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Stephan Harbarth

Publications and source records attributed to Stephan Harbarth.

48 records · Page 3Linked to original sources
PubMed2003

Antibiotic consumption, bacterial resistance and their correlation in a Swiss university hospital and its adult intensive care units.

Ecological surveys of high-antibiotic use areas in the hospital should be used to evaluate patterns and trends in order to optimise antibiotic consumption and minimise resistance. We conducted a retrospective cohort study with the aim to examine trends in antimicrobial consumption and bacterial susceptibility at the Geneva University Hospital and its adult ICUs between 1996 and 2000. The average annual consumption of antimicrobials was 400 d-defined doses (DDD)/1000 patient-d in the entire hospital, 462 in the surgical ICU and 683 in the medical ICU. In the medical ICU, we observed a steady decrease of intravenous antimicrobial use, whereas a 25% increase in the total antimicrobial consumption was noted in 1999 and 2000 for the entire hospital. The proportion of different bacterial species, resistance rates and antibiotic consumption rates differed between the entire hospital and the ICUs, with moderate variation between y. Possible relationships between antibiotic consumption and resistance rates, expressed as DDD and as number of resistant isolates per 1000 patient-d respectively, were calculated for of the most frequently isolated bacteria (total 71 correlations). Statistically significant positive correlations between antibiotic consumption and resistance were found in Escherichia coli for piperacillin, in Pseudomonas aeruginosa for piperacillin, cephalosporins and aminoglycosides, in Klebsiella spp. for cephalosporin, in coagulase-negative staphylococci for gentamicin and in Streptococcus pneumoniae for penicillin.

Anti-Bacterial Agents↗
PubMed2003

Bacteremic sepsis in intensive care: temporal trends in incidence, organ dysfunction, and prognosis.

OBJECTIVE: To determine whether changes have occurred at our center in the incidence, patterns of organ dysfunctions, prognostic factors, and case-fatality rate of bacteremic sepsis. DESIGN: Retrospective comparative study (1984-1988 vs. 1994-1997). SETTING: University hospital surgical intensive care unit. PATIENTS: A total of 372 critically ill patients with sepsis and positive blood cultures. INTERVENTION: None. MEASUREMENTS AND MAIN RESULTS: In the 1984-1988 study, 176 patients developed bacteremic sepsis (3.2 per 100 admissions), with a fatality rate of 35% at 28 days, whereas in the 1994-1997 study, 196 patients had bacteremic sepsis (4.3 per 100 admissions), with a 28-day fatality rate of 37%. The frequency of primary bacteremia increased from 21% to 47% (p <.001), paralleled by an increase in the proportional frequency of Gram-positive microorganisms. In 1984-1988, 69% (n = 120) of patients had at least one organ dysfunction, compared with 80% (n = 156) in 1994-1997 (p =.02). The prevalence of pulmonary and cardiac dysfunction increased. The case- fatality rate of septic shock remained high (69% vs. 68%). For both cohorts, the two strongest predictors of mortality remained the Acute Physiology and Chronic Health Evaluation II score at the onset of sepsis and the number of evolving organ dysfunctions. CONCLUSION: The fatality rate of bacteremic sepsis remained constant over the study period, despite an increased incidence of bacteremia and associated organ dysfunction. Continued efforts need to be directed toward the prevention of bacteremic sepsis, given the magnitude and poor prognosis of this syndrome.

Aged↗
PubMed2002

Clinical and economic outcomes of conventional amphotericin B-associated nephrotoxicity.

A retrospective 9-year cohort study was conducted to identify the hospitalization costs, length of hospital stay, and mortality associated with nephrotoxicity (NT) among 494 inpatients who were treated with conventional amphotericin B (CAB). Survival regression methods were used to model the effect of NT. The rate of NT was 12%; the overall in-hospital mortality rate was 22%. After adjustment for confounding, NT was associated with a 2.7-fold higher risk of death (P<.001). Although the unadjusted effects of NT on length of hospital stay and hospitalization costs after the initiation of CAB were consistent with small increases, such effects were not significant in multivariate models (time ratio, 1.2 [P=.2]; cost ratio, 1.1 [P=.8]). The greater the number of days before the onset of NT that were included in the analysis, the greater the apparent effect of NT on costs. CAB-associated NT was associated with increased mortality, but it did not impact the costs and length of hospital stay.

Amphotericin B↗
PubMed2002

Diagnostic accuracy of G-CSF, IL-8, and IL-1ra in critically ill children with suspected infection.

OBJECTIVE: To elucidate the diagnostic accuracy of granulocyte colony-stimulating factor (G-CSF), interleukin-8 (IL-8), and interleukin-1 receptor antagonist (IL-1ra) in identifying patients with sepsis among critically ill pediatric patients with suspected infection. DESIGN AND SETTING: Nested case-control study in a multidisciplinary neonatal and pediatric intensive care unit (PICU) PATIENTS: PICU patients during a 12-month period with suspected infection, and plasma available from the time of clinical suspicion (254 episodes, 190 patients). MEASUREMENTS AND RESULTS: Plasma levels of G-CSF, IL-8, and IL-1ra. Episodes classified on the basis of clinical and bacteriological findings into: culture-confirmed sepsis, probable sepsis, localized infection, viral infection, and no infection. Plasma levels were significantly higher in episodes of culture-confirmed sepsis than in episodes with ruled-out infection. The area under the receiver operating characteristic curve was higher for IL-8 and G-CSF than for IL-1ra. Combining IL-8 and G-CSF improved the diagnostic performance, particularly as to the detection of Gram-negative sepsis. Sensitivity was low (<50%) in detecting Staphylococcus epidermidis bacteremia or localized infections. CONCLUSIONS: In this heterogeneous population of critically ill children with suspected infection, a model combining plasma levels of IL-8 and G-CSF identified patients with sepsis. Negative results do not rule out S. epidermidis bacteremia or locally confined infectious processes. The model requires validation in an independent data-set.

Area Under Curve↗
PubMed2002

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

OBJECTIVE: To assess the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) in Switzerland. MATERIAL AND METHODS: 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. RESULTS: 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. CONCLUSION: 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.

Adolescent↗
PubMed2002

Epidemiology and prognostic determinants of bloodstream infections in surgical intensive care.

HYPOTHESIS: A set of clinical variables available at the bedside can be used to predict outcome in critically ill patients with bloodstream infection (BSI). DESIGN: A 3-year retrospective cohort study. SETTING: A surgical intensive care unit in Switzerland. PATIENTS: All patients with BSI were potentially eligible. MAIN OUTCOME MEASURES: Clinical variables, organ dysfunctions, and outcome. RESULTS: Among 4530 admissions to the surgical intensive care unit, 224 clinically significant episodes of BSI were recorded (incidence, 4.9%), with a 28-day fatality of 36%. A total of 110 patients had primary bacteremia, of which 39 (35%) were catheter related. Although gram-positive organisms were the most frequently isolated pathogens (58% [159/275]), they were associated with lower case-fatality (30%) than BSI due to gram-negative bacteria (44%). Organ dysfunctions associated with the highest risk of death were neurologic dysfunction (hazard ratio [HR], 6.9; 95% confidence interval [CI], 3.3-14.5), hepatic dysfunction (HR, 3.9; 95% CI, 2.1-7.4), and disseminated intravascular coagulation (HR, 3.0; 95% CI, 1.5-6.1). By multivariate analysis, 2 independent predictors of mortality were the APACHE II (Acute Physiology and Chronic Health Evaluation II) score at onset of BSI (HR per 1-point increase, 1.08; 95% CI, 1.04-1.12) and the number of evolving organ dysfunctions (HR, 1.4; 95% CI, 1.2-1.7). Appropriate antimicrobial therapy was associated with improved outcome (HR, 0.4; 95% CI, 0.2-0.6). CONCLUSIONS: Bloodstream infection in critically ill patients is a common and frequently fatal condition. Its outcome can be predicted by the severity of illness at onset of BSI and the number of organ dysfunctions evolving thereafter. Appropriate antimicrobial therapy is an important determinant for survival.

Adolescent↗
PubMed2002

Interventional study to evaluate the impact of an alcohol-based hand gel in improving hand hygiene compliance.

OBJECTIVE: To evaluate the effects of the introduction of an alcohol-based hand gel and multifaceted quality improvement (QI) interventions on hand hygiene (HH) compliance. DESIGN: Interventional, randomized cohort study with four study phases (baseline; limited intervention in two units; full intervention in three units; washout phase), performed in three intensive care units at a pediatric referral hospital. METHODS: During 724 thirty-minute daytime monitoring sessions, a nonidentified observer witnessed 12,216 opportunities for HH and recorded compliance. INTERVENTIONS: Introduction of an alcohol-based hand gel; multifaceted QI interventions (educational program, opinion leaders, performance feedback). RESULTS: Baseline compliance decreased after the first 2 weeks of observation from 42.5% to 28.2% (presumably because of waning of a Hawthorne effect), further decreased to 23.3% in the limited intervention phase and increased to 35.1% after the introduction of a hand gel with QI support in all three units (P < 0.001). The rise in compliance persisted in the last phase (compliance, 37.2%); however, a gradual decline was observed during the final weeks. Except for the limited intervention phase, compliance achieved through standard handwashing and glove use remained stable around 20 and 10%, respectively, whereas compliance achieved through gel use increased to 8% (P < 0.001). After adjusting for confounding, implementation of the hand gel with QI support remained significantly associated with compliance (odds ratio, 1.6; 95% confidence interval, 1.4 to 1.8). In a final survey completed by 62 staff members, satisfaction with the hand gel was modest (45%). CONCLUSIONS: We noted a statistically significant, modest improvement in compliance after introduction of an alcohol-based hand gel with multifaceted QI support. When appropriately implemented, alcohol-based HH may be effective in improving compliance.

Alcohols↗
PubMed2002

Outpatient antibiotic use and prevalence of antibiotic-resistant pneumococci in France and Germany: a sociocultural perspective.

The prevalence of penicillin-nonsusceptible pneumococci is sharply divided between France (43%) and Germany (7%). These differences may be explained on different levels: antibiotic-prescribing practices for respiratory tract infections; patient-demand factors and health-belief differences; social determinants, including differing child-care practices; and differences in regulatory practices. Understanding these determinants is crucial for the success of possible interventions. Finally, we emphasize the overarching importance of a sociocultural approach to preventing antibiotic resistance in the community.

Ambulatory Care↗
PubMed1998

Resistance to amikacin and gentamicin among Gram-negative bloodstream isolates in a university hospital between 1989 and 1994.

OBJECTIVE: To characterize antimicrobial resistance patterns to amikacin (AN) and gentamicin (GM) among Gram-negative bloodstream isolates and to determine the possible relationship between use of AN and GM and the occurrence of antibiotic resistance during a 6-year period. METHODS: Standard media and techniques of isolation and identification were used. Antimicrobial susceptibility testing was performed with the disk diffusion method and API rapid ATB E strips. Data on consumption of aminoglycosides were collected by the central hospital pharmacy and were expressed as daily defined doses. RESULTS: One thousand nine hundred and four bloodstream isolates were tested for AN and GM susceptibility between 1989 and 1994. Activities of AN and GM remained high during the study period against most isolates of Gram-negative bacteria. No relationship could be observed between the use of AN/GM and the rate of AN/GM resistance. Nosocomial Gram-negative bloodstream isolates showed a higher degree of resistance towards both AN (3.9% of all nosocomial isolates) and GM (7.9%) than community-acquired isolates (1.8% toward AN and 3.1% towards GM, respectively). There was a significant increase (P=0.004) in the risk of GM resistance in patients with nosocomial Gram-negative bacteremia detected more than 14 days after admission. The proportion of GM-susceptible Pseudomonas aeruginosa isolates decreased linearly from 97% for infections acquired between day 3 and day 10 following admission to 80% for bacteremia developing 30 days or more after admission (P=0.008). CONCLUSIONS: AN and GM remain highly active antimicrobial drugs for treatment of GNB in times of growing resistance to cephalosporins and fluoroquinolones.

Journal Article↗