Training infection control and hospital hygiene professionals in Europe, 2010: agreed core competencies among 33 European countries.

The harmonisation of training programmes for infection control and hospital hygiene (IC/HH) professionals in Europe is a requirement of the Council recommendation on patient safety. The European Centre for Disease Prevention and Control commissioned the 'Training Infection Control in Europe' project to develop a consensus on core competencies for IC/HH professionals in the European Union (EU). Core competencies were drafted on the basis of the Improving Patient Safety in Europe (IPSE) project's core curriculum (CC), evaluated by questionnaire and approved by National Representatives (NRs) for IC/HH training. NRs also re-assessed the status of IC/HH training in European countries in 2010 in comparison with the situation before the IPSE CC in 2006. The IPSE CC had been used to develop or update 28 of 51 IC/HH courses. Only 10 of 33 countries offered training and qualification for IC/HH doctors and nurses. The proposed core competencies are structured in four areas and 16 professional tasks at junior and senior level. They form a reference for standardisation of IC/HH professional competencies and support recognition of training initiatives.

Candida species distribution and antifungal susceptibility testing according to European Committee on Antimicrobial Susceptibility Testing and new vs. old Clinical and Laboratory Standards Institute clinical breakpoints: a 6-year prospective candidaemia survey from the fungal infection network of Switzerland.

We analyzed the species distribution of Candida blood isolates (CBIs), prospectively collected between 2004 and 2009 within FUNGINOS, and compared their antifungal susceptibility according to clinical breakpoints defined by the European Committee on Antimicrobial Susceptibility Testing (EUCAST) in 2013, and the Clinical and Laboratory Standards Institute (CLSI) in 2008 (old CLSI breakpoints) and 2012 (new CLSI breakpoints). CBIs were tested for susceptiblity to fluconazole, voriconazole and caspofungin by microtitre broth dilution (Sensititre® YeastOne™ test panel). Of 1090 CBIs, 675 (61.9%) were C. albicans, 191 (17.5%) C. glabrata, 64 (5.9%) C. tropicalis, 59 (5.4%) C. parapsilosis, 33 (3%) C. dubliniensis, 22 (2%) C. krusei and 46 (4.2%) rare Candida species. Independently of the breakpoints applied, C. albicans was almost uniformly (>98%) susceptible to all three antifungal agents. In contrast, the proportions of fluconazole- and voriconazole-susceptible C. tropicalis and F-susceptible C. parapsilosis were lower according to EUCAST/new CLSI breakpoints than to the old CLSI breakpoints. For caspofungin, non-susceptibility occurred mainly in C. krusei (63.3%) and C. glabrata (9.4%). Nine isolates (five C. tropicalis, three C. albicans and one C. parapsilosis) were cross-resistant to azoles according to EUCAST breakpoints, compared with three isolates (two C. albicans and one C. tropicalis) according to new and two (2 C. albicans) according to old CLSI breakpoints. Four species (C. albicans, C. glabrata, C. tropicalis and C. parapsilosis) represented >90% of all CBIs. In vitro resistance to fluconazole, voriconazole and caspofungin was rare among C. albicans, but an increase of non-susceptibile isolates was observed among C. tropicalis/C. parapsilosis for the azoles and C. glabrata/C. krusei for caspofungin according to EUCAST and new CLSI breakpoints compared with old CLSI breakpoints.

Multidrug-resistant bacteria in travellers hospitalized abroad: prevalence, characteristics, and influence on clinical outcome.

BACKGROUND: Worldwide, the burden of multidrug-resistant bacteria (MDR) is increasing, especially in the hospital setting. AIM: To explore characteristics and clinical relevance of MDR obtained from travellers transferred from hospitals abroad. METHODS: This retrospective study included patients transferred from hospitals abroad to the University Hospital Zurich, Switzerland, who routinely underwent admission screening for possible colonization with meticillin-resistant Staphylococcus aureus (MRSA), extended-spectrum beta-lactamase-producing bacteria (ESBL) and multidrug-resistant Gram-negative bacteria (MR Gram negative). FINDINGS: Forty-six (17%) of 259 subjects were found to be colonized with MDR and nine (3.5%) patients to be infected. Thirty-three (12%) patients were colonized with one bacterial species, 12 (4.6%) with two, and three (1.2%) were colonized with three different bacterial species. In total, 36 ESBL, 21 MR Gram-negative and three MRSA isolates were detected. Escherichia coli (N = 18, 30%), Klebsiella pneumoniae (N = 14, 23%) and Acinetobacter baumannii (N = 14, 23%) were most frequently isolated. The most common sites of detection were skin (97%) and respiratory tract (41%). Being colonized contributed to an increased length of ICU stay [median (range): 8 (1-35) vs 3.5 (1-78) days; P = 0.011]. In-hospital mortality in patients colonized with MDR (10.9%) was higher than in uncolonized patients (2.3%, P = 0.018). Being colonized with MDR was associated with death (adjusted odds ratio: 5.176; 95% confidence interval: 1.325-20.218). CONCLUSIONS: A substantial proportion of patients transferred from abroad are colonized with MDR, a fact which is associated with poor clinical outcome.

Initial management of and outcome in patients with pneumococcal bacteremia: a retrospective study at a Swiss university hospital, 2003-2009.

PURPOSE: The aim of this quality control study was to assess the time to initial diagnostic procedures and the time to the first dose of antibiotics in patients with pneumococcal bacteremia, and to investigate whether the timeliness of these interventions influenced outcome. METHODS: We retrospectively studied patient characteristics, chronological sequence of diagnostic and therapeutic steps, and the course of disease of all patients with pneumococcal bacteremia at a Swiss university hospital between 2003 and 2009, and we analyzed associations between these factors and the length of hospital stay (LOS) and mortality. RESULTS: A total of 102 episodes of pneumococcal bacteremia in 98 patients were analyzed, of whom 15.7% died during hospitalization. The median time (interquartile range [IQR]) to the first antibiotic dose was 4.0 (2.0-5.9) h, and the median times (IQR]) to blood cultures, chest radiograph, lumbar puncture, and brain computed tomography (CT) scan or magnetic resonance imaging (MRI) were 1.4 (0.5-3.3), 2.5 (1.2-4.2), 4.2 (2.7-7.2), and 2.3 (0.6-6.2) h, respectively. The time to diagnostic procedures and therapy were not associated with LOS or death. Risk factors for death in the univariable analysis were: Charlson comorbidity index [odds ratio [OR] (95% confidence interval) per unit increase, 1.3 (1.1-1.6)], neutropenia [OR 10.1 (2.0-51.0)], human immunodeficiency virus (HIV) infection [OR 3.9 (1.1-13.8)], chronic respiratory disease [OR 4.4 (1.2-16.0)], chronic liver disease [OR 3.2 (1.0-9.7)], smoking [OR 3.8 (1.1-13.5)], injection drug use [OR 9.7 (1.5-63.7)], and antibiotic therapy within 6 months before admission [OR 4.0 (1.3-12.5)]. The multivariable analysis revealed age >60 years (P = 0.048) and alcoholism (P = 0.009) as risks for prolonged LOS. CONCLUSIONS: The outcome of pneumococcal bacteremia may be more influenced by patient characteristics than by minor differences in the timeliness of initial diagnostic and therapeutic measures within the first several hours after hospital admission.

Extended-spectrum ß-lactamase-producing Gram-negative pathogens in community-acquired urinary tract infections: an increasing challenge for antimicrobial therapy.

BACKGROUND: Extended-spectrum ß-lactamases (ESBLs) are an increasing challenge in the treatment of urinary tract infections (UTIs), and also in the community. We aimed to investigate the characteristics of patients with UTIs due to ESBL-producing Escherichia coli and to assess the risk factors for ESBLs in community-acquired isolates. METHODS: We performed a retrospective study from January 1, 2007 to December 31, 2009 at a tertiary care teaching hospital in Switzerland, comparing patients with community-acquired versus healthcare-associated UTIs due to ESBL-producing E. coli. Additionally, we investigated the antimicrobial susceptibility of these isolates. RESULTS: A total of 123 patients were studied, of whom 79 (64%) had community-acquired and 44 (36%) had healthcare-associated UTIs. Community-acquired isolates were associated with acute uncomplicated UTIs (odds ratio [OR] 6.62, 95% confidence interval [CI] 1.83-36.5, P < 0.001). Risk factors were recurrent UTI (OR 3.04, 95% CI 1.14-9.14, P = 0.022) and female sex (OR 2.46, 95% CI 1.01-6.08). Community-acquired ESBL-producing E. coli urinary isolates showed high resistance rates to most of the currently used oral antimicrobial agents, including ß-lactam antibiotics (amoxicillin-clavulanic acid, 69.6% resistance), quinolones (ciprofloxacin, 84.8% resistance; norfloxacin, 83.9% resistance), and trimethoprim-sulfamethoxazole (75.9% resistance), except for nitrofurantoin (15% resistance) and fosfomycin (0% resistance). CONCLUSION: UTI due to ESBL-producing E. coli are emerging, and also in a country with low antibiotic use. Because of increasing antibiotic resistance rates of E. coli to current standard therapy and because of the resistance patterns of ESBL-producing E. coli, guidelines for the management of UTIs must be revised. Fosfomycin or nitrofurantoin are recommended for the first-line empirical oral treatment of community-acquired uncomplicated UTIs.

Successful control of methicillin-resistant Staphylococcus aureus outbreak at a university department of dermatology.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the leading strains among multiresistant hospital microflora. In 2003, we noted an increase in the number of MRSA strain 35 among patients at the University of Zurich, Department of Dermatology. At the end of 2003, we implemented additional policies in hospital hygiene, which significantly decreased the number of MRSA infections. METHODS: This is a retrospective study on 65 consecutive patients at the Department of Dermatology, University Hospital of Zurich, in whom MRSA contamination was newly diagnosed during the period of 2003-2008. All isolated strains were genotyped. We implemented additional policies as strict hand hygiene and avoidance of sharing the same ointment pots or tubes amongst patients. As soon as the skin disease was healed, decolonization of MRSA was undertaken by a 5-day topical treatment. RESULTS: Of the 65 MRSA patients, 19 (29%) patients carried a genotypical strain (MRSA 35) that was identified to be specific for the Department of Dermatology. Three health care workers (HCWs) were tested positive. The outlined measures reduced the incidence of new transmissions of this specific strain MRSA 35 significantly (P=0.001) with a complete disappearance of new transmissions of MRSA 35 in the year 2008. Of the 65 patients, 15 (23%) patients became long-term carriers, among all (15/15; 100%) had persisting active skin lesions. CONCLUSIONS: Strict hand hygiene and avoidance of sharing ointments among patients were highly effective measures in controlling an outbreak of MRSA. Complete of near-to-complete remission of the underlying dermatoses, skin lesions or chronic wounds, is a prerequisite for complete decolonization of MRSA carriers.

Air suctioning during colon biopsy forceps removal reduces bacterial air contamination in the endoscopy suite.

BACKGROUND AND STUDY AIMS: Bacterial contamination of endoscopy suites is of concern; however studies evaluating bacterial aerosols are lacking. We aimed to determine the effectiveness of air suctioning during removal of biopsy forceps in reducing bacterial air contamination. PATIENTS AND METHODS: This was a prospective single-blinded trial involving 50 patients who were undergoing elective nontherapeutic colonoscopy. During colonoscopy, endoscopists removed the biopsy forceps first without and then with suctioning following contact with the sigmoid mucosa. A total of 50 L of air was collected continuously for 30 seconds at 30-cm distance from the biopsy channel valve of the colonoscope, with time starting at forceps removal. Airborne bacteria were collected by an impactor air sampler (MAS-100). Standard Petri dishes with CNA blood agar were used to culture Gram-positive bacteria. Main outcome measure was the bacterial load in endoscopy room air. RESULTS: At the beginning and end of the daily colonoscopy program, the median (and interquartile [IQR] range) bioaerosol burden was 4 colony forming units (CFU)/m (3) (IQR 3 - 6) and 16 CFU/m (3) (IQR 13 - 18), respectively. Air suctioning during removal of the biopsy forceps reduced the bioaerosol burden from a median of 14 CFU/m (3) (IQR 11 - 29) to a median of 7 CFU/m (3) (IQR 4 - 16) ( P = 0.0001). Predominantly enterococci were identified on the agar plates. CONCLUSION: The bacterial aerosol burden during handling of biopsy forceps can be reduced by applying air suction while removing the forceps. This simple method may reduce transmission of infectious agents during gastrointestinal endoscopies.

Risks factors for infections with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care university hospital in Switzerland.

BACKGROUND: There are considerable geographical differences in the occurrence of extended-spectrum beta-lactamase(ESBL)-producing bacteria, both in the community and in the hospital setting. Our aim was to assess risk factors for blood stream, urinary tract, and vascular catheter-associated infections with ESBL-producing Escherichia coli and Klebsiella pneumoniae at a tertiary care hospital in a low-prevalence country. METHODS: We performed a case-control study comparing 58 patients with infections due to ESBL-producing E. coli orK. pneumoniae vs 116 controls with infections due to non-ESBL producing organisms at the University Hospital Zurich, Switzerland, between 1 July 2005 and 30 June 2007. RESULTS: Cases included 15 outpatients and 43 inpatients. Multivariable analyses found three risk factors for ESBL-producing isolates: begin of symptoms or recent antibiotic pre-treatment in a foreign country (odds ratio [OR] 27.01,95% confidence interval [CI] 2.38-1,733.28], p = 0.042),antibiotic therapy within the year preceding the isolation of the ESBL-producing strain (OR 2.88, 95% CI 1.13-8.49,p = 0.025), and mechanical ventilation (OR 10.56, 95% CI 1.06-579.10, p = 0.042). CONCLUSIONS: The major risk factors for infections due to ESBL-producing bacteria were travel in high-prevalence countries, prior antibiotic use, and mechanical ventilation during a stay in the intensive care unit. Community-acquired infections were documented in 17% of the patients.An early identification of risk factors is crucial to providing the patients an optimal empiric antibiotic therapy and to keep the use of carbapenems to a minimum.