Evaluation of a surveillance system for Clostridioides difficile infections for Swiss hospitals.

AIMS: This study evaluated an approach to establishing a comprehensive nationwide surveillance system for Clostridioides difficile infection in Switzerland. We report the results of patient-related surveillance and calculate the incidence rate of C. difficile infection in Switzerland in 2022. METHODS: Initiated in 2017 by the National Centre for Infection Prevention (Swissnoso), in collaboration with the Swiss Centre for Antibiotic Resistance (ANRESIS), laboratory surveillance enables the automatic import of C. difficile infection laboratory data and is fully operational. However, the very limited number of participating laboratories impedes the generation of representative results. To address this gap, Swissnoso introduced patient-related surveillance, with a questionnaire-based survey used across Swiss acute care hospitals. RESULTS: This survey revealed an incidence of 3.8 (Poisson 95% CI: 3.2-4.5) C. difficile infection episodes per 10,000 patient-days, just above the mean rate reported by the European Centre for Disease Prevention and Control (ECDC). Additionally, we report substantial heterogeneity in laboratory tests, diagnostic criteria and infection control practices among Swiss hospitals. CONCLUSION: This study underscores the importance of a joint effort towards standardized surveillance practices in providing comprehensive insights into C. difficile infection epidemiology and effective prevention strategies in Swiss healthcare settings. The patient-related approach remains the gold standard for C. difficile infection surveillance, although it demands substantial resources and provides results only annually. The proposed implementation of nationwide automated laboratory-based surveillance would be pragmatic and efficient, empowering authorities and hospitals to detect outbreaks promptly and to correlate infection rates with antibiotic consumption.

Nutritional and Chemical Quality of Maize Hybrids from Different FAO Maturity Groups Developed and Grown in Serbia.

Maize is a globally significant cereal crop, contributing to the production of essential food products and serving as a pivotal resource for diverse industrial applications. This study investigated the proximate analysis of maize hybrids from different FAO maturity groups in Serbia, exploring variations in polyphenols, flavonoids, carotenoids, tocopherols, and fatty acids with the aim of understanding how agroecological conditions influence the nutritional potential of maize hybrids. The results indicate substantial variations in nutritional composition and antioxidant properties among different maturity groups. The levels of total polyphenols varied among FAO groups, indicating that specific hybrids may offer greater health benefits. Flavonoids and carotenoids also showed considerable variation, with implications for nutritional quality. Tocopherol content varied significantly, emphasizing the diversity in antioxidant capacity. Fatty acid analysis revealed high levels of unsaturated fatty acids, particularly linoleic acid, indicating favorable nutritional and industrial properties. The study highlights the importance of considering maturity groups in assessing the nutritional potential of maize hybrids.

Comparative Study of the Nutritional and Chemical Composition of New Oil Rape, Safflower and Mustard Seed Varieties Developed and Grown in Serbia.

Oilseed crops are widely cultivated and are related to nutrition and human health as valuable nutraceutical sources with valuable biological properties. The growing demand for oil plants used in human and animal nutrition or for the processing industry has contributed to the diversification and development of a new variety of oil crops. Increased oil crop diversity, besides ensuring reduced sensitivity to pests and climate conditions, has also led to improved nutritional values. In order to enable oil crop cultivation to become commercially sustainable, a comprehensive characterization of newly created varieties of oilseeds, including their nutritional and chemical composition, is required. In this study, two varieties of safflower and white and black mustard were investigated as alternative oil species for nutritional parameters, mainly protein, fat, carbohydrate, moisture, ash, polyphenols, flavonoids, chlorophylls contents, acids and mineral composition, and compared with those of two different genotypes of rapeseeds as a traditional oil crop plant. The proximate analysis found that the highest oil content was found in the oil rape NS Svetlana genotype (33.23%), while the lowest was in black mustard (25.37%). The protein content varies from around 26% in safflower samples to 34.63%, determined in white mustard. High content of unsaturated fatty acids and low content of saturated fatty acid was observed in the analyzed samples. In mineral analysis, the dominant elements were phosphorus, potassium, calcium and magnesium, in descending order. The observed oil crops are also good sources of microelements, including iron, copper, manganese and zinc, accompanied by high antioxidant activity due to the presence of significant amounts of polyphenolic and flavonoid compounds.

A systematic outbreak investigation of SARS-CoV-2 transmission clusters in a tertiary academic care center.

BACKGROUND: We sought to decipher transmission pathways in healthcare-associated infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within our hospital by epidemiological work-up and complementary whole genome sequencing (WGS). We report the findings of the four largest epidemiologic clusters of SARS-CoV-2 transmission occurring during the second wave of the pandemic from 11/2020 to 12/2020. METHODS: At the University Hospital Basel, Switzerland, systematic outbreak investigation is initiated at detection of any nosocomial case of SARS-CoV-2 infection, as confirmed by polymerase chain reaction, occurring more than five days after admission. Clusters of nosocomial infections, defined as the detection of at least two positive patients and/or healthcare workers (HCWs) within one week with an epidemiological link, were further investigated by WGS on respective strains. RESULTS: The four epidemiologic clusters included 40 patients and 60 HCWs. Sequencing data was available for 70% of all involved cases (28 patients and 42 HCWs), confirmed epidemiologically suspected in house transmission in 33 cases (47.1% of sequenced cases) and excluded transmission in the remaining 37 cases (52.9%). Among cases with identical strains, epidemiologic work-up suggested transmission mainly through a ward-based exposure (24/33, 72.7%), more commonly affecting HCWs (16/24, 66.7%) than patients (8/24, 33.3%), followed by transmission between patients (6/33, 18.2%), and among HCWs and patients (3/33, 9.1%, respectively two HCWs and one patient). CONCLUSIONS: Phylogenetic analyses revealed important insights into transmission pathways supporting less than 50% of epidemiologically suspected SARS-CoV-2 transmissions. The remainder of cases most likely reflect community-acquired infection randomly detected by outbreak investigation. Notably, most transmissions occurred between HCWs, possibly indicating lower perception of the risk of infection during contacts among HCWs.

A qualitative study on the perception of infection prevention and control measures among healthcare workers without patient contact during the SARS-CoV-2 pandemic.

We conducted a qualitative interview-based study to examine the perception of infection prevention and control (IPC) measures implemented during the COVID-19 pandemic among healthcare workers (HCWs) without patient contact in a tertiary academic care center. We compared these findings to those derived from interviews of HCWs with patient contact from the same institution using the same study design. The following main four themes were identified: (1) As for HCWs with patient contact, transparent communication strongly contributes to employees' sense of security. (2) Information on personal protective equipment (PPE) usage needs to be stratified according to different educational backgrounds and professions. (3) Consistency of IPC measures was positively perceived yet a desire for constant reminders to counteract the fatigue effect played a more significant role for HCWs without patient contact. (4) As compared to HCWs with patient contact, HCWs without patient contact preferred uniform digital training resources rather than more face-to-face training. This study shows that the needs of HCWs with and without patient contact differ and need to be considered in pandemic management.

A Case Study of Zoonotic Chlamydia abortus Infection: Diagnostic Challenges From Clinical and Microbiological Perspectives.

Chlamydia abortus is the most common causative agent of abortion in small ruminants, but it is poorly recognized as a human pathogen. In most published case studies, diagnosis remained difficult and often resulted in delayed initiation of therapy. In this case study of severe C abortus infection in a pregnant farmer from Switzerland, we highlight the clinical and microbiological diagnostic challenges and provide evidence of a zoonotic epidemiological link.

A qualitative study on safety perception among healthcare workers of a tertiary academic care center during the SARS-CoV-2 pandemic.

BACKGROUND: Protecting healthcare workers (HCWs) from exposure to SARS-CoV-2 during patient care is central to managing the current pandemic. Higher levels of trust in personal protective equipment (PPE) and infection prevention and control (IPC) strategies have been previously related to lower levels of emotional exhaustion, yet little is known on how to achieve such a perception of safety. We thus sought to identify institutional actions, strategies and policies related to HCWs' safety perception during the early phase of the pandemic at a tertiary care center in Switzerland by interviewing HCWs from different clinics, professions, and positions. METHODS: For this qualitative study, 36 face-to-face semi-structured interviews were performed. Interviews were based on a guide that addressed the perception of institutional strategies and policies during the first phase of the pandemic in March 2020. The participants included doctors (n = 19) and nurses (n = 17) in senior and non-senior positions from eight clinics in the University Hospital Basel, Switzerland, all involved in patient care. All interviews were audio-recorded and transcribed verbatim. Data were analyzed using qualitative content analysis and organized using MAXQDA (VERBI Software GmbH, Berlin). FINDINGS: Five recurring themes were identified to affect HCWs' perception of their safety during the SARS-CoV-2 pandemic: (1) transparency and clarity of information, (2) communication on the availability of PPE (with the provision of information alone increasing the feeling of safety even if supplies of PPE were reported as low), (3) uniformity and consistency of guidelines, (4) digital resources to support face-to-face teaching (although personal information transfer is still being considered superior in terms of strengthening safety perception) and (5) support and appreciation for the work performed. CONCLUSIONS: This study identifies institutional policies and actions influencing HCWs' safety perception during the first wave of the COVID-19 pandemic, the most important of which is the factor of transparent communication. This knowledge reveals potential areas of action critical to improving preparedness and management in hospitals faced with an infectious disease threat.

Cutting edges in Clostridioides difficile infections.

Clostridioides difficile is the most common cause of hospital-acquired diarrhoea and one of the most important causes of hospital-acquired infections. It results in significant morbidity, mortality and economic burden - especially in the context of recurrent infections. After initial antibiotic therapy of a C. difficile infection, recurrence occurs in about 20% of all patients, which increases the risk of further recurrence to about 45%. Traditional therapeutic options for treatment of C. difficile infection include metronidazole or vancomycin. Newer therapy options such as fidaxomicin, the administration of monoclonal antibodies or faecal microbiota transplantation demonstrate significant advantages over traditional therapies, particularly regarding the reduction of the recurrence rate. This article highlights the main differences between the recommendations of the Swiss Society for Infectious Diseases on the management of "Clostridioides difficile infection" and the IDSA/SHEA reference guideline "Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA)" and discusses some important challenges in -treatment of C. difficile.

A comprehensive study of parameters correlated with honey health benefits.

One hundred honey samples of different floral origin (acacia, sunflower, meadow, and forest) collected from nine European countries (Serbia, Albania, Croatia, Montenegro, Romania, Bulgaria, Bosnia and Herzegovina, North Macedonia and Hungary) were analysed for various physicochemical, sensory, antioxidant and antibacterial parameters. The relative antioxidant capacity index and relative antibacterial index were calculated, integrated and expressed as a new property - Power of Honey, intended to be used to predict the health potential of a honey based on its antioxidant and antibacterial activities. Free acidity and colour coordinates L* and a* were chosen for building an artificial neural network model for the prediction of honey health potential. These were chosen based on the obtained correlations between the investigated parameters and in light of the simplicity of the analysis. This model successfully predicted the Power of Honey with a gained coefficient of determination of 0.856. Forest honey samples exhibited the highest Power of Honey. This novel approach should make it possible for honey producers to predict the honey health potential of a particular honey based on a quick and simple analysis.

Parvimonas micra as a rare cause of spondylodiscitis - case series from a single centre.

BACKGROUND: The anaerobe Parvimonas micra is usually recovered as part of the normal flora or in polymicrobial infections of odontogenic or gastrointestinal origin. P. micra has rarely been described as the causative organism of pyogenic spondylodiscitis. Here we report multiple cases of spondylodiscitis caused by this organism and compare their clinical features with the published literature. METHODS: We performed a retrospective review of all institutional cases with P. micra spondylodiscitis between 01 June 2012 and 31 May 2019. For comparison, the literature was searched for studies reporting vertebral infections with P. micra in adult patients. RESULTS: Over 7 years, six cases were identified: one with a polymicrobial infection (with P. micra and Fusobacterium nucleatum) and five with P. micra as the only pathogen isolated. The six patients with P. micra infections were between 63 and 82 years old (median 72 years) and presented with persistent lower back pain. Common findings were infection of the lumbar spine region (in 6/6 cases) and recent dental inflammation (4/6 cases). 3/6 patients had previously undergone decompressive spinal surgery due to spinal stenosis (2 to 11 years before). In 4/6 cases the organism was detected in blood cultures drawn at admission. Treatment consisted of antibiotics for all patients and additional decompressive surgery due to abscess formation in half the cases. Outcomes were mostly favourable, but persistent pain was a common complaint after resolution of infection. CONCLUSIONS: P. micra is a rare cause of spondylodiscitis. Nevertheless, recent dental procedures with subsequent back pain should lead to the consideration of possible anaerobic causes of spondylodiscitis. Heightened awareness of this pathogen and improvements in diagnostic methods might lead to higher detection rates.

Low rates of influenza vaccination uptake among healthcare workers: Distinguishing barriers between occupational groups.

BACKGROUND: To gain further insights into health care workers (HCWs) attitudes toward influenza vaccination to guide future interventions to increase vaccination rates. METHODS: A standardized anonymous questionnaire was sent to all employees of the University Hospital Basel, Switzerland following the influenza season 2013/2014. We collected information regarding HCW's demographics, experiences with flu vaccinations, and reasons for nonvaccination. RESULTS: Vaccination rates ranged from 14.7% to 31% from 2007 to 2019. A total of 1,454 HCW participated in the survey, of which 62% reported being vaccinated. HCW not vaccinated were more commonly female and differed by occupational group and department. The main reasons for nonvaccination were fear of short-term adverse reactions, followed by assessing the evidence regarding vaccination-benefits as insufficient and fears of violation of the right to self-determination. Fear of long-term sequela and violation of the right of self-determination differed between the 4 professional groups, both being most commonly indicated by nurses and at least indicated by physicians. CONCLUSIONS: This study provides some insight into differences regarding barriers to vaccination between different occupational groups, which might not have been adequately addressed so far. Policy makers should consider such differences when designing campaigns to raise acceptance of influenza vaccine among HCWs.

Potentiometric Stripping Analysis of Cadmium and Lead with Constant Inverse Current in the Analytical Step Using an Open Tubular Mercury-Coated Glassy Carbon Electrode.

The most important experimental parameters of the flow potentiometric stripping analysis (PSA) with oxygen as an oxidant were investigated and optimised. A simple, homemade flow system consisting of glassy carbon tubes, which served as a working and auxiliary electrode, was used. By applying a rest period before the stripping step (the flow stop mode) and by imposing a constant reductive current simultaneously with the interruption of potentiostatic control, significant increase of the flow PSA sensitivity was achieved. In the determination of cadmium and lead, quantitation limits of 0.11 and 0.82 µg/L were obtained. The precision of the method was evaluated in terms of repeatability and reproducibility, with values of relative standard deviation lower than 4.0% for cadmium and 4.2% for lead. This modified technique was applied for simultaneous determination of cadmium and lead in milk, after a simple pretreatment of the samples by dilution and acidification. The method accuracy was confirmed by analysing the certified reference material of skimmed milk powder (ERM-BD151).

Distinguishing Clostridium difficile Recurrence From Reinfection: Independent Validation of Current Recommendations.

OBJECTIVE Distinguishing recurrent Clostridium difficile infection (CDI), defined as CDI caused by the same genotype, from reinfection with a different genotype, has important implications for surveillance and clinical trials investigating treatment effectiveness. We validated the proposed 8-week period for distinguishing "same genotype CDI" from "different genotype CDI," and we aimed to identify clinical variables with distinctiveness to propose an improved definition. METHODS From January 2004 to December 2013, a cohort of all inpatients with CDI at the University Hospital Basel, Switzerland, was established, and respective strains were collected. In patients with a second episode of CDI, both strains were compared using polymerase chain reaction (PCR) ribotyping. The standard definition of recurrence (within 8 weeks after initial diagnosis) was evaluated for its performance to predict CDI caused by the same genotype. RESULTS Among 750 patients with CDI, 130 (17.3%) were diagnosed with recurrence or reinfection. Strains from both episodes were available from 106 patients. Identical strains were identified in 36 patients with recurrence (36 of 47) and 27 patients with reinfection (27 of 59). Sensitivity, specificity, and negative and positive predictive values of the standard definition were 56%, 74%, 53%, and 76%, respectively. An extended period of 20 weeks resulted in the best match for both sensitivity and specificity (83% and 58%, respectively), while none of the clinical characteristics revealed independent distinctive power. CONCLUSIONS Our results challenge the utility of the 8-week cutoff for distinguishing recurrent CDI from reinfection. An extended period of 20 weeks may result in improved overall performance characteristics, but this finding requires external validation. Infect Control Hosp Epidemiol 2017;38:891-896.

Development and Validation of Chronopotentiometric Method for Imidacloprid Determination in Pesticide Formulations and River Water Samples.

A new electrochemical method for determination of imidacloprid using chronopotentiometry on thin film mercury and glassy carbon electrode was presented. The most important experimental parameters of chronopotentiometry were examined and optimized with respect to imidacloprid analytical signal. Imidacloprid provided well-defined reduction peak in Britton-Robinson buffer on thin film mercury electrode at -1.0 V (versus Ag/AgCl (KCl, 3.5 mol/L)) and on glassy carbon electrode at -1.2 V (versus Ag/AgCl (KCl, 3.5 mol/L)). The reduction time was linearly proportional to concentrations from 0.8 to 30.0 mg/L on thin film mercury electrode and from 7.0 to 70.0 mg/L on glassy carbon electrode. The detection limits were 0.17 mg/L and 0.93 mg/L for thin film mercury and glassy carbon electrode, respectively. The estimation of method precision as a function of repeatability and reproducibility showed relative standard deviations values lower than 3.73%. Recovery values from 97.3 to 98.1% confirmed the accuracy of the proposed method, while the constancy of the transition time with deliberated small changes in the experimental parameters indicated a very good robustness. A minor influence of possible interfering compounds proved good selectivity of the method. Developed method was applied for imidacloprid determination in commercial pesticide formulations and river water samples.

Simple, Rapid and Selective Chronopotentiometric Method for the Determination of Riboflavin in Pharmaceutical Preparations Using a Glassy Carbon Electrode.

A novel, simple, sensitive and reliable electrochemical method for the riboflavin determination using chronopotentiomery with glassy carbon electrode was developed. The most important instrumental parameters of chronopotentiometry including type and concentration of supporting electrolyte, initial potential and current range were examined and optimised in respect to riboflavin analytical signal. Riboflavin provided well defined reduction signal at -0.12 V vs. Ag/AgCl (3.5 mol/L KCl) electrode in 0.025 mol/L HCl. Under optimal conditions, linear response of riboflavin was observed in the concentration range of 0.2 - 70 mg/L with achieved limit of detection of 0.076 mg/L and limit of quantitation of 0.23 mg/L of riboflavin. Common vitamins and filing materials did not interfere in the determination. The proposed method was successfully applied for determination of riboflavin in commercially available pharmaceutical preparations. The obtained results were in statistical agreement to the contents declared by manufacturer and to those obtained by HPLC used as comparative method.

Determination of heavy metals in milk and fermented milk products by potentiometric stripping analysis with constant inverse current in the analytical step.

A simple and rapid method for the direct determination of cadmium, lead and copper in milk and fermented milk products by potentiometric stripping analysis (PSA) with oxygen as an oxidant and with inverse current imposed through the stripping step is described. For the more selective metals determination a samples pretreatment by the microwave acid extraction was applied. Due to the significant increase of the modified technique sensitivity, the detection limits of 0.30, 1.7 and 3.8 µg/l were obtained, for cadmium, lead and copper, respectively. The method accuracy was confirmed by analysing the standard reference material (SRM 1577 b). The contents of cadmium, lead and copper in milk samples were in the range of 2.13-4.82, 54.3-95.2 and 112.2-124.7 µg/kg, respectively, whereas in the samples of fermented milk products in the range of 6.30-24.1, 210.1-463.6 and 260.0-320.7 µg/kg, respectively.