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1.
Crit Care Med ; 44(8): e774-5, 2016 08.
Article in English | MEDLINE | ID: mdl-27428154
2.
Crit Care Med ; 44(4): 773-81, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26741577

ABSTRACT

OBJECTIVES: Staphylococcus aureus bloodstream infection is associated with considerable mortality. Experimental models suggest a direct antistaphylococcal effect of acetylsalicylic acid, but evidence from human studies is scarce. We aimed to estimate the effect of low-dose acetylsalicylic acid therapy on mortality in bloodstream infections caused by S. aureus compared with Escherichia coli. DESIGN: Retrospective cohort study based on observational data from 838 and 602 episodes of S. aureus and E. coli bloodstream infection, respectively. SETTING: Swiss tertiary referral center. PATIENTS: Adult patients with S. aureus and E. coli bloodstream infection, respectively, categorized according to low-dose acetylsalicylic acid therapy as outpatient or inpatient before bacteremia. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Thirty-day all-cause mortality was analyzed in a total of 314 propensity score-matched S. aureus bloodstream infection and in 268 E. coli bloodstream infection patients, respectively (1:1 match of low-dose acetylsalicylic acid users and nonusers). S. aureus bloodstream infection cases and controls were equally matched for relevant confounders except treatment with statins, which was strongly associated with a low-dose acetylsalicylic acid use (p < 0.001). At day 30, 12.1% of cases and 27.4% of controls had died (hazard ratio, 0.40; p < 0.001). Low-dose acetylsalicylic acid use was associated with a reduced 30-day all-cause mortality in multivariate analysis (hazard ratio, 0.38; 95% CI, 0.21-0.69; p = 0.001) of matched patients and also of the entire cohort (n = 689) after adjustment for the propensity score (hazard ratio, 0.58, 95% CI, 0.34-0.98; p = 0.04). In contrast, low-dose acetylsalicylic acid use was not associated with the primary endpoint in patients with E. coli bloodstream infection (hazard ratio, 0.78; 95% CI, 0.40-1.55; p = 0.8). CONCLUSIONS: Low-dose acetylsalicylic acid at the time of bloodstream infection was strongly associated with a reduced short-term mortality in patients with S. aureus bloodstream infection. Future studies are required to investigate if early low-dose acetylsalicylic acid is a suitable treatment in patients with S. aureus bloodstream infection.


Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Aspirin/therapeutic use , Staphylococcal Infections/drug therapy , Staphylococcus aureus/isolation & purification , Adult , Bacteremia/drug therapy , Bacteremia/prevention & control , Cross Infection/mortality , Escherichia coli/isolation & purification , Escherichia coli Infections/blood , Escherichia coli Infections/drug therapy , Female , Hospital Mortality , Humans , Male , Middle Aged , Propensity Score , Proportional Hazards Models , Retrospective Studies , Staphylococcal Infections/blood , Staphylococcal Infections/mortality , Switzerland
3.
PLoS One ; 9(11): e112947, 2014.
Article in English | MEDLINE | ID: mdl-25393400

ABSTRACT

OBJECTIVE: Little is known about optimal management of prosthetic vascular graft infections, which are a rare but serious complication associated with graft implants. The goal of this study was to compare and characterize these infections with respect to the location of the graft and to identify factors associated with outcome. METHODS: This was a retrospective study over more than a decade at a tertiary care university hospital that has an established multidisciplinary approach to treating graft infections. Cases of possible prosthetic vascular graft infection were identified from the hospital's infectious diseases database and evaluated against strict diagnostic criteria. Patients were divided into groups according to the locations of their grafts: thoracic-aortic, abdominal-aortic, or peripheral-arterial. Statistical analyses included evaluation of patient and infection characteristics, time to treatment failure, and factors associated specifically with cure rates in aortic graft infections. The primary endpoint was cure at one year after diagnosis of the infection. RESULTS: Characterization of graft infections according to the graft location did show that these infections differ in terms of their characteristics and that the prognosis for treatment seems to be influenced by the location of the infection. Cure rate and all-cause mortality at one year were 87.5% and 12.5% in 24 patients with thoracic-aortic graft infections, 37.0% and 55.6% in 27 patients with abdominal-aortic graft infections, and 70.0% and 30.0% in 10 patients with peripheral-arterial graft infections. In uni- and multivariate analysis, the type of surgical intervention used in managing infections (graft retention versus graft replacement) did not affect primary outcome, whereas a rifampicin-based antimicrobial regimen was associated with a higher cure rate. CONCLUSIONS: We recommend that future prospective studies differentiate prosthetic vascular graft infections according to the location of the grafts and that rifampicin-based antimicrobial regimens be evaluated in clinical trials involving vascular graft infections caused by staphylococci.


Subject(s)
Antibiotics, Antitubercular/administration & dosage , Blood Vessel Prosthesis , Infections/drug therapy , Postoperative Complications/drug therapy , Rifampin/administration & dosage , Vascular Surgical Procedures/adverse effects , Aged , Aortic Diseases/epidemiology , Aortic Diseases/surgery , Female , Humans , Infections/epidemiology , Infections/etiology , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies
4.
Swiss Med Wkly ; 144: w14009, 2014.
Article in English | MEDLINE | ID: mdl-25250957

ABSTRACT

Most hospital-acquired infections arise from colonising bacteria. Intensive care patients and immunocompromised individuals are at highest risk for microbial invasion and subsequent infection due to multiple invasive procedures in addition to frequent application of chemotherapeutics and presence of poor microperfusion leading to mucosal disruption. In this narrative review, we summarise the literature on bacterial colonisation in intensive care patients, in particular the epidemiology, the clinical impact and respective infection control strategies of three pathogens, i.e., Enterococcus spp., extended-spectrum ß-lactamase producing gram-negative bacteria and Clostridium difficile, which have evolved from commensals to a public health concern today.


Subject(s)
Bacterial Infections/epidemiology , Bacterial Infections/prevention & control , Cross Infection/epidemiology , Cross Infection/prevention & control , Intensive Care Units , Age Factors , Bacterial Vaccines , Chlorhexidine , Clostridioides difficile , Drug Resistance, Multiple, Bacterial , Enterococcus , Gram-Negative Bacteria , Hospital Mortality , Humans , Infection Control/organization & administration , Microbial Sensitivity Tests , Prevalence , Risk Factors , beta-Lactamases
5.
Pediatr Infect Dis J ; 31(12): 1233-8, 2012 Dec.
Article in English | MEDLINE | ID: mdl-23190745

ABSTRACT

BACKGROUND: Viral nosocomial infections (NIs) in children are common and most frequently affect the gastrointestinal or respiratory tract. Few studies are dedicated to this topic. We aimed to determine incidence and characteristics of these specific viral NIs at our hospital. METHODS: This was a retrospective analysis of nosocomial gastroenteritis and respiratory tract infections (RTIs) of hospitalized patients at the University Children's Hospital Basel over a 12-month period. Patients with new-onset gastroenteritis or RTI during hospitalization or a physician diagnosis of NI on discharge were included for analysis. NIs were defined by use of Centers for Disease Control and Prevention recommendations and specific agents' incubation periods. RESULTS: Overall, 5493 patients were hospitalized accounting for 22,251 hospital days. Forty-five (0.8%) patients acquired an NI: 15 cases of gastroenteritis (mean age, 9.9 months; range: 3-24; NI incidence: 0.7 per 1000 hospitalization days) and 30 cases of RTI (mean age, 63.7 months; range: 1-174; NI incidence: 1.3 per 1000 hospitalization days). Main agents were rotavirus (10/15 gastroenteritis, 67%) and rhinovirus (22/30 nosocomial RTI; 73%). Physicians reported 9 cases of NI, of which 2 (22%) did not fulfill the criteria for an NI, 3 were surgical site infections, 1 was a case of rotavirus gastroenteritis and 3 were RTIs by rhinovirus. CONCLUSIONS: Viral NIs, especially caused by rotavirus and rhinovirus, are frequent in children of all ages but underestimated if exclusively reported by physicians. Prospective studies should further investigate the role and epidemiology of rhinovirus in nosocomial RTI, ideally by use of automated information technology support.


Subject(s)
Cross Infection/epidemiology , Gastroenteritis/epidemiology , Respiratory Tract Infections/epidemiology , Virus Diseases/epidemiology , Viruses/isolation & purification , Adolescent , Adult , Child , Child, Preschool , Cross Infection/virology , Female , Gastroenteritis/virology , Hospitals, Pediatric , Hospitals, University , Humans , Incidence , Infant , Infant, Newborn , Male , Respiratory Tract Infections/virology , Retrospective Studies , Switzerland/epidemiology , Virus Diseases/virology , Viruses/classification , Young Adult
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