Search

Additional file 1. Figure S1. Swiss map with the included ICU sites. Figure S2. Flowchart of the included blood culture episodes during the study after exclusion of episodes identified outside ICU, among children under 16 years of age or from patients abroad. Figure S3. Correlations of the ICU occupation due to all patients with blood culture contaminations incidence (A), ICU-BSI incidence (B) and percentage of blood culture contaminations (C). Figure S4. Weekly count of blood culture episodes reported to ANRESIS over the period 01.01.2018 ���31.05.2021. Figure S5. Confirmatory analysis on secular trends of blood culture for the intermediate and second pandemic period using a Poisson regression model.

Background Evidence about the impact of the pandemic of COVID-19 on the incidence rates of blood cultures contaminations and bloodstream infections in intensive care units (ICUs) remains scant. The objective of this study was to investigate the nationwide epidemiology of positive blood cultures drawn in ICUs during the first two pandemic waves of COVID-19 in Switzerland. Methods We analyzed data on positive blood cultures among ICU patients, prospectively collected through a nationwide surveillance system (ANRESIS), from March 30, 2020, to May 31, 2021, a 14-month timeframe that included a first wave of COVID-19, which affected the French and Italian-speaking regions, an interim period (summer 2020) and a second wave that affected the entire country. We used the number of ICU patient-days provided by the Swiss Federal Office of Public Health as denominator to calculate incidence rates of blood culture contaminations and bloodstream infections (ICU-BSI). Incidence rate ratios comparing the interim period with the second wave were determined by segmented Poisson regression models. Results A total of 1099 blood culture contaminations and 1616 ICU-BSIs were identified in 52 ICUs during the study. Overall, more episodes of blood culture contaminations and ICU-BSI were observed during the pandemic waves, compared to the interim period. The proportions of blood culture contaminations and ICU-BSI were positively associated with the ICU occupancy rate, which was higher during the COVID-19 waves. During the more representative second wave (versus interim period), we observed an increased incidence of blood culture contaminations (IRR 1.57, 95% CI 1.16–2.12) and ICU-BSI (IRR 1.20, 95% CI 1.03–1.39). Conclusions An increase in blood culture contaminations and ICU-BSIs was observed during the second COVID-19 pandemic wave, especially in months when the ICU burden of COVID-19 patients was high. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03814-z.

Background Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. Methods This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. Results One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. Discussion While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). Conclusion This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients’ management strategies and fungal epidemiology. 24;1

OBJECTIVES Breakthrough candidemia (BTC) on fluconazole was associated with non-susceptible Candida spp. and increased mortality. This nationwide FUNGINOS study analyzed clinical and mycological BTC characteristics. METHODS 3-year prospective study in 567 consecutive candidemias. Species identification and susceptibility testing (CLSI) in reference laboratory. Data analysis according to STROBE criteria. RESULTS 43/576 (8%) BTC were studied: 37/43 (86%) on fluconazole (28 prophylaxis, median 200mg/day). 21% BTC vs. 23% non-BTC presented severe sepsis/septic shock. Overall mortality was 34% vs. 32%. BTC was associated with gastrointestinal mucositis (multivariate OR 5.25, 95%CI 2.23-12.40, p

Introduction Nous avons recemment decrit une methode utilisant la spectrometrie de masse MALDI-TOF pour detecter, identifier et quantifier un disaccharide (MSDS) dont la presence dans le serum est associee aux infections fongiques invasives (IFI). Nos premieres investigations, portant sur des cas de candidoses et d’aspergilloses invasives (IC et IA) recrutes dans notre CHU, ont montre que les performances diagnostiques de cette methode etaient comparables a celles des tests Platelia™ et Fungitell ® et qu’en outre elle permettait de diagnostiquer les mucormycoses (MM) pour lesquelles ces tests serologiques sont en defaut. Cette etude a comme objectif de confirmer ces resultats de maniere multicentrique. Patients et methodes Les patients ont ete selectionnes, par divers centres specialises dans la prise en charge d’IFI, sur base de la disponibilite de serums durant des episodes infectieux documentes. Les patients atteints de CI, provenaient des centres de Genes et de Rome (26 patients, 57 serums). Les patients atteints d’AI provenaient de Strasbourg (19 patients, 52 serums). Les patients atteints de mucormycoses provenaient de deux centres Paris et Dijon (23 patients, 72 serums). Des temoins hospitalises presentant les memes facteurs de risque que les patients atteints d’IFI ont egalement ete selectionnes par des centres exterieurs et testes a l’aveugle parallelement a ces derniers. Il s’agissait de 20 patients neutropeniques (Genes) et de 20 patients de reanimation ayant presente une bacteriemie (Lausanne). Pour chaque type d’IFI, les tests preconises pour leur diagnostic visant a detecter le Mannane (Mnn), le Galactomannane (GM), les b-glucanes (BDG) ou la q-PCR ont ete realises parallelement a la detection du MSDS. Resultats L’etablissement de courbes ROC pour les IC et les IA a permis de definir un cutoff optimal du MSDS a 290 permettant de differencier au mieux les patients atteints d’IFI des temoins. Les resultats correspondants en termes de sensibilite et de specificite sont resumes dans le tableau ci-dessous par comparaison aux tests de detection des glycannes actuellement disponibles ( Tableau 1 ). Pour les MM, un certain nombre de resultats en cours d’acquisition seront integres a notre communication. Il ressort des resultats preliminaires une cinetique de circulation differente de l’ADN et du MSDS. Bien que la sensibilite de ce dernier soit inferieure a celle de la q-PCR, il permet de diagnostiquer isolement des cas de MM et se revele complementaire dans l’evolution de leur suivi. Conclusion Cette etude confirme l’interet diagnostique du MSDS, sa precocite, sensibilite et sa specificite sont comparables a celles de tests recommandes par l’EORTC et l’IDSA. Le caractere panfongique du MSDS permet de le proposer en test de depistage pour les patients a haut risque. Sa contribution au diagnostic apparait complementaire de celle des tests actuels dont aucun n’est adapte, a lui seul, a la detection de l’ensemble des IFI.

BACKGROUND Candidemia is an opportunistic infection associated with high morbidity and mortality in patients hospitalized both inside and outside intensive care units (ICUs). Identification of patients at risk is crucial to ensure prompt antifungal therapy. We sought to assess risk factors for candidemia and death, both outside and inside ICUs. METHODS This prospective multicenter matched case-control study involved six teaching hospitals in Switzerland and France. Cases were defined by positive blood cultures for Candida sp. Controls were matched to cases using the following criteria: age, hospitalization ward, hospitalization duration, and, when applicable, type of surgery. One to three controls were enrolled by case. Risk factors were analyzed by univariate and multivariate conditional regression models, as a basis for a new scoring system to predict candidemia. RESULTS One hundred ninety-two candidemic patients and 411 matched controls were included. Forty-four percent of included patients were hospitalized in ICUs, and 56% were hospitalized outside ICUs. Independent risk factors for candidemia in the ICU population included total parenteral nutrition, acute kidney injury, heart disease, prior septic shock, and exposure to aminoglycoside antibiotics. Independent risk factors for candidemia in the non-ICU population included central venous catheter, total parenteral nutrition, and exposure to glycopeptides and nitroimidazoles. The accuracy of the scores based on these risk factors is better in the ICU than in the non-ICU population. Independent risk factors for death in candidemic patients included septic shock, acute kidney injury, and the number of antibiotics to which patients were exposed before candidemia. DISCUSSION While this study shows a role for known and novel risk factors for candidemia, it specifically highlights important differences in their distribution according to the hospital setting (ICU versus non-ICU). CONCLUSION This study provides novel risk scores for candidemia accounting for the hospital setting and recent progress in patients' management strategies and fungal epidemiology.

Changing microorganism distributions and decreasing antibiotic susceptibility over the duration of hospitalization have been described for the colonization or infection of selected organ systems. Few data are available on bacteremias in the intensive care unit (ICU) setting. We conducted a nationwide study on bloodstream infection (BSI) using data from the Swiss Centre for Antibiotic Resistance (ANRESIS). We analyzed data on BSI detected in the ICU from hospitals that sent information on a regular basis during the entire study period (2008-2017). We described specific trends of pathogen distribution and resistance during hospitalization duration. We included 6505 ICU- BSI isolates from 35 Swiss hospitals. We observed 2587 possible skin contaminants, 3788 bacteremias and 130 fungemias. The most common microorganism was Escherichia coli (23.2%, 910), followed by Staphylococcus aureus (18.7%, 734) and enterococci (13.1%, 515). Enterococcus spp (p

There is limited and conflicting information on the prevalence of the contamination of hematopoietic stem and progenitor cell products (HPCPs) and their optimal management remains unclear. We reviewed the microbial surveillance data of HPCPs collected between 01/2002 and 12/2019 for autologous transplantation at our 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 a preemptive antimicrobial therapy initiated in 6/22. None developed subsequent infectious complications. Our data suggest that microbial contamination of autologous HPCPs and associated adverse outcomes are rare.