, Schrenzel, J., additional, Leib, S., additional, Widmer, A.F., additional, Zanetti, G., additional, and Zbinden, R., additional
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- 2018
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17. Low incidence of subsequent bacteraemia or fungaemia after removal of a colonized intravascular catheter tip
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Burnens, A., Cherkaoui, A., Gaia, V., Dubuis, O., Viollier, A.G., Egli, A., Koch, D., Kronenberg, A., Luyet, S., Nordmann, P., Perreten, V., Piffaretti, J.-C., Prod'hom, G., Schrenzel, J., Leib, S., Widmer, A.F., Zanetti, G., Zbinden, R., Buetti, N., Lo Priore, E., Atkinson, A., and Marschall, J.
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- 2018
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18. Different epidemiology of bloodstream infections in COVID-19 compared to non-COVID-19 critically ill patients: a descriptive analysis of the Eurobact II study
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Buetti, Niccolò, Tabah, Alexis, Loiodice, Ambre, Ruckly, Stéphane, Aslan, Abdullah Tarik, Montrucchio, Giorgia, Cortegiani, Andrea, Saltoglu, Nese, Kayaaslan, Bircan, Aksoy, Firdevs, Murat, Akova, Akdoğan, Özlem, Saracoglu, Kemal Tolga, Erdogan, Cem, Leone, Marc, Ferrer, Ricard, Paiva, José-Artur, Hayashi, Yoshiro, Ramanan, Mahesh, Conway Morris, Andrew, Barbier, François, Timsit, Jean-François, Lipman, Jeffrey, Litton, Edward, Palermo, Anna Maria, Yap, Timothy, Eroglu, Ege, Hosokawa, Koji, Yoshida, Hideki, Fujitani, Shigeki, Zand, Farid, Mahmoodpoor, Ata, Tabatabaei, Seyed Mohammad Nasirodin, Elrabi, Omar, Almekhlafi, Ghaleb A, Vidal, Gabriela, Aparicio, Marta, Alonzo, Irene, Namendys-Silva, Silvio A, Hermosillo, Mariana, Castillo, Roberto Alejandro, De Bus, Liesbet, De Waele, Jan, Hollevoet, Isabelle, De Schryver, Nicolas, Serck, Nicolas, Kovacevic, Pedja, Zlojutro, Biljana, Ruppe, Etienne, Montravers, Philippe, Dulac, Thierry, Castanera, Jérémy, Massri, Alexandre, Guesdon, Charlotte, Garcon, Pierre, Duprey, Matthieu, Philippart, François, Tran, Marc, Bruel, Cédric, Kalfon, Pierre, Badre, Gaëtan, Demeret, Sophie, Le Guennec, Loïc, Bassetti, Matteo, Giacobbe, Daniele, Sales, Gabriele, Daroui, Ivan, Lodi, Giovanni, Ippolito, Mariachiara, Bellina, Davide, Di Guardo, Andrea, Rocco, Monica, Fiorelli, Silvia, Mikstacki, Adam, Peichota, Mariusz, Pietraszek-Grzywaczewska, Iwona, Póvoa, Pedro, Krystopchuk, Andriy, Teresa, Ana, De Figueiredo, António Manuel Pereira, Botelho, Isabel, Costa, Vasco, Cunha, Rui Pedro, Gritsan, Alexey, Belskiy, Vladislav, Furman, Mikhail, Martinez, Maria, Casares, Vanessa, Arnillas, Maria Pilar Gracia, Bermudez, Rosana Munoz, Ubeda, Alejandro, Salgado, Maria, Maseda, Emilio, De La Rica, Alejandro Suarez, Blasco-Navalpotro, Miguel Angel, Gallego, Alberto Orejas, Prazak, Josef, Pagani, JL, Abed-Maillard, S, Iskit, Arzu Topeli, Mehtap, Selcuk, Ceyhun, Solakoğlu, Kalem, Ayşe Kaya, Kurt, Ibrahim, Telli, Murat, Ozturk, Barcin, Baykam, Nurcan, Karaali, Ridvan, Koksal, Iftihar, Bilir, Yeliz, Guzeldag, Seda, Ersoz, Gulden, Evik, Guliz, Bayindir, Yasar, Ersoy, Yasemin, Ercole, Ari, Raj, Ashok, Zormpa, Artemis, Tinaslanidis, George, Khade, Reena, Roshdy, Ashraf, Kannan, Santhana, Antrolikar, Supriya, Marsden, Nicholas, Attwood, Ben, Patel, Jamie, Gurjar, Mohan, Dsilva, Carol, Chandran, Jagadish, Sanousi, Bashir El, Saidahmed, Elfayadh, Hamid, Hytham KS, Buetti, Niccolò, Tabah, Alexi, Loiodice, Ambre, Ruckly, Stéphane, Aslan, Abdullah Tarik, Montrucchio, Giorgia, Cortegiani, Andrea, Saltoglu, Nese, Kayaaslan, Bircan, Aksoy, Firdev, Murat, Akova, Akdoğan, Özlem, Saracoglu, Kemal Tolga, Erdogan, Cem, Leone, Marc, Ferrer, Ricard, Paiva, José-Artur, Hayashi, Yoshiro, Ramanan, Mahesh, Conway Morris, Andrew, Barbier, Françoi, Timsit, Jean-François, Conway Morris, Andrew [0000-0002-3211-3216], Apollo - University of Cambridge Repository, Institut Català de la Salut, [Buetti N] Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland. INSERM, IAME, Université Paris-Cité, Paris, France. [Tabah A] Intensive Care Unit, Redclife Hospital, Metro North Hospital and Health Services, Brisbane, QLD, Australia. Queensland University of Technology, Brisbane, QLD, Australia. Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia. [Loiodice A, Ruckly S] ICURESEARCH, Fonaine, France. [Aslan AT] Department of Internal Medicine, Hacettepe University, Sihhiye, Ankara, Turkey. [Montrucchio G] Department of Surgical Sciences, University of Turin, Turin, Italy. Department of Anaesthesia, Critical Care and Emergency, Città Della Salute e Della Scienza Hospital, Turin, Italy. [Ferrer R] Servei de Medicina Intensiva, Vall d’Hebron Hospital Universitari, Barcelona, Spain. Grup de Recerca en Xoc, Disfunció Orgànica i Ressuscitació, Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Timsit, Jean-Françoi, Lipman, Jeffrey, Litton, Edward, Palermo, Anna Maria, Yap, Timothy, Eroglu, Ege, Hosokawa, Koji, Yoshida, Hideki, Fujitani, Shigeki, Zand, Farid, Mahmoodpoor, Ata, Tabatabaei, Seyed Mohammad Nasirodin, Elrabi, Omar, Almekhlafi, Ghaleb A., Vidal, Gabriela, Aparicio, Marta, Alonzo, Irene, Namendys-Silva, Silvio A., Hermosillo, Mariana, Castillo, Roberto Alejandro, De Bus, Liesbet, De Waele, Jan, Hollevoet, Isabelle, De Schryver, Nicola, Serck, Nicola, Kovacevic, Pedja, Zlojutro, Biljana, Ruppe, Etienne, Montravers, Philippe, Dulac, Thierry, Castanera, Jérémy, Massri, Alexandre, Guesdon, Charlotte, Garcon, Pierre, Duprey, Matthieu, Philippart, Françoi, Tran, Marc, Bruel, Cédric, Kalfon, Pierre, Badre, Gaëtan, Demeret, Sophie, Le Guennec, Loïc, Bassetti, Matteo, Giacobbe, Daniele, Sales, Gabriele, Daroui, Ivan, Lodi, Giovanni, Ippolito, Mariachiara, Bellina, Davide, Di Guardo, Andrea, Rocco, Monica, Fiorelli, Silvia, Mikstacki, Adam, Peichota, Mariusz, Pietraszek-Grzywaczewska, Iwona, Póvoa, Pedro, Krystopchuk, Andriy, Teresa, Ana, de Figueiredo, António Manuel Pereira, Botelho, Isabel, Costa, Vasco, Cunha, Rui Pedro, Gritsan, Alexey, Belskiy, Vladislav, Furman, Mikhail, Martinez, Maria, Casares, Vanessa, Arnillas, Maria Pilar Gracia, Bermudez, Rosana Munoz, Ubeda, Alejandro, Salgado, Maria, Maseda, Emilio, De La Rica, Alejandro Suarez, Blasco-Navalpotro, Miguel Angel, Gallego, Alberto Oreja, Prazak, Josef, Pagani, J. L., Abed-Maillard, S., Iskit, Arzu Topeli, Mehtap, Selcuk, Ceyhun, Solakoğlu, Kalem, Ayşe Kaya, Kurt, Ibrahim, Telli, Murat, Ozturk, Barcin, Baykam, Nurcan, Karaali, Ridvan, Koksal, Iftihar, Bilir, Yeliz, Guzeldag, Seda, Ersoz, Gulden, Evik, Guliz, Bayindir, Yasar, Ersoy, Yasemin, Ercole, Ari, Raj, Ashok, Zormpa, Artemi, Tinaslanidis, George, Khade, Reena, Roshdy, Ashraf, Kannan, Santhana, Antrolikar, Supriya, Marsden, Nichola, Attwood, Ben, Patel, Jamie, Gurjar, Mohan, Dsilva, Carol, Chandran, Jagadish, Sanousi, Bashir El, Saidahmed, Elfayadh, and Hamid, Hytham K. S.
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Male ,bloodstream infections ,Other subheadings::Other subheadings::/epidemiology [Other subheadings] ,Critical Illness ,COVID-19 (Malaltia) - Epidemiologia ,RESISTANT ENTEROCOCCI ,Bacteremia ,Bloodstream infection ,Critical Care and Intensive Care Medicine ,Pathological Conditions, Signs and Symptoms::Pathologic Processes::Disease Attributes::Critical Illness [DISEASES] ,Cohort Studies ,afecciones patológicas, signos y síntomas::procesos patológicos::atributos de la enfermedad::enfermedad crítica [ENFERMEDADES] ,Sepsis ,virosis::infecciones por virus ARN::infecciones por Nidovirales::infecciones por Coronaviridae::infecciones por Coronavirus [ENFERMEDADES] ,Medicine and Health Sciences ,Humans ,NCT03937245 ,Unitats de cures intensives ,Aged ,Cross Infection ,Malalties bacterianes ,infecciones bacterianas y micosis::infección::infección hospitalaria [ENFERMEDADES] ,Research ,Otros calificadores::Otros calificadores::/epidemiología [Otros calificadores] ,COVID-19 ,Enterococcus ,ICU-acquired ,Virus Diseases::RNA Virus Infections::Nidovirales Infections::Coronaviridae Infections::Coronavirus Infections [DISEASES] ,Bacterial Infections and Mycoses::Infection::Cross Infection [DISEASES] ,Intensive Care Units ,NCT ,ICU ,RNA - Abstract
Funder: European society of Intensive Care Medicine, Funder: European Society of Clinical Microbiology and Infectious Diseases (ESCMID), Funder: Norva Dahlia foundation and the Redcliffe Hospital Private Practice Trust Fund, Background The study aimed to describe the epidemiology and outcomes of hospital-acquired bloodstream infections (HABSIs) between COVID-19 and non-COVID-19 critically ill patients. Methods We used data from the Eurobact II study, a prospective observational multicontinental cohort study on HABSI treated in ICU. For the current analysis, we selected centers that included both COVID-19 and non-COVID-19 critically ill patients. We performed descriptive statistics between COVID-19 and non-COVID-19 in terms of patients’ characteristics, source of infection and microorganism distribution. We studied the association between COVID-19 status and mortality using multivariable fragility Cox models. Results A total of 53 centers from 19 countries over the 5 continents were eligible. Overall, 829 patients (median age 65 years [IQR 55; 74]; male, n = 538 [64.9%]) were treated for a HABSI. Included patients comprised 252 (30.4%) COVID-19 and 577 (69.6%) non-COVID-19 patients. The time interval between hospital admission and HABSI was similar between both groups. Respiratory sources (40.1 vs. 26.0%, p < 0.0001) and primary HABSI (25.4% vs. 17.2%, p = 0.006) were more frequent in COVID-19 patients. COVID-19 patients had more often enterococcal (20.5% vs. 9%) and Acinetobacter spp. (18.8% vs. 13.6%) HABSIs. Bacteremic COVID-19 patients had an increased mortality hazard ratio (HR) versus non-COVID-19 patients (HR 1.91, 95% CI 1.49–2.45). Conclusions We showed that the epidemiology of HABSI differed between COVID-19 and non-COVID-19 patients. Enterococcal HABSI predominated in COVID-19 patients. COVID-19 patients with HABSI had elevated risk of mortality. Trial registration ClinicalTrials.org number NCT03937245. Registered 3 May 2019.
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- 2022
19. Clustering of health behaviours in adult survivors of childhood cancer and the general population
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Rebholz C E, Rueegg C S, Michel G, Ammann R A, von der Weid N X, Kuehni C E, Spycher B D, Swiss Paediatric Oncology Group (SPOG), Swiss Paediatric Oncology Group (SPOG), Angst, R., Paulussen, M., Kühne, T., Hirt, A., Leibundgut, K., Ozsahin, AH., Popovic, MB., Buetti, N., Brazzola, P., Caflisch, U., Greiner, J., Hengartner, H., Grotzer, M., and Niggli, F.
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Male ,Gerontology ,Marijuana Abuse ,Cancer Research ,Health Behavior ,Psychological intervention ,0302 clinical medicine ,Risk Factors ,Neoplasms ,Medicine ,Survivors ,030212 general & internal medicine ,education.field_of_study ,Smoking ,Cannabis use ,humanities ,Latent class model ,3. Good health ,Oncology ,030220 oncology & carcinogenesis ,population characteristics ,Female ,Switzerland ,Sports ,Adult ,Adolescent ,Alcohol Drinking ,childhood cancer survivors ,alcohol consumption ,Childhood cancer ,Population ,610 Medicine & health ,03 medical and health sciences ,Risk-Taking ,health behaviour ,Humans ,Social determinants of health ,education ,Life Style ,business.industry ,Health behaviour ,social sciences ,Diet ,Alcohol Drinking/epidemiology ,Follow-Up Studies ,Marijuana Abuse/epidemiology ,Neoplasms/epidemiology ,Smoking/epidemiology ,Survivors/psychology ,Switzerland/epidemiology ,Clinical Study ,Moderate drinking ,business ,human activities ,cluster analysis - Abstract
Background:Little is known about engagement in multiple health behaviours in childhood cancer survivors.Methods:Using latent class analysis we identified health behaviour patterns in 835 adult survivors of childhood cancer (age 20 35 years) and 1670 age and sex matched controls from the general population. Behaviour groups were determined from replies to questions on smoking drinking cannabis use sporting activities diet sun protection and skin examination.Results:The model identified four health behaviour patterns: 'risk avoidance' with a generally healthy behaviour; 'moderate drinking' with higher levels of sporting activities but moderate alcohol consumption; 'risk taking' engaging in several risk behaviours; and 'smoking' smoking but not drinking. Similar proportions of survivors and controls fell into the 'risk avoiding' (42 vs 44) and the 'risk taking' cluster (14 vs 12) but more survivors were in the 'moderate drinking' (39 vs 28) and fewer in the 'smoking' cluster (5 vs 16). Determinants of health behaviour clusters were gender migration background income and therapy.Conclusion:A comparable proportion of childhood cancer survivors as in the general population engage in multiple health compromising behaviours. Because of increased vulnerability of survivors multiple risk behaviours should be addressed in targeted health interventions.British Journal of Cancer advance online publication 21 June 2012; doi:10.1038/bjc.2012.250 www.bjcancer.com.
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- 2012
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20. Risk factors for bloodstream infections due to carbapenem-resistant Enterobacterales: a nested case-control-control study.
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Zhou H, Buetti N, Pérez-Galera S, Bravo-Ferrer J, Gutiérrez-Gutiérrez B, Paniagua-García M, Feifel J, Sauser J, Kostyanev T, Canton R, Tan LK, Basoulis D, Pintado V, Roilides E, Dragovac G, Torre-Cisneros J, Mediç D, Akova M, Goossens H, Bonten M, Harbarth S, Rodriguez-Baño J, and De Kraker MEA
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- Humans, Case-Control Studies, Risk Factors, Male, Female, Aged, Middle Aged, Prospective Studies, Europe epidemiology, Aged, 80 and over, Enterobacteriaceae Infections epidemiology, Enterobacteriaceae Infections microbiology, Bacteremia microbiology, Bacteremia epidemiology, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use, Carbapenems pharmacology, Carbapenem-Resistant Enterobacteriaceae drug effects, Carbapenem-Resistant Enterobacteriaceae isolation & purification
- Abstract
Background: Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible Enterobacterales (CSE) BSI, and patients without Enterobacterales infection (uninfected patients)., Methods: A multicentre, case-control-control study was nested in a European prospective cohort study on CRE (EURECA). CRE BSI:CSE BSI matching was 1:1, CRE BSI:Uninfected patients matching was 1:3, based on hospital, ward and length of stay. Conditional logistic regression was applied., Results: From March 2016 to November 2018, 73 CRE BSIs, 73 CSE BSIs and 219 uninfected patients were included from 18 European hospitals. For CRE versus CSE BSI, previous CRE colonization/infection [incidence rate ratio (IRR) 7.32; 95% CI 1.65-32.38) increased the risk. For CRE versus uninfected controls, independent risk factors included: older age (IRR 1.03; 95% CI 1.01-1.06), patient referral (long-term care facility: IRR 7.19; 95% CI 1.51-34.24; acute care hospital: IRR 5.26; 95% CI 1.61-17.11), previous colonization/infection with other MDR organisms (MDROs) (IRR 9.71; 95% CI 2.33-40.56), haemodialysis (IRR 8.59; 95% CI 1.82-40.53), invasive procedures (IRR 5.66; 95% CI 2.11-15.16), and β-lactam/β-lactamase inhibitor combinations (IRR 3.92; 95% CI 1.68-9.13) or third/fourth generation cephalosporin (IRR 2.75; 95% CI 1.06-7.11) exposure within 3 months before enrolment., Conclusions: Evidence of previous CRE colonization/infection was a major risk factor for carbapenem resistance among Enterobacterales BSI. Compared with uninfected patients, evidence of previous MDRO colonization/infection and healthcare exposure were important risk factors for CRE BSI. Targeted screening, infection prevention and antimicrobial stewardship should focus on these high-risk patients., (© The Author(s) 2024. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy.)
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- 2024
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21. Variability in forgoing life-sustaining treatment practices in critically Ill patients with hospital-acquired bloodstream infections: a secondary analysis of the EUROBACT-2 international cohort.
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Wozniak H, Tabah A, De Waele JJ, Timsit JF, and Buetti N
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- Humans, Male, Female, Middle Aged, Aged, Cohort Studies, Intensive Care Units organization & administration, Intensive Care Units statistics & numerical data, Withholding Treatment statistics & numerical data, Critical Illness therapy, Critical Illness epidemiology, Cross Infection
- Abstract
Background: The decision to forgo life-sustaining treatment in intensive care units (ICUs) is influenced by ethical, cultural, and medical factors. This study focuses on a population of patients with hospital-acquired bloodstream infections (HABSI) to investigate the association between patient, pathogen, center and country-level factors and these decisions., Methods: We analyzed data from the EUROBACT-2 study (June 2019-January 2021) from 265 centers worldwide, focusing on non-COVID-19 patients who died in the hospital or within 28 days after HABSI. We assessed whether death was preceded by a decision to forgo life-sustaining treatment, examining country, center, patient, and pathogen variables. To assess the association of each potentially important variable with the decision to forgo life-sustaining treatment, univariable mixed logistic regression models with a random center effect were performed., Results: Among 1589 non-COVID-19 patients, 519 (32.7%) died, with 191 (36.8%) following a decision to forgo life-sustaining treatment. Significant geographical differences were observed, with no reported decisions to forgo life-sustaining treatment in African countries and fewer in the Middle East compared to Western Europe, Australia, and Asia. Once a center effect was considered, only health expenditure (Odds ratio 1.79, 95%CI: 1.45-2.21, p < 0.01) and age (Odds ratio 1.02, 95%CI: 1.002-1.05, p = 0.03) were significantly associated with decisions to forgo life-sustaining treatment, while other patient and pathogen factors were not., Conclusion: Economic and regional disparities significantly impact end-of-life decision-making in ICUs. Global policies should consider these disparities to ensure equitable end-of-life care practices., (© 2024. The Author(s).)
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- 2024
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22. Correction: Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study.
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Margalit I, Yahav D, Hoffman T, Tabah A, Ruckly S, Barbier F, Singer P, Timsit JF, Prendki V, and Buetti N
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- 2024
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23. Controlling the hospital aquatic reservoir of multidrug-resistant organisms: a cross-sectional study followed by a nested randomized trial of sink decontamination.
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Catho G, Cave C, Grant R, Carry J, Martin Y, Renzi G, Nguyen A, Buetti N, Schrenzel J, and Harbarth S
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- Cross-Sectional Studies, Humans, Water Microbiology, Disinfectants pharmacology, Sodium Hypochlorite pharmacology, Cross Infection prevention & control, Cross Infection microbiology, beta-Lactamases metabolism, Tertiary Care Centers, Hospitals, Drug Resistance, Multiple, Bacterial, Disinfection methods, Decontamination methods
- Abstract
Objectives: The hospital water environment is an important reservoir of multidrug-resistant organisms (MDROs) and presents a risk for patient safety. We assessed the effectiveness of thermal and chemical interventions on sinks contaminated with MDRO in the hospital setting., Methods: We conducted a cross-sectional assessment of MDRO contamination of sinks and toilets in 26 clinical wards of a tertiary care hospital. MDRO-contaminated sink traps were then replaced and randomized (1:1:1) to receive chemical (sodium hypochlorite), thermal disinfection (steam), or no intervention. Interventions were repeated weekly for 4 weeks. Sinks were resampled 7 days after the last intervention. The primary outcome was the proportion of decontaminated sinks. MDROs of interest were extended spectrum beta-lactamase (ESBL) producing and carbapenemase-producing Enterobacterales, and non-fermentative Gram-negative bacilli., Results: In the cross-sectional assessment, at least one MDRO was identified in 258 (36%) of the 748 samples and in 91 (47%) of the 192 water sources. In total, 57 (42%) of the 137 sinks and 34 (62%) of the 55 toilets were contaminated with 137 different MDROs. The most common MDRO were ESBL Enterobacterales (69%, 95/137), followed by Verona Integron-Borne Metallo-β-Lactamase (VIM) carbapenemase producing Pseudomonas aeruginosa (9%, 12/137) and Citrobacter spp. (6%, 5/137). In the nested randomized trial, five of the 16 sinks (31%) in the chemical disinfection group were decontaminated, compared with 8 of 18 (44%) in the control group (OR 0.58; 95% CI, 0.14-2.32) and 9 of 17 (53%) in the thermal disinfection group (OR 1.40; 95% CI, 0.37-5.32)., Discussion: Our study failed to demonstrate an added benefit of repeated chemical or thermal disinfection, beyond changing sink traps, in the MDRO decontamination of sinks. Routine chlorine-based disinfection of sinks may need to be reconsidered., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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24. Treatment of positive catheter tip culture without bloodstream infections in critically ill patients. A case-cohort study from the OUTCOMEREA network.
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Buetti N, Zahar JR, Adda M, Ruckly S, Bruel C, Schwebel C, Darmon M, Adrie C, Cohen Y, Siami S, Laurent V, Souweine B, and Timsit JF
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- Humans, Male, Female, Middle Aged, Retrospective Studies, Aged, Case-Control Studies, Proportional Hazards Models, Anti-Bacterial Agents therapeutic use, Propensity Score, Cohort Studies, Critical Illness, Catheter-Related Infections drug therapy, Catheter-Related Infections microbiology, Catheter-Related Infections mortality, Intensive Care Units statistics & numerical data
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Purpose: This study aimed to evaluate the impact on subsequent infections and mortality of an adequate antimicrobial therapy within 48 h after catheter removal in intensive care unit (ICU) patients with positive catheter tip culture., Methods: We performed a retrospective analysis of prospectively collected data from 29 centers of the OUTCOMEREA network. We developed a propensity score (PS) for adequate antimicrobial treatment, based on expert opinion of 45 attending physicians. We conducted a 1:1 case-cohort study matched on the PS score of being adequately treated. A PS-matched subdistribution hazard model was used for detecting subsequent infections and a PS-matched Cox model was used to evaluate the impact of antibiotic therapy on mortality., Results: We included 427 patients with a catheter tip culture positive with potentially pathogenic microorganisms. We matched 150 patients with an adequate antimicrobial therapy with 150 controls. In the matched population, 30 (10%) subsequent infections were observed and 62 patients died within 30 days. Using subdistribution hazard models, the daily risk to develop subsequent infection up to Day-30 was similar between treated and non-treated groups (subdistribution hazard ratio [sHR] 1.08, 95% confidence interval [CI] 0.62-1.89, p = 0.78). Using Cox proportional hazard models, the 30-day mortality risk was similar between treated and non-treated groups (HR 0.89, 95% CI 0.45-1.74, p = 0.73)., Conclusions: Antimicrobial therapy was not associated with decreased risk of subsequent infection or death in short-term catheter tip colonization in critically ill patients. Antibiotics may be unnecessary for positive catheter tip cultures., (© 2024. The Author(s).)
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- 2024
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25. Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study.
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Margalit I, Yahav D, Hoffman T, Tabah A, Ruckly S, Barbier F, Singer P, Timsit JF, Prendki V, and Buetti N
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Purpose: Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI)., Methods: Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge)., Results: Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time., Conclusions: Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients., (© 2024. The Author(s).)
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- 2024
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26. Insertion site and risk of peripheral intravenous catheter colonization and/or local infection: a post hoc analysis of the CLEAN 3 study including more than 800 catheters.
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Drugeon B, Marjanovic N, Boisson M, Buetti N, Mimoz O, and Guenezan J
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- Humans, Female, Male, Middle Aged, Aged, Chlorhexidine, Adult, Disinfection methods, Povidone-Iodine, Risk Factors, Anti-Infective Agents, Local, Equipment Contamination, Wrist microbiology, Catheterization, Peripheral adverse effects, Catheter-Related Infections prevention & control, Catheter-Related Infections microbiology
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Aim: Although uncommon, infections associated with peripheral intravenous catheters (PIVCs) may be responsible for severe life-threatening complications and increase healthcare costs. Few data are available on the relationship between PIVC insertion site and risk of infectious complications., Methods: We performed a post hoc analysis of the CLEAN 3 database, a randomized 2 × 2 factorial study comparing two skin disinfection procedures (2% chlorhexidine-alcohol or 5% povidone iodine-alcohol) and two types of medical devices (innovative or standard) in 989 adults patients requiring PIVC insertion before admission to a medical ward. Insertion sites were grouped into five areas: hand, wrist, forearm, cubital fossa and upper arm. We evaluated the risk of risk of PIVC colonization (i.e., tip culture eluate in broth showing at least one microorganism in a concentration of at least 1000 Colony Forming Units per mL) and/or local infection (i.e., organisms growing from purulent discharge at PIVC insertion site with no evidence of associated bloodstream infection), and the risk of positive PIVC tip culture (i.e., PIVC-tip culture eluate in broth showing at least one microorganism regardless of its amount) using multivariate Cox models., Results: Eight hundred twenty three PIVCs with known insertion site and sent to the laboratory for quantitative culture were included. After adjustment for confounding factors, PIVC insertion at the cubital fossa or wrist was associated with increased risk of PIVC colonization and/or local infection (HR [95% CI], 1.64 [0.92-2.93] and 2.11 [1.08-4.13]) and of positive PIVC tip culture (HR [95% CI], 1.49 [1.02-2.18] and 1.59 [0.98-2.59])., Conclusion: PIVC insertion at the wrist or cubital fossa should be avoided whenever possible to reduce the risk of catheter colonization and/or local infection and of positive PIVC tip culture., (© 2024. The Author(s).)
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- 2024
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27. Correction: The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections.
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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, and Timsit JF
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- 2024
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28. The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections.
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Buetti N, Tabah A, Setti N, Ruckly S, Barbier F, Akova M, Aslan AT, Leone M, Bassetti M, Morris AC, Arvaniti K, Paiva JA, Ferrer R, Qiu H, Montrucchio G, Cortegiani A, Kayaaslan B, De Bus L, De Waele JJ, and Timsit JF
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- Humans, Male, Female, Middle Aged, Prospective Studies, Aged, Anti-Bacterial Agents therapeutic use, Bacteremia mortality, Bacteremia drug therapy, Europe epidemiology, Drug Monitoring methods, Drug Monitoring statistics & numerical data, Outcome and Process Assessment, Health Care, Cross Infection mortality, Cross Infection drug therapy, Critical Illness mortality, Intensive Care Units statistics & numerical data, Intensive Care Units organization & administration
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Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI)., Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators., Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality., Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients., (© 2024. The Author(s).)
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- 2024
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29. Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study.
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Wozniak H, Tabah A, Barbier F, Ruckly S, Loiodice A, Akova M, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Ferrer R, de Bus L, Paiva JA, Bracht H, Mikstacki A, Alsisi A, Valeanu L, Prazak J, Timsit JF, and Buetti N
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Background: Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections. This study aims to describe epidemiological differences in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients hospitalized in the ICU regarding infection sources, microorganisms and mortality., Methods: Using prospective Eurobact-2 international cohort study data, we compared hospital-acquired bloodstream infections sources and microorganisms in cirrhotic and non-cirrhotic patients. The association between Enterococcus faecium and cirrhosis was studied using a multivariable mixed logistic regression. The association between cirrhosis and mortality was assessed by a multivariable frailty Cox model., Results: Among the 1059 hospital-acquired bloodstream infections patients included from 101 centers, 160 had cirrhosis. Hospital-acquired bloodstream infection source in cirrhotic patients was primarily abdominal (35.6%), while it was pulmonary (18.9%) for non-cirrhotic (p < 0.01). Gram-positive hospital-acquired bloodstream infections accounted for 42.3% in cirrhotic patients compared to 33.2% in non-cirrhotic patients (p = 0.02). Hospital-acquired bloodstream infections in cirrhotic patients were most frequently caused by Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%) and E. faecium (11.5%). E. faecium bacteremia was more frequent in cirrhotic patients (11.5% versus 4.5%, p < 0.01). After adjusting for possible confounding factors, cirrhosis was associated with higher E. faecium hospital-acquired bloodstream infections risk (Odds ratio 2.5, 95% CI 1.3-4.5, p < 0.01). Cirrhotic patients had increased mortality compared to non-cirrhotic patients (Hazard Ratio 1.3, 95% CI 1.01-1.7, p = 0.045)., Conclusions: Critically ill cirrhotic patients with hospital-acquired bloodstream infections exhibit distinct epidemiology, with more Gram-positive infections and particularly Enterococcus faecium., (© 2024. The Author(s).)
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- 2024
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30. Surveillance of catheter-associated bloodstream infections: development and validation of a fully automated algorithm.
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Catho G, Fortchantre L, Teixeira D, Galas-Haddad M, Boroli F, Chraïti MN, Abbas M, Harbarth S, and Buetti N
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- Humans, Female, Middle Aged, Prospective Studies, Retrospective Studies, Catheters, Algorithms, Cross Infection epidemiology, Cross Infection microbiology, Catheterization, Central Venous, Catheter-Related Infections diagnosis, Catheter-Related Infections epidemiology, Catheter-Related Infections microbiology, Sepsis
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Background: Most surveillance systems for catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI) are based on manual chart review. Our objective was to validate a fully automated algorithm for CRBSI and CLABSI surveillance in intensive care units (ICU)., Methods: We developed a fully automated algorithm to detect CRBSI, CLABSI and ICU-onset bloodstream infections (ICU-BSI) in patients admitted to the ICU of a tertiary care hospital in Switzerland. The parameters included in the algorithm were based on a recently performed systematic review. Structured data on demographics, administrative data, central vascular catheter and microbiological results (blood cultures and other clinical cultures) obtained from the hospital's data warehouse were processed by the algorithm. Validation for CRBSI was performed by comparing results with prospective manual BSI surveillance data over a 6-year period. CLABSI were retrospectively assessed over a 2-year period., Results: From January 2016 to December 2021, 854 positive blood cultures were identified in 346 ICU patients. The median age was 61.7 years [IQR 50-70]; 205 (24%) positive samples were collected from female patients. The algorithm detected 5 CRBSI, 109 CLABSI and 280 ICU-BSI. The overall CRBSI and CLABSI incidence rates determined by automated surveillance for the period 2016 to 2021 were 0.18/1000 catheter-days (95% CI 0.06-0.41) and 3.86/1000 catheter days (95% CI: 3.17-4.65). The sensitivity, specificity, positive predictive and negative predictive values of the algorithm for CRBSI, were 83% (95% CI 43.7-96.9), 100% (95% CI 99.5-100), 100% (95% CI 56.5-100), and 99.9% (95% CI 99.2-100), respectively. One CRBSI was misclassified as an ICU-BSI by the algorithm because the same bacterium was identified in the blood culture and in a lower respiratory tract specimen. Manual review of CLABSI from January 2020 to December 2021 (n = 51) did not identify any errors in the algorithm., Conclusions: A fully automated algorithm for CRBSI and CLABSI detection in critically-ill patients using only structured data provided valid results. The next step will be to assess the feasibility and external validity of implementing it in several hospitals with different electronic health record systems., (© 2024. The Author(s).)
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- 2024
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31. Catheter size and risk of short-term peripheral venous catheter-associated bloodstream infections: an observational study.
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Faltoni M, Catho G, Pianca E, Minka-Obama B, Zanella MC, Chraiti MN, Fortchantre L, Harbarth S, and Buetti N
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- Adult, Humans, Catheters, Hospitals, Incidence, Catheterization, Peripheral adverse effects, Sepsis, Catheter-Related Infections epidemiology
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Objectives: Short-term peripheral venous catheter-associated bloodstream infections (PVC-associated BSI) are disregarded in the literature because of their relatively low incidence. No data are available on the association between PVC diameter size and the risk of PVC-associated BSI., Methods: Using a prospective database, we performed an observational study at the University of Geneva Hospitals from 1 January 2020 to 31 December 2021, including all patients with a PVC. We used univariable and multivariable marginal Cox regression models for clustered data to investigate the association between catheter size and PVC-associated BSI. The main variable of interest 'catheter size' was forced into our multivariable models. Confounders, which are thought to influence the risk of PVC-associated BSI, were used as adjustment factors., Results: A total of 206 804 PVCs were included. In all, 10 806 of 201 413 (5.4%), 80 274 of 201 413 (39.9%), 93 047 of 201 413 (46.2%) and 17 286 of 201 413 (8.6%) PVCs measured ≤16G, 18G, 20G and ≥22G, respectively. The univariable analysis showed that diameters of ≤16G were significantly associated with a higher risk of PVC-associated BSI (hazard ratio [HR] 4.52, 95% CI, 1.14-18.00). Multivariable models confirmed these results (HR 4.65, 95% CI, 1.19-18.20). Sensitivity analyses including PVC inserted only in 2021 (HR 4.80, 95% CI, 1.21-19.10), for dwell time >2 days (HR 3.67, 95% CI, 0.92-14.65) and only in adults (HR 3.97, 95% CI, 0.97-15.39) showed similar results., Discussion: Larger PVC size may increase the risk of PVC-associated BSI. Diameter size should be considered when selecting PVCs to reduce the burden of PVC-associated BSI., (Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2024
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32. Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters.
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Lotfinejad N, Januel JM, Tschudin-Sutter S, Schreiber PW, Grandbastien B, Damonti L, Lo Priore E, Scherrer A, Harbarth S, Catho G, and Buetti N
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Introduction: Intravascular catheters are crucial devices in medical practice that increase the risk of healthcare-associated infections (HAIs), and related health-economic adverse outcomes. This scoping review aims to provide a comprehensive overview of published automated algorithms for surveillance of catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI)., Methods: We performed a scoping review based on a systematic search of the literature in PubMed and EMBASE from 1 January 2000 to 31 December 2021. Studies were included if they evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We assessed the design of the automated systems, including the definitions used to develop algorithms (CLABSI versus CRBSI), the datasets and denominators used, and the algorithms evaluated in each of the studies., Results: We screened 586 studies based on title and abstract, and 99 were assessed based on full text. Nine studies were included in the scoping review. Most studies were monocentric (n = 5), and they identified CLABSI (n = 7) as an outcome. The majority of the studies used administrative and microbiological data (n = 9) and five studies included the presence of a vascular central line in their automated system. Six studies explained the denominator they selected, five of which chose central line-days. The most common rules and steps used in the algorithms were categorized as hospital-acquired rules, infection rules (infection versus contamination), deduplication, episode grouping, secondary BSI rules (secondary versus primary BSI), and catheter-associated rules., Conclusion: The automated surveillance systems that we identified were heterogeneous in terms of definitions, datasets and denominators used, with a combination of rules in each algorithm. Further guidelines and studies are needed to develop and implement algorithms to detect CLABSI/CRBSI, with standardized definitions, appropriate data sources and suitable denominators., (© 2024. The Author(s).)
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- 2024
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33. Challenges and success stories of the implementation of infection control and antimicrobial stewardship strategies: proceedings of the 5th Global Ministerial Summit on Patient Safety, 2023.
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Büchler AC, Haddad Galas M, Buetti N, Alp E, Apisarnthanarak A, Dziekan G, Fabre V, Gottwalt S, Jindai K, Ndoye B, Márquez Villareal H, Otaiza F, Pittet D, Schellack N, Gardiol C, and Harbarth S
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- Humans, Patient Safety, Pandemics prevention & control, Anti-Bacterial Agents therapeutic use, Infection Control, Antimicrobial Stewardship, Cross Infection prevention & control, Cross Infection drug therapy, COVID-19 prevention & control
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The 5th edition of the Global Ministerial Summit on Patient Safety was held in Montreux, Switzerland, in February 2023, delayed by three years due to the COVID-19 pandemic. The overarching theme of the summit was "Less Harm, Better Care - from Resolution to Implementation", focusing on the challenges of implementation of infection prevention and control (IPC) strategies as well as antimicrobial stewardship programs (ASP) around the world. IPC strategies and ASP are of increasing importance due to the substantial burden of healthcare-associated infections and antimicrobial resistance threatening patient safety. Here, we summarize countries' and regional experiences and activities related to the implementation of IPC strategies and ASP shared at the meeting. Full implementation of effective programs remains a major challenge in all settings due to limited support by political and healthcare leaders, and human and financial constraints. In addition, the COVID-19 pandemic challenged already well-established programs. By enforcing sustained implementation by dedicated, cross-disciplinary healthcare personnel with a broad skill set, a reduction in healthcare-associated infections and multidrug-resistant pathogens can be achieved, leading ultimately to improved patient safety., (© 2024. The Author(s).)
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- 2024
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34. Single-drug versus combination antimicrobial therapy in critically ill patients with hospital-acquired pneumonia and ventilator-associated pneumonia due to Gram-negative pathogens: a multicenter retrospective cohort study.
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Barbier F, Dupuis C, Buetti N, Schwebel C, Azoulay É, Argaud L, Cohen Y, Hong Tuan Ha V, Gainnier M, Siami S, Forel JM, Adrie C, de Montmollin É, Reignier J, Ruckly S, Zahar JR, and Timsit JF
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- Humans, Prospective Studies, Retrospective Studies, Critical Illness therapy, Anti-Bacterial Agents therapeutic use, Gram-Negative Bacteria, Hospitals, Pneumonia, Ventilator-Associated microbiology, Anti-Infective Agents therapeutic use, Healthcare-Associated Pneumonia drug therapy, Acute Kidney Injury drug therapy, Acute Kidney Injury complications
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Key Messages: In this study including 391 critically ill patients with nosocomial pneumonia due to Gram-negative pathogens, combination therapy was not associated with a reduced hazard of death at Day 28 or a greater likelihood of clinical cure at Day 14. No over-risk of AKI was observed in patients receiving combination therapy., Background: The benefits and harms of combination antimicrobial therapy remain controversial in critically ill patients with hospital-acquired pneumonia (HAP), ventilated HAP (vHAP) or ventilator-associated pneumonia (VAP) involving Gram-negative bacteria., Methods: We included all patients in the prospective multicenter OutcomeRea database with a first HAP, vHAP or VAP due to a single Gram-negative bacterium and treated with initial adequate single-drug or combination therapy. The primary endpoint was Day-28 all-cause mortality. Secondary endpoints were clinical cure rate at Day 14 and a composite outcome of death or treatment-emergent acute kidney injury (AKI) at Day 7. The average effects of combination therapy on the study endpoints were investigated through inverse probability of treatment-weighted regression and multivariable regression models. Subgroups analyses were performed according to the resistance phenotype of the causative pathogens (multidrug-resistant or not), the pivotal (carbapenems or others) and companion (aminoglycosides/polymyxins or others) drug classes, the duration of combination therapy (< 3 or ≥ 3 days), the SOFA score value at pneumonia onset (< 7 or ≥ 7 points), and in patients with pneumonia due to non-fermenting Gram-negative bacteria, pneumonia-related bloodstream infection, or septic shock., Results: Among the 391 included patients, 151 (38.6%) received single-drug therapy and 240 (61.4%) received combination therapy. VAP (overall, 67.3%), vHAP (16.4%) and HAP (16.4%) were equally distributed in the two groups. All-cause mortality rates at Day 28 (overall, 31.2%), clinical cure rate at Day 14 (43.7%) and the rate of death or AKI at Day 7 (41.2%) did not significantly differ between the groups. In inverse probability of treatment-weighted analyses, combination therapy was not independently associated with the likelihood of all-cause death at Day 28 (adjusted odd ratio [aOR], 1.14; 95% confidence interval [CI] 0.73-1.77; P = 0.56), clinical cure at Day 14 (aOR, 0.79; 95% CI 0.53-1.20; P = 0.27) or death or AKI at Day 7 (aOR, 1.07; 95% CI 0.71-1.63; P = 0.73). Multivariable regression models and subgroup analyses provided similar results., Conclusions: Initial combination therapy exerts no independent impact on Day-28 mortality, clinical cure rate at Day 14, and the hazard of death or AKI at Day 7 in critically ill patients with mono-bacterial HAP, vHAP or VAP due to Gram-negative bacteria., (© 2024. The Author(s).)
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- 2024
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35. Comparison of clinical outcomes over time of inpatients with healthcare-associated or community-acquired coronavirus disease 2019 (COVID-19): A multicenter, prospective cohort study.
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Grant RL, Sauser J, Atkinson A, D'Incau S, Buetti N, Zanella MC, Harbarth S, Marschall J, and Catho G
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- Humans, Prospective Studies, SARS-CoV-2, Inpatients, Retrospective Studies, Intensive Care Units, Hospital Mortality, COVID-19 epidemiology
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Objective: To compare clinical outcomes over time of inpatients with healthcare-associated coronavirus disease 2019 (HA-COVID-19) versus community-acquired COVID-19 (CA-COVID-19)., Design: We conducted a multicenter, prospective observational cohort study of inpatients with COVID-19., Setting: The study was conducted across 16 acute-care hospitals in Switzerland., Participants and Methods: We compared HA-COVID-19 cases, defined as patients with a positive severe acute respiratory coronavirus virus 2 (SARS-CoV-2) test > 5 days after hospital admission, with hospitalized CA-COVID-19 cases, defined as those who tested positive within 5 days of admission. The composite primary outcome was patient transfer to an intensive care unit (ICU) or an intermediate care unit (IMCU) and/or all-cause in-hospital mortality. We used cause-specific Cox regression and Fine-Gray regression to model the time to the composite clinical outcome, adjusting for confounders and accounting for the competing event of discharge from hospital. We compared our results to those from a conventional approach using an adjusted logistic regression model where time-varying effects and competitive risk were ignored., Results: Between February 19, 2020, and December 31, 2020, we included 1,337 HA-COVID-19 cases and 9,068 CA-COVID-19 cases. HA-COVID-19 patients were significantly older: median, 80 (interquartile range [IQR], 71-87) versus median 70 (IQR, 57-80) ( P < .001). A greater proportion of HA-COVID-19 patients had a Charlson comorbidity index ≥ 5 (79% vs 55%; P < .001) than did CA-COVID-19 patients. In time-varying analyses, between day 0 and 8, HA-COVID-19 cases had a decreased risk of death or ICU or IMCU transfer compared to CA-COVID-19 cases (cause-specific hazard ratio [csHR], 0.43; 95% confidence interval [CI], 0.33-0.56). In contrast, from day 8 to 30, HA-COVID-19 cases had an increased risk of death or ICU or IMCU transfer (csHR, 1.49; 95% CI, 1.20-1.85), with no significant effect on the rate of discharge (csHR, 0.83; 95% CI, 0.61-1.14). In the conventional logistic regression model, HA-COVID-19 was protective against transfer to an ICU or IMCU and/or all-cause in-hospital mortality (adjusted odds ratio [aOR], 0.79, 95% CI, 0.67-0.93)., Conclusions: The risk of adverse clinical outcomes for HA-COVID-19 cases increased substantially over time in hospital and exceeded that for CA-COVID-19. Using approaches that do not account for time-varying effects or competing events may not fully capture the true risk of HA-COVID-19 compared to CA-COVID-19.
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- 2024
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36. Increased Peripheral Venous Catheter Bloodstream Infections during COVID-19 Pandemic, Switzerland.
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Zanella MC, Pianca E, Catho G, Obama B, De Kraker MEA, Nguyen A, Chraiti MN, Sobel J, Fortchantre L, Harbarth S, Abbas M, and Buetti N
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- Humans, Switzerland epidemiology, Pandemics, Catheters adverse effects, Catheterization, Peripheral adverse effects, COVID-19 epidemiology, COVID-19 complications, Sepsis etiology, Cross Infection epidemiology, Bacteremia epidemiology, Bacteremia complications
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Studies suggest that central venous catheter bloodstream infections (BSIs) increased during the COVID-19 pandemic. We investigated catheter-related BSIs in Switzerland and found peripheral venous catheter (PVC) BSI incidence increased during 2021-2022 compared with 2020. These findings should raise awareness of PVC-associated BSIs and prompt inclusion of PVC BSIs in surveillance systems.
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- 2024
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37. Mortality, incidence, and microbiological documentation of ventilated acquired pneumonia (VAP) in critically ill patients with COVID-19 or influenza.
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Laurichesse G, Schwebel C, Buetti N, Neuville M, Siami S, Cohen Y, Laurent V, Mourvillier B, Reignier J, Goldgran-Toledano D, Ruckly S, de Montmollin E, Souweine B, Timsit JF, and Dupuis C
- Abstract
Background: Data on ventilator associated pneumonia (VAP) in COVID-19 and influenza patients admitted to intensive care units (ICU) are scarce. This study aimed to estimate day-60 mortality related to VAP in ICU patients ventilated for at least 48 h, either for COVID-19 or for influenza, and to describe the epidemiological characteristics in each group of VAP., Design: Multicentre retrospective observational study., Setting: Eleven ICUs of the French OutcomeRea
™ network., Patients: Patients treated with invasive mechanical ventilation (IMV) for at least 48 h for either COVID-19 or for flu., Results: Of the 585 patients included, 503 had COVID-19 and 82 had influenza between January 2008 and June 2021. A total of 232 patients, 209 (41.6%) with COVID-19 and 23 (28%) with influenza, developed 375 VAP episodes. Among the COVID-19 and flu patients, VAP incidences for the first VAP episode were, respectively, 99.2 and 56.4 per 1000 IMV days (p < 0.01), and incidences for all VAP episodes were 32.8 and 17.8 per 1000 IMV days (p < 0.01). Microorganisms of VAP were Gram-positive cocci in 29.6% and 23.5% of episodes of VAP (p < 0.01), respectively, including Staphylococcus aureus in 19.9% and 11.8% (p = 0.25), and Gram-negative bacilli in 84.2% and 79.4% (p = 0.47). In the overall cohort, VAP was associated with an increased risk of day-60 mortality (aHR = 1.77 [1.36; 2.30], p < 0.01), and COVID-19 had a higher mortality risk than influenza (aHR = 2.22 [CI 95%, 1.34; 3.66], p < 0.01). VAP was associated with increased day-60 mortality among COVID-19 patients (aHR = 1.75 [CI 95%, 1.32; 2.33], p < 0.01), but not among influenza patients (aHR = 1.75 [CI 95%, 0.48; 6.33], p = 0.35)., Conclusion: The incidence of VAP was higher in patients ventilated for at least 48 h for COVID-19 than for influenza. In both groups, Gram-negative bacilli were the most frequently detected microorganisms. In patients ventilated for either COVID-19 or influenza VAP and COVID-19 were associated with a higher risk of mortality., (© 2023. The Author(s).)- Published
- 2023
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38. Introduction to A Compendium of Strategies to Prevent Healthcare-Associated Infections In Acute-Care Hospitals: 2022 Updates .
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Deloney VM, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, and Maragakis LL
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- Child, Humans, Communicable Diseases epidemiology, Delivery of Health Care, Hospitals, United States epidemiology, Pandemics, Communicable Disease Control, COVID-19 epidemiology, COVID-19 prevention & control, Cross Infection epidemiology, Cross Infection prevention & control
- Abstract
Since the initial publication of A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals in 2008, the prevention of healthcare-associated infections (HAIs) has continued to be a national priority. Progress in healthcare epidemiology, infection prevention, antimicrobial stewardship, and implementation science research has led to improvements in our understanding of effective strategies for HAI prevention. Despite these advances, HAIs continue to affect ∼1 of every 31 hospitalized patients, leading to substantial morbidity, mortality, and excess healthcare expenditures, and persistent gaps remain between what is recommended and what is practiced.The widespread impact of the coronavirus disease 2019 (COVID-19) pandemic on HAI outcomes in acute-care hospitals has further highlighted the essential role of infection prevention programs and the critical importance of prioritizing efforts that can be sustained even in the face of resource requirements from COVID-19 and future infectious diseases crises.The Compendium: 2022 Updates document provides acute-care hospitals with up-to-date, practical expert guidance to assist in prioritizing and implementing HAI prevention efforts. It is the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Disease Society of America (IDSA), the Association for Professionals in Infection Control and Epidemiology (APIC), the American Hospital Association (AHA), and The Joint Commission, with major contributions from representatives of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Pediatric Infectious Disease Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), the Surgical Infection Society (SIS), and others.
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- 2023
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39. Executive Summary: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute-Care Hospitals: 2022 Updates.
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Yokoe DS, Advani SD, Anderson DJ, Babcock HM, Bell M, Berenholtz SM, Bryant KA, Buetti N, Calderwood MS, Calfee DP, Dubberke ER, Ellingson KD, Fishman NO, Gerding DN, Glowicz J, Hayden MK, Kaye KS, Klompas M, Kociolek LK, Landon E, Larson EL, Malani AN, Marschall J, Meddings J, Mermel LA, Patel PK, Perl TM, Popovich KJ, Schaffzin JK, Septimus E, Trivedi KK, Weinstein RA, and Maragakis LL
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- Humans, Hospitals, Delivery of Health Care, Cross Infection prevention & control
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- 2023
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40. Risk of infections in intravascular catheters in situ for more than 10 days: a post hoc analysis of randomized controlled trials.
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Buetti N, Ruckly S, Souweine B, Mimoz O, and Timsit JF
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- Humans, Renal Dialysis adverse effects, Randomized Controlled Trials as Topic, Risk Factors, Catheter-Related Infections epidemiology, Catheter-Related Infections etiology, Central Venous Catheters adverse effects, Catheterization, Central Venous adverse effects
- Abstract
Objectives: We aimed to describe the infectious risk during the dwell time for different catheter types. Furthermore, we wanted to identify risk factors for infections from catheters in place for >10 days., Methods: We performed a post hoc analysis using prospectively collected data from four randomized controlled trials. First, we evaluated the infectious risk after 10 days of analysing the significance of the interaction between dwell time and catheter type in a Cox model. Second, we investigated risk factors for infection in catheters in place for >10 days using multivariable marginal Cox models., Results: We included 15 036 intravascular catheters from 24 intensive care units. Infections occurred in 46 (0.7%) of 6298 arterial catheters (ACs), 62 (1.0%) of 6036 central venous catheters (CVCs) and 47 (1.7%) of 2702 short-term dialysis catheters (DCs). The interaction between dwell time beyond 10 days and catheter type was significant for CVCs (p 0.008) and DCs (p < 0.001), thus indicating an increased risk of infection after 10 days. The interaction was not significant for ACs (p 0.98). Therefore, we selected 1405 CVCs and 454 DCs in place for >10 days for further analyses. In the multivariable marginal Cox model, we observed an increased hazard ratio (HR) for infection for femoral CVC (HR, 6.33; 95% CI, 1.99-20.09), jugular CVC (HR, 2.82; 95% CI, 1.13-7.07), femoral DC (HR, 4.53; 95% CI, 1.54-13.33) and jugular DC (HR, 4.50; 95% CI, 1.42-14.21) compared with subclavian insertions., Discussion: We showed that the risk of catheter infection for CVCs and DCs increased 10 days after insertion, thus suggesting routine replacement for nonsubclavian catheters in situ for >10 days., (Copyright © 2023 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.)
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- 2023
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41. Predictive performance of automated surveillance algorithms for intravascular catheter bloodstream infections: a systematic review and meta-analysis.
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Januel JM, Lotfinejad N, Grant R, Tschudin-Sutter S, Schreiber PW, Grandbastien B, Jent P, Lo Priore E, Scherrer A, Harbarth S, Catho G, and Buetti N
- Subjects
- Humans, Algorithms, Data Collection, Central Venous Catheters, Sepsis
- Abstract
Background: Intravascular catheter infections are associated with adverse clinical outcomes. However, a significant proportion of these infections are preventable. Evaluations of the performance of automated surveillance systems for adequate monitoring of central-line associated bloodstream infection (CLABSI) or catheter-related bloodstream infection (CRBSI) are limited., Objectives: We evaluated the predictive performance of automated algorithms for CLABSI/CRBSI detection, and investigated which parameters included in automated algorithms provide the greatest accuracy for CLABSI/CRBSI detection., Methods: We performed a meta-analysis based on a systematic search of published studies in PubMed and EMBASE from 1 January 2000 to 31 December 2021. We included studies that evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We estimated the pooled sensitivity and specificity of algorithms for accuracy and performed a univariable meta-regression of the different parameters used across algorithms., Results: The search identified five full text studies and 32 different algorithms or study populations were included in the meta-analysis. All studies analysed central venous catheters and identified CLABSI or CRBSI as an outcome. Pooled sensitivity and specificity of automated surveillance algorithm were 0.88 [95%CI 0.84-0.91] and 0.86 [95%CI 0.79-0.92] with significant heterogeneity (I
2 = 91.9, p < 0.001 and I2 = 99.2, p < 0.001, respectively). In meta-regression, algorithms that include results of microbiological cultures from specific specimens (respiratory, urine and wound) to exclude non-CRBSI had higher specificity estimates (0.92, 95%CI 0.88-0.96) than algorithms that include results of microbiological cultures from any other body sites (0.88, 95% CI 0.81-0.95). The addition of clinical signs as a predictor did not improve performance of these algorithms with similar specificity estimates (0.92, 95%CI 0.88-0.96)., Conclusions: Performance of automated algorithms for detection of intravascular catheter infections in comparison to manual surveillance seems encouraging. The development of automated algorithms should consider the inclusion of results of microbiological cultures from specific specimens to exclude non-CRBSI, while the inclusion of clinical data may not have an added-value. Trail Registration Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42022299641; January 21, 2022). https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022299641., (© 2023. BioMed Central Ltd., part of Springer Nature.)- Published
- 2023
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42. Increase in methicillin-susceptible Staphylococcus aureus bloodstream infections in Switzerland: a nationwide surveillance study (2008-2021).
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Renggli L, Gasser M, Buetti N, and Kronenberg A
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- Humans, Male, Aged, Aged, 80 and over, Staphylococcus aureus, Methicillin, Switzerland epidemiology, Methicillin-Resistant Staphylococcus aureus, Cross Infection epidemiology, Staphylococcal Infections epidemiology, Sepsis
- Abstract
Purpose: An increasing burden of Staphylococcus aureus bloodstream infections (BSI), despite a decrease in the percentage of methicillin-resistant S. aureus (MRSA), was described recently in other European countries. The main aim of this study was to analyse recent temporal trends of S. aureus, methicillin-susceptible S. aureus (MSSA) and MRSA BSI for Switzerland as well as the different linguistic regions within Switzerland. An additional aim was to estimate potential differences among patient-based and epidemiological risk factors., Methods: A retrospective observational study was conducted in Switzerland over a period of 14 years (2008-2021). Trends in S. aureus, MSSA and MRSA BSI were analysed by applying linear regression models., Results: Staphylococcus aureus BSI increased by + 30% from 19.7 to 25.6 cases per 100,000 inhabitants between 2008 and 2021 (P < 0.01) in Switzerland. Thereof, MSSA increased by + 37% from 17.8 to 24.4 cases per 100,000 inhabitants (P < 0.01). MRSA decreased from 1.9 to 1.2 cases per 100,000 inhabitants (P < 0.01), which was driven by decreasing incidence in the French-speaking region. MSSA BSI increased significantly (P < 0.01) in both linguistic regions. A further stratification revealed that incidence increased the most in male patients of the age group ≥ 80 years of the German-speaking region., Conclusion: The increasing health burden of MSSA BSI in Switzerland indicates that not only proportions of resistant microorganisms but also total BSI incidences should be monitored. In addition, data stratification revealed that the increase was mainly driven by an increasing incidence in elderly males of the German-speaking region., (© 2023. The Author(s).)
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- 2023
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43. Epidemiology and risk factors of 28-day mortality of hospital-acquired bloodstream infection in Turkish intensive care units: a prospective observational cohort study.
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Aslan AT, Tabah A, Köylü B, Kalem AK, Aksoy F, Erol Ç, Karaali R, Tunay B, Guzeldağ S, Batirel A, Dindar EK, Akdoğan Ö, Bilir Y, Ersöz G, Öztürk B, Selçuk M, Yilmaz M, Akyol A, Akbaş T, Sungurtekin H, Timuroğlu A, Gürbüz Y, Çolak O, Bayindir Y, Eroğlu A, Ferlicolak L, Çeşme U, Dağ O, Buetti N, Barbier F, Ruckly S, Staiquly Q, Timsit JF, and Akova M
- Subjects
- Humans, Male, Female, Prospective Studies, Cohort Studies, Intensive Care Units, Risk Factors, Carbapenems, Hospitals, COVID-19, Cross Infection microbiology, Sepsis, Bacteremia drug therapy, Bacteremia epidemiology, Bacteremia microbiology
- Abstract
Objectives: To uncover clinical epidemiology, microbiological characteristics and outcome determinants of hospital-acquired bloodstream infections (HA-BSIs) in Turkish ICU patients., Methods: The EUROBACT II was a prospective observational multicontinental cohort study. We performed a subanalysis of patients from 24 Turkish ICUs included in this study. Risk factors for mortality were identified using multivariable Cox frailty models., Results: Of 547 patients, 58.7% were male with a median [IQR] age of 68 [55-78]. Most frequent sources of HA-BSIs were intravascular catheter [182, (33.3%)] and lower respiratory tract [175, (32.0%)]. Among isolated pathogens (n = 599), 67.1% were Gram-negative, 21.5% Gram-positive and 11.2% due to fungi. Carbapenem resistance was present in 90.4% of Acinetobacter spp., 53.1% of Klebsiella spp. and 48.8% of Pseudomonas spp. In monobacterial Gram-negative HA-BSIs (n = 329), SOFA score (aHR 1.20, 95% CI 1.14-1.27), carbapenem resistance (aHR 2.46, 95% CI 1.58-3.84), previous myocardial infarction (aHR 1.86, 95% CI 1.12-3.08), COVID-19 admission diagnosis (aHR 2.95, 95% CI 1.25-6.95) and not achieving source control (aHR 2.02, 95% CI 1.15-3.54) were associated with mortality. However, availability of clinical pharmacists (aHR 0.23, 95% CI 0.06-0.90) and source control (aHR 0.46, 95% CI 0.28-0.77) were associated with survival. In monobacterial Gram-positive HA-BSIs (n = 93), SOFA score (aHR 1.29, 95% CI 1.17-1.43) and age (aHR 1.05, 95% CI 1.03-1.08) were associated with mortality, whereas source control (aHR 0.41, 95% CI 0.20-0.87) was associated with survival., Conclusions: Considering high antimicrobial resistance rate, importance of source control and availability of clinical pharmacists, a multifaceted management programme should be adopted in Turkish ICUs., (© The Author(s) 2023. Published by Oxford University Press on behalf of British Society for Antimicrobial Chemotherapy. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
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- 2023
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44. Which trial do we need? Infectious and non-infectious complications of peripherally inserted central venous catheters and midline catheters.
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Buetti N, Marschall J, Catho G, Timsit JF, and Mermel L
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- Humans, Risk Factors, Retrospective Studies, Central Venous Catheters adverse effects, Central Venous Catheters microbiology, Catheterization, Central Venous adverse effects, Communicable Diseases complications, Catheterization, Peripheral adverse effects, Catheter-Related Infections microbiology
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- 2023
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45. The effect of duration of antimicrobial treatment for bacteremia in critically ill patients on in-hospital mortality - Retrospective double center analysis.
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Zuercher P, Moser A, Frey MC, Pagani JL, Buetti N, Eggimann P, Daneman N, Fowler R, Que YA, and Prazak J
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- Humans, Hospital Mortality, Retrospective Studies, Anti-Bacterial Agents therapeutic use, Intensive Care Units, Critical Illness, Bacteremia drug therapy
- Abstract
Purpose: Excessive duration of antibiotic treatment is a major factor for inappropriate antibiotic consumption. Although in some instances shorter antibiotic courses are as efficient as longer ones, no specific recommendations as to the duration of antimicrobial treatment for bloodstream infections currently exist. In the present study, we investigated the effect of antibiotic treatment duration on in-hospital mortality using retrospective data from two cohorts that included patients with bacteremia at two Swiss tertiary Intensive Care Units (ICUs)., Materials and Methods: Overall 8227 consecutive patients requiring ICU admission were screened for bacteremia between 01/2012-12/2013 in Lausanne and between 07/2016-05/2017 in Bern. Patients with an infection known to require prolonged treatment or having single positive blood culture with common contaminant pathogens were excluded. The primary outcome of interest was the time from start of antimicrobial treatment to in-hospital death or hospital discharge, whichever comes first. The predictor of interest was adequate antimicrobial treatment duration, further divided into shorter (≤10 days) and longer (>10 days) durations. A time-dependent Cox model and a cloning approach were used to address immortality bias. The secondary outcomes were the median duration of antimicrobial treatment for patients with bacteremia overall and stratified by underlying infectious syndrome and pathogens in the case of secondary bacteremia., Results: Out of the 707 patients with positive blood cultures, 382 were included into the primary analysis. Median duration of antibiotic therapy was 14 days (IQR, 7-20). Most bacteremia (84%) were monomicrobial; 18% of all episodes were primary bacteremia. Respiratory (28%), intra-abdominal (23%) and catheter infections (17%) were the most common sources of secondary bacteremia. Using methods to mitigate the risk of confounding associated with antibiotic treatment durations, shorter versus longer treatment groups showed no differences in in-hospital survival (time-dependent Cox-model: HR 1.5, 95% CI (0.8, 2.7), p = 0.20; Cloning approach: HR 1.0, 95% CI (0.7,1.5) p = 0.83). Sensitivity analyses showed that the interpretation did not change when using a 7 days cut-off., Conclusions: In this restrospective study, we found no evidence for a survival benefit of longer (>10 days) versus shorter treatment course in ICU patients with bacteremia., Trial Registration: The study was retrospectively registered on clinicatrials.gov (NCT05236283), 11 February 2022. The respective cantonal ethics commission (KEK Bern # 2021-02302) has approved the study., Competing Interests: Declaration of Competing Interest Patrick Zuercher, André Moser, Michael C. Frey, Jean-Luc Pagani, Niccolo Buetti, Philippe Eggimmann, Nick Daneman, Rob Fowler, Yok-Ai Que. and Josef Prazak have no conflict of interest to declare., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)
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- 2023
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46. Risk factors for in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza: a large retrospective cohort study.
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Yi G, de Kraker MEA, Buetti N, Zhong X, Li J, Yuan Z, Zhu W, Zhou J, and Zhou H
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- Humans, Male, Adult, Aged, Retrospective Studies, Hospital Mortality, Risk Factors, Influenza, Human complications, Pneumonia, Bacterial complications, Community-Acquired Infections
- Abstract
Background: Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza., Methods: A retrospective cohort study was performed at a tertiary teaching hospital in southwest China. The study cohort included all adult hospitalized patients with a laboratory-confirmed, community-acquired influenza virus infection during three consecutive influenza seasons from 2017 to 2020. Cause-specific Cox regression was used to analyze risk factors for mortality and secondary bacterial pneumonia, respectively, accounting for competing events (discharge alive and discharge alive or death without secondary bacterial pneumonia, respectively)., Results: Among 174 patients enrolled in this study, 14.4% developed secondary bacterial pneumonia and 11.5% died during hospitalization. For all-cause in-hospital mortality, time-varying secondary bacterial pneumonia was a direct risk factor of death (cause-specific hazard ratio [csHR] 3.38, 95% confidence interval [CI] 1.25-9.17); underlying disease indirectly increased death risk through decreasing the hazard of being discharged alive (csHR 0.55, 95% CI 0.39-0.77). For secondary bacterial pneumonia, the final model only confirmed direct risk factors: age ≥ 65 years (csHR 2.90, 95% CI 1.27-6.62), male gender (csHR 3.78, 95% CI 1.12-12.84) and mechanical ventilation on admission (csHR 2.96, 95% CI 1.32-6.64)., Conclusions: Secondary bacterial pneumonia was a major risk factor for in-hospital mortality among adult hospitalized patients with community-acquired influenza. Prevention strategies for secondary bacterial pneumonia should target elderly male patients and critically ill patients under mechanical ventilation., (© 2023. The Author(s).)
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- 2023
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47. Ventilator-Associated Pneumonia in COVID-19 Patients Admitted in Intensive Care Units: Relapse, Therapeutic Failure and Attributable Mortality-A Multicentric Observational Study from the OutcomeRea Network.
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Wicky PH, Dupuis C, Cerf C, Siami S, Cohen Y, Laurent V, Mourvillier B, Reignier J, Goldgran-Toledano D, Schwebel C, Ruckly S, de Montmollin E, Buetti N, and Timsit JF
- Abstract
Introduction: Ventilator-associated pneumonia (VAP) incidence is high among critically ill COVID-19 patients. Its attributable mortality remains underestimated, especially for unresolved episodes. Indeed, the impact of therapeutic failures and the determinants that potentially affect mortality are poorly evaluated. We assessed the prognosis of VAP in severe COVID-19 cases and the impact of relapse, superinfection, and treatment failure on 60-day mortality. Methods: We evaluated the incidence of VAP in a multicenter prospective cohort that included adult patients with severe COVID-19, who required mechanical ventilation for ≥48 h between March 2020 and June 2021. We investigated the risk factors for 30-day and 60-day mortality, and the factors associated with relapse, superinfection, and treatment failure. Results: Among 1424 patients admitted to eleven centers, 540 were invasively ventilated for 48 h or more, and 231 had VAP episodes, which were caused by Enterobacterales (49.8%), P. aeruginosa (24.8%), and S. aureus (22%). The VAP incidence rate was 45.6/1000 ventilator days, and the cumulative incidence at Day 30 was 60%. VAP increased the duration of mechanical ventilation without modifying the crude 60-day death rate (47.6% vs. 44.7% without VAP) and resulted in a 36% increase in death hazard. Late-onset pneumonia represented 179 episodes (78.2%) and was responsible for a 56% increase in death hazard. The cumulative incidence rates of relapse and superinfection were 45% and 39.5%, respectively, but did not impact death hazard. Superinfection was more frequently related to ECMO and first episode of VAP caused by non-fermenting bacteria. The risk factors for treatment failure were an absence of highly susceptible microorganisms and vasopressor need at VAP onset. Conclusions: The incidence of VAP, mainly late-onset episodes, is high in COVID-19 patients and associated with an increased risk of death, similar to that observed in other mechanically ventilated patients. The high rate of VAP due to difficult-to-treat microorganisms, pharmacokinetic alterations induced by renal replacement therapy, shock, and ECMO likely explains the high cumulative risk of relapse, superinfection, and treatment failure.
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- 2023
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48. Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study.
- Author
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Tabah A, Buetti N, Staiquly Q, Ruckly S, Akova M, Aslan AT, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Lipman J, Ferrer R, Qiu H, Paiva JA, Povoa P, De Bus L, De Waele J, Zand F, Gurjar M, Alsisi A, Abidi K, Bracht H, Hayashi Y, Jeon K, Elhadi M, Barbier F, and Timsit JF
- Subjects
- Adult, Humans, Cohort Studies, Prospective Studies, Intensive Care Units, Escherichia coli, Hospitals, Carbapenems therapeutic use, Anti-Bacterial Agents therapeutic use, Bacteremia drug therapy, Cross Infection prevention & control, Anti-Infective Agents therapeutic use
- Abstract
Purpose: In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials., Methods: We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021., Results: 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28., Conclusions: HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes., (© 2023. Springer-Verlag GmbH Germany, part of Springer Nature.)
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- 2023
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49. Development and validation of a multivariable model predicting the required catheter dwell time among mechanically ventilated critically ill patients in three randomized trials.
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Iachkine J, Buetti N, de Grooth HJ, Briant AR, Mimoz O, Mégarbane B, Mira JP, Valette X, Daubin C, du Cheyron D, Mermel LA, Timsit JF, and Parienti JJ
- Abstract
Background: The anatomic site for central venous catheter insertion influences the risk of central venous catheter-related intravascular complications. We developed and validated a predictive score of required catheter dwell time to identify critically ill patients at higher risk of intravascular complications., Methods: We retrospectively conducted a cohort study from three multicenter randomized controlled trials enrolling consecutive patients requiring central venous catheterization. The primary outcome was the required catheter dwell time, defined as the period between the first catheter insertion and removal of the last catheter for absence of utility. Predictors were identified in the training cohort (3SITES trial; 2336 patients) through multivariable analyses based on the subdistribution hazard function accounting for death as a competing event. Internal validation was performed in the training cohort by 500 bootstraps to derive the CVC-IN score from robust risk factors. External validation of the CVC-IN score were performed in the testing cohort (CLEAN, and DRESSING2; 2371 patients)., Results: The analysis was restricted to patients requiring mechanical ventilation to comply with model assumptions. Immunosuppression (2 points), high creatinine > 100 micromol/L (2 points), use of vasopressor (1 point), obesity (1 point) and older age (40-59, 1 point; ≥ 60, 2 points) were independently associated with the required catheter dwell time. At day 28, area under the ROC curve for the CVC-IN score was 0.69, 95% confidence interval (CI) [0.66-0.72] in the training cohort and 0.64, 95% CI [0.61-0.66] in the testing cohort. Patients with a CVC-IN score ≥ 4 in the overall cohort had a median required catheter dwell time of 24 days (versus 11 days for CVC-IN score < 4 points). The positive predictive value of a CVC-IN score ≥ 4 was 76.9% for > 7 days required catheter dwell time in the testing cohort., Conclusion: The CVC-IN score, which can be used for the first catheter, had a modest ability to discriminate required catheter dwell time. Nevertheless, preference of the subclavian site may contribute to limit the risk of intravascular complications, in particular among ventilated patients with high CVC-IN score. Trials Registration NCT01479153, NCT01629550, NCT01189682., (© 2023. The Author(s).)
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- 2023
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50. Nosocomial outbreak of vancomycin-resistant Enterococcus faecium (VRE) ST796, Switzerland, 2017 to 2020.
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Piezzi V, Wassilew N, Atkinson A, D'Incau S, Kaspar T, Seth-Smith HM, Casanova C, Bittel P, Jent P, Sommerstein R, Buetti N, and Marschall J
- Subjects
- Humans, Vancomycin, Switzerland epidemiology, Disease Outbreaks, Hospitals, University, Enterococcus faecium genetics, Cross Infection epidemiology, Vancomycin-Resistant Enterococci genetics, Gram-Positive Bacterial Infections epidemiology
- Abstract
A large clonal outbreak caused by vancomycin-resistant Enterococcus faecium (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as vanB VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.
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- 2022
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