Trends and characteristics of attendance at the emergency department of a Swiss university hospital: 2002-2012.

BACKGROUND: The numbers of people attending emergency departments (EDs) at hospitals are increasing. We aimed to analyse trends in ED attendance at a Swiss university hospital between 2002 and 2012, focussing on age-related differences and hospital admission criteria. METHODS: We used hospital administrative data for all patients aged ≥16 years who attended the ED (n = 298,306) at this university hospital between 1 January 2002, and 31 December 2012. We descriptively analysed the numbers of ED visits according to the admission year and stratified by age (≥65 vs <65 years). RESULTS: People attending the ED were on average 46.6 years old (standard deviation 20 years, maximum range 16‒99 years). The annual number of ED attendances grew by n = 6,639 (27.6%) from 24,080 in 2002 to 30,719 in 2012. In the subgroup of patients aged ≥65 the relative increase was 42.3%, which is significantly higher (Pearson's χ2 = 350.046, df = 10; p = 0.000) than the relative increase of 23.4% among patients <65 years. The subgroup of patients ≥65 years attended the ED more often because of diseases (n = 56,307; 85%) than accidents (n = 9,844; 14.9%). This subgroup (patients ≥65 years) was also more often admitted to hospital (Pearson's χ2 = 23,377.190; df = 1; p = 0.000) than patients <65 years. CONCLUSIONS: ED attendance of patients ≥65 years increased in absolute and relative terms. The study findings suggest that staff of this ED may want to assess the needs of patients ≥65 years and, if necessary, adjust the services (e.g., adapted triage scales, adapted geriatric screenings, and adapted hospital admission criteria).

The Stealthy Superbug: the Role of Asymptomatic Enteric Carriage in Maintaining a Long-Term Hospital Outbreak of ST228 Methicillin-Resistant Staphylococcus aureus.

UNLABELLED: Whole-genome sequencing (WGS) of 228 isolates was used to elucidate the origin and dynamics of a long-term outbreak of methicillin-resistant Staphylococcus aureus (MRSA) sequence type 228 (ST228) SCCmec I that involved 1,600 patients in a tertiary care hospital between 2008 and 2012. Combining of the sequence data with detailed metadata on patient admission and movement confirmed that the outbreak was due to the transmission of a single clonal variant of ST228, rather than repeated introductions of this clone into the hospital. We note that this clone is significantly more frequently recovered from groin and rectal swabs than other clones (P < 0.0001) and is also significantly more transmissible between roommates (P < 0.01). Unrecognized MRSA carriers, together with movements of patients within the hospital, also seem to have played a major role. These atypical colonization and transmission dynamics can help explain how the outbreak was maintained over the long term. This "stealthy" asymptomatic colonization of the gut, combined with heightened transmissibility (potentially reflecting a role for environmental reservoirs), means the dynamics of this outbreak share some properties with enteric pathogens such as vancomycin-resistant enterococci or Clostridium difficile. IMPORTANCE: Using whole-genome sequencing, we showed that a large and prolonged outbreak of methicillin-resistant Staphylococcus aureus was due to the clonal spread of a specific strain with genetic elements adapted to the hospital environment. Unrecognized MRSA carriers, the movement of patients within the hospital, and the low detection with clinical specimens were also factors that played a role in this occurrence. The atypical colonization of the gut means the dynamics of this outbreak may share some properties with enteric pathogens.

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1922 (SER2,T30).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1921 (SER2,T29).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1889 (SER2,T4).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1924/01/01 (SER2,T32)-1924/03/31 (SER2,T32).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1906 (SER2,T15).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1893 (SER2,T6).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1876 (SER1,T11)-1878.

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1886 (SER2,T3)-1888.

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1897 (SER2,T9)-1898.

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1863 (SER1,T9,PART1)-1866.

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1907 (SER2,T16).

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1879 (SER1,T12)-1880.

Recueil de lois, ordonnances, décrets, réglements et circulaires concernant les différents services du Ministère des travaux publics : ancien Recueil Potiquet / dressé par les soins de l'Administration centrale

1908 (SER2,T17).