Stephan Harbarth

..Overall, in contrast to recently published reports, these results suggest that combination antibiotic therapy does not decrease mortality after severe pneumococcal sepsis...

..for cephalosporin, in coagulase-negative staphylococci for gentamicin and in Streptococcus pneumoniae for penicillin...

..This spread among neonates and was subsequently transmitted to another mother and a sibling. This is the first report of a successfully controlled neonatology outbreak of genetically distinct PVL-producing CA-MRSA in Europe...

..We demonstrated strain diversity, including clones rarely found in Europe. Local epidemiology of community-associated MRSA is diverse and is evolving by importation and transmission of new strains...

..Indiscriminate application of these guidelines can result in a large number of unnecessary screening tests...

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..The present commentary highlights important findings of a surveillance study of antimicrobial use and resistance in German ICUs over 8 years with a focus on Gram-negative resistance...

..The family decides to sue. We present how experts from four different countries assess the medicolegal issues involved in this case...

..Therefore, we will test the clinical efficacy of a previously validated diagnostic strategy to reduce antibiotic usage and nosocomial infection related morbidity...

..This study aims to evaluate the diagnostic and prognostic accuracy of clinical signs and symptoms and laboratory biomarkers for CAP...

..MRSA carriage on admission did not predict MRSA SSI...

..We determined the prevalence and risk profile of patients with previously unknown carriage of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission...

..In particular, there is still a substantial gap in our understanding of what actually happens to MRSA incidence when a planned intervention is made on use of one or more antibiotic drug classes...

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..Experts and policy makers have repeatedly called for universal screening at hospital admission to reduce nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection...

..The ideal therapeutic regimen for these high-risk patients remains to be determined, but empirical therapy directed against enterococci should be considered...

..This review summarises recent advances and studies that address these issues. Overall, it seems that there is no level of MRSA prevalence for which active control measures are no longer warranted...

..Excessive antibiotic use has individual and ecologic effects that can alter clinical practice and increase treatment costs...

..The present report describes the questions and student performance for this infection control exercise set and evaluates performance variability between countries...

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..Finally, better risk scores and laboratory tools are urgently needed to improve the adequacy of empirical antibiotic therapy and patient outcomes...

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..This strategy is likely to be cost effective if linked to prompt institution of control measures...

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..Finally, we suggest that a macro-level perspective on antibiotic resistance can broaden the understanding of this worldwide calamity, and help prevent further dissemination of multiply resistant microorganisms...

..This short overview highlights recent advances and future priorities in infection prevention research, including methodological challenges to be addressed...

..9/1,000 admissions. Although 5 CA-MRSA isolates contained Panton-Valentine leukocidin, only 1 patient had a previous skin infection. No easily modifiable risk factor for CA-MRSA was identified...

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..A major cause of sepsis is community-acquired pneumonia (CAP). The aim of this study was to investigate the value of proADM levels for severity assessment and outcome prediction in CAP...

..aureus agr type. This assay represents a rapid and affordable alternative to sequence-based strategies for assessing relevant epidemiological information...

..The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile...

..This type of rapid and high-throughput methodology opens the possibility to rapidly assess long-term nosocomial transmission or to characterize infecting strains in the general procedure of routine laboratories, in real-time...

..3%) among all orthopedic patients. Conclusion. Institution-wide MRSA endemicity does not necessarily lead to a high MRSA infection risk after elective hip and knee arthroplasty...

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..All steps of this new procedure were developed to ensure a rapid turnaround time and moderate cost. The results obtained suggest that this rapid approach is a valuable tool for the genotyping of S. aureus isolates in real time...

..Our results suggest that users of orfX-staphylococcal cassette chromosome mec-based assays should repeatedly monitor the local epidemiology to minimize the risks of detection bias and the omission of emerging MRSA clones...

..Once validated in a clinical trial, our risk score may be used as a tool to optimise MRSA control...

..0001). Detection of elevated teicoplanin MICs may help to predict a poor response to glycopeptide therapy in MRSA bacteremic patients...

..Previous skin carriage of methicillin-resistant Staphylococcus aureus (MRSA) leads frequently to empiric antibiotic MRSA coverage for skin & soft tissue infections...

..The duration of antibiotic therapy in critically ill patients with sepsis can result in antibiotic overuse, increasing the risk of developing bacterial resistance...

..Between April 2006 and September 2008, we investigated an outbreak of P. aeruginosa infection occurring in a pediatric intensive care unit. We conducted epidemiologic and molecular investigations to identify the source of the outbreak...

..To evaluate the impact of methicillin resistance in Staphylococcus aureus on mortality, length of hospitalization, and hospital charges...

..The prognostic value of MR-proADM was independent of the sepsis classification system used. CONCLUSION: MR-proADM may be helpful in individual risk assessment in septic patients...

..QUESTIONS UNDER STUDY / PRINCIPLES: The value of postoperative pro-calcitonin (PCT) in the follow-up of patients with localised infections in the orthopaedic domain is unknown...

..To determine the temporal relationship between antibiotic use and incidence of antibiotic-resistant Escherichia coli in both the inpatient and outpatient setting of a large urban area...

..The total cost of the hand hygiene promotion corresponded to less than 1% of the costs associated with nosocomial infections. Successful hand hygiene promotion is probably cost-saving...

..This novel assay constitutes a valuable tool for evaluating the molecular epidemiology of MRSA and adjusting infection control strategies against MRSA...

..In patients with community-acquired pneumonia, guidelines recommend antibiotic treatment for 7 to 21 d. Procalcitonin is elevated in bacterial infections, and its dynamics have prognostic implications...

..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...

..To describe new trends in the epidemiology of methicillin-resistant Staphylococcus aureus in the community, among animals and in long-term care settings and to discuss potential infection control implications...

..Although theoretically reducible to zero, the maximal realistic extent by which SSI can be decreased remains unknown...

..When appropriately implemented, alcohol-based HH may be effective in improving compliance...

..To examine the effect of inappropriate initial antimicrobial therapy on the prognosis of patients with sepsis who were enrolled in a clinical trial of an immunomodulating agent conducted in 108 hospitals in North America and Europe...

Benedikt Huttner and Stephan Harbarth discuss the implications of a new study that examined the impact of a national campaign in France to reduce antibiotic overuse.

..Oral combination therapy with fluoroquinolones plus rifampicin is a promising alternative to standard parenteral therapy for staphylococcal infections...

..To assess long-term trends in the volume of ambulatory antibiotic prescriptions and prescription and consultation rates for respiratory tract infections (RTIs) in France in relation to the yearly public antibiotic campaign since 2002...

..We investigated the daily clinical activity and the impact on antibiotic costs in the Septic Unit since 2000...

..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...

..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...

..aeruginosa infections, adding the external ear to the list of colonized body sites that may serve as a source of potentially pathogenic organisms...

..An opportunity now exists to learn from the different strategies that have been adopted...

..Resistance of specific C. difficile strains to clindamycin and other antimicrobial agents may contribute to their hospital dissemination and explain, in part, the propensity of clindamycin to trigger nosocomial outbreaks...

..Although the most effective interventions and potential adverse outcomes remain unclear, public campaigns can probably contribute to more careful use of antibiotics in outpatients, at least in high-prescribing countries...

..This paper reviews publications focusing exclusively on new findings related to Gram-positive bacteraemia in the published literature from July 2006 to June 2007...

..84 [69-94] mg/dL, p =.028). CONCLUSION: A low serum level of apolipoprotein A-I at ICU admission is associated with an increase of the number of SIRS criteria during the ICU stay...

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..Both patients did not share risk factors for CA-MRSA acquisition besides scuba diving. Scuba diving equipment may represent a possible new mode of acquisition of CA-MRSA...

..Physicians' prognoses regarding the presence of serious infection were remarkably precise. Studies investigating the value of new tests for diagnosis of sepsis should establish that they add incremental value to physicians' judgment...

..There is growing concern that changes in nurse workforce and hospital-restructuring interventions negatively impact on patient outcomes. This review focuses on the association between understaffing and health-care-associated infections...

..Domiciliary nursing assistance could be a target for specific control measures to prevent transmission of GS-MRSA in our setting...

..Prevalence studies are an easy surveillance tool that can be exploited further by analysing data according to hospital care settings to identify high-risk areas...

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..We describe determinants likely to influence the future epidemiology and health impact of antimicrobial-resistant infections. Understanding these factors will ultimately optimize preventive strategies for an unpredictable future...

..To investigate the reliability of the public health event notification assessment process under the International Health Regulations (2005) (IHR)...

..This article reviews the epidemiology, pathogenesis, diagnostic and treatment of urinary tract infections in adults...

..summarise the epidemiology of nocardial arthritis and outline the feasibility of relatively short antibiotic treatments after careful surgical drainage...

..We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel...

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..Prevention and control of CA-MRSA infections represent a challenge for the future, requiring contact tracing, education and treatment of infected and colonised contacts...

..Besides adequate antibiotic treatment, surgical drainage and incision of the skin lesions are important. It is therefore essential to respect elementary hygiene rules in order to prevent the acquisition and transmission of CA-MRSA...

..2-16.3; P = 0.025) were independent predictors of treatment failure after debridement. Therapy using a combination of antimicrobials should be considered for patients with MRSA ODRI, especially when implant removal is not feasible...

..Further studies are needed to elucidate the role of migration as a factor contributing to the emergence of CA-MRSA in Europe...

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..CAB-associated NT was associated with increased mortality, but it did not impact the costs and length of hospital stay...

..Based on the assumption that nosocomial infections have causal and preventive factors that can be identified through systematic investigation, epidemiologic methods add important knowledge to reduce hospital-acquired infections...

..Despite evidence supporting short antibiotic prophylaxis (ABP), it is still common practice to continue ABP for more than 48 hours after coronary artery bypass graft (CABG) surgery...

..Infections may also become manifest after several weeks of hospitalisation. In case of life-threatening infection, antibiotic therapy should cover non-fermenting pathogens...

..Shortage-triggered treatment changes had a negative effect on prescribing patterns, which may contribute to antibiotic resistance...

..We compiled a selection of Web sites that seemed to be useful as starting points for physicians, epidemiologists, researchers, or patients interested in this topic...

..CONCLUSIONS: The prognosis of postoperative PM endophthalmitis remains poor, despite adequate treatment of the infection. A history of recent pet exposure should alert physicians to this possible aetiological factor...

..No previous study has compared hospitals with respect to the variation of antimicrobial utilization (AU) for cancer patients with febrile neutropenia (FNE)...

..Multicenter studies should include individual-patient-level data to elucidate more fully the relation between antibiotic exposure and resistance...

..14). Elevated PCT concentrations appear to be a promising indicator of sepsis in newly admitted, critically ill patients capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection...

..Only limited data exist on the costs of genital herpes (GH) in the USA. We estimated the economic burden of GH in the USA using two different costing approaches...

..6; CI, 1.7-12.3). Our results did not confirm that extended prophylaxis after clean surgery increases the risk of CDAD, which remains an uncommon postoperative complication, associated even with short antibiotic exposure...