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1. Meticillin-resistant Staphylococcus aureus Contact Screening Strategy in a Low Prevalence Setting; a Nested Case-Control Study

Author

Magi Bächli, Rami Sommerstein, Carlo Casanova, Sara Droz, Marianne Küffer, and Jonas Marschall

Subjects
MRSA, Screening strategy, Spa type, Contact patient, Nosocomial transmission, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: The optimal screening strategy in hospitals to identify secondary cases after contact with a meticillin-resistant Staphylococcus aureus (MRSA) index patient in a low prevalence setting is not well defined. We aimed at identifying factors associated with documented MRSA transmissions. Method: Single center, retrospective, nested case-control study. We evaluated the screening strategy in our 950 bed tertiary care hospital from 2008 – 2014. Room and ward contacts of MRSA index patients present at time of MRSA identification were screened. We compared characteristics of Staphylococcus aureus Protein A (spa)-type matched contact patients (cases) to negative or spa-type mismatched contact patients (controls). Results: Among 270,000 inpatients from 2008 – 2014, 215 MRSA screenings yielded 3013 contact patients, and 6 (0.2%) spa-type matched pairs. We included 225 controls for the nested case-control study. The contact type for the cases was more frequently “same room” and less frequently “same ward” compared with the controls (P = 0.001). Also, exposure time was longer for cases (median of 6 days [IQR 3–9]) than for controls (1 day [0–3], P=0.016). Conclusion: The extensive MRSA screening strategy revealed only few index/contact matches based on spa-typing. Prolonged exposure time and a shared room were significantly associated with MRSA transmission. A targeted screening strategy may be more useful in a low prevalence setting than screening entire wards.

Published
2022
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2. Systematic review of healthcare-associated Burkholderia cepacia complex outbreaks: presentation, causes and outbreak control

Author

Emmanuel Häfliger, Andrew Atkinson, and Jonas Marschall

Subjects
Burkholderia cepacia, Nocosomial, Outbreak, Intrinsic, Disinfectant, Infectious and parasitic diseases, RC109-216, Public aspects of medicine, RA1-1270
Abstract

Summary: Background: Over the past decades, the Burkholderia cepacia complex (BCC) has been linked to multiple healthcare-associated outbreaks. No systematic analysis of these outbreaks has been carried out to date. The aim of this study was to conduct a systematic review of reports on nosocomial BCC outbreaks. Methods: Published studies from 1971 until 9/12/2019 presenting nosocomial BCC outbreaks were identified using Embase, Pubmed and abstracts from professional meetings. Results: We identified a total of 111 outbreak reports. Thirty-two percent of the affected institutions were academic hospitals and 43.8% community hospitals. The average outbreak duration was 198.6 ± 604.4 days. A total of 240 deaths (10% of the 2390 case patients) were reported but only 28 (1.2% of the 2390 case patients and 11.7% of the 240 deaths) were directly attributable to BCC. The source could be identified in 73.9% of the outbreaks; 53.2% were caused by contaminated medical solutions and medications, 12% were due to a contaminated disinfectant. In 28.2% of the outbreaks intrinsic product contamination was reported. Multidrug resistance was noted in 26.1% of the BCC strains. PFGE was the most frequently used typing method (43.2%) in the context of outbreak work-up. Conclusion: Medical products are the most frequent source of BCC outbreaks, representing over half of the identified sources, with 12% of the outbreaks caused by disinfectant products. Intrinsic product contamination was detected frequently, suggesting a need for stricter regulation. While BCC-related mortality was low, our systematic review revealed significant heterogeneity in both investigations and reporting of BCC outbreaks.

Published
2020
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4. Distribution of pathogens and antimicrobial resistance in bacteremia according to hospitalization duration: A nationwide surveillance study in Switzerland

Author

Niccolò Buetti, Jonas Marschall, Jean-François Timsit, Andrew Atkinson, Andreas Kronenberg, Rami Sommerstein, A. Burnens, A. Cherkaoui, C. Corradi, O. Dubuis, A.G. Viollier, A. Egli, V. Gaia, D. Koch, A. Kronenberg, S.L. Leib, J. Marschall, P. Nordmann, V. Perreten, J.-C. Piffaretti, G. Prod'hom, J. Schrenzel, A.F. Widmer, G. Zanetti, R. Zbinden, Cherkaoui, Abdessalam, and Schrenzel, Jacques

Subjects
0301 basic medicine, Microbiology (medical), Microorganism, medicine.medical_specialty, Klebsiella pneumoniae, medicine.drug_class, Resistance, 030106 microbiology, Antibiotics, Bacteremia, 610 Medicine & health, Microbial Sensitivity Tests, Bloodstream infection, medicine.disease_cause, Enterococcus faecalis, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, Internal medicine, Streptococcus pneumoniae, Drug Resistance, Bacterial, medicine, Humans, 030212 general & internal medicine, Hospitalization duration, ddc:616, biology, Pseudomonas aeruginosa, business.industry, Ceftriaxone, General Medicine, Length of Stay, biology.organism_classification, medicine.disease, Anti-Bacterial Agents, Hospitalization, Infectious Diseases, Bacteraemia, Length of stay, 570 Life sciences, business, Switzerland, Enterococcus faecium
Abstract

OBJECTIVES Changing microorganism distributions and decreasing antibiotic susceptibility with increasing length of hospital stay have been demonstrated for the colonization or infection of selected organ systems. We wanted to describe microorganism distribution or antibiotic resistance in bacteremia according to duration of the hospitalization using a large national epidemiological/microbiological database (ANRESIS) in Switzerland. METHODS We conducted a nationwide, observational study on bacteremia using ANRESIS data from 1st January 2008 to 31st December 2017. We analyzed data on bacteremia from those Swiss hospitals that sent information on a regular basis during the entire study period. We described the pathogen distribution and specific trends of resistance during the hospitalization for E. coli, K. pneumoniae, P. aeruginosa, S. marcescens and S. aureus. RESULTS We included 28,318 bacteremia isolates from 90 Swiss hospitals. The most common etiology was E. coli (33.4%, 9,459), followed by S. aureus (16.7%, 4,721), K. pneumoniae (7.1%, 2,005), E. faecalis (5.2%, 1,473), P. aeruginosa (4.3%, 1,228), S. pneumoniae (4.3%, 1,208) and E. faecium (3.9%, 1,101). We observed 489 (1.73%) Serratia marcescens isolates. We observed an increasing trend for Enterococcus faecium (from 1.5% at day 0 to 13.7% at day 30; p

Published
2021
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5. Prevalence and significance of bacterial contamination of autologous stem cell products

Author

Jonas Marschall, Lauro Damonti, Gabriela M. Baerlocher, Thomas Pabst, Niccolò Buetti, Behrouz Mansouri Taleghani, Ulrike Bacher, and Sara Droz

Subjects
Microbiology (medical), medicine.medical_specialty, Adverse outcomes, 610 Medicine & health, 030501 epidemiology, Transplantation, Autologous, 03 medical and health sciences, Internal medicine, Prevalence, medicine, Humans, Autologous transplantation, Progenitor cell, Retrospective Studies, 0303 health sciences, 030306 microbiology, business.industry, Hematopoietic Stem Cell Transplantation, General Medicine, Contamination, Hematopoietic Stem Cells, Antimicrobial, Optimal management, 3. Good health, Haematopoiesis, Infectious Diseases, 570 Life sciences, biology, Stem cell, 0305 other medical science, business
Abstract

There is limited and conflicting information on the prevalence of contamination of haematopoietic stem and progenitor cell products (HPCPs), and their optimal management remains unclear. The authors reviewed the microbial surveillance data of HPCPs collected between January 2002 and December 2019 for autologous transplantation at the study institution to determine the prevalence of microbial contamination and the potential infectious complications among recipients. Among 3935 HPCPs, 25 (0.6%) were contaminated. Ultimately, 22 patients received contaminated grafts, with pre-emptive antimicrobial therapy initiated in six of these patients. No patients developed subsequent infectious complications. These data suggest that microbial contamination of autologous HPCPs and associated adverse outcomes are rare.

Published
2021
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6. Successful Management of a Clostridioides difficile Ribotype 027 Outbreak with a Lean Intervention Bundle

Author

Carlo Casanova, Thomas Bodmer, Helena M. B. Seth-Smith, Silvie Burri, Rami Sommerstein, Niccolò Buetti, Adrian Egli, Andrea B Kuenzli, and Jonas Marschall

Subjects
Microbiology (medical), Diarrhea, medicine.medical_specialty, Hand washing, 610 Medicine & health, Ribotyping, Disease Outbreaks, 03 medical and health sciences, 0302 clinical medicine, Intervention (counseling), Epidemiology, Health care, medicine, Infection control, Humans, 030212 general & internal medicine, Phylogeny, Aged, Aged, 80 and over, 0303 health sciences, Infection Control, Whole Genome Sequencing, 030306 microbiology, business.industry, Transmission (medicine), Clostridioides difficile, Outbreak, General Medicine, Middle Aged, Hospitals, 3. Good health, Infectious Diseases, Emergency medicine, Clostridium Infections, business, Clostridioides, Switzerland
Abstract

Summary Background In a 2015 point-prevalence study, Clostridioides difficile 027, a hypervirulent ribotype, was absent from healthcare institutions in Switzerland. In late 2016, we detected an outbreak of C. difficile infection (CDI) with ribotype 027 occurring across several hospitals in the same hospital network. Methods The first cases of CDI due to ribotype 027 triggered an outbreak investigation, including whole genome sequencing (WGS) to identify outbreak strains. Findings Twenty-eight patients with CDI caused by ribotype 027 between December 2016 and December 2017 were identified, out of which 20 were caused by a single clone. Commonalities among these patients were hospitalization in the same room or on the same ward, receiving care from the same healthcare workers, and shared toilet areas. In addition to the epidemiological links suggesting possible transmission pathways between cases, WGS confirmed the clonality of this C. difficile 027 outbreak. The outbreak was contained by isolation precautions, raising awareness among healthcare workers, harmonizing diagnostic algorithms, and switching to a sporicidal agent for environmental disinfection. Of note, neither default gowning and gloving nor hand washing with water and soap were implemented. Conclusion This C. difficile 027 outbreak was recognized belatedly due to lack of screening for this ribotype in some hospitals, and was contained by a swift response with simple infection prevention measures and adapting the laboratory approach. In order to have a better understanding of C. difficile epidemiology, diagnostic approaches should be standardized, CDI declared notifiable, and longitudinal data on prevalent ribotypes collected in countries where this is not established.

Published
2020
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7. Systematic review of healthcare-associated Burkholderia cepacia complex outbreaks: presentation, causes and outbreak control

Author

Andrew Atkinson, Jonas Marschall, and Emmanuel Häfliger

Subjects
biology, business.industry, Nocosomial, lcsh:Public aspects of medicine, Outbreak, Context (language use), lcsh:RA1-1270, 610 Medicine & health, Burkholderia cepacia, biology.organism_classification, lcsh:Infectious and parasitic diseases, Burkholderia cepacia complex, Healthcare associated, Intrinsic, Disinfectant, Environmental health, Medicine, lcsh:RC109-216, Original Research Article, Outbreak control, business
Abstract

Background Over the past decades, the Burkholderia cepacia complex (BCC) has been linked to multiple healthcare-associated outbreaks. No systematic analysis of these outbreaks has been carried out to date. The aim of this study was to conduct a systematic review of reports on nosocomial BCC outbreaks. Methods Published studies from 1971 until 9/12/2019 presenting nosocomial BCC outbreaks were identified using Embase, Pubmed and abstracts from professional meetings. Results We identified a total of 111 outbreak reports. Thirty-two percent of the affected institutions were academic hospitals and 43.8% community hospitals. The average outbreak duration was 198.6 ± 604.4 days. A total of 240 deaths (10% of the 2’390 case patients) were reported but only 28 (1.2% of the 2’390 case patients and 11.7% of the 240 deaths) were directly attributable to BCC. The source could be identified in 73.9% of the outbreaks; 53.2% were caused by contaminated medical solutions and medications, 12% were due to a contaminated disinfectant. In 28.2% of the outbreaks intrinsic product contamination was reported. Multidrug resistance was noted in 26.1% of the BCC strains. PFGE was the most frequently used typing method (43.2%) in the context of outbreak work-up. Conclusion Medical products are the most frequent source of BCC outbreaks, representing over half of the identified sources, with 12% of the outbreaks caused by disinfectant products. Intrinsic product contamination was detected frequently, suggesting a need for stricter regulation. While BCC-related mortality was low, our systematic review revealed significant heterogeneity in both investigations and reporting of BCC outbreaks.

Published
2020
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8. Intestinal Colonization with Extended-Spectrum Cephalosporin-Resistant Enterobacteriaceae in Different Populations in Switzerland: Prevalence, Risk Factors and Molecular Features

Author

Vincent Perreten, Christoph Hatz, Sara Kasraian, Regula Tinguely, Andrea Endimiani, Christoph Hauser, Andrew Atkinson, Esther Kuenzli, João Pires, Jonas Marschall, Hansjakob Furrer, and Andri Rauch

Subjects
Adult, Male, 0301 basic medicine, Microbiology (medical), Genotype, medicine.drug_class, 030106 microbiology, Immunology, Cephalosporin, Microbial Sensitivity Tests, Microbiology, Feces, 03 medical and health sciences, Enterobacteriaceae, Risk Factors, Surveys and Questionnaires, Prevalence, medicine, Humans, Immunology and Allergy, 610 Medicine & health, Phylogeny, Molecular Epidemiology, Cephalosporin Resistance, biology, 630 Agriculture, Enterobacteriaceae Infections, Middle Aged, biology.organism_classification, Anti-Bacterial Agents, Intestinal colonisation, 570 Life sciences, Female, Topography, Medical, Switzerland, Multilocus Sequence Typing
Published
2018
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10. List of Contributors

Author

Fredrick M. Abrahamian, Michael J. Aldape, Edelweiss Aldasoro, Upton D. Allen, Hythem Al-Sum, Milan J. Anadkat, Katherine Anders, Emmanouil Angelakis, Brian John Angus, Anastasia Antoniadou, Fabio Arena, Joop E. Arends, Jose R. Arribas, Andrew W. Artenstein, John C. Atherton, John N. Aucott, Tar-Ching Aw, Hilary M. Babcock, Robin Bailey, Thomas C. Bailey, Adam Z. Banks, David J. Barillo, Ernie-Paul Barrette, Martijn P. Bauer, Roger Bayston, C. Ben Beard, Justin Beardsley, Nick J. Beeching, Rodolfo E. Bégué, Guido Beldi, Constance A. Benson, Elie F. Berbari, Jean-Michel Berenger, Christoph Berger, Jose I. Bernardino, Jacques Bille, Alexander C. Billioux, Ari Bitnun, Iain Blair, Stéphane Blanche, Thomas P. Bleck, Chantal P. Bleeker-Rovers, Gijs Bleijenberg, Karen C. Bloch, Johannes Blum, Emily A. Blumberg, Robert A. Bonomo, Marc J.M. Bonten, Rafik Bourayou, Emilio Bouza, K. Ashley Brandt, Florence Bretelle, Sylvain Brisse, Warwick J. Britton, Itzhak Brook, Matthijs C. Brouwer, Sarah K. Browne, Amy E. Bryant, Silja Bühler, Eileen M. Bulger, R. Mark L. Buller, Leah A. Burke, Christian Burri, Marcus W. Butler, Thierry Calandra, David P. Calfee, Antonia Calvo-Cano, D. William Cameron, Joseph A. Carcillo, Gail Carson, Stephen T. Chambers, Remi N. Charrel, Vinh Chau Van Nguyen, Stéphane Chevaliez, Tom M. Chiller, Eirini Christaki, Kevin K. Chung, David B. Clifford, Nathan Clumeck, Jonathan Cohen, John Collinge, Christopher P. Conlon, Curdin Conrad, Fiona J. Cooke, Jennifer Rittenhouse Cope, G. Ralph Corey, John H. Cross, Burke A. Cunha, Cheston B. Cunha, Benoit D'Journo, George L. Daikos, Johannes M.A. Daniels, Robert N. Davidson, Nicholas P.J. Day, Kevin M. De Cock, Thushan I. de Silva, Henry J.C. de Vries, Stéphane de Wit, Julie Delaloye, David W. Denning, David T. Dennis, Shireesha Dhanireddy, Elodi J. Dielubanza, David J. Diemert, Mehmet Doganay, Tom Doherty, Christiane Dolecek, Arjen M. Dondorp, Abby Douglas, Michel Drancourt, Grégory Dubourg, Michael N. Dudley, Guillaume Durand, Benjamin J. Eckhardt, Androulla Efstratiou, Miquel B. Ekkelenkamp, Ambika Eranki, Hakan Erdem, Gerome V. Escota, Heather L. Evans, Alice Chijioke Eziefula, Florence Fenollar, Alan Fenwick, Joshua Fierer, Roger G. Finch, James M. Fleckenstein, Christina Forstner, Federico Foschi, Pierre-Edouard Fournier, Martyn A. French, Kenneth L. Gage, Lynne S. Garcia, Joaquim Gascon, Arturo S. Gastañaduy, Philippe Gautret, William M. Geisler, Khalil G. Ghanem, Tommaso Giani, Maddalena Giannella, Bruce L. Gilliam, Michel Gilliet, Carol A. Glaser, Youri Glupczynski, John W. Gnann, Ellie J.C. Goldstein, Bruno Gottstein, Frederique Gouriet, Patti E. Gravitt, Michael D. Green, Stephen T. Green, Andreas H. Groll, Roy M. Gulick, Arjun Gupta, Gilbert Habib, Stephan Harbarth, Marianne Harris, Frederick G. Hayden, David J. Hetem, Philip C. Hill, Bernard Hirschel, Aimee C. Hodowanec, Louis Hoffart, Christian Hoffmann, Steven M. Holland, Peter W. Horby, David J. Horne, Sami Hraiech, Mark W. Hull, Angela Huttner, Richard J.M. Ingram, Jasmin Islam, Michael G. Ison, Scott H. James, Claire Jenkins, Stephen G. Jenkins, Jørgen Skov Jensen, Christine Johnston, Theodore B. Jones, Stephen J. Jordan, Kathleen G. Julian, Yasuyuki Kato, Carol A. Kauffman, Keith S. Kaye, Michael P. Keane, James Keeney, Paul Kelly, Stephen J. Kent, Winfried V. Kern, Yoav Keynan, Andrea A. Kim, Isabelle Koné-Paut, Chris Kosmidis, Aloys C.M. Kroes, Frank P. Kroon, Thomas G. Ksiazek, F. Matthew Kuhlmann, Ed J. Kuijper, Jennie H. Kwon, George B. Kyei, Karine Lacombe, Philippe Lagacé-Wiens, Jean-Christophe Lagier, Theresa Lamagni, Luce Landraud, Fanny Lanternier, Kerry L. LaPlante, Stephen D. Lawn, Steven J. Lawrence, Hakan Leblebicioglu, Nelson Lee, James E. Leggett, Philippe Lehours, Pierre-Yves Levy, Rainer G. Leyh, Rebecca A. Lillis, Direk Limmathurotsakul, Jennifer Lin, H.D. Alan Lindquist, Benjamin A. Lipsky, Christina Liscynesky, David Looney, Olivier Lortholary, Franklin D. Lowy, Benjamin J. Luft, Philip A. Mackowiak, Paul A. MacPherson, Valérie Maghraoui-Slim, Patrick W. Mallon, Julie E. Mangino, Oriol Manuel, Oscar Marchetti, Kristen M. Marks, Kieren A. Marr, Jeanne Marrazzo, Jonas Marschall, David H. Martin, Frédéric Matonti, Richard S. Matulewicz, Kenneth H. Mayer, Russell J. McCulloh, Rose McGready, Rennatus Mdodo, Simon Mead, Francis Mégraud, Graeme Meintjes, Sarah C. Metcalf, Marian G. Michaels, Giovanni Battista Migliori, Michael A. Miles, Alastair Miller, Matthew J. Mimiaga, Marie-Paule Mingeot-Leclercq, Elizabeth Ann Misch, Makedonka Mitreva, Julio S.G. Montaner, Caroline B. Moore, Patricia Muñoz, Jose Muñoz, Clinton K. Murray, Didier Musso, Mable Mutengo, Misha M. Mutizwa, Kurt G. Naber, Pavithra Natarajan, Santiago Neme, Paul N. Newton, Ronald A. Nichols, Lindsay E. Nicolle, François Nosten, Luigi D. Notarangelo, Thomas B. Nutman, Paul Nyirjesy, P. Ronan O'Connell, Steven M. Opal, L. Peter Ormerod, Douglas R. Osmon, Marie Boulze Pankert, Giuseppe Pantaleo, Laurent Papazian, Diane M. Parente, Philippe Parola, Shadi Parsaei, Manuel A. Pascual, Rupa Patel, Eleni Patrozou, Jean-Michel Pawlotsky, Sharon J. Peacock, Jean-Claude Pechère, Ivan Pelegrin, Barry S. Peters, Edgar J.G. Peters, Jeannine M. Petersen, Lyle R. Petersen, Vidmantas Petraitis, Luu-Ly Pham, Albert Picado, Adrian Pilatz, Benoit Pilmis, María-Jesús Pinazo, Mathias W. Pletz, Jason M. Pogue, Evelyn L. Polgreen, Philip M. Polgreen, Klara M. Posfay-Barbe, William G. Powderly, Rachel Presti, Guy Prod'hom, Mirja Puolakkainen, Thomas C. Quinn, Didier Raoult, Raymund R. Razonable, Robert C. Read, Robert R. Redfield, Rob J. Rentenaar, Steven J. Reynolds, Camillo Ribi, Malcolm D. Richardson, Michele L. Ritter, Antoine Roch, Jürgen Kurt Rockstroh, Amanda Rojek, José R. Romero, Suzan H.M. Rooijakkers, Daniel Rosenbluth, Sergio D. Rosenzweig, Gian Maria Rossolini, Ethan Rubinstein, Greg Ryan, Steven A. Safren, Vikrant V. Sahasrabuddhe, Pekka A.I. Saikku, Mohammad M. Sajadi, Michelle R. Salvaggio, Carlos A.Q. Santos, Michael J. Satlin, Anthony J. Schaeffer, Christoph Schimmer, Robert T. Schooley, Richard F. Schumacher, Beverly E. Sha, Daniel S. Shapiro, Gerard Sheehan, David M. Shlaes, Shmuel Shoham, Cameron P. Simmons, Dennis W. Simon, Matthew S. Simon, Kari A. Simonsen, Mary P.E. Slack, Tyrel T. Smith, Jack D. Sobel, Maria Souli, Shruti Sridhar, James M. Steckelberg, Dennis L. Stevens, Heather Strah, A. Willem Sturm, Somnuek Sungkanuparph, Sarah J. Tabrizi, Evelina Tacconelli, Chen Sabrina Tan, Randy A. Taplitz, Guillemette Thomas, Lora D. Thomas, Franck Thuny, Guy Thwaites, Frederic Tissot, Tone Tønjum, Francesca J. Torriani, Christian Toso, Paul M. Tulkens, Allan R. Tunkel, Claire E. Turner, Andrew P. Ustianowski, Françoise van Bambeke, Reinout van Crevel, Diederik van de Beek, Christian van Delden, Menno M. van der Eerden, Jos W.M. van der Meer, Tom van der Poll, Jakko van Ingen, Jos van Putten, Bernard P. Vaudaux, Sten H. Vermund, Raphael P. Viscidi, Kumar Visvanathan, Govinda S. Visvesvara, Lorenz von Seidlein, Florian M.E. Wagenlehner, Anna Wald, Thomas J. Walsh, David C. Warhurst, David W. Warnock, David A. Warrell, Mary J. Warrell, Adilia Warris, Richard R. Watkins, David J. Weatherall, Rainer Weber, Wolfgang Weidner, Jonathan R. White, Peter J. White, James Whitehorn, Richard J. Whitley, Christopher J.M. Whitty, Willem Joost Wiersinga, Mark H. Wilcox, Thomas N. Williams, Cara C. Wilson, Mary Elizabeth Wilson, Hilmar Wisplinghoff, Robin Wood, Richard G. Wunderink, David Wyles, Zhi-Tao Yang, Jonathan S. Yoder, Najam A. Zaidi, Andrea J. Zimmer, Jane N. Zuckerman, and Alimuddin Zumla

Published
2017
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11. Overtreatment of asymptomatic bacteriuria: a qualitative study

Author

Matthias F. Lang, Myriam Marcelle Eyer, Drahomir Aujesky, and Jonas Marschall

Subjects
0301 basic medicine, Microbiology (medical), medicine.medical_specialty, Bacteriuria, medicine.drug_class, Best practice, 030106 microbiology, Antibiotics, Medical Overuse, Asymptomatic, Drug Prescriptions, Interviews as Topic, Tertiary Care Centers, 03 medical and health sciences, 0302 clinical medicine, Antibiotic resistance, Surveys and Questionnaires, Poster Abstracts, medicine, Humans, 030212 general & internal medicine, Peer pressure, Practice Patterns, Physicians', Intensive care medicine, 610 Medicine & health, Asymptomatic Infections, Asymptomatic bacteriuria, business.industry, Workload, General Medicine, IDWeek 2015 Abstracts, medicine.disease, Drug Utilization, Surgery, Anti-Bacterial Agents, Infectious Diseases, Oncology, Evaluation Studies as Topic, Family medicine, Anxiety, 570 Life sciences, biology, medicine.symptom, business, Switzerland, Qualitative research, International management, Healthcare system
Abstract

Summary Background Overtreatment of asymptomatic bacteriuria (ASB) is widespread and may result in antibiotic side-effects, excess costs to the healthcare system, and may potentially trigger antimicrobial resistance. According to international management guidelines, ASB is not an indication for antibiotic treatment (with few exceptions). Aim To determine reasons for using antibiotics to treat ASB in the absence of a treatment indication. Methods A qualitative study was conducted at a tertiary care hospital in Switzerland during 2011. We interviewed 21 internal medicine residents and attending physicians selected by purposive sampling, using a semi-structured questionnaire. Responses were analysed in an inductive thematic content approach using dedicated software (MAXQDA ® ). Findings In the 21 interviews, the following thematic rationales for antibiotic overtreatment of ASB were reported (in order of reporting frequency): (i) treating laboratory findings without taking the clinical picture into account ( N = 17); (ii) psychological factors such as anxiety, overcautiousness, or anticipated positive impact on patient outcomes ( N = 13); (iii) external pressors such as institutional culture, peer pressure, patient expectation, and excessive workload that interferes with proper decision-making ( N = 9); (iv) difficulty with interpreting clinical signs and symptoms ( N = 8). Conclusion In this qualitative study we identified both physician-centred factors (e.g. overcautiousness) and external pressors (e.g. excessive workload) as motivators for prescribing unnecessary antibiotics. Also, we interpreted the frequently cited practice of treating asymptomatic patients based on laboratory findings alone as lack of awareness of evidence-based best practices.

Published
2016
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