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2. An appeal for strengthening genomic pathogen surveillance to improve pandemic preparedness and infection prevention: the German perspective

Author

Salzberger, Bernd, Mellmann, Alexander, Bludau, Anna, Ciesek, Sandra, Corman, Victor, Dilthey, Alexander, Donker, Tjibbe, Eckmanns, Tim, Egelkamp, Richard, Gatermann, Sören G., Grundmann, Hajo, Häcker, Georg, Kaase, Martin, Lange, Berit, Mielke, Martin, Pletz, Mathias W., Semmler, Torsten, Thürmer, Andrea, Wieler, Lothar H., Wolff, Thorsten, Widmer, Andreas F., and Scheithauer, Simone

Published
2023
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7. Povidone Iodine vs Chlorhexidine Gluconate in Alcohol for Preoperative Skin Antisepsis: A Randomized Clinical Trial.

Author

Widmer, Andreas F., Atkinson, Andrew, Kuster, Stefan P., Wolfensberger, Aline, Klimke, Steffi, Sommerstein, Rami, Eckstein, Friedrich S., Schoenhoff, Florian, Beldi, Guido, Gutschow, Christian A., Marschall, Jonas, Schweiger, Alexander, and Jent, Philipp

Subjects
*ASEPSIS & antisepsis, *CHLORHEXIDINE, *POVIDONE-iodine, *CLINICAL trials, *SURGICAL site infections, *ABDOMINAL surgery
Abstract

Key Points: Question: Is preoperative skin antisepsis with povidone iodine in alcohol noninferior to chlorhexidine gluconate in alcohol to prevent surgical site infections after cardiac or abdominal surgery? Findings: In this randomized clinical trial that included 3360 patients, surgical site infections after cardiac or abdominal surgery were identified in 80 patients (5.1%) in the povidone iodine group vs 97 (5.5%) in the chlorhexidine gluconate group, a difference of 0.4% that met the predefined noninferiority margin of an absolute difference of 2.5%. Meaning: Povidone iodine was noninferior compared with chlorhexidine gluconate as preoperative skin antisepsis in preventing surgical site infections after cardiac or abdominal surgery. Importance: Preoperative skin antisepsis is an established procedure to prevent surgical site infections (SSIs). The choice of antiseptic agent, povidone iodine or chlorhexidine gluconate, remains debated. Objective: To determine whether povidone iodine in alcohol is noninferior to chlorhexidine gluconate in alcohol to prevent SSIs after cardiac or abdominal surgery. Design, Setting, and Participants: Multicenter, cluster-randomized, investigator-masked, crossover, noninferiority trial; 4403 patients undergoing cardiac or abdominal surgery in 3 tertiary care hospitals in Switzerland between September 2018 and March 2020 were assessed and 3360 patients were enrolled (cardiac, n = 2187 [65%]; abdominal, n = 1173 [35%]). The last follow-up was on July 1, 2020. Interventions: Over 18 consecutive months, study sites were randomly assigned each month to either use povidone iodine or chlorhexidine gluconate, each formulated in alcohol. Disinfectants and skin application processes were standardized and followed published protocols. Main Outcomes and Measures: Primary outcome was SSI within 30 days after abdominal surgery and within 1 year after cardiac surgery, using definitions from the US Centers for Disease Control and Prevention's National Healthcare Safety Network. A noninferiority margin of 2.5% was used. Secondary outcomes included SSIs stratified by depth of infection and type of surgery. Results: A total of 1598 patients (26 cluster periods) were randomly assigned to receive povidone iodine vs 1762 patients (26 cluster periods) to chlorhexidine gluconate. Mean (SD) age of patients was 65.0 years (39.0-79.0) in the povidone iodine group and 65.0 years (41.0-78.0) in the chlorhexidine gluconate group. Patients were 32.7% and 33.9% female in the povidone iodine and chlorhexidine gluconate groups, respectively. SSIs were identified in 80 patients (5.1%) in the povidone iodine group vs 97 (5.5%) in the chlorhexidine gluconate group, a difference of 0.4% (95% CI, −1.1% to 2.0%) with the lower limit of the CI not exceeding the predefined noninferiority margin of −2.5%; results were similar when corrected for clustering. The unadjusted relative risk for povidone iodine vs chlorhexidine gluconate was 0.92 (95% CI, 0.69-1.23). Nonsignificant differences were observed following stratification by type of surgical procedure. In cardiac surgery, SSIs were present in 4.2% of patients with povidone iodine vs 3.3% with chlorhexidine gluconate (relative risk, 1.26 [95% CI, 0.82-1.94]); in abdominal surgery, SSIs were present in 6.8% with povidone iodine vs 9.9% with chlorhexidine gluconate (relative risk, 0.69 [95% CI, 0.46-1.02]). Conclusions and Relevance: Povidone iodine in alcohol as preoperative skin antisepsis was noninferior to chlorhexidine gluconate in alcohol in preventing SSIs after cardiac or abdominal surgery. Trial Registration: ClinicalTrials.gov Identifier: NCT03685604 This multicenter, cluster-randomized, noninferiority trial investigates the effectiveness of povidone iodine vs chlorhexidine gluconate in alcohol as preoperative skin antisepsis in preventing surgical site infections in adults undergoing abdominal or cardiac surgery. [ABSTRACT FROM AUTHOR]

Published
2024
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10. Multicenter Prevalence Study Comparing Molecular and Toxin Assays for Clostridioides difficile Surveillance, Switzerland

Author

Widmer, Andreas F., Frei, Reno, Kuijper, Ed.J., Wilcox, Mark H., Schindler, Ruth, Spaniol, Violeta, Goldenberger, Daniel, Egli, Adrian, and Tschudin-Sutter, Sarah

Subjects
Algorithms -- Health aspects -- Analysis, Hospital patients -- Analysis -- Health aspects, Enzymes -- Health aspects -- Analysis, Diarrhea -- Health aspects -- Analysis, Algorithm, Health
Abstract

Since its identification as a cause of antibiotic-associated pseudomembraneous colitis in 1978 (1), Clostridioides difficile has emerged as a major healthcare-associated pathogen worldwide. In the United States, C. difficile infection [...]

Published
2020
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12. Effectiveness of a Chlorhexidine Dressing on Silver-coated External Ventricular Drain–associated Colonization and Infection : A Prospective Single-blinded Randomized Controlled Clinical Trial

Author

Roethlisberger, Michel, Moffa, Giusi, Fisch, Urs, Wiggli, Benedikt, Schoen, Stephan, Kelly, Christopher, Leu, Severina, Croci, Davide, Zumofen, Daniel W., Cueni, Nadine, Nogarth, Danica, Schulz, Marianne, Bucher, Heiner C., Weisser-Rohacek, Maja, Wasner, Morten-Goetz, Widmer, Andreas F., and Mariani, Luigi

Published
2018

13. Systematic screening on admission for SARS-CoV-2 to detect asymptomatic infections

Author

Stadler, Rahel N., Maurer, Laura, Aguilar-Bultet, Lisandra, Franzeck, Fabian, Ruchti, Chantal, Kühl, Richard, Widmer, Andreas F., Schindler, Ruth, Bingisser, Roland, Rentsch, Katharina M., Pargger, Hans, Sutter, Raoul, Steiner, Luzius, Meier, Christoph, Kübler, Werner, Hirsch, Hans H., Egli, Adrian, Battegay, Manuel, Bassetti, Stefano, and Tschudin-Sutter, Sarah

Published
2021
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21. Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study

Author

van Ingen, Jakko, Kohl, Thomas A, Kranzer, Katharina, Hasse, Barbara, Keller, Peter M, Katarzyna Szafrańska, Anna, Hillemann, Doris, Chand, Meera, Schreiber, Peter Werner, Sommerstein, Rami, Berger, Christoph, Genoni, Michele, Rüegg, Christian, Troillet, Nicolas, Widmer, Andreas F, Becker, Sören L, Herrmann, Mathias, Eckmanns, Tim, Haller, Sebastian, Höller, Christiane, Debast, Sylvia B, Wolfhagen, Maurice J, Hopman, Joost, Kluytmans, Jan, Langelaar, Merel, Notermans, Daan W, ten Oever, Jaap, van den Barselaar, Peter, Vonk, Alexander B A, Vos, Margreet C, Ahmed, Nada, Brown, Timothy, Crook, Derrick, Lamagni, Theresa, Phin, Nick, Smith, E Grace, Zambon, Maria, Serr, Annerose, Götting, Tim, Ebner, Winfried, Thürmer, Alexander, Utpatel, Christian, Spröer, Cathrin, Bunk, Boyke, Nübel, Ulrich, Bloemberg, Guido V, Böttger, Erik C, Niemann, Stefan, Wagner, Dirk, and Sax, Hugo

Published
2017
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23. Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

Author

Sommerstein, Rami; https://orcid.org/0000-0003-1011-6878, Troillet, Nicolas, Harbarth, Stephan, de Kraker, Marlieke E A; https://orcid.org/0000-0003-0903-8614, Vuichard-Gysin, Danielle, Kuster, Stefan P; https://orcid.org/0000-0002-0525-6529, Widmer, Andreas F; https://orcid.org/0000-0002-7661-5824, Swissnoso group, Sommerstein, Rami; https://orcid.org/0000-0003-1011-6878, Troillet, Nicolas, Harbarth, Stephan, de Kraker, Marlieke E A; https://orcid.org/0000-0003-0903-8614, Vuichard-Gysin, Danielle, Kuster, Stefan P; https://orcid.org/0000-0002-0525-6529, Widmer, Andreas F; https://orcid.org/0000-0002-7661-5824, and Swissnoso group

Abstract

IMPORTANCE World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited. OBJECTIVE To assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI). DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023. EXPOSURES Timing of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol. MAIN OUTCOMES AND MEASURES Occurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied. RESULTS Of 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds rat

Published
2023

24. Timing of surgical antimicrobial prophylaxis: a phase 3 randomised controlled trial

Author

Weber, Walter P, Mujagic, Edin, Zwahlen, Marcel, Bundi, Marcel, Hoffmann, Henry, Soysal, Savas D, Kraljević, Marko, Delko, Tarik, von Strauss, Marco, Iselin, Lukas, Da Silva, Richard X Sousa, Zeindler, Jasmin, Rosenthal, Rachel, Misteli, Heidi, Kindler, Christoph, Müller, Peter, Saccilotto, Ramon, Lugli, Andrea Kopp, Kaufmann, Mark, Gürke, Lorenz, von Holzen, Urs, Oertli, Daniel, Bucheli-Laffer, Evelin, Landin, Julia, Widmer, Andreas F, Fux, Christoph A, and Marti, Walter R

Published
2017
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28. Effect of Antibiotic Prescription Audit and Feedback on Antibiotic Prescribing in Primary Care

Author

Aghlmandi, Soheila, primary, Halbeisen, Florian S., additional, Saccilotto, Ramon, additional, Godet, Pascal, additional, Signorell, Andri, additional, Sigrist, Simon, additional, Glinz, Dominik, additional, Moffa, Giusi, additional, Zeller, Andreas, additional, Widmer, Andreas F., additional, Kronenberg, Andreas, additional, Bielicki, Julia, additional, and Bucher, Heiner C., additional

Published
2023
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29. Additional file 1 of Variability in contact precautions to control the nosocomial spread of multi-drug resistant organisms in the endemic setting: a multinational cross-sectional survey

Author

Vuichard Gysin, Danielle, Cookson, Barry, Saenz, Henri, Dettenkofer, Markus, and Widmer, Andreas F.

Abstract

Table S1. Country of workplace of the 213 survey participants (number of respondents per country). Table S2. Survey respondents affiliations (n = 213). Table S3. MRSA contact precaution measures according to professional background. Table S4. GRE contact precaution measures according to professional background. Table S5. ESBL-E. coli contact precaution measures according to professional background. Table S6. ESBL-non-E. coli contact precaution measures according to professional background. Table S7. CR-E. coli contact precaution measures according to professional background. Table S8. CRE contact precaution measures according to professional background. Table S9. MRD P. aeruginosa contact precaution measures according to professional background. Table S10. MRD A. baumannii contact precaution measures according to professional background. Table S11. Indication and specification for contact precautions (CP) and isolation (cont. Next page) after deduplication*. Table S12. Other specific requirements for CP, results after deduplication*. Table S13. Characteristics of respondents that indicated “unknown” compared to respondents that provided any other answer. (DOCX 78 kb)

Published
2023
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30. Timing of Cefuroxime Surgical Antimicrobial Prophylaxis and Its Association With Surgical Site Infections

Author

Sommerstein, Rami, Troillet, Nicolas, Harbarth, Stephan, de Kraker, Marlieke E A, Vuichard-Gysin, Danielle, Kuster, Stefan P, and Widmer, Andreas F

Subjects
610 Medicine & health
Abstract

IMPORTANCE World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited. OBJECTIVE To assess whether earlier vs later timing of administration of cefuroxime SAP is associated with the occurrence of surgical site infections (SSI). DESIGN, SETTING, AND PARTICIPANTS This cohort study included adult patients who underwent 1 of 11 major surgical procedures with cefuroxime SAP, documented by the Swissnoso SSI surveillance system between January 2009 and December 2020 at 158 Swiss hospitals. Data were analyzed from January 2021 to April 2023. EXPOSURES Timing of cefuroxime SAP administration before incision was divided into 3 groups: 61 to 120 minutes before incision, 31 to 60 minutes before incision, and 0 to 30 minutes before incision. In addition, a subgroup analysis was performed with time windows of 30 to 55 minutes and 10 to 25 minutes as a surrogate marker for administration in the preoperating room vs in the operating room, respectively. The timing of SAP administration was defined as the start of the infusion obtained from the anesthesia protocol. MAIN OUTCOMES AND MEASURES Occurrence of SSI according to Centers for Disease Control and Prevention definitions. Mixed-effects logistic regression models adjusted for institutional, patient, and perioperative variables were applied. RESULTS Of 538 967 surveilled patients, 222 439 (104 047 men [46.8%]; median [IQR] age, 65.7 [53.9-74.2] years), fulfilled inclusion criteria. SSI was identified in 5355 patients (2.4%). Cefuroxime SAP was administered 61 to 120 minutes prior to incision in 27 207 patients (12.2%), 31 to 60 minutes prior to incision in 118 004 patients (53.1%), and 0 to 30 minutes prior to incision in 77 228 patients (34.7%). SAP administration at 0 to 30 minutes was significantly associated with a lower SSI rate (adjusted odds ratio [aOR], 0.85; 95% CI, 0.78-0.93; P

Published
2023
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31. Effect of Antibiotic Prescription Audit and Feedback on Antibiotic Prescribing in Primary Care: A Randomized Clinical Trial

Author

Aghlmandi, Soheila, Halbeisen, Florian S, Saccilotto, Ramon, Godet, Pascal, Signorell, Andri, Sigrist, Simon, Glinz, Dominik, Moffa, Giusi, Zeller, Andreas, Widmer, Andreas F, Kronenberg, Andreas, Bielicki, Julia, and Bucher, Heiner C

Subjects
Internal Medicine, 610 Medizin und Gesundheit, 570 Biowissenschaften, Biologie
Abstract

ImportanceAntibiotics are commonly prescribed in primary care, increasing the risk of antimicrobial resistance in the population.ObjectiveTo investigate the effect of quarterly audit and feedback on antibiotic prescribing among primary care physicians in Switzerland with medium to high antibiotic prescription rates.Design, Setting, and ParticipantsThis pragmatic randomized clinical trial was conducted from January 1, 2018, to December 31, 2019, among 3426 registered primary care physicians and pediatricians in single or small practices in Switzerland who were among the top 75% prescribers of antibiotics. Intention-to-treat analysis was performed using analysis of covariance models and conducted from September 1, 2021, to January 31, 2022.InterventionsPrimary care physicians were randomized in a 1:1 fashion to undergo quarterly antibiotic prescribing audit and feedback with peer benchmarking vs no intervention for 2 years, with 2017 used as the baseline year. Anonymized patient-level claims data from 3 health insurers serving roughly 50% of insurees in Switzerland were used for audit and feedback. The intervention group also received evidence-based guidelines for respiratory tract and urinary tract infection management and community antibiotic resistance information. Physicians in the intervention group were blinded regarding the nature of the trial, and physicians in the control group were not informed of the trial.Main Outcomes and MeasuresThe claims data used for audit and feedback were analyzed to assess outcomes. Primary outcome was the antibiotic prescribing rate per 100 consultations during the second year of the intervention. Secondary end points included overall antibiotic use in the first year and over 2 years, use of quinolones and oral cephalosporins, all-cause hospitalizations, and antibiotic use in 3 age groups.ResultsA total of 3426 physicians were randomized to the intervention (n = 1713) and control groups (n = 1713) serving 629 825 and 622 344 patients, respectively, with a total of 4 790 525 consultations in the baseline year of 2017. In the entire cohort, a 4.2% (95% CI, 3.9%-4.6%) relative increase in the antibiotic prescribing rate was noted during the second year of the intervention compared with 2017. In the intervention group, the median annual antibiotic prescribing rate per 100 consultations was 8.2 (IQR, 6.1-11.4) in the second year of the intervention and was 8.4 (IQR, 6.0-11.8) in the control group. Relative to the overall increase, a –0.1% (95% CI, –1.2% to 1.0%) lower antibiotic prescribing rate per 100 consultations was found in the intervention group compared with the control group. No relevant reductions in specific antibiotic prescribing rates were noted between groups except for quinolones in the second year of the intervention (–0.9% [95% CI, –1.5% to –0.4%]).Conclusions and RelevanceThis randomized clinical trial found that quarterly personalized antibiotic prescribing audit and feedback with peer benchmarking did not reduce antibiotic prescribing among primary care physicians in Switzerland with medium to high antibiotic prescription rates.Trial RegistrationClinicalTrials.gov Identifier: NCT03379194

Published
2023
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32. Surgical Infection

Author

Maiwald, Matthias, Widmer, Andreas F., Shaw, David, Coventry, Brendon J., and Coventry, Brendon J., Series editor

Published
2014
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47. Quantifying the Effects of Prior Acetyl-Salicylic Acid on Sepsis-Related Deaths: An Individual Patient Data Meta-Analysis Using Propensity Matching*

Author

Trauer, James, Muhi, Stephen, McBryde, Emma S., Al Harbi, Shmeylan A., Arabi, Yaseen M., Boyle, Andrew J., Cartin-Ceba, Rodrigo, Chen, Wei, Chen, Yung-Tai, Falcone, Marco, Gajic, Ognjen, Godsell, Jack, Gong, Michelle Ng, Kor, Daryl, Lösche, Wolfgang, McAuley, Daniel F., O’Neal, Hollis R., Jr, Osthoff, Michael, Otto, Gordon P., Sossdorf, Maik, Tsai, Min-Juei, Valerio-Rojas, Juan C., van der Poll, Tom, Violi, Francesco, Ware, Lorraine, Widmer, Andreas F., Wiewel, Maryse A., Winning, Johannes, and Eisen, Damon P.

Published
2017
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