Risk factors for treatment failure and mortality among hospitalized patients with complicated urinary tract infection: A multicenter retrospective cohort study (RESCUING study group)

Background. Complicated urinary tract infections (cUTIs) are responsible for a major share of all antibiotic consumption in hospitals. We aim to describe risk factors for treatment failure and mortality among patients with cUTIs. Methods. A multinational, multicentre retrospective cohort study, conducted in 20 countries in Europe and the Middle East. Data were collected from patients' files on hospitalised patients with a diagnosis of cUTI during 2013-2014. Primary outcome was treatment failure, secondary outcomes included 30 days all-cause mortality,among other outcomes. Multivariable analysis using a logistic model and the hospital as a random variable was performed to identify independent predictors for these outcomes. Results. A total of 981 patients with cUTI were included. Treatment failure was observed in 26.6% (261/981), all cause 30-day mortality rate was 8.7% (85/976), most of these in patients with catheter related UTI (CaUTI). Risk factors for treatment failure in multivariable analysis were ICU admission (OR 5.07, 95% CI 3.18-8.07), septic shock (OR 1.92, 95% CI 0.93-3.98), corticosteroid treatment (OR 1.92, 95% CI 1.12-3.54), bedridden (OR 2.11, 95%CI 1.4-3.18), older age (OR 1.02, 95% CI 1.0071.03-), metastatic cancer (OR 2.89, 95% CI 1.46-5.73) and CaUTI (OR 1.48, 95% CI 1.04-2.11). Management variables, such as inappropriate empirical antibiotic treatment or days to starting antibiotics were not associated with treatment failure or 30-day mortality. More patients with pyelonephritis were given appropriate empirical antibiotic therapy than other CaUTI [110/171; 64.3% vs. 116/270; 43%, p <0.005], nevertheless, this afforded no advantage in treatment failure rates nor mortality in these patients. Conclusions. In patients with cUTI we found no benefit of early appropriate empirical treatment on survival rates or other outcomes. Physicians might consider supportive treatment and watchful waiting in stable patients until the causative pathogen is defined

Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking

Infection control capacity building in European countries with limited resources: issues and priorities

We report the results of a panel investigation aimed at assessing the critical aspects regarding healthcare-associated infections in European countries with limited resources and pinpointing the highest priority issues that need to be addressed for effective infection control. Questionnaires were designed and information collected from national EUNETIPS representatives in Bulgaria, Hungary, Kosovo, Romania, and Serbia. Based on the data collected, we concluded that rigorous implementation of existing law, standardized training, and political commitment constitute a common relevant background and provide the lessons to be learnt for aligning healthcare systems in this area with internationally recommended standards of infection control

PREVALENCE OF CLOSTRIDIUM DIFFICILE PCR RIBOTYPES IN BULGARIA, 2008-2010

Clostridium difficile is one of the most important causative agents of severe diarrhoea in hospitalised patients treated with antibiotics. Since 2008, Bulgaria participated in the Pan-European Surveillance Study investigating the prevalence of C. difficile infections (CDI) in different European countries. In the period November 2008 - March 2010, the incidence of CDI in nine participating hospitals was 7.94 per 10 000 patient admissions (0.34 per 10 000 patient-days). In total, sixty five fecal samples from patients with mild to severe enterocolitis and previous antibiotic treatment were investigated for CDI. Strains were typed and further characterized for the presence of toxins A (TcdA), B (TcdB) and binary toxins (CdtA and CdtB). Of 65 stool samples included, 15 were toxin and culture positive for C. difficile. Six of the isolates (40%) belonged to PCR ribotype 017 (TcdA(-).; TcdB(+); CdtA/B-), followed by 002 (n = 2 isolates) and 014 (n = 2 isolates). The remaining C. difficile isolates were typed as 012 (n = 1), 046 (n = 1), 078 ribotypes (n = 1) and 2 isolates were untypable. In conclusion, after the Pan-European surveillance study, a laboratory-based surveillance of CDI has been introduced in Bulgaria. The most prevalent C. difficile ribotype in Bulgaria was 017 (40%). All determined PCR ribotypes were found to be associated with severe CDI and a high percentage of lethal outcomes, indicating that improvements of surveillance with appropriate clinical and epidemiological criteria is warranted.Medical Microbiolog

PREVALENCE OF CLOSTRIDIUM DIFFICILE PCR RIBOTYPES IN BULGARIA, 2008-2010

Clostridium difficile is one of the most important causative agents of severe diarrhoea in hospitalised patients treated with antibiotics. Since 2008, Bulgaria participated in the Pan-European Surveillance Study investigating the prevalence of C. difficile infections (CDI) in different European countries. In the period November 2008 - March 2010, the incidence of CDI in nine participating hospitals was 7.94 per 10 000 patient admissions (0.34 per 10 000 patient-days). In total, sixty five fecal samples from patients with mild to severe enterocolitis and previous antibiotic treatment were investigated for CDI. Strains were typed and further characterized for the presence of toxins A (TcdA), B (TcdB) and binary toxins (CdtA and CdtB). Of 65 stool samples included, 15 were toxin and culture positive for C. difficile. Six of the isolates (40%) belonged to PCR ribotype 017 (TcdA(-).; TcdB(+); CdtA/B-), followed by 002 (n = 2 isolates) and 014 (n = 2 isolates). The remaining C. difficile isolates were typed as 012 (n = 1), 046 (n = 1), 078 ribotypes (n = 1) and 2 isolates were untypable. In conclusion, after the Pan-European surveillance study, a laboratory-based surveillance of CDI has been introduced in Bulgaria. The most prevalent C. difficile ribotype in Bulgaria was 017 (40%). All determined PCR ribotypes were found to be associated with severe CDI and a high percentage of lethal outcomes, indicating that improvements of surveillance with appropriate clinical and epidemiological criteria is warranted

Sous-structuration dynamique des structures dissipatives en utilisant les modes libres sur le bord de chaque sous-structure Cas d'un assemblage de plaques minces en flexion

Communication to : GDR vibroacoustique, LAUM - Le Mans (France), 3-4 mars 1997Available from INIST (FR), Document Supply Serviceunder shelf-number : 22419, issue : a.1997 n.23 / INIST-CNRS - Institut de l'Information Scientifique et TechniqueSIGLEFRFranc

National hand hygiene campaigns in Europe, 2000-2009.

Item does not contain fulltextHand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites