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Haller S, Babouee Flury B. Zoonotic poxvirus lesions vs mosquito bite lesions: differential diagnosis of the uncommon vs the common. J Travel Med 2023; 30:taad064. [PMID: 37133452 DOI: 10.1093/jtm/taad064] [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: 04/05/2023] [Revised: 04/20/2023] [Accepted: 04/22/2023] [Indexed: 05/04/2023]
Abstract
A returning traveller presents with skin lesions resembling an orthopox virus infection and a history of animal contact. Despite the suggestive presentation, polymerase chain reaction (PCR) rules out this rare differential diagnosis. The clinical course and histologic analysis lead to the diagnosis of insect bites; a common traveller’s affliction with an unusual presentation.
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Affiliation(s)
- Sabine Haller
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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2
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Bösch A, Macha ME, Ren Q, Kohler P, Qi W, Babouee Flury B. Resistance development in Escherichia coli to delafloxacin at pHs 6.0 and 7.3 compared to ciprofloxacin. Antimicrob Agents Chemother 2023; 67:e0162522. [PMID: 37882542 PMCID: PMC10649057 DOI: 10.1128/aac.01625-22] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 09/08/2023] [Indexed: 10/27/2023] Open
Abstract
Understanding the resistance mechanisms of antibiotics in the micro-environment of the infection is important to assess their clinical applicability and potentially prevent resistance development. We compared the laboratory resistance evolution of Escherichia coli to delafloxacin (DLX) compared to ciprofloxacin (CIP), the co-resistance evolution, and underlying resistance mechanisms at different pHs. Three clones from each of the eight clinical E. coli isolates were subjected to subinhibitory concentrations of DLX or CIP in parallel at either pH 7.3 or 6.0. Minimum inhibitory concentrations (MICs) were regularly tested (at respective pHs), and the antibiotic concentration was adjusted accordingly. After 30 passages, MICs were determined in the presence of the efflux pump inhibitor phenylalanine-arginine-β-naphthylamide. Whole genome sequencing of the parental isolates and their resistant derivatives (n = 54) was performed. Complementation assays were carried out for selected mutations. Quantitative PCR and efflux experiments were carried out for selected derivatives. For DLX-challenged strains, resistance to DLX evolved much slower in acidic than in neutral pH, whereas for CIP-challenged strains, the opposite was the case. Mutations in the quinolone resistance-determining region were mainly seen in CIP-challenged E. coli, whereas a multifactorial mechanism including mutations in efflux-related genes played a role in DLX resistance evolution (predominantly at pH 6.0). This work provides novel insights into the resistance mechanisms of E. coli to delafloxacin and highlights the importance of understanding micro-environmental conditions at the infection site that might affect the true clinical efficacy of antibiotics and challenges our current antibiotic susceptibility-testing paradigm.
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Affiliation(s)
- Anja Bösch
- Medical Research Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Magreth E. Macha
- Medical Research Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
- St. Francis University College of Health and Allied Sciences, Morogoro, Tanzania
| | - Qun Ren
- Laboratory for Biointerfaces, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Weihong Qi
- Functional Genomics Center Zurich, University of Zurich, ETH Zurich, Zurich, Switzerland
| | - Baharak Babouee Flury
- Medical Research Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
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Bilal M, Zoller M, Fuhr U, Jaehde U, Ullah S, Liebchen U, Büsker S, Zander J, Babouee Flury B, Taubert M. Cefepime Population Pharmacokinetics, Antibacterial Target Attainment, and Estimated Probability of Neurotoxicity in Critically Ill Patients. Antimicrob Agents Chemother 2023; 67:e0030923. [PMID: 37366614 PMCID: PMC10353438 DOI: 10.1128/aac.00309-23] [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: 03/08/2023] [Accepted: 06/01/2023] [Indexed: 06/28/2023] Open
Abstract
Cefepime has been reported to cause concentration-related neurotoxicity, especially in critically ill patients with renal failure. This evaluation aimed to identify a dosing regimen providing a sufficient probability of target attainment (PTA) and the lowest justifiable risk of neurotoxicity in critically ill patients. A population pharmacokinetic model was developed based on plasma concentrations over four consecutive days obtained from 14 intensive care unit (ICU) patients. The patients received a median dose of 2,000 mg cefepime by 30-min intravenous infusions with dosing intervals of every 8 h (q8h) to q24h. A time that the free drug concentration exceeds the MIC over the dosing interval (fT>MIC) of 65% and an fT>2×MIC of 100% were defined as treatment targets. Monte Carlo simulations were carried out to identify a dosing regimen for a PTA of 90% and a probability of neurotoxicity not exceeding 20%. A two-compartment model with linear elimination best described the data. Estimated creatinine clearance was significantly related to the clearance of cefepime in nondialysis patients. Interoccasion variability on clearance improved the model, reflecting dynamic clearance changes. The evaluations suggested combining thrice-daily administration as an appropriate choice. In patients with normal renal function (creatinine clearance, 120 mL/min), for the pharmacodynamics target of 100% fT>2×MIC and a PTA of 90%, a dose of 1,333 mg q8h was found to be related to a probability of neurotoxicity of ≤20% and to cover MICs up to 2 mg/L. Continuous infusion appears to be superior to other dosing regimens by providing higher efficacy and a low risk of neurotoxicity. The model makes it possible to improve the predicted balance between cefepime efficacy and neurotoxicity in critically ill patients. (This study has been registered at ClinicalTrials.gov under registration no. NCT01793012).
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Affiliation(s)
- Muhammad Bilal
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | - Michael Zoller
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Uwe Fuhr
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
| | - Ulrich Jaehde
- Department of Clinical Pharmacy, Institute of Pharmacy, University of Bonn, Bonn, Germany
| | - Sami Ullah
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
| | - Uwe Liebchen
- Department of Anaesthesiology, Hospital of the Ludwig Maximilians University of Munich, Munich, Germany
| | - Sören Büsker
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
| | | | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Max Taubert
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Center for Pharmacology, Department I of Pharmacology, Cologne, Germany
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Kohler P, Babouee Flury B, Güsewell S, Egger T, Leal O, Brucher A, Lemmenmeier E, Meier Kleeb D, Möller JC, Ortner M, Rieder P, Ruetti M, Schmid H, Stocker R, Vuichard‐Gysin D, Speer O, Wiggli B, Besold U, McGeer A, Risch L, Friedl A, Schlegel M, Vernazza P, Kahlert CR, Kuster SP. Clinical symptoms of SARS-CoV-2 breakthrough infection during the Omicron period in relation to baseline immune status and booster vaccination-A prospective multicentre cohort of health professionals (SURPRISE study). Influenza Other Respir Viruses 2023; 17:e13167. [PMID: 37346094 PMCID: PMC10279996 DOI: 10.1111/irv.13167] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
The effects of different types of pre-existing immunity on the frequency of clinical symptoms caused by the SARS-CoV-2 breakthrough infection were prospectively assessed in healthcare workers during the Omicron period. Among 518 participants, hybrid immunity was associated with symptom reduction for dizziness, muscle or limb pain and headache as compared to vaccination only. Moreover, the frequencies of dizziness, cough and muscle or limb pain were lower in participants who had received a booster vaccine dose. Thus, hybrid immunity appeared to be superior in preventing specific symptoms during breakthrough infection compared to vaccination alone. A booster vaccine dose conferred additional symptom reduction.
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Affiliation(s)
- Philipp Kohler
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Sabine Güsewell
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Thomas Egger
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Onicio Leal
- EpitrackRecifeBrazil
- Department of EconomicsUniversity of ZurichZurichSwitzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St. Gallen (South)PfäfersSwitzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and PsychotherapyLittenheidSwitzerland
| | | | | | - Manuela Ortner
- Rheintal Werdenberg Sarganserland Hospital GroupGrabsSwitzerland
| | | | - Markus Ruetti
- Fuerstenland Toggenburg Hospital GroupWilSwitzerland
| | | | | | - Danielle Vuichard‐Gysin
- Division of Infectious Diseases and Hospital EpidemiologyThurgau Hospital GroupMuensterlingenSwitzerland
| | - Oliver Speer
- Thurgau Hospital GroupInstitute for Laboratory MedicineMuensterlingenSwitzerland
| | - Benedikt Wiggli
- Division of Infectious Diseases and Hospital EpidemiologyKantonsspital BadenBadenSwitzerland
| | | | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AGBuchsSwitzerland
- Private Universität im Fürstentum LiechtensteinTriesenLiechtenstein
- Center of Laboratory MedicineUniversity Institute of Clinical Chemistry, University of Bern, InselspitalBernSwitzerland
| | - Andrée Friedl
- Thurgau Hospital GroupInstitute for Laboratory MedicineMuensterlingenSwitzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Christian R. Kahlert
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
- Department of Infectious Diseases and Hospital EpidemiologyChildren's Hospital of Eastern SwitzerlandSt. GallenSwitzerland
| | - Stefan P. Kuster
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
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Babouee Flury B, Bösch A, Gisler V, Egli A, Seiffert SN, Nolte O, Findlay J. Multifactorial resistance mechanisms associated with resistance to ceftazidime-avibactam in clinical Pseudomonas aeruginosa isolates from Switzerland. Front Cell Infect Microbiol 2023; 13:1098944. [PMID: 37180441 PMCID: PMC10166991 DOI: 10.3389/fcimb.2023.1098944] [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: 11/15/2022] [Accepted: 04/05/2023] [Indexed: 05/16/2023] Open
Abstract
Background Increasing reports of multidrug resistance (MDR) in clinical Pseudomonas aeruginosa have led to a necessity for new antimicrobials. Ceftazidime-avibactam (CZA) is indicated for use against MDR P. aeruginosa across a broad range of infection types and particularly those that are carbapenem resistant. This study sought to determine the molecular mechanisms of CZA and imipenem (IPM)-resistance in clinical P. aeruginosa isolates obtained from Swiss hospitals. Methods Clinical P. aeruginosa isolates were obtained from inpatients in three hospitals in Switzerland. Susceptibility was determined by either antibiotic disc testing or broth microdilution according to EUCAST methodology. AmpC activity was determined using cloxacillin and efflux activity was determined using phenylalanine-arginine β-naphthylamide, in agar plates. Whole Genome Sequencing was performed on 18 clinical isolates. Sequence types (STs) and resistance genes were ascertained using the Centre for Genomic Epidemiology platform. Genes of interest were extracted from sequenced isolates and compared to reference strain P. aeruginosa PAO1. Results Sixteen different STs were identified amongst the 18 isolates in this study indicating a high degree of genomic diversity. No carbapenemases were detected but one isolate did harbor the ESBL bla PER-1. Eight isolates were CZA-resistant with MICs ranging from 16-64 mg/L, and the remaining ten isolates had either low/wildtype MICs (n=6; 1-2 mg/L) or elevated, but still susceptible, MICs (n=4; 4-8 mg/L). Ten isolates were IPM-resistant, seven of which had mutations resulting in truncations of OprD, and the remaining nine IPM-susceptible isolates had intact oprD genes. Within CZA-R isolates, and those with reduced susceptibility, mutations resulting in ampC derepression, OprD loss, mexAB overexpression and ESBL (bla PER-1) carriage were observed in various combinations and one harbored a truncation of the PBP4 dacB gene. Within the six isolates with wildtype-resistance levels, five had no mutations that would affect any antimicrobial resistance (AMR) genes of interest when compared to PAO1. Conclusion This preliminary study highlights that CZA-resistance in P. aeruginosa is multifactorial and could be caused by the interplay between different resistance mechanisms including ESBL carriage, increased efflux, loss of permeability and derepression of its intrinsic ampC.
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Affiliation(s)
- Baharak Babouee Flury
- Medical Research Center, Kantonspital St. Gallen, St. Gallen, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Anja Bösch
- Medical Research Center, Kantonspital St. Gallen, St. Gallen, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Valentin Gisler
- Clinic of Infectious Diseases and Hospital Hygiene, Kantonsspital Aarau, Aarau, Switzerland
- Department of Microbiology, Institute for Laboratory Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Adrian Egli
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
| | - Salome N. Seiffert
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Oliver Nolte
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | - Jacqueline Findlay
- Medical and Molecular Microbiology, Faculty of Science and Medicine, University of Fribourg, Fribourg, Switzerland
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Babouee Flury B, Güsewell S, Egger T, Leal O, Brucher A, Lemmenmeier E, Meier Kleeb D, Möller JC, Rieder P, Rütti M, Schmid HR, Stocker R, Vuichard-Gysin D, Wiggli B, Besold U, McGeer A, Risch L, Friedl A, Schlegel M, Kuster SP, Kahlert CR, Kohler P. Risk and symptoms of COVID-19 in health professionals according to baseline immune status and booster vaccination during the Delta and Omicron waves in Switzerland-A multicentre cohort study. PLoS Med 2022; 19:e1004125. [PMID: 36342956 PMCID: PMC9678290 DOI: 10.1371/journal.pmed.1004125] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/21/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Knowledge about protection conferred by previous Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and/or vaccination against emerging viral variants allows clinicians, epidemiologists, and health authorities to predict and reduce the future Coronavirus Disease 2019 (COVID-19) burden. We investigated the risk and symptoms of SARS-CoV-2 (re)infection and vaccine breakthrough infection during the Delta and Omicron waves, depending on baseline immune status and subsequent vaccinations. METHODS AND FINDINGS In this prospective, multicentre cohort performed between August 2020 and March 2022, we recruited hospital employees from ten acute/nonacute healthcare networks in Eastern/Northern Switzerland. We determined immune status in September 2021 based on serology and previous SARS-CoV-2 infections/vaccinations: Group N (no immunity); Group V (twice vaccinated, uninfected); Group I (infected, unvaccinated); Group H (hybrid: infected and ≥1 vaccination). Date and symptoms of (re)infections and subsequent (booster) vaccinations were recorded until March 2022. We compared the time to positive SARS-CoV-2 swab and number of symptoms according to immune status, viral variant (i.e., Delta-dominant before December 27, 2021; Omicron-dominant on/after this date), and subsequent vaccinations, adjusting for exposure/behavior variables. Among 2,595 participants (median follow-up 171 days), we observed 764 (29%) (re)infections, thereof 591 during the Omicron period. Compared to group N, the hazard ratio (HR) for (re)infection was 0.33 (95% confidence interval [CI] 0.22 to 0.50, p < 0.001) for V, 0.25 (95% CI 0.11 to 0.57, p = 0.001) for I, and 0.04 (95% CI 0.02 to 0.10, p < 0.001) for H in the Delta period. HRs substantially increased during the Omicron period for all groups; in multivariable analyses, only belonging to group H was associated with protection (adjusted HR [aHR] 0.52, 95% CI 0.35 to 0.77, p = 0.001); booster vaccination was associated with reduction of breakthrough infection risk in groups V (aHR 0.68, 95% CI 0.54 to 0.85, p = 0.001) and H (aHR 0.67, 95% CI 0.45 to 1.00, p = 0.048), largely observed in the early Omicron period. Group H (versus N, risk ratio (RR) 0.80, 95% CI 0.66 to 0.97, p = 0.021) and participants with booster vaccination (versus nonboosted, RR 0.79, 95% CI 0.71 to 0.88, p < 0.001) reported less symptoms during infection. Important limitations are that SARS-CoV-2 swab results were self-reported and that results on viral variants were inferred from the predominating strain circulating in the community at that time, rather than sequencing. CONCLUSIONS Our data suggest that hybrid immunity and booster vaccination are associated with a reduced risk and reduced symptom number of SARS-CoV-2 infection during Delta- and Omicron-dominant periods. For previously noninfected individuals, booster vaccination might reduce the risk of symptomatic Omicron infection, although this benefit seems to wane over time.
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Affiliation(s)
- Baharak Babouee Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Sabine Güsewell
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Thomas Egger
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Onicio Leal
- Epitrack, Recife, Brazil
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St. Gallen (South), St Gallen, Switzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | | | | | | | - Markus Rütti
- Fuerstenland Toggenburg Hospital Group, Wil, Switzerland
| | | | | | - Danielle Vuichard-Gysin
- Thurgau Hospital Group, Division of Infectious Diseases and Hospital Epidemiology, Muensterlingen, Switzerland
| | - Benedikt Wiggli
- Kantonsspital Baden, Division of Infectious Diseases and Hospital Epidemiology, Baden, Switzerland
| | - Ulrike Besold
- Geriatric Clinic St. Gallen, St. Gallen, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Andrée Friedl
- Kantonsspital Baden, Division of Infectious Diseases and Hospital Epidemiology, Baden, Switzerland
| | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Stefan P. Kuster
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- Children’s Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
- * E-mail: (CRK); (PK)
| | - Philipp Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- * E-mail: (CRK); (PK)
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Kusejko K, Tschumi N, Chaudron SE, Nguyen H, Battegay M, Bernasconi E, Böni J, Huber M, Calmy A, Cavassini M, Egle A, Grabmeier-Pfistershammer K, Haas B, Hirsch H, Klimkait T, Öllinger A, Perreau M, Ramette A, Flury BB, Sarcletti M, Scherrer A, Schmid P, Yerly S, Zangerle R, Günthard HF, Kouyos RD. Similar But Different: Integrated Phylogenetic Analysis of Austrian and Swiss HIV-1 Sequences Reveal Differences in Transmission Patterns of the Local HIV-1 Epidemics. J Acquir Immune Defic Syndr 2022; 90:e4-e12. [PMID: 35298446 PMCID: PMC9394492 DOI: 10.1097/qai.0000000000002949] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Phylogenetic analyses of 2 or more countries allow to detect differences in transmission dynamics of local HIV-1 epidemics beyond differences in demographic characteristics. METHODS A maximum-likelihood phylogenetic tree was built using pol -sequences of the Swiss HIV Cohort Study (SHCS) and the Austrian HIV Cohort Study (AHIVCOS), with international background sequences. Three types of phylogenetic cherries (clusters of size 2) were analyzed further: (1) domestic cherries; (2) international cherries; and (3) SHCS/AHIVCOS-cherries. Transmission group and ethnicities observed within the cherries were compared with the respective distribution expected from a random distribution of patients on the phylogeny. RESULTS The demographic characteristics of the AHIVCOS (included patients: 3'141) and the SHCS (included patients: 12'902) are very similar. In the AHIVCOS, 36.5% of the patients were in domestic cherries, 8.3% in international cherries, and 7.0% in SHCS/AHIVCOS cherries. Similarly, in the SHCS, 43.0% of the patients were in domestic cherries, 8.2% in international cherries, and 1.7% in SHCS/AHIVCOS cherries. Although international cherries in the SHCS were dominated by heterosexuals with men who have sex with men being underrepresented, the opposite was the case for the AHIVCOS. In both cohorts, cherries with one patient belonging to the transmission group intravenous drug user and the other one non-intravenous drug user were underrepresented. CONCLUSIONS In both cohorts, international HIV transmission plays a major role in the local epidemics, mostly driven by men who have sex with men in the AHIVOS, and by heterosexuals in the SHCS, highlighting the importance of international collaborations to understand global HIV transmission links on the way to eliminate HIV.
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Affiliation(s)
- Katharina Kusejko
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Nadine Tschumi
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
- Department of Clinical Research, University of Basel, Basel, Switzerland
| | - Sandra E. Chaudron
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Huyen Nguyen
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Manuel Battegay
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Enos Bernasconi
- Division of Infectious Diseases, Regional Hospital Lugano, University of Geneva and University of Southern Switzerland, Lugano, Switzerland
| | - Jürg Böni
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Alexandra Calmy
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Matthias Cavassini
- Division of Infectious Diseases, Lausanne University Hospital, Lausanne, Switzerland
| | - Alexander Egle
- Department of Internal Medicine III with Haematology, Medical Oncology, Haemostaseology, Infectiology and Rheumatology, Oncologic Center, Paracelsus Medical University, Salzburg, Austria
| | | | - Bernhard Haas
- Institute of Hospital Hygiene and Microbiology, Styrian Hospital Corporation, The Styrian Healthcare Company, Graz, Austria
| | - Hans Hirsch
- Molecular Virology, Department of Biomedicine–Petersplatz, University of Basel, Basel, Switzerland
| | - Thomas Klimkait
- Molecular Virology, Department of Biomedicine–Petersplatz, University of Basel, Basel, Switzerland
| | - Angela Öllinger
- Department of Dermatology, Kepler University Hospital, Linz, Austria
| | - Matthieu Perreau
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Alban Ramette
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St. Gallen, Switzerland; and
| | - Mario Sarcletti
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Scherrer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Patrick Schmid
- Division of Infectious Diseases, Cantonal Hospital St Gallen, St. Gallen, Switzerland; and
| | - Sabine Yerly
- Laboratory of Virology and Division of Infectious Diseases, Geneva University Hospital, University of Geneva, Geneva, Switzerland
| | - Robert Zangerle
- Department of Dermatology, Venereology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Huldrych F. Günthard
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Roger D. Kouyos
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
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Hachfeld A, Atkinson A, Stute P, Calmy A, Tarr PE, Darling K, Babouee Flury B, Polli C, Sultan-Beyer L, Abela IA, Aebi-Popp K. Women with HIV transitioning through menopause: Insights from the Swiss HIV Cohort Study (SHCS). HIV Med 2022; 23:417-425. [PMID: 35194949 PMCID: PMC9306735 DOI: 10.1111/hiv.13255] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 11/30/2022]
Abstract
Objectives We aimed to assess prevalence and age at menopause, identify factors associated with early menopause and explore the provision and utilization of healthcare in women living with HIV in Switzerland. Methods This was a retrospective Swiss HIV Cohort Study analysis from January 2010 to December 2018. Descriptive statistics to characterise the population and menopause onset. Logistic regression analysis to identify risk factors for early menopause. Results Of all women in the SHCS, the proportion of postmenopausal women tripled from 11.5% (n = 274) in 2010 to 36.1% (n = 961) in 2018. The median age at menopause was 50 years. Early menopause (< 45 years) occurred in 115 (10.2%) women and premature ovarian insufficiency (POI) (< 40 years) in 23 (2%) women. Early menopause was associated with black ethnicity (52.2% vs. 21.6%, p < 0.001), but not with HIV acquisition mode, CDC stage, viral suppression, CD4 cell count, hepatitis C, smoking or active drug use. While 92% of the postmenopausal women underwent a gynaecological examination during the 36 months before menopause documentation, only 27% received a bone mineral density measurement within 36 months after the last bleed and 11% were on hormone replacement therapy at the time of menopause documentation. Conclusions The median age of women living with HIV at menopause is around 2 years lower than that reported for HIV‐negative women in Switzerland. HIV care providers need to adapt their services to the requirements of the increasing number of women living with HIV transitioning through menopause. They should be able to recognize menopause‐associated symptoms and improve access to bone mineral density measurement as well as hormone replacement therapy.
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Affiliation(s)
- Anna Hachfeld
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Petra Stute
- Departement of Obstetrics and Gynecology, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Alexandra Calmy
- Department of Infectious Diseases University Hospital Geneva, Geneva, Switzerland
| | - Philip E Tarr
- Department of Infectious Diseases, University Hospital Basel, Bruderholz, Switzerland
| | - Katharine Darling
- Department of Infectious Diseases, University Hospital Lausanne, Lausanne, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Christian Polli
- Department of Obstetrics and Gynecology, Regional Hospital, Lugano, Switzerland
| | - Leila Sultan-Beyer
- Department of Obstetrics and Gynecology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Irene A Abela
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zürich, Zurich, Switzerland
| | - Karoline Aebi-Popp
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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9
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Notter J, Seiffert SN, Zimmermann-Kogadeeva M, Bösch A, Wenger R, Strahm C, Frischknecht M, Livermore DM, Babouee Flury B. AmpC hyperproduction in a Cedecea davisae implant-associated bone infection during treatment: a case report and therapeutic implications. BMC Infect Dis 2022; 22:33. [PMID: 34991516 PMCID: PMC8734214 DOI: 10.1186/s12879-021-07000-y] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 12/21/2021] [Indexed: 11/25/2022] Open
Abstract
Background Data on antimicrobial resistance mechanisms are scanty for Cedecea spp., with very variable antibiotic resistance patterns documented. Here we report the first in vivo resistance evolution of a C. davisae clinical isolate in a patient with a complex hand trauma and provide insight in the resistance mechanism, leading to therapeutic implications for this pathogen. Case presentation Cedecea davisae was isolated from a patient with hand trauma during a first surgical debridement. Six days after primary surgical treatment and under antimicrobial treatment with amoxicillin-clavulanic acid and later cefepime, follow up cultures yielded C. davisae which demonstrated a resistance development. The susceptible parental isolate and its resistant derivative were characterized by whole genome sequencing, ampC, ompC and ompF by RT- PCR. The resistant derivative demonstrated an A224G SNP in ampD, the transcriptional regulator of ampC, leading to a His75Arg change in the corresponding AmpD protein. AmpC transcription of the resistant derivative was 362-times higher than the susceptible isolate. Transcription levels of ompF and ompC were 8.5-fold and 1.3-fold lower, respectively, in the resistant derivative. Downregulation of OmpF putatively resulted from a mutation in the presumed promoter region upstream of the dusB-Fis operon, a proposed regulator for ompF. Conclusions This case demonstrates the in vivo resistance development of C. davisae within 7 days similar to that of the members of the Enterobacter cloacae complex. Our findings add valuable information for future therapeutic management of these opportunistic pathogens as they warrant the same empirical treatment as AmpC producers.
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Affiliation(s)
- Julia Notter
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
| | - Salome N Seiffert
- Division of Human Microbiology, Centre for Laboratory Medicine, St. Gallen, Switzerland
| | | | - Anja Bösch
- Medical Research Centre, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Robert Wenger
- Division of Hand, Plastic and Reconstructive Surgery, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Carol Strahm
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Manuel Frischknecht
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | | | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.,Medical Research Centre, Kantonsspital St. Gallen, St. Gallen, Switzerland
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10
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Leal-Neto O, Egger T, Schlegel M, Flury D, Sumer J, Albrich W, Babouee Flury B, Kuster S, Vernazza P, Kahlert C, Kohler P. Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study. JMIR Public Health Surveill 2021; 7:e33576. [PMID: 34727046 PMCID: PMC8610449 DOI: 10.2196/33576] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 12/24/2022] Open
Abstract
Background The implementation of novel techniques as a complement to traditional disease surveillance systems represents an additional opportunity for rapid analysis. Objective The objective of this work is to describe a web-based participatory surveillance strategy among health care workers (HCWs) in two Swiss hospitals during the first wave of COVID-19. Methods A prospective cohort of HCWs was recruited in March 2020 at the Cantonal Hospital of St. Gallen and the Eastern Switzerland Children’s Hospital. For data analysis, we used a combination of the following techniques: locally estimated scatterplot smoothing (LOESS) regression, Spearman correlation, anomaly detection, and random forest. Results From March 23 to August 23, 2020, a total of 127,684 SMS text messages were sent, generating 90,414 valid reports among 1004 participants, achieving a weekly average of 4.5 (SD 1.9) reports per user. The symptom showing the strongest correlation with a positive polymerase chain reaction test result was loss of taste. Symptoms like red eyes or a runny nose were negatively associated with a positive test. The area under the receiver operating characteristic curve showed favorable performance of the classification tree, with an accuracy of 88% for the training data and 89% for the test data. Nevertheless, while the prediction matrix showed good specificity (80.0%), sensitivity was low (10.6%). Conclusions Loss of taste was the symptom that was most aligned with COVID-19 activity at the population level. At the individual level—using machine learning–based random forest classification—reporting loss of taste and limb/muscle pain as well as the absence of runny nose and red eyes were the best predictors of COVID-19.
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Affiliation(s)
- Onicio Leal-Neto
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Thomas Egger
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Matthias Schlegel
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Domenica Flury
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Johannes Sumer
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Werner Albrich
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland.,Medical Research Center, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | | | - Pietro Vernazza
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
| | - Christian Kahlert
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland.,Department of Infectious Diseases and Hospital Epidemiology, Children's Hospital of Eastern Switzerland, St Gallen, Switzerland
| | - Philipp Kohler
- Clinic for Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St Gallen, Switzerland
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11
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Barnsteiner S, Baty F, Albrich WC, Babouee Flury B, Gasser M, Plüss-Suard C, Schlegel M, Kronenberg A, Kohler P. Antimicrobial resistance and antibiotic consumption in intensive care units, Switzerland, 2009 to 2018. Euro Surveill 2021; 26. [PMID: 34794535 PMCID: PMC8603405 DOI: 10.2807/1560-7917.es.2021.26.46.2001537] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Intensive care units (ICU) constitute a high-risk setting for antimicrobial resistance (AMR). Aim We aimed to describe secular AMR trends including meticillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci (GRE), extended-spectrum cephalosporin-resistant Escherichia coli (ESCR-EC) and Klebsiella pneumoniae (ESCR-KP), carbapenem-resistant Enterobacterales (CRE) and Pseudomonas aeruginosa (CRPA) from Swiss ICU. We assessed time trends of antibiotic consumption and identified factors associated with CRE and CRPA. Methods We analysed patient isolate and antibiotic consumption data of Swiss ICU sent to the Swiss Centre for Antibiotic Resistance (2009–2018). Time trends were assessed using linear logistic regression; a mixed-effects logistic regression was used to identify factors associated with CRE and CRPA. Results Among 52 ICU, MRSA decreased from 14% to 6% (p = 0.005; n = 6,465); GRE increased from 1% to 3% (p = 0.011; n = 4,776). ESCR-EC and ESCR-KP increased from 7% to 15% (p < 0.001, n = 10,648) and 5% to 11% (p = 0.002; n = 4,052), respectively. CRE, mostly Enterobacter spp., increased from 1% to 5% (p = 0.008; n = 17,987); CRPA remained stable at 27% (p = 0.759; n = 4,185). Antibiotic consumption in 58 ICU increased from 2009 to 2013 (82.5 to 97.4 defined daily doses (DDD)/100 bed-days) and declined until 2018 (78.3 DDD/100 bed-days). Total institutional antibiotic consumption was associated with detection of CRE in multivariable analysis (odds ratio per DDD: 1.01; 95% confidence interval: 1.0–1.02; p = 0.004). Discussion In Swiss ICU, antibiotic-resistant Enterobacterales have been steadily increasing over the last decade. The emergence of CRE, associated with institutional antibiotic consumption, is of particular concern and calls for reinforced surveillance and antibiotic stewardship in this setting.
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Affiliation(s)
- Stefanie Barnsteiner
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Florent Baty
- Lung Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.,Medical Research Center, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Michael Gasser
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | | | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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12
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Kohler P, Seiffert SN, Kessler S, Rettenmund G, Lemmenmeier E, Qalla Widmer L, Nolte O, Seth-Smith HMB, Albrich WC, Babouee Flury B, Gardiol C, Harbarth S, Münzer T, Schlegel M, Petignat C, Egli A, Héquet D. Molecular Epidemiology and Risk Factors for Extended-Spectrum β-Lactamase-Producing Enterobacterales in Long-Term Care Residents. J Am Med Dir Assoc 2021; 23:475-481.e5. [PMID: 34297981 DOI: 10.1016/j.jamda.2021.06.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES We aimed to assess the burden of extended-spectrum β-lactamase (ESBL)-producing Enterobacterales in Swiss long-term care facilities (LTCFs) to describe the molecular epidemiology, describe the intrainstitutional and regional clusters of resistant pathogens, and identify independent institution- and resident-level factors associated with colonization. DESIGN Cross-sectional study. SETTING AND PARTICIPANTS From August to October 2019, we performed a point prevalence study among residents from 16 LTCFs in Western and Eastern Switzerland (8 per region). METHODS Residents underwent screening for ESBL-producing Enterobacterales (ESBL-E); whole-genome sequencing (WGS) was performed. We gathered institution-level (eg, number of beds, staff-resident ratio, alcoholic hand rub consumption) and resident-level [eg, anthropometric data, time in facility, dependency, health care exposure, antibiotic treatment, proton-pump inhibitor (PPI) use] characteristics. Factors associated with colonization were identified using a generalized linear model. RESULTS Among 1185 eligible residents, 606 (51%) consented to the study. ESBL-E prevalence was 11.6% (70/606), ranging from 1.9% to 33.3% between institutions, with a median of 12.5% in the West and 6.9% in the East (P = .03). Among 59 Escherichia coli (from 58 residents), multilocus sequence type (ST) 131 was most common (n = 43/59, 73%), predominantly its subclone H30R1 (n = 37/43, 86%). WGS data identified multiple intrainstitutional and regional clusters. Independent risk factors for ESBL carriage were previous ESBL colonization [adjusted odds ratio (aOR) 23.5, 95% confidence interval (CI) 6.6-83.8, P < .001), male gender (aOR 2.6, 95% CI 1.5-4.6, P = .002), and use of PPIs (aOR 2.2, 95% CI 1.2-3.8, P = .01). CONCLUSIONS AND IMPLICATIONS Overall ESBL-E prevalence in Swiss LTCF residents is low. Yet, we identified several clusters of residents with identical pathogens within the same institution. This implies that particularly affected institutions might benefit from targeted infection control interventions. PPI use was the only modifiable factor associated with carriage of ESBL producers. This study adds to the growing list of adverse outcomes associated with PPIs, calling for action to restrict their use in the long-term care setting.
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Affiliation(s)
- Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
| | - Salome N Seiffert
- Division of Human Microbiology, Centre for Laboratory Medicine, St Gallen, Switzerland
| | - Simone Kessler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Gabriela Rettenmund
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Eva Lemmenmeier
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Laetitia Qalla Widmer
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
| | - Oliver Nolte
- Division of Human Microbiology, Centre for Laboratory Medicine, St Gallen, Switzerland
| | - Helena M B Seth-Smith
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Stephan Harbarth
- Division of Infectious Diseases and Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | | | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Christiane Petignat
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland; Applied Microbiology Research, University of Basel, Basel, Switzerland
| | - Delphine Héquet
- Unité cantonale hygiène, prévention et contrôle de l'infection, Canton of Vaud, Switzerland
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13
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Kahlert CR, Persi R, Güsewell S, Egger T, Leal-Neto OB, Sumer J, Flury D, Brucher A, Lemmenmeier E, Möller JC, Rieder P, Stocker R, Vuichard-Gysin D, Wiggli B, Albrich WC, Babouee Flury B, Besold U, Fehr J, Kuster SP, McGeer A, Risch L, Schlegel M, Friedl A, Vernazza P, Kohler P. Non-occupational and occupational factors associated with specific SARS-CoV-2 antibodies among hospital workers - A multicentre cross-sectional study. Clin Microbiol Infect 2021; 27:1336-1344. [PMID: 34020033 PMCID: PMC8131187 DOI: 10.1016/j.cmi.2021.05.014] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 12/18/2022]
Abstract
Objectives Protecting healthcare workers (HCWs) from coronavirus disease-19 (COVID-19) is critical to preserve the functioning of healthcare systems. We therefore assessed seroprevalence and identified risk factors for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) seropositivity in this population. Methods Between 22 June 22 and 15 August 2020, HCWs from institutions in northern/eastern Switzerland were screened for SARS-CoV-2 antibodies. We recorded baseline characteristics, non-occupational and occupational risk factors. We used pairwise tests of associations and multivariable logistic regression to identify factors associated with seropositivity. Results Among 4664 HCWs from 23 healthcare facilities, 139 (3%) were seropositive. Non-occupational exposures independently associated with seropositivity were contact with a COVID-19-positive household (adjusted OR 59, 95% CI 33–106), stay in a COVID-19 hotspot (aOR 2.3, 95% CI 1.2–4.2) and male sex (aOR 1.9, 95% CI 1.1–3.1). Blood group 0 vs. non-0 (aOR 0.5, 95% CI 0.3–0.8), active smoking (aOR 0.4, 95% CI 0.2–0.7), living with children <12 years (aOR 0.3, 95% CI 0.2–0.6) and being a physician (aOR 0.2, 95% CI 0.1–0.5) were associated with decreased risk. Other occupational risk factors were close contact to COVID-19 patients (aOR 2.7, 95% CI 1.4–5.4), exposure to COVID-19-positive co-workers (aOR 1.9, 95% CI 1.1–2.9), poor knowledge of standard hygiene precautions (aOR 1.9, 95% CI 1.2–2.9) and frequent visits to the hospital canteen (aOR 2.3, 95% CI 1.4–3.8). Discussion Living with COVID-19-positive households showed the strongest association with SARS-CoV-2 seropositivity. We identified several potentially modifiable work-related risk factors, which might allow mitigation of the COVID-19 risk among HCWs. The lower risk among those living with children, even after correction for multiple confounders, is remarkable and merits further study.
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Affiliation(s)
- Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland; Children's Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Raphael Persi
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital of St Gallen, St. Gallen, Switzerland
| | - Thomas Egger
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Onicio B Leal-Neto
- Epitrack, Recife, Brazil; Department of Economics, University of Zurich, Zurich, Switzerland
| | - Johannes Sumer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St Gallen (South), St Gallen, Switzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | - J Carsten Möller
- Centre for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | | | | | - Danielle Vuichard-Gysin
- Thurgau Hospital Group, Division of Infectious Diseases and Hospital Epidemiology, Muensterlingen, Switzerland; Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland
| | - Benedikt Wiggli
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Werner C Albrich
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Jan Fehr
- Department of Public and Global Health, University of Zurich, Zurich, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital and University of Zurich, Zurich, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland; Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein; Centre of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Andrée Friedl
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland.
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14
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Kohler PP, Kahlert CR, Sumer J, Flury D, Güsewell S, Leal-Neto OB, Notter J, Albrich WC, Babouee Flury B, McGeer A, Kuster S, Risch L, Schlegel M, Vernazza P. Prevalence of SARS-CoV-2 antibodies among Swiss hospital workers: Results of a prospective cohort study. Infect Control Hosp Epidemiol 2021; 42:604-608. [PMID: 33028454 PMCID: PMC7582018 DOI: 10.1017/ice.2020.1244] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [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: 07/08/2020] [Revised: 09/20/2020] [Accepted: 09/23/2020] [Indexed: 01/31/2023]
Abstract
In this prospective cohort of 1,012 Swiss hospital employees, 3 different assays were used to screen serum for SARS-CoV-2 antibodies. Seropositivity was 1%; the positive predictive values of the lateral-flow immunoassay were 64% (IgG) and 13% (IgM). History of fever and myalgia most effectively differentiated seropositive and seronegative participants.
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Affiliation(s)
- Philipp P. Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- Children’s Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Johannes Sumer
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Domenica Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Sabine Güsewell
- Clinical Trials Unit, Cantonal Hospital of St Gallen, St Gallen, Switzerland
| | - Onicio B. Leal-Neto
- Epitrack, Recife, Brazil
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Julia Notter
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Werner C. Albrich
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Baharak Babouee Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | | | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr. Risch, Buchs, Switzerland
| | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Pietro Vernazza
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
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15
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Hebeisen U, Babouee Flury B, Atkinson A, Marschall J, Buetti N. Catheter-related bloodstream infections due to coagulase-negative staphylococci managed with catheter removal: Recurrences are rare. Am J Infect Control 2020; 48:837-839. [PMID: 31753551 DOI: 10.1016/j.ajic.2019.10.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 06/11/2019] [Revised: 10/11/2019] [Accepted: 10/11/2019] [Indexed: 11/18/2022]
Abstract
Little research has been carried out on recurrences of catheter-related bloodstream infection due to coagulase-negative staphylococci (CoNS-CRBSI). The main objective of this study was to characterize patients with CoNS-CRBSI and infection recurrence after catheter removal. We included 184 CoNS-CRBSI episodes. Only 8 patients experienced recurrent bacteremia and none of them developed secondary infection of preexisting orthopedic or intravascular implant material.
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Affiliation(s)
- Ursula Hebeisen
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; Paediatric Pharmacology and Pharmacometrics, University of Basel Children's Hospital, Basel, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland
| | - Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Switzerland; UMR 1137 - IAME Team 5 - DeSCID: Decision SCiences in Infectious Diseases, Control and Care Inserm/University Paris Diderot, Sorbonne Paris Cité, Paris, France.
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16
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Lo Priore E, Livermore DM, Buetti N, Jent P, Pelzer N, Casanova C, Furrer H, Babouee Flury B. Successful Treatment of Acute Prostatitis Caused by Multidrug-Resistant Escherichia coli With Tigecycline Monotherapy. Open Forum Infect Dis 2020; 7:ofz551. [PMID: 31988977 PMCID: PMC6975247 DOI: 10.1093/ofid/ofz551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 01/07/2020] [Indexed: 11/14/2022] Open
Abstract
We present a successful treatment, with tigecycline monotherapy, of acute prostatitis caused by multidrug-resistant Escherichia coli harboring an NDM-1 carbapemenase along with a CMY-2 cephalosporinase and a TEM ESBL.
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Affiliation(s)
- Elia Lo Priore
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - David M Livermore
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Niccolo Buetti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Niklas Pelzer
- UroSwiss AG, Department of Urology, Oberaargau Regional Hospital, Langenthal, Switzerland
| | - Carlo Casanova
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baharak Babouee Flury
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland.,Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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17
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Donà V, Scheidegger M, Pires J, Furrer H, Atkinson A, Babouee Flury B. Gradual in vitro Evolution of Cefepime Resistance in an ST131 Escherichia coli Strain Expressing a Plasmid-Encoded CMY-2 β-Lactamase. Front Microbiol 2019; 10:1311. [PMID: 31244817 PMCID: PMC6581752 DOI: 10.3389/fmicb.2019.01311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background In a previous report, a clinical ST131 Escherichia coli isolate (Ec-1),producing a plasmid-encoded AmpC β-lactamase CMY-2, evolved in vivo under cefepime (FEP) treatment to the FEP-resistant Ec-2 strain expressing an extended-spectrum β-lactamase CMY-33. To compare factors responsible for in vitro and in vivo FEP resistance, we reproduced in vitro FEP resistance evolution in Ec-1. Methods FEP-resistant mutants were generated by subjecting Ec-1 (FEP MIC = 0.125 mg/L) to sub-inhibitory concentrations of FEP. MICs were obtained by broth microdilution or Etest. Strains were sequenced on an Illumina HiSeq platform. Transcriptional levels and plasmid copy numbers were determined by real-time PCR. Outer membrane proteins (OMPs) were extracted and separated by SDS-PAGE. Growth kinetics was evaluated by measuring OD450. Results The CMY-2 expressed by Ec-1 evolved to a CMY-69 (strain EC-4) by an Ala294Pro substitution after 24 passages. After 30 passages, the FEP MIC increased to 256 mg/L (strain EC-32). SDS PAGE did not reveal any lack of OMPs in the mutant strains. However, blaCMY transcription levels were up to 14-times higher than in Ec-1, which was partially explained by mutations in the upstream region of repA resulting in a higher copy number of the blaCMY-harboring IncI1 plasmid. All mutants showed a slight growth defect but no significant difference in relative growth rates compared to Ec-1. Conclusion In vitro sub-inhibitory concentrations of FEP resulted in the selection of resistance mutations altering the H-10 helix of the CMY-2 and increasing the plasmid copy number. Appropriate dosing strategies may help preventing resistance evolution during treatments.
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Affiliation(s)
- Valentina Donà
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | | | - João Pires
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.,Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Baharak Babouee Flury
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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18
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Babouee Flury B, Donà V, Buetti N, Furrer H, Endimiani A. First two cases of severe multifocal infections caused by Klebsiella pneumoniae in Switzerland: characterization of an atypical non-K1/K2-serotype strain causing liver abscess and endocarditis. J Glob Antimicrob Resist 2017; 10:165-170. [PMID: 28729207 DOI: 10.1016/j.jgar.2017.04.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/17/2017] [Revised: 03/24/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND We describe the first two multifocal invasive infections due to Klebsiella pneumoniae recently observed in Switzerland. METHODS Phenotypic (MIC assays and string test) and molecular analyses (PCR/Sequencing for bla, virulence factor genes and whole genome sequencing for one strain) were performed to characterize the causative K. pneumoniae isolates. RESULTS Both K. pneumoniae isolates (Kp1 and Kp2) were pan-susceptible to antibiotics and produced narrow-spectrum SHV β-lactamases. However, only Kp1 was string test positive. Kp1 was of ST380 and caused liver abscess as well as pneumonia and orbital phlegmon in an Eritrean patient. It belonged to the hypervirulent capsular serotype K2 and harboured the classic virulence-associated rmpA and aerobactin genes, fulfilling both the clinical and microbiological definitions for an invasive K. pneumoniae syndrome. Kp2 was of ST1043 and caused both liver abscess and endocarditis in a Swiss patient. Moreover, it did not possess the classic virulence-associated genes. Whole genome sequencing identified less well-known virulence factors in Kp2 that might have contributed to its virulence. Among these there were genes important for intestinal colonization and/or invasion, such as genes involved in adhesion (e.g., fimABCD and mrkABCD), regulation of capsule polysaccharide biosynthesis (e.g., evgS-evgA), as well as iron uptake (iroN), energy conversion, and metabolism. DISCUSSION This report confirms the continuous dissemination of hypervirulent K. pneumoniae strains among patients of non-Asian descent in Europe. Moreover, it highlights the genetic background of an atypical hypervirulent K. pneumoniae causing a severe invasive infection despite not possessing the classical virulence characteristics of hypermucoviscous strains.
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Affiliation(s)
- Baharak Babouee Flury
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland; Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Valentina Donà
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Hansjakob Furrer
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrea Endimiani
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
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Babouee Flury B, Ellington MJ, Hopkins KL, Turton JF, Doumith M, Woodford N. The differential importance of mutations within AmpD in cephalosporin resistance of Enterobacter aerogenes and Enterobacter cloacae. Int J Antimicrob Agents 2016; 48:555-558. [DOI: 10.1016/j.ijantimicag.2016.07.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/28/2016] [Accepted: 07/30/2016] [Indexed: 10/21/2022]
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20
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Babouee Flury B, Elzi L, Kolbe M, Frei R, Weisser M, Schären S, Widmer AF, Battegay M. Is switching to an oral antibiotic regimen safe after 2 weeks of intravenous treatment for primary bacterial vertebral osteomyelitis? BMC Infect Dis 2014; 14:226. [PMID: 24767169 PMCID: PMC4012835 DOI: 10.1186/1471-2334-14-226] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [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: 08/22/2013] [Accepted: 04/17/2014] [Indexed: 12/18/2022] Open
Abstract
Background Vertebral osteomyelitis (VO) may lead to disabling neurologic complications. Little evidence exists on optimal antibiotic management. Methods All patients with primary, non-implant VO, admitted from 2000–2010 were retrospectively analyzed. Patients with endocarditis, immunodeficiency, vertebral implants and surgical site infection following spine surgery were excluded. Persistence of clinical or laboratory signs of inflammation at 1 year were defined as treatment failure. Logistic regression was used to estimate the odds ratios (OR) of switch to an oral regimen after 2 weeks. Results Median antibiotic treatment was 8.1 weeks in 61 identified patients. Switch to oral antibiotics was performed in 72% of patients after a median intravenous therapy of 2.7 weeks. Switch to oral therapy was already performed after two weeks in 34% of the patients. A lower CRP at 2 weeks was the only independent predictor for switch to oral therapy (OR 0.7, 95% confidence interval 0.5-0.9, p = 0.041, per 10 mg/l increase). Staphylococcus aureus was the most frequently isolated microorganism (21%). Indications for surgery, other than biopsy, included debridement with drainage of epidural or paravertebral abscess (26 patients; 42%), and CT - guided drainage (3 patients). During the follow-up, no recurrences were observed but 2 patients died of other reasons than VO, i.e. the 1 year intention to treat success rate was 97%. Conclusions Cure rates for non-implant VO were very high with partly short intravenous and overall antibiotic therapy. Switching to an oral antibiotic regimen after two weeks intravenous treatment may be safe, provided that CRP has decreased and epidural or paravertebral abscesses of significant size have been drained.
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Affiliation(s)
- Baharak Babouee Flury
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Petersgraben 4, Basel 4031, Switzerland.
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