Postoperative Wundinfektionen: Essenzielles für Internisten

Zusammenfassung: Chirurgische Wundinfektionen gehören zu den häufigsten nosokomialen Infektionen auf chirurgischen Stationen. Risikofaktoren für eine postoperative Wundinfektion sind vor allem Grundleiden des Patienten, aber auch vermeidbare Risikofaktoren im Krankenhaus. Dazu gehören z.B. eine ungenügende Antibiotikaprophylaxe, die fehlende Vorbereitung der Patienten durch Sistieren des Rauchens und Gewichtsabnahme und vor allem bei Implantatoperationen eine fehlende Dekolonisation von Staphylococcus-aureus-Trägern. Eine gut organisierte Surveillance postoperativer Wundinfektionen und ein konstruktives Feedback an die Operierenden führte in allen bisherigen Studien zu einer 30%igen Reduktion dieser infektiösen Komplikation. Die Weltgesundheitsorganisation hat 2009 Richtlinien publiziert, die das Risiko postoperativer infektiöser und nicht-infektiöser Komplikationen vermindern könne

Impfungen gegen Pneumokokken und Influenza: Wie groß ist die Evidenz?

Zusammenfassung: Durch Pneumokokken verursachte Infektionen und die Influenza können bei Kindern und älteren Personen sowie bei chronisch Kranken und Immunosupprimierten zu schweren, komplizierten Verläufen führen. Bei der alternden Bevölkerung in westlichen Ländern sind sie wichtige Ursachen für erhöhte Morbidität und Letalität. Weltweit unterstreicht die Antibiotikaresistenzentwicklung die Notwendigkeit der effektiven Impfung. Der 23-valente Polysaccharidimpfstoff gegen Pneumokokken wird kontrovers diskutiert. Neue Metaanalysen zeigten keine/wenig Wirksamkeit der Impfung in Bezug auf invasive Pneumokokkenerkrankungen oder Gesamtletalität. Jedoch dokumentierte eine neue Studie bei Pflegeheimbewohnern eine signifikante Reduktion von Pneumonie und Tod durch Pneumokokkenerkrankungen nach Impfungen. Der 7-valente Konjugatimpfstoff ist bei Kindern und bei Immunosupprimierten deutlich immunogener und effizienter und ist im schweizerischen Impfplan für Kinder integriert. In Deutschland wurde er bereits durch den 13-valenten Konjugatimpfstoff ersetzt. Influenzaimpfungen sind gut immunogen. Dies wird durch Adjuvanzien bei einer älteren Bevölkerung erhöht. Aufgrund der pandemischen Influenza H1N1 2009 wurden die Impfempfehlungen und die Zusammensetzung der Impfstoffe durch die WHO für den Herbst/Winter 2010/2011 entsprechend angepasst. Die Influenzaimpfung bietet zwar keinen guten Schutz gegen die Ansteckung, jedoch einen guten Schutz gegen Komplikationen der Influenz

Infection control and hospital epidemiology outside the United States

Abstract Objective: To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss university hospitals. Design and Setting: A 1-week period-prevalence survey conducted in May 1996 in medical, surgical, and intensive-care wards of four Swiss university hospitals (900-1,500 beds). Centers for Disease Control and Prevention definitions were used, except that asymptomatic bacteriuria was not categorized as NI. Study variables included patient demographics, primary diagnosis, comorbidities, exposure to medical and surgical risk factors, and use of antimicrobials. Risk factors for NIs were determined using logistic regression with adjustment for length of hospital stay, study center, device use, and patients' comorbidities. Results: 176 NI were recorded in 156 of 1,349 screened patients (11.6%; interhospital range, 9.8%-13.5%). The most frequent NI was surgical-site infection (53; 30%), followed by urinary tract infection (39; 22%), lower respiratory tract infection (27; 15%), and bloodstream infection (23; 13%). Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards (12%). Overall, 65% of NIs were culture-proven; the leading pathogens were Enterobacteriaceae (44; 28%), Staphylococcus aureus (20; 13%), Pseudomonas aeruginosa (17; 11%), and Candida species (16; 10%). Independent risk factors for NI were central venous catheter (CVC) use (odds ratio [OR], 3.35; 95% confidence interval [CI95], 2.91-3.80), admission to intensive care (OR, 1.75; CI95, 1.30-2.21), emergency admission (OR, 1.57; CI95, 1.15-2.00), impaired functional status (Karnofsky index 1-4: OR, 2.56; CI95, 1.95-3.17), and McCabe classification of ultimately fatal (OR, 2.50; CI95, 2.04-2.96) or rapidly fatal (OR 2.25; CI95,1.52-2.98) underlying condition. Conclusions: According to the results of this survey, NIs are frequent in Swiss university hospitals. This investigation confirms the importance of CVCs as a major risk factor for NI. Patient comorbidities must be taken into account to adjust for case mix in any study comparing interhospital or intrahospital infection rate

Infektiologische Erstbeurteilung und erste Abklärungsschritte bei Fieber

Zusammenfassung: Die Erstbeurteilung sowie die ersten Abklärungsschritte bei Patienten mit infektiösen Erkrankungen sind wegen der breiten Differenzialdiagnose anspruchsvoll. Der klinische Ersteindruck, die Anamneseerhebung, die gewissenhafte körperliche Untersuchung und das Routinelabor ermöglichen eine vorläufige Diagnose und Therapie. Leitbeschwerden engen die Differenzialdiagnose wesentlich ein. Bei lebensbedrohlichen Erkrankungen wie Sepsis, Endokarditis, bakterieller Meningitis oder schwerer Pneumonie müssen die ersten diagnostischen und therapeutischen Schritte rasch erfolgen: Nach Abnahme bakteriologischer Proben aus Blut, Liquor und/oder Sputum ist eine empirische Antibiotikatherapie rasch zu initiieren; das der Erkrankung mutmaßlich zugrunde liegende bakterielle Erregerspektrum muss dadurch abgedeckt sein. In weniger dringlichen Fällen lohnt sich ein Abklärungsverfahren in mehreren Schritten. In dieser Situation ist es wichtig, die mikrobiologische Diagnose abzuwarten, um eine erreger- und resistenzgerechte Antibiotikatherapie durchführen zu können. Atypische Verläufe müssen eine erneute Diagnostik auslösen, wobei die Diagnose kritisch zu beurteilen und neue Differenzialdiagnosen in Betracht zu ziehen sin

Epidemiology of methicillin-resistant Staphylococcus aureus: results of a nation-wide survey in Switzerland.

To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Switzerland. One-year national survey of all MRSA cases detected in a large sample of Swiss healthcare institutions (HCI). Analysis of epidemiological and molecular typing data (PFGE) of MRSA strains. During 1997, 385 cases of MRSA were recorded in the 5 university hospitals, in 33 acute care community hospitals, and 14 rehabilitation or long-term care institutions. Half of the cases were found at the University of Geneva Hospitals where MRSA was already known to be endemic (41.1 cases/10,000 admissions). The remaining cases (200) were distributed throughout Switzerland. The highest rates (>100 cases/10,000 admissions) were reported from non-acute care institutions. Rates ranged from 3.3 to 41.1 cases/10,000 admissions for university hospitals (mean 15.5); 0.67 to 90.4 for community hospitals (mean 4.8), and 28.2 to 315 for non-acute care institutions reporting MRSA (mean 85.7). Forty percent of MRSA patients were infected, while 60% were only colonised. The leading infection sites were skin and soft tissue (21%), surgical site (15%), and the urinary tract (26%). Whereas in Eastern Swiss HCI most MRSA cases occurred in acute care hospitals (n = 47, 98%), rehabilitation and long-term care institutions accounted for an important number of the identified cases (n = 107, 38%) in Western Switzerland. Low rates of MRSA were still observed in Swiss HCI, despite one outlying acute care centre with endemic MRSA and some nonacute care institutions with epidemic MRSA. Rehabilitation and long-term care institutions contributed to a substantial proportion of cases in Western Switzerland and may constitute a significant reservoir. Overall, a national approach to surveillance and control of MRSA is mandatory in order to preserve a still favourable situation, and to decrease the risk of epidemic MRSA dissemination

Multicenter prevalence study comparing molecular and toxin assays for clostridioides difficile surveillance, Switzerland

Public health authorities in the United States and Europe recommend surveillance for Clostridioides difficile infections among hospitalized patients, but differing diagnostic algorithms can hamper comparisons between institutions and countries. We compared surveillance based on detection of C. difficile by PCR or enzyme immunoassay (EIA) in a nationwide C. difficile prevalence study in Switzerland. We included all routinely collected stool samples from hospitalized patients with diarrhea in 76 hospitals in Switzerland on 2 days, 1 in winter and 1 in summer, in 2015. EIA C. difficile detection rates were 6.4 cases/10,000 patient bed-days in winter and 5.7 cases/10,000 patient bed-days in summer. PCR detection rates were 11.4 cases/10,000 patient bed-days in winter and 7.1 cases/10,000 patient bed-days in summer. We found PCR used alone increased reported C. difficile prevalence rates by <= 80% compared with a 2-stage EIA-based algorithm.Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc

NEOTROPICAL XENARTHRANS: a data set of occurrence of xenarthran species in the Neotropics

Xenarthrans – anteaters, sloths, and armadillos – have essential functions for ecosystem maintenance, such as insect control and nutrient cycling, playing key roles as ecosystem engineers. Because of habitat loss and fragmentation, hunting pressure, and conflicts with 24 domestic dogs, these species have been threatened locally, regionally, or even across their full distribution ranges. The Neotropics harbor 21 species of armadillos, ten anteaters, and six sloths. Our dataset includes the families Chlamyphoridae (13), Dasypodidae (7), Myrmecophagidae (3), Bradypodidae (4), and Megalonychidae (2). We have no occurrence data on Dasypus pilosus (Dasypodidae). Regarding Cyclopedidae, until recently, only one species was recognized, but new genetic studies have revealed that the group is represented by seven species. In this data-paper, we compiled a total of 42,528 records of 31 species, represented by occurrence and quantitative data, totaling 24,847 unique georeferenced records. The geographic range is from the south of the USA, Mexico, and Caribbean countries at the northern portion of the Neotropics, to its austral distribution in Argentina, Paraguay, Chile, and Uruguay. Regarding anteaters, Myrmecophaga tridactyla has the most records (n=5,941), and Cyclopes sp. has the fewest (n=240). The armadillo species with the most data is Dasypus novemcinctus (n=11,588), and the least recorded for Calyptophractus retusus (n=33). With regards to sloth species, Bradypus variegatus has the most records (n=962), and Bradypus pygmaeus has the fewest (n=12). Our main objective with Neotropical Xenarthrans is to make occurrence and quantitative data available to facilitate more ecological research, particularly if we integrate the xenarthran data with other datasets of Neotropical Series which will become available very soon (i.e. Neotropical Carnivores, Neotropical Invasive Mammals, and Neotropical Hunters and Dogs). Therefore, studies on trophic cascades, hunting pressure, habitat loss, fragmentation effects, species invasion, and climate change effects will be possible with the Neotropical Xenarthrans dataset

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

No time for handwashing!

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