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Lotfinejad N, Januel JM, Tschudin-Sutter S, Schreiber PW, Grandbastien B, Damonti L, Lo Priore E, Scherrer A, Harbarth S, Catho G, Buetti N. Systematic scoping review of automated systems for the surveillance of healthcare-associated bloodstream infections related to intravascular catheters. Antimicrob Resist Infect Control 2024; 13:25. [PMID: 38419046 PMCID: PMC10903068 DOI: 10.1186/s13756-024-01380-x] [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: 11/27/2023] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION Intravascular catheters are crucial devices in medical practice that increase the risk of healthcare-associated infections (HAIs), and related health-economic adverse outcomes. This scoping review aims to provide a comprehensive overview of published automated algorithms for surveillance of catheter-related bloodstream infections (CRBSI) and central line-associated bloodstream infections (CLABSI). METHODS We performed a scoping review based on a systematic search of the literature in PubMed and EMBASE from 1 January 2000 to 31 December 2021. Studies were included if they evaluated predictive performance of automated surveillance algorithms for CLABSI/CRBSI detection and used manually collected surveillance data as reference. We assessed the design of the automated systems, including the definitions used to develop algorithms (CLABSI versus CRBSI), the datasets and denominators used, and the algorithms evaluated in each of the studies. RESULTS We screened 586 studies based on title and abstract, and 99 were assessed based on full text. Nine studies were included in the scoping review. Most studies were monocentric (n = 5), and they identified CLABSI (n = 7) as an outcome. The majority of the studies used administrative and microbiological data (n = 9) and five studies included the presence of a vascular central line in their automated system. Six studies explained the denominator they selected, five of which chose central line-days. The most common rules and steps used in the algorithms were categorized as hospital-acquired rules, infection rules (infection versus contamination), deduplication, episode grouping, secondary BSI rules (secondary versus primary BSI), and catheter-associated rules. CONCLUSION The automated surveillance systems that we identified were heterogeneous in terms of definitions, datasets and denominators used, with a combination of rules in each algorithm. Further guidelines and studies are needed to develop and implement algorithms to detect CLABSI/CRBSI, with standardized definitions, appropriate data sources and suitable denominators.
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Affiliation(s)
- Nasim Lotfinejad
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Jean-Marie Januel
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases & Hospital Epidemiology, University Hospital Basel and University of Basel, Basel, Switzerland
| | - Peter W Schreiber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Bruno Grandbastien
- Infection Prevention and Control Unit, Service of Infectious Disease, Lausanne University Hospital, Lausanne, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elia Lo Priore
- Department of Infectious Diseases and Hospital Epidemiology, EOC Regional Hospital of Lugano, Lugano, Switzerland
| | | | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Gaud Catho
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Division of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Niccolò Buetti
- Infection Control Program and WHO Collaborating Centre, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
- Université Paris-Cité, INSERM, IAME UMR 1137 , Paris, 75018, France
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Estill J, Venkova-Marchevska P, Günthard HF, Botero-Mesa S, Thiabaud A, Roelens M, Vancauwenberghe L, Damonti L, Heininger U, Iten A, Schreiber PW, Sommerstein R, Tschudin-Sutter S, Troillet N, Vuichard-Gysin D, Widmer A, Hothorn T, Keiser O. Treatment effect of remdesivir on the mortality of hospitalised COVID-19 patients in Switzerland across different patient groups: a tree-based model analysis. Swiss Med Wkly 2023; 153:40095. [PMID: 37769356 DOI: 10.57187/smw.2023.40095] [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: 09/30/2023] Open
Abstract
AIMS OF THE STUDY Remdesivir has shown benefits against COVID-19. However, it remains unclear whether, to what extent, and among whom remdesivir can reduce COVID-19-related mortality. We explored whether the treatment response to remdesivir differed by patient characteristics. METHODS We analysed data collected from a hospital surveillance study conducted in 21 referral hospitals in Switzerland between 2020 and 2022. We applied model-based recursive partitioning to group patients by the association between treatment levels and mortality. We included either treatment (levels: none, remdesivir within 7 days of symptom onset, remdesivir after 7 days, or another treatment), age and sex, or treatment only as regression variables. Candidate partitioning variables included a range of risk factors and comorbidities (and age and sex unless included in regression). We repeated the analyses using local centring to correct the results for the propensity to receive treatment. RESULTS Overall (n = 21,790 patients), remdesivir within 7 days was associated with increased mortality (adjusted hazard ratios 1.28-1.54 versus no treatment). The CURB-65 score caused the most instability in the regression parameters of the model. When adjusted for age and sex, patients receiving remdesivir within 7 days of onset had higher mortality than those not treated in all identified eight patient groups. When age and sex were included as partitioning variables instead, the number of groups increased to 19-20; in five to six of those branches, mortality was lower among patients who received early remdesivir. Factors determining the groups where remdesivir was potentially beneficial included the presence of oncological comorbidities, male sex, and high age. CONCLUSIONS Some subgroups of patients, such as individuals with oncological comorbidities or elderly males, may benefit from remdesivir.
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Affiliation(s)
- Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland
- School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | | | - Huldrych F Günthard
- Department of Infectious Diseaes and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
- Institute of Medical Virology, University of Zürich, Switzerland
| | - Sara Botero-Mesa
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Amaury Thiabaud
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | - Maroussia Roelens
- Institute of Global Health, University of Geneva, Geneva, Switzerland
| | | | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Anne Iten
- Service of Prevention and Infection Control, Directorate of Medicine and Quality, Geneva University Hospitals, Geneva, Switzerland
| | - Peter W Schreiber
- Department of Infectious Diseaes and Hospital Epidemiology, University Hospital Zürich, Zürich, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sarah Tschudin-Sutter
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Danielle Vuichard-Gysin
- Department of Infectious Diseases, Thurgau Hospital Group, Muensterlingen and Frauenfeld, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland
| | - Torsten Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Geneva, Switzerland
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3
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Damonti L, Atkinson A, Fontannaz L, Burnham JP, Jent P, Troillet N, Widmer A, Marschall J. Influence of environmental temperature and heatwaves on surgical site infection after hip and knee arthroplasty: a nationwide study. J Hosp Infect 2023; 135:125-131. [PMID: 36996907 DOI: 10.1016/j.jhin.2023.03.014] [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: 01/23/2023] [Revised: 03/13/2023] [Accepted: 03/18/2023] [Indexed: 04/01/2023]
Abstract
BACKGROUND Previous studies reported higher incidence of surgical site infection (SSI) after procedures performed in summer or with high temperatures. However, no study used detailed climate data to assess this risk after hip and knee arthroplasty, and no study specifically investigated the role of heatwaves. AIM To assess the impact of higher environmental temperatures and heatwaves on SSI rates after hip and knee arthroplasty. METHODS Data on hip and knee arthroplasty procedures performed between 01/2013 - 09/2019 in hospitals participating in the Swiss SSI surveillance were linked to climate data extracted from weather stations located in their vicinity. The association between temperature, heatwaves and SSI was studied using mixed effects logistic regression models fitted at the patient level. Poisson mixed models were fitted for both calendar year and month of the year to investigate the SSI incidence trajectory over time. RESULTS We included 116,981 procedures performed in 122 hospitals. Significantly higher SSI rates were observed for procedures performed in the summertime (incidence rate ratio 1.39, 95% CI [1.20-1.60], p<0.001; reference: autumn) or in calendar months in which the mean temperature was above 20°C (reference 05-10°C; odds ratio 1.59, 95% CI [1.27, 1.98] p<0.001). We observed a slight but non-significant increase in the rate of SSI during heatwaves (1.44% versus 1.01%, p=0.2). CONCLUSION SSI rates after hip and knee replacement appear to increase with higher environmental temperature. To establish if, and to what extent, heatwaves increase the risk of SSI, studies involving geographical areas with larger variability in temperature are needed.
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Affiliation(s)
- Lauro Damonti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Andrew Atkinson
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lionel Fontannaz
- Federal Office of Meteorology and Climatology MeteoSwiss, Bern, Switzerland
| | - Jason P Burnham
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, U.S
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Nicolas Troillet
- Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Andreas Widmer
- Division of Infectious Diseases and Hospital Epidemiology, University of Basel Hospitals and Clinics, Basel, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO, U.S
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Horn MP, Jonsdottir HR, Brigger D, Damonti L, Suter‐Riniker F, Endrich O, Froehlich TK, Fiedler M, Largiadèr CR, Marschall J, Weber B, Eggel A, Nagler M. Serological testing for SARS-CoV-2 antibodies in clinical practice: A comparative diagnostic accuracy study. Allergy 2022; 77:2090-2103. [PMID: 34986501 PMCID: PMC9303219 DOI: 10.1111/all.15206] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 11/16/2021] [Accepted: 11/17/2021] [Indexed: 01/28/2023]
Abstract
Background Serological tests are a powerful tool in the monitoring of infectious diseases and the detection of host immunity. However, manufacturers often provide diagnostic accuracy data generated through biased studies, and the performance in clinical practice is essentially unclear. Objectives We aimed to determine the diagnostic accuracy of various serological testing strategies for (a) identification of patients with previous coronavirus disease‐2019 (COVID‐19) and (b) prediction of neutralizing antibodies against SARS‐CoV‐2 in real‐life clinical settings. Methods We prospectively included 2573 consecutive health‐care workers and 1085 inpatients with suspected or possible previous COVID‐19 at a Swiss University Hospital. Various serological immunoassays based on different analytical techniques (enzyme‐linked immunosorbent assays, ELISA; chemiluminescence immunoassay, CLIA; electrochemiluminescence immunoassay, ECLIA; and lateral flow immunoassay, LFI), epitopes of SARS‐CoV‐2 (nucleocapsid, N; receptor‐binding domain, RBD; extended RBD, RBD+; S1 or S2 domain of the spike [S] protein, S1/S2), and antibody subtypes (IgG, pan‐Ig) were conducted. A positive real‐time PCR test from a nasopharyngeal swab was defined as previous COVID‐19. Neutralization assays with live SARS‐CoV‐2 were performed in a subgroup of patients to assess neutralization activity (n = 201). Results The sensitivity to detect patients with previous COVID‐19 was ≥85% in anti‐N ECLIA (86.8%) and anti‐S1 ELISA (86.2%). Sensitivity was 84.7% in anti‐S1/S2 CLIA, 84.0% in anti‐RBD+LFI, 81.0% in anti‐N CLIA, 79.2% in anti‐RBD ELISA, and 65.6% in anti‐N ELISA. The specificity was 98.4% in anti‐N ECLIA, 98.3% in anti‐N CLIA, 98.2% in anti‐S1 ELISA, 97.7% in anti‐N ELISA, 97.6% in anti‐S1/S2 CLIA, 97.2% in anti‐RBD ELISA, and 96.1% in anti‐RBD+LFI. The sensitivity to detect neutralizing antibodies was ≥85% in anti‐S1 ELISA (92.7%), anti‐N ECLIA (91.7%), anti‐S1/S2 CLIA (90.3%), anti‐RBD+LFI (87.9%), and anti‐RBD ELISA (85.8%). Sensitivity was 84.1% in anti‐N CLIA and 66.2% in anti‐N ELISA. The specificity was ≥97% in anti‐N CLIA (100%), anti‐S1/S2 CLIA (97.7%), and anti‐RBD+LFI (97.9%). Specificity was 95.9% in anti‐RBD ELISA, 93.0% in anti‐N ECLIA, 92% in anti‐S1 ELISA, and 65.3% in anti‐N ELISA. Diagnostic accuracy measures were consistent among subgroups. Conclusions The diagnostic accuracy of serological tests for SARS‐CoV‐2 antibodies varied remarkably in clinical practice, and the sensitivity to identify patients with previous COVID‐19 deviated substantially from the manufacturer's specifications. The data presented here should be considered when using such tests to estimate the infection burden within a specific population and determine the likelihood of protection against re‐infection.
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Affiliation(s)
- Michael P. Horn
- University Institute of Clinical Chemistry Inselspital University Hospital Bern Switzerland
| | - Hulda R. Jonsdottir
- Department of Rheumatology, Immunology, and Allergology Inselspital University Hospital Bern Switzerland
- Department of BioMedical Research University of Bern Bern Switzerland
- Spiez Laboratory Federal Office for Civil Protection Spiez Switzerland
| | - Daniel Brigger
- Department of Rheumatology, Immunology, and Allergology Inselspital University Hospital Bern Switzerland
- Department of BioMedical Research University of Bern Bern Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases Bern University Hospital and University of Bern Bern Switzerland
- Ente Ospedaliero Cantonale Division of Infectious Diseases Regional Hospital Lugano Lugano Switzerland
| | | | - Olga Endrich
- Medical Directorate Inselspital University Hospital of Bern Berne Switzerland
| | - Tanja K. Froehlich
- University Institute of Clinical Chemistry Inselspital University Hospital Bern Switzerland
| | - Martin Fiedler
- University Institute of Clinical Chemistry Inselspital University Hospital Bern Switzerland
| | - Carlo R. Largiadèr
- University Institute of Clinical Chemistry Inselspital University Hospital Bern Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases Bern University Hospital and University of Bern Bern Switzerland
| | - Benjamin Weber
- Spiez Laboratory Federal Office for Civil Protection Spiez Switzerland
| | - Alexander Eggel
- Department of Rheumatology, Immunology, and Allergology Inselspital University Hospital Bern Switzerland
- Department of BioMedical Research University of Bern Bern Switzerland
| | - Michael Nagler
- University Institute of Clinical Chemistry Inselspital University Hospital Bern Switzerland
- Department of BioMedical Research University of Bern Bern Switzerland
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5
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Fröhlich GM, De Kraker MEA, Abbas M, Keiser O, Thiabaud A, Roelens M, Cusini A, Flury D, Schreiber PW, Buettcher M, Corti N, Vuichard-Gysin D, Troillet N, Sauser J, Gaudenz R, Damonti L, Balmelli C, Iten A, Widmer A, Harbarth S, Sommerstein R. Hospital outcomes of community-acquired COVID-19 versus influenza: Insights from the Swiss hospital-based surveillance of influenza and COVID-19. Euro Surveill 2022; 27:2001848. [PMID: 34991775 PMCID: PMC8739338 DOI: 10.2807/1560-7917.es.2022.27.1.2001848] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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] [Indexed: 01/02/2023] Open
Abstract
BackgroundSince the onset of the COVID-19 pandemic, the disease has frequently been compared with seasonal influenza, but this comparison is based on little empirical data.AimThis study compares in-hospital outcomes for patients with community-acquired COVID-19 and patients with community-acquired influenza in Switzerland.MethodsThis retrospective multi-centre cohort study includes patients > 18 years admitted for COVID-19 or influenza A/B infection determined by RT-PCR. Primary and secondary outcomes were in-hospital mortality and intensive care unit (ICU) admission for patients with COVID-19 or influenza. We used Cox regression (cause-specific and Fine-Gray subdistribution hazard models) to account for time-dependency and competing events with inverse probability weighting to adjust for confounders.ResultsIn 2020, 2,843 patients with COVID-19 from 14 centres were included. Between 2018 and 2020, 1,381 patients with influenza from seven centres were included; 1,722 (61%) of the patients with COVID-19 and 666 (48%) of the patients with influenza were male (p < 0.001). The patients with COVID-19 were younger (median 67 years; interquartile range (IQR): 54-78) than the patients with influenza (median 74 years; IQR: 61-84) (p < 0.001). A larger percentage of patients with COVID-19 (12.8%) than patients with influenza (4.4%) died in hospital (p < 0.001). The final adjusted subdistribution hazard ratio for mortality was 3.01 (95% CI: 2.22-4.09; p < 0.001) for COVID-19 compared with influenza and 2.44 (95% CI: 2.00-3.00, p < 0.001) for ICU admission.ConclusionCommunity-acquired COVID-19 was associated with worse outcomes compared with community-acquired influenza, as the hazards of ICU admission and in-hospital death were about two-fold to three-fold higher.
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Affiliation(s)
- Georg Marcus Fröhlich
- HeartClinic Lucerne, Lucerne, Switzerland.,Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Marlieke E A De Kraker
- Infection Control program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Mohamed Abbas
- Infection Control program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Olivia Keiser
- Institute of Global Health of the University of Geneva, Geneva, Switzerland
| | - Amaury Thiabaud
- Institute of Global Health of the University of Geneva, Geneva, Switzerland
| | - Maroussia Roelens
- Institute of Global Health of the University of Geneva, Geneva, Switzerland
| | - Alexia Cusini
- Kantonsspital Graubünden, Department for General Medicine, Chur, Switzerland
| | | | - Peter W Schreiber
- University Hospital Zurich, Division of Infectious Diseases and Hospital Epidemiology, and University of Zurich, Zurich, Switzerland
| | - Michael Buettcher
- Cantonal Hospital Lucerne, Children's Hospital, Pediatric Infectious Diseases, Lucerne, Switzerland
| | - Natascia Corti
- Department for General Medicine, Klinik Hirslanden, Zürich, Switzerland
| | - Danielle Vuichard-Gysin
- Department for General Medicine, Spital Thurgau, Frauenfeld, Switzerland.,Swissnoso, the National Center for Infection Control, Bern, Switzerland
| | - Nicolas Troillet
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Julien Sauser
- Infection Control program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Roman Gaudenz
- Department for General Medicine, Kantonsspital Nidwalden, Stans, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Carlo Balmelli
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Ente Ospedaliero Cantonale Ticino, Division of Infection control and Hospital Epidemiology, Bellinzona, Switzerland
| | - Anne Iten
- Infection Control program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Andreas Widmer
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Department for Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Stephan Harbarth
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Infection Control program, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Rami Sommerstein
- Swissnoso, the National Center for Infection Control, Bern, Switzerland.,Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.,Department of Health Sciences and Medicine, Clinic St. Anna, University of Lucerne, Lucerne, Switzerland
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Damonti L, Kronenberg A, Marschall J, Jent P, Sommerstein R, De Kraker MEA, Harbarth S, Gasser M, Buetti N. The effect of the COVID-19 pandemic on the epidemiology of positive blood cultures in Swiss intensive care units: a nationwide surveillance study. Crit Care 2021; 25:403. [PMID: 34809698 PMCID: PMC8607066 DOI: 10.1186/s13054-021-03814-z] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 11/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence about the impact of the pandemic of COVID-19 on the incidence rates of blood cultures contaminations and bloodstream infections in intensive care units (ICUs) remains scant. The objective of this study was to investigate the nationwide epidemiology of positive blood cultures drawn in ICUs during the first two pandemic waves of COVID-19 in Switzerland. METHODS We analyzed data on positive blood cultures among ICU patients, prospectively collected through a nationwide surveillance system (ANRESIS), from March 30, 2020, to May 31, 2021, a 14-month timeframe that included a first wave of COVID-19, which affected the French and Italian-speaking regions, an interim period (summer 2020) and a second wave that affected the entire country. We used the number of ICU patient-days provided by the Swiss Federal Office of Public Health as denominator to calculate incidence rates of blood culture contaminations and bloodstream infections (ICU-BSI). Incidence rate ratios comparing the interim period with the second wave were determined by segmented Poisson regression models. RESULTS A total of 1099 blood culture contaminations and 1616 ICU-BSIs were identified in 52 ICUs during the study. Overall, more episodes of blood culture contaminations and ICU-BSI were observed during the pandemic waves, compared to the interim period. The proportions of blood culture contaminations and ICU-BSI were positively associated with the ICU occupancy rate, which was higher during the COVID-19 waves. During the more representative second wave (versus interim period), we observed an increased incidence of blood culture contaminations (IRR 1.57, 95% CI 1.16-2.12) and ICU-BSI (IRR 1.20, 95% CI 1.03-1.39). CONCLUSIONS An increase in blood culture contaminations and ICU-BSIs was observed during the second COVID-19 pandemic wave, especially in months when the ICU burden of COVID-19 patients was high.
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Affiliation(s)
- Lauro Damonti
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
- Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.
| | - Andreas Kronenberg
- Swiss Centre for Antibiotic Resistance, Institute for Infectious Diseases, University Bern, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Rami Sommerstein
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Marlieke E A De Kraker
- Infection Control Program and WHO Collaborating Centre on Patient Safety, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland
| | - Michael Gasser
- Swiss Centre for Antibiotic Resistance, Institute for Infectious Diseases, University Bern, Bern, Switzerland
| | - Niccolò Buetti
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, WHO Collaborating Center, Geneva, Switzerland
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France
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7
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Battistolo J, Glampedakis E, Damonti L, Poissy J, Grandbastien B, Kalbermatter L, Pagani JL, Eggimann P, Bochud PY, Calandra T, Marchetti O, Lamoth F. Increasing morbidity and mortality of candidemia over one decade in a Swiss university hospital. Mycoses 2021; 64:1512-1520. [PMID: 34587318 PMCID: PMC9298218 DOI: 10.1111/myc.13376] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/02/2021] [Accepted: 09/27/2021] [Indexed: 01/07/2023]
Abstract
Background The epidemiology of candidemia is evolving with raising concern about the emergence of intrinsically resistant non‐albicans Candida species and acquisition of antifungal resistance. In addition to microbiological surveys, epidemiological studies including clinical data are needed to assess the impact of candidemia on morbidity and mortality. Objectives To assess the clinical and microbiological trends of candidemia in a Swiss university hospital. Patients/Methods. This single‐centre retrospective study compared the incidence of candidemia, Candida species distribution, antifungal resistance profiles, clinical characteristics and outcomes between two periods separated by one decade. Results A total of 170 candidemic episodes were included (68 from period 1, 2004‐2006, and 102 from period 2, 2014‐2017). Incidence of candidemia (0.85 to 0.97 episode/10,000 patient‐days), species distribution (55%–57% C albicans) and antifungal susceptibilities remained unchanged. During period 2, candidemia was more frequently observed in intensive care units (ICU, 38% vs 19% in period 1, P = .01) and amongst older patients (median age 68 vs 59 years old, P < .01) with more immunosuppressive conditions (24% vs 9%, P = .01). Candidemia in period 2 was more frequently followed by septic shock (23% vs 7% in period 1, P = .01) and ICU admission (42% vs 12%, P < .01) and was associated with higher mortality (34% vs 18%, P = .03). Overall, factors associated with mortality in multivariate analyses included cirrhosis, solid malignancies and ICU stay at the time of candidemia. Conclusions Despite stable incidence, species distribution and antifungal resistance of candidemia, an epidemiological shift of the disease towards older and more critically ill patients was observed, with higher mortality rates.
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Affiliation(s)
- Julien Battistolo
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Emmanouil Glampedakis
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Hospital Preventive Medicine Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Lauro Damonti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Julien Poissy
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,UMR 8576 - UGSF and Unit of Structural and Functional Glycobiology, University of Lille, Inserm U1285, CHU Lille, Pôle de médecine intensive-réanimation, CNRS, Lille, France
| | - Bruno Grandbastien
- Hospital Preventive Medicine Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Laetitia Kalbermatter
- Hospital Preventive Medicine Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Pagani
- Adult Intensive Care Service, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Philippe Eggimann
- Department of Orthopedics and Traumatology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland
| | - Frederic Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Microbiology, Department of Laboratories, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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8
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Sommerstein R, Damonti L, Marschall J, Harbarth S, Gasser M, Kronenberg A, Buetti N. Distribution of pathogens and antimicrobial resistance in ICU-bloodstream infections during hospitalization: a nationwide surveillance study. Sci Rep 2021; 11:16876. [PMID: 34413340 PMCID: PMC8376881 DOI: 10.1038/s41598-021-95873-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 07/28/2021] [Indexed: 12/14/2022] Open
Abstract
Changing microorganism distributions and decreasing antibiotic susceptibility over the duration of hospitalization have been described for the colonization or infection of selected organ systems. Few data are available on bacteremias in the intensive care unit (ICU) setting. We conducted a nationwide study on bloodstream infection (BSI) using data from the Swiss Centre for Antibiotic Resistance (ANRESIS). We analyzed data on BSI detected in the ICU from hospitals that sent information on a regular basis during the entire study period (2008–2017). We described specific trends of pathogen distribution and resistance during hospitalization duration. We included 6505 ICU- BSI isolates from 35 Swiss hospitals. We observed 2587 possible skin contaminants, 3788 bacteremias and 130 fungemias. The most common microorganism was Escherichia coli (23.2%, 910), followed by Staphylococcus aureus (18.7%, 734) and enterococci (13.1%, 515). Enterococcus spp (p < 0.0001) and Candida spp (p < 0.0001) increased in proportion, whereas E. coli (p < 0.0001) and S. aureus (p < 0.0001) proportions decreased during hospitalization. Resistances against first- and second-line antibiotics increased linearly during hospitalization. Pathogen distribution and antimicrobial resistance in ICU-BSI depends on the duration of the hospitalization. The proportion of enterococcal BSI, candidemia and resistant microorganisms against first- and second-line antibiotics increased during hospitalization.
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Affiliation(s)
- Rami Sommerstein
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Stephan Harbarth
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Michael Gasser
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Andreas Kronenberg
- Swiss Centre for Antibiotic Resistance (ANRESIS), Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Niccolò Buetti
- Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. .,INSERM, IAME, University of Paris, Paris, France.
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9
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Bibert S, Guex N, Lourenco J, Brahier T, Papadimitriou-Olivgeris M, Damonti L, Manuel O, Liechti R, Götz L, Tschopp J, Quinodoz M, Vollenweider P, Pagani JL, Oddo M, Hügli O, Lamoth F, Erard V, Voide C, Delorenzi M, Rufer N, Candotti F, Rivolta C, Boillat-Blanco N, Bochud PY. Transcriptomic Signature Differences Between SARS-CoV-2 and Influenza Virus Infected Patients. Front Immunol 2021; 12:666163. [PMID: 34135895 PMCID: PMC8202013 DOI: 10.3389/fimmu.2021.666163] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/19/2022] Open
Abstract
The reason why most individuals with COVID-19 have relatively limited symptoms while other develop respiratory distress with life-threatening complications remains unknown. Increasing evidence suggests that COVID-19 associated adverse outcomes mainly rely on dysregulated immunity. Here, we compared transcriptomic profiles of blood cells from 103 patients with different severity levels of COVID-19 with that of 27 healthy and 22 influenza-infected individuals. Data provided a complete overview of SARS-CoV-2-induced immune signature, including a dramatic defect in IFN responses, a reduction of toxicity-related molecules in NK cells, an increased degranulation of neutrophils, a dysregulation of T cells, a dramatic increase in B cell function and immunoglobulin production, as well as an important over-expression of genes involved in metabolism and cell cycle in patients infected with SARS-CoV-2 compared to those infected with influenza viruses. These features also differed according to COVID-19 severity. Overall and specific gene expression patterns across groups can be visualized on an interactive website (https://bix.unil.ch/covid/). Collectively, these transcriptomic host responses to SARS-CoV-2 infection are discussed in the context of current studies, thereby improving our understanding of COVID-19 pathogenesis and shaping the severity level of COVID-19.
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Affiliation(s)
- Stéphanie Bibert
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Nicolas Guex
- Bioinformatics Competence Center, University of Lausanne, Lausanne, Switzerland
| | - Joao Lourenco
- SIB Swiss Institute of Bioinformatics and Department of Fundamenal Oncology, University of Lausanne, Lausanne, Switzerland
| | - Thomas Brahier
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | | | - Lauro Damonti
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Oriol Manuel
- Infectious Diseases Service and Transplantation Center, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Robin Liechti
- Bioinformatics Competence Center, University of Lausanne, Lausanne, Switzerland
- SIB Swiss Institute of Bioinformatics and Department of Fundamenal Oncology, University of Lausanne, Lausanne, Switzerland
| | - Lou Götz
- Bioinformatics Competence Center, University of Lausanne, Lausanne, Switzerland
- SIB Swiss Institute of Bioinformatics and Department of Fundamenal Oncology, University of Lausanne, Lausanne, Switzerland
| | - Jonathan Tschopp
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mathieu Quinodoz
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Peter Vollenweider
- Internal Medicine Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Jean-Luc Pagani
- Department of Adult Intensive Care Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Mauro Oddo
- Department of Adult Intensive Care Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Olivier Hügli
- Emergency Department, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
- Department of Laboratory Medicine, Institute of Microbiology, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Véronique Erard
- Clinique de Médecine et spécialités, Infectiologie, Hôpital Fribourgeois-Fribourg, Fribourg, Switzerland
| | - Cathy Voide
- Department of Infectious Diseases, Central Institute, Valais Hospital, Sion, Switzerland
| | - Mauro Delorenzi
- SIB Swiss Institute of Bioinformatics and Department of Fundamenal Oncology, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, University Hospital and University of Lausanne, Epalinges, Switzerland
| | - Nathalie Rufer
- Department of Oncology, University Hospital and University of Lausanne, Epalinges, Switzerland
| | - Fabio Candotti
- Division of Immunology and Allergy, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Carlo Rivolta
- Institute of Molecular and Clinical Ophthalmology Basel (IOB), Basel, Switzerland
- Department of Ophthalmology, University Hospital Basel, Basel, Switzerland
- Department of Genetics and Genome Biology, University of Leicester, Leicester, United Kingdom
| | - Noémie Boillat-Blanco
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, University Hospital and University of Lausanne, Lausanne, Switzerland
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10
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Obmann VC, Bickel F, Hosek N, Ebner L, Huber AT, Damonti L, Zimmerli S, Christe A. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. ROFO-FORTSCHR RONTG 2021; 193:1304-1314. [PMID: 34034346 DOI: 10.1055/a-1482-8336] [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: 12/12/2022]
Abstract
PURPOSE Clinical signs and symptoms related to invasive fungal disease are nonspecific and need to be followed up by appropriate diagnostic procedures. The goal of this study was to analyze CT imaging patterns in invasive fungal infections and their correlation with the immune status and clinical outcome. MATERIALS AND METHODS We performed a retrospective multicenter study including 85 consecutive patients with invasive pulmonary fungal infection (2011-2014). Lung patterns on computed tomography (CT) scans were classified according to the Fleischner Society glossary. The patients were grouped according to immune status (neutropenia, steroid therapy, organ transplant recipient, and other cause) and outcome (positive outcome, progressive disease, and death). The Chi square test or Fisher exact test was used. Bonferroni correction was applied. RESULTS The total number of patients with invasive Aspergillus and non-Aspergillus infection (IANA), Pneumocystis jirovecii pneumonia (PCP), and Cryptococcus (CRY) was 60, 22, and 3, respectively. Patients with IANA demonstrated significantly more nodules (93 % vs. 59 %, p = 0.001), significantly fewer ground glass opacities (58 % vs. 96 %, p = 0.005), and significantly fewer positive lymph nodes (5 % vs. 41 %, p < 0.001) than patients with PCP. All patients with PCP and CRY had a favorable outcome. Patients with IANA and an adverse outcome demonstrated significantly more nodules with halo sign than patients with IANA and a favorable outcome (42.5 % vs. 15.9 %, p < 0.0001). Interestingly, patients with IANA and a favorable outcome had a higher prevalence of pulmonary infarction than patients with an adverse outcome (8 % vs. 1 %, p = 0.047). Patients with neutropenia showed significantly more consolidations (66 %) than organ transplant recipients (27 %, p = 0.045). CONCLUSION Patients with IANA showed a higher prevalence of nodules and a lower prevalence of ground glass opacities than patients with PCP. In patients with IANA, nodules with halo sign were associated with an adverse outcome. Patients with neutropenia showed generally more consolidations, but the consolidations were not associated with an adverse outcome. KEY POINTS · Nodules, ground glass opacities, and consolidations are common CT findings in all invasive pulmonary fungal infections.. · There is no pattern that is unique for one specific pathogen, although nodules are more predominant in IANA and Cryptococcus, and ground glass opacities are more predominant in PCP patients.. · Immune status had an impact on CT findings in fungal pneumonia with less consolidation in patients after organ transplantation compared to patients with neutropenia.. · Nodules with a halo sign are associated with a worse outcome.. CITATION FORMAT · Obmann VC, Bickel F, Hosek N et al. Radiological CT Patterns and Distribution of Invasive Pulmonary Aspergillus, Non-Aspergillus, Cryptococcus and Pneumocystis Jirovecii Mold Infections - A Multicenter Study. Fortschr Röntgenstr 2021; DOI: 10.1055/a-1482-8336.
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Affiliation(s)
- Verena C Obmann
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Flurina Bickel
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Nicola Hosek
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Lukas Ebner
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Adrian T Huber
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Inselspital, University of Bern, Switzerland
| | - Stefan Zimmerli
- Department of Infectious Diseases, Inselspital, University of Bern, Switzerland
| | - Andreas Christe
- Department of Interventional, Pediatric and Diagnostic Radiology, Inselspital, University of Bern, Switzerland
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11
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Damonti L, Buetti N, Droz S, Bacher U, Pabst T, Taleghani BM, Baerlocher GM, Marschall J. Prevalence and significance of bacterial contamination of autologous stem cell products. J Hosp Infect 2021; 114:175-179. [PMID: 33864895 DOI: 10.1016/j.jhin.2021.04.006] [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: 12/16/2020] [Revised: 04/06/2021] [Accepted: 04/12/2021] [Indexed: 10/21/2022]
Abstract
There is limited and conflicting information on the prevalence of contamination of haematopoietic stem and progenitor cell products (HPCPs), and their optimal management remains unclear. The authors reviewed the microbial surveillance data of HPCPs collected between January 2002 and December 2019 for autologous transplantation at the study institution to determine the prevalence of microbial contamination and the potential infectious complications among recipients. Among 3935 HPCPs, 25 (0.6%) were contaminated. Ultimately, 22 patients received contaminated grafts, with pre-emptive antimicrobial therapy initiated in six of these patients. No patients developed subsequent infectious complications. These data suggest that microbial contamination of autologous HPCPs and associated adverse outcomes are rare.
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Affiliation(s)
- L Damonti
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland; Ente Ospedaliero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland.
| | - N Buetti
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland; Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland; UMR 1137 IAME Team 5 DeSCID: Decision Sciences in Infectious Diseases, Control and Care Inserm/University Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - S Droz
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - U Bacher
- Department of Haematology and Central Haematology Laboratory, Inselspital, University Hospital Bern, Bern, Switzerland
| | - T Pabst
- Department of Medical Oncology, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - B M Taleghani
- Department of Haematology and Central Haematology Laboratory, Inselspital, University Hospital Bern, Bern, Switzerland
| | - G M Baerlocher
- Laboratory for Cellular Therapies, Department of Haematology and Central Haematology Laboratory, Inselspital, Bern University Hospital, Bern, Switzerland; Laboratory for Haematopoiesis and Molecular Genetics, Department of BioMedical Research, University of Bern, Bern, Switzerland
| | - J Marschall
- Department of Infectious Diseases, Inselspital, University Hospital Bern, Bern, Switzerland
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12
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Brigger D, Horn MP, Pennington LF, Powell AE, Siegrist D, Weber B, Engler O, Piezzi V, Damonti L, Iseli P, Hauser C, Froehlich TK, Villiger PM, Bachmann MF, Leib SL, Bittel P, Fiedler M, Largiadèr CR, Marschall J, Stalder H, Kim PS, Jardetzky TS, Eggel A, Nagler M. Accuracy of serological testing for SARS-CoV-2 antibodies: First results of a large mixed-method evaluation study. Allergy 2021; 76:853-865. [PMID: 32997812 PMCID: PMC7537154 DOI: 10.1111/all.14608] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [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: 08/03/2020] [Revised: 09/11/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Serological immunoassays that can identify protective immunity against SARS-CoV-2 are needed to adapt quarantine measures, assess vaccination responses, and evaluate donor plasma. To date, however, the utility of such immunoassays remains unclear. In a mixed-design evaluation study, we compared the diagnostic accuracy of serological immunoassays that are based on various SARS-CoV-2 proteins and assessed the neutralizing activity of antibodies in patient sera. METHODS Consecutive patients admitted with confirmed SARS-CoV-2 infection were prospectively followed alongside medical staff and biobank samples from winter 2018/2019. An in-house enzyme-linked immunosorbent assay utilizing recombinant receptor-binding domain (RBD) of the SARS-CoV-2 spike protein was developed and compared to three commercially available enzyme-linked immunosorbent assays (ELISAs) targeting the nucleoprotein (N), the S1 domain of the spike protein (S1), and a lateral flow immunoassay (LFI) based on full-length spike protein. Neutralization assays with live SARS-CoV-2 were performed. RESULTS One thousand four hundred and seventy-seven individuals were included comprising 112 SARS-CoV-2 positives (defined as a positive real-time PCR result; prevalence 7.6%). IgG seroconversion occurred between day 0 and day 21. While the ELISAs showed sensitivities of 88.4% for RBD, 89.3% for S1, and 72.9% for N protein, the specificity was above 94% for all tests. Out of 54 SARS-CoV-2 positive individuals, 96.3% showed full neutralization of live SARS-CoV-2 at serum dilutions ≥ 1:16, while none of the 6 SARS-CoV-2-negative sera revealed neutralizing activity. CONCLUSIONS ELISAs targeting RBD and S1 protein of SARS-CoV-2 are promising immunoassays which shall be further evaluated in studies verifying diagnostic accuracy and protective immunity against SARS-CoV-2.
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Affiliation(s)
- Daniel Brigger
- Department of Rheumatology, Immunology, and AllergologyInselspital University HospitalBernSwitzerland
- Department of BioMedical ResearchUniversity of BernBernSwitzerland
| | - Michael P. Horn
- University Institute of Clinical ChemistryInselspital University HospitalBernSwitzerland
| | - Luke F. Pennington
- Department of Structural BiologyStanford University School of MedicineStanfordCAUSA
| | - Abigail E. Powell
- Standford Chem‐H and Department of BiochemistryStanford University School of MedicineStanfordCAUSA
- Chan Zuckerberg BiohubSan FranciscoCAUSA
| | - Denise Siegrist
- Spiez LaboratoryFederal Office for Civil ProtectionSpiezSwitzerland
| | - Benjamin Weber
- Spiez LaboratoryFederal Office for Civil ProtectionSpiezSwitzerland
| | - Olivier Engler
- Spiez LaboratoryFederal Office for Civil ProtectionSpiezSwitzerland
| | - Vanja Piezzi
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
| | - Lauro Damonti
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
| | - Patricia Iseli
- Occupational MedicineInselspital University HospitalBernSwitzerland
| | - Christoph Hauser
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
| | - Tanja K. Froehlich
- University Institute of Clinical ChemistryInselspital University HospitalBernSwitzerland
| | - Peter M. Villiger
- Department of Rheumatology, Immunology, and AllergologyInselspital University HospitalBernSwitzerland
| | - Martin F. Bachmann
- Department of Rheumatology, Immunology, and AllergologyInselspital University HospitalBernSwitzerland
- Department of BioMedical ResearchUniversity of BernBernSwitzerland
| | - Stephen L. Leib
- Institute for Infectious DiseasesUniversity of BernBernSwitzerland
| | - Pascal Bittel
- Institute for Infectious DiseasesUniversity of BernBernSwitzerland
| | - Martin Fiedler
- University Institute of Clinical ChemistryInselspital University HospitalBernSwitzerland
| | - Carlo R. Largiadèr
- University Institute of Clinical ChemistryInselspital University HospitalBernSwitzerland
| | - Jonas Marschall
- Department of Infectious DiseasesBern University HospitalUniversity of BernBernSwitzerland
| | - Hanspeter Stalder
- Vetsuisse FacultyInstitute of Virology and ImmunologyUniversity of BernBernSwitzerland
| | - Peter S. Kim
- Standford Chem‐H and Department of BiochemistryStanford University School of MedicineStanfordCAUSA
- Chan Zuckerberg BiohubSan FranciscoCAUSA
| | | | - Alexander Eggel
- Department of Rheumatology, Immunology, and AllergologyInselspital University HospitalBernSwitzerland
- Department of BioMedical ResearchUniversity of BernBernSwitzerland
| | - Michael Nagler
- University Institute of Clinical ChemistryInselspital University HospitalBernSwitzerland
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13
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Thiabaud A, Iten A, Balmelli C, Senn L, Troillet N, Widmer A, Flury D, Schreiber PW, Vázquez M, Damonti L, Buettcher M, Vuichard-Gysin D, Kuhm C, Cusini A, Riedel T, Nussbaumer-Ochsner Y, Gaudenz R, Heininger U, Berger C, Zucol F, Bernhard-Stirnemann S, Corti N, Zimmermann P, Uka A, Niederer-Loher A, Gardiol C, Roelens M, Keiser O. Cohort profile: SARS-CoV-2/COVID-19 hospitalised patients in Switzerland. Swiss Med Wkly 2021; 151:w20475. [PMID: 33638351 DOI: 10.4414/smw.2021.20475] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND SARS-CoV-2/COVID-19, which emerged in China in late 2019, rapidly spread across the world with several million victims in 213 countries. Switzerland was severely hit by the virus, with 43,000 confirmed cases as of 1 September 2020. AIM In cooperation with the Federal Office of Public Health, we set up a surveillance database in February 2020 to monitor hospitalised patients with COVID-19, in addition to their mandatory reporting system. METHODS Patients hospitalised for more than 24 hours with a positive polymerase chain-reaction test, from 20 Swiss hospitals, are included. Data were collected in a customised case report form based on World Health Organisation recommendations and adapted to local needs. Nosocomial infections were defined as infections for which the onset of symptoms was more than 5 days after the patient’s admission date. RESULTS As of 1 September 2020, 3645 patients were included. Most patients were male (2168, 59.5%), and aged between 50 and 89 years (2778, 76.2%), with a median age of 68 (interquartile range 54–79). Community infections dominated with 3249 (89.0%) reports. Comorbidities were frequently reported, with hypertension (1481, 61.7%), cardiovascular diseases (948, 39.5%) and diabetes (660, 27.5%) being the most frequent in adults; respiratory diseases and asthma (4, 21.1%), haematological and oncological diseases (3, 15.8%) were the most frequent in children. Complications occurred in 2679 (73.4%) episodes, mostly respiratory diseases (2470, 93.2% in adults; 16, 55.2% in children), and renal (681, 25.7%) and cardiac (631, 23.8%) complications for adults. The second and third most frequent complications in children affected the digestive system and the liver (7, 24.1%). A targeted treatment was given in 1299 (35.6%) episodes, mostly with hydroxychloroquine (989, 76.1%). Intensive care units stays were reported in 578 (15.8%) episodes. A total of 527 (14.5%) deaths were registered, all among adults. CONCLUSION The surveillance system has been successfully initiated and provides a robust set of data for Switzerland by including about 80% (compared with official statistics) of SARS-CoV-2/COVID-19 hospitalised patients, with similar age and comorbidity distributions. It adds detailed information on the epidemiology, risk factors and clinical course of these cases and, therefore, is a valuable addition to the existing mandatory reporting.
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Affiliation(s)
- Amaury Thiabaud
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
| | - Anne Iten
- Service de prévention et contrôle de l'infection, Direction médicale et qualité, HUG, Geneva, Switzerland
| | - Carlo Balmelli
- Infection Control Programme, EOC Hospitals, Ticino, Switzerland
| | - Laurence Senn
- Service de médecine préventive hospitalière, CHUV, Lausanne, Switzerland
| | - Nicolas Troillet
- Service of Infectious Diseases, Central Institute, Valais Hospitals, Sion, Switzerland
| | - Andreas Widmer
- Department of Infectious Diseases, University Hospital Basel, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Switzerland
| | - Peter W Schreiber
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich and University of Zurich, Switzerland
| | - Miriam Vázquez
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital (Inselspital), Bern, Switzerland
| | - Michael Buettcher
- Paediatric Infectious Diseases, Department of Paediatrics, Children's Hospital, Cantonal Hospital Lucerne, Switzerland
| | | | - Christoph Kuhm
- Department of Infectious Diseases, Thurgau Cantonal Hospital, Thurgau, Switzerland
| | - Alexia Cusini
- Department of Infectious Diseases, Cantonal Hospital Graubuenden, Chur, Switzerland
| | - Thomas Riedel
- Department of Paediatrics, Cantonal Hospital Graubuenden, Chur, Switzerland
| | | | - Roman Gaudenz
- Innere Medizin und Infektiologie, Kantonsspital Nidwalden, Stans, Switzerland
| | - Ulrich Heininger
- Infectious Diseases and Vaccinology, University of Basel Children's Hospital, Basel, Switzerland
| | - Christoph Berger
- Division of Infectious Diseases and Children's Research Centre, University Children's Hospital Zurich, Switzerland
| | - Franziska Zucol
- Paediatric Infectious Diseases, Department of Paediatrics, Cantonal Hospital Winterthur, Switzerland
| | | | - Natascia Corti
- Unit of General Internal Medicine, Hirslanden Clinic, Zurich, Switzerland
| | - Petra Zimmermann
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | - Anita Uka
- Faculty of Science and Medicine, University of Fribourg, Switzerland / Department of Paediatrics, Fribourg Hospital HFR, Fribourg, Switzerland
| | | | - Céline Gardiol
- Swiss Federal Office of Public Health, Bern, Switzerland
| | - Maroussia Roelens
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
| | - Olivia Keiser
- Institut de Santé Globale, Faculté de Médecine de l'Université de Genève, Geneva, Switzerland
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14
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Poissy J, Damonti L, Bignon A, Khanna N, Von Kietzell M, Boggian K, Neofytos D, Vuotto F, Coiteux V, Artru F, Zimmerli S, Pagani JL, Calandra T, Sendid B, Poulain D, van Delden C, Lamoth F, Marchetti O, Bochud PY. Risk factors for candidemia: a prospective matched case-control study. Crit Care 2020; 24:109. [PMID: 32188500 PMCID: PMC7081522 DOI: 10.1186/s13054-020-2766-1] [Citation(s) in RCA: 80] [Impact Index Per Article: 20.0] [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] [Received: 11/01/2019] [Accepted: 02/07/2020] [Indexed: 12/29/2022]
Abstract
Background Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. Methods This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. Results One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. Discussion While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). Conclusion This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology.
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Affiliation(s)
- Julien Poissy
- Current affiliation : Univ. Lille, Inserm U1285, CHU Lille, Pôle de réanimation, NRS, UMR 8576 - UGSF - Unité de Glycobiologie Structurale et Fonctionnelle, F-59000, Lille, France.,Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.,Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Lauro Damonti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Department of Infectious Diseases Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Anne Bignon
- Surgical Intensive Care Unit, University Hospital of Lille, F-59000, Lille, France
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, University and University Hospital of Basel, Basel, Switzerland
| | - Matthias Von Kietzell
- Infectious Diseases Department, Cantonal Hospital of Saint Gallen, St. Gallen, Switzerland
| | - Katia Boggian
- Infectious Diseases Department, Cantonal Hospital of Saint Gallen, St. Gallen, Switzerland
| | - Dionysios Neofytos
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Fanny Vuotto
- Infectious Diseases Department, University Hospital of Lille, F-59000, Lille, France
| | - Valérie Coiteux
- Hematological Disorders Department, University Hospital and University of Lille, F-59000, Lille, France
| | - Florent Artru
- Digestive Intensive Care Department, University Hospital and University of Lille, F-59000, Lille, France
| | - Stephan Zimmerli
- Department of Infectious Diseases Department, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jean-Luc Pagani
- Adult Intensive Care Service, University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Boualem Sendid
- Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.,Laboratory of Mycology and Parasitology, Hospital and University of Lille, F-59000, Lille, France
| | - Daniel Poulain
- Inserm, U995-2 "Fungal Associated Invasive and Inflammatory Diseases", F-59000, Lille, France.,Laboratory of Mycology and Parasitology, Hospital and University of Lille, F-59000, Lille, France
| | - Christian van Delden
- Transplant Infectious Diseases Unit, University Hospitals of Geneva, Geneva, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Microbiology Institute, Lausanne University Hospital and University of Lausanne, CH-1010, Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.,Department of Medicine, Ensemble Hospitalier de la Côte, CH-1110, Morges, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital and University of Lausanne, rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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15
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Damonti L, Marschall J, Lo Priore E, Buetti N. Disseminated meningococcal infection, early petechiae. Int J Infect Dis 2020; 93:231-232. [PMID: 32045696 DOI: 10.1016/j.ijid.2020.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/03/2020] [Accepted: 02/03/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Lauro Damonti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.
| | - Jonas Marschall
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Elia Lo Priore
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Niccolò Buetti
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland; INSERM IAME, U1137, Team DesCID, Paris, France
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16
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Damonti L, Erard V, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, Imhof A, Zbinden R, Fehr J, Boggian K, Bruderer T, Flückiger U, Frei R, Orasch C, Conen A, Khanna N, Bregenzer T, Bille J, Lamoth F, Marchetti O, Bochud PY. Correction to: Catheter retention as a consequence rather than a cause of unfavorable outcome in candidemia. Intensive Care Med 2018; 44:405-407. [PMID: 29464298 DOI: 10.1007/s00134-018-5081-4] [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: 11/25/2022]
Abstract
In the original publication the members of the FUNGINOS network were provided in such a way that they could not be indexed as collaborators on PubMed.
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Affiliation(s)
- Lauro Damonti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Véronique Erard
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Department of Medicine, HFR-Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Jorge Garbino
- Infectious Diseases Service, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Zimmerli
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Alexander Imhof
- Department of Medicine, Oberaargau Hospital, Langenthal, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Zürich University Hospital, Zürich, Switzerland
| | - Reinhard Zbinden
- Laboratory of Microbiological Diagnostics, Institute of Medical Microbiology, University of Zürich, Zürich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, Zürich University Hospital, Zürich, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, Sankt Gallen, Switzerland
| | - Thomas Bruderer
- Department of Bacteriology, Mycology and Parasitology, Center of Laboratory Medicine, Cantonal Hospital, Sankt Gallen, Switzerland
| | - Ursula Flückiger
- Internal Medicine and Infectious Diseases, Hirslanden Klinik, Aarau, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Reno Frei
- Laboratory Medicine, Division of Clinical Microbiology, Basel University Hospital, Basel, Switzerland
| | - Christina Orasch
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Internal Medicine and Infectious Diseases, Hirslanden Klinik, St. Anna, Lucerne, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Anna Conen
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
- Division of lnfectious Diseases and Hospital Hygiene, Cantonal Hospital, Aarau, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Thomas Bregenzer
- Division of lnfectious Diseases and Hospital Hygiene, Cantonal Hospital, Aarau, Switzerland
- Clinics for Internal Medicine, Hospital Lachen AG, Lachen, Switzerland
| | - Jacques Bille
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland.
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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17
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Lamoth F, Chung SJ, Damonti L, Alexander BD. Changing Epidemiology of Invasive Mold Infections in Patients Receiving Azole Prophylaxis. Clin Infect Dis 2018; 64:1619-1621. [PMID: 28199491 DOI: 10.1093/cid/cix130] [Citation(s) in RCA: 92] [Impact Index Per Article: 15.3] [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: 11/08/2016] [Accepted: 02/10/2017] [Indexed: 11/14/2022] Open
Abstract
Breakthrough invasive mold infections (IMIs) that occur during posaconazole or voriconazole prophylaxis are rare complications for which epidemiological data are lacking. This retrospective analysis comparing 24 microbiologically documented breakthrough with 66 nonbreakthrough IMIs shows a shift towards non-Aspergillus molds with a significantly increased proportion of rare multidrug-resistant molds.
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Affiliation(s)
- Frederic Lamoth
- Division of Infectious Diseases and International Health, Department of Medicine, and.,Clinical Microbiology Laboratory, Department of Pathology, Duke University Medical Center, Durham, North Carolina.,Infectious Diseases Service, Department of Medicine, and.,Institute of Microbiology, Lausanne University Hospital, Switzerland ; and
| | - Shimin J Chung
- Division of Infectious Diseases and International Health, Department of Medicine, and.,Department of Infectious Diseases, Singapore General Hospital, Singapore
| | - Lauro Damonti
- Infectious Diseases Service, Department of Medicine, and
| | - Barbara D Alexander
- Division of Infectious Diseases and International Health, Department of Medicine, and.,Clinical Microbiology Laboratory, Department of Pathology, Duke University Medical Center, Durham, North Carolina
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18
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Orasch C, Mertz D, Garbino J, van Delden C, Emonet S, Schrenzel J, Zimmerli S, Damonti L, Mühlethaler K, Imhof A, Ruef C, Fehr J, Zbinden R, Boggian K, Bruderer T, Flückiger U, Conen A, Khanna N, Frei R, Bregenzer T, Lamoth F, Erard V, Bochud PY, Calandra T, Bille J, Marchetti O. Fluconazole non-susceptible breakthrough candidemia after prolonged low-dose prophylaxis: a prospective FUNGINOS study. J Infect 2018; 76:489-495. [PMID: 29378240 DOI: 10.1016/j.jinf.2017.12.018] [Citation(s) in RCA: 9] [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] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 12/10/2017] [Accepted: 12/11/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Breakthrough candidemia (BTC) on fluconazole was associated with non-susceptible Candida spp. and increased mortality. This nationwide FUNGINOS study analyzed clinical and mycological BTC characteristics. METHODS A 3-year prospective study was conducted in 567 consecutive candidemias. Species identification and antifungal susceptibility testing (CLSI) were performed in the FUNGINOS reference laboratory. Data were analyzed according to STROBE criteria. RESULTS 43/576 (8%) BTC occurred: 37/43 (86%) on fluconazole (28 prophylaxis, median 200 mg/day). 21% BTC vs. 23% non-BTC presented severe sepsis/septic shock. Overall mortality was 34% vs. 32%. BTC was associated with gastrointestinal mucositis (multivariate OR 5.25, 95%CI 2.23-12.40, p < 0.001) and graft-versus-host-disease (6.25, 1.00-38.87, p = 0.05), immunosuppression (2.42, 1.03-5.68, p = 0.043), and parenteral nutrition (2.87, 1.44-5.71, p = 0.003). Non-albicans Candida were isolated in 58% BTC vs. 35% non-BTC (p = 0.005). 63% of 16 BTC occurring after 10-day fluconazole were non-susceptible (Candida glabrata, Candida krusei, Candida norvegensis) vs. 19% of 21 BTC (C. glabrata) following shorter exposure (7.10, 1.60-31.30, p = 0.007). Median fluconazole MIC was 4 mg/l vs. 0.25 mg/l (p < 0.001). Ten-day fluconazole exposure predicted non-susceptible BTC with 73% accuracy. CONCLUSIONS Outcomes of BTC and non-BTC were similar. Fluconazole non-susceptible BTC occurred in three out of four cases after prolonged low-dose prophylaxis. This implies reassessment of prophylaxis duration and rapid de-escalation of empirical therapy in BTC after short fluconazole exposure.
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Affiliation(s)
- Christina Orasch
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Infectious Diseases and Hospital Epidemiology, Hirslanden Klinik St. Anna, Lucerne, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland.
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Jorge Garbino
- Infectious Diseases Service, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Christian van Delden
- Infectious Diseases Service, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Stephane Emonet
- Infectious Diseases Service, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Service of Laboratory Medicine, Department of Genetics & Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Zimmerli
- Department of Infectious Diseases, Bern University Hospital (Inselspital), and Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Lauro Damonti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Infectious Diseases, Bern University Hospital (Inselspital), and Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Konrad Mühlethaler
- Department of Infectious Diseases, Bern University Hospital (Inselspital), and Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Alexander Imhof
- Department of Medicine, Zurich University Hospital, Zurich; Department of Medicine, Oberaargau Hospital, Langenthal, Switzerland
| | - Christian Ruef
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland; Hirslanden Klinik, Zürich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Reinhard Zbinden
- Institute of Medical Microbiology, University of Zürich, Zürich, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, Sankt Gallen, Switzerland
| | - Thomas Bruderer
- Department of Bacteriology, Mycology and Parasitology, Center of Laboratory Medicine, Cantonal Hospital, Sankt Gallen, Switzerland
| | - Ursula Flückiger
- Hirslanden Klinik, Aarau, Switzerland; Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Anna Conen
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland; Division of Infectious Diseases and Hospital Hygiene, Kantonsspital, Aarau, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Reno Frei
- Division of Clinical Microbiology, Laboratory Medicine, Basel University Hospital, Basel, Switzerland
| | - Thomas Bregenzer
- Division of Infectious Diseases and Hospital Hygiene, Kantonsspital, Aarau, Switzerland; Klinik für Innere Medizin, Spital Lachen AG, Lachen, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Véronique Erard
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Clinique of Medicine, HFR-Fribourg Hospital, Fribourg, Switzerland
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Thierry Calandra
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Jacques Bille
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Lausanne, Switzerland; Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland.
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19
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Damonti L, Erard V, Garbino J, Schrenzel J, Zimmerli S, Mühlethaler K, Imhof A, Zbinden R, Fehr J, Boggian K, Bruderer T, Flückiger U, Frei R, Orasch C, Conen A, Khanna N, Bregenzer T, Bille J, Lamoth F, Marchetti O, Bochud PY. Catheter retention as a consequence rather than a cause of unfavorable outcome in candidemia. Intensive Care Med 2017; 43:935-939. [PMID: 28271318 DOI: 10.1007/s00134-017-4737-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Lauro Damonti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
| | - Véronique Erard
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Department of Medicine, HFR-Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Jorge Garbino
- Infectious Diseases Service, Department of Medical Specialties, Geneva University Hospitals, Geneva, Switzerland
| | - Jacques Schrenzel
- Bacteriology Laboratory, Service of Laboratory Medicine, Department of Genetics and Laboratory Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Stefan Zimmerli
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Konrad Mühlethaler
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Alexander Imhof
- Department of Medicine, Oberaargau Hospital, Langenthal, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Zürich University Hospital, Zürich, Switzerland
| | - Reinhard Zbinden
- Laboratory of Microbiological Diagnostics, Institute of Medical Microbiology, University of Zürich, Zürich, Switzerland
| | - Jan Fehr
- Division of Infectious Diseases and Hospital Epidemiology, Zürich University Hospital, Zürich, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital, Sankt Gallen, Switzerland
| | - Thomas Bruderer
- Department of Bacteriology, Mycology and Parasitology, Center of Laboratory Medicine, Cantonal Hospital, Sankt Gallen, Switzerland
| | - Ursula Flückiger
- Internal Medicine and Infectious Diseases, Hirslanden Klinik, Aarau, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Reno Frei
- Laboratory Medicine, Division of Clinical Microbiology, Basel University Hospital, Basel, Switzerland
| | - Christina Orasch
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Internal Medicine and Infectious Diseases, Hirslanden Klinik, St. Anna, Lucerne, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Anna Conen
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
- Division of lnfectious Diseases and Hospital Hygiene, Cantonal Hospital, Aarau, Switzerland
| | - Nina Khanna
- Division of Infectious Diseases and Hospital Epidemiology, Basel University Hospital, Basel, Switzerland
| | - Thomas Bregenzer
- Division of lnfectious Diseases and Hospital Hygiene, Cantonal Hospital, Aarau, Switzerland
- Clinics for Internal Medicine, Hospital Lachen AG, Lachen, Switzerland
| | - Jacques Bille
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Frédéric Lamoth
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland
- Institute of Microbiology, Department of Laboratories, Lausanne University Hospital, Lausanne, Switzerland
| | - Oscar Marchetti
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
- Department of Medicine, Ensemble Hospitalier de la Côte, Morges, Switzerland.
| | - Pierre-Yves Bochud
- Infectious Diseases Service, Department of Medicine, Lausanne University Hospital, Rue du Bugnon 46, CH-1011, Lausanne, Switzerland.
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20
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Damonti L, Boggian K. Aspergillose. Therapeutische Umschau 2016; 73:469-474. [DOI: 10.1024/0040-5930/a000820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung. Aspergillus spp gehört zur Gattung der Schimmelpilze und kann, abhängig von der Abwehrsituation des Wirtes, die verschiedensten Krankheitsbilder hervorrufen. Die invasive pulmonale Aspergillose kommt in erster Linie bei schwer immunsupprimierten Patienten vor. Neue Risikofaktoren für eine pulmonale Aspergillose sind die intensivmedizinische Behandlung und chronische Lungenerkrankungen. Dank der besseren antifungalen Therapie hat die Mortalität insgesamt im Vergleich zu früheren Jahren leicht abgenommen, ist aber bei bestimmten Grunderkrankungen immer noch sehr hoch. Wir gehen in erster Linie auf die invasive pulmonale Aspergillose ein, werden aber auch die chronisch pulmonale Aspergillose und die allergisch bronchopulmonale Aspergillose beleuchten.
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Affiliation(s)
- Lauro Damonti
- Universitätsklinik für Infektiologie, Inselspital Bern
| | - Katia Boggian
- Infektiologie/Spitalhygiene, Kantonsspital St. Gallen
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