Articles

Acquisition of multidrug-resistant Enterobacterales during international travel: a systematic review of clinical and microbiological characteristics and meta-analyses of risk factors

International tourism increased from 25 million tourist arrivals in 1950 to over 1.3 billion in 2017. These travelers can be exposed to (multi) resistant microorganisms, may become colonized, and bring them ba...

Authors: Anne F. Voor in ‘t holt, Kees Mourik, Berend Beishuizen, Adriënne S. van der Schoor, Annelies Verbon, Margreet C. Vos and Juliëtte A. Severin

In vitro evaluation of double carbapenem and colistin combinations against OXA-48, NDM carbapenemase-producing colistin-resistant Klebsiella pneumoniae strains

Treatment of pandrug-resistant isolates often necessitates combination therapy. Checkerboard synergy and time-killing assay tests were performed to evaluate the benefits of a triple combination with meropenem,...

Authors: Fatma Erdem, Ayham Abulaila, Zerrin Aktas and Oral Oncul

Implementing a combined infection prevention and control with antimicrobial stewardship joint program to prevent caesarean section surgical site infections and antimicrobial resistance: a Tanzanian tertiary hospital experience

Surgical site infections are a leading cause of morbidity and mortality after caesarean section, especially in Low and Middle Income Countries. We hypothesized that a combined infection prevention and control ...

Authors: Elisa Gentilotti, Pasquale De Nardo, Boniface Nguhuni, Alessandro Piscini, Caroline Damian, Francesco Vairo, Zainab Chaula, Paola Mencarini, Peter Torokaa, Alimuddin Zumla, Emanuele Nicastri and Giuseppe Ippolito

Rumors and incorrect reports are more deadly than the new coronavirus (SARS-CoV-2)

Authors: Rostam Jalali and Masoud Mohammadi

Emergence of β-lactamase- and carbapenemase- producing Enterobacteriaceae at integrated fish farms

Epidemiological studies suggested that determinants for antibiotic resistance have originated in aquaculture. Recently, the integrated agriculture-aquaculture system has been implemented, where fish are raised...

Authors: Dalia Hamza, Sohad Dorgham, Elshaimaa Ismael, Sherein Ismail Abd El-Moez, Mahmoud Elhariri, Rehab Elhelw and Eman Hamza

Predicting the occurrence of multidrug-resistant organism colonization or infection in ICU patients: development and validation of a novel multivariate prediction model

Multidrug-resistant organisms (MDROs) have emerged as an important cause of poor prognoses of patients in the intensive care unit (ICU). This study aimed to establish an easy-to-use nomogram for predicting the...

Authors: Li Wang, Xiaolong Huang, Jiating Zhou, Yajing Wang, Weizhang Zhong, Qing Yu, Weiping Wang, Zhiqiao Ye, Qiaoyan Lin, Xing Hong, Ping Zeng and Minwei Zhang

Implementation of the WHO hand hygiene strategy in Faranah regional hospital, Guinea

Healthcare-associated infections are the most frequent adverse events in healthcare worldwide, with limited available evidence suggesting highest burden in resource-limited settings. Recent Ebola epidemics emp...

Authors: S. A. Müller, A. O. K. Diallo, R. Wood, M. Bayo, T. Eckmanns, O. Tounkara, M. Arvand, M. Diallo and M. Borchert

Outbreak investigation of Serratia marcescens neurosurgical site infections associated with a contaminated shaving razors

Surgical site infection (SSI) is the most common healthcare-associated infection. We report an outbreak of neurosurgical site infections caused by Serratia marcescens after craniotomy in a tertiary care hospital.

Authors: Eun Jin Kim, Wan Beom Park, Jung-Ki Yoon, Won-Sang Cho, Su Jung Kim, Young Rok Oh, Kang Il Jun, Chang Kyung Kang, Pyeong Gyun Choe, Jong-Il Kim, Eun Hwa Choi, Myoung Don Oh and Nam Joong Kim

Point-prevalence survey of hospital acquired infections in three acute care hospitals in Northern Nigeria

Effective infection prevention and control strategies require reliable data describing the epidemiology of hospital acquired infections (HAIs), and this is currently lacking in Nigeria. The objective of this s...

Authors: Usman Abubakar

Screening for triazole resistance in clinically significant Aspergillus species; report from Pakistan

Burden of aspergillosis is reported to be significant from developing countries including those in South Asia. The estimated burden in Pakistan is also high on the background of tuberculosis and chronic lung d...

Authors: Safia Moin, Joveria Farooqi, Kauser Jabeen, Sidra Laiq and Afia Zafar

Clinical impact of endemic NDM-producing Klebsiella pneumoniae in intensive care units of the national referral hospital in Jakarta, Indonesia

A prospective observational study was performed to assess the epidemiology and clinical impact of carbapenem-non-susceptible Klebsiella pneumoniae (CNKP) in intensive care units (ICUs) of the national referral ho...

Authors: Yulia Rosa Saharman, Anis Karuniawati, Rudyanto Sedono, Dita Aditianingsih, Wil H. F. Goessens, Corné H. W. Klaassen, Henri A. Verbrugh and Juliëtte A. Severin

The potential negative impact of antibiotic pack on antibiotic stewardship in primary care in Switzerland: a modelling study

In Switzerland, oral antibiotics are dispensed in packs rather than by exact pill-count. We investigated whether available packs support compliance with recommended primary care treatment regimens for common i...

Authors: Julia Füri, Andreas Widmer, Delia Bornand, Christoph Berger, Benedikt Huttner and Julia Anna Bielicki

Correction to: Implementation and impact of pediatric antimicrobial stewardship programs: a systematic scoping review

The original article [1] contains an error in Fig. 1 whereby the number of selected articles of the first box is incorrect.

Authors: D. Donà, E. Barbieri, M. Daverio, R. Lundin, C. Giaquinto, T. Zaoutis and M. Sharland

Bacteremia in critical care units at Bugando Medical Centre, Mwanza, Tanzania: the role of colonization and contaminated cots and mothers’ hands in cross-transmission of multidrug resistant Gram-negative bacteria

Multidrug resistance (MDR) is a major clinical problem in tertiary hospitals in Tanzania and jeopardizes the life of neonates in critical care units (CCUs). To better understand methods for prevention of MDR i...

Authors: Vitus Silago, Dory Kovacs, Delfina R. Msanga, Jeremiah Seni, Louise Matthews, Katarina Oravcová, Ruth N. Zadoks, Athumani M. Lupindu, Abubakar S. Hoza and Stephen E. Mshana

The great nursing brain drain and its effects on patient safety

The World Health Organization (WHO) has declared 2020 the “Year of the Nurse and Midwife”. On May 5th of this year, for the annual celebration of the SAVE LIVES: Clean Your Hands campaign, the WHO will focus o...

Authors: Alexandra Peters, Rafael Palomo and Didier Pittet

The global prevalence of Daptomycin, Tigecycline, Quinupristin/Dalfopristin, and Linezolid-resistant Staphylococcus aureus and coagulase–negative staphylococci strains: a systematic review and meta-analysis

Methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-resistant coagulase-negative Staphylococcus (MRCoNS) are among the main causes of nosocomial infections, which have caused major problems in rece...

Authors: Aref Shariati, Masoud Dadashi, Zahra Chegini, Alex van Belkum, Mehdi Mirzaii, Seyed Sajjad Khoramrooz and Davood Darban-Sarokhalil

Persuasive antimicrobial stewardship intervention in the context of a KPC outbreak: a controlled interrupted time series analysis

Antimicrobial resistance is a major public health threat. Antimicrobial stewardship (AMS) is one of the key strategies to overcome resistance, but robust evidence on the effect of specific interventions is lac...

Authors: Nuno Rocha-Pereira, Paulo Figueiredo Dias, Sofia Correia, Shirin Shahriari, João Neves, José Teixeira, José Artur Paiva, Carlos Lima Alves and Ana Azevedo

“Nurses and midwives: clean care is in your hands”: the 5th May 2020 World Health Organization SAVE LIVES: Clean Your Hands campaign

In honor of Florence Nightingale’s 200th birthday, the World Health Organization (WHO) has declared 2020 the “Year of the Nurse and Midwife”. On May 5th of this year, for the annual celebration of the SAVE LIV...

Authors: Alexandra Peters, Nasim Lotfinejad, Chloé Guitart, Alice Simniceanu, Maria Clara Padoveze, Tcheun Borzykowski, Benedetta Allegranzi and Didier Pittet

Secular trend analysis of antibiotic utilisation in China’s hospitals 2011–2018, a retrospective analysis of procurement data

This study was aimed to explore the secular trends of antibiotic utilisation in China’s hospitals over an 8-year period.

Authors: Haishaerjiang Wushouer, Yue Zhou, Xi Zhang, Mengyuan Fu, Daiming Fan, Luwen Shi and Xiaodong Guan

Emerging coexistence of three PMQR genes on a multiple resistance plasmid with a new surrounding genetic structure of qnrS2 in E. coli in China

Quinolones are commonly used for treatment of infections by bacteria of the Enterobacteriaceae family. However, the rising resistance to quinolones worldwide poses a major clinical and public health risk. This st...

Authors: Ying Tao, Kaixin Zhou, Lianyan Xie, Yanping Xu, Lizhong Han, Yuxing Ni, Jieming Qu and Jingyong Sun

Sustained effects of a multimodal campaign aiming at hand hygiene improvement on compliance and healthcare-associated infections in a large gynaecology/obstetrics tertiary-care centre in Vietnam

Hung Vuong Hospital (HVH) is a 900-bed maternity hospital in Ho-Chi-Minh-City, Vietnam. Due to low compliance, a quasi-experimental, observational study was conducted with the aim to improve hand hygiene.

Authors: Hang Thi Phan, Walter Zingg, Hang Thi Thuy Tran, Anh Pham Phuong Dinh and Didier Pittet

Candida tropicalis is the most prevalent yeast species causing candidemia in Algeria: the urgent need for antifungal stewardship and infection control measures

Despite being associated with a high mortality and economic burden, data regarding candidemia are scant in Algeria. The aim of this study was to unveil the epidemiology of candidemia in Algeria, evaluate the a...

Authors: Youcef Megri, Amir Arastehfar, Teun Boekhout, Farnaz Daneshnia, Caroline Hörtnagl, Bettina Sartori, Ahmed Hafez, Weihua Pan, Cornelia Lass-Flörl and Boussad Hamrioui

Different screening frequencies of carbapenem-resistant Enterobacteriaceae in patients undergoing hematopoietic stem cell transplantation: which one is better?

A consensus has been reached that carbapenem-resistant Enterobacteriaceae (CRE) screening in immunosuppressed individuals can reduce the incidence of CRE bloodstream infection (BSI).

Authors: Ting-Ting Yang, Xue-Ping Luo, Qing Yang, Hong-Chao Chen, Yi Luo, Yan-Min Zhao, Yi-Shan Ye, Xiao-Yu Lai, Jian Yu, Ya-Min Tan, Guo-Qing Wei, He Huang and Ji-Min Shi

Development of amoxicillin resistance in Escherichia coli after exposure to remnants of a non-related phagemid-containing E. coli: an exploratory study

To determine the effect of exposure to remnants of a phagemid-containing E. coli, killed by treatment with a propanol-based hand rub, on antimicrobial resistance in E. coli isolates.

Authors: Joep J. J. M. Stohr, Marjolein F. Q. Kluytmans-van den Bergh, Carlo J. M. M. Verhulst, John W. A. Rossen and Jan A. J. W. Kluytmans

The prevalence and molecular mechanisms of mupirocin resistance in Staphylococcus aureus isolates from a Hospital in Cape Town, South Africa

Antimicrobial resistance is an increasingly serious problem in public health globally. Monitoring resistance levels within healthcare and community settings is critical to combat its ongoing increase. This stu...

Authors: Shima M. Abdulgader, Tshepiso Lentswe, Andrew Whitelaw and Mae Newton-Foot

Antibiogram and beta-lactamase genes among cefotaxime resistant E. coli from wastewater treatment plant

The World Health Organization (WHO) recently classified Enterobacteriaceae resistance to third-generation cephalosporin into the group of pathogens with critical criteria for future research.

Authors: Anthony Ayodeji Adegoke, Chibuzor Ezinne Madu, Olayinka Ayobami Aiyegoro, Thor Axel Stenström and Anthony Ifeanyi Okoh

Oral colonisation by antimicrobial-resistant Gram-negative bacteria among long-term care facility residents: prevalence, risk factors, and molecular epidemiology

For residents of long-term care facilities (LTCFs), antimicrobial-resistant bacteria (ARB) are a risk factor, yet their oral colonisation, potentially leading to aspiration pneumonia, remains unclear. This stu...

Authors: Mi Nguyen-Tra Le, Shizuo Kayama, Mineka Yoshikawa, Toshinori Hara, Seiya Kashiyama, Junzo Hisatsune, Keiko Tsuruda, Makoto Onodera, Hiroki Ohge, Kazuhiro Tsuga and Motoyuki Sugai

Antimicrobial use and resistance in food-producing animals and the environment: an African perspective

The overuse of antimicrobials in food animals and the subsequent contamination of the environment have been associated with development and spread of antimicrobial resistance. This review presents information ...

Authors: Zuhura I. Kimera, Stephen E. Mshana, Mark M. Rweyemamu, Leonard E. G. Mboera and Mecky I. N. Matee

Prevalence, risk factors, phenotypic and molecular characteristics for Staphylococcus aureus carriage in community-based drug users in Guangzhou, China

Staphylococcus aureus (S. aureus), particularly methicillin-resistant Staphylococcus aureus (MRSA), remains the predominant cause of infections in drug users. This cross-sectional study aims to elucidate the prev...

Authors: Yingying Wang, Jialing Lin, Junli Zhou, Zhigang Han and Zhenjiang Yao

Molecular characterization of methicillin-resistant Staphylococcus aureus clinical strains from the endotracheal tubes of patients with nosocomial pneumonia

Among all cases of nosocomial pneumonia, Staphylococcus aureus is the second most prevalent pathogen (17.8%). In Europe, 29.9% of the isolates are oxacillin-resistant. The changing epidemiology of methicillin-res...

Authors: Roberto Cabrera, Laia Fernández-Barat, Anna Motos, Rubén López-Aladid, Nil Vázquez, Mauro Panigada, Francisco Álvarez-Lerma, Yuly López, Laura Muñoz, Pedro Castro, Jordi Vila and Antoni Torres

Infection control link nurse programs in Dutch acute care hospitals; a mixed-methods study

Infection control link nurse programs show considerable variation. We report how Dutch link nurse programs are organized, how they progress, and how contextual factors may play a role in the execution of these...

Authors: Mireille Dekker, Rosa van Mansfeld, Christina Vandenbroucke-Grauls, Martine de Bruijne and Irene Jongerden

Prevalence and molecular characterizations of Staphylococcus aureus nasal colonization among patients in pediatric intensive care units in Taiwan

Nasal colonization of Staphylococcus aureus is a risk factor for the pathogen transmission and the development of infections. Limited information is available on the prevalence and molecular characteristics of S....

Authors: Yu-Hsin Chen, Kuan-Ying A. Huang, Yi-Chuan Huang, Hsin Chi, Chun-Yi Lu, Luan-Yin Chang, Yu-Huai Ho, Chia-Yu Chi, Ching-Chuan Liu, Li-Min Huang, Tien Yu Owen Yang and Yhu-Chering Huang

The appropriateness of antimicrobial use in the outpatient clinics of three hospitals in the Netherlands

Antimicrobial Stewardship Programs commonly have an in-hospital focus. Little is known about the quality of antimicrobial use in hospital outpatient clinics. We investigated the extent and appropriateness of a...

Authors: Annemieke K. van den Broek, Reinier M. van Hest, Kamilla D. Lettinga, Afra Jimmink, Fanny N. Lauw, Caroline E. Visser and Jan M. Prins

Whole-genome sequencing to explore nosocomial transmission and virulence in neonatal methicillin-susceptible Staphylococcus aureus bacteremia

Neonatal Staphylococcus aureus (S. aureus) bacteremia is an important cause of morbidity and mortality. In this study, we examined whether methicillin-susceptible S. aureus (MSSA) transmission and genetic makeup ...

Authors: Bibi C. G. C. Slingerland, Margreet C. Vos, Willeke Bras, René F. Kornelisse, Dieter De Coninck, Alex van Belkum, Irwin K. M. Reiss, Wil H. F. Goessens, Corné H. W. Klaassen and Nelianne J. Verkaik

Antibiotic resistance in patients with clinical features of healthcare-associated infections in an urban tertiary hospital in Sierra Leone: a cross-sectional study

Available data on antibiotic resistance in sub-Saharan Africa is limited despite its increasing threat to global public health. As there is no previous study on antibiotic resistance in patients with clinical ...

Authors: Sulaiman Lakoh, Letian Li, Stephen Sevalie, Xuejun Guo, Olukemi Adekanmbi, Guang Yang, Oladimeji Adebayo, Le Yi, Joshua M. Coker, Shuchao Wang, Tiecheng Wang, Weiyang Sun, Abdulrazaq G. Habib and Eili Y. Klein

Carbapenemase-producing Enterobacteriaceae circulating in the Reunion Island, a French territory in the Southwest Indian Ocean

The spread of carbapenemase-producing Enterobacteriaceae (CPE) in the Southwest Indian Ocean area (SIOA) is poorly documented. Reunion Island is a French overseas territory located close to Madagascar and connect...

Authors: Guillaume Miltgen, Pascal Cholley, Daniel Martak, Michelle Thouverez, Paul Seraphin, Alexandre Leclaire, Nicolas Traversier, Bénédicte Roquebert, Marie-Christine Jaffar-Bandjee, Nathalie Lugagne, Céline Ben Cimon, Mahery Ramiandrisoa, Sandrine Picot, Anne Lignereux, Geoffrey Masson, Jérôme Allyn…

Effectiveness of a structured, framework-based approach to implementation: the Researching Effective Approaches to Cleaning in Hospitals (REACH) Trial

Implementing sustainable practice change in hospital cleaning has proven to be an ongoing challenge in reducing healthcare associated infections. The purpose of this study was to develop a reliable framework-b...

Authors: Lisa Hall, Nicole M. White, Michelle Allen, Alison Farrington, Brett G. Mitchell, Katie Page, Kate Halton, Thomas V. Riley, Christian A. Gericke, Nicholas Graves and Anne Gardner

Flies from a tertiary hospital in Rwanda carry multidrug-resistant Gram-negative pathogens including extended-spectrum beta-lactamase-producing E. coli sequence type 131

Multidrug-resistant gram-negative (MRGN) bacteria are a serious threat to global health. We used genomics to study MRGN obtained from houseflies in a tertiary Rwandan hospital. Our analysis revealed a high abu...

Authors: Stefan E. Heiden, Mathis S. E. Kurz, Jürgen Bohnert, Claude Bayingana, Jules M. Ndoli, Augustin Sendegeya, Jean Bosco Gahutu, Elias Eger, Frank P. Mockenhaupt and Katharina Schaufler

Risk perception of antimicrobial resistance by infection control specialists in Europe: a case-vignette study

Using case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients.

Authors: Gabriel Birgand, Nico T. Mutters, Raheelah Ahmad, Evelina Tacconelli, Jean-Christophe Lucet and Alison Holmes

Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016

Antimicrobial resistance is a growing threat to the world’s ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. Thi...

Authors: Wallis Rudnick, Michelle Science, Daniel J. G. Thirion, Kahina Abdesselam, Kelly B. Choi, Linda Pelude, Kanchana Amaratunga, Jeannette L. Comeau, Bruce Dalton, Johan Delport, Rita Dhami, Joanne Embree, Yannick Émond, Gerald Evans, Charles Frenette, Susan Fryters…

Risk factors for fecal carriage of drug-resistant Escherichia coli: a systematic review and meta-analysis

Antimicrobial resistance is a serious public health problem. Fecal carriage of drug-resistant bacteria has been suggested as an important source of antimicrobial resistant genes (ARGs). We aimed to identify ri...

Authors: Yuan Hu, Yusuke Matsui and Lee W. Riley

Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study

The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these...

Authors: Kenneth I. Onyedibe, Nathan Y. Shehu, Daniela Pires, Samson E. Isa, Mark O. Okolo, Simji S. Gomerep, Comfort Ibrahim, Sunday J. Igbanugo, Rachel U. Odesanya, Adebola Olayinka, Daniel Z. Egah and Didier Pittet

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasin...

Authors: Po Ying Chia, Sharmila Sengupta, Anjanna Kukreja, Sasheela S.L. Ponnampalavanar, Oon Tek Ng and Kalisvar Marimuthu

Enhanced bactericidal effect of ceftriaxone drug encapsulated in nanostructured lipid carrier against gram-negative Escherichia coli bacteria: drug formulation, optimization, and cell culture study

Ceftriaxone is one of the most common types of antibiotics used to treat most deadly bacterial infections. One way to alleviate the side effects of medication is to reduce drug consumption by changing the ordi...

Authors: Sahar Ebrahimi, Nafiseh Farhadian, Mohammad Karimi and Mohsen Ebrahimi

Emojis in public health and how they might be used for hand hygiene and infection prevention and control

Emojis are frequently used picture characters known as possible surrogates for non-verbal aspects of behavior. Considering the ability of emojis to enhance and facilitate communication, there has been a growin...

Authors: Nasim Lotfinejad, Reza Assadi, Mohammad Hassan Aelami and Didier Pittet

“Infection prevention and control idea challenge” contest: a fresh view on medical education and problem solving

Healthcare-associated infections (HAIs) challenge modern medicine. Considering their high prevalence in Iran, we aimed to provide knowledge on the subject, and to teach about the importance of infection preven...

Authors: Arash Arianpoor, Ahmadreza Zarifian, Emran Askari, Arash Akhavan-Rezayat, Mojtaba Dayyani, Amin Rahimian, Elahe Amini, Roya Amel, Aghigh Ziaeemehr, Walter Zingg, Mohammad Hasan Aelami and Didier Pittet

Mortality associated with carbapenem-susceptible and Verona Integron-encoded Metallo-β-lactamase-positive Pseudomonas aeruginosa bacteremia

Studies on various Gram-negative bacteria suggest that resistance to carbapenem antibiotics is responsible for increased mortality in patients; however, results are not conclusive. We first assessed the 28-day...

Authors: Marjolein C. Persoon, Anne F. Voor in’t holt, Cornelia C. H. Wielders, Diederik Gommers, Margreet C. Vos and Juliëtte A. Severin

Correction to: Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control

The original article [1] contained a misspelling in author, Fernando Bellissimo-Rodrigues’s name which has since been corrected.

Authors: Ermira Tartari, Carolina Fankhauser, Sarah Masson-Roy, Hilda Márquez-Villarreal, Inmaculada Fernández Moreno, Ma Luisa Rodriguez Navas, Odet Sarabia, Fernando Bellissimo-Rodrigues, Marcela Hernández-de Mezerville, Yew Fong Lee, Mohammad Hassan Aelami, Shaheen Mehtar, Américo Agostinho, Liberato Camilleri, Benedetta Allegranzi, Daniela Pires…

Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis

Studies on risk factors for carbapenem-resistant Klebsiella pneumoniae (CRKP) infection have provided inconsistent results, partly due to the choice of the control group. We conducted a systematic review and meta...

Authors: Wei-min Zhu, Zhe Yuan and Hong-yu Zhou

Does vancomycin resistance increase mortality in Enterococcus faecium bacteraemia after orthotopic liver transplantation? A retrospective study

The relevance of vancomycin resistance in enterococcal blood stream infections (BSI) is still controversial. Aim of this study was to outline the effect of vancomycin resistance of Enterococcus faecium on the out...

Authors: S. Dubler, M. Lenz, S. Zimmermann, D. C. Richter, K. H. Weiss, A. Mehrabi, M. Mieth, T. Bruckner, M. A. Weigand, T. Brenner and A. Heininger