Summary In 2010–11, a trial conducted in nursing homes showed no benefit of meticillin-resistant Staphylococcus aureus (MRSA) universal screening and decolonization over standard precautions to ...reduce the prevalence of MRSA carriage. Accordingly, no routine screening was performed from 2012. A five-year follow-up shows no new evidence supporting the intervention. Recommendations issued after trial (no screening and decolonization of MRSA residents) were retained.
Surveillance is a key component of any control strategy for healthcare-associated infections (HAIs) and antimicrobial resistance (AMR), and public availability of methodologic aspects is crucial for ...the interpretation of the data. We sought to systematically review publicly available information for HAIs and/or AMR surveillance systems organized by public institutions or scientific societies in European countries.
A systematic review of scientific and grey literature following the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines was performed. Information on HAIs and/or AMR surveillance systems published until 31 October 2016 were included.
A total of 112 surveillance systems were detected; 56 from 20 countries were finally included. Most exclusions were due to lack of publicly available information. Regarding AMR, the most frequent indicator was the proportion of resistant isolates (27 of 34 providing information, 79.42%); only 18 (52.9%) included incidence rates; the data were only laboratory based in 33 (78.5%) of the 42 providing this information. Regarding HAIs in intensive care units, all 22 of the systems providing data included central line–associated bloodstream infections, and 19 (86.3%) included ventilator-associated pneumonia and catheter-associated urinary tract infections; incidence density was the most frequent indicator. Regarding surgical site infections, the most frequent procedures included were hip prosthesis, colon surgery and caesarean section (21/22, 95.5%).
Publicly available information about the methods and indicators of the surveillance system is frequently lacking. Despite the efforts of European Centre for Disease Control and Prevention (ECDC) and other organizations, wide heterogeneity in procedures and indicators still exists.
Abstract Background The status of the surgical margins of lumpectomy is one of the most important determinants of local recurrence in breast cancer. Systematically practicing cavity margin resection ...is debated but may avoid surgical re-excision and allow the diagnosis of multifocality. Methods This multicentric retrospective study included 294 patients who underwent conservative management of breast cancer with 2–4 systematic cavity shavings. Clinico-biological characteristics of the patients were collected in order to establish whether surgical management was modified by systematic cavity shaving. Local recurrence rate with a long-term follow up of minimum 4 years was evaluated. Results Cavity shaving avoided the need for re-excision in 25% of cases and helped in the diagnosis of multifocality in 8% of cases. Resection volume was not associated with usefulness of the cavity shaving. No predictive factor of positive cavity shaving was found. The rate of local recurrence was 3.7% and appeared in a median time of 3 years and 8 month. Only one quarter of the patients with local recurrence had initially positive lumpectomy margins but negative cavity shaving. Discussion Systematic cavity shaving can change surgical management of conservative treatment. No specific target population for useful cavity shaving was found, such that we recommend utilising it systematically.
Abstract
Nosocomial influenza increases morbidity and mortality in hospitalised patients. No multicentre study analysed its impact in Swiss hospitals yet. This study was conducted From November 1st ...to April 30th in 2016-2017 and 2017-2018 in 27 acute-care public hospitals in South-western Switzerland. It aimed at describing nosocomial cases of seasonal influenza. During these 2 time-periods, every patient hospitalized for >72 hours that was positively screened by RT-PCR or antigen detection for influenza was retrospectively included in the survey. Policies to prevent influenza were collected in each participating hospital. Characteristics of patients included age, sex, and comorbidities. Included patients were followed-up until discharge or death. Complications and administration of anti-neuraminidases and/or antibiotics were registered.
The mean influenza vaccine coverage of healthcare workers (HCW) was 40%. 836 patients were included (98% with a type A influenza virus in 2016-2017; 77% with a type B virus in 2017-2018). Most patients (81%) had an unknown vaccine status. Overall, the incidence of nosocomial influenza was 0.3/100 admissions (0.35/1000 patient-days). The most frequent comorbidities were diabetes (21%), chronic respiratory diseases (18%), and malnutrition (17%). Fever (77%) and cough (66%) were the most frequent symptoms. 70% of patients received anti-neuraminidases, 28% received antibiotics. Infectious complications such as pneumonia were reported in 8%. Overall, the all-cause mortality was 6%.
The occurrence of nosocomial influenza underlines the importance of vaccinating patients and HCW, rapidly recognising community or hospital-acquired cases, and applying adequate additional measures to prevent dissemination, including the timely administration of anti-neuraminidases to avoid antibiotic use (and misuse).
Key messages
Important to encourage patients to be vaccinated against influenza.
Apply additional measures in order to prevent influenza dissemination.
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