
Marlieke de KrakerHôpitaux Universitaires de Genève | HUG · SPCI
Marlieke de Kraker
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110
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Introduction
Skills and Expertise
Publications
Publications (110)
Background
As COVID-19 is integrated into existing infectious disease control programs, it is important to understand the comparative clinical impact of COVID-19 and other respiratory diseases.
Methods
We conducted a retrospective cohort study of patients with symptomatic healthcare-associated COVID-19 or influenza reported to the nationwide, hosp...
To reduce antimicrobial resistance (AMR), pathogen-specific AMR burden data are crucial to guide target selection for research and development of vaccines and monoclonal antibodies (mAbs). We identified knowledge gaps through previously conducted systematic reviews, which informed a Delphi expert consultation on future AMR research priorities and h...
Background
Multiple treatment options frequently exist for a single medical condition with no single standard of care (SoC), rendering a classic randomised trial comparing a specific treatment to a control treatment infeasible. A novel design, the personalised randomised controlled trial (PRACTical), allows individualised randomisation lists and bo...
Background
Carbapenem-resistant Enterobacterales (CRE) bloodstream infections (BSIs) are a major threat to patients. To date, data on risk factors have been limited, with low internal and external validity. In this multicentre study, risk factors for CRE BSI were determined by comparison with two control groups: patients with carbapenem-susceptible...
Background
The burden of antimicrobial resistance (AMR) has been estimated to be the highest in sub-Saharan Africa (SSA). The current study estimated the proportion of drug-resistant Enterobacterales causing infections in SSA children.
Methods
We searched MEDLINE/PubMed, Embase and the Cochrane Library to identify retrospective and prospective stu...
Studies suggest that central venous catheter bloodstream infections (BSIs) increased during the COVID-19 pandemic. We investigated catheter-related BSIs in Switzerland and found peripheral venous catheter (PVC) BSI incidence increased during 2021-2022 compared with 2020. These findings should raise awareness of PVC-associated BSIs and prompt inclus...
Marlieke de Kraker discusses a systematic review and meta-analysis reporting the magnitude and consequences of bloodstream infections in low- and middle-income countries.
Background:
Bacteria of the order Enterobacterales are common pathogens causing bloodstream infections in sub-Saharan Africa and are frequently resistant to third-generation cephalosporin antibiotics. Although third-generation cephalosporin resistance is believed to lead to adverse outcomes, this relationship is difficult to quantify and has rarel...
Importance:
World Health Organization guidelines recommend administering surgical antimicrobial prophylaxis (SAP), including cefuroxime, within 120 minutes prior to incision. However, data from clinical settings supporting this long interval is limited.
Objective:
To assess whether earlier vs later timing of administration of cefuroxime SAP is a...
There is an urgent need for novel approaches to reduce the spread and clinical impact of infections with MDR bacteria. Da Volterra (Paris, France) is a biopharmaceutical company specializing in the development of microbiota-protective therapies. In 2010, they introduced DAV-132, an active charcoal preparation designed to protect the gut microbiota...
Background
Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza.
Methods
A ret...
Background:
Data on risk factors for carbapenem-resistant Enterobacterales (CRE) with wider applicability are needed to inform preventive measures and efficient design of randomised trials.
Methods:
An international matched case-control-control study was performed in 50 hospitals with high CRE incidence from March 2016 to November 2018 to invest...
Importance:
With the ongoing COVID-19 pandemic, it is crucial to assess the current burden of disease of community-acquired SARS-CoV-2 Omicron variant in hospitalized patients to tailor appropriate public health policies. Comparisons with better-known seasonal influenza infections may facilitate such decisions.
Objective:
To compare the in-hospi...
Objective:
We aimed to assess the association between carbapenem-resistant Enterobacterales (CRE) colonization pressure and carbapenem exposure and acquisition of carbapenemase-producing Enterobacterales (CPE) and non-carbapenemase producing CRE (non-CP-CRE).
Methods:
We conducted a parallel 1:2 matched case-control study at Rambam Health Care C...
Background: Secondary bacterial pneumonia is an important complication of seasonal influenza, but little data is available about impact on death and risk factors. This study identified risk factors for all-cause in-hospital mortality and secondary bacterial pneumonia among hospitalized adult patients with community-acquired influenza. Methods: A re...
The increasing threat of emerging infectious diseases and antimicrobial resistance requires more efficient, high-quality research. Perpetual Observational Studies (POS) nested within a clinical research network can improve planning, quality and efficiency of interventional and observational studies, although real-life benefits and challenges need t...
Introduction
Little is known about the bloodstream infection (BSI) risk associated with short-term peripheral venous catheters (PVCs) and no large study investigated the insertion site-related risk for PVC-BSI.
Methods
We performed a cohort study at the University of Geneva Hospitals using the prospective hospital-wide BSI surveillance database. W...
Background
Health care-associated infections (HAIs) are a major threat to patient safety worldwide. The importance of the health care environment in patient care is not always adequately addressed. Currently, no overview exists of how health care environmental hygiene (HEH) is performed around the world.
Methods
Our pilot survey tested a prelimina...
Background
: Enterobacteriaceae are common pathogens causing bloodstream infection (BSI) in sub-Saharan Africa and frequently express 3rd generation cephalosporin (3GC)-resistance, however the impact of 3GC-resistance on clinical outcomes is rarely studied.
Methods
: We conducted a single-site prospective cohort study at Tygerberg Hospital, Cape T...
Background
Healthcare-associated infections (HAI) are one of the gravest threats to patient safety worldwide. The importance of the hospital environment has recently been revalued in infection prevention and control. Though the literature is evolving rapidly, many institutions still do not consider healthcare environmental hygiene (HEH) very import...
Background
WHO core components for infection prevention and control (IPC) are important building blocks for effective IPC programmes. To our knowledge, we did the first WHO global survey to assess implementation of these programmes in health-care facilities.
Methods
In this cross-sectional survey, IPC professionals were invited through global outr...
Background
Since the onset of the COVID-19 pandemic, the disease has frequently been compared with seasonal influenza, but this comparison is based on little empirical data.
Aim
This study compares in-hospital outcomes for patients with community-acquired COVID-19 and patients with community-acquired influenza in Switzerland.
Methods
This retr...
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 C...
Background:
Acute Myeloid Leukemia (AML) and high-risk Myelodysplastic Syndrome (MDS) patients frequently receive antibiotics (ABX) for febrile neutropenia (prophylaxis or empirical treatment) or for suspected or documented bacterial infections. ABX affect the composition of the human intestinal microbiome and the resulting dysbiosis can have impor...
Importance
Peripheral intravenous catheters (PVCs) are the most frequently used indwelling devices in hospitals worldwide. Peripheral intravenous catheter bloodstream infections (PVC-BSIs) are rare, but severe and preventable, adverse events.
Objective
To investigate the incidence of PVC-BSIs after changing the policy of routine PVC replacement ev...
Objectives
The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control.
Methods
From October to December 2020, WHO Global Antimicrobial R...
As with any health threat, our ability to respond to the emergence and spread of antimicrobial resistance depends on our ability to understand the scale of the problem, magnitude, geographical spread, and trends over time. This is especially true for resistance emergence to newer antibiotics coming to the market as last-resort treatments. Yet curre...
Objectives
The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control.
Methods
From October-December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (G...
There has been an increased focus on the public health burden of antimicrobial resistance (AMR). This raises conceptual challenges such as determining how much harm multi-drug resistant organisms do compared to what, or how to establish the burden. In this viewpoint we will present a counterfactual framework and provide guidance to harmonize method...
Background
Bloodstream infections (BSI) caused by Enterobacteriaceae show increasing frequency of resistance to third-generation cephalosporin (3GC) antibiotics on the African continent but the mortality impact has not been quantified.
Methods
We used historic data from six African hospitals to assess the impact of 3GC resistance on clinical outco...
[This corrects the article DOI: 10.1093/jacamr/dlaa130.].
Background
The health impact of antimicrobial resistance (AMR) has not been included in the Global Burden Disease (GBD) report, as reliable data has been lacking. AMR burden estimates have been derived from models combining incidence and/or prevalence data from national and/or international surveillance systems and mortality estimates from clinical...
Objectives
This study aimed to determine rates and risk factors of ESBL-producing Enterobacteriaceae (ESBL-PE) acquisition and transmission within households after hospital discharge of an ESBL-PE-positive index patient.
Methods
2-year prospective cohort study in 5 European cities. Patients colonised with ESBL-producing Escherichia coli (ESBL-Ec)...
Objectives/purpose
The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a h...
Background
Coronavirus disease 19 (COVID-19) has frequently been colloquially compared to the seasonal influenza, but comparisons based on empirical data are scarce.
Aims
To compare in-hospital outcomes for patients admitted with community-acquired COVID-19 to patients with community-acquired influenza in Switzerland.
Methods
Patients >18 years,...
Objectives/Purpose
The costs attributable to antimicrobial resistance (AMR) across human, animal, and environmental health remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR; historically many studies have considered only direct costs associated with human infection from a h...
Objectives/Purpose The costs attributable to antimicrobial resistance (AMR) remain theoretical and largely unspecified. Current figures fail to capture the full health and economic burden caused by AMR across human, animal, and environmental health; historically many studies have considered only direct costs associated with human infection from a h...
The scarcity of novel antibiotic compounds in a time of increasing resistance rates has begun to ring alarm bells at the highest echelons of government. Large new financial incentives to accelerate antibiotic research and development, such as market entry rewards (MERs), are being considered. However, there is little focus on how to sustain the eff...
Background:
Hand hygiene is crucial in infection prevention and control. It is unclear whether sprayed alcohol-based handrub (ABHR) is non-inferior to the WHO recommended method of handrubbing with poured ABHR.
Aim:
We tested whether sprayed ABHR can be an alternative (non-inferior) method for effective hand hygiene with/without handrubbing.
Me...
Objectives:
The aim was to evaluate the effect of duration of therapy (DOT) on mortality and relapse for patients with Staphylococcus aureus bacteraemia (SAB).
Methods:
We performed a retrospective single-centre cohort study including adult patients with SAB. We determined the association between DOT (≤14 days versus >14 days) and mortality by a...
Background:
Surveillance of surgical site infections (SSIs) is a core component of effective infection control practices, though its impact has not been quantified on a large scale.
Aim:
To determine the time-trend of SSI rates in surveillance networks.
Methods:
SSI surveillance networks provided procedure-specific data on numbers of SSIs and...
Objectives:
Compliance with the World Health Organization 'how to handrub' action is suboptimal. Simplifying the hand-hygiene action may improve practice. However, it is crucial to preserve antibacterial efficacy. We tested the non-inferiority of 15 versus 30 seconds handrubbing for Staphylococcus aureus and Escherichia coli contamination at diffe...
Innovations are urgently required for clinical development of antibacterials against multidrug-resistant organisms. Therefore, a European, public-private working group (STAT-Net; part of Combatting Bacterial Resistance in Europe [COMBACTE]), has reviewed and tested several innovative trials designs and analytical methods for randomized clinical tri...
Introduction
Inappropriate use of antimicrobials in hospitals contributes to antimicrobial resistance. Antimicrobial stewardship (AMS) interventions aim to improve antimicrobial prescribing, but they are often resource and personnel intensive. Computerised decision supportsystems (CDSSs) seem a promising tool to improve antimicrobial prescribing bu...
We evaluated whether hand wiping is noninferior to hand rubbing in reducing the bacterial concentration on hands. In 20 healthy volunteers, hand wiping with or without an alcohol-based solution was inferior to hand rubbing with an alcohol-based solution. This finding warrants a note of caution for the application of wipes in health care.
Infect Con...
Antimicrobial resistance poses a growing threat to public health and the provision of health care. Its surveillance should provide up-to-date and relevant information to monitor the appropriateness of therapy guidelines, antibiotic formulary, antibiotic stewardship programmes, public health interventions, infection control policies, and antimicrobi...
In 2017, the global hand hygiene day (5th May) focuses on battling antimicrobial resistance (AMR). It promotes strong infection prevention and control and comprehensive antimicrobial stewardship programmes to prevent hospital-acquired infections and reduce the spread of AMR in healthcare facilities.
PurposeIn this era of rising antimicrobial resistance, slowly refilling antibiotic development pipelines, and an aging population, we need to ensure that randomized clinical trials (RCTs) determine the added benefit of new antibiotic agents effectively and in a valid way, especially for severely ill patients. Unfortunately, universally accepted end...
Aims
In this narrative review, we provide a framework for assessing the quality of evidence provided by studies investigating antimicrobial stewardship (AMS) interventions, and inform the design and planning stage for future AMS evaluation studies to determine the best strategies to keep antimicrobial resistance at bay.
Sources
Cochrane/Pubmed
Co...
Introduction
The rapid worldwide spread of carbapenem-resistant Enterobacteriaceae (CRE) constitutes a major challenge. The aim of the EUropean prospective cohort study on Enterobacteriaceae showing REsistance to CArbapenems (EURECA), which is part of the Innovative Medicines Initiative Joint Undertaking (IMI JU) funded COMBACTE-CARE project, is to...
Marlieke de Kraker and colleagues reflect on the need for better global estimates for the burden of antimicrobial resistance.
On the 10th anniversary of the “Clean Care is Safer Care” programme, the WHO Collaborating Centre on Patient Safety launched the “Global Hand Sanitizing Relay 2015” (HSRelay). This hospital-wide activity promotes the WHO handrubbing technique to improve hand hygiene (HH) compliance. More than 15,000 health-care workers (HCWs) from 133 hospitals in...
INTRODUCTION:
We aimed to evaluate the effectiveness of a symbiotic product to decolonize the intestinal tract of patients harboring multidrug-resistant (MDR) Gram-negative bacilli and to prevent nosocomial infections.
METHODS:
This was a randomized, double blind, placebo-controlled clinical trial, conducted in a tertiary-care university hospital....
On 31 May 2011, after notification of Klebsiella pneumoniae (KP)OXA-48;CTX-M-15 in two patients, nosocomial transmission was suspected in a Dutch hospital. Hospital-wide infection control measures and an outbreak investigation were initiated. A total of 72,147 patients were categorised into groups based on risk of OXA-48 colonisation or infection,...
Background:
Complicated urinary tract infections (c-UTIs) are among the most common nosocomial infections and a substantial part of the antimicrobial agents used in hospitals is for the treatment of c-UTIs. Data from surveillance can be used to guide the empirical treatment choices of clinicians when treating c-UTIs. We therefore used nation-wide...
Prevalence of, and risk factors for, carriage of extended-spectrum β-lactamase (ESBL) -producing Enterobacteriaceae were determined for 1025 Dutch adults in municipalities with either high or low broiler densities. Overall prevalence of ESBL carriage was 5.1%. The hypothesis that individuals in areas with high broiler densities are at greater risk...
Clin Microbiol Infect ABSTRACT: We investigated bacteraemia trends for five major bacterial pathogens, Staphylococcus aureus, Escherichia coli, Streptococcus pneumoniae, Enterococcus faecalis and Enterococcus faecium, and determined how expanding antimicrobial resistance influenced the total burden of bacteraemias in Europe. Aetiological fractions...
Clin Microbiol Infect 2012; 18: E466–E472
Dutch laboratories are currently changing their breakpoint criteria from mostly Clinical Laboratory and Standards Institute (CLSI) breakpoints to European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints. To evaluate the impact of these changes, we studied antimicrobial resistance tren...
Trends in the number of S. aureus BSIs and the proportion of these that were resistant for methicillin for EARSS laboratories consistently reporting from 2001–2015. (A) Number of S. aureus BSIs. (B) Proportion resistant for methicillin. Diamonds indicate ascertained values, and trend line projections are based on regression analysis; regression equ...
Parameter estimates. Adjusted odds ratios for 30-d mortality and excess length of hospital stay, in days, associated with MRSA, MSSA, G3CREC, and G3CSEC bacteremias, and the derived number needed to be exposed for one excess death (NNE) [3],[4].
(PDF)
Estimated number of excess deaths associated with MRSA, MSSA, G3CREC, and G3CSEC bacteremias in 2007. Countries include all European Union member states (excluding Slovakia), both candidate countries (Croatia and Turkey), two EFTA countries (Iceland and Norway), and Israel.
(PDF)
Trends in the number of E. coli BSIs and the proportion of these that were resistant for third-generation cephalosporins for EARSS laboratories consistently reporting from 2003–2015. (A) Number of E. coli BSIs. (B) Proportion resistant for third-generation cephalosporins. Diamonds indicate ascertained values, and trend line projections are based on...
Number of acute care beds for 2007. Beds per 10,000 inhabitants.
(PDF)
Estimated excess number of bed-days and costs associated with MRSA, MSSA, G3CREC, and G3CSEC bacteremias in 2007. Countries include all European Union member states (excluding Slovakia), both candidate countries (Croatia and Turkey), two EFTA countries (Iceland and Norway), and Israel.
(PDF)
Background:
The relative importance of human diseases is conventionally assessed by cause-specific mortality, morbidity, and economic impact. Current estimates for infections caused by antibiotic-resistant bacteria are not sufficiently supported by quantitative empirical data. This study determined the excess number of deaths, bed-days, and hospit...
1did a large retrospective study in intensive care units (ICU) from ten European countries. They concluded that ICU-acquired pneumonia and bloodstream infections substantially increased mortality and ICU stay, while the additional eff ect of antibiotic resistance in this group of patients was relatively modest. We believe that this study design is...