Legionellen sind Wasserkeime und konnen zwei typische Krankheitsbilder auslosen: Das Pontiac-Fieb... more Legionellen sind Wasserkeime und konnen zwei typische Krankheitsbilder auslosen: Das Pontiac-Fieber und die Legionarskrankheit. Letztere ist eine seltene (3–7%), potentiell lebensbedrohliche Pneumonie. In fast allen Fallen ist Legionella pneumophila Serogruppe I fur die Pneumonie verantwortlich. Es gibt aber 42 Arten und 64 Serotypen, wobei Legionella micdadei der zweithaufigste Erreger ist. Die Letalitat der Legionellenpneumonie liegt immer noch um 5% bis 10% und ist bei hospitalisierten Patienten hoher. Etablierte Risiken sind Nikotinabusus, chronisch-obstruktive Pneumopathie, sowie Immunsuppression. Die Kultur bedingt Spezialnahrmedien, so dass die Diagnose nicht mit Routinemethoden gestellt werden kann. Die Einfuhrung des Antigentestes im Urin hat die Diagnostik wesentlich verbessert. Eine PCR fur Sputum erganzt die neuen diagnostischen Moglichkeiten, wobei hier die Kosten und die Spezifitat die Anwendung auf Spezialfalle einschrankt. Therapie der Wahl sind neuere Makrolide oder alternativ neuere Quin...
This chapter discussed the management of antimicrobial resistance (AMR) under the One Health prog... more This chapter discussed the management of antimicrobial resistance (AMR) under the One Health programme and presents examples of AMR in hospital germs circulating between animals and humans as well as discussed some evidences of environmental-animal-human AMR exchange.
We appreciate the insightful comments made by Werth et al pertaining to the 2015 Infectious Disea... more We appreciate the insightful comments made by Werth et al pertaining to the 2015 Infectious Diseases Society of America guidelines on native vertebral osteomyelitis (NVO) published in the September 2015 issue of Clinical Infectious Diseases [1]. The points raised are related to the extended duration of concomitant aminoglycoside therapy and the optimal dose of daptomycin in enterococcal NVO. Enterococcus species comprised 2% of episodes of NVO in a cohort of 260 patients seen at the Mayo Clinic between 1994 and 2006 [2]. The incidence is even lower in other cohorts and community-based series [3, 4]. Therefore, one can imagine that the level of clinical evidence supporting any management strategies pertaining to enterococcal NVO is going to be very low. We agree that in the presence of concomitant infective endocarditis (IE), NVO patients should be managed according to the most recent IE guidelines. Based on the IE guidelines that were subsequently published in October 2015, the use of dual β-lactams (ampicillin and ceftriaxone) as an alternative to penicillin and gentamicin carried a recommendations of class IIa, with level of evidence B [5]. As outlined in Table 2 of the NVO guidelines, other patients with enterococcal NVO (without associated endocarditis) can be managed with penicillin without or with a short course of aminoglycoside therapy [1].The average age of the patients diagnosed with NVO is 59 years of age, rendering the tolerance of aminoglycoside use in this patient papulation less of an issue when compared to IE [2, 3, 4]. The experience on the use of daptomycin in enterococcal IE is stemming from case reports and small case series [5]. The experience in the management of enterococcal NVO is also stemming from few case reports and the collective experience of the panel members. The dose of daptomycin of 10–12 mg/kg mentioned in the letter to the editor is for the rare enterococcal endocarditis cases caused by strains that are resistant to penicillin, aminoglycosides, and vancomycin [5]. In a European retrospective clinical registry study on the use of daptomycin in 220 patients with osteomyelitis, 11 (5%) were due to Enterococcus species and 11% had “back” listed as the site of the infection. In this study, the use of higher dosage of daptomycin was not associated with a better outcome when compared with the standard dose [6], The high protein binding of daptomycin may limit its effectiveness, despite high serum levels. We believe that the use of higher dosage of daptomycin should be reserved to occasional cases of NVO due to vancomycinresistant enterococci in consultation with an infectious diseases clinician and a spine surgeon.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2015
These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neu... more These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.
These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neu... more These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.
Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It... more Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It is conceivable that catheter replacement causes bacteremia and contributes to this morbidity and mortality. The purpose of our study was to determine the incidence and clinical relevance of bacteremia induced by urinary catheter replacements. We analyzed clinical signs and symptoms and laboratory measures (leukocyte count, C-reactive protein, urine sediment, urine culture) during 120 routine catheter replacements in geriatric patients. In addition, blood cultures were drawn before and at 5, 15, and 30 minutes after catheter replacement. The urine cultures showed growth of 1 to 5 different microorganisms before replacement. Of 480 blood cultures, 27 (5.6%) were positive. However, the same species grew from blood and urine in only 5 catheter replacements. None of the patients met criteria for systemic inflammatory response syndrome. There were no significant differences in clinical and laboratory findings between patients with and without bacteremia. Coagulase-negative staphylococci grew in 12 blood cultures. Their distribution over time suggested that they mainly represented catheter replacement-related bacteremia rather than contaminants. Consequently, 64 intraurethral catheter segments were additionally cultured. Coagulase-negative staphylococci grew in 10 catheter cultures, but in only 2 simultaneously cultured urine samples. Bacteremia induced by routine replacement of long-term urinary catheters occurred in 4.2% (5/120) of replacements in geriatric patients. Such bacteremia did not have a detectable clinical relevance in our study.
Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infec... more Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infections with molds other than aspergilli have been increasingly seen in patients with hematologic cancers, but epidemics of these infections have not yet been reported. To describe an outbreak of invasive mycoses with Paecilomyces lilacinus in severely neutropenic patients. An outbreak investigation. The hematology-oncology isolation and bone marrow transplantation unit of the University Hospital, Basel, Switzerland. 25 consecutive patients admitted between 17 August 1993 (the date of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed). Clinical and microbiological data, including histologic findings; cultures from several patient sites; and environmental examinations of potential airborne, parenteral, enteric, and horizontal routes of transmission. Infections were defined by the isolation of P. lilacinus from clinically evident skin eruptions. 12 of the 25 patients (48%) were infected or colonized. Nine patients (36%), including all bone marrow transplant recipients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patients with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and kidney infiltrates. Seven affected patients no longer had P. lilacinus after recovery of bone marrow function. The organism was resistant in vitro to amphotericin B, itraconazole, and fluconazole. Patients did not respond clinically to these agents. The outbreak was ultimately traced to a contaminated, commercially available, pharmaceutically prepared skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years. Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a common saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.
Few methicillin-resistantStaphylococcus aureus(MRSA) from the early years of its global emergence... more Few methicillin-resistantStaphylococcus aureus(MRSA) from the early years of its global emergence have been sequenced. Knowledge about evolutionary factors promoting the success of specific MRSA multi-locus sequence types (MLSTs) remains scarce. We aimed to characterize a legacy MRSA collection isolated from 1965 to 1987 and compare it against publicly available international and local genomes.We accessed 451 ancient (1965-1987) Swiss MRSA isolates, stored in the Culture Collection of Switzerland. We determined phenotypic antimicrobial resistance (AMR) and performed Illumina short-read sequencing on all isolates and long-read sequencing on a selection with Oxford Nanopore Technology. For context, we included 103 publicly available international genomes from 1960 to 1992 and sequenced 1207 modern Swiss MRSA isolates from 2007 to 2022. We analyzed the core genome (cg)MLST and predicted SCCmeccassette types, AMR, and virulence genes.Among the 451 ancient Swiss MRSA isolates, we found 1...
Antimicrobial Resistance and Infection Control, 2021
Background The hospital environment has got more attention as evidence as source for bacterial tr... more Background The hospital environment has got more attention as evidence as source for bacterial transmission and subsequent hospital-acquired infection increased. Regular cleaning and disinfection have been proposed to lower the risk of infection, in particular for gram-positive bacteria. Auto-disinfecting surfaces would allow to decrease survival of pathogens, while limiting resource to achieve a safe environment in patient rooms. Methods A controlled trial to evaluate the antimicrobial effectiveness of a polyvinyl chloride foil containing an integrated silver-based agent (containing silver ions 2%) on high-touch surfaces in patient rooms. Results The overall log reduction of the mean values was 1.8 log 10 CFU, the median 0.5 log 10 CFU comparing bioburden of control vs antimicrobial foil (p < 0.01). Important pathogens were significantly less likely recovered from the foil, in particular enterococci. These effects were present even after 6 months of in-use. Conclusions A foil co...
Candida auris, a globally emerging pathogen, has been repeatedly introduced into European healthc... more Candida auris, a globally emerging pathogen, has been repeatedly introduced into European healthcare settings, leading to large and long-lasting nosocomial outbreaks. The pathogen has already been isolated in Switzerland, requiring clinicians and microbiologists to become alert. This is the first comprehensive guidance document on prevention and control of C. auris in Swiss acute care hospitals. It brings to light the most recent evidence from published original articles and reviews. We emphasise the importance of quickly identifying this yeast by means of screening in order to prevent an outbreak that could be difficult to contain. Key containment strategies include reinforcing early detection, hand hygiene, application of strict contact precautions for colonised and infected patients, and thorough specific environmental cleaning and disinfection.
Antimicrobial Resistance & Infection Control, 2020
Background The World Health Organization (WHO) recommends administration of surgical antimicrobia... more Background The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother. Methods Study design: Cohort. Setting: 75 participating Swiss hospitals, from 2009 to 2018. Participants: A total of 55,901 patients were analyzed. Main outcome measures: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. Results SAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4–1.8%]) occurred before incision and 449 (1.7% [1.5–1.9%]) after clamping (...
Legionellen sind Wasserkeime und konnen zwei typische Krankheitsbilder auslosen: Das Pontiac-Fieb... more Legionellen sind Wasserkeime und konnen zwei typische Krankheitsbilder auslosen: Das Pontiac-Fieber und die Legionarskrankheit. Letztere ist eine seltene (3–7%), potentiell lebensbedrohliche Pneumonie. In fast allen Fallen ist Legionella pneumophila Serogruppe I fur die Pneumonie verantwortlich. Es gibt aber 42 Arten und 64 Serotypen, wobei Legionella micdadei der zweithaufigste Erreger ist. Die Letalitat der Legionellenpneumonie liegt immer noch um 5% bis 10% und ist bei hospitalisierten Patienten hoher. Etablierte Risiken sind Nikotinabusus, chronisch-obstruktive Pneumopathie, sowie Immunsuppression. Die Kultur bedingt Spezialnahrmedien, so dass die Diagnose nicht mit Routinemethoden gestellt werden kann. Die Einfuhrung des Antigentestes im Urin hat die Diagnostik wesentlich verbessert. Eine PCR fur Sputum erganzt die neuen diagnostischen Moglichkeiten, wobei hier die Kosten und die Spezifitat die Anwendung auf Spezialfalle einschrankt. Therapie der Wahl sind neuere Makrolide oder alternativ neuere Quin...
This chapter discussed the management of antimicrobial resistance (AMR) under the One Health prog... more This chapter discussed the management of antimicrobial resistance (AMR) under the One Health programme and presents examples of AMR in hospital germs circulating between animals and humans as well as discussed some evidences of environmental-animal-human AMR exchange.
We appreciate the insightful comments made by Werth et al pertaining to the 2015 Infectious Disea... more We appreciate the insightful comments made by Werth et al pertaining to the 2015 Infectious Diseases Society of America guidelines on native vertebral osteomyelitis (NVO) published in the September 2015 issue of Clinical Infectious Diseases [1]. The points raised are related to the extended duration of concomitant aminoglycoside therapy and the optimal dose of daptomycin in enterococcal NVO. Enterococcus species comprised 2% of episodes of NVO in a cohort of 260 patients seen at the Mayo Clinic between 1994 and 2006 [2]. The incidence is even lower in other cohorts and community-based series [3, 4]. Therefore, one can imagine that the level of clinical evidence supporting any management strategies pertaining to enterococcal NVO is going to be very low. We agree that in the presence of concomitant infective endocarditis (IE), NVO patients should be managed according to the most recent IE guidelines. Based on the IE guidelines that were subsequently published in October 2015, the use of dual β-lactams (ampicillin and ceftriaxone) as an alternative to penicillin and gentamicin carried a recommendations of class IIa, with level of evidence B [5]. As outlined in Table 2 of the NVO guidelines, other patients with enterococcal NVO (without associated endocarditis) can be managed with penicillin without or with a short course of aminoglycoside therapy [1].The average age of the patients diagnosed with NVO is 59 years of age, rendering the tolerance of aminoglycoside use in this patient papulation less of an issue when compared to IE [2, 3, 4]. The experience on the use of daptomycin in enterococcal IE is stemming from case reports and small case series [5]. The experience in the management of enterococcal NVO is also stemming from few case reports and the collective experience of the panel members. The dose of daptomycin of 10–12 mg/kg mentioned in the letter to the editor is for the rare enterococcal endocarditis cases caused by strains that are resistant to penicillin, aminoglycosides, and vancomycin [5]. In a European retrospective clinical registry study on the use of daptomycin in 220 patients with osteomyelitis, 11 (5%) were due to Enterococcus species and 11% had “back” listed as the site of the infection. In this study, the use of higher dosage of daptomycin was not associated with a better outcome when compared with the standard dose [6], The high protein binding of daptomycin may limit its effectiveness, despite high serum levels. We believe that the use of higher dosage of daptomycin should be reserved to occasional cases of NVO due to vancomycinresistant enterococci in consultation with an infectious diseases clinician and a spine surgeon.
Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, Jan 15, 2015
These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neu... more These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.
These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neu... more These guidelines are intended for use by infectious disease specialists, orthopedic surgeons, neurosurgeons, radiologists, and other healthcare professionals who care for patients with native vertebral osteomyelitis (NVO). They include evidence and opinion-based recommendations for the diagnosis and management of patients with NVO treated with antimicrobial therapy, with or without surgical intervention.
Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It... more Geriatric patients with long-term urinary catheters have an increased morbidity and mortality. It is conceivable that catheter replacement causes bacteremia and contributes to this morbidity and mortality. The purpose of our study was to determine the incidence and clinical relevance of bacteremia induced by urinary catheter replacements. We analyzed clinical signs and symptoms and laboratory measures (leukocyte count, C-reactive protein, urine sediment, urine culture) during 120 routine catheter replacements in geriatric patients. In addition, blood cultures were drawn before and at 5, 15, and 30 minutes after catheter replacement. The urine cultures showed growth of 1 to 5 different microorganisms before replacement. Of 480 blood cultures, 27 (5.6%) were positive. However, the same species grew from blood and urine in only 5 catheter replacements. None of the patients met criteria for systemic inflammatory response syndrome. There were no significant differences in clinical and laboratory findings between patients with and without bacteremia. Coagulase-negative staphylococci grew in 12 blood cultures. Their distribution over time suggested that they mainly represented catheter replacement-related bacteremia rather than contaminants. Consequently, 64 intraurethral catheter segments were additionally cultured. Coagulase-negative staphylococci grew in 10 catheter cultures, but in only 2 simultaneously cultured urine samples. Bacteremia induced by routine replacement of long-term urinary catheters occurred in 4.2% (5/120) of replacements in geriatric patients. Such bacteremia did not have a detectable clinical relevance in our study.
Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infec... more Invasive mycoses are an important cause of illness and death in immunocompromised patients. Infections with molds other than aspergilli have been increasingly seen in patients with hematologic cancers, but epidemics of these infections have not yet been reported. To describe an outbreak of invasive mycoses with Paecilomyces lilacinus in severely neutropenic patients. An outbreak investigation. The hematology-oncology isolation and bone marrow transplantation unit of the University Hospital, Basel, Switzerland. 25 consecutive patients admitted between 17 August 1993 (the date of the first manifestation of P. lilacinus infection) and 31 October 1993 (when the unit was closed). Clinical and microbiological data, including histologic findings; cultures from several patient sites; and environmental examinations of potential airborne, parenteral, enteric, and horizontal routes of transmission. Infections were defined by the isolation of P. lilacinus from clinically evident skin eruptions. 12 of the 25 patients (48%) were infected or colonized. Nine patients (36%), including all bone marrow transplant recipients, had documented invasive P. lilacinus infections. All 9 infected patients had papular, pustular, or necrotic skin eruptions. Two patients with severe graft-versus-host disease died with refractory fungal disease; 1 also had microbiologically documented endophthalmitis and kidney infiltrates. Seven affected patients no longer had P. lilacinus after recovery of bone marrow function. The organism was resistant in vitro to amphotericin B, itraconazole, and fluconazole. Patients did not respond clinically to these agents. The outbreak was ultimately traced to a contaminated, commercially available, pharmaceutically prepared skin lotion. The outbreak ended after the skin lotion was recalled and has not recurred after a follow-up period of 2 years. Contaminated skin lotion is a potential cause of opportunistic fungal infections in immunocompromised hosts. Paecilomyces lilacinus is a common saprophytic mold that can cause, by direct cutaneous inoculation, invasive infections associated with illness and death.
Few methicillin-resistantStaphylococcus aureus(MRSA) from the early years of its global emergence... more Few methicillin-resistantStaphylococcus aureus(MRSA) from the early years of its global emergence have been sequenced. Knowledge about evolutionary factors promoting the success of specific MRSA multi-locus sequence types (MLSTs) remains scarce. We aimed to characterize a legacy MRSA collection isolated from 1965 to 1987 and compare it against publicly available international and local genomes.We accessed 451 ancient (1965-1987) Swiss MRSA isolates, stored in the Culture Collection of Switzerland. We determined phenotypic antimicrobial resistance (AMR) and performed Illumina short-read sequencing on all isolates and long-read sequencing on a selection with Oxford Nanopore Technology. For context, we included 103 publicly available international genomes from 1960 to 1992 and sequenced 1207 modern Swiss MRSA isolates from 2007 to 2022. We analyzed the core genome (cg)MLST and predicted SCCmeccassette types, AMR, and virulence genes.Among the 451 ancient Swiss MRSA isolates, we found 1...
Antimicrobial Resistance and Infection Control, 2021
Background The hospital environment has got more attention as evidence as source for bacterial tr... more Background The hospital environment has got more attention as evidence as source for bacterial transmission and subsequent hospital-acquired infection increased. Regular cleaning and disinfection have been proposed to lower the risk of infection, in particular for gram-positive bacteria. Auto-disinfecting surfaces would allow to decrease survival of pathogens, while limiting resource to achieve a safe environment in patient rooms. Methods A controlled trial to evaluate the antimicrobial effectiveness of a polyvinyl chloride foil containing an integrated silver-based agent (containing silver ions 2%) on high-touch surfaces in patient rooms. Results The overall log reduction of the mean values was 1.8 log 10 CFU, the median 0.5 log 10 CFU comparing bioburden of control vs antimicrobial foil (p < 0.01). Important pathogens were significantly less likely recovered from the foil, in particular enterococci. These effects were present even after 6 months of in-use. Conclusions A foil co...
Candida auris, a globally emerging pathogen, has been repeatedly introduced into European healthc... more Candida auris, a globally emerging pathogen, has been repeatedly introduced into European healthcare settings, leading to large and long-lasting nosocomial outbreaks. The pathogen has already been isolated in Switzerland, requiring clinicians and microbiologists to become alert. This is the first comprehensive guidance document on prevention and control of C. auris in Swiss acute care hospitals. It brings to light the most recent evidence from published original articles and reviews. We emphasise the importance of quickly identifying this yeast by means of screening in order to prevent an outbreak that could be difficult to contain. Key containment strategies include reinforcing early detection, hand hygiene, application of strict contact precautions for colonised and infected patients, and thorough specific environmental cleaning and disinfection.
Antimicrobial Resistance & Infection Control, 2020
Background The World Health Organization (WHO) recommends administration of surgical antimicrobia... more Background The World Health Organization (WHO) recommends administration of surgical antimicrobial prophylaxis (SAP) in cesarean section prior to incision to prevent surgical site infections (SSI). This study aimed to determine whether SAP administration following cord clamping confers an increased SSI risk to the mother. Methods Study design: Cohort. Setting: 75 participating Swiss hospitals, from 2009 to 2018. Participants: A total of 55,901 patients were analyzed. Main outcome measures: We assessed the association between SAP administration relative to incision and clamping and the SSI rate, using generalized linear multilevel models, adjusted for patient characteristics, procedural variables, and health-care system factors. Results SAP was administered before incision in 26′405 patients (47.2%) and after clamping in 29,496 patients (52.8%). Overall 846 SSIs were documented, of which 379 (1.6% [95% CI, 1.4–1.8%]) occurred before incision and 449 (1.7% [1.5–1.9%]) after clamping (...
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Papers by Andreas Widmer