1
|
Müller M, Wiencierz A, Gehringer C, Muigg V, Bassetti S, Siegemund M, Hinic V, Tschudin-Sutter S, Egli A. Factors associated with non-carbapenemase mediated carbapenem resistance of Gram-negative bacteria: a retrospective case-control study. Int Microbiol 2024; 27:597-606. [PMID: 37556067 PMCID: PMC10991015 DOI: 10.1007/s10123-023-00405-6] [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: 03/04/2023] [Revised: 07/10/2023] [Accepted: 07/15/2023] [Indexed: 08/10/2023]
Abstract
Infections with carbapenemase-producing Gram-negative bacteria are related to increased morbidity and mortality, yet little is known regarding infections caused by non-beta-lactamase mediated carbapenem-resistant bacteria. Our objective was to identify risk factors for, and the clinical impact of infections caused by carbapenem-resistant carbapenemase-negative Enterobacterales and Pseudomonas aeruginosa. This retrospective matched case-control study was performed at the University Hospital of Basel, Switzerland, in 2016. We focused on other resistance mechanisms by excluding laboratory-confirmed carbapenemase-positive cases. Carbapenem resistance was set as the primary endpoint, and important risk factors were investigated by conditional logistic regression. The clinical impact of carbapenem resistance was estimated using regression models containing the resistance indicator as explanatory factor and adjusting for potential confounders. Seventy-five cases of infections with carbapenem-resistant, carbapenemase-negative bacteria were identified and matched with 75 controls with carbapenem-susceptible infections. The matched data set was well-balanced regarding age, gender, and comorbidity. Duration of prior carbapenem treatment (OR 1.15, [1.01, 1.31]) correlated with resistance to carbapenems. Our study showed that patients with carbapenem-resistant bacteria stayed 1.59 times (CI [0.81, 3.14]) longer in an ICU. The analyzed dataset did not provide evidence for strong clinical implications of resistance to carbapenems or increased mortality. The duration of prior carbapenem treatment seems to be a strong risk factor for the development of carbapenem resistance. The higher risk for a longer ICU stay could be a consequence of a carbapenem resistance. In contrast to carbapenemase-producers, the clinical impact of carbapenamase-negative, carbapenem-resistant strains may be limited. Trial registration: The study design was prospectively approved by the local Ethics Commission on 10.08.2017 (EKNZ BASEC 2017-00222).
Collapse
Affiliation(s)
- Marius Müller
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Andrea Wiencierz
- Clinical Trial Unit, University Hospital Basel, Basel, Switzerland
| | - Christian Gehringer
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Veronika Muigg
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, 8006, Zurich, Switzerland.
| |
Collapse
|
2
|
Benvenga V, Cuénod A, Purushothaman S, Dasen G, Weisser M, Bassetti S, Roloff T, Siegemund M, Heininger U, Bielicki J, Wehrli M, Friderich P, Frei R, Widmer A, Herzog K, Fankhauser H, Nolte O, Bodmer T, Risch M, Dubuis O, Pranghofer S, Calligaris-Maibach R, Graf S, Perreten V, Seth-Smith HMB, Egli A. Historic methicillin-resistant Staphylococcus aureus: expanding current knowledge using molecular epidemiological characterization of a Swiss legacy collection. Genome Med 2024; 16:23. [PMID: 38317199 PMCID: PMC10840241 DOI: 10.1186/s13073-024-01292-w] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 01/22/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND Few methicillin-resistant Staphylococcus aureus (MRSA) from the early years of its global emergence have been sequenced. Knowledge about evolutionary factors promoting the success of specific MRSA multi-locus sequence types (MLSTs) remains scarce. We aimed to characterize a legacy MRSA collection isolated from 1965 to 1987 and compare it against publicly available international and local genomes. METHODS We accessed 451 historic (1965-1987) MRSA isolates stored in the Culture Collection of Switzerland, mostly collected from the Zurich region. We determined phenotypic antimicrobial resistance (AMR) and performed whole genome sequencing (WGS) using Illumina short-read sequencing on all isolates and long-read sequencing on a selection with Oxford Nanopore Technology. For context, we included 103 publicly available international assemblies from 1960 to 1992 and sequenced 1207 modern Swiss MRSA isolates from 2007 to 2022. We analyzed the core genome (cg)MLST and predicted SCCmec cassette types, AMR, and virulence genes. RESULTS Among the 451 historic Swiss MRSA isolates, we found 17 sequence types (STs) of which 11 have been previously described. Two STs were novel combinations of known loci and six isolates carried previously unsubmitted MLST alleles, representing five new STs (ST7843, ST7844, ST7837, ST7839, and ST7842). Most isolates (83% 376/451) represented ST247-MRSA-I isolated in the 1960s, followed by ST7844 (6% 25/451), a novel single locus variant (SLV) of ST239. Analysis by cgMLST indicated that isolates belonging to ST7844-MRSA-III cluster within the diversity of ST239-MRSA-III. Early MRSA were predominantly from clonal complex (CC)8. From 1980 to the end of the twentieth century, we observed that CC22 and CC5 as well as CC8 were present, both locally and internationally. CONCLUSIONS The combined analysis of 1761 historic and contemporary MRSA isolates across more than 50 years uncovered novel STs and allowed us a glimpse into the lineage flux between Swiss-German and international MRSA across time.
Collapse
Affiliation(s)
- Vanni Benvenga
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland
| | - Aline Cuénod
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland
| | - Srinithi Purushothaman
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland
| | | | - Maja Weisser
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Tim Roloff
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland
- Swiss Institute of Bioinformatics, University of Basel, Lausanne, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Hospital Epidemiology, University of Basel Children's Hospital, Basel, Switzerland
| | - Julia Bielicki
- Infectious Diseases and Hospital Epidemiology, University of Basel Children's Hospital, Basel, Switzerland
| | - Marianne Wehrli
- Microbiology Department, Hospital of Schaffhausen, Schaffhausen, Switzerland
| | - Paul Friderich
- Medicinal microbiology department, Hospital of Lucerne, Lucerne, Switzerland
| | - Reno Frei
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Andreas Widmer
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Kathrin Herzog
- Clinical Microbiology, Cantonal Hospital Thurgau, Münsterlingen, Switzerland
| | - Hans Fankhauser
- Clinical Microbiology, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Oliver Nolte
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland
- Clinical Microbiology, Zentrum für Labormedizin St, Gallen, St. Gallen, Switzerland
| | | | | | - Olivier Dubuis
- Clinical Microbiology, Viollier AG, Allschwil, Switzerland
| | | | | | - Susanne Graf
- Clinical Microbiology, Cantonal Hospital Basellandschaft, Liestal, Switzerland
| | - Vincent Perreten
- Institute of Veterinary Bacteriology, University of Bern, Bern, Switzerland
- Swiss Pathogen Surveillance Platform (SPSP), Lausanne, Switzerland
| | - Helena M B Seth-Smith
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland
- Swiss Institute of Bioinformatics, University of Basel, Lausanne, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30, Zurich, 8006, Switzerland.
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Swiss Pathogen Surveillance Platform (SPSP), Lausanne, Switzerland.
| |
Collapse
|
3
|
Søgaard KK, Hinic V, Goldenberger D, Gensch A, Schweitzer M, Bättig V, Siegemund M, Bassetti S, Bingisser R, Tamm M, Battegay M, Weisser M, Stolz D, Khanna N, Egli A. Evaluation of the clinical relevance of the Biofire © FilmArray pneumonia panel among hospitalized patients. Infection 2024; 52:173-181. [PMID: 37572241 PMCID: PMC10810975 DOI: 10.1007/s15010-023-02080-1] [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: 04/04/2023] [Accepted: 07/27/2023] [Indexed: 08/14/2023]
Abstract
PURPOSE Panel PCR tests provide rapid pathogen identification. However, their diagnostic performance is unclear. We assessed the performance of the Biofire© FilmArray pneumonia (PN)-panel against standard culture in broncho-alveolar lavage (BAL) samples. METHODS Setting: University Hospital Basel (February 2019 to July 2020), including hospitalized patients with a BAL (± pneumonia). We determined sensitivity and specificity of the PN-panel against standard culture. Using univariate logistic regression, we calculated odds ratios (OR) for pneumonia according to PN-panel and culture status, stratifying by chronic pulmonary disease. We calculated ORs for pneumonia for different pathogens to estimate the clinical relevance. RESULTS We included 840 adult patients, 60% were males, median age was 68 years, 35% had chronic pulmonary disease, 21% had pneumonia, and 36% had recent antibiotic use. In 1078 BAL samples, bacterial pathogens were detected in 36% and 16% with PN-panel and culture, respectively. The overall sensitivity and specificity of the PN-panel was high, whereas the positive predictive value was low. The OR of pneumonia was 1.1 (95% CI 0.7-1.6) for PN-panel-positive only; 2.6 (95% CI 1.3-5.3) for culture-positive only, and 1.6 (95% CI 1.0-2.4) for PN-panel and culture-positive. The detection rate of Haemophilus influenzae, Staphylococcus aureus, and Moraxella catarrhalis in the PN-panel was high but not associated with pneumonia. CONCLUSION While sensitivity and specificity of PN-panel are high compared to culture, pathogen detection did not correlate well with a pneumonia diagnosis. Patients with culture-positive BAL had the highest OR for pneumonia-thus the impact of the PN-panel on clinical management needs further evaluation in randomized controlled trials.
Collapse
Affiliation(s)
- Kirstine K Søgaard
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031, Basel, Switzerland
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30 8006, Zurich, Switzerland
| | - Daniel Goldenberger
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031, Basel, Switzerland
| | - Alexander Gensch
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031, Basel, Switzerland
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Michael Schweitzer
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031, Basel, Switzerland
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Veronika Bättig
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Tamm
- Pneumology, University Hospital Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Daiana Stolz
- Pneumology, University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, 4031, Basel, Switzerland.
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland.
- Institute of Medical Microbiology, University of Zurich, Gloriastrasse 28/30 8006, Zurich, Switzerland.
| |
Collapse
|
4
|
Cuénod A, Agnetti J, Seth-Smith HMB, Roloff T, Wälchli D, Shcherbakov D, Akbergenov R, Tschudin-Sutter S, Bassetti S, Siegemund M, Nickel CH, Moran-Gilad J, Keys TG, Pflüger V, Thomson NR, Egli A. Bacterial genome-wide association study substantiates papGII of Escherichia coli as a major risk factor for urosepsis. Genome Med 2023; 15:89. [PMID: 37904175 PMCID: PMC10614358 DOI: 10.1186/s13073-023-01243-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/06/2023] [Accepted: 10/02/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are among the most common bacterial infections worldwide, often caused by uropathogenic Escherichia coli. Multiple bacterial virulence factors or patient characteristics have been linked separately to progressive, more invasive infections. In this study, we aim to identify pathogen- and patient-specific factors that drive the progression to urosepsis by jointly analysing bacterial and host characteristics. METHODS We analysed 1076 E. coli strains isolated from 825 clinical cases with UTI and/or bacteraemia by whole-genome sequencing (Illumina). Sequence types (STs) were determined via srst2 and capsule loci via fastKaptive. We compared the isolates from urine and blood to confirm clonality. Furthermore, we performed a bacterial genome-wide association study (bGWAS) (pyseer) using bacteraemia as the primary clinical outcome. Clinical data were collected by an electronic patient chart review. We concurrently analysed the association of the most significant bGWAS hit and important patient characteristics with the clinical endpoint bacteraemia using a generalised linear model (GLM). Finally, we designed qPCR primers and probes to detect papGII-positive E. coli strains and prospectively screened E. coli from urine samples (n = 1657) at two healthcare centres. RESULTS Our patient cohort had a median age of 75.3 years (range: 18.00-103.1) and was predominantly female (574/825, 69.6%). The bacterial phylogroups B2 (60.6%; 500/825) and D (16.6%; 137/825), which are associated with extraintestinal infections, represent the majority of the strains in our collection, many of which encode a polysaccharide capsule (63.4%; 525/825). The most frequently observed STs were ST131 (12.7%; 105/825), ST69 (11.0%; 91/825), and ST73 (10.2%; 84/825). Of interest, in 12.3% (13/106) of cases, the E. coli pairs in urine and blood were only distantly related. In line with previous bGWAS studies, we identified the gene papGII (p-value < 0.001), which encodes the adhesin subunit of the E. coli P-pilus, to be associated with 'bacteraemia' in our bGWAS. In our GLM, correcting for patient characteristics, papGII remained highly significant (odds ratio = 5.27, 95% confidence interval = [3.48, 7.97], p-value < 0.001). An independent cohort of cases which we screened for papGII-carrying E. coli at two healthcare centres further confirmed the increased relative frequency of papGII-positive strains causing invasive infection, compared to papGII-negative strains (p-value = 0.033, chi-squared test). CONCLUSIONS This study builds on previous work linking papGII with invasive infection by showing that it is a major risk factor for progression from UTI to bacteraemia that has diagnostic potential.
Collapse
Affiliation(s)
- Aline Cuénod
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Parasites and Microbes, Wellcome Trust Sanger Institute, Hinxton, UK.
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland.
- Department of Microbiology and Immunology, McGill University, Montréal, Canada.
| | - Jessica Agnetti
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Helena M B Seth-Smith
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Tim Roloff
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Denise Wälchli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Dimitri Shcherbakov
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Rashid Akbergenov
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Christian H Nickel
- Emergency Department, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Jacob Moran-Gilad
- Department of Health Policy and Management, School of Public Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Be'er Sheva, Israel
| | - Timothy G Keys
- Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | | | - Nicholas R Thomson
- Parasites and Microbes, Wellcome Trust Sanger Institute, Hinxton, UK
- Department of Pathogen Molecular Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Institute for Medical Microbiology, University of Zurich, Zurich, Switzerland.
| |
Collapse
|
5
|
Agnetti J, Büchler AC, Osthoff M, Helfenstein F, Weisser M, Siegemund M, Bassetti S, Bingisser R, Schaefer DJ, Clauss M, Hinic V, Tschudin-Sutter S, Bättig V, Khanna N, Egli A. Identification of microorganisms by a rapid PCR panel from positive blood cultures leads to faster optimal antimicrobial therapy - a before-after study. BMC Infect Dis 2023; 23:730. [PMID: 37884860 PMCID: PMC10601314 DOI: 10.1186/s12879-023-08732-9] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/20/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND The BioFire® FilmArray® Blood Culture Identification Panel 1 (BF-FA-BCIP) detects microorganisms with high accuracy in positive blood cultures (BC) - a key step in the management of patients with suspected bacteraemia. We aimed to compare the time to optimal antimicrobial therapy (OAT) for the BF-FA-BCIP vs. standard culture-based identification. METHODS In this retrospective single-centre study with a before-after design, 386 positive BC cases with identification by BF-FA-BCIP were compared to 414 controls with culture-based identification. The primary endpoint was the time from BC sampling to OAT. Secondary endpoints were time to effective therapy, length of stay, (re-)admission to ICU, in-hospital and 30-day mortality. Outcomes were assessed using Cox proportional hazard models and logistic regressions. RESULTS Baseline characteristics of included adult inpatients were comparable. Main sources of bacteraemia were urinary tract and intra-abdominal infection (19.2% vs. 22.0% and 16.8% vs. 15.7%, for cases and controls, respectively). Median (95%CI) time to OAT was 25.5 (21.0-31.2) hours with BF-FA-BCIP compared to 45.7 (37.7-51.4) hours with culture-based identification. We observed no significant difference for secondary outcomes. CONCLUSIONS Rapid microorganism identification by BF-FA-BCIP was associated with a median 20-h earlier initiation of OAT in patients with positive BC. No impact on length of stay and mortality was noted. TRIAL REGISTRATION Clinicaltrials.gov, NCT04156633, registered on November 5, 2019.
Collapse
Affiliation(s)
- Jessica Agnetti
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Andrea C Büchler
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Internal Medicine, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Fabrice Helfenstein
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Maja Weisser
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Dirk J Schaefer
- Plastic, Reconstructive, Aesthetic Surgery and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Martin Clauss
- Center for Musculoskeletal Infections (ZMSI), University Hospital Basel, Basel, Switzerland
- Orthopaedics and Traumatology, University Hospital Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Present Address: Institute for Medical Microbiology, University of Zurich, Gloriastrasse 28/30, CH-8006, Zurich, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Veronika Bättig
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Nina Khanna
- Infectious Diseases and Hospital Epidemiology, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland.
- Department of Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland.
- Present Address: Institute for Medical Microbiology, University of Zurich, Gloriastrasse 28/30, CH-8006, Zurich, Switzerland.
| |
Collapse
|
6
|
Gross S, Becker C, Beck K, Memma V, Gaab J, Schütz P, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Occurrence of sensitive topics during ward round: an ancillary analysis of the BEDSIDE-OUTSIDE trial. BMJ Open 2023; 13:e073584. [PMID: 37734895 PMCID: PMC10514661 DOI: 10.1136/bmjopen-2023-073584] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 08/21/2023] [Indexed: 09/23/2023] Open
Abstract
OBJECTIVE Discussing sensitive topics (eg, medical uncertainty, social issues, non-adherence) during ward rounds is challenging and may negatively impact patient satisfaction with the healthcare they are receiving. In the previous multicentre randomised BEDSIDE-OUTSIDE trial focusing on communication during ward rounds, we investigated the interplay between sensitive topics and low reported satisfaction with care. DESIGN Pre-planned secondary analysis of a randomised controlled trial. For this analysis data of the original trial was pooled across intervention groups. SETTING Three Swiss teaching hospitals. PARTICIPANTS Adult patients hospitalised for medical care. INTERVENTIONS We analysed predefined sensitive health topics and specific elements of communication from audiotapes recorded during ward rounds, for both patients dealing with and without sensitive topics. PRIMARY AND SECONDARY OUTCOME MEASURES The primary endpoint was overall patient satisfaction with care; measured on a Visual Analogue Scale from 0 to 100. Secondary endpoints included duration of ward rounds and further satisfaction outcomes. RESULTS Of the 919 included patients, 474 had at least one sensitive topic including medical uncertainty (n=251), psychiatric comorbidities (n=161), tumour diagnosis (n=137) and social issues (n=125). Compared with patients without sensitive topics, patients with sensitive topics reported lower satisfaction with care (mean (SD), 87.7 (±14.6) vs 90.2 (±12.1), adjusted difference -2.5 (95% CI -4.28 to -0.72), p=0.006. Among patients with sensitive topics, risk factors for low satisfaction included several parameters concerning patient-physician interaction such as disagreements during ward rounds (mean (SD), 14/212 (6.6%) vs 41/254 (16.1%), adjusted OR 2.78 (95% CI 1.47 to 5.27), p=0.002). CONCLUSIONS A large proportion of medical inpatients must deal with sensitive health topics. This is associated with lower satisfaction with care, particularly if the patient perceives the interaction with doctors during ward rounds as unsatisfactory. Educating physicians on specific communication techniques may help improve care for these patients. TRIAL REGISTRATION NUMBER NCT03210987.
Collapse
Affiliation(s)
- Sebastian Gross
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Christoph Becker
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Emergency Department, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Katharina Beck
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Valentina Memma
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Philipp Schütz
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Division of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Jörg D Leuppi
- Faculty of Medicine, University of Basel, Basel, Switzerland
- University Center of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Rainer Schaefert
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Psychosomatics and Psychiatry, Bethesda Hospital, Basel, Switzerland
| | - Wolf Langewitz
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Marten Trendelenburg
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Tobias Breidthardt
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Jens Eckstein
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Department of Medical Communication / Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
7
|
Gross-Erne M, Zimmerli L, Bassetti S, Li Q, Feller A, Mingrone W. A long-term retrospective observational study at a medium-sized medical oncology service in Switzerland: comparison of overall survival with a national cohort and adherence to treatment guidelines. Swiss Med Wkly 2023; 153:40091. [PMID: 37459836 DOI: 10.57187/smw.2023.40091] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
AIMS There is a lack of national and international publicly available long-term survival outcome data from individual healthcare providers in medical oncology. In this study, the overall survival at a medium-sized medical oncology service at Olten Cantonal Hospital was evaluated and compared as a local benchmark report with national data from the Swiss Cancer Registries. Furthermore, adherence to treatment guidelines was investigated as an additional quality indicator. METHODS The 1- and 5-year overall survival of all patients with breast cancer, testicular cancer, colon cancer, non-small-cell lung cancer, Hodgkin lymphoma, and diffuse large B-cell lymphoma in Switzerland from 2008 to 2017 with at least one outpatient visit at the in-house medical oncology service at Olten Cantonal Hospital was analysed and compared with the specific overall population-based outcome data provided by the National Agency for Cancer Registration (NACR), which were set as a national benchmark. Until 2020, no data from the Canton of Solothurn, to which Olten belongs, were reported to the NACR. Further, adherence to internationally recognized clinical guidelines for stage-specific treatment was assessed. RESULTS Until September 8, 2020, data on 842 patients with a median follow-up period of 70 months were collected and analysed. The 1- and 5-year overall survival for colon and non-small cell cancer, Hodgkin lymphoma, and diffuse large B-cell lymphoma and the 5-year overall survival for testicular cancer in the Olten cohort did not significantly differ from the NACR data. The 1-year overall survival for testicular cancer was not comparable statistically. The 5-year overall survival for breast cancer (unadjusted for stage) was significantly higher in the NACR collective (84.5%) than in the Olten collective (79.7%) but not for the individual breast cancer stages. The Olten collective included approximately 2.5 times as many patients with stage 4 breast cancer (17.5%) as the NACR collective (6.9%). Approximately 92.4% of the patients in the curative setting and 85.8% of the patients in the palliative setting received first-line treatment according to guidelines. CONCLUSIONS The statistically comparable local 1- and 5-year overall survival of the analysed malignancies, with adjustment for stage for the 5-year overall survival for breast cancer, is in line with the national benchmark. Adherence to treatment guidelines is high.
Collapse
Affiliation(s)
- Mirjam Gross-Erne
- Division of Medical Oncology, Kantonsspital Olten, Olten, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine, Kantonsspital Olten, Olten, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Qiyu Li
- SAKK Coordinating Center, Bern, Switzerland
| | - Anita Feller
- Foundation National Institute for Cancer Epidemiology and Registration (NICER), Zurich, Switzerland
- National Agency for Cancer Registration (NACR) operated by NICER, Zurich, Switzerland
| | - Walter Mingrone
- Division of Medical Oncology, Kantonsspital Olten, Olten, Switzerland
| |
Collapse
|
8
|
von Rotz M, Kuehl R, Durovic A, Zingg S, Apitz A, Wegner F, Seth-Smith HMB, Roloff T, Leuzinger K, Hirsch HH, Kuster S, Battegay M, Mariani L, Schaeren S, Bassetti S, Banderet-Uglioni F, Egli A, Tschudin-Sutter S. A systematic outbreak investigation of SARS-CoV-2 transmission clusters in a tertiary academic care center. Antimicrob Resist Infect Control 2023; 12:38. [PMID: 37085891 PMCID: PMC10119817 DOI: 10.1186/s13756-023-01242-y] [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: 01/15/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
BACKGROUND We sought to decipher transmission pathways in healthcare-associated infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within our hospital by epidemiological work-up and complementary whole genome sequencing (WGS). We report the findings of the four largest epidemiologic clusters of SARS-CoV-2 transmission occurring during the second wave of the pandemic from 11/2020 to 12/2020. METHODS At the University Hospital Basel, Switzerland, systematic outbreak investigation is initiated at detection of any nosocomial case of SARS-CoV-2 infection, as confirmed by polymerase chain reaction, occurring more than five days after admission. Clusters of nosocomial infections, defined as the detection of at least two positive patients and/or healthcare workers (HCWs) within one week with an epidemiological link, were further investigated by WGS on respective strains. RESULTS The four epidemiologic clusters included 40 patients and 60 HCWs. Sequencing data was available for 70% of all involved cases (28 patients and 42 HCWs), confirmed epidemiologically suspected in house transmission in 33 cases (47.1% of sequenced cases) and excluded transmission in the remaining 37 cases (52.9%). Among cases with identical strains, epidemiologic work-up suggested transmission mainly through a ward-based exposure (24/33, 72.7%), more commonly affecting HCWs (16/24, 66.7%) than patients (8/24, 33.3%), followed by transmission between patients (6/33, 18.2%), and among HCWs and patients (3/33, 9.1%, respectively two HCWs and one patient). CONCLUSIONS Phylogenetic analyses revealed important insights into transmission pathways supporting less than 50% of epidemiologically suspected SARS-CoV-2 transmissions. The remainder of cases most likely reflect community-acquired infection randomly detected by outbreak investigation. Notably, most transmissions occurred between HCWs, possibly indicating lower perception of the risk of infection during contacts among HCWs.
Collapse
Affiliation(s)
- Matthias von Rotz
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Richard Kuehl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ana Durovic
- Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Sandra Zingg
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anett Apitz
- Employee Health Service, University Hospital Basel, Basel, Switzerland
| | - Fanny Wegner
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Helena M B Seth-Smith
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Tim Roloff
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Karoline Leuzinger
- Clinical Virology, Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
- Clinical Virology, Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
- Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Sabine Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Luigi Mariani
- Department of Neurosurgery, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Schaeren
- Department of Traumatology and Orthopedics, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, University of Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.
| |
Collapse
|
9
|
Etienne S, Oliveras R, Schiboni G, Durrer L, Rochat F, Eib P, Zahner M, Osthoff M, Bassetti S, Eckstein J. Free-living core body temperature monitoring using a wrist-worn sensor after COVID-19 booster vaccination: a pilot study. Biomed Eng Online 2023; 22:25. [PMID: 36915134 PMCID: PMC10010220 DOI: 10.1186/s12938-023-01081-3] [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: 09/06/2022] [Accepted: 02/13/2023] [Indexed: 03/14/2023] Open
Abstract
Core body temperature (CBT) is a key vital sign and fever is an important indicator of disease. In the past decade, there has been growing interest for vital sign monitoring technology that may be embedded in wearable devices, and the COVID-19 pandemic has highlighted the need for remote patient monitoring systems. While wrist-worn sensors allow continuous assessment of heart rate and oxygen saturation, reliable measurement of CBT at the wrist remains challenging. In this study, CBT was measured continuously in a free-living setting using a novel technology worn at the wrist and compared to reference core body temperature measurements, i.e., CBT values acquired with an ingestible temperature-sensing pill. Fifty individuals who received the COVID-19 booster vaccination were included. The datasets of 33 individuals were used to develop the CBT prediction algorithm, and the algorithm was then validated on the datasets of 17 participants. Mean observation time was 26.4 h and CBT > 38.0 °C occurred in 66% of the participants. CBT predicted by the wrist-worn sensor showed good correlation to the reference CBT (r = 0.72). Bland-Altman statistics showed an average bias of 0.11 °C of CBT predicted by the wrist-worn device compared to reference CBT, and limits of agreement were - 0.67 to + 0.93 °C, which is comparable to the bias and limits of agreement of commonly used tympanic membrane thermometers. The small size of the components needed for this technology would allow its integration into a variety of wearable monitoring systems assessing other vital signs and at the same time allowing maximal freedom of movement to the user.
Collapse
Affiliation(s)
- Samuel Etienne
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | | | | | | | | | | | | | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Jens Eckstein
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department Digitalization and ICT, University Hospital Basel, Basel, Switzerland.
| |
Collapse
|
10
|
Biggel M, Johler S, Roloff T, Tschudin-Sutter S, Bassetti S, Siegemund M, Egli A, Stephan R, Seth-Smith HMB. PorinPredict: In Silico Identification of OprD Loss from WGS Data for Improved Genotype-Phenotype Predictions of P. aeruginosa Carbapenem Resistance. Microbiol Spectr 2023; 11:e0358822. [PMID: 36715510 PMCID: PMC10100854 DOI: 10.1128/spectrum.03588-22] [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: 09/06/2022] [Accepted: 12/29/2022] [Indexed: 01/31/2023] Open
Abstract
The increasing integration of genomics into routine clinical diagnostics requires reliable computational tools to identify determinants of antimicrobial resistance (AMR) from whole-genome sequencing data. Here, we developed PorinPredict, a bioinformatic tool that predicts defects of the Pseudomonas aeruginosa outer membrane porin OprD, which are strongly associated with reduced carbapenem susceptibility. PorinPredict relies on a database of intact OprD variants and reports inactivating mutations in the coding or promoter region. PorinPredict was validated against 987 carbapenemase-negative P. aeruginosa genomes, of which OprD loss was predicted for 454 out of 522 (87.0%) meropenem-nonsusceptible and 46 out of 465 (9.9%) meropenem-susceptible isolates. OprD loss was also found to be common among carbapenemase-producing isolates, resulting in even further increased MICs. Chromosomal mutations in quinolone resistance-determining regions and OprD loss commonly co-occurred, likely reflecting the restricted use of carbapenems for multidrug-resistant infections as recommended in antimicrobial stewardship programs. In combination with available AMR gene detection tools, PorinPredict provides a robust and standardized approach to link P. aeruginosa phenotypes to genotypes. IMPORTANCE Pseudomonas aeruginosa is a major cause of multidrug-resistant nosocomial infections. The emergence and spread of clones exhibiting resistance to carbapenems, a class of critical last-line antibiotics, is therefore closely monitored. Carbapenem resistance is frequently mediated by chromosomal mutations that lead to a defective outer membrane porin OprD. Here, we determined the genetic diversity of OprD variants across the P. aeruginosa population and developed PorinPredict, a bioinformatic tool that enables the prediction of OprD loss from whole-genome sequencing data. We show a high correlation between predicted OprD loss and meropenem nonsusceptibility irrespective of the presence of carbapenemases, which are a second widespread determinant of carbapenem resistance. Isolates with resistance determinants to other antibiotics were disproportionally affected by OprD loss, possibly due to an increased exposure to carbapenems. Integration of PorinPredict into genomic surveillance platforms will facilitate a better understanding of the clinical impact of OprD modifications and transmission dynamics of resistant clones.
Collapse
Affiliation(s)
- Michael Biggel
- Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Sophia Johler
- Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Tim Roloff
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich
| | - Roger Stephan
- Institute for Food Safety and Hygiene, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - Helena M. B. Seth-Smith
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich
| |
Collapse
|
11
|
Romann L, Werlen L, Rommers N, Hermann A, Gisler I, Bassetti S, Bingisser R, Siegemund M, Roloff T, Weisser M, Muigg V, Hinic V, Osthoff M, Franzeck FC, Egli A. Factors impacting the pre-analytical quality of blood cultures-Analysis at a tertiary medical center. PLoS One 2023; 18:e0282918. [PMID: 36928259 PMCID: PMC10019732 DOI: 10.1371/journal.pone.0282918] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Blood cultures (BC) are critical for the diagnosis of bloodstream infections, pathogen identification, and resistance testing. Guidelines recommend a blood volume of 8-10 mL per bottle as lower volumes result in decreased sensitivity. We aimed to evaluate factors for non-adherence to recommended volumes and assess the effects on diagnostic performance. METHODS From February to April 2020, we measured collected blood volumes by weighing all BC containers from inpatient samples at the University Hospital Basel. Information on BC volumes was merged with clinical and microbiological data, as well as nursing staff schedules. We analyzed factors associated with (i) BC sampling volume, (ii) reaching recommended volumes (≥8 mL), (iii) BC positivity, and (iv) time to positivity using linear and generalized linear mixed effect models. RESULTS We evaluated a total of 4'118 BC bottles collected from 686 patients. A total of 1'495 (36.3%) of all bottles contained the recommended filling volume of ≥8 mL. Using a central venous and arterial catheter for drawing blood resulted in an increase of filling volume by 0.26 mL (95% CI 0.10, 0.41) and 0.50 mL (95% CI 0.31, 0.69) compared to peripheral venipuncture, respectively. Each additional nursing staff working at the time of blood drawing was associated with 6% higher odds of achieving the recommended filling volume. We found no significant correlation between the filling volume and the positivity rate. CONCLUSION Our results indicate critical pre-analytical quality markers linked to BC collection procedures to reach recommended collection volumes. No significant impact on the positivity rate was found.
Collapse
Affiliation(s)
- Lucas Romann
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Department Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
- * E-mail:
| | - Laura Werlen
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Nikki Rommers
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
| | - Anja Hermann
- Chief Medical and Nursing Office, University Hospital Basel, Basel, Switzerland
| | - Isabelle Gisler
- Chief Medical and Nursing Office, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Tim Roloff
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Department Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Veronika Muigg
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Vladimira Hinic
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Michael Osthoff
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Fabian C. Franzeck
- Department of Research and Analytics Services, University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Department Biomedicine, Applied Microbiology Research, University of Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, University Hospital Basel, Basel, Switzerland
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| |
Collapse
|
12
|
Dongre K, Schmid Y, Nussbaum L, Winterhalder C, Bassetti S, Holbro A, Degen L, Leuppi-Taegtmeyer AB. Gastrointestinal bleeding during anticoagulation with direct oral anticoagulants compared to vitamin K antagonists. Glob Cardiol Sci Pract 2022; 2022:e202221. [PMID: 36660168 PMCID: PMC9840132 DOI: 10.21542/gcsp.2022.21] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 09/30/2022] [Indexed: 12/14/2022] Open
Abstract
Aim: Patients receiving oral anticoagulants with vitamin K antagonists (VKAs) and direct oral anticoagulants (DOACs) have an increased risk of gastrointestinal bleeding (GIB). We compared cases of GIB associated with VKAs and DOACs in terms of risk factors, scores, timing, location, severity, and outcome. Methods: Data from patients treated at a university hospital in Switzerland for GIB under VKA and DOACs between 2012 and 2018 were analyzed in this investigator-driven, retrospective, single-center study. Results: A total of 248 patients (110 males; median age, 80 years; 134 VKA, 114 DOAC) were included. No significant differences in age, weight or sex were observed. The propensity of the VKA group for risk factors such as comorbidities, interacting medications, or a high risk for bleeding (HAS-BLED score) was higher than that of the DOAC group. 56% of the VKA-treated patients had a supratherapeutic INR, and 25% in the DOAC group received an unlicensed dose. Significantly more patients in the DOAC group were not formally overdosed with OAC whilst receiving amiodarone compared to the VKA group (57% vs. 18%, respectively, p = 0.03). Latency between the documented start of oral anticoagulation and GIB was shorter in the DOAC group (median 3 months) than in the VKA group (median 23.5 months, p¡0.001). There were no differences in terms of location and severity of the GIB, length of hospitalization, or mortality. Conclusion: Patients taking VKAs displayed more risk factors for GIB than those taking DOACs. Treatment with DOACs was associated with early GIB and calls for increased vigilance during the first months after commencement. Co-medication with amiodarone appeared to be a risk factor for GIB in patients taking DOACs.
Collapse
Affiliation(s)
- Kanchan Dongre
- Department of Patient Safety, Medical Directorate, University Hospital Basel, Switzerland
| | - Yasmin Schmid
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Luana Nussbaum
- Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Clemens Winterhalder
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Andreas Holbro
- Blood Transfusion Centre, Swiss Red Cross, Basel, Switzerland,Department of Hematology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Lukas Degen
- Clarunis, University Center for Gastrointestinal and Liver Diseases, Basel, Switzerland
| | - Anne B. Leuppi-Taegtmeyer
- Department of Patient Safety, Medical Directorate, University Hospital Basel, Switzerland,Department of Clinical Pharmacology and Toxicology, University Hospital Basel and University of Basel, Basel, Switzerland
| |
Collapse
|
13
|
Er AG, Alonso AAR, Marin-Leon I, Sayiner A, Bassetti S, Demirkan K, Lacor P, Lode H, Lesniak W, Tanriover MD, Kalyoncu AF, Merchante N, Unal S. Community-acquired pneumonia - An EFIM guideline critical appraisal adaptation for internists. Eur J Intern Med 2022; 106:1-8. [PMID: 36272872 DOI: 10.1016/j.ejim.2022.10.009] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 10/05/2022] [Accepted: 10/11/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND In real-life settings, guidelines frequently cannot be followed since many patients are multimorbid and/or elderly or have other complicating conditions which carry an increased risk of drug-drug interactions. This document aimed to adapt recommendations from existing clinical practice guidelines (CPGs) to assist physicians' decision-making processes concerning specific and complex scenarios related to acute CAP. METHODS The process for the adaptation procedure started with the identification of unsolved clinical questions (PICOs) in patients with CAP and continued with critically appraising the updated existing CPGs and choosing the recommendations, which are most applicable to these specific scenarios. RESULTS Seventeen CPGs were appraised to address five PICOs. Twenty-seven recommendations were endorsed based on 7 high, 9 moderate, 10 low, and 1 very low-quality evidence. The most valid recommendations applicable to the clinical practice were the following ones: Respiratory virus testing is strongly recommended during periods of increased respiratory virus activity. Assessing the severity with a validated prediction rule to discriminate where to treat the patient is strongly recommended along with reassessing the patient periodically for improvement as expected. In adults with multiple comorbidities, polypharmacy, or advanced age, it is strongly recommended to check for possible drug interactions before starting treatment. Strong graded recommendations exist on antibiotic treatment and its duration. Recommendations on the use of biomarkers such as C-reactive protein or procalcitonin to improve severity assessment are reported. CONCLUSION This document provides a simple and reliable updated guide for clinical decision-making in the management of complex patients with multimorbidity and CAP in the real-life setting.
Collapse
Affiliation(s)
- Ahmet Gorkem Er
- Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, Turkey
| | | | - Ignacio Marin-Leon
- CIBERESP-IBIS-ROCIO-University Hospital, Fundación Enebro, Seville, Spain
| | - Abdullah Sayiner
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | - Stefano Bassetti
- Division of Internal Medicine and Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Kutay Demirkan
- Department of Clinical Pharmacy, Hacettepe University, Faculty of Pharmacy, Turkey
| | - Patrick Lacor
- Department of Internal Medicine, Infectious Diseases Unit, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Hartmut Lode
- RCCOS, affil. Institute Clinical Pharmacology, Charite Universitätsmedizin Berlin, Germany
| | - Wiktoria Lesniak
- Evidence-Based Medicine Unit, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Mine Durusu Tanriover
- Section of General Internal Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Ali Fuat Kalyoncu
- Hacettepe University Faculty of Medicine Department of Chest Diseases Division of Allergy and Clinical Immunology, Turkey
| | - Nicolás Merchante
- Chief of Infectious Disease Department, Valme University Hospital, Associated Professor, University of Seville- Institute of Biomedicine (IBIS), Seville, Spain
| | - Serhat Unal
- Hacettepe University Faculty of Medicine Department of Infectious Diseases and Clinical Microbiology, Turkey.
| |
Collapse
|
14
|
Glatz TS, Hinic V, Martinez AE, Eckstein F, Bassetti S, Osthoff M. [Better Late than Never - Fever of Unknown Origin in a Patient with a Prosthetic Valve]. Praxis (Bern 1994) 2022; 111:889-893. [PMID: 36415980 DOI: 10.1024/1661-8157/a003942] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Better Late than Never - Fever of Unknown Origin in a Patient with a Prosthetic Valve Abstract. A patient presents with worsening of his general condition, chills and dyspnoea on exertion. With a history of aortic valve replacement, infective endocarditis is suspected, but due to negative imaging by transesophageal echocardiography and negative blood cultures cannot be confirmed. Finally, Cutibacterium acnes prosthetic valve endocarditis is diagnosed after culture of C. acnes during an extended incubation period of blood cultures, the presence of embolic complications and a characteristic finding on PET-CT scan.
Collapse
Affiliation(s)
| | - Vladimira Hinic
- Klinische Bakteriologie und Mykologie, Universitätsspital Basel, Basel, Schweiz
| | | | | | | | | |
Collapse
|
15
|
Campos L, Barreto JV, Bassetti S, Bivol M, Burbridge A, Castellino P, Correia JA, Durusu-Tanriöver M, Fierbinteanu-Braticevici C, Hanslik T, Heleniak Z, Hojs R, Lazebnic L, Mylona M, Raspe M, Melo JQE, Pietrantonio F, Gans R, Pálsson R, Montano N, Gómez-Huelgas R, Dicker D. Physicians' responsibility toward environmental degradation and climate change: A position paper of the European Federation of Internal Medicine. Eur J Intern Med 2022; 104:55-58. [PMID: 36055953 DOI: 10.1016/j.ejim.2022.08.001] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 11/16/2022]
Abstract
The current data on climate change and environmental degradation are dramatic. The consequences of these changes are already having a significant impact on people's health. Physicians - as advocates of the patients, but also as citizens - have an ethical obligation to be involved in efforts to stop these changes. The European Federation of Internal Medicine (EFIM) strongly encourages the Internal Medicine societies and internists across Europe to play an active role in matters related to climate change and environmental degradation. At a national level, this includes advocating the adoption of measures that reduce greenhouse gas (GHG) emissions and environmental degradation and contributing to policy decisions related to these issues. At a hospital level and in clinical practice, supporting actions by the health sector to reduce its ecological footprint is vital. At the level of EFIM and its associated internal societies, promoting educational activities and developing a toolkit to prepare internists to better care for citizens who suffer from the consequences of climate change. In addition to advocating and implementing effective actions to reduce the ecological footprint of the health industry, recommending the introduction of these themes in scientific programs of Internal Medicine meetings and congresses and the pre- and postgraduate medical training. At a personal level, internists must be active agents in advocating sustainable practices for the environment, increasing the awareness of the community about the health risks of climate change and environmental degradation, and being role models in the adoption of environmentally friendly behaviour.
Collapse
Affiliation(s)
- Luís Campos
- Department of Internal Medicine, Hospital CUF Tejo, Lisbon, Portugal.
| | - J Vasco Barreto
- Internal Medicine Service, Medicine Department, Hospital Pedro Hispano, School of Medicine and Biomedical Sciences, University of Porto, Porto, Portugal
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Monica Bivol
- Medical Division, Akershus University Hospital, Lorenskog, Norway
| | - Amie Burbridge
- Acute Medicine Department, University Hospitals Coventry and Warwickshire, Coventry, United Kingdom
| | - Pietro Castellino
- Department of Internal Medicine, University of Catania, Catania, Italy
| | - João Araújo Correia
- Serviço de Medicina Interna, Centro Hospitalar e Universitário do Porto, Porto, Portugal
| | - Mine Durusu-Tanriöver
- Department of General Internal Medicine, Hacettepe University Hospital, Ankara, Turkey
| | - Carmen Fierbinteanu-Braticevici
- "Carol Davila" University of Medicine and Pharmacy Bucharest, Medical Clinic II and Gastroenterology, Department of Gastroenterology, University Hospital Bucharest, Bucharest, Romania
| | - Thomas Hanslik
- Service de Médecine Interne, Hôpital Ambroise Paré, Boulogne Billancourt, France
| | - Zbigniew Heleniak
- Department of Nephrology, Transplantology and Internal Medicine, Medical, University of Gdansk, Gdansk, Poland
| | - Radovan Hojs
- Clinic for Internal Medicine, University Clinical Centre Maribor, Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Leonid Lazebnic
- The Moscow State University of Medicine and Dentistry, Moscow, Russian Federation
| | - Maria Mylona
- 1st Department of Propaedeutic & Internal Medicine, Laiko General Hospital, Athens University Medical School, Athens, Greece
| | - Matthias Raspe
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - Reinold Gans
- Internal Medicine Department, University Medical Center, Groningen, The Netherlands
| | - Runólfur Pálsson
- Landspitali-The National University Hospital of Iceland and University of Iceland, Reykjavik, Iceland
| | - Nicola Montano
- University of Milan, UNIMI - Department of Clinical Sciences and Community Health, Milan, Italy
| | - Ricardo Gómez-Huelgas
- Department of Internal Medicine, Regional University Hospital of Málaga, Biomedical Research Institute of Málaga, University of Málaga, Málaga, Spain
| | - Dror Dicker
- Internal Medicine D and Obesity Clinic, Hasharon Hospital, Rabin Medical Center, Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
16
|
Bruni F, Charitos P, Lampart M, Moser S, Siegemund M, Bingisser R, Osswald S, Bassetti S, Twerenbold R, Trendelenburg M, Rentsch KM, Osthoff M. Complement and endothelial cell activation in COVID-19 patients compared to controls with suspected SARS-CoV-2 infection: A prospective cohort study. Front Immunol 2022; 13:941742. [PMID: 36203596 PMCID: PMC9530900 DOI: 10.3389/fimmu.2022.941742] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
Background Thromboinflammation may influence disease outcome in COVID-19. We aimed to evaluate complement and endothelial cell activation in patients with confirmed COVID-19 compared to controls with clinically suspected but excluded SARS-CoV-2 infection. Methods In a prospective, observational, single-center study, patients presenting with clinically suspected COVID-19 were recruited in the emergency department. Blood samples on presentation were obtained for analysis of C5a, sC5b-9, E-selectin, Galectin-3, ICAM-1 and VCAM-1. Results 153 cases and 166 controls (suffering mainly from non-SARS-CoV-2 respiratory viral infections, non-infectious inflammatory conditions and bacterial pneumonia) were included. Hospital admission occurred in 62% and 45% of cases and controls, respectively. C5a and VCAM-1 concentrations were significantly elevated and E-selectin concentrations decreased in COVID-19 out- and inpatients compared to the respective controls. However, relative differences in outpatients vs. inpatients in most biomarkers were comparable between cases and controls. Elevated concentrations of C5a, Galectin-3, ICAM-1 and VCAM-1 on presentation were associated with the composite outcome of ICU- admission or 30-day mortality in COVID-19 and controls, yet more pronounced in COVID-19. C5a and sC5b-9 concentrations were significantly higher in COVID-19 males vs. females, which was not observed in the control group. Conclusions Our data indicate an activation of the complement cascade and endothelium in COVID-19 beyond a nonspecific inflammatory trigger as observed in controls (i.e., “over”-activation).
Collapse
Affiliation(s)
- Flavio Bruni
- Division of Internal Medicine, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Panteleimon Charitos
- Division of Internal Medicine, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maurin Lampart
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stephan Moser
- Division of Internal Medicine, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- University Center of Cardiovascular Science & Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marten Trendelenburg
- Division of Internal Medicine, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Michael Osthoff
- Division of Internal Medicine, Department of Biomedicine and Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
- *Correspondence: Michael Osthoff,
| |
Collapse
|
17
|
Becker C, Gross S, Gamp M, Beck K, Amacher SA, Mueller J, Bohren C, Blatter R, Schaefert R, Schuetz P, Leuppi J, Bassetti S, Hunziker S. Patients' Preference for Participation in Medical Decision-Making: Secondary Analysis of the BEDSIDE-OUTSIDE Trial. J Gen Intern Med 2022; 38:1180-1189. [PMID: 36085211 PMCID: PMC10110786 DOI: 10.1007/s11606-022-07775-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/19/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND Patients may prefer different levels of involvement in decision-making regarding their medical care which may influence their medical knowledge. OBJECTIVE We investigated associations of patients' decisional control preference (DCP) with their medical knowledge, ward round performance measures (e.g., duration, occurrence of sensitive topics), and perceived quality of care measures (e.g., trust in the healthcare team, satisfaction with hospital stay). DESIGN This is a secondary analysis of a randomized controlled multicenter trial conducted between 2017 and 2019 at 3 Swiss teaching hospitals. PARTICIPANTS Adult patients that were hospitalized for inpatient care. MAIN MEASURES The primary outcome was patients' subjective average knowledge of their medical care (rated on a visual analog scale from 0 to 100). We classified patients as active, collaborative, and passive according to the Control Preference Scale. Data collection was performed before, during, and after the ward round. KEY RESULTS Among the 761 included patients, those with a passive DCP had a similar subjective average (mean ± SD) knowledge (81.3 ± 19.4 points) compared to patients with a collaborative DCP (78.7 ± 20.3 points) and active DCP (81.3 ± 21.5 points), p = 0.25. Regarding patients' trust in physicians and nurses, we found that patients with an active vs. passive DCP reported significantly less trust in physicians (adjusted difference, - 5.08 [95% CI, - 8.69 to - 1.48 points], p = 0.006) and in nurses (adjusted difference, - 3.41 [95% CI, - 6.51 to - 0.31 points], p = 0.031). Also, patients with an active vs. passive DCP were significantly less satisfied with their hospital stay (adjusted difference, - 7.17 [95% CI, - 11.01 to - 3.34 points], p < 0.001). CONCLUSION Patients with active DCP have lower trust in the healthcare team and lower overall satisfaction despite similar perceived medical knowledge. The knowledge of a patient's DCP may help to individualize patient-centered care. A personalized approach may improve the patient-physician relationship and increase patients' satisfaction with medical care. TRIAL REGISTRATION ClinicalTrials.gov (NCT03210987).
Collapse
Affiliation(s)
- Christoph Becker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.,Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Sebastian Gross
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Martina Gamp
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Katharina Beck
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Simon A Amacher
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.,Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Jonas Mueller
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Chantal Bohren
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - René Blatter
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland
| | - Rainer Schaefert
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland.,Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Joerg Leuppi
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Stefano Bassetti
- Faculty of Medicine, University of Basel, Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Petersgraben 4, 4031, Basel, CH, Switzerland. .,Faculty of Medicine, University of Basel, Basel, Switzerland.
| |
Collapse
|
18
|
Kutz A, Koch D, Haubitz S, Conca A, Baechli C, Regez K, Gregoriano C, Ebrahimi F, Bassetti S, Eckstein J, Beer J, Egloff M, Kaeppeli A, Ehmann T, Hoess C, Schaad H, Wharam JF, Lieberherr A, Wagner U, de Geest S, Schuetz P, Mueller B. Association of Interprofessional Discharge Planning Using an Electronic Health Record Tool With Hospital Length of Stay Among Patients with Multimorbidity: A Nonrandomized Controlled Trial. JAMA Netw Open 2022; 5:e2233667. [PMID: 36169957 PMCID: PMC9520366 DOI: 10.1001/jamanetworkopen.2022.33667] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
IMPORTANCE Whether interprofessional collaboration is effective and safe in decreasing hospital length of stay remains controversial. OBJECTIVE To evaluate the outcomes and safety associated with an electronic interprofessional-led discharge planning tool vs standard discharge planning to safely reduce length of stay among medical inpatients with multimorbidity. DESIGN, SETTING, AND PARTICIPANTS This multicenter prospective nonrandomized controlled trial used interrupted time series analysis to examine medical acute hospitalizations at 82 hospitals in Switzerland. It was conducted from February 2017 through January 2019. Data analysis was conducted from March 2021 to July 2022. INTERVENTION After a 12-month preintervention phase (February 2017 through January 2018), an electronic interprofessional-led discharge planning tool was implemented in February 2018 in 7 intervention hospitals in addition to standard discharge planning. MAIN OUTCOMES AND MEASURES Mixed-effects segmented regression analyses were used to compare monthly changes in trends of length of stay, hospital readmission, in-hospital mortality, and facility discharge after the implementation of the tool with changes in trends among control hospitals. RESULTS There were 54 695 hospitalizations at intervention hospitals, with 27 219 in the preintervention period (median [IQR] age, 72 [59-82] years; 14 400 [52.9%] men) and 27 476 in the intervention phase (median [IQR] age, 72 [59-82] years; 14 448 [52.6%] men) and 438 791 at control hospitals, with 216 261 in the preintervention period (median [IQR] age, 74 [60-83] years; 109 770 [50.8%] men) and 222 530 in the intervention phase (median [IQR] age, 74 [60-83] years; 113 053 [50.8%] men). The mean (SD) length of stay in the preintervention phase was 7.6 (7.1) days for intervention hospitals and 7.5 (7.4) days for control hospitals. During the preintervention phase, population-averaged length of stay decreased by -0.344 hr/mo (95% CI, -0.599 to -0.090 hr/mo) in control hospitals; however, no change in trend was observed among intervention hospitals (-0.034 hr/mo; 95% CI, -0.646 to 0.714 hr/mo; difference in slopes, P = .09). Over the intervention phase (February 2018 through January 2019), length of stay remained unchanged in control hospitals (slope, -0.011 hr/mo; 95% CI, -0.281 to 0.260 hr/mo; change in slope, P = .03), but decreased steadily among intervention hospitals by -0.879 hr/mo (95% CI, -1.607 to -0.150 hr/mo; change in slope, P = .04, difference in slopes, P = .03). Safety analyses showed no change in trends of hospital readmission, in-hospital mortality, or facility discharge over the whole study time. CONCLUSIONS AND RELEVANCE In this nonrandomized controlled trial, the implementation of an electronic interprofessional-led discharge planning tool was associated with a decline in length of stay without an increase in hospital readmission, in-hospital mortality, or facility discharge. TRIAL REGISTRATION isrctn.org Identifier: ISRCTN83274049.
Collapse
Affiliation(s)
- Alexander Kutz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daniel Koch
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Sebastian Haubitz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Antoinette Conca
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Ciril Baechli
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Katharina Regez
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Claudia Gregoriano
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
| | - Fahim Ebrahimi
- Division of Gastroenterology, University Center for Gastrointestinal and Liver Diseases, St Clara Hospital and University Hospital, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Jens Eckstein
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Juerg Beer
- Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | - Michael Egloff
- Department of Medicine, Cantonal Hospital Baden, Baden, Switzerland
| | | | - Tobias Ehmann
- Department of Medicine, Hospital Zofingen, Zofingen, Switzerland
| | - Claus Hoess
- Department of Medicine, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland
| | - Heinz Schaad
- Department of Medicine, Hospital Interlaken, Hospitals Frutigen Meiringen Interlaken, Interlaken, Switzerland
| | - James Frank Wharam
- Department of Medicine, Duke University and Duke-Margolis Center for Health Policy, Durham, North Carolina
| | | | - Ulrich Wagner
- National Institute for Cancer Epidemiology and Registration, National Agency for Cancer Registration, University of Zurich, Switzerland
| | - Sabina de Geest
- Nursing Science, Department of Public Health of Basel, Switzerland
| | - Philipp Schuetz
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Beat Mueller
- Medical University Department, Division of General Internal and Emergency Medicine, Cantonal Hospital Aarau, Aarau, Switzerland
- Faculty of Medicine, University of Basel, Basel, Switzerland
| |
Collapse
|
19
|
Darie AM, Khanna N, Jahn K, Osthoff M, Bassetti S, Osthoff M, Schumann DM, Albrich WC, Hirsch H, Brutsche M, Grize L, Tamm M, Stolz D. Fast multiplex bacterial PCR of bronchoalveolar lavage for antibiotic stewardship in hospitalised patients with pneumonia at risk of Gram-negative bacterial infection (Flagship II): a multicentre, randomised controlled trial. The Lancet Respiratory Medicine 2022; 10:877-887. [DOI: 10.1016/s2213-2600(22)00086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 02/21/2022] [Accepted: 02/22/2022] [Indexed: 10/18/2022]
|
20
|
Weisser M, Khanna N, Hedstueck A, Tschudin Sutter S, Roesch S, Stehle G, Sava M, Deigendesch N, Battegay M, Infanti L, Holbro A, Bassetti S, Pargger H, Hirsch HH, Leuzinger K, Kaiser L, Vu D, Baur K, Massaro N, Busch MP, Simmons G, Stone M, Felgner PL, de Assis RR, Khan S, Tsai C, Robinson PV, Seftel D, Irsch J, Bagri A, Buser AS, Corash L. Characterization of Pathogen Inactivated
COVID
‐19 Convalescent Plasma and Responses in Transfused Patients. Transfusion 2022; 62:1997-2011. [PMID: 36054476 PMCID: PMC9538076 DOI: 10.1111/trf.17083] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/31/2022] [Accepted: 07/31/2022] [Indexed: 12/15/2022]
Abstract
Background Efficacy of donated COVID‐19 convalescent plasma (dCCP) is uncertain and may depend on antibody titers, neutralizing capacity, timing of administration, and patient characteristics. Study Design and Methods In a single‐center hypothesis‐generating prospective case–control study with 1:2 matched dCCP recipients to controls according to disease severity at day 1, hospitalized adults with COVID‐19 pneumonia received 2 × 200 ml pathogen‐reduced treated dCCP from 2 different donors. We evaluated severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) antibodies in COVID‐19 convalescent plasma donors and recipients using multiple antibody assays including a Coronavirus antigen microarray (COVAM), and binding and neutralizing antibody assays. Outcomes were dCCP characteristics, antibody responses, 28‐day mortality, and dCCP ‐related adverse events in recipients. Results Eleven of 13 dCCPs (85%) contained neutralizing antibodies (nAb). PRT did not affect dCCP antibody activity. Fifteen CCP recipients and 30 controls (median age 64 and 65 years, respectively) were enrolled. dCCP recipients received 2 dCCPs from 2 different donors after a median of one hospital day and 11 days after symptom onset. One dCCP recipient (6.7%) and 6 controls (20%) died (p = 0.233). We observed no dCCP‐related adverse events. Transfusion of unselected dCCP led to heterogeneous SARS CoV‐2 antibody responses. COVAM clustered dCCPs in 4 distinct groups and showed endogenous immune responses to SARS‐CoV‐2 antigens over 14–21 days post dCCP in all except 4 immunosuppressed recipients. Discussion PRT did not impact dCCP anti‐virus neutralizing activity. Transfusion of unselected dCCP did not impact survival and had no adverse effects. Variable dCCP antibodies and post‐transfusion antibody responses indicate the need for controlled trials using well‐characterized dCCP with informative assays.
Collapse
Affiliation(s)
- Maja Weisser
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
- Department of Clinical Research University Hospital Basel Basel Switzerland
| | - Nina Khanna
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
- Department of Clinical Research University Hospital Basel Basel Switzerland
| | - Anemone Hedstueck
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
| | - Sarah Tschudin Sutter
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
- Department of Clinical Research University Hospital Basel Basel Switzerland
| | - Sandra Roesch
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
| | - Gregor Stehle
- Regional Blood Transfusion Service, Swiss Red Cross, Basel Basel Switzerland
| | - Mihaela Sava
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
| | | | - Manuel Battegay
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
- Department of Clinical Research University Hospital Basel Basel Switzerland
| | - Laura Infanti
- Regional Blood Transfusion Service, Swiss Red Cross, Basel Basel Switzerland
| | - Andreas Holbro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel Basel Switzerland
| | - Stefano Bassetti
- Department of Clinical Research University Hospital Basel Basel Switzerland
- Department of Internal Medicine University Hospital Basel Basel Switzerland
| | - Hans Pargger
- Department of Clinical Research University Hospital Basel Basel Switzerland
- Department of Intensive Care University Hospital Basel Basel Switzerland
| | - Hans H. Hirsch
- Division of Infectious Diseases & Hospital Epidemiology University and University Hospital of Basel Basel Switzerland
- Department of Clinical Research University Hospital Basel Basel Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine University of Basel Basel Switzerland
| | - Karoline Leuzinger
- Transplantation & Clinical Virology, Department of Biomedicine University of Basel Basel Switzerland
| | - Laurent Kaiser
- Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1205 Geneva, Switzerland; Laboratory of Virology, Division of Laboratory Medicine, Geneva University Hospitals & Faculty of Medicine University of Geneva Geneva Switzerland
| | - Diem‐Lan Vu
- Division of Infectious Diseases Geneva University Hospitals Geneva Switzerland
| | - Katharina Baur
- Regional Blood Transfusion Service, Swiss Red Cross, Basel Basel Switzerland
| | - Nadine Massaro
- Regional Blood Transfusion Service, Swiss Red Cross, Basel Basel Switzerland
| | - Michael Paul Busch
- Department of Laboratory Medicine University of California, San Francisco San Francisco CA USA
- Vitalant Research Institute San Francisco CA
| | - Graham Simmons
- Department of Laboratory Medicine University of California, San Francisco San Francisco CA USA
- Vitalant Research Institute San Francisco CA
| | - Mars Stone
- Department of Laboratory Medicine University of California, San Francisco San Francisco CA USA
- Vitalant Research Institute San Francisco CA
| | - Philip L. Felgner
- Department of Physiology and Biophysics, Vaccine Research and Development Laboratory University of California, Irvine Irvine CA USA
| | - Rafael R. de Assis
- Department of Physiology and Biophysics, Vaccine Research and Development Laboratory University of California, Irvine Irvine CA USA
| | - Saahir Khan
- Division of Infectious Diseases, Department of Medicine, Keck School of Medicine University of Southern California Los Angeles CA USA
| | | | | | | | | | | | - Andreas S. Buser
- Department of Clinical Research University Hospital Basel Basel Switzerland
- Regional Blood Transfusion Service, Swiss Red Cross, Basel Basel Switzerland
| | | |
Collapse
|
21
|
Lampart M, Zellweger N, Bassetti S, Tschudin-Sutter S, Rentsch KM, Siegemund M, Bingisser R, Osswald S, Kuster GM, Twerenbold R. Clinical utility of inflammatory biomarkers in COVID-19 in direct comparison to other respiratory infections-A prospective cohort study. PLoS One 2022; 17:e0269005. [PMID: 35622838 PMCID: PMC9140295 DOI: 10.1371/journal.pone.0269005] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/13/2022] [Indexed: 01/08/2023] Open
Abstract
Background Inflammatory biomarkers are associated with severity of coronavirus disease 2019 (COVID-19). However, direct comparisons of their utility in COVID-19 versus other respiratory infections are largely missing. Objective We aimed to investigate the prognostic utility of various inflammatory biomarkers in COVID-19 compared to patients with other respiratory infections. Materials and methods Patients presenting to the emergency department with symptoms suggestive of COVID-19 were prospectively enrolled. Levels of Interleukin-6 (IL-6), c-reactive protein (CRP), procalcitonin, ferritin, and leukocytes were compared between COVID-19, other viral respiratory infections, and bacterial pneumonia. Primary outcome was the need for hospitalisation, secondary outcome was the composite of intensive care unit (ICU) admission or death at 30 days. Results Among 514 patients with confirmed respiratory infections, 191 (37%) were diagnosed with COVID-19, 227 (44%) with another viral respiratory infection (viral controls), and 96 (19%) with bacterial pneumonia (bacterial controls). All inflammatory biomarkers differed significantly between diagnoses and were numerically higher in hospitalized patients, regardless of diagnoses. Discriminative accuracy for hospitalisation was highest for IL-6 and CRP in all three diagnoses (in COVID-19, area under the curve (AUC) for IL-6 0.899 [95%CI 0.850–0.948]; AUC for CRP 0.922 [95%CI 0.879–0.964]). Similarly, IL-6 and CRP ranged among the strongest predictors for ICU admission or death at 30 days in COVID-19 (AUC for IL-6 0.794 [95%CI 0.694–0.894]; AUC for CRP 0.807 [95%CI 0.721–0.893]) and both controls. Predictive values of inflammatory biomarkers were generally higher in COVID-19 than in controls. Conclusion In patients with COVID-19 and other respiratory infections, inflammatory biomarkers harbour strong prognostic information, particularly IL-6 and CRP. Their routine use may support early management decisions.
Collapse
Affiliation(s)
- Maurin Lampart
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Núria Zellweger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Department of Clinical Research, University of Basel, Basel, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | | | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabriela M. Kuster
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
- University Center of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Center Hamburg, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg-Kiel-Lübeck, Hamburg, Germany
- * E-mail:
| |
Collapse
|
22
|
Arslani K, Eken C, Tschudin-Sutter S, Gebhard CE, Zellweger N, Bassetti S, Bingisser R, Lampart M, Osswald S, Kuster GM, Twerenbold R. Sex disparities in patients with suspected COVID-19 presenting at an emergency department in Switzerland. Swiss Med Wkly 2022; 152:w30167. [PMID: 35633632 DOI: 10.4414/smw.2022.w30167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
AIMS OF THE STUDY In the global COVID-19 pandemic, female sex is associated with comparable infection rates but better outcome. However, most studies lacked appropriate controls. We investigated whether these sex disparity findings are specific to patients with COVID-19 or generalizable to patients presenting to the emergency room (ER) with similar symptoms but no COVID-19. METHODS In this prospective cohort study, consecutive patients presenting with symptoms suggestive of COVID-19 were recruited at the ER of the University Hospital Basel, Switzerland from March to June 2020. Patients were categorized as SARS-CoV-2 positive (cases) or negative (controls) based on nasopharyngeal PCR swab tests. The final clinical diagnosis was determined for all patients. The primary outcome was a composite of intensive care admission, rehospitalization for respiratory distress and all-cause death within 30 days. We used Kaplan-Meier curves and Cox proportional hazards models to explore associations between sex and outcomes. RESULTS Among 1,081 consecutive ER patients, 191 (18%) tested positive for SARS-CoV-2, with an even sex distribution (17.9% female vs. 17.5% male, p = 0.855). In COVID-19 patients, female sex was associated with lower risk of hospitalization (51% vs. 66%, p = 0.034), lower necessity of haemodynamic support (8% vs. 20%, p = 0.029), lower rates of intubation (10% vs. 21%, p = 0.037) and the primary outcome (18% vs. 31%, p = 0.045; age-adjusted HR 0.536, 95%CI 0.290-0.989, p = 0.046) compared with male sex. Sex disparities were most prominent in patients ≥55 years (HR for composite primary outcome in women 0.415, 95%CI 0.201-0.855, p = 0.017). In contrast to the COVID-19 patients, no sex-specific differences in outcomes were observed in the unselected overall control group (age-adjusted HR 0.844, 95%CI 0.560-1.273, p = 0.419) or in a subgroup of controls with upper respiratory tract infections or pneumonia (age-adjusted HR 0.840, 95%CI 0.418-1.688, p = 0.624). CONCLUSION In this unselected, consecutive cohort study at a tertiary hospital in Switzerland, female sex is associated with better outcome in patients presenting to the ER with COVID-19. These sex disparities seem to be at least partly specific to COVID-19, as they were not observed in comparable controls.
Collapse
Affiliation(s)
- Ketina Arslani
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ceylan Eken
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland.,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Caroline E Gebhard
- Department of Intensive Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Nuria Zellweger
- Department of Intensive Care, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Roland Bingisser
- Department of Emergency Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maurin Lampart
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gabriela M Kuster
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology and Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland.,University Centre of Cardiovascular Science and Department of Cardiology, University Heart and Vascular Centre Hamburg, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.,German Centre for Cardiovascular Research (DZHK) Partner Site Hamburg-Kiel-Lübeck, Germany
| | | |
Collapse
|
23
|
Bassetti S, Tschudin-Sutter S, Egli A, Osthoff M. Optimizing antibiotic therapies to reduce the risk of bacterial resistance. Eur J Intern Med 2022; 99:7-12. [PMID: 35074246 DOI: 10.1016/j.ejim.2022.01.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 01/02/2023]
Abstract
The incidence of infections caused by bacteria that are resistant to antibiotics is constantly increasing. In Europe alone, it has been estimated that each year about 33'000 deaths are attributable to such infections. One important driver of antimicrobial resistance is the use and abuse of antibiotics in human medicine. Inappropriate prescribing of antibiotics is still very frequent: up to 50% of all antimicrobials prescribed in humans might be unnecessary and several studies show that at least 50% of antibiotic treatments are inadequate, depending on the setting. Possible strategies to optimize antibiotic use in everyday clinical practice and to reduce the risk of inducing bacterial resistance include: the implementation of rapid microbiological diagnostics for identification and antimicrobial susceptibility testing, the use of inflammation markers to guide initiation and duration of therapies, the reduction of standard durations of antibiotic courses, the individualization of antibiotic therapies and dosing considering pharmacokinetics/pharmacodynamics targets, and avoiding antibiotic classes carrying a higher risk for induction of bacterial resistance. Importantly, measures to improve antibiotic prescribing and antibiotic stewardship programs should focus on facilitating clinical reasoning and improving prescribing environment in order to remove any barriers to good prescribing.
Collapse
Affiliation(s)
- Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland.
| | - Sarah Tschudin-Sutter
- Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland
| | - Adrian Egli
- Division of Clinical Bacteriology and Mycology, University Hospital Basel and University of Basel, Switzerland; Department of Biomedicine, University Hospital Basel and University of Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel and University of Basel, Switzerland; Department of Clinical Research, University Hospital Basel and University of Basel, Switzerland
| |
Collapse
|
24
|
Peter JK, Wegner F, Gsponer S, Helfenstein F, Roloff T, Tarnutzer R, Grosheintz K, Back M, Schaubhut C, Wagner S, Seth-Smith HMB, Scotton P, Redondo M, Beckmann C, Stadler T, Salzmann A, Kurth H, Leuzinger K, Bassetti S, Bingisser R, Siegemund M, Weisser M, Battegay M, Sutter ST, Lebrand A, Hirsch HH, Fuchs S, Egli A. SARS-CoV-2 Vaccine Alpha and Delta Variant Breakthrough Infections Are Rare and Mild but Can Happen Relatively Early after Vaccination. Microorganisms 2022; 10:microorganisms10050857. [PMID: 35630302 PMCID: PMC9146960 DOI: 10.3390/microorganisms10050857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Some COVID-19 vaccine recipients show breakthrough infection. It remains unknown, which factors contribute to risks and severe outcomes. Our aim was to identify risk factors for SCoV2 breakthrough infections in fully vaccinated individuals. (2) Methods: We conducted a retrospective case-control study from 28 December 2020 to 25 October 2021. Data of all patients with breakthrough infection was compared to data of all vaccine recipients in the Canton of Basel-City, Switzerland. Further, breakthrough infections by Alpha- and Delta-variants were compared. (3) Results: Only 0.39% (488/126,586) of all vaccine recipients suffered from a breakthrough infection during the observational period, whereof most cases were asymptomatic or mild (97.2%). Breakthrough infections after full vaccination occurred in the median after 78 days (IQR 47-123.5). Factors with lower odds for breakthrough infection were age (OR 0.987) and previous COVID-19 infection prior to vaccination (OR 0.296). Factors with higher odds for breakthrough infection included vaccination with Pfizer/BioNTech instead of Moderna (OR 1.459), chronic disease (OR 2.109), and healthcare workers (OR 1.404). (4) Conclusions: Breakthrough infections are rare and mild but can occur early after vaccination. This implies that booster vaccination might be initiated earlier, especially for risk groups. Due to new variants emerging repeatedly, continuous monitoring of breakthrough infections is crucial.
Collapse
Affiliation(s)
- Jelissa Katharina Peter
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Fanny Wegner
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4056 Basel, Switzerland; (F.W.); (T.R.); (H.M.B.S.-S.)
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland;
| | - Severin Gsponer
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Fabrice Helfenstein
- Department of Clinical Research, University Hospital Basel, 4031 Basel, Switzerland;
| | - Tim Roloff
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4056 Basel, Switzerland; (F.W.); (T.R.); (H.M.B.S.-S.)
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland;
| | - Rahel Tarnutzer
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Kerstin Grosheintz
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Moritz Back
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Carla Schaubhut
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Sabina Wagner
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Helena M. B. Seth-Smith
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4056 Basel, Switzerland; (F.W.); (T.R.); (H.M.B.S.-S.)
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland
- SIB Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland;
| | - Patrick Scotton
- Corona Vaccination Centre for the Canton of Basel-City, 4058 Basel, Switzerland;
| | - Maurice Redondo
- Viollier AG, 4123 Allschwil, Switzerland; (M.R.); (C.B.); (A.S.); (H.K.); (H.H.H.)
| | - Christiane Beckmann
- Viollier AG, 4123 Allschwil, Switzerland; (M.R.); (C.B.); (A.S.); (H.K.); (H.H.H.)
| | - Tanja Stadler
- Department of Biosystems Science and Engineering, ETH Zurich, 4058 Basel, Switzerland;
| | - Andrea Salzmann
- Viollier AG, 4123 Allschwil, Switzerland; (M.R.); (C.B.); (A.S.); (H.K.); (H.H.H.)
| | - Henriette Kurth
- Viollier AG, 4123 Allschwil, Switzerland; (M.R.); (C.B.); (A.S.); (H.K.); (H.H.H.)
| | - Karoline Leuzinger
- Clinical Virology, University Hospital Basel, 4031 Basel, Switzerland;
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, 4056 Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Roland Bingisser
- Emergency Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Martin Siegemund
- Intensive Care Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Maja Weisser
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.W.); (M.B.); (S.T.S.)
| | - Manuel Battegay
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.W.); (M.B.); (S.T.S.)
| | - Sarah Tschudin Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.W.); (M.B.); (S.T.S.)
| | - Aitana Lebrand
- SIB Swiss Institute of Bioinformatics, 1015 Lausanne, Switzerland;
| | - Hans H. Hirsch
- Viollier AG, 4123 Allschwil, Switzerland; (M.R.); (C.B.); (A.S.); (H.K.); (H.H.H.)
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, 4056 Basel, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.W.); (M.B.); (S.T.S.)
| | - Simon Fuchs
- Department of Health Basel-City, 4052 Basel, Switzerland; (J.K.P.); (S.G.); (R.T.); (K.G.); (M.B.); (C.S.); (S.W.); (S.F.)
| | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, 4056 Basel, Switzerland; (F.W.); (T.R.); (H.M.B.S.-S.)
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, 4031 Basel, Switzerland
- Correspondence:
| |
Collapse
|
25
|
Cardoso E, Herrmann MJ, Grize L, Hostettler KE, Bassetti S, Siegemund M, Khanna N, Sava M, Sommer G, Tamm M, Stolz D. Is sleep-disordered breathing a risk factor for COVID-19 or vice versa? ERJ Open Res 2022; 8:00034-2022. [PMID: 35475113 PMCID: PMC8883039 DOI: 10.1183/23120541.00034-2022] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Sleep is a physiologically invigorating, mostly nocturnal state, that plays an important role in the empowerment of the immune system [1]. Obstructive sleep apnoea (OSA) is the most frequent form of sleep disordered breathing (SDB) [2], which may represent a relevant risk factor for the clinical course and prognosis of coronavirus disease 2019 (COVID-19) [3, 4]. Common characteristics and comorbidities of OSA and COVID-19 (male gender, age >60 years, metabolic syndrome, cardiovascular and chronic pulmonary disease) were recently described as prognostic factors in COVID-19 [5]. However, the prevalence of SDB after COVID-19 remains insufficiently explored. Sleep disordered breathing may be a risk factor or a sequela of COVID-19.https://bit.ly/37v5Gyz
Collapse
|
26
|
Gross S, Beck K, Becker C, Gamp M, Mueller J, Loretz N, Amacher SA, Bohren C, Gaab J, Schuetz P, Mueller B, Fux CA, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Perception of physicians and nursing staff members regarding outside versus bedside ward rounds: ancillary analysis of the randomised BEDSIDE-OUTSIDE trial. Swiss Med Wkly 2022; 152:w30112. [PMID: 35072414 DOI: 10.4414/smw.2022.w30112] [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: 11/18/2022] Open
Abstract
BACKGROUND We recently compared the effects of bedside and outside the room ward rounds on patients' knowledge about their medical care. Here, we report preferences of medical and nursing staff members regarding outside versus bedside ward rounds. METHODS Within this ancillary project of a large multicentre randomised controlled trial, we prospectively conducted a survey of medical and nursing staff members participating in the weekly consultant ward rounds in the internal medicine division of three Swiss teaching hospitals between July 2017 and October 2019. Participants were asked about their preferences on outside versus bedside ward rounds. The primary endpoint was satisfaction of healthcare workers with the ward round measured with a visual analogue scale from 0 to 100. RESULTS Between July 2017 and October 2019, 919 patients were included in the trial, and we received 891 survey responses (nurses 15.6%, residents 26.8%, attending physicians 29.6%, consultants 7.8% and chief physicians 20.2%. In the overall analysis, mean (± standard deviation) satisfaction of healthcare workers was higher with outside the room than bedside ward rounds (78.03 ± 16.96 versus 68.25 ± 21.10 respectively; age-, gender- and centre-adjusted difference of -10.46, 95% confidence interval [CI] -12.73 to -8.19; p <0.001). Healthcare workers reported better time management, more discussion of sensitive topics and less discomfort when case presentations were conducted outside the room. A stratified subgroup analysis considering the profession, however, showed strong differences, with nurses being more satisfied with bedside rounds (69.20 ± 20.32 versus 65.32 ± 20.92, respectively; adjusted difference 4.35, 95% CI -1.79 to 10.51; p <0.001), whereas attending physicians showed higher satisfaction with outside the room rounds (82.63 ± 13.87 versus 66.59 ± 21.82; adjusted difference -16.51, 95% CI -20.29 to -12.72; p = 0.002). CONCLUSIONS While bedside ward rounds are considered more patient centred and are preferred by the nursing staff, physicians prefer outside the room presentation of patients during ward rounds because of the perceived better discussion of sensitive topics, better time management and less staff discomfort. Continuous training including medical communication techniques may help to increase satisfaction of physicians with bedside ward rounds. Trial registration: https://clinicaltrials.gov/ct2/show/NCT03210987.
Collapse
Affiliation(s)
- Sebastian Gross
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Katharina Beck
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Christoph Becker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Emergency Department, University Hospital Basel, Switzerland
| | - Martina Gamp
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Jonas Mueller
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Nina Loretz
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Simon A Amacher
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Intensive Care, University Hospital Basel, Switzerland
| | - Chantal Bohren
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Philipp Schuetz
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Beat Mueller
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Christoph A Fux
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Jörg D Leuppi
- Faculty of Medicine, University of Basel, Switzerland.,University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland
| | - Rainer Schaefert
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Faculty of Medicine, University of Basel, Switzerland
| | - Wolf Langewitz
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Faculty of Medicine, University of Basel, Switzerland
| | - Marten Trendelenburg
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Tobias Breidthardt
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Jens Eckstein
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Michael Osthoff
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Stefano Bassetti
- Faculty of Medicine, University of Basel, Switzerland.,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication, Department of Psychosomatic Medicine, University Hospital Basel, Switzerland.,Faculty of Medicine, University of Basel, Switzerland
| |
Collapse
|
27
|
El Saghir A, Dimitriou G, Scholer M, Istampoulouoglou I, Heinrich P, Baumgartl K, Schwendimann R, Bassetti S, Leuppi-Taegtmeyer A. Development and Implementation of an e-Trigger Tool for Adverse Drug Events in a Swiss University Hospital. Drug Healthc Patient Saf 2021; 13:251-263. [PMID: 34992466 PMCID: PMC8713708 DOI: 10.2147/dhps.s334987] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/03/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE The purpose of the study was to develop and implement an institution-specific trigger tool based on the Institute for Healthcare Improvement medication module trigger tool (IHI MMTT) in order to detect and monitor ADEs. METHODS We performed an investigator-driven, single-center study using retrospective and prospective patient data to develop ("development phase") and implement ("implementation phase") an efficient, institution-specific trigger tool based on the IHI MMTT. Complete medical data from 1008 patients hospitalized in 2018 were used in the development phase. ADEs were identified by chart review. The performance of two versions of the tool was assessed by comparing their sensitivities and specificities. Tool A employed only digitally extracted triggers ("e-trigger-tool") while Tool B employed an additional manually extracted trigger. The superior tool - taking efficiency into account - was applied prospectively to 19-22 randomly chosen charts per month for 26 months during the implementation phase. RESULTS In the development phase, 189 (19%) patients had ≥1 ADE (total 277 ADEs). The time needed to identify these ADEs was 15 minutes/chart. A total of 203 patients had ≥1 trigger (total 273 triggers - Tool B). The sensitivities and specificities of Tools A and B were 0.41 and 0.86, and 0.43 and 0.86, respectively. Tool A was more time-efficient than Tool B (4 vs 9 minutes/chart) and was therefore used in the implementation phase. During the 26-month implementation phase, 22 patients experienced trigger-identified ADEs and 529 did not. The median number of ADEs per 1000 patient days was 6 (range 0-13). Patients with at least one ADE had a mean hospital stay of 22.3 ± 19.7 days, compared to 8.0 ± 7.6 days for those without an ADE (p = 2.7×10-14). CONCLUSION We developed and implemented an e-trigger tool that was specific and moderately sensitive, gave consistent results and required minimal resources.
Collapse
Affiliation(s)
- Amina El Saghir
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Georgios Dimitriou
- Division of Internal Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Miriam Scholer
- Department of Information Technology, University Hospital Basel, Basel, Switzerland
| | - Ioanna Istampoulouoglou
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland
| | - Patrick Heinrich
- Department of Information Technology, University Hospital Basel, Basel, Switzerland
| | - Klaus Baumgartl
- Department of Information Technology, University Hospital Basel, Basel, Switzerland
| | - René Schwendimann
- Patient Safety Office, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital and University of Basel, Basel, Switzerland
| | - Anne Leuppi-Taegtmeyer
- Department of Clinical Pharmacology & Toxicology, University Hospital and University of Basel, Basel, Switzerland
| |
Collapse
|
28
|
Haslbauer JD, Stalder A, Zinner C, Bassetti S, Mertz KD, Went P, Matter M, Tzankov A. Immunohistochemical and Transcriptional Analysis of SARS-CoV-2 Entry Factors and Renin-Angiotensin-Aldosterone System Components in Lethal COVID-19. Pathobiology 2021; 89:166-177. [PMID: 34915500 PMCID: PMC8805061 DOI: 10.1159/000520221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 07/15/2021] [Accepted: 10/02/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Since angiotensin converting enzyme-2 (ACE2) was discovered as an essential entry factor of SARS-CoV-2 (severe acute respiratory syndrome coronavirus-2), there has been conflicting evidence regarding the role of renin-angiotensin-aldosterone system (RAAS) in COVID-19. This study elucidates pulmonary expression patterns SARS-CoV-2 entry factors (ACE2 and transmembrane protease serine subtype 2, TMPRSS2) and RAAS components in lethal COVID-19. Methods Lung tissue from COVID-19 autopsies (n = 27) and controls (n = 23) underwent immunohistochemical staining for RAAS components (angiotensin receptors 1 and 2, ACE2 and Mas-receptor) and bradykinin receptors 1 and 2. Staining of individual cellular populations (alveolar pneumocytes [ALV], desquamated cells [DES] and endothelium [END]) was measured by a binary scale (positive/negative). SARS-CoV-2 was detected using immunohistochemistry against nucleocapsid protein, in-situ hybridization and quantitative reverse transcriptase polymerase chain reaction. Gene expression profiling for ACE2, ACE and TMPRSS2 was performed. Results Subtle differences were observed when comparing COVID-19 patients and controls not reaching statistical significance, such as a higher incidence of ACE2-positivity in END (52% vs. 39%) but lower positivity in ALVs (63% vs. 70%) and an overall downregulation of ACE2 gene expression (0.25 vs. 0.55). However, COVID-19 patients with RAAS inhibitor (RAASi) intake had significantly shorter hospitalization times (5 vs. 12 days), higher viral loads (57,517 vs. 15,980/10<sup>6</sup> RNase P-gene copies) and decreased ACE/ACE2-expression ratios (4.58 vs. 11.07) than patients without. TMPRSS2 expression was significantly (1.76-fold) higher in COVID-19 patients than controls. Conclusion Our study delineates the heterogeneous expression patterns of RAAS components in the lungs, which vary amongst cellular populations, and implies that COVID-19 patients with RAASi-intake present with a more rapid disease progression, although this requires further investigation.
Collapse
Affiliation(s)
- Jasmin Dionne Haslbauer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Anna Stalder
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Carl Zinner
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Philip Went
- Institute of Pathology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Matthias Matter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
29
|
Haslbauer JD, Zinner C, Stalder AK, Schneeberger J, Menter T, Bassetti S, Mertz KD, Went P, Matter MS, Tzankov A. Vascular Damage, Thromboinflammation, Plasmablast Activation, T-Cell Dysregulation and Pathological Histiocytic Response in Pulmonary Draining Lymph Nodes of COVID-19. Front Immunol 2021; 12:763098. [PMID: 34966385 PMCID: PMC8710573 DOI: 10.3389/fimmu.2021.763098] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 11/18/2021] [Indexed: 12/19/2022] Open
Abstract
Although initial immunophenotypical studies on peripheral blood and bronchoalveolar lavage samples have provided a glimpse into the immunopathology of COVID-19, analyses of pulmonary draining lymph nodes are currently scarce. 22 lethal COVID-19 cases and 28 controls were enrolled in this study. Pulmonary draining lymph nodes (mediastinal, tracheal, peribronchial) were collected at autopsy. Control lymph nodes were selected from a range of histomorphological sequelae [unremarkable histology, infectious mononucleosis, follicular hyperplasia, non-SARS related HLH, extrafollicular plasmablast activation, non-SARS related diffuse alveolar damage (DAD), pneumonia]. Samples were mounted on a tissue microarray and underwent immunohistochemical staining for a selection of immunological markers and in-situ hybridization for Epstein Barr Virus (EBV) and SARS-CoV-2. Gene expression profiling was performed using the HTG EdgeSeq Immune Response Panel. Characteristic patterns of a dysregulated immune response were detected in COVID-19: 1. An accumulation of extrafollicular plasmablasts with a relative paucity or depletion of germinal centers. 2. Evidence of T-cell dysregulation demonstrated by immunohistochemical paucity of FOXP3+, Tbet+ and LEF1+ positive T-cells and a downregulation of key genes responsible for T-cell crosstalk, maturation and migration as well as a reactivation of herpes viruses in 6 COVID-19 lymph nodes (EBV, HSV). 3. Macrophage activation by a M2-polarized, CD163+ phenotype and increased incidence of hemophagocytic activity. 4. Microvascular dysfunction, evidenced by an upregulation of hemostatic (CD36, PROCR, VWF) and proangiogenic (FLT1, TEK) genes and an increase of fibrin microthrombi and CD105+ microvessels. Taken together, these findings imply widespread dysregulation of both innate and adoptive pathways with concordant microvascular dysfunction in severe COVID-19.
Collapse
Affiliation(s)
- Jasmin D. Haslbauer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Carl Zinner
- Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Anna K. Stalder
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jan Schneeberger
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Thomas Menter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | | | - Philip Went
- Pathology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Matthias S. Matter
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, University of Basel, Basel, Switzerland
- *Correspondence: Alexandar Tzankov,
| |
Collapse
|
30
|
Beck K, Vincent A, Cam H, Becker C, Gross S, Loretz N, Müller J, Amacher SA, Bohren C, Sutter R, Bassetti S, Hunziker S. Medical futility regarding cardiopulmonary resuscitation in in-hospital cardiac arrests of adult patients: A systematic review and Meta-analysis. Resuscitation 2021; 172:181-193. [PMID: 34896244 DOI: 10.1016/j.resuscitation.2021.11.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/29/2021] [Indexed: 11/19/2022]
Abstract
AIM For some patients, survival with good neurologic function after cardiopulmonary resuscitation (CPR) is highly unlikely, thus CPR would be considered medically futile. Yet, in clinical practice, there are no well-established criteria, guidelines or measures to determine futility. We aimed to investigate how medical futility for CPR in adult patients is defined, measured, and associated with do-not-resuscitate (DNR) code status as well as to evaluate the predictive value of clinical risk scores through meta-analysis. METHODS We searched Embase, PubMed, CINAHL, and PsycINFO from the inception of each database up to January 22, 2021. Data were pooled using a fixed-effects model. Data collection and reporting followed the PRISMA guidelines. RESULTS Thirty-one studies were included in the systematic review and 11 in the meta-analysis. Medical futility defined by risk scores was associated with a significantly higher risk of in-hospital mortality (5 studies, 3102 participants with Pre-Arrest Morbidity (PAM) and Prognosis After Resuscitation (PAR) score; overall RR 3.38 [95% CI 1.92-5.97]) and poor neurologic outcome/in-hospital mortality (6 studies, 115,213 participants with Good Outcome Following Attempted Resuscitation (GO-FAR) and Prediction of Outcome for In-Hospital Cardiac Arrest (PIHCA) score; RR 6.93 [95% CI 6.43-7.47]). All showed high specificity (>90%) for identifying patients with poor outcome. CONCLUSION There is no international consensus and a lack of specific definitions of CPR futility in adult patients. Clinical risk scores might aid decision-making when CPR is assumed to be futile. Future studies are needed to assess their clinical value and reliability as a measure of futility regarding CPR.
Collapse
Affiliation(s)
- Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Missionsstrasse 60/62, 4055 Basel, Switzerland
| | - Hasret Cam
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Department of Emergency Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Nina Loretz
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Jonas Müller
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Simon A Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Clinic of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Chantal Bohren
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland
| | - Raoul Sutter
- Clinic of Intensive Care, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland; Department of Neurology, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Medical Faculty, University of Basel, Klingelbergstrasse 61, 4031 Basel, Switzerland; Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Klingelbergstrasse 23, 4031 Basel, Switzerland; Medical Faculty, University of Basel, Klingelbergstrasse 61, 4031 Basel, Switzerland.
| |
Collapse
|
31
|
Charitos P, Heijnen IAFM, Egli A, Bassetti S, Trendelenburg M, Osthoff M. Functional Activity of the Complement System in Hospitalized COVID-19 Patients: A Prospective Cohort Study. Front Immunol 2021; 12:765330. [PMID: 34777382 PMCID: PMC8581394 DOI: 10.3389/fimmu.2021.765330] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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: 08/26/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022] Open
Abstract
Aims Although the exact factors promoting disease progression in COVID-19 are not fully elucidated, unregulated activation of the complement system (CS) seems to play a crucial role in the pathogenesis of acute lung injury (ALI) induced by SARS-CoV-2. In particular, the lectin pathway (LP) has been implicated in previous autopsy studies. The primary purpose of our study is to investigate the role of the CS in hospitalized COVID-19 patients with varying degrees of disease severity. Methods In a single-center prospective observational study, 154 hospitalized patients with PCR-confirmed SARS-CoV-2 infection were included. Serum samples on admission to the COVID-19 ward were collected for analysis of CS pathway activities and concentrations of LP proteins [mannose-binding lectin (MBL) and ficolin-3 (FCN-3)] & C1 esterase inhibitor (C1IHN). The primary outcome was mechanical ventilation or in-hospital death. Results The patients were predominately male and had multiple comorbidities. ICU admission was required in 16% of the patients and death (3%) or mechanical ventilation occurred in 23 patients (15%). There was no significant difference in LP activity, MBL and FCN-3 concentrations according to different peak disease severities. The median alternative pathway (AP) activity was significantly lower (65%, IQR 50-94) in patients with death/invasive ventilation compared to patients without (87%, IQR 68-102, p=0.026). An optimal threshold of <65.5% for AP activity was derived from a ROC curve resulting in increased odds for death or mechanical ventilation (OR 4,93; 95% CI 1.70-14.33, p=0.003) even after adjustment for confounding factors. Classical pathway (CP) activity was slightly lower in patients with more severe disease (median 101% for death/mechanical ventilation vs 109%, p=0.014). C1INH concentration correlated positively with length of stay, inflammatory markers and disease severity on admission but not during follow-up. Conclusion Our results point to an overactivated AP in critically ill COVID-19 patients in vivo leading to complement consumption and consequently to a significantly reduced AP activity in vitro. The LP does not seem to play a role in the progression to severe COVID-19. Apart from its acute phase reaction the significance of C1INH in COVID-19 requires further studies.
Collapse
Affiliation(s)
| | - Ingmar A F M Heijnen
- Division of Medical Immunology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland.,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Marten Trendelenburg
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland.,Department of Clinical Research, University of Basel, Basel, Switzerland
| |
Collapse
|
32
|
Jahn K, Sava M, Sommer G, Schumann DM, Bassetti S, Siegemund M, Battegay M, Stolz D, Tamm M, Khanna N, Hostettler KE. Exercise capacity-impairment after COVID-19 pneumonia is mainly caused by deconditioning. Eur Respir J 2021; 59:13993003.01136-2021. [PMID: 34737222 PMCID: PMC8573604 DOI: 10.1183/13993003.01136-2021] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/10/2021] [Indexed: 02/02/2023]
Abstract
Not pulmonary factors, but physical deconditioning is the main limiting factor of exercise capacity in patients after severe COVID-19 pneumonitis. This underscores the importance of an early rehabilitative intervention in these patients.https://bit.ly/2XVvr6C
Collapse
Affiliation(s)
- Kathleen Jahn
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Mihaela Sava
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Gregor Sommer
- Department of Radiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Desiree M Schumann
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Clinical Research, University Hospital Basel and University of Basel, Basel, Switzerland.,Department of Intensive Care Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Daiana Stolz
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Michael Tamm
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Katrin E Hostettler
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Basel, Switzerland
| |
Collapse
|
33
|
Becker C, Beck K, Zumbrunn S, Memma V, Herzog N, Bissmann B, Gross S, Loretz N, Mueller J, Amacher SA, Bohren C, Schaefert R, Bassetti S, Fux C, Mueller B, Schuetz P, Hunziker S. Long COVID 1 year after hospitalisation for COVID-19: a prospective bicentric cohort study. Swiss Med Wkly 2021; 151:w30091. [PMID: 34694106 DOI: 10.4414/smw.2021.w30091] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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
AIMS OF THE STUDY: There is increasing interest in better understanding of long COVID, a condition characterised by long-term sequelae — appearing or persisting after the typical convalescence period — of coronavirus disease 2019 (COVID-19). Herein, we describe long-term outcomes regarding residual symptoms and psychological distress in hospitalised patients 1 year after COVID-19.
METHODS: This prospective cohort study included consecutive adult patients hospitalised for confirmed COVID-19 in two Swiss tertiary-care hospitals between March and June 2020. The primary endpoint was evidence of long COVID 1 year after discharge, defined as ≥1 persisting or new symptom related to COVID-19, from a predefined list of symptoms. Secondary endpoints included psychological distress and symptoms of post-traumatic stress disorder (PTSD).
RESULTS: Among 90 patients included in the study, 63 (70%) had symptoms of long COVID 1 year after hospitalisation, particularly fatigue (46%), concentration difficulties (31%), shortness of breath (21%) and post-exertion malaise (20%). Three predictors, namely duration of hospitalisation (odds ratio [OR] 1.11, 95% confidence interval [CI] 1.00–1.22; p = 0.041), severity of illness (OR 1.19, 95% CI 1.04–1.37; p = 0.013), and self-perceived overall health status 30 days after hospitalisation (OR 0.97, 95% CI 0.94–1.00; p = 0.027) were associated with long COVID. Regarding secondary endpoints, 16 (18%) experienced psychological distress and 3 (3.3%) patients had symptoms of PTSD.
CONCLUSION: A high proportion of COVID-19 patients report symptoms of long COVID 1 year after hospitalisation, which negatively affects their quality of life. The most important risk factors were severe initial presentation of COVID-19 with long hospital stays.
Collapse
Affiliation(s)
- Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland,Emergency Department, University Hospital Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Samuel Zumbrunn
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Valentina Memma
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Naemi Herzog
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Benjamin Bissmann
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Sebastian Gross
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Nina Loretz
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Jonas Mueller
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Simon A. Amacher
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland,Intensive Care Unit, University Hospital Basel, Switzerland
| | - Chantal Bohren
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland
| | - Rainer Schaefert
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland,Department for Psychosomatic Medicine, University Hospital Basel, Switzerland,Medical Faculty of the University of Basel, Switzerland
| | - Stefano Bassetti
- Medical Faculty of the University of Basel, Switzerland,Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Christoph Fux
- Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Beat Mueller
- Medical Faculty of the University of Basel, Switzerland,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Philipp Schuetz
- Medical Faculty of the University of Basel, Switzerland,Division of Internal Medicine, Kantonsspital Aarau, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Switzerland,Medical Faculty of the University of Basel, Switzerland
| |
Collapse
|
34
|
Cuénod A, Wüthrich D, Seth-Smith HMB, Ott C, Gehringer C, Foucault F, Mouchet R, Kassim A, Revathi G, Vogt DR, von Felten S, Bassetti S, Tschudin-Sutter S, Hettich T, Schlotterbeck G, Homberger C, Casanova C, Moran-Gilad J, Sagi O, Rodríguez-Sánchez B, Müller F, Aerni M, Gaia V, van Dessel H, Kampinga GA, Müller C, Daubenberger C, Pflüger V, Egli A. Whole-genome sequence-informed MALDI-TOF MS diagnostics reveal importance of Klebsiella oxytoca group in invasive infections: a retrospective clinical study. Genome Med 2021; 13:150. [PMID: 34517886 PMCID: PMC8438989 DOI: 10.1186/s13073-021-00960-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 08/27/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Klebsiella spp. are opportunistic pathogens which can cause severe infections, are often multi-drug resistant and are a common cause of hospital-acquired infections. Multiple new Klebsiella species have recently been described, yet their clinical impact and antibiotic resistance profiles are largely unknown. We aimed to explore Klebsiella group- and species-specific clinical impact, antimicrobial resistance (AMR) and virulence. METHODS We analysed whole-genome sequence data of a diverse selection of Klebsiella spp. isolates and identified resistance and virulence factors. Using the genomes of 3594 Klebsiella isolates, we predicted the masses of 56 ribosomal subunit proteins and identified species-specific marker masses. We then re-analysed over 22,000 Matrix-Assisted Laser Desorption Ionization - Time Of Flight (MALDI-TOF) mass spectra routinely acquired at eight healthcare institutions in four countries looking for these species-specific markers. Analyses of clinical and microbiological endpoints from a subset of 957 patients with infections from Klebsiella species were performed using generalized linear mixed-effects models. RESULTS Our comparative genomic analysis shows group- and species-specific trends in accessory genome composition. With the identified species-specific marker masses, eight Klebsiella species can be distinguished using MALDI-TOF MS. We identified K. pneumoniae (71.2%; n = 12,523), K. quasipneumoniae (3.3%; n = 575), K. variicola (9.8%; n = 1717), "K. quasivariicola" (0.3%; n = 52), K. oxytoca (8.2%; n = 1445), K. michiganensis (4.8%; n = 836), K. grimontii (2.4%; n = 425) and K. huaxensis (0.1%; n = 12). Isolates belonging to the K. oxytoca group, which includes the species K. oxytoca, K. michiganensis and K. grimontii, were less often resistant to 4th-generation cephalosporins than isolates of the K. pneumoniae group, which includes the species K. pneumoniae, K. quasipneumoniae, K. variicola and "K. quasivariicola" (odds ratio = 0.17, p < 0.001, 95% confidence interval [0.09,0.28]). Within the K. pneumoniae group, isolates identified as K. pneumoniae were more often resistant to 4th-generation cephalosporins than K. variicola isolates (odds ratio = 2.61, p = 0.003, 95% confidence interval [1.38,5.06]). K. oxytoca group isolates were found to be more likely associated with invasive infection to primary sterile sites than K. pneumoniae group isolates (odds ratio = 2.39, p = 0.0044, 95% confidence interval [1.05,5.53]). CONCLUSIONS Currently misdiagnosed Klebsiella spp. can be distinguished using a ribosomal marker-based approach for MALDI-TOF MS. Klebsiella groups and species differed in AMR profiles, and in their association with invasive infection, highlighting the importance for species identification to enable effective treatment options.
Collapse
Affiliation(s)
- Aline Cuénod
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland.
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Daniel Wüthrich
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Helena M B Seth-Smith
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Chantal Ott
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Christian Gehringer
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | | | | | - Ali Kassim
- Aga Khan University Hospital, Nairobi, Kenya
| | | | - Deborah R Vogt
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Stefanie von Felten
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Timm Hettich
- Division of Instrumental Analytics, School of Applied Sciences (FHNW), Muttenz, Switzerland
| | - Götz Schlotterbeck
- Division of Instrumental Analytics, School of Applied Sciences (FHNW), Muttenz, Switzerland
| | - Christina Homberger
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Carlo Casanova
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Jacob Moran-Gilad
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Soroka University Medical Center, Beer Sheva, Israel
| | - Orli Sagi
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
- Soroka University Medical Center, Beer Sheva, Israel
| | - Belén Rodríguez-Sánchez
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Servicio de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain. Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | | | | | - Valeria Gaia
- Servizio di microbiologia EOLAB, Ente Ospedaliero Cantonale, Bellinzona, Switzerland
| | - Helke van Dessel
- Department of Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Greetje A Kampinga
- Department of Medical Microbiology & Infection prevention, University of Groningen, Groningen, the Netherlands
- University Medical Center Groningen (UMCG), Groningen, the Netherlands
| | | | - Claudia Daubenberger
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Sciences, University of Basel, Basel, Switzerland
| | | | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Hebelstrasse 20, 4031, Basel, Switzerland.
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| |
Collapse
|
35
|
Becker C, Gamp M, Schuetz P, Beck K, Vincent A, Hochstrasser S, Metzger K, Widmer M, Thommen E, Mueller B, Fux CA, Leuppi JD, Schaefert R, Langewitz W, Trendelenburg M, Breidthardt T, Eckstein J, Osthoff M, Bassetti S, Hunziker S. Effect of Bedside Compared With Outside the Room Patient Case Presentation on Patients' Knowledge About Their Medical Care : A Randomized, Controlled, Multicenter Trial. Ann Intern Med 2021; 174:1282-1292. [PMID: 34181449 DOI: 10.7326/m21-0909] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although bedside case presentation contributes to patient-centered care through active patient participation in medical discussions, the complexity of medical information and jargon-induced confusion may cause misunderstandings and patient discomfort. OBJECTIVE To compare bedside versus outside the room patient case presentation regarding patients' knowledge about their medical care. DESIGN Randomized, controlled, parallel-group trial. (ClinicalTrials.gov: NCT03210987). SETTING 3 Swiss teaching hospitals. PATIENTS Adult medical patients who were hospitalized. INTERVENTION Patients were randomly assigned to bedside or outside the room case presentation. MEASUREMENTS The primary endpoint was patients' average knowledge of 3 dimensions of their medical care (each rated on a visual analogue scale from 0 to 100): understanding their disease, the therapeutic approach being used, and further plans for care. RESULTS Compared with patients in the outside the room group (n = 443), those in the bedside presentation group (n = 476) reported similar knowledge about their medical care (mean, 79.5 points [SD, 21.6] vs. 79.4 points [SD, 19.8]; adjusted difference, 0.09 points [95% CI, -2.58 to 2.76 points]; P = 0.95). Also, an objective rating of patient knowledge by the study team was similar for the 2 groups, but the bedside presentation group had higher ratings of confusion about medical jargon and uncertainty caused by team discussions. Bedside ward rounds were more efficient (mean, 11.89 minutes per patient [SD, 4.92] vs. 14.14 minutes per patient [SD, 5.65]; adjusted difference, -2.31 minutes [CI, -2.98 to -1.63 minutes]; P < 0.001). LIMITATION Only Swiss hospitals and medical patients were included. CONCLUSION Compared with outside the room case presentation, bedside case presentation was shorter and resulted in similar patient knowledge, but sensitive topics were more often avoided and patient confusion was higher. Physicians presenting at the bedside need to be skilled in the use of medical language to avoid confusion and misunderstandings. PRIMARY FUNDING SOURCE Swiss National Foundation (10531C_ 182422).
Collapse
Affiliation(s)
- Christoph Becker
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Martina Gamp
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Philipp Schuetz
- University of Basel, Basel, and Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M., C.A.F.)
| | - Katharina Beck
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Alessia Vincent
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Seraina Hochstrasser
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Kerstin Metzger
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Madlaina Widmer
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Emanuel Thommen
- University Hospital Basel, Basel, Switzerland (C.B., M.G., K.B., A.V., S.H., K.M., M.W., E.T.)
| | - Beat Mueller
- University of Basel, Basel, and Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M., C.A.F.)
| | - Christoph A Fux
- University of Basel, Basel, and Kantonsspital Aarau, Aarau, Switzerland (P.S., B.M., C.A.F.)
| | - Jörg D Leuppi
- University of Basel, Basel, and University Clinic of Medicine, Kantonsspital Baselland, Liestal, Switzerland (J.D.L.)
| | - Rainer Schaefert
- University Hospital Basel and University of Basel, Basel, Switzerland (R.S., W.L., S.H.)
| | - Wolf Langewitz
- University Hospital Basel and University of Basel, Basel, Switzerland (R.S., W.L., S.H.)
| | - Marten Trendelenburg
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Tobias Breidthardt
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Jens Eckstein
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Michael Osthoff
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Stefano Bassetti
- University of Basel and University Hospital Basel, Basel, Switzerland (M.T., T.B., J.E., M.O., S.B.)
| | - Sabina Hunziker
- University Hospital Basel and University of Basel, Basel, Switzerland (R.S., W.L., S.H.)
| | | |
Collapse
|
36
|
Sava M, Sommer G, Daikeler T, Woischnig AK, Martinez AE, Leuzinger K, Hirsch H, Erlanger T, Wiencierz A, Bassetti S, Tamm M, Tschudin-Sutter S, Stoeckle M, Pargger H, Siegemund M, Boss R, Zimmer G, Vu DL, Kaiser L, Dell-Kuster S, Weisser M, Battegay M, Hostettler K, Khanna N. Ninety-day outcome of patients with severe COVID-19 treated with tocilizumab - a single centre cohort study. Swiss Med Wkly 2021; 151:w20550. [PMID: 34375986 DOI: 10.4414/smw.2021.20550] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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 Patients with severe COVID-19 may be at risk of longer term sequelae. Long-term clinical, immunological, pulmonary and radiological outcomes of patients treated with anti-inflammatory drugs are lacking. METHODS In this single-centre prospective cohort study, we assessed 90-day clinical, immunological, pulmonary and radiological outcomes of hospitalised patients with severe COVID-19 treated with tocilizumab from March 2020 to May 2020. Criteria for tocilizumab administration were oxygen saturation <93%, respiratory rate >30/min, C-reactive protein levels >75 mg/l, extensive area of ground-glass opacities or progression on computed tomography (CT). Descriptive analyses were performed using StataIC 16. RESULTS Between March 2020 and May 2020, 50 (27%) of 186 hospitalised patients had severe COVID-19 and were treated with tocilizumab. Of these, 52% were hospitalised on the intensive care unit (ICU) and 12% died. Eleven (22%) patients developed at least one microbiologically confirmed super-infection, of which 91% occurred on ICU. Median duration of hospitalisation was 15 days (interquartile range [IQR] 10–24) with 24 days (IQR 14–32) in ICU patients and 10 days (IQR 7–15) in non-ICU patients. At day 90, 41 of 44 survivors (93%) were outpatients. No long-term adverse events or late-onset infections were identified after acute hospital care. High SARS-CoV-2 antibody titres were found in all but one patient, who was pretreated with rituximab. Pulmonary function tests showed no obstructive patterns, but restrictive patterns in two (5.7%) and impaired diffusion capacities for carbon monoxide in 11 (31%) of 35 patients, which predominated in prior ICU patients. Twenty-one of 35 (60%) CT-scans at day 90 showed residual abnormalities, with similar distributions between prior ICU and non-ICU patients. CONCLUSIONS In this cohort of severe COVID-19 patients, no tocilizumab-related long-term adverse events or late-onset infections were identified. Although chest CT abnormalities were highly prevalent at day 90, the majority of patients showed normal lung function. TRIAL REGISTRATION ClinicalTrials.gov NCT04351503.
Collapse
Affiliation(s)
- Mihaela Sava
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland / Department of Infectious Diseases, West German Centre of Infectious Diseases, University Hospital Essen, Germany
| | - Gregor Sommer
- Clinic of Radiology and Nuclear Medicine, University Hospital Basel and University of Basel, Switzerland
| | - Thomas Daikeler
- Division of Rheumatology, University Hospital of Basel, Switzerland / Department of Clinical Research, University Hospital Basel, Switzerland
| | - Anne-Kathrin Woischnig
- Infection Biology Laboratory, Department of Biomedicine, University of Basel, Switzerland
| | - Aurelien E Martinez
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland
| | - Karoline Leuzinger
- Division of Clinical Virology, University Hospital Basel, Switzerland / Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Switzerland
| | - Hans Hirsch
- Division of Clinical Virology, University Hospital Basel, Switzerland / Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Switzerland
| | - Tobias Erlanger
- Department of Clinical Research, University Hospital Basel, Switzerland
| | - Andrea Wiencierz
- Department of Clinical Research, University Hospital Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Michael Tamm
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland / Department of Clinical Research, University Hospital Basel, Switzerland
| | - Marcel Stoeckle
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland
| | - Hans Pargger
- Department of Intensive Care Medicine, University Hospital Basel, Switzerland
| | - Martin Siegemund
- Department of Clinical Research, University Hospital Basel, Switzerland / Department of Intensive Care Medicine, University Hospital Basel, Switzerland
| | - Renate Boss
- Federal Food Safety and Veterinary Office, Bern, Switzerland
| | - Gert Zimmer
- Institute of Virology and Immunology (IVI), Mittelhäusern, Switzerland / Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Switzerland
| | - Diem-Lan Vu
- Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland / Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Laurent Kaiser
- Division of Infectious Disease, Geneva University Hospitals, Geneva, Switzerland / Laboratory of Virology, Geneva University Hospitals, Geneva, Switzerland
| | - Salome Dell-Kuster
- Department of Clinical Research, University Hospital Basel, Switzerland / Department of Anaesthesiology, Prehospital Emergency Medicine and Pain Therapy, University Hospital Basel, Switzerland / Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, Switzerland
| | - Maja Weisser
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland / Department of Clinical Research, University Hospital Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland
| | - Katrin Hostettler
- Clinics of Respiratory Medicine, University Hospital Basel and University of Basel, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Switzerland / Department of Clinical Research, University Hospital Basel, Switzerland / Infection Biology Laboratory, Department of Biomedicine, University of Basel, Switzerland
| |
Collapse
|
37
|
Vincent A, Beck K, Becker C, Zumbrunn S, Ramin-Wright M, Urben T, Quinto A, Schaefert R, Meinlschmidt G, Gaab J, Reinhardt T, Bassetti S, Schuetz P, Hunziker S. Psychological burden in patients with COVID-19 and their relatives 90 days after hospitalization: A prospective observational cohort study. J Psychosom Res 2021; 147:110526. [PMID: 34051515 PMCID: PMC8132501 DOI: 10.1016/j.jpsychores.2021.110526] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 05/17/2021] [Accepted: 05/17/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE COVID-19 causes psychological distress for patients and their relatives at short term. However, little research addressed the longer-term psychological outcomes in this population. Therefore, we aimed to prospectively assess clinically relevant psychological distress in hospitalized patients with COVID-19 and their relatives 90 days after hospital discharge. METHODS This exploratory, prospective, observational cohort study included consecutive adult patients hospitalized in two Swiss tertiary-care hospitals between March and June 2020 for confirmed COVID-19 and their relatives. The primary outcome was psychological distress defined as clinically relevant symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS) 90 days after discharge. RESULTS Clinically relevant psychological distress 90 days after hospital discharge was present in 23/108 patients (21.3%) and 22/120 relatives (18.3%). For patients, risk and protective factors associated with clinically relevant psychological distress included sociodemographic, illness-related, psychosocial, and hospital-related factors. A model including these factors showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.84. For relatives, relevant risk factors were illness-related, psychosocial, and hospital-related factors. Resilience was negatively associated with anxiety and depression in both patients and relatives and regarding PTSD in relatives only. CONCLUSION COVID-19 is linked to clinically relevant psychological distress in a subgroup of patients and their relatives 90 days after hospitalization. If confirmed in an independent and larger patient cohort, knowledge about these potential risk and protective factors might help to develop preventive strategies.
Collapse
Affiliation(s)
- Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Samuel Zumbrunn
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Maja Ramin-Wright
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Tabita Urben
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Adrian Quinto
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Rainer Schaefert
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Medical Faculty of the University of Basel, Basel, Switzerland
| | - Gunther Meinlschmidt
- Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland,Medical Faculty of the University of Basel, Basel, Switzerland,Division of Clinical Psychology and Cognitive Behavioural Therapy, International Psychoanalytic University, Berlin, Germany,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Jens Gaab
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Switzerland
| | - Thomas Reinhardt
- Human Resources & Leadership Development, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Medical Faculty of the University of Basel, Basel, Switzerland,Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical Faculty of the University of Basel, Basel, Switzerland,Department of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland; Medical Faculty of the University of Basel, Basel, Switzerland.
| |
Collapse
|
38
|
Diebold M, Martinez AE, Adam KM, Bassetti S, Osthoff M, Kassi E, Steiger J, Pargger H, Siegemund M, Battegay M, Khanna N, Schaub S, Wesch C, Dickenmann M, Weisser M. Temporal trends of COVID-19 related in-hospital mortality and demographics in Switzerland - a retrospective single centre cohort study. Swiss Med Wkly 2021; 151:w20572. [PMID: 34324697 DOI: 10.4414/smw.2021.20572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS The aim of this study was to analyse the demographics, risk factors and in-hospital mortality rates of patients admitted with coronavirus disease 2019 (COVID-19) to a tertiary care hospital in Switzerland. METHODS In this single-centre retrospective cohort study at the University Hospital Basel, we included all patients with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection hospitalised from 27 February 2020 to 10 May 2021. Patients’ characteristics were extracted from the electronic medical record system. The primary outcome of this study was temporal trends of COVID-19-related in-hospital mortality. Secondary outcomes were COVID-19-related mortality in patients hospitalised on the intensive care unit (ICU), admission to ICU, renal replacement therapy and length of hospital stay, as well as a descriptive analysis of risk factors for in-hospital mortality. RESULTS During the study period we included 943 hospitalisations of 930 patients. The median age was 65 years (interquartile range [IQR] 53–76) and 63% were men. The numbers of elderly patients, patients with multiple comorbidities and need for renal replacement therapy decreased from the first and second to the third wave. The median length of stay and need for ICU admission were similar in all waves. Throughout the study period 88 patients (9.3%) died during the hospital stay. Crude in-hospital mortality was similar over the course of the first two waves (9.5% and 10.2%, respectively), whereas it decreased in the third wave (5.4%). Overall mortality in patients without comorbidities was low at 1.6%, but it increased in patients with any comorbidity to 12.6%. Predictors of all-cause mortality over the whole period were age (adjusted odds ratio [aOR] per 10-year increase 1.81, 95% confidence interval [CI] 1.45–2.26; p <0.001), male sex (aOR 1.68, 95% CI 1.00–2.82; p = 0.048), immunocompromising condition (aOR 2.09, 95% CI 1.01–4.33; p = 0.048) and chronic kidney disease (aOR 2.25, 95% CI 1.35–3.76; p = 0.002). CONCLUSION In our study in-hospital mortality was 9.5%, 10.2% and 5.4% in the first, second and third waves, respectively. Age, immunocompromising condition, male sex and chronic kidney disease were factors associated with in-hospital mortality. Importantly, patients without any comorbidity had a very low in-hospital mortality regardless of age.
Collapse
Affiliation(s)
- Matthias Diebold
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Switzerland
| | | | - Kai-Manuel Adam
- Division of infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Switzerland / Department of Clinical Research, University of Basel, Switzerland
| | - Elianne Kassi
- Division of Internal Medicine, University Hospital Basel, Switzerland
| | - Jürg Steiger
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Basel, University Hospital, Switzerland
| | - Martin Siegemund
- Department of Clinical Research, University of Basel, Switzerland / Intensive Care Unit, University Basel, University Hospital, Switzerland
| | - Manuel Battegay
- Division of infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Nina Khanna
- Division of infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Switzerland
| | - Conrad Wesch
- Intensive Care Unit, University Basel, University Hospital, Switzerland
| | - Michael Dickenmann
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, Switzerland
| | - Maja Weisser
- Division of infectious Diseases and Hospital Epidemiology, University Hospital Basel, Switzerland
| |
Collapse
|
39
|
Moser S, Rehm S, Guertler N, Hinic V, Dräger S, Bassetti S, Rentsch KM, Sendi P, Osthoff M. Probability of pharmacological target attainment with flucloxacillin in Staphylococcus aureus bloodstream infection: a prospective cohort study of unbound plasma and individual MICs. J Antimicrob Chemother 2021; 76:1845-1854. [PMID: 33860325 PMCID: PMC8212765 DOI: 10.1093/jac/dkab089] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/01/2021] [Indexed: 12/22/2022] Open
Abstract
Objectives MSSA bloodstream infections (BSIs) are associated with considerable mortality. Data regarding therapeutic drug monitoring (TDM) and pharmacological target attainment of the β-lactam flucloxacillin are scarce. Patients and methods We determined the achievement of pharmacokinetic/pharmacodynamic targets and its association with clinical outcome and potential toxicity in a prospective cohort of 50 patients with MSSA-BSI. Strain-specific MICs and unbound plasma flucloxacillin concentrations (at five different timepoints) were determined by broth microdilution and HPLC–MS, respectively. Results In our study population, 48% were critically ill and the 30 day mortality rate was 16%. The median flucloxacillin MIC was 0.125 mg/L. The median unbound trough concentration was 1.7 (IQR 0.4–9.3), 1.9 (IQR 0.4–6.2) and 1.0 (IQR 0.6–3.4) mg/L on study day 1, 3 and 7, respectively. Optimal (100% fT>MIC) and maximum (100% fT>4×MIC) target attainment was achieved in 45 (90%) and 34 (68%) patients, respectively, throughout the study period. Conversely, when using the EUCAST epidemiological cut-off value instead of strain-specific MICs, target attainment was achieved in only 13 (26%) patients. The mean unbound flucloxacillin trough concentration per patient was associated with neurotoxicity (OR 1.12 per 1 mg/L increase, P = 0.02) and significantly higher in deceased patients (median 14.8 versus 1.7 mg/L, P = 0.01). Conclusions Flucloxacillin pharmacological target attainment in MSSA-BSI patients is frequently achieved when unbound flucloxacillin concentrations and strain-specific MICs are considered. However, currently recommended dosing regimens may expose patients to excessive flucloxacillin concentrations, potentially resulting in drug-related organ damage.
Collapse
Affiliation(s)
- Stephan Moser
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sophia Rehm
- Department of Laboratory Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Nicolas Guertler
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Vladimira Hinic
- Division of Clinical Bacteriology and Mycology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Sarah Dräger
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Katharina M Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Parham Sendi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.,Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, 3001 Bern, Switzerland
| | - Michael Osthoff
- Division of Internal Medicine, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland.,Department of Clinical Research, University of Basel, Schanzenstrasse 55, 4056, Basel, Switzerland
| |
Collapse
|
40
|
Istampoulouoglou I, Zimmermanns B, Grandinetti T, Marzolini C, Harings-Kaim A, Koechlin-Lemke S, Scholz I, Bassetti S, Leuppi-Taegtmeyer AB. Cardiovascular adverse effects of lopinavir/ritonavir and hydroxychloroquine in COVID-19 patients: Cases from a single pharmacovigilance centre. Glob Cardiol Sci Pract 2021; 2021:e202111. [PMID: 34285902 PMCID: PMC8272412 DOI: 10.21542/gcsp.2021.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
In this article we summarize the cardiovascular adverse events that were observed in three patients during their treatment for COVID-19 and discuss their association with lopinavir/ ritonavir (LPV/r) and hydroxychloroquine (HCQ). The cases were reported to our regional pharmacovigilance centre in April 2020. All three patients were above 75 years in age, male and multimorbid, and had been hospitalized for treatment of COVID-19. As part of their treatment, all of them received a very strictly monitored off-label therapy with LPV/r and HCQ, for which they had given their prior, written, informed consent. In one patient, erythromycin was also administered. All three patients developed a significant QTc time prolongation during or shortly after therapy with the above drugs. On account of this, the treatment had to be discontinued early in each case and QTc time recovered in all three patients.
Collapse
Affiliation(s)
- Ioanna Istampoulouoglou
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Barbara Zimmermanns
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Tanja Grandinetti
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Catia Marzolini
- Division of Infectious Diseases & Hospital Hygiene, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Annette Harings-Kaim
- Regional Pharmacovigilance Centre Basel, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Sarah Koechlin-Lemke
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Irene Scholz
- Swissmedic, Schweizerisches Heilmittelinstitut, Bern, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| | - Anne B Leuppi-Taegtmeyer
- Department of Clinical Pharmacology & Toxicology, University Hospital Basel, Switzerland.,Regional Pharmacovigilance Centre Basel, University Hospital Basel, Switzerland.,University of Basel, Basel, Switzerland
| |
Collapse
|
41
|
Meienberg A, Mayr M, Bassetti S, Potlukova E. Are we fit to teach? A survey in physicians of the in- and outpatient departments of internal medicine at a Swiss university hospital. Swiss Med Wkly 2021; 151:w20505. [PMID: 34098583 DOI: 10.4414/smw.2021.20505] [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: 11/18/2022] Open
Abstract
AIM OF THE STUDY Teaching is one of the three pillars of medical-academic activity, alongside patient care and research. The aim of our study was to assess current teaching practice in the medical departments of the University Hospital Basel, Switzerland, in order to organise a faculty development programme tailored to local needs. METHODS We performed a cross-sectional online survey among the teaching faculty and the residents. For both groups, we assessed their estimation of the general importance and perceived frequency of various teaching formats in everyday practice. Additionally, we asked the senior physicians to evaluate their teaching competencies and the residents to state their opinion on factors promoting a positive learning experience. RESULTS Twenty-eight of 34 senior physicians (82%) and 48 of 90 residents (53%) participated in the study. Both groups broadly agreed on the importance of various teaching formats for the professional development of physicians, placing particular importance on bedside teaching, providing feedback, teaching during case discussions, and observation and modeling. However, the residents perceived that they obtained less teaching, feedback and support than the senior physicians perceived they were giving. Overall, teaching during case discussions represented the format most often applied, and it was also the one in which the senior physicians felt most competent. Residents claimed “time” to be the most important factor promoting a positive learning experience, followed by a positive attitude und the personal characteristics of the supervisor. CONCLUSION Our study shows that, despite being an integral part of everyday work at a university clinic, many aspects of current teaching practice allow discussion on possibilities of adaptations and improvement. Evaluation of current teaching practice provides the basis for designing a faculty development programme tailored to specific needs.
Collapse
Affiliation(s)
- Andrea Meienberg
- Outpatient Medical Department, University Hospital Basel and University of Basel, Switzerland
| | - Michael Mayr
- Outpatient Medical Department, University Hospital Basel and University of Basel, Switzerland
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel and University of Basel, Switzerland
| | - Eliska Potlukova
- Division of Internal Medicine, University Hospital Basel and University of Basel, Switzerland
| |
Collapse
|
42
|
Simon NR, Jauslin AS, Rueegg M, Twerenbold R, Lampart M, Osswald S, Bassetti S, Tschudin-Sutter S, Siegemund M, Nickel CH, Bingisser R. Association of Frailty with Adverse Outcomes in Patients with Suspected COVID-19 Infection. J Clin Med 2021; 10:jcm10112472. [PMID: 34199572 PMCID: PMC8199640 DOI: 10.3390/jcm10112472] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 04/27/2021] [Revised: 05/27/2021] [Accepted: 05/30/2021] [Indexed: 12/17/2022] Open
Abstract
Older age and frailty are predictors of adverse outcomes in patients with COVID-19. In emergency medicine, patients do not present with the diagnosis, but with suspicion of COVID-19. The aim of this study was to assess the association of frailty and age with death or admission to intensive care in patients with suspected COVID-19. This single-centre prospective cohort study was performed in the Emergency Department of a tertiary care hospital. Patients, 65 years and older, with suspected COVID-19 presenting to the Emergency Department during the first wave of the pandemic were consecutively enrolled. All patients underwent nasopharyngeal SARS-CoV-2 PCR swab tests. Patients with a Clinical Frailty Scale (CFS) > 4, were considered to be frail. Associations between age, gender, frailty, and COVID-19 status with the composite adverse outcome of 30-day-intensive-care-admission and/or 30-day-mortality were tested. In the 372 patients analysed, the median age was 77 years, 154 (41.4%) were women, 44 (11.8%) were COVID-19-positive, and 125 (33.6%) were frail. The worst outcome was seen in frail COVID-19-patients with six (66.7%) adverse outcomes. Frailty (CFS > 4) and COVID-19-positivity were associated with an adverse outcome after adjustment for age and gender (frailty: OR 5.01, CI 2.56–10.17, p < 0.001; COVID-19: OR 3.47, CI 1.48–7.89, p = 0.003). Frailty was strongly associated with adverse outcomes and outperformed age as a predictor in emergency patients with suspected COVID-19.
Collapse
Affiliation(s)
- Noemi R. Simon
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Andrea S. Jauslin
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Marco Rueegg
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (R.T.); (M.L.); (S.O.)
| | - Maurin Lampart
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (R.T.); (M.L.); (S.O.)
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, 4031 Basel, Switzerland; (R.T.); (M.L.); (S.O.)
| | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, 4031 Basel, Switzerland;
| | - Sarah Tschudin-Sutter
- Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, 4031 Basel, Switzerland;
- Department of Clinical Research, University of Basel, C/O University Hospital Basel, 4031 Basel, Switzerland;
| | - Martin Siegemund
- Department of Clinical Research, University of Basel, C/O University Hospital Basel, 4031 Basel, Switzerland;
- Department of Intensive Care, University Hospital Basel, 4031 Basel, Switzerland
| | - Christian H. Nickel
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, 4031 Basel, Switzerland; (N.R.S.); (A.S.J.); (M.R.); (C.H.N.)
- Correspondence: ; Tel.: +41-61-265-58-30
| |
Collapse
|
43
|
Diebold M, Zimmermann T, Dickenmann M, Schaub S, Bassetti S, Siegemund M, Breidthardt T, Twerenbold R. FC 047COMPARISON OF THE CHARACTERISTICS AND MORTALITY OF ACUTE KIDNEY INJURY IN PATIENTS WITH COVID-19 AND OTHER RESPIRATORY INFECTIONS: A PROSPECTIVE COHORT STUDY. Nephrol Dial Transplant 2021. [PMCID: PMC8195057 DOI: 10.1093/ndt/gfab116.003] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and Aims
Previous studies have indicated a coherency between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI), indicating poor outcomes. However, most studies only included patients with COVID-19 and lacked a control group. Therefore, the aim of this study was to investigate the prevalence and prognostic impact of AKI in patients with COVID-19 in comparison with other respiratory tract infections.
Method
The prospective single-center observational case-control COronaVIrus surviVAl (COVIVA, clinicaltrials.gov NCT04366765) study performed at the University Hospital Basel Switzerland consecutively enrolled patients presenting to the emergency department with symptoms suggestive of COVID-19 between March 23 and May 31, 2020. The final diagnosis that led to the inclusion in the study was adjudicated by physicians after reviewing all available medical data including laboratory test results 30 days after discharge. For this analysis, we compared patients tested positive for SARS-CoV-2 with patients tested negative but with an adjudicated diagnosis of upper or lower respiratory tract infection including pneumonia. Primary outcome measure was death at 30 days, secondary outcomes were AKI incidence, renal recovery and need for renal replacement therapy. AKI was defined according to the serum creatinine criteria of the 2012 KDIGO clinical practice guideline.
Results
Of the 1086 patients included, 507 had a final adjudicated diagnosis of respiratory tract infection and were eligible for this analysis. Of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. Baseline characteristics were comparable between patients with and without COVID-19.
AKI occurred in 95 patients (19%) with a higher incidence (30%, 95%CI 24-37 versus 12%, 95%CI 9-17, p<0.001) and a higher severity (KDIGO stage 3, 22% versus 10%, p=0.003) in patients with COVID-19 as compared to controls, respectively. Need for intensive care (22% versus 6%, p<0.001) and requirement for RRT were higher in patients with COVID-19 (8 patients (4.4%) versus 2 patients (0.62%); p=0.01). Renal recovery at discharge in survivors was similar in patients with (64%) and without COVID-19 (48%, p=0.175). Survival analysis identified AKI as a predictor of 30-day mortality independent of COVID-19 status (adjusted hazard ratio (aHR) 3.44, 95% confidence interval (CI) 1.55-7.63, p=0.002), but COVID-19 patients with AKI carried the highest risk (aHR 4.24, 95%CI 1,82-9.88, p<0.001). (Figure 1)
Conclusion
AKI occurs more frequently and more severely in patients with COVID-19 compared to other respiratory tract infections. It is associated with an increased risk for death, with the highest risk observed in COVID-19 patients. This underlines the augmented burden of AKI during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Matthias Diebold
- University Hospital Basel, Clinic for Transplantation Immunology and Nephrology, Basel, Switzerland
| | - Tobias Zimmermann
- University Hospital Basel, Department of Intensive Care Medicine, Basel, Switzerland
| | - Michael Dickenmann
- University Hospital Basel, Clinic for Transplantation Immunology and Nephrology, Basel, Switzerland
| | - Stefan Schaub
- University Hospital Basel, Clinic for Transplantation Immunology and Nephrology, Basel, Switzerland
| | - Stefano Bassetti
- University Hospital Basel, Division of Internal Medicine, Basel, Switzerland
| | - Martin Siegemund
- University Hospital Basel, Department of Intensive Care Medicine, Basel, Switzerland
| | - Tobias Breidthardt
- University Hospital Basel, Division of Internal Medicine, Basel, Switzerland
| | | |
Collapse
|
44
|
Diebold M, Zimmermann T, Strebel I, Wussler D, Bassetti S, Mueller C, Breidthardt T. MO355ACUTE KIDNEY INJURY INCREASES THE RISK FOR SUBSEQUENT HEART FAILURE HOSPITALIZATIONS. Nephrol Dial Transplant 2021. [DOI: 10.1093/ndt/gfab082.009] [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: 11/12/2022] Open
Abstract
Abstract
Background and Aims
Acute kidney injury (AKI) is common and associated with increased mortality and morbidity. The impact of AKI on subsequent heart failure remains largely unknown.
Method
The Basics in Acute Shortness of Breath Evaluation Study (BaselV) prospectively enrolled patients presenting the emergency department with acute dyspnea. Two independent specialists adjudicated the final cause of dyspnea. Serum creatinine concentrations were prospectively assessed throughout the hospitalization. AKI was defined according to the serum creatinine criteria of the 2012 KDIGO clinical practice guideline. AKI adjudication occurred blinded to the cause of dyspnea. Mortality and rehospitalizations were prospectively assessed during follow-up (median:768 days [IQR:290-950]. Renal recovery was defined as a discharge creatinine<1.25x baseline creatinine.
Results
AKI occurred in 809 (40%) of 2021 patients and was associated with increased all-cause (adjusted Hazard Ratio [aHR] 1.33, 95%CI 1.13-1.55; p<0.01) and cardiovascular mortality (aHR 1.43, 95%CI 1.16-1.75; p<0.01). However, the impact of AKI on mortality was time-dependent with the highest impact on early 30-day mortality (aHR 2.47, 95%CI 1.62-3.76; p<0.01) (Figure 1A). AKI was not associated with all-cause or cardiovascular mortality in patients achieving renal recovery (p=0.10 and p=0.30). In contrast, AKI displayed a time-independent association with subsequent hospitalisations for heart failure (hHF) (aHR 1.49, 95%CI 1.15-1.94; p<0.01) (Figure 1B). The association with hHF was stronger for higher degrees of AKI (stage 2/3 aHR: 1.89; 95%CI 1.33-2.83; p<0.01). This association with hHF persisted in patients with non-cardiac dyspnea (aHR 2.43, 95%CI 1.05-5.59; p=0.04), even after renal recovery (aHR 2.56, 95%CI 1.00-6.54; p=0.05). Again, in patients with non-cardiac dyspnea the association of advanced AKI (stage 2/3) with hHF was even stronger (aHR 4.25, 95%CI 1.59-11.36; p<0.01).
Conclusion
AKI independently increases the risk of hHF by almost 50%. This association persists in patients with non-cardiac dyspnea, even after renal recovery by discharge. This suggests AKI to be a novel risk-factor for the development of clinically significant HF.
Collapse
Affiliation(s)
- Matthias Diebold
- University Hospital Basel, Clinic for Transplantation Immunology and Nephrology, Basel, Switzerland
| | - Tobias Zimmermann
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Ivo Strebel
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Desiree Wussler
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Stefano Bassetti
- University Hospital Basel, Division of Internal Medicine, Basel, Switzerland
| | - Christian Mueller
- University Hospital Basel, Cardiovascular Research Institute Basel, Basel, Switzerland
| | - Tobias Breidthardt
- University Hospital Basel, Division of Internal Medicine, Basel, Switzerland
| |
Collapse
|
45
|
Diebold M, Zimmermann T, Dickenmann M, Schaub S, Bassetti S, Tschudin-Sutter S, Bingisser R, Heim C, Siegemund M, Osswald S, Kuster GM, Rentsch KM, Breidthardt T, Twerenbold R. Comparison of Acute Kidney Injury in Patients with COVID-19 and Other Respiratory Infections: A Prospective Cohort Study. J Clin Med 2021; 10:2288. [PMID: 34070339 PMCID: PMC8197451 DOI: 10.3390/jcm10112288] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 05/10/2021] [Accepted: 05/22/2021] [Indexed: 01/14/2023] Open
Abstract
Previous studies have indicated an association between coronavirus disease 2019 (COVID-19) and acute kidney injury (AKI) but lacked a control group. The prospective observational COronaVIrus-surviVAl (COVIVA) study performed at the University Hospital, Basel, Switzerland consecutively enrolled patients with symptoms suggestive of COVID-19. We compared patients who tested positive for SARS-CoV-2 with patients who tested negative but with an adjudicated diagnosis of a respiratory tract infection, including pneumonia. The primary outcome measure was death at 30 days, and the secondary outcomes were AKI incidence and a composite endpoint of death, intensive care treatment or rehospitalization at 30 days. Five hundred and seven patients were diagnosed with respiratory tract infections, and of those, 183 (36%) had a positive PCR swab test for SARS-CoV-2. The incidence of AKI was higher in patients with COVID-19 (30% versus 12%, p < 0.001), more severe (KDIGO stage 3, 22% versus 13%, p = 0.009) and more often required renal replacement therapy (4.4% versus 0.93%; p = 0.03). The risk of 30-day mortality and a composite endpoint was higher in patients with COVID-19-associated AKI (adjusted hazard ratio (aHR) mortality 3.98, 95% confidence interval (CI) 1.10-14.46, p = 0.036; composite endpoint aHR 1.84, 95% CI 1.02-3.31, p = 0.042). The mortality risk was attenuated when adjusting for disease severity (aHR 3.60, 95% CI 0.93-13.96, p = 0.062). AKI occurs more frequently and with a higher severity in patients with COVID-19 and is associated with worse outcomes.
Collapse
Affiliation(s)
- Matthias Diebold
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.D.); (S.S.)
| | - Tobias Zimmermann
- Department of Intensive Care Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Michael Dickenmann
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.D.); (S.S.)
| | - Stefan Schaub
- Clinic for Transplantation Immunology and Nephrology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (M.D.); (S.S.)
| | - Stefano Bassetti
- Division of Internal Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (S.B.); (T.B.)
| | - Sarah Tschudin-Sutter
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
- Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.B.); (C.H.)
| | - Corin Heim
- Emergency Department, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (R.B.); (C.H.)
| | - Martin Siegemund
- Department of Intensive Care Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
- Department of Clinical Research, University of Basel, 4031 Basel, Switzerland;
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (S.O.); (G.M.K.); (R.T.)
| | - Gabriela M. Kuster
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (S.O.); (G.M.K.); (R.T.)
| | - Katharina M. Rentsch
- Department of Laboratory Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland;
| | - Tobias Breidthardt
- Division of Internal Medicine, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (S.B.); (T.B.)
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, University of Basel, 4031 Basel, Switzerland; (S.O.); (G.M.K.); (R.T.)
- Department of Cardiology and University Center of Cardiovascular Science, University Heart and Vascular Center Hamburg, 20246 Hamburg, Germany
| |
Collapse
|
46
|
Beck K, Vincent A, Becker C, Keller A, Cam H, Schaefert R, Reinhardt T, Sutter R, Tisljar K, Bassetti S, Schuetz P, Hunziker S. Prevalence and factors associated with psychological burden in COVID-19 patients and their relatives: A prospective observational cohort study. PLoS One 2021; 16:e0250590. [PMID: 33951085 PMCID: PMC8099094 DOI: 10.1371/journal.pone.0250590] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 04/11/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Due to the dramatic measures accompanying isolation and the general uncertainty and fear associated with COVID-19, patients and relatives may be at high risk for adverse psychological outcomes. Until now there has been limited research focusing on the prevalence of psychological distress and associated factors in COVID-19 patients and their relatives. The objective of our study was to assess psychological distress in COVID-19 patients and their relatives 30 days after hospital discharge. METHODS In this prospective observational cohort study at two Swiss tertiary-care hospitals we included consecutive adult patients hospitalized between March and June 2020 for a proven COVID-19 and their relatives. Psychological distress was defined as symptoms of anxiety and/or depression measured with the Hospital Anxiety and Depression Scale (HADS), i.e., a score of ≥8 on the depression and/or anxiety subscale. We further evaluated symptoms of post-traumatic stress disorder (PTSD), defined as a score of ≥1.5 on the Impact of Event Scale-Revised (IES-R). RESULTS Among 126 included patients, 24 (19.1%) had psychological distress and 10 (8.7%) had symptoms of PTSD 30 days after hospital discharge. In multivariate logistic regression analyses three factors were independently associated with psychological distress in patients: resilience (OR 0.82; 95%CI 0.71 to 0.94; p = 0.005), high levels of perceived stress (OR 1.21; 95%CI 1.06 to 1.38; p = 0.006) and low frequency of contact with relatives (OR 7.67; 95%CI 1.42 to 41.58; p = 0.018). The model showed good discrimination, with an area under the receiver-operating characteristic curve (AUC) of 0.92. Among 153 relatives, 35 (22.9%) showed symptoms of psychological distress, and 3 (2%) of PTSD. For relatives, resilience was negatively associated (OR 0.85; 95%CI 0.75 to 0.96; p = 0.007), whereas perceived overall burden caused by COVID-19 was positively associated with psychological distress (OR 1.72; 95%CI 1.31 to 2.25; p<0.001). The overall model also had good discrimination, with an AUC of 0.87. CONCLUSION A relevant number of COVID-19 patients as well as their relatives exhibited psychological distress 30 days after hospital discharge. These results might aid in development of strategies to prevent psychological distress in COVID-19 patients and their relatives.
Collapse
Affiliation(s)
- Katharina Beck
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Alessia Vincent
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Division of Clinical Psychology and Psychotherapy, Faculty of Psychology, University of Basel, Basel, Switzerland
| | - Christoph Becker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Annalena Keller
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Hasret Cam
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
| | - Rainer Schaefert
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| | - Thomas Reinhardt
- Human Resources & Leadership Development, University Hospital Basel, Basel, Switzerland
| | - Raoul Sutter
- Medical Faculty of the University of Basel, Basel, Switzerland
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
- Department of Clinical Research, University Hospital Basel, Basel, Switzerland
| | - Kai Tisljar
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Medical Faculty of the University of Basel, Basel, Switzerland
- Division of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Philipp Schuetz
- Medical Faculty of the University of Basel, Basel, Switzerland
- Division of Internal Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Sabina Hunziker
- Medical Communication and Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Department for Psychosomatic Medicine, University Hospital Basel, Basel, Switzerland
- Medical Faculty of the University of Basel, Basel, Switzerland
| |
Collapse
|
47
|
Atila C, Sailer CO, Bassetti S, Tschudin-Sutter S, Bingisser R, Siegemund M, Osswald S, Rentsch K, Rueegg M, Schaerli S, Kuster GM, Twerenbold R, Christ-Crain M. Prevalence and outcome of dysnatremia in patients with COVID-19 compared to controls. Eur J Endocrinol 2021; 184:409-418. [PMID: 33449918 PMCID: PMC9494345 DOI: 10.1530/eje-20-1374] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/12/2021] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The pandemic of coronavirus disease (COVID-19) has rapidly spread globally and infected millions of people. The prevalence and prognostic impact of dysnatremia in COVID-19 is inconclusive. Therefore, we investigated the prevalence and outcome of dysnatremia in COVID-19. DESIGN The prospective, observational, cohort study included consecutive patients with clinical suspicion of COVID-19 triaged to a Swiss Emergency Department between March and July 2020. METHODS Collected data included clinical, laboratory and disease severity scoring parameters on admission. COVID-19 cases were identified based on a positive nasopharyngeal swab test for SARS-CoV-2, patients with a negative swab test served as controls. The primary analysis was to assess the prognostic impact of dysnatremia on 30-day mortality using a cox proportional hazard model. RESULTS 172 (17%) cases with COVID-19 and 849 (83%) controls were included. Patients with COVID-19 showed a higher prevalence of hyponatremia compared to controls (28.1% vs 17.5%, P < 0.001); while comparable for hypernatremia (2.9% vs 2.1%, P = 0.34). In COVID-19 but not in controls, hyponatremia was associated with a higher 30-day mortality (HR: 1.4, 95% CI: 1.10-16.62, P = 0.05). In both groups, hypernatremia on admission was associated with higher 30-day mortality (COVID-19 - HR: 11.5, 95% CI: 5.00-26.43, P < 0.001; controls - HR: 5.3, 95% CI: 1.60-17.64, P = 0.006). In both groups, hyponatremia and hypernatremia were significantly associated with adverse outcome, for example, intensive care unit admission, longer hospitalization and mechanical ventilation. CONCLUSION Our results underline the importance of dysnatremia as predictive marker in COVID-19. Treating physicians should be aware of appropriate treatment measures to be taken for patients with COVID-19 and dysnatremia.
Collapse
Affiliation(s)
- Cihan Atila
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Clara O Sailer
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Department of Clinical Research, Basel, Switzerland
| | - Stefano Bassetti
- Department of Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- University of Basel, Department of Clinical Research, Basel, Switzerland
- Division of Infectious Disease & Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Department of Intensive Care, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Katharina Rentsch
- Department of Laboratory Medicine, University Hospital Basel, Basel, Switzerland
| | - Marco Rueegg
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Sabrina Schaerli
- Emergency Department, University Hospital Basel, Basel, Switzerland
| | - Gabriela M Kuster
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Raphael Twerenbold
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
- Correspondence should be addressed to R Twerenbold;
| | - Mirjam Christ-Crain
- Department of Endocrinology, Diabetology and Metabolism, University Hospital Basel, Basel, Switzerland
- University of Basel, Department of Clinical Research, Basel, Switzerland
- Correspondence should be addressed to M Christ-Crain;
| |
Collapse
|
48
|
Stange M, Mari A, Roloff T, Seth-Smith HMB, Schweitzer M, Brunner M, Leuzinger K, Søgaard KK, Gensch A, Tschudin-Sutter S, Fuchs S, Bielicki J, Pargger H, Siegemund M, Nickel CH, Bingisser R, Osthoff M, Bassetti S, Schneider-Sliwa R, Battegay M, Hirsch HH, Egli A. SARS-CoV-2 outbreak in a tri-national urban area is dominated by a B.1 lineage variant linked to a mass gathering event. PLoS Pathog 2021; 17:e1009374. [PMID: 33740028 PMCID: PMC8011817 DOI: 10.1371/journal.ppat.1009374] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 03/31/2021] [Accepted: 02/12/2021] [Indexed: 12/18/2022] Open
Abstract
The first case of SARS-CoV-2 in Basel, Switzerland was detected on February 26th 2020. We present a phylogenetic study to explore viral introduction and evolution during the exponential early phase of the local COVID-19 outbreak from February 26th until March 23rd. We sequenced SARS-CoV-2 naso-oropharyngeal swabs from 746 positive tests that were performed at the University Hospital Basel during the study period. We successfully generated 468 high quality genomes from unique patients and called variants with our COVID-19 Pipeline (COVGAP), and analysed viral genetic diversity using PANGOLIN taxonomic lineages. To identify introduction and dissemination events we incorporated global SARS-CoV-2 genomes and inferred a time-calibrated phylogeny. Epidemiological data from patient questionnaires was used to facilitate the interpretation of phylogenetic observations. The early outbreak in Basel was dominated by lineage B.1 (83·6%), detected first on March 2nd, although the first sample identified belonged to B.1.1. Within B.1, 68·2% of our samples fall within a clade defined by the SNP C15324T ('Basel cluster'), including 157 identical sequences at the root of the 'Basel cluster', some of which we can specifically trace to regional spreading events. We infer the origin of B.1-C15324T to mid-February in our tri-national region. The other genomes map broadly over the global phylogenetic tree, showing several introduction events from and/or dissemination to other regions of the world via travellers. Family transmissions can also be traced in our data. A single lineage variant dominated the outbreak in the Basel area while other lineages, such as the first (B.1.1), did not propagate. A mass gathering event was the predominant initial source of cases, with travel returners and family transmissions to a lesser extent. We highlight the importance of adding specific questions to epidemiological questionnaires, to obtain data on attendance of large gatherings and their locations, as well as travel history, to effectively identify routes of transmissions in up-coming outbreaks. This phylogenetic analysis in concert with epidemiological and contact tracing data, allows connection and interpretation of events, and can inform public health interventions. Trial Registration: ClinicalTrials.gov NCT04351503.
Collapse
Affiliation(s)
- Madlen Stange
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Alfredo Mari
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Tim Roloff
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Helena MB Seth-Smith
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Swiss Institute for Bioinformatics, Basel, Switzerland
| | - Michael Schweitzer
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Myrta Brunner
- Human Geography, University of Basel, Basel, Switzerland
| | - Karoline Leuzinger
- Clinical Virology, University Hospital Basel, Basel, Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Kirstine K. Søgaard
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| | - Alexander Gensch
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Simon Fuchs
- Health Services for the City of Basel, Basel, Switzerland
| | - Julia Bielicki
- Pediatric Infectious Diseases, University Children’s Hospital Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | - Martin Siegemund
- Intensive Care Unit, University Hospital Basel, Basel, Switzerland
| | | | - Roland Bingisser
- Emergency Medicine, University Hospital Basel, Basel, Switzerland
| | - Michael Osthoff
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Manuel Battegay
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Hans H. Hirsch
- Clinical Virology, University Hospital Basel, Basel, Switzerland
- Transplantation & Clinical Virology, Department of Biomedicine, University of Basel, Basel, Switzerland
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Adrian Egli
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
| |
Collapse
|
49
|
Stadler RN, Maurer L, Aguilar-Bultet L, Franzeck F, Ruchti C, Kühl R, Widmer AF, Schindler R, Bingisser R, Rentsch KM, Pargger H, Sutter R, Steiner L, Meier C, Kübler W, Hirsch HH, Egli A, Battegay M, Bassetti S, Tschudin-Sutter S. Systematic screening on admission for SARS-CoV-2 to detect asymptomatic infections. Antimicrob Resist Infect Control 2021; 10:44. [PMID: 33640031 PMCID: PMC7912536 DOI: 10.1186/s13756-021-00912-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 01/24/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022] Open
Abstract
The proportion of asymptomatic carriers of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) remains elusive and the potential benefit of systematic screening during the SARS-CoV-2-pandemic is controversial. We investigated the proportion of asymptomatic inpatients who were identified by systematic screening for SARS-CoV-2 upon hospital admission. Our analysis revealed that systematic screening of asymptomatic inpatients detects a low total number of SARS-CoV-2 infections (0.1%), questioning the cost-benefit ratio of this intervention. Even when the population-wide prevalence was low, the proportion of asymptomatic carriers remained stable, supporting the need for universal infection prevention and control strategies to avoid onward transmission by undetected SARS-CoV-2-carriers during the pandemic.
Collapse
Affiliation(s)
- Rahel N Stadler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Laura Maurer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Lisandra Aguilar-Bultet
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Fabian Franzeck
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Chantal Ruchti
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Richard Kühl
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Andreas F Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Ruth Schindler
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Roland Bingisser
- Emergency Department, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Katharina M Rentsch
- Laboratory Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hans Pargger
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Raoul Sutter
- Intensive Care Unit, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Luzius Steiner
- Anesthesiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Christoph Meier
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Werner Kübler
- University Hospital Basel, University of Basel, Basel, Switzerland
| | - Hans H Hirsch
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,Clinical Virology, Laboratory Medicine, University Hospital Basel, Basel, Switzerland.,Transplantation and Clinical Virology, Department Biomedicine, University of Basel, Basel, Switzerland
| | - Adrian Egli
- Clinical Microbiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland
| | - Stefano Bassetti
- Internal Medicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,Department of Clinical Research, University Hospital Basel, University of Basel, Basel, Switzerland.
| |
Collapse
|
50
|
Gehringer C, Regeniter A, Rentsch K, Tschudin-Sutter S, Bassetti S, Egli A. Accuracy of urine flow cytometry and urine test strip in predicting relevant bacteriuria in different patient populations. BMC Infect Dis 2021; 21:209. [PMID: 33632129 PMCID: PMC7908726 DOI: 10.1186/s12879-021-05893-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/16/2020] [Accepted: 02/12/2021] [Indexed: 11/11/2022] Open
Abstract
Background Urinary tract infection (UTI) is diagnosed combining urinary symptoms with demonstration of urine culture growth above a given threshold. Our aim was to compare the diagnostic accuracy of Urine Flow Cytometry (UFC) with urine test strip in predicting bacterial growth and in identifying contaminated urine samples, and to derive an algorithm to identify relevant bacterial growth for clinical use. Methods Species identification and colony-forming unit (CFU/ml) quantification from bacterial cultures were matched to corresponding cellular (leucocytes/epithelial cells) and bacteria counts per μl. Results comprise samples analysed between 2013 and 2015 for which urine culture (reference standard) and UFC and urine test strip data (index tests, Sysmex UX-2000) were available. Results 47,572 urine samples of 26,256 patients were analysed. Bacteria counts used to predict bacterial growth of ≥105 CFU/ml showed an accuracy with an area under the receiver operating characteristic curve of > 93% compared to 82% using leukocyte counts. The relevant bacteriuria rule-out cut-off of 50 bacteria/μl reached a negative predictive value of 98, 91 and 89% and the rule-in cut-off of 250 bacteria/μl identified relevant bacteriuria with an overall positive predictive value of 67, 72 and 73% for microbiologically defined bacteriuria thresholds of 105, 104 or 103 CFU/ml, respectively. Measured epithelial cell counts by UFC could not identify contaminated urine. Conclusions Prediction of a relevant bacterial growth by bacteria counts was most accurate and was a better predictor than leucocyte counts independently of the source of the urine and the medical specialty ordering the test (medical, surgical or others). Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-05893-3.
Collapse
Affiliation(s)
- Christian Gehringer
- University Hospital Basel, Division of Internal Medicine, University of Basel, Basel, Switzerland.,University Hospital Basel, Division of Clinical Bacteriology and Mycology, University of Basel, Petersgraben 4, 4031, Basel, Switzerland.,University Hospital Basel, Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Axel Regeniter
- Current affiliation: Medica Medical Laboratories Dr. F. Käppeli, Wolfbachstrasse 17, Zurich, Switzerland
| | - Katharina Rentsch
- University Hospital Basel, Division of Clinical Chemistry, University of Basel, Basel, Switzerland
| | - Sarah Tschudin-Sutter
- Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Stefano Bassetti
- University Hospital Basel, Division of Internal Medicine, University of Basel, Basel, Switzerland.,University Hospital Basel, Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Adrian Egli
- University Hospital Basel, Division of Clinical Bacteriology and Mycology, University of Basel, Petersgraben 4, 4031, Basel, Switzerland. .,University Hospital Basel, Department of Clinical Research, University of Basel, Basel, Switzerland. .,Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland.
| |
Collapse
|