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Raschpichler G, Raupach-Rosin H, Akmatov MK, Castell S, Rübsamen N, Feier B, Szkopek S, Bautsch W, Mikolajczyk R, Karch A. Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany. Sci Rep 2020; 10:17998. [PMID: 33093607 PMCID: PMC7582828 DOI: 10.1038/s41598-020-75094-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 10/07/2020] [Indexed: 11/09/2022] Open
Abstract
In countries with low endemic Methicillin-resistant Staphylococcus aureus (MRSA) prevalence, identification of risk groups at hospital admission is considered more cost-effective than universal MRSA screening. Predictive statistical models support the selection of suitable stratification factors for effective screening programs. Currently, there are no universal guidelines in Germany for MRSA screening. Instead, a list of criteria is available from the Commission for Hospital Hygiene and Infection Prevention (KRINKO) based on which local strategies should be adopted. We developed and externally validated a model for individual prediction of MRSA carriage at hospital admission in the region of Southeast Lower Saxony based on two prospective studies with universal screening in Braunschweig (n = 2065) and Wolfsburg (n = 461). Logistic regression was used for model development. The final model (simplified to an unweighted score) included history of MRSA carriage, care dependency and cancer treatment. In the external validation dataset, the score showed a sensitivity of 78.4% (95% CI: 64.7-88.7%), and a specificity of 70.3% (95% CI: 65.0-75.2%). Of all admitted patients, 25.4% had to be screened if the score was applied. A model based on KRINKO criteria showed similar sensitivity but lower specificity, leading to a considerably higher proportion of patients to be screened (49.5%).
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Affiliation(s)
- Gabriele Raschpichler
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Heike Raupach-Rosin
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Manas K Akmatov
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Central Research Institute of Ambulatory Health Care in Germany (ZI), Berlin, Germany
| | - Stefanie Castell
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
| | - Nicole Rübsamen
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany
| | - Birgit Feier
- Central Laboratory, Klinikum Wolfsburg, Wolfsburg, Germany
| | - Sebastian Szkopek
- Institute for Microbiology, Immunology and Hospital Hygiene, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany
| | - Wilfried Bautsch
- Institute for Microbiology, Immunology and Hospital Hygiene, Städtisches Klinikum Braunschweig gGmbH, Brunswick, Germany
| | - Rafael Mikolajczyk
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany
- Institute for Medical Epidemiology, Biometry, and Informatics (IMEBI), Medical Faculty of the Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Hanover Medical School, Hanover, Germany
| | - André Karch
- Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Brunswick, Germany.
- Institute of Epidemiology and Social Medicine, University of Münster, Münster, Germany.
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Raupach-Rosin H, Rübsamen N, Szkopek S, Schmalz O, Karch A, Mikolajczyk R, Castell S. Care for MRSA carriers in the outpatient sector: a survey among MRSA carriers and physicians in two regions in Germany. BMC Infect Dis 2016; 16:184. [PMID: 27112442 PMCID: PMC4845324 DOI: 10.1186/s12879-016-1503-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 04/09/2016] [Indexed: 11/23/2022] Open
Abstract
Background Little is known about the management of methicillin-resistant Staphylococcus aureus (MRSA) carriers in the German outpatient sector and about the impact of MRSA on their daily life. Reimbursement for MRSA related costs in the German outpatient sector is available since 2012, but its impact has not been studied yet. The aim of the study was to analyze the outpatient management of MRSA carriers from both, physicians’ and MRSA carriers’ perspective. Methods Paper-based questionnaires were mailed to physicians providing outpatient care and to MRSA carriers in 2013. MRSA carriers were recruited among patients tested positive for MRSA during a hospital stay in 2012. General practitioners, specialists for internal medicine, urologists, and dermatologists working in the outpatient catchment areas of the hospitals were contacted. Results Out of 910 MRSA carriers 16.5 % completed the questionnaires; among 851 physicians 9.5 % participated. 27.3 % of the responding MRSA carriers stated that no healthcare professional had ever talked to them about MRSA. 17.4 % reported self-stigmatization in terms of restricting social contacts; 47.3 % remembered decolonization and 33.3 % reported that their MRSA status was checked after discharge. Physicians displayed heterogeneous attitude and activity towards MRSA (number of applied decolonization and MRSA screenings). A minority (15.2 %) were satisfied with the reimbursement of costs, 35.9 % reported full agreement with the general recommendations for the handling of MRSA carriers. Conclusions MRSA carriers appear not well informed; (self-) stigmatization is occurring and should be tackled. Greater awareness of MRSA as a problem in the outpatient sector could lead to a better handling of MRSA carriers. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1503-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heike Raupach-Rosin
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
| | - Nicole Rübsamen
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany
| | - Sebastian Szkopek
- Städtisches Klinikum Braunschweig, Institut für Mikrobiologie, Immunologie und Krankenhaushygiene, Braunschweig, Germany
| | - Oliver Schmalz
- Helios Klinikum Wuppertal, Abteilung für Onkologie und Palliativmedizin, Heusnerstraße 40, 42283, Wuppertal, Germany
| | - André Karch
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany.,PhD Programme "Epidemiology", Braunschweig-Hannover, Germany.,German Centre for Infection Research, Hannover-Braunschweig, Germany
| | - Rafael Mikolajczyk
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,German Centre for Infection Research, Hannover-Braunschweig, Germany. .,Hannover Medical School, Hannover, Germany.
| | - Stefanie Castell
- Department Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany
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Gerlich MG, Piegsa J, Schäfer C, Hübner NO, Wilke F, Reuter S, Engel G, Ewert R, Claus F, Hübner C, Ried W, Flessa S, Kramer A, Hoffmann W. Improving hospital hygiene to reduce the impact of multidrug-resistant organisms in health care--a prospective controlled multicenter study. BMC Infect Dis 2015; 15:441. [PMID: 26493394 PMCID: PMC4619269 DOI: 10.1186/s12879-015-1184-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 10/06/2015] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Nosocomial infections are the most common complication during inpatient hospital care. An increasing proportion of these infections are caused by multidrug-resistant organisms (MDROs). This report describes an intervention study which was designed to address the practical problems encountered in trying to avoid and treat infections caused by MDROs. The aim of the HARMONIC (Harmonized Approach to avert Multidrug-resistant Organisms and Nosocomial Infections) study is to provide comprehensive support to hospitals in a defined study area in north-east Germany, to meet statutory requirements. To this end, a multimodal system of hygiene management was implemented in the participating hospitals. METHODS/DESIGN HARMONIC is a controlled intervention study conducted in eight acute care hospitals in the 'Health Region Baltic Sea Coast' in Germany. The intervention measures include the provision of written recommendations on methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE) and multi-resistant Gram-negative bacteria (MRGN), supplemented by regional recommendations for antibiotic prescriptions. In addition, there is theoretical and practical training of health care workers (HCWs) in the prevention and handling of MDROs, as well as targeted and critically gauged applications of antibiotics. The main outcomes of the implementation and analysis of the HARMONIC study are: (i) screening rates for MRSA, VRE and MRGN in high-risk patients, (ii) the frequency of MRSA decolonization, (iii) the level of knowledge of HCWs concerning MDROs, and (iv) specific types and amounts of antibiotics used. The data are predominantly obtained by paper-based questionnaires and documentation sheets. A computer-assisted workflow-based documentation system was developed in order to provide support to the participating facilities. The investigation includes three nested studies on risk profiles of MDROs, health-related quality of life, and cost analysis. A six-month follow-up study investigates the quality of life after discharge, the long-term costs of the treatment of infections caused by MDROs, and the sustainability of MRSA eradication. DISCUSSION The aim of this study is to implement and evaluate an area-wide harmonized hygiene program to control the nosocomial spreading of MDROs. Comparability between the intervention and control group is ensured by matching the hospitals according to size (number of discharges per year/number of beds) and level of care (standard or maximum). The results of the study may provide important indications for the implementation of regional MDRO management programs.
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Affiliation(s)
- Miriam G Gerlich
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Jens Piegsa
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Christian Schäfer
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
| | - Nils-Olaf Hübner
- Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt-Universität, Walter-Rathenau-Straße 49a, 17475, Greifswald, Germany.
| | - Florian Wilke
- Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt-Universität, Walter-Rathenau-Straße 49a, 17475, Greifswald, Germany.
| | - Susanne Reuter
- Universitätsapotheke, Ernst-Moritz-Arndt-Universität, Friedrich-Ludwig-Jahn-Straße 20, 17475, Greifswald, Germany.
| | - Georg Engel
- Universitätsapotheke, Ernst-Moritz-Arndt-Universität, Friedrich-Ludwig-Jahn-Straße 20, 17475, Greifswald, Germany.
| | - Ralf Ewert
- Zentrum für Innere Medizin, Klinik und Poliklinik für Innere Medizin B, Ernst-Moritz-Arndt-Universität, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - Franziska Claus
- Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 70, 17487, Greifswald, Germany.
| | - Claudia Hübner
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 70, 17487, Greifswald, Germany.
| | - Walter Ried
- Lehrstuhl für Allgemeine Volkswirtschaftslehre und Finanzwissenschaft, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 70, 17487, Greifswald, Germany.
| | - Steffen Flessa
- Lehrstuhl für Allgemeine Betriebswirtschaftslehre und Gesundheitsmanagement, Ernst-Moritz-Arndt-Universität, Friedrich-Loeffler-Straße 70, 17487, Greifswald, Germany.
| | - Axel Kramer
- Institut für Hygiene und Umweltmedizin, Ernst-Moritz-Arndt-Universität, Walter-Rathenau-Straße 49a, 17475, Greifswald, Germany.
| | - Wolfgang Hoffmann
- Institut für Community Medicine, Ernst-Moritz-Arndt-Universität, Ellernholzstraße 1-2, 17487, Greifswald, Germany.
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Antonanzas F, Lozano C, Torres C. Economic features of antibiotic resistance: the case of methicillin-resistant Staphylococcus aureus. PHARMACOECONOMICS 2015; 33:285-325. [PMID: 25447195 DOI: 10.1007/s40273-014-0242-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This paper analyses and updates the economic information regarding methicillin-resistant Staphylococcus aureus (MRSA), including information that has been previously reviewed by other authors, and new information, for the purpose of facilitating health management and clinical decisions. The analysed articles reveal great disparity in the economic burden on MRSA patients; this is mainly due to the diversity of the designs of the studies, as well as the variability of the patients and the differences in health care systems. Regarding prophylactic strategies, the studies do not provide conclusive results that could unambiguously orientate health management. The studies addressing treatments noted that linezolid seems to be a cost-effective treatment for MRSA, mostly because it is associated with a shorter length of stay (LOS) in hospital. However, important variables such as antimicrobial susceptibility, infection type and resistance emergence should be included in these analyses before a conclusion is reached regarding which treatment is the best (most efficient). The reviewed studies found that rapid MRSA detection, using molecular techniques, is an efficient technique to control MRSA. As a general conclusion, the management of MRSA infections implicates important economic costs for hospitals, as they result in higher direct costs and longer LOS than those related to methicillin-susceptible S. aureus (MSSA) patients or MRSA-free patients; there is wide variability in those increased costs, depending on different variables. Moreover, the research reveals a lack of studies on other related topics, such as the economic implications of changes in MRSA epidemiology (community patients and lineages associated with farm animals).
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Cantas L, Shah SQA, Cavaco LM, Manaia CM, Walsh F, Popowska M, Garelick H, Bürgmann H, Sørum H. A brief multi-disciplinary review on antimicrobial resistance in medicine and its linkage to the global environmental microbiota. Front Microbiol 2013; 4:96. [PMID: 23675371 PMCID: PMC3653125 DOI: 10.3389/fmicb.2013.00096] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 04/04/2013] [Indexed: 01/14/2023] Open
Abstract
The discovery and introduction of antimicrobial agents to clinical medicine was one of the greatest medical triumphs of the 20th century that revolutionized the treatment of bacterial infections. However, the gradual emergence of populations of antimicrobial-resistant pathogenic bacteria resulting from use, misuse, and abuse of antimicrobials has today become a major global health concern. Antimicrobial resistance (AMR) genes have been suggested to originate from environmental bacteria, as clinically relevant resistance genes have been detected on the chromosome of environmental bacteria. As only a few new antimicrobials have been developed in the last decade, the further evolution of resistance poses a serious threat to public health. Urgent measures are required not only to minimize the use of antimicrobials for prophylactic and therapeutic purposes but also to look for alternative strategies for the control of bacterial infections. This review examines the global picture of antimicrobial resistance, factors that favor its spread, strategies, and limitations for its control and the need for continuous training of all stake-holders i.e., medical, veterinary, public health, and other relevant professionals as well as human consumers, in the appropriate use of antimicrobial drugs.
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Affiliation(s)
- L Cantas
- Department of Food Safety and Infection Biology, Norwegian School of Veterinary Science Oslo, Norway
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Hübner NO, Fleßa S, Jakisch R, Assadian O, Kramer A. Review of indicators for cross-sectoral optimization of nosocomial infection prophylaxis - a perspective from structurally- and process-oriented hygiene. GMS KRANKENHAUSHYGIENE INTERDISZIPLINAR 2012; 7:Doc15. [PMID: 22558049 PMCID: PMC3334955 DOI: 10.3205/dgkh000199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In the care of patients, the prevention of nosocomial infections is crucial. For it to be successful, cross-sectoral, interface-oriented hygiene quality management is necessary. The goal is to apply the HACCP (Hazard Assessment and Critical Control Points) concept to hospital hygiene, in order to create a multi-dimensional hygiene control system based on hygiene indicators that will overcome the limitations of a procedurally non-integrated and non-cross-sectoral view of hygiene. Three critical risk dimensions can be identified for the implementation of three-dimensional quality control of hygiene in clinical routine: the constitution of the person concerned, the surrounding physical structures and technical equipment, and the medical procedures. In these dimensions, the establishment of indicators and threshold values enables a comprehensive assessment of hygiene quality. Thus, the cross-sectoral evaluation of the quality of structure, processes and results is decisive for the success of integrated infection prophylaxis. This study lays the foundation for hygiene indicator requirements and develops initial concepts for evaluating quality management in hygiene.
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Bergström K, Nyman G, Widgren S, Johnston C, Grönlund-Andersson U, Ransjö U. Infection prevention and control interventions in the first outbreak of methicillin-resistant Staphylococcus aureus infections in an equine hospital in Sweden. Acta Vet Scand 2012; 54:14. [PMID: 22401493 PMCID: PMC3325856 DOI: 10.1186/1751-0147-54-14] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2011] [Accepted: 03/08/2012] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The first outbreak of methicillin-resistant Staphylococcus aureus (MRSA) infection in horses in Sweden occurred in 2008 at the University Animal Hospital and highlighted the need for improved infection prevention and control. The present study describes interventions and infection prevention control in an equine hospital setting July 2008 - April 2010. METHOD This descriptive study of interventions is based on examination of policy documents, medical records, notes from meetings and cost estimates. MRSA cases were identified through clinical sampling and telephone enquiries about horses post-surgery. Prospective sampling in the hospital environment with culture for MRSA and genotyping of isolates by spa-typing and pulsed-field gel electrophoresis (PFGE) were performed. RESULTS Interventions focused on interruption of indirect contact spread of MRSA between horses via staff and equipment and included: Temporary suspension of elective surgery; and identification and isolation of MRSA-infected horses; collaboration was initiated between authorities in animal and human public health, human medicine infection control and the veterinary hospital; extensive cleaning and disinfection was performed; basic hygiene and cleaning policies, staff training, equipment modification and interior renovation were implemented over seven months.Ten (11%) of 92 surfaces sampled between July 2008 and April 2010 tested positive for MRSA spa-type 011, seven of which were from the first of nine sampling occasions. PFGE typing showed the isolates to be the outbreak strain (9 of 10) or a closely related strain. Two new cases of MRSA infection occurred 14 and 19 months later, but had no proven connections to the outbreak cases. CONCLUSIONS Collaboration between relevant authorities and the veterinary hospital and formation of an infection control committee with an executive working group were required to move the intervention process forward. Support from hospital management and the dedication of staff were essential for the development and implementation of new, improved routines. Demonstration of the outbreak strain in the environment was useful for interventions such as improvement of cleaning routines and interior design, and increased compliance with basic hygienic precautions. The interventions led to a reduction in MRSA-positive samples and the outbreak was considered curbed as no new cases occurred for over a year.
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Affiliation(s)
- Karin Bergström
- Department of Animal Environment and Health, Faculty of Veterinary Medicine and Animal Husbandry, Swedish University of Agricultural Sciences, SE 750 07 Uppsala, Sweden
- Department of Animal Health and Antimicrobial Strategies, SVA, SE 750 89 Uppsala, Sweden
| | - Görel Nyman
- Department of Animal Environment and Health, Faculty of Veterinary Medicine and Animal Husbandry, Swedish University of Agricultural Sciences, SE 750 07 Uppsala, Sweden
| | - Stefan Widgren
- Department of Disease Control and Epidemiology, SVA, SE 750 89 Uppsala, Sweden
| | - Christopher Johnston
- Equine Clinics, University Animal Hospital, University of Agricultural Sciences, SE 750 07 Uppsala, Sweden
| | | | - Ulrika Ransjö
- Department of Clinical Microbiology, Uppsala University Hospital, SE 751 85 Uppsala, Sweden
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