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Background Prospective randomized controlled studies have demonstrated that addition of chlorhexidine (CHG) dressings reduces the rate of catheter (central venous and arterial)-associated bloodstream infections (CABSIs). However, studies confirming their impact in a real-world setting are lacking. Methods We conducted a real-world data study evaluating the impact of incrementally introducing chlorhexidine dressings (sponge or gel) in addition to an ongoing catheter bundle on the rates of CABSI, expressed as incidence density rates per 1000 catheter-days measured as part of a surveillance program. Poisson regression models were used to compare infection rates over time. Both dressings were used simultaneously during one of the five study periods. Results From 2006 to 2014, 18,286 patients were admitted (91,292 ICU-days and 155,242 catheter-days). We recorded 111 CABSIs. We observed a progressive but significant decrease of CABSI rates from 1.48 (95% CI 1.09-2.01) without CHG dressings to 0.69 (95% CI 0.43-1.09) and 0.23 (95% CI 0.11-0.48) episodes per 1000 catheter-days when CHG sponge and CHG gel dressings were used (p = 0.0007; p < 0.001). A non-significant lower rate of infections occurred with CHG gel compared with CHG sponge dressings. An identical low rate of allergic skin reactions (0.3/1000 device-days) was observed with both types of CHX dressings. Post-study data until 2018 confirmed a sustained decrease of infection rates over 11 years. Conclusions The addition of chlorhexidine dressings to all CVC and arterial lines to an ongoing catheter bundle was associated with a sustained 11-year reduction of all catheter-associated bloodstream infections. This large real-world data study further supports the current recommendations for the systematic use of CHG dressings on all catheters of ICU patients., Author(s): Philippe Eggimann [sup.1] [sup.6], Jean-Luc Pagani [sup.1], Elise Dupuis-Lozeron [sup.2], Bruce Ekholm MS [sup.3], Marie-Josèphe Thévenin [sup.4], Christine Joseph [sup.1], Jean-Pierre Revelly [sup.1], Yok-Ai Que [sup.5] Author Affiliations: (1) [...]

Author(s): José-Artur Paiva [sup.1], Philippe Eggimann [sup.2] Author Affiliations: (1) grid.5808.5, 0000000115037226, Department of Emergency and Intensive Care, Faculty of Medicine, Grupo de Infecçao e Sepsis, Centro Hospitalar Sao Joao, [...]

Author(s): Jozef Kesecioglu [sup.1], Philippe Eggimann [sup.2] Author Affiliations: (1) grid.7692.a, 0000000090126352, Department of Intensive Care Medicine, University Medical Center Utrecht, , Utrecht, The Netherlands (2) grid.8515.9, 0000000104234662, Department of [...]

The antibiotic pipeline continues to diminish and the majority of the public remains unaware of this critical situation. The cause of the decline of antibiotic development is multifactorial and currently most ICUs are confronted with the challenge of multidrug-resistant organisms. Antimicrobial multidrug resistance is expanding all over the world, with extreme and pandrug resistance being increasingly encountered, especially in healthcare-associated infections in large highly specialized hospitals. Antibiotic stewardship for critically ill patients translated into the implementation of specific guidelines, largely promoted by the Surviving Sepsis Campaign, targeted at education to optimize choice, dosage, and duration of antibiotics in order to improve outcomes and reduce the development of resistance. Inappropriate antimicrobial therapy, meaning the selection of an antibiotic to which the causative pathogen is resistant, is a consistent predictor of poor outcomes in septic patients. Therefore, pharmacokinetically/pharmacodynamically optimized dosing regimens should be given to all patients empirically and, once the pathogen and susceptibility are known, local stewardship practices may be employed on the basis of clinical response to redefine an appropriate regimen for the patient. This review will focus on the most severely ill patients, for whom substantial progress in organ support along with diagnostic and therapeutic strategies markedly increased the risk of nosocomial infections., Author(s): Matteo Bassetti [sup.1] [sup.14], Jan J. De Waele [sup.2], Philippe Eggimann [sup.3], Josè Garnacho-Montero [sup.4], Gunnar Kahlmeter [sup.5], Francesco Menichetti [sup.6], David P. Nicolau [sup.7], Jose Arturo Paiva [sup.8], [...]

Introduction For decades, clinicians dealing with immunocompromised and critically ill patients have perceived a link between Candida colonization and subsequent infection. However, the pathophysiological progression from colonization to infection was clearly established only through the formal description of the colonization index (CI) in critically ill patients. Unfortunately, the literature reflects intense confusion about the pathophysiology of invasive candidiasis and specific associated risk factors. Methods We review the contribution of the CI in the field of Candida infection and its development in the 20 years following its original description in 1994. The development of the CI enabled an improved understanding of the pathogenesis of invasive candidiasis and the use of targeted empirical antifungal therapy in subgroups of patients at increased risk for infection. Results The recognition of specific characteristics among underlying conditions, such as neutropenia, solid organ transplantation, and surgical and nonsurgical critical illness, has enabled the description of distinct epidemiological patterns in the development of invasive candidiasis. Conclusions Despite its limited bedside practicality and before confirmation of potentially more accurate predictors, such as specific biomarkers, the CI remains an important way to characterize the dynamics of colonization, which increases early in patients who develop invasive candidiasis., Author(s): Philippe Eggimann [sup.1], Didier Pittet [sup.2] Author Affiliations: (1) grid.8515.9, 0000000104234662, Adult Critical Care Medicine and Burn Unit, Centre Hospitalier Universitaire Vaudois (CHUV), , Lausanne, Switzerland (2) grid.150338.c, 0000000107219812, [...]

Author(s): Philippe Montravers [sup.1] [sup.2], Herve Dupont [sup.3], Philippe Eggimann [sup.4] Author Affiliations: (1) grid.469994.f, 0000000417886194, University of Paris Diderot, Sorbonne Paris Cité, , Paris, France (2) grid.50550.35, 0000000121754109, Département [...]