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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, Harbarth S. 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. Antimicrob Resist Infect Control 2024; 13:16. [PMID: 38331974 PMCID: PMC10854024 DOI: 10.1186/s13756-023-01344-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 11/25/2023] [Indexed: 02/10/2024] Open
Abstract
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.
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Affiliation(s)
- Andrea C Büchler
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Murielle Haddad Galas
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Niccolò Buetti
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
- IAME UMR 1137, INSERM, Université Paris-Cité, Paris, France
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Türkiye
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University Hospital, Pathum Thani, Thailand
| | - Gerald Dziekan
- Communicable Disease Division, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Valeria Fabre
- Department of Medicine, Division of Infectious Diseases, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Simon Gottwalt
- Communicable Disease Division, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Kazuaki Jindai
- Department of Virology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Department of Healthcare Epidemiology, School of Public Health, Kyoto University, Kyoto, Japan
| | - Babacar Ndoye
- Infection Control and Patient Safety, WHO Afro Consultant, Brazzaville, Congo Republic
| | - Hilda Márquez Villareal
- Department of Public Health. University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Fernando Otaiza
- Department of Quality of Healthcare and Patient Safety, National Infection Control Program, Ministry of Health of Chile, Santiago, Chile
| | - Didier Pittet
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland
| | - Natalie Schellack
- Departement of Pharmacology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Céline Gardiol
- Communicable Disease Division, Federal Office of Public Health FOPH, Bern, Switzerland
| | - Stephan Harbarth
- Infection Control Program, Faculty of Medicine, Geneva University Hospitals, WHO Collaborating Center, Rue Gabrielle-Perret-Gentil 4, Genève, 1205, Switzerland.
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Bloch N, Männer J, Gardiol C, Kohler P, Kuhn J, Münzer T, Schlegel M, Kuster SP, Flury D. Effective infection prevention and control measures in long-term care facilities in non-outbreak and outbreak settings: a systematic literature review. Antimicrob Resist Infect Control 2023; 12:113. [PMID: 37853477 PMCID: PMC10585745 DOI: 10.1186/s13756-023-01318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Healthcare-associated infections in long-term care are associated with substantial morbidity and mortality. While infection prevention and control (IPC) guidelines are well-defined in the acute care setting, evidence of effectiveness for long-term care facilities (LTCF) is missing. We therefore performed a systematic literature review to examine the effect of IPC measures in the long-term care setting. METHODS We systematically searched PubMed and Cochrane libraries for articles evaluating the effect of IPC measures in the LTCF setting since 2017, as earlier reviews on this topic covered the timeframe up to this date. Cross-referenced studies from identified articles and from mentioned earlier reviews were also evaluated. We included randomized-controlled trials, quasi-experimental, observational studies, and outbreak reports. The included studies were analyzed regarding study design, type of intervention, description of intervention, outcomes and quality. We distinguished between non-outbreak and outbreak settings. RESULTS We included 74 studies, 34 (46%) in the non-outbreak setting and 40 (54%) in the outbreak setting. The most commonly studied interventions in the non-outbreak setting included the effect of hand hygiene (N = 10), oral hygiene (N = 6), antimicrobial stewardship (N = 4), vaccination of residents (N = 3), education (N = 2) as well as IPC bundles (N = 7). All but one study assessing hand hygiene interventions reported a reduction of infection rates. Further successful interventions were oral hygiene (N = 6) and vaccination of residents (N = 3). In outbreak settings, studies mostly focused on the effects of IPC bundles (N = 24) or mass testing (N = 11). In most of the studies evaluating an IPC bundle, containment of the outbreak was reported. Overall, only four articles (5.4%) were rated as high quality. CONCLUSION In the non-outbreak setting in LTCF, especially hand hygiene and oral hygiene have a beneficial effect on infection rates. In contrast, IPC bundles, as well as mass testing seem to be promising in an outbreak setting.
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Affiliation(s)
- Nando Bloch
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
| | - Jasmin Männer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | | | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Jacqueline Kuhn
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St.Gallen, St.Gallen, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
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Grant R, Benamouzig D, Catton H, Cheng VCC, Dhingra N, Laxminarayan R, Legido-Quigley H, Martinez SL, Marikar K, Mendelson M, Parneix P, Perencevich E, Singh H, Tschudin-Sutter S, Ushiro S, Wesangula E, Gardiol C, Dziekan G, Harbarth S, Pittet D. COVID-19 pandemic: a catalyst for accelerating global action on patient safety. Lancet Infect Dis 2023; 23:1108-1110. [PMID: 37572686 DOI: 10.1016/s1473-3099(23)00485-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 07/19/2023] [Indexed: 08/14/2023]
Affiliation(s)
- Rebecca Grant
- Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Daniel Benamouzig
- Sciences Po, Centre de Sociologie des Organisations and Chaire Santé, CNRS, Paris, France
| | - Howard Catton
- International Council of Nurses, Geneva, Switzerland
| | - Vincent Chi-Chung Cheng
- Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | | | | | | | | | - Kadar Marikar
- Malaysian Society for Quality in Health, Kuala Lumpur, Malaysia
| | - Marc Mendelson
- Division of Infectious Diseases & HIV Medicine, Department of Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
| | - Pierre Parneix
- Nouvelle Aquitaine Healthcare-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - Eli Perencevich
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Hardeep Singh
- Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Shin Ushiro
- Division of Patient Safety, Kyushu University Hospital, Fukuoka, Japan
| | - Evelyn Wesangula
- East Central and Southern Africa Health Community, Arusha, Tanzania; Patient and Health Workers Safety Division, Ministry of Health, Nairobi, Kenya
| | | | | | - Stephan Harbarth
- Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Didier Pittet
- Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
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Vuichard-Gysin D, Sommerstein R, Kronenberg A, Buetti N, Eder M, Piezzi V, Gardiol C, Schlegel M, Harbarth S, Widmer A. High adherence to national IPC guidelines as key to sustainable VRE control in Swiss hospitals: a cross-sectional survey. Antimicrob Resist Infect Control 2022; 11:19. [PMID: 35090563 PMCID: PMC8795934 DOI: 10.1186/s13756-022-01051-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/22/2021] [Indexed: 11/30/2022] Open
Abstract
Background Vancomycin resistant enterococci (VRE) are on the rise in many European hospitals. In 2018, Switzerland experienced its largest nosocomial VRE outbreak. The national center for infection prevention (Swissnoso) elaborated recommendations for controlling this outbreak and published guidelines to prevent epidemic and endemic VRE spread. The primary goal of this study was to evaluate adherence to this new guideline and its potential impact on the VRE epidemiology in Swiss acute care hospitals. Methods In March 2020, Swissnoso distributed a survey among all Swiss acute care hospitals. The level of adherence as well as changes of infection prevention and control (IPC) strategies in the years 2018 and 2019 after publication of the national guidelines were asked along with an inventory on VRE surveillance and outbreaks. Results Data of 97/146 (66%) participants were available, representing 81.6% of all acute care beds operated in Switzerland in 2019. The vast majority—72/81 (88%) responding hospitals—have entirely or largely adopted our new national guideline. 38/51 (74.5%) hospitals which experienced VRE cases were significantly more likely to have changed their IPC strategies than those 19/38 (50%) hospitals without VRE cases p = 0.017). The new IPC guidelines included (1) introduction of targeted admission screening in 89.5%, (2) screening of close contacts of VRE cases in 56%, and (3) contact precaution for suspected VRE cases 58% of these hospitals. 52 (54%) hospitals reported 569 new VRE cases in 2018 including 14 bacteremia, and 472 new cases in 2019 with 10 bacteremia. The ten largest outbreaks encountered between 2018 and 2019 included 671 VRE cases, of which most (93.4%) consisted of colonization events, 29 (4.3%) infections and 15 (2.2%) bacteremia. Conclusion Wide adoption of this VRE control guideline seemed to have a positive effect on VRE containment in Swiss acute care hospitals over two years, even if its long-term impact on the VRE epidemiology remains to be evaluated. Broad dissemination and strict implementation of a uniform national guideline may therefore serve as model for other countries to fight VRE epidemics on a national level. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01051-9.
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Roelens M, Martin A, Friker B, Sousa FM, Thiabaud A, Vidondo B, Buchter V, Gardiol C, Vonlanthen J, Balmelli C, Battegay M, Berger C, Buettcher M, Cusini A, Flury D, Heininger U, Niederer-Loher A, Riedel T, Schreiber PW, Sommerstein R, Troillet N, Tschudin-Sutter S, Vetter P, Bernhard-Stirnemann S, Corti N, Gaudenz R, Marschall J, Nussbaumer-Ochsner Y, Senn L, Vuichard-Gysin D, Zimmermann P, Zucol F, Iten A, Keiser O. Evolution of COVID-19 mortality over time: results from the Swiss hospital surveillance system (CH-SUR). Swiss Med Wkly 2021; 151:w30105. [PMID: 34843180 DOI: 10.4414/smw.2021.w30105] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND When the periods of time during and after the first wave of the ongoing SARS-CoV-2/COVID-19 pandemic in Europe are compared, the associated COVID-19 mortality seems to have decreased substantially. Various factors could explain this trend, including changes in demographic characteristics of infected persons and the improvement of case management. To date, no study has been performed to investigate the evolution of COVID-19 in-hospital mortality in Switzerland, while also accounting for risk factors. METHODS We investigated the trends in COVID-19-related mortality (in-hospital and in-intermediate/intensive-care) over time in Switzerland, from February 2020 to June 2021, comparing in particular the first and the second wave. We used data from the COVID-19 Hospital-based Surveillance (CH-SUR) database. We performed survival analyses adjusting for well-known risk factors of COVID-19 mortality (age, sex and comorbidities) and accounting for competing risk. RESULTS Our analysis included 16,984 patients recorded in CH-SUR, with 2201 reported deaths due to COVID-19 (13.0%). We found that overall in-hospital mortality was lower during the second wave of COVID-19 than in the first wave (hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.63- 0.78; p <0.001), a decrease apparently not explained by changes in demographic characteristics of patients. In contrast, mortality in intermediate and intensive care significantly increased in the second wave compared with the first wave (HR 1.25, 95% CI 1.05-1.49; p = 0.029), with significant changes in the course of hospitalisation between the first and the second wave. CONCLUSION We found that, in Switzerland, COVID-19 mortality decreased among hospitalised persons, whereas it increased among patients admitted to intermediate or intensive care, when comparing the second wave to the first wave. We put our findings in perspective with changes over time in case management, treatment strategy, hospital burden and non-pharmaceutical interventions. Further analyses of the potential effect of virus variants and of vaccination on mortality would be crucial to have a complete overview of COVID-19 mortality trends throughout the different phases of the pandemic.
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Affiliation(s)
- Maroussia Roelens
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Alexis Martin
- Swiss Tropical and Public Health Institute, Basel, Switzerland.,University of Basel, Switzerland
| | - Brian Friker
- Veterinary Public Health Institute, University of Bern, Switzerland
| | | | - Amaury Thiabaud
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Beatriz Vidondo
- Veterinary Public Health Institute, University of Bern, Switzerland
| | | | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | | | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases, and Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | | | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland.,Infectious Diseases and Hospital Hygiene Clinic St Anna, Department of Health Sciences and Medicine, University of Lucerne, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Pauline Vetter
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Natascia Corti
- Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland
| | - Roman Gaudenz
- Internal Medicine and Infectiology, Cantonal Hospital Nidwalden, Stans, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | | | - Laurence Senn
- Service of Preventive Medicine, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Danielle Vuichard-Gysin
- Division of Infectious Diseases and Hospital Hygiene, Thurgau Hospital Group Münsterlingen and Frauenfeld, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland.,Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, University Hospital Geneva, HUG, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
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Héquet D, Kessler S, Rettenmund G, Lemmenmeier E, Qalla-Widmer L, Gardiol C, Münzer T, Schlegel M, Petignat C, Kohler P. Healthcare-associated infections and antibiotic use in long-term care residents from two geographical regions in Switzerland. J Hosp Infect 2021; 117:172-178. [PMID: 34428504 DOI: 10.1016/j.jhin.2021.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/21/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND The burden of healthcare-associated infections (HAIs) and antimicrobial use in Swiss long-term care facilities (LTCFs) is currently unknown. This study assessed the prevalence of HAIs and antibiotic use among LTCF residents in Switzerland. METHODS A point-prevalence study was undertaken in LTCFs in eastern and western Switzerland from August to October 2019 according to the 'Healthcare-associated infections in long-term care facilities' (HALT) protocol. Characteristics of residents (age, sex, wounds, dementia, indwelling catheters) and institutions (specific factors, geographic region) were assessed. LTCF residents were screened for HAIs and current antibiotic treatment. Personal and institutional factors associated with HAIs were assessed. RESULTS In total, 1185 residents from 16 LTCFs (eight per geographic region) were screened for HAIs and antibiotic treatment. Median age was 87 years (interquartile range 79-91) and 71% were female. The prevalence of HAIs was 4.2% (west 4.3% vs east 4.2%; P=0.93), with mucocutaneous skin infections (36%) and respiratory tract infections (30%) being the most common. Independent risk factors for the presence of HAIs were presence of a chronic wound [odds ratio (OR) 2.4, 95% confidence interval (CI) 1.1-5.0; P=0.02] and being immobile (OR 1.8, 95% CI 1.0-3.3; P=0.04). Antibiotics were given to 2.9% of residents (west 3.9% vs east 1.8%; P=0.05) on the day of the survey. The most commonly prescribed antibiotics were amoxicillin-clavulanic acid and quinolones. CONCLUSIONS The prevalence of HAIs in Swiss LTCFs is similar to that in other European countries, whereas antibiotic consumption is lower. Further point-prevalence surveys on a broader scale are recommended to improve understanding of the burden of HAIs and antibiotic consumption in this setting.
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Affiliation(s)
- D Héquet
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland.
| | - S Kessler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - G Rettenmund
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - E Lemmenmeier
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - L Qalla-Widmer
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | - C Gardiol
- Federal Office of Public Health, Bern, Switzerland
| | - T Münzer
- Geriatrische Klinik St. Gallen, St. Gallen, Switzerland
| | - M Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - C Petignat
- Cantonal Unit for Infection Control and Prevention, Public Health Service, Lausanne, Switzerland
| | - P Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
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Maximiano Sousa F, Roelens M, Fricker B, Thiabaud A, Iten A, Cusini A, Flury D, Buettcher M, Zukol F, Balmelli C, Zimmermann P, Troillet N, Vuichard-Gysin D, Schreiber PW, Bernhard-Stirnemann S, Tschudin-Sutter S, Nussbaumer-Ochsner Y, Sommerstein R, Gaudenz R, Marschall J, Senn L, Gardiol C, Keiser O, Schüpbach G, Wymann M, Vidondo B, Ch-Sur Study Group. Risk factors for severe outcomes for COVID-19 patients hospitalised in Switzerland during the first pandemic wave, February to August 2020: prospective observational cohort study. Swiss Med Wkly 2021; 151:w20547. [PMID: 34324698 DOI: 10.4414/smw.2021.20547] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND As clinical signs of COVID-19 differ widely among individuals, from mild to severe, the definition of risk groups has important consequences for recommendations to the public, control measures and patient management, and needs to be reviewed regularly. AIM The aim of this study was to explore risk factors for in-hospital mortality and intensive care unit (ICU) admission for hospitalised COVID-19 patients during the first epidemic wave in Switzerland, as an example of a country that coped well during the first wave of the pandemic. METHODS This study included all (n = 3590) adult polymerase chain reaction (PCR)-confirmed hospitalised patients in 17 hospitals from the hospital-based surveillance of COVID-19 (CH-Sur) by 1 September 2020. We calculated univariable and multivariable (adjusted) (1) proportional hazards (Fine and Gray) survival regression models and (2) logistic regression models for in-hospital mortality and admission to ICU, to evaluate the most common comorbidities as potential risk factors. RESULTS AND DISCUSSION We found that old age was the strongest factor for in-hospital mortality after having adjusted for gender and the considered comorbidities (hazard ratio [HR] 2.46, 95% confidence interval [CI] 2.33−2.59 and HR 5.6 95% CI 5.23−6 for ages 65 and 80 years, respectively). In addition, male gender remained an important risk factor in the multivariable models (HR 1.47, 95% CI 1.41−1.53). Of all comorbidities, renal disease, oncological pathologies, chronic respiratory disease, cardiovascular disease (but not hypertension) and dementia were also risk factors for in-hospital mortality. With respect to ICU admission risk, the pattern was different, as patients with higher chances of survival might have been admitted more often to ICU. Male gender (OR 1.91, 95% CI 1.58−2.31), hypertension (OR 1.3, 95% CI 1.07−1.59) and age 55–79 years (OR 1.15, 95% CI 1.06−1.26) are risk factors for ICU admission. Patients aged 80+ years, as well as patients with dementia or with liver disease were admitted less often to ICU. CONCLUSION We conclude that increasing age is the most important risk factor for in-hospital mortality of hospitalised COVID-19 patients in Switzerland, along with male gender and followed by the presence of comorbidities such as renal diseases, chronic respiratory or cardiovascular disease, oncological malignancies and dementia. Male gender, hypertension and age between 55 and 79 years are, however, risk factors for ICU admission. Mortality and ICU admission need to be considered as separate outcomes when investigating risk factors for pandemic control measures and for hospital resources planning.
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Affiliation(s)
- Filipe Maximiano Sousa
- Swiss Federal Office of Public Health, Bern, Switzerland / Veterinary Public Health Institute, University of Bern, Switzerland
| | - Maroussia Roelens
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Brian Fricker
- Swiss Federal Office of Public Health, Bern, Switzerland / Veterinary Public Health Institute, University of Bern, Switzerlan
| | - Amaury Thiabaud
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, University Hospital Geneva, HUG, Geneva, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | - Franziska Zukol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Danielle Vuichard-Gysin
- Division of Infectious Diseases and Hospital Hygiene, Thurgau Hospital Group Münsterlingen and Frauenfeld, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | | | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland
| | | | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland / Infectious Diseases and Hospital Hygiene, Hirslanden Central Switzerland, Lucerne, Switzerland
| | - Roman Gaudenz
- Internal Medicine and Infectiology, Cantonal Hospital Nidwalden, Stans, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Laurence Senn
- Service of Preventive Medicine, Lausanne University Hospital, CHUV, Lausanne, Switzerland
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Olivia Keiser
- Institute of Global Health, Faculty of Medicine, University of Geneva, Switzerland
| | - Gertraud Schüpbach
- Swiss Federal Office of Public Health, Bern, Switzerland / Veterinary Public Health Institute, University of Bern, Switzerland
| | - Monica Wymann
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Beatriz Vidondo
- Swiss Federal Office of Public Health, Bern, Switzerland / Veterinary Public Health Institute, University of Bern, Switzerland
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Kohler P, Seiffert SN, Kessler S, Rettenmund G, Lemmenmeier E, Qalla Widmer L, Nolte O, Seth-Smith HMB, Albrich WC, Babouee Flury B, Gardiol C, Harbarth S, Münzer T, Schlegel M, Petignat C, Egli A, Héquet D. Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacterales in Long-Term Care Residents. J Am Med Dir Assoc 2021; 23:475-481.e5. [PMID: 34297981 DOI: 10.1016/j.jamda.2021.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We aimed to assess the burden of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in Swiss long-term care facilities (LTCFs) to describe the molecular epidemiology, describe the intrainstitutional and regional clusters of resistant pathogens, and identify independent institution- and resident-level factors associated with colonization. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS From August to October 2019, we performed a point prevalence study among residents from 16 LTCFs in Western and Eastern Switzerland (8 per region). METHODS Residents underwent screening for ESBL-producing Enterobacterales (ESBL-E); whole-genome sequencing (WGS) was performed. We gathered institution-level (eg, number of beds, staff-resident ratio, alcoholic hand rub consumption) and resident-level [eg, anthropometric data, time in facility, dependency, health care exposure, antibiotic treatment, proton-pump inhibitor (PPI) use] characteristics. Factors associated with colonization were identified using a generalized linear model. RESULTS Among 1185 eligible residents, 606 (51%) consented to the study. ESBL-E prevalence was 11.6% (70/606), ranging from 1.9% to 33.3% between institutions, with a median of 12.5% in the West and 6.9% in the East (P = .03). Among 59 Escherichia coli (from 58 residents), multilocus sequence type (ST) 131 was most common (n = 43/59, 73%), predominantly its subclone H30R1 (n = 37/43, 86%). WGS data identified multiple intrainstitutional and regional clusters. Independent risk factors for ESBL carriage were previous ESBL colonization [adjusted odds ratio (aOR) 23.5, 95% confidence interval (CI) 6.6-83.8, P < .001), male gender (aOR 2.6, 95% CI 1.5-4.6, P = .002), and use of PPIs (aOR 2.2, 95% CI 1.2-3.8, P = .01). CONCLUSIONS AND IMPLICATIONS Overall ESBL-E prevalence in Swiss LTCF residents is low. Yet, we identified several clusters of residents with identical pathogens within the same institution. This implies that particularly affected institutions might benefit from targeted infection control interventions. PPI use was the only modifiable factor associated with carriage of ESBL producers. This study adds to the growing list of adverse outcomes associated with PPIs, calling for action to restrict their use in the long-term care setting.
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Affiliation(s)
- Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
| | - Salome N Seiffert
- Division of Human Microbiology, Centre for Laboratory Medicine, St Gallen, Switzerland
| | - Simone Kessler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Gabriela Rettenmund
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Eva Lemmenmeier
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Laetitia Qalla Widmer
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
| | - Oliver Nolte
- Division of Human Microbiology, Centre for Laboratory Medicine, St Gallen, Switzerland
| | - Helena M B Seth-Smith
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Stephan Harbarth
- Division of Infectious Diseases and Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christiane Petignat
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Delphine Héquet
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
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Metsini A, Widmer A, Zingg W, Gardiol C, Vuichard-Gysin D, Eder M, Maag J, Schlegel M, Marschall J, Harbarth S, Sommerstein R. Evaluation of existing and desired measures to monitor, prevent and control healthcare-associated infections in Swiss hospitals. Swiss Med Wkly 2021; 151:w20516. [PMID: 34265072 DOI: 10.4414/smw.2021.20516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Optimal surveillance and prevention of healthcare-associated infections (HAI) are crucial for a well-functioning health care system. With a view to establishing a national state-of-the-art programme for surveillance and prevention of HAIs, the Swiss National Center for Infection Control, Swissnoso, developed a survey to explore the options for expanding the existing Swiss HAI surveillance system. METHODS An online survey was sent to all Swiss acute care hospitals. Local infection prevention and control (IPC) professionals were asked to answer on behalf of their institutions. The questions covered the structure and organisation of IPC programmes, current preventive measures, availability and capacity of electronic medical record (EMR) systems, and ability and willingness to establish and participate in the proposed new surveillance modules. An invitation was sent to the 156 acute care hospitals and hospital networks in June 2020. Responses were collected up to the end of August 2020. RESULTS Ninety-four hospitals and hospital networks out of 156 (60%) completed the survey. Among 84 hospitals reporting the number of acute care beds, 61 (73%) were small (<200 beds), 16 (19%) medium (200–650 beds) and 7 (8%) large hospitals (>650 beds). Twenty-nine different EMR systems were used in the participating hospitals. Twenty-two hospitals were using a different EMR system in their intensive care unit. There were 17 hospitals (18%) without an EMR system but which planned to introduce one soon, and eight small hospitals (9%) neither had an EMR system nor were preparing to introduce one. Surveillance for central-line associated bloodstream infection, catheter-associated urinary tract infection and ventilator-associated pneumonia were already established in 26 (28%), 15 (16%) and 15 (16%) hospitals, respectively. Thirty hospitals (36%) would be willing to participate in the pilot phase of a new surveillance system. Of these, 15 stated that they wanted to be part of the pilot hospital network, 6 could provide hospital-wide surveillance denominators (such as catheter-days and patient-days) to compute incidence rates, and 8 indicated interest in doing both. Large hospitals interested in participating in the pilot phase reported more full-time equivalent staff available for surveillance activities than those who did not declare an interest. CONCLUSIONS Baseline information on hospital IPC structure and process indicators are essential for the roll-out of national surveillance programmes and for improving surveillance activities. Having an EMR system in place and adequate personnel resources dedicated for surveillance activities are crucial prerequisites for developing and implementing an effective HAI surveillance system. The lack of an EMR system and the diversity and capacities of EMR solutions will be the main challenges for successful implementation of national HAI surveillance modules.
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Affiliation(s)
- Aliki Metsini
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Cantonal Physician Office, Canton of Geneva, Switzerland
| | - Andreas Widmer
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Division of Infectious diseases and Hospital Epidemiology, University of Basel Hospitals and Clinics, Basel, Switzerland
| | - Walter Zingg
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Switzerland
| | | | - Danielle Vuichard-Gysin
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Division of Infectious Diseases and Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen and Frauenfeld, Switzerland
| | - Marcus Eder
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland
| | - Judith Maag
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland
| | - Matthias Schlegel
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Jonas Marschall
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Stephan Harbarth
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Rami Sommerstein
- Swissnoso, Swiss Centre for Infection Prevention, Bern, Switzerland / Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland / Infectious Diseases, Hirslanden Central Switzerland, Lucerne, Switzerland
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Sieber P, Flury D, Güsewell S, Albrich WC, Boggian K, Gardiol C, Schlegel M, Sieber R, Vernazza P, Kohler P. Characteristics of patients with Coronavirus Disease 2019 (COVID-19) and seasonal influenza at time of hospital admission: a single center comparative study. BMC Infect Dis 2021; 21:271. [PMID: 33731019 PMCID: PMC7968573 DOI: 10.1186/s12879-021-05957-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 03/03/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND In the future, co-circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza viruses A/B is likely. From a clinical point of view, differentiation of the two disease entities is crucial for patient management. We therefore aim to detect clinical differences between Coronavirus Disease 2019 (COVID-19) and seasonal influenza patients at time of hospital admission. METHODS In this single-center observational study, we included all consecutive patients hospitalized for COVID-19 or influenza between November 2019 and May 2020. Data were extracted from a nationwide surveillance program and from electronic health records. COVID-19 and influenza patients were compared in terms of baseline characteristics, clinical presentation and outcome. We used recursive partitioning to generate a classification tree to discriminate COVID-19 from influenza patients. RESULTS We included 96 COVID-19 and 96 influenza patients. Median age was 68 vs. 70 years (p = 0.90), 72% vs. 56% (p = 0.024) were males, and median Charlson Comorbidity Index (CCI) was 1 vs. 2 (p = 0.027) in COVID-19 and influenza patients, respectively. Time from symptom onset to hospital admission was longer for COVID-19 (median 7 days, IQR 3-10) than for influenza patients (median 3 days, IQR 2-5, p < 0.001). Other variables favoring a diagnosis of COVID-19 in the classification tree were higher systolic blood pressure, lack of productive sputum, and lack of headache. The tree classified 86/192 patients (45%) into two subsets with ≥80% of patients having influenza or COVID-19, respectively. In-hospital mortality was higher for COVID-19 patients (16% vs. 5%, p = 0.018). CONCLUSION Discriminating COVID-19 from influenza patients based on clinical presentation is challenging. Time from symptom onset to hospital admission is considerably longer in COVID-19 than in influenza patients and showed the strongest discriminatory power in our classification tree. Although they had fewer comorbidities, in-hospital mortality was higher for COVID-19 patients.
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Affiliation(s)
- Pablo Sieber
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trial Unit, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | | | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Robert Sieber
- Emergency Department, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
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Thiabaud A, Iten A, Balmelli C, Senn L, Troillet N, Widmer A, Flury D, Schreiber PW, Vázquez M, Damonti L, Buettcher M, Vuichard-Gysin D, Kuhm C, Cusini A, Riedel T, Nussbaumer-Ochsner Y, Gaudenz R, Heininger U, Berger C, Zucol F, Bernhard-Stirnemann S, Corti N, Zimmermann P, Uka A, Niederer-Loher A, Gardiol C, Roelens M, Keiser O. Cohort profile: SARS-CoV-2/COVID-19 hospitalised patients in Switzerland. Swiss Med Wkly 2021; 151:w20475. [PMID: 33638351 DOI: 10.4414/smw.2021.20475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND SARS-CoV-2/COVID-19, which emerged in China in late 2019, rapidly spread across the world with several million victims in 213 countries. Switzerland was severely hit by the virus, with 43,000 confirmed cases as of 1 September 2020. AIM In cooperation with the Federal Office of Public Health, we set up a surveillance database in February 2020 to monitor hospitalised patients with COVID-19, in addition to their mandatory reporting system. METHODS Patients hospitalised for more than 24 hours with a positive polymerase chain-reaction test, from 20 Swiss hospitals, are included. Data were collected in a customised case report form based on World Health Organisation recommendations and adapted to local needs. Nosocomial infections were defined as infections for which the onset of symptoms was more than 5 days after the patient’s admission date. RESULTS As of 1 September 2020, 3645 patients were included. Most patients were male (2168, 59.5%), and aged between 50 and 89 years (2778, 76.2%), with a median age of 68 (interquartile range 54–79). Community infections dominated with 3249 (89.0%) reports. Comorbidities were frequently reported, with hypertension (1481, 61.7%), cardiovascular diseases (948, 39.5%) and diabetes (660, 27.5%) being the most frequent in adults; respiratory diseases and asthma (4, 21.1%), haematological and oncological diseases (3, 15.8%) were the most frequent in children. Complications occurred in 2679 (73.4%) episodes, mostly respiratory diseases (2470, 93.2% in adults; 16, 55.2% in children), and renal (681, 25.7%) and cardiac (631, 23.8%) complications for adults. The second and third most frequent complications in children affected the digestive system and the liver (7, 24.1%). A targeted treatment was given in 1299 (35.6%) episodes, mostly with hydroxychloroquine (989, 76.1%). Intensive care units stays were reported in 578 (15.8%) episodes. A total of 527 (14.5%) deaths were registered, all among adults. CONCLUSION The surveillance system has been successfully initiated and provides a robust set of data for Switzerland by including about 80% (compared with official statistics) of SARS-CoV-2/COVID-19 hospitalised patients, with similar age and comorbidity distributions. It adds detailed information on the epidemiology, risk factors and clinical course of these cases and, therefore, is a valuable addition to the existing mandatory reporting.
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Affiliation(s)
- Amaury Thiabaud
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
| | - Anne Iten
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, HUG, Geneva, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Laurence Senn
- Service de médecine préventive hospitalière, CHUV, Lausanne, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Andreas Widmer
- Department of Infectious Diseases, University Hospital Basel, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | - Miriam Vázquez
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | | | - Christoph Kuhm
- Department of Infectious Diseases, Thurgau Cantonal Hospital, Thurgau, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | | | - Roman Gaudenz
- Innere Medizin und Infektiologie, Kantonsspital Nidwalden, Stans, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | | | - Natascia Corti
- Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | | | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Maroussia Roelens
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
| | - Olivia Keiser
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
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Zingg W, Metsini A, Balmelli C, Neofytos D, Behnke M, Gardiol C, Widmer A, Pittet D, On Behalf Of The Swissnoso Network. National point prevalence survey on healthcare-associated infections in acute care hospitals, Switzerland, 2017. ACTA ACUST UNITED AC 2020; 24. [PMID: 31411135 PMCID: PMC6693290 DOI: 10.2807/1560-7917.es.2019.24.32.1800603] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background As a part of the national strategy on the prevention of healthcare-associated infections (HAI), a point prevalence survey (PPS) was conducted in acute care hospitals in Switzerland. Aim Our objective was to assess the burden of HAI in Swiss acute care hospitals. Methods All acute care hospitals were invited to participate in this cross-sectional survey during the second quarter of 2017. The protocol by the European Centre for Disease Prevention and Control was applied. Patients of all ages, hospitalised on the day of survey were included, except when admitted to outpatient clinics, emergency and psychiatry. Results Ninety-six acute care hospitals (79% of all hospitals ≥ 100 beds) provided data on 12,931 patients. Pooled and randomised HAI prevalences were 5.9% (95% confidence interval (CI): 5.5–6.3) and 5.4% (95% CI: 4.8–6.0), respectively. The HAI incidence was estimated at 4.5 (95% CI: 4.0–5.0). The most common type of HAI was surgical site infection (29.0%), followed by lower respiratory tract (18.2%), urinary tract (14.9%) and bloodstream (12.8%) infections. The highest prevalence was identified in intensive care (20.6%), in large hospitals > 650 beds (7.8%), among elderly patients (7.4%), male patients (7.2%) and patients with an ultimately (9.3%) or rapidly (10.6%) fatal McCabe score. Discussion This is the first national PPS of Switzerland allowing direct comparison with other European countries. The HAI prevalence was at European Union average (5.9% in 2016 and 2017), but higher than in some countries neighbouring Switzerland. Based on the limited information from previous surveys, HAI appear not to decrease.
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Affiliation(s)
- Walter Zingg
- These authors contributed equally.,Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Aliki Metsini
- These authors contributed equally.,Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, Cantonal Hospital Authority, Ticino, Switzerland
| | - Dionysios Neofytos
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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Voumard R, Gardiol C, André P, Arensdorff L, Cochet C, Boillat-Blanco N, Decosterd L, Buclin T, de Vallière S. Efficacy and safety of continuous infusions with elastomeric pumps for outpatient parenteral antimicrobial therapy (OPAT): an observational study. J Antimicrob Chemother 2019; 73:2540-2545. [PMID: 29982449 DOI: 10.1093/jac/dky224] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 05/19/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives This study aimed to evaluate the efficacy and safety of continuous antimicrobial infusion using elastomeric pumps in an outpatient setting, while simultaneously documenting circulating antibiotic concentration exposure achieved with this mode of administration. Methods Clinical outcomes, adverse events and antibiotic plasma concentrations were recorded for all patients treated by continuous infusion with elastomeric pumps at the outpatient parenteral antimicrobial therapy (OPAT) unit of the University Hospital of Lausanne between December 2013 and January 2017. The study was registered under ClinicalTrials.gov identifier NCT03221140. Results One hundred and fifty outpatients were treated by continuous intravenous infusions using flucloxacillin (70 patients), cefepime (36), vancomycin (32) and piperacillin/tazobactam (12). The calculated free fractions of each antibiotic were above the epidemiological cut-off values for resistance (ECOFF) of the treated microorganisms in 92% of measurements. Cure was achieved in 143 patients (95%) 3 months after the end of treatment. Four patients needed unexpected readmission and three had a relapse. In none of the patients with unsuccessful treatment was the ratio of free antibiotic plasma concentration/ECOFF <1. Sixteen patients (11%) had an adverse event, none of them being of severity grade 4 or 5. Conclusions Continuous infusions of flucloxacillin, cefepime, vancomycin and piperacillin/tazobactam using elastomeric pumps seem to be an effective and safe approach to treat outpatients. The number of treatment successes was very high and adverse events occurred at a similar rate as reported by other OPAT centres. The measured antibiotic plasma concentrations confirmed adequate drug concentration exposure for the vast majority of patients.
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Affiliation(s)
- Rachel Voumard
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011 Lausanne, Switzerland
| | - Céline Gardiol
- Department of Ambulatory Care and Community Medicine, and Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 44, 1011 Lausanne, Switzerland
| | - Pascal André
- Service of Clinical Pharmacology, University Hospital of Lausanne, Av du Bugnon 17, 1011 Lausanne, Switzerland
| | - Lyne Arensdorff
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011 Lausanne, Switzerland
| | - Camille Cochet
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011 Lausanne, Switzerland
| | - Noémie Boillat-Blanco
- Department of Ambulatory Care and Community Medicine, and Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 44, 1011 Lausanne, Switzerland
| | - Laurent Decosterd
- Laboratory and Service of Clinical Pharmacology, University Hospital of Lausanne, Av du Bugnon 19, 1011 Lausanne, Switzerland
| | - Thierry Buclin
- Service of Clinical Pharmacology, University Hospital of Lausanne, Av du Bugnon 17, 1011 Lausanne, Switzerland
| | - Serge de Vallière
- Department of Ambulatory Care and Community Medicine, and Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 44, 1011 Lausanne, Switzerland
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Zingg W, Metsini A, Gardiol C, Balmelli C, Behnke M, Troillet N, Widmer A, Pittet D. Antimicrobial use in acute care hospitals: national point prevalence survey on healthcare-associated infections and antimicrobial use, Switzerland, 2017. Euro Surveill 2019; 24:1900015. [PMID: 31431211 PMCID: PMC6702796 DOI: 10.2807/1560-7917.es.2019.24.33.1900015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 04/09/2019] [Indexed: 11/20/2022] Open
Abstract
BackgroundA point prevalence survey (PPS) on healthcare-associated infections (HAI) and antimicrobial use was conducted in Swiss acute care hospitals in 2017.AimOur objective was to assess antimicrobial use in Swiss acute care hospitals.MethodsAll patients hospitalised in any acute care hospital in Switzerland were eligible. We used the most recent version of the PPS protocol of the European Centre for Disease Prevention and Control.ResultsData from 12,931 patients of 96 hospitals were collected. Of these, 4,265 (33%; 95% confidence interval (CI): 32.2-33.8) were on 5,354 antimicrobials for 4,487 indications. Most of the 2,808 therapeutic indications addressed 1,886 community-acquired infections (67.2%; 95% CI: 65.4-68.9). Of the 1,176 surgical prophylaxes, 350 (29.8%; 95% CI: 27.1-32.4) exceeded the duration of 1 day. Of the 1,090 antimicrobial regimens that were changed, 309 (28.3%; 95% CI: 25.7-31.0) were escalated and 337 (30.9%; 95% CI: 28.2-33.7) were de-escalated. Amoxicillin/clavulanic acid was the most frequent antimicrobial (18.8%; 95% CI: 17.7-19.8), prescribed mainly for therapeutic indications (76.0%; 95% CI: 73.3-78.7). A total of 1,931 (37.4%; 95% CI: 36.1-38.8) of the 5,158 antimicrobials for systemic use were broad-spectrum antibiotics, most frequently third- and fourth-generation cephalosporins (35.9%; 95% CI: 33.8-38.1).ConclusionsAntimicrobial consumption was at European average, the use of broad-spectrum antibiotics in the lower third. Swiss acute care hospitals should invest in antimicrobial stewardship, particularly in reducing the use of broad-spectrum antibiotics.
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Affiliation(s)
- Walter Zingg
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
- Imperial College London, London, United Kingdom
| | - Aliki Metsini
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, Cantonal Hospital Authority, Ticino, Switzerland
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - Nicolas Troillet
- Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals, Geneva, Switzerland
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15
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Buetti N, Wassilew N, Rion V, Senn L, Gardiol C, Widmer A, Marschall J. Emergence of vancomycin-resistant enterococci in Switzerland: a nation-wide survey. Antimicrob Resist Infect Control 2019; 8:16. [PMID: 30675343 PMCID: PMC6337856 DOI: 10.1186/s13756-019-0466-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/08/2019] [Indexed: 11/10/2022] Open
Abstract
This nation-wide survey on the epidemiology of vancomycin-resistant enterococci (VRE) included 142 healthcare institutions and showed an increasing number of VRE colonizations and infections in Switzerland, probably for the most part due to nosocomial dissemination. The introduction and spread of a new clone, gaps in VRE screening policies as well as heterogeneity regarding the management of VRE clusters may be possible explanations.
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Affiliation(s)
- Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland.,Swissnoso, National Center for Infection Control, Bern, Switzerland.,3UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, control and care Inserm, University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Nasstasja Wassilew
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
| | - Viktorija Rion
- Swissnoso, National Center for Infection Control, Bern, Switzerland
| | - Laurence Senn
- 4Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Céline Gardiol
- 5Swiss Federal Office of Public Health, Bern, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
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16
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Metsini A, Vazquez M, Sommerstein R, Marschall J, Voide C, Troillet N, Gardiol C, Pittet D, Zingg W, The Swissnoso Network. Point prevalence of healthcare-associated infections and antibiotic use in three large Swiss acute-care hospitals. Swiss Med Wkly 2018; 148:w14617. [PMID: 29698542 DOI: 10.4414/smw.2018.14617] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The overall burden of healthcare-associated infections (HAIs) remains high, even in high-income countries. However, the current burden of HAI in Switzerland is unknown. Prevalence surveys have a long tradition in the field of infection prevention and control for measuring both HAI and antimicrobial use. The objective of this survey was to test the point prevalence survey (PPS) methodology of the European Centre for Disease Prevention and Control (ECDC) in acute-care hospitals in Switzerland. METHODS Two tertiary care hospitals and one secondary care hospital in central and western Switzerland participated in the survey. Patients from all wards except for emergency departments and psychiatric wards were included. Data were collected on a single day for every ward with a maximum time frame of 2 weeks for completing data collection. Methodology and definitions were based on the most recent ECDC PPS protocol. RESULTS Data on a total of 2421 patients were analysed. One hundred thirty-six patients had 153 HAIs, corresponding to a prevalence of 5.6% (95% confidence interval [CI] 4.7-6.5%). Rapidly fatal McCabe score, hospitalisation in the intensive care unit (ICU), and having a medical device in place were independent risk factors for HAI. Lower respiratory tract infection was the most frequent HAI type (24.8%), followed by surgical site infection (22.2%), bloodstream infection (17.0%) and urinary tract infection (13.7%). The highest HAI prevalence (26.2%) was observed in the ICU. In total, 60.8% of all HAIs were microbiologically confirmed. The most common microorganism was Escherichia coli (21.1%). Six hundred sixty-nine patients (27.6%, 95% CI 25.9-29.4%) received 893 antimicrobials for 705 indications. Community-acquired infections (39.0%) were the most common indication for antimicrobial use and amoxicillin-clavulanate was the most commonly prescribed antimicrobial (18.4%). CONCLUSIONS HAI prevalence and antimicrobial use in this survey were similar to findings of the past ECDC PPS. The ECDC methodology proved applicable to Swiss acute-care hospitals.
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Affiliation(s)
- Aliki Metsini
- Infection Control Programme and WHO Collaborating Centre for Patient Safety; University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Miriam Vazquez
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Cathy Voide
- Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Nicolas Troillet
- Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Centre for Patient Safety; University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Walter Zingg
- Infection Control Programme and WHO Collaborating Centre for Patient Safety; University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
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17
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Voumard R, Van Neyghem N, Cochet C, Gardiol C, Decosterd L, Buclin T, de Valliere S. Antibiotic stability related to temperature variations in elastomeric pumps used for outpatient parenteral antimicrobial therapy (OPAT). J Antimicrob Chemother 2018; 72:1462-1465. [PMID: 28158637 DOI: 10.1093/jac/dkw582] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 12/14/2016] [Indexed: 11/14/2022] Open
Abstract
Background Elastomeric pumps can be used for the continuous administration of antimicrobials in the outpatient setting. A potentially limiting factor in their use is the stability of antimicrobials. Objectives To investigate under real-life conditions the temperature variations of antibiotic solutions contained in elastomeric pumps, and to examine under such conditions the stability of five antibiotics. Methods Healthy volunteers carried the elastomeric pumps in carry pouches during their daily activities. A thermologger measured the temperatures every 15 min over 24 h. Antibiotic concentrations were measured by HPLC coupled to tandem MS. Results During daytime, the temperature of solutions in the pumps increased steadily, warming to >30°C. During the night, when the pumps were kept attached to the waist, the temperatures reached up to 33°C. The use of white carry pouches avoided excessive temperature increases. Over seven experiments, cefazolin, cefepime, piperacillin and tazobactam were found to be stable over 24 h. Flucloxacillin showed a mean decrease in concentration of 11% ( P = 0.001). Conclusions Real-life situations can cause significant temperature rises in elastomeric pumps, thereby potentially increasing the risk of antibiotic degradation. Patients should be instructed to avoid situations causing excessive temperature increases. Despite these temperature variations, cefazolin, cefepime, piperacillin and tazobactam were found to be stable over 24 h. A moderate degradation was noticed for flucloxacillin, albeit most probably not to an extent that might impair anti-infective efficacy.
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Affiliation(s)
- Rachel Voumard
- Department of Internal Medicine, University Hospital of Lausanne, Av. du Bugnon 46, Lausanne, 1011, Switzerland
| | - Niklas Van Neyghem
- Interfaculty Institute of Bioengineering, Swiss Federal Institute of Technology in Lausanne, Route Cantonal, Lausanne, 1015, Switzerland
| | - Camille Cochet
- Treatment and Rehabilitation Center, Gilly Hospital, Road Pavillon 12, Gilly, 1182, Switzerland
| | - Céline Gardiol
- Infectious Diseases Service, University Hospital of Lausanne, Av. du Bugnon 46, Lausanne, 1011, Switzerland
| | - Laurent Decosterd
- Laboratory of Clinical Pharmacology, Service of Biomedicine, University Hospital of Lausanne, Av. du Bugnon 46, Lausanne, 1011, Switzerland
| | - Thierry Buclin
- Division of Clinical Pharmacology, Service of Biomedicine, University Hospital of Lausanne, Av. du Bugnon 46, Lausanne, 1011, Switzerland
| | - Serge de Valliere
- Infectious Diseases Service, University Hospital of Lausanne, Av. du Bugnon 46, Lausanne, 1011, Switzerland.,Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av. du Bugnon 44, Lausanne, 1011, Switzerland
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18
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Saillen L, Arensdorff L, Moulin E, Voumard R, Cochet C, Boillat-Blanco N, Gardiol C, de Vallière S. Patient satisfaction in an outpatient parenteral antimicrobial therapy (OPAT) unit practising predominantly self-administration of antibiotics with elastomeric pumps. Eur J Clin Microbiol Infect Dis 2017; 36:1387-1392. [PMID: 28283831 DOI: 10.1007/s10096-017-2944-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 02/13/2017] [Indexed: 11/26/2022]
Abstract
Self-administration of antibiotics using elastomeric pumps has become the most frequently used treatment modality at the outpatient parenteral antimicrobial therapy (OPAT) unit of the University Hospital of Lausanne. However, it remains unknown how comfortable patients feel using this mode of treatment. A questionnaire was offered to all patients treated at the OPAT unit between June 2014 and December 2015. The questionnaire was distributed to 188 patients and 112 questionnaires were returned. Seventy-one patients were treated by self-administration, 21 attended the OPAT unit on a daily basis, and 20 received their antibiotics from home-care nurses. Overall, 83-97% of the patients gave the highest possible scores to the four items evaluating their global satisfaction. Subjects treated by self-administration gave a significantly better rating to 6 of the 17 semi-quantitative questions than the patients treated at the OPAT unit or by home-care nurses. There was no item which was more poorly rated by patients treated by self-administered OPAT than by the other treatment groups. In conclusion satisfaction was high in all patients treated by OPAT. The particularly high satisfaction of patients treated by self-administration of antibiotics with elastomeric pumps suggests that a significant number of patients are happy to take over some responsibility for their treatment. Patients' capacity to appropriate their care themselves should not be underestimated by health care professionals.
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Affiliation(s)
- L Saillen
- Department of Surgery, Hôpital intercantonal de la Broye, 1530, Payerne, Switzerland
| | - L Arensdorff
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011, Lausanne, Switzerland
| | - E Moulin
- Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 46, 1011, Lausanne, Switzerland
| | - R Voumard
- Department of Internal Medicine, University Hospital of Lausanne, Av du Bugnon 46, 1011, Lausanne, Switzerland
| | - C Cochet
- Treatment and Rehabilitation Center, Gilly Hospital, 1182, Gilly, Switzerland
| | - N Boillat-Blanco
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011, Lausanne, Switzerland
- Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 46, 1011, Lausanne, Switzerland
| | - C Gardiol
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011, Lausanne, Switzerland
- Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 46, 1011, Lausanne, Switzerland
| | - S de Vallière
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Av du Bugnon 44, 1011, Lausanne, Switzerland.
- Infectious Diseases Service, University Hospital of Lausanne, Av du Bugnon 46, 1011, Lausanne, Switzerland.
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19
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Gardiol C, Voumard R, Cochet C, de Vallière S. Setting up an outpatient parenteral antimicrobial therapy (OPAT) unit in Switzerland: review of the first 18 months of activity. Eur J Clin Microbiol Infect Dis 2016; 35:839-45. [PMID: 26886452 DOI: 10.1007/s10096-016-2606-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 02/05/2016] [Indexed: 11/24/2022]
Abstract
Outpatient parenteral antimicrobial therapy (OPAT) has been recognised as a useful, cost-effective and safe alternative to inpatient treatment, but no formal OPAT unit existed in Switzerland until recently. In December 2013 an OPAT unit was established at Lausanne University Hospital. We review here the experience of this new OPAT unit after 18 months of activity. Patient characteristics, clinical activities and outcomes were recorded prospectively. Need and acceptance was evaluated as number of OPAT courses administered and number of patients refusing OPAT. Safety and efficacy were evaluated as: (1) adverse events linked to antimicrobials and catheters, (2) re-admission to hospital, (3) rate of treatment failures and (4) mortality. Over 18 months, 179 courses of OPAT were administered. Acceptance was high with only four patients refusing OPAT. Urinary tract infections with resistant bacteria and musculoskeletal infections were the most common diagnoses. Self-administration of antibiotics using elastomeric pumps became rapidly the most frequently used approach. Sixteen patients presented with adverse events linked to antimicrobials and catheters. OPAT-related readmissions occurred in nine patients. The overall cure rate was 94 %. This study shows that OPAT is very well accepted by patients and medical staff, even in a setting which has not used this type of treatment approach until now. Self-administration using elastomeric pumps proved to be particularly useful, safe and efficient. OPAT offers a good alternative to hospitalisation for patients presenting with infections due to resistant bacteria that cannot be treated orally anymore and for difficult to treat infections.
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Affiliation(s)
- C Gardiol
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.
| | - R Voumard
- Service of Internal Medicine, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - C Cochet
- Department of Outpatient Care and Community Medicine, Rue du Bugnon 44, 1011, Lausanne, Switzerland
| | - S de Vallière
- Service of Infectious Diseases, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland.,Department of Outpatient Care and Community Medicine, Rue du Bugnon 44, 1011, Lausanne, Switzerland
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20
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Mercier T, Tissot F, Gardiol C, Corti N, Wehrli S, Guidi M, Csajka C, Buclin T, Couet W, Marchetti O, Decosterd LA. High-throughput hydrophilic interaction chromatography coupled to tandem mass spectrometry for the optimized quantification of the anti-Gram-negatives antibiotic colistin A/B and its pro-drug colistimethate. J Chromatogr A 2014; 1369:52-63. [PMID: 25441071 DOI: 10.1016/j.chroma.2014.09.063] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Revised: 09/01/2014] [Accepted: 09/24/2014] [Indexed: 11/27/2022]
Abstract
Colistin is a last resort's antibacterial treatment in critically ill patients with multi-drug resistant Gram-negative infections. As appropriate colistin exposure is the key for maximizing efficacy while minimizing toxicity, individualized dosing optimization guided by therapeutic drug monitoring is a top clinical priority. Objective of the present work was to develop a rapid and robust HPLC-MS/MS assay for quantification of colistin plasma concentrations. This novel methodology validated according to international standards simultaneously quantifies the microbiologically active compounds colistin A and B, plus the pro-drug colistin methanesulfonate (colistimethate, CMS). 96-well micro-Elution SPE on Oasis Hydrophilic-Lipophilic-Balanced (HLB) followed by direct analysis by Hydrophilic Interaction Liquid Chromatography (HILIC) with Ethylene Bridged Hybrid--BEH--Amide phase column coupled to tandem mass spectrometry allows a high-throughput with no significant matrix effect. The technique is highly sensitive (limit of quantification 0.014 and 0.006 μg/mL for colistin A and B), precise (intra-/inter-assay CV 0.6-8.4%) and accurate (intra-/inter-assay deviation from nominal concentrations -4.4 to +6.3%) over the clinically relevant analytical range 0.05-20 μg/mL. Colistin A and B in plasma and whole blood samples are reliably quantified over 48 h at room temperature and at +4°C (<6% deviation from nominal values) and after three freeze-thaw cycles. Colistimethate acidic hydrolysis (1M H2SO4) to colistin A and B in plasma was completed in vitro after 15 min of sonication while the pro-drug hydrolyzed spontaneously in plasma ex vivo after 4 h at room temperature: this information is of utmost importance for interpretation of analytical results. Quantification is precise and accurate when using serum, citrated or EDTA plasma as biological matrix, while use of heparin plasma is not appropriate. This new analytical technique providing optimized quantification in real-life conditions of the microbiologically active compounds colistin A and B offers a highly efficient tool for routine therapeutic drug monitoring aimed at individualizing drug dosing against life-threatening infections.
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Affiliation(s)
- Thomas Mercier
- Division and Laboratory of Clinical Pharmacology, Service of Biomedicine, Department of Laboratories, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Fréderic Tissot
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Lausanne, Switzerland
| | - Céline Gardiol
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Lausanne, Switzerland
| | - Natascia Corti
- Department of Clinical Pharmacology and Toxicology, Zürich University Hospital (Universitätsspital Zürich, USZ), Zürich, Switzerland
| | - Stéphane Wehrli
- Nephrology Service, Department of Medicine, Cantonal Hospital, Winterthur, Switzerland
| | - Monia Guidi
- Division and Laboratory of Clinical Pharmacology, Service of Biomedicine, Department of Laboratories, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Chantal Csajka
- Division and Laboratory of Clinical Pharmacology, Service of Biomedicine, Department of Laboratories, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - Thierry Buclin
- Division and Laboratory of Clinical Pharmacology, Service of Biomedicine, Department of Laboratories, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland
| | - William Couet
- INSERM, ERI 23, 40 Avenue du Recteur Pineau, Poitiers 86000, France; Université of Poitiers, Faculty of Medicine and Pharmacy, and Centre Hospitalier Universitaire Poitiers, 2 Rue de la Milétrie, Poitiers 86000, France
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Lausanne, Switzerland
| | - Laurent A Decosterd
- Division and Laboratory of Clinical Pharmacology, Service of Biomedicine, Department of Laboratories, Lausanne University Hospital (Centre Hospitalier Universitaire Vaudois, CHUV), Rue du Bugnon 46, CH-1011 Lausanne, Switzerland.
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Gardiol C, Cavassini M. [Key aspects regarding HIV and travel]. Rev Med Suisse 2013; 9:963-967. [PMID: 23750388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
The risk of contracting a sexually transmitted infection while traveling abroad is increased in certain populations. Pre-travel consultation should include the education of travelers on the prevalence of HIV in the countries visited and on appropriate prevention measures. In patients infected with HIV (PHIV), combined antiretroviral therapy (cART) improves immunity, enabling them to travel with less risk for their health. Pre-travel consultation of PVIH has the following objectives: to determine immune status, to update immunization and to decide on anti-malaria drug prophylaxis, taking into account potential drug interactions with antiretroviral therapy. Vaccine response and duration of protection is shorter-lived in PVIH, especially if the CD4 count is below 200 cells/mm3 and the HIV viral load is detectable. Therefore cART is a cornerstone for disease prevention among patients infected with HIV who travel.
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Affiliation(s)
- Céline Gardiol
- Service des maladies infectieuses, Département de médecine interne, CHUV, 1011 Lausanne.
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Abstract
A 98-year-old woman was referred to our hospital because of myoclonia. The concentration of calcium and vitamin D in the serum was low. In this context, we concluded of neuromuscular irritability secondary to hypocalcaemia. The symptoms disappeared after a treatment of intravenous calcium. This case shows how important it is to investigate electrolytes in case of neuromuscular irritability symptoms in elderly people.
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Affiliation(s)
- C Gardiol
- Service de Médecine interne, CHU Vaudois, Lausanne
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