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Arens B, L'Hoest H, Wolf A, Hennig B, Marschall U, Nachtigall I. Antibiotikaverordnungsraten bei ambulant behandelten Infektionen der oberen Atemwege anhand von Routinedaten einer deutschen Krankenkasse. Gesundheitswesen 2024. [PMID: 38714307 DOI: 10.1055/a-2321-8275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
Einleitung:
Akute unkomplizierte obere Atemwegserkrankungen (ARE) sind häufige Gründe für Antibiotikaverordnungen im ambulanten Sektor, obwohl diese zu > 90 % viral bedingt und in der Mehrzahl selbstlimitierende Erkrankungen sind. Deutschland hat im europäischen Vergleich eine niedrige Antibiotikaverordnungsrate, jedoch zeigen sich regionale Unterschiede. Die von der ESAC-Studiengruppe (European Surveillance of Antimicrobial Consumption Network) entwickelten krankheitsspezifischen Qualitätsindikatoren (QI) adressieren die Verordnungsrate (Zielbereich < 20 %) und Wahl des Antibiotikums (Zielbereich > 80 %) in einer allgemeinen Hausarztpopulation. Ziel dieser Datenanalyse war die Operationalisierung der ESAC-Net-QI mit Hilfe von Sekundärdaten einer Krankenkasse auf Ebene der Erkrankungen und Betriebstätten sowie die Analyse von möglichem Verbesserungspotential.
Material und Methoden:
Datengrundlage sind die vertragsärztlichen und stationären Abrechnungsdaten sowie die Arzneiverordnungsdaten der BARMER Krankenkasse (§§ 295, 300, 301 SGB V). Die Auswertung erfolgte für das Jahr 2022. Die kategorialen Merkmale werden als Häufigkeit und Prozent angegeben. Es wurde eine größtmögliche Spezifität angestrebt, weshalb durch einen sehr umfassenden Algorithmus potentiell risikobehaftete Krankheitsverläufe ausgeschlossen wurden.
Ergebnisse:
Die Gesamtverordnungsrate von Antibiotika bei ARE lag im Jahr 2022 vor Anwendung der Ein- und Ausschlusskriterien bei 25 % (1.197.568 / 4.720.786). Durch den Algorithmus sank die Verordnungsrate für alle ARE-Fälle auf 6 % (80.786 / 1.365.646). Werden spezifische ARE-Indikationen betrachtet, so erhielten jeweils 35% (13.465 / 38.913) der akuten Bronchitis- und akuten Sinusitisfälle (4.971 / 14.051) eine Antibiotikaverordnung. Auf Betriebsstättenebene erreichten für die Behandlung der akuten Bronchitis 38 % der Praxen (1.396 / 3.705) und der akuten Sinusitis 41 % der Praxen (539 / 1.300) das angestrebte QI Ziel von < 20 % Antibiotikaverordnungen. Nur 29 % aller ARE-Fälle mit Antibiotikaverordnung (23.733 / 80.786) erhielten ein Antibiotikum der 1. Wahl.
Schlussfolgerung:
Die Datenanalyse zeigt, dass die ESAC-Net-Qualitätsindikatoren für die akuten Atemwegsinfekte mit Hilfe von Routinedaten der Krankenkassen auf Fall- und Betriebsstättenebene berechnet werden können. Es fanden sich Hinweise auf Verbesserungspotentiale in der Häufigkeit und Auswahl der verordneten Antibiotika für spezifische Atemwegsinfektionen.
Background:
Acute uncomplicated upper respiratory tract infections (RTIs) are common reasons for antibiotic prescriptions in the outpatient sector, although > 90 % are of viral origins and mostly self-limiting. Germany has a low antibiotic prescription rate compared to other European countries, but regional differences are evident. Disease-specific quality indicators (QI) developed by the European Surveillance of Antimicrobial Consumption Network (ESAC-Net) address the prescription rates (target <20%) and choice of antibiotic (target > 80 %) in a general practitioner population. The aim of this analysis was to operationalise the ESAC-Net-QI using secondary data from a health insurance company at the level of diseases and healthcare facilities, as well as to analyse areas for improvement.
Method:
The underlying database comprises the panel physician billing, hospital and prescription data in accordance with German law (§§ 295, 300 and 301 SGB V) of the Barmer health insurance company for the year 2022. Categorical features are presented as frequency and percentage. Maximum specificity was aimed, hence potentially risky disease courses were excluded.
Results:
The overall RTI prescription rate of antibiotics was 25% in 2022 before applying inclusion and exclusion criteria (1.197.568 / 4.720.786). After applying the algorithm, the prescription rate for all RTI cases dropped to 6% (80.786 / 1.365.646). When specific RTI indications are considered, 35 % (13.465 / 38.913) of acute bronchitis and acute sinusitis cases (4.971 / 14.051) received an antibiotic prescription each. At the facility level, 38 % of practices (1.396 / 3.705) treating acute bronchitis and 41 % of practices (539 / 1.300) treating acute sinusitis achieved the target of < 20 % antibiotic prescriptions. Only 29 % of all RTI cases with antibiotic prescriptions (23.733 / 80.786) received a first-choice antibiotic.
Conclusion:
The analysis indicates that the ESAC-Net-QI for RTIs can be calculated at case and facility levels using routine health insurance data. For specific RTIs were indications of improvement potential in the frequency and selection of prescribed antibiotics.
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Affiliation(s)
- Birgit Arens
- Kompetenz-Centrum Qualitätssicherung, Medizinischer Dienst der Krankenversicherung Baden-Wurttemberg, Stuttgart, Germany
| | - Helmut L'Hoest
- Abteilung Medizin und Versorgungsforschung, BARMER Institut für Gesundheitssystemforschung (bifg), Wuppertal, Germany
| | - Alissa Wolf
- Kompetenz-Centrum Qualitätssicherung, Medizinischer Dienst der Krankenversicherung Baden-Württemberg, Mannheim, Germany
| | - Beata Hennig
- Abteilung Medizin und Versorgungsforschung, BARMER Institut für Gesundheitssystemforschung (bifg), Wuppertal, Germany
| | - Ursula Marschall
- Abteilung Medizin und Versorgungsforschung, BARMER Institut für Gesundheitssystemforschung (bifg), Wuppertal, Germany
| | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil von Behring, Berlin, Germany
- Infektiologie, MSB Medical School Berlin GmbH, Berlin, Germany
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Kodde C, Timmen F, Hohenstein S, Bollmann A, Bonsignore M, Kuhlen R, Nachtigall I, Tasci S. Impact of Dexamethasone on the Pathogen Profile of Critically Ill COVID-19 Patients. Viruses 2023; 15:v15051076. [PMID: 37243161 DOI: 10.3390/v15051076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Even though several therapeutic options are available, COVID-19 is still lacking a specific treatment regimen. One potential option is dexamethasone, which has been established since the early beginnings of the pandemic. The aim of this study was to determine its effects on the microbiological findings in critically ill COVID-19 patients. METHODS A multi-center, retrospective study was conducted, in which all the adult patients who had a laboratory-confirmed (PCR) SARS-CoV-2 infection and were treated on intensive care units in one of twenty hospitals of the German Helios network between February 2020-March 2021 were included. Two cohorts were formed: patients who received dexamethasone and those who did not, followed by two subgroups according to the application of oxygen: invasive vs. non-invasive. RESULTS The study population consisted of 1.776 patients, 1070 of whom received dexamethasone, and 517 (48.3%) patients with dexamethasone were mechanically ventilated, compared to 350 (49.6%) without dexamethasone. Ventilated patients with dexamethasone were more likely to have any pathogen detection than those without (p < 0.026; OR = 1.41; 95% CI 1.04-1.91). A significantly higher risk for the respiratory detection of Klebsiella spp. (p = 0.016; OR = 1.68 95% CI 1.10-2.57) and for Enterobacterales (p = 0.008; OR = 1.57; 95% CI 1.12-2.19) was found for the dexamethasone cohort. Invasive ventilation was an independent risk factor for in-hospital mortality (p < 0.01; OR = 6.39; 95% CI 4.71-8.66). This risk increased significantly in patients aged 80 years or older by 3.3-fold (p < 0.01; OR = 3.3; 95% CI 2.02-5.37) when receiving dexamethasone. CONCLUSION Our results show that the decision to treat COVID-19 patients with dexamethasone should be a matter of careful consideration as it involves risks and bacterial shifts.
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Affiliation(s)
- Cathrin Kodde
- Germany Department of Respiratory Diseases, Lungenklinik Heckeshorn, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, 13353 Berlin, Germany
| | - Finja Timmen
- Medical Faculty, University of Bonn, 53113 Bonn, Germany
| | - Sven Hohenstein
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Andreas Bollmann
- Department of Cardiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany
| | - Marzia Bonsignore
- Division of Infectious Diseases and Prevention, Helios Hospitals, 47166 Duisburg, Germany
- Center for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, 42283 Wuppertal, Germany
| | | | - Irit Nachtigall
- Division of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany
- Institute of Hygiene and Environmental Medicine, Charité-Universitaetsmedizin Berlin, 12203 Berlin, Germany
| | - Selcuk Tasci
- Department of Respiratory Diseases, Helios Hospital Bonn/Siegburg, 53721 Siegburg, Germany
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Kodde C, Tafelski S, Balamitsa E, Nachtigall I, Bonsignore M. Factors Influencing Antibody Response to SARS-CoV-2 Vaccination. Vaccines (Basel) 2023; 11:vaccines11020451. [PMID: 36851326 PMCID: PMC9967627 DOI: 10.3390/vaccines11020451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/01/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023] Open
Abstract
Vaccination plays a key role in tackling the ongoing SARS-CoV-2 pandemic but data regarding the individual's protective antibody level are still pending. Our aim is to identify factors that influence antibody response following vaccination in healthcare workers. This single-center study was conducted at Evangelische Kliniken Gelsenkirchen, Germany. Healthcare workers were invited to answer a questionnaire about their vaccinations and adverse reactions. Subsequently, the level of anti-receptor binding domain (RBD) IgG antibody against SARS-CoV-2's spike protein through blood samples was measured. For statistics, we used a defined correlation of protection (CoP) and examined risk factors associated with being below the given CoP. A total of 645 employees were included and most were female (n = 481, 77.2%). A total of 94.2% participants had received two doses of vaccines (n = 587) and 12.4% (n = 720) had been infected at least once. Most common prime-boost regimen was BNT162b2 + BNT162b2 (57.9%, n = 361). Age (p < 0.001), days since vaccination (p = 0.007), and the homologous vaccination regimen with ChAdOx + ChAdOx (p = 0.004) were risk factors for the antibody level being below the CoP, whereas any previous COVID-19 infection (p < 0.001), the number of vaccines (p = 0.016), and physical complaints after vaccination (p = 0.01) were associated with an antibody level above the CoP. Thus, age, vaccination regimen, days since vaccination, and previous infection influence the antibody level. These risk factors should be considered for booster and vaccinations guidelines.
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Affiliation(s)
- Cathrin Kodde
- Department of Respiratory Diseases “Heckeshorn”, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany
- Correspondence:
| | - Sascha Tafelski
- Department of Anaesthesiology and Operative Intensive Care Medicine, Charité—Universitätsmedizin Berlin, 13353 Berlin, Germany
| | - Efthimia Balamitsa
- Center for Hygiene, Evangelische Kliniken Gelsenkirchen, 45879 Gelsenkirchen, Germany
| | - Irit Nachtigall
- Division of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany
| | - Marzia Bonsignore
- Department of Infectious Diseases and Prevention, Helios Hospitals Duisburg, 47166 Duisburg, Germany
- Center for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, 42283 Wuppertal, Germany
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Leiner J, Hohenstein S, Pellissier V, König S, Winklmair C, Nachtigall I, Bollmann A, Kuhlen R. COVID-19 and Severe Acute Respiratory Infections: Monitoring Trends in 421 German Hospitals During the First Four Pandemic Waves. Infect Drug Resist 2023; 16:2775-2781. [PMID: 37187482 PMCID: PMC10178997 DOI: 10.2147/idr.s402313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 04/12/2023] [Indexed: 05/17/2023] Open
Abstract
Introduction Reliable surveillance systems to monitor trends of COVID-19 case numbers and the associated healthcare burden play a central role in efficient pandemic management. In Germany, the federal government agency Robert-Koch-Institute uses an ICD-code-based inpatient surveillance system, ICOSARI, to assess temporal trends of severe acute respiratory infection (SARI) and COVID-19 hospitalization numbers. In a similar approach, we present a large-scale analysis covering four pandemic waves derived from the Initiative of Quality Medicine (IQM), a German-wide network of acute care hospitals. Methods Routine data from 421 hospitals for the years 2019-2021 with a "pre-pandemic" period (01-01-2019 to 03-03-2020) and a "pandemic" period (04-03-2020 to 31-12-2021) was analysed. SARI cases were defined by ICD-codes J09-J22 and COVID-19 by ICD-codes U07.1 and U07.2. The following outcomes were analysed: intensive care treatment, mechanical ventilation, in-hospital mortality. Results Over 1.1 million cases of SARI and COVID-19 were identified. Patients with COVID-19 and additional codes for SARI were at higher risk for adverse outcomes when compared to non-COVID SARI and COVID-19 without any coding for SARI. During the pandemic period, non-COVID SARI cases were associated with 28%, 23% and 27% higher odds for intensive care treatment, mechanical ventilation and in-hospital mortality, respectively, compared to pre-pandemic SARI. Conclusion The nationwide IQM network could serve as an excellent data source to enhance COVID-19 and SARI surveillance in view of the ongoing pandemic. Future developments of COVID-19/SARI case numbers and associated outcomes should be closely monitored to identify specific trends, especially considering novel virus variants.
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Affiliation(s)
- Johannes Leiner
- Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | - Sebastian König
- Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | | | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany and Charité - Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - Andreas Bollmann
- Heart Centre Leipzig at University of Leipzig, Department of Electrophysiology, Leipzig, Germany
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
- Helios Health Institute, Berlin, Germany
| | - Ralf Kuhlen
- Initiative of Quality Medicine, Berlin, Germany
- Helios Health Institute, Berlin, Germany
- Helios Health, Berlin, Germany
- Correspondence: Ralf Kuhlen, Initiative Qualitaetsmedizin e.V, Alt-Moabit 104, Berlin, 10559, Germany, Tel +49 30 7262 152 - 0, Email
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Kodde C, Bonsignore M, Schöndube D, Bauer T, Hohenstein S, Bollmann A, Meier-Hellmann A, Kuhlen R, Nachtigall I. Mortality in cancer patients with SARS-CoV-2 or seasonal influenza: an observational cohort study from a German-wide hospital network. Infection 2023; 51:119-127. [PMID: 35657531 PMCID: PMC9163872 DOI: 10.1007/s15010-022-01852-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Accepted: 05/07/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE At the beginning of the COVID-19 pandemic, SARS-CoV-2 was often compared to seasonal influenza. We aimed to compare the outcome of hospitalized patients with cancer infected by SARS-CoV-2 or seasonal influenza including intensive care unit admission, mechanical ventilation and in-hospital mortality. METHODS We analyzed claims data of patients with a lab-confirmed SARS-CoV-2 or seasonal influenza infection admitted to one of 85 hospitals of a German-wide hospital network between January 2016 and August 2021. RESULTS 29,284 patients with COVID-19 and 7442 patients with seasonal influenza were included. Of these, 360 patients with seasonal influenza and 1625 patients with COVID-19 had any kind of cancer. Cancer patients with COVID-19 were more likely to be admitted to the intensive care unit than cancer patients with seasonal influenza (29.4% vs 24.7%; OR 1.31, 95% CI 1.00-1.73 p < .05). No statistical significance was observed in the mechanical ventilation rate for cancer patients with COVID-19 compared to those with seasonal influenza (17.2% vs 13.6% OR 1.34, 95% CI 0.96-1.86 p = .09). 34.9% of cancer patients with COVID-19 and 17.9% with seasonal influenza died (OR 2.45, 95% CI 1.81-3.32 p < .01). Risk factors among cancer patients with COVID-19 or seasonal influenza for in-hospital mortality included the male gender, age, a higher Elixhauser comorbidity index and metastatic cancer. CONCLUSION Among cancer patients, SARS-CoV-2 was associated with a higher risk for in-hospital mortality than seasonal influenza. These findings underline the need of protective measurements to prevent an infection with either COVID-19 or seasonal influenza, especially in this high-risk population.
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Affiliation(s)
- Cathrin Kodde
- Department of Respiratory Diseases “Heckeshorn”, Helios Clinic Emil-Von-Behring, Berlin, Germany
| | - Marzia Bonsignore
- Division of Infectious Diseases and Prevention, Helios Hospitals Duisburg, Duisburg, Germany
| | - Daniel Schöndube
- grid.491878.b0000 0004 0542 382XDepartment of Oncology and Hematology, Helios Klinikum Bad Saarow, Bad Saarow, Germany
| | - Torsten Bauer
- Department of Respiratory Diseases “Heckeshorn”, Helios Clinic Emil-Von-Behring, Berlin, Germany
| | - Sven Hohenstein
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | - Andreas Bollmann
- grid.9647.c0000 0004 7669 9786Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Irit Nachtigall
- Division of Infectious Diseases and Infection Prevention, Helios Hospital Emil-Von-Behring, Berlin, Germany ,grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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König S, Hohenstein S, Pellissier V, Leiner J, Hindricks G, Nachtigall I, Kuhlen R, Bollmann A. Changing trends of patient characteristics and treatment pathways during the COVID-19 pandemic: A cross-sectional analysis of 72,459 inpatient cases from the German Helios database. Front Public Health 2022; 10:1028062. [PMID: 36420010 PMCID: PMC9678052 DOI: 10.3389/fpubh.2022.1028062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 10/12/2022] [Indexed: 11/09/2022] Open
Abstract
Background This study compared patient profiles and clinical courses of SARS-CoV-2 infected inpatients over different pandemic periods. Methods In a retrospective cross-sectional analysis, we examined administrative data of German Helios hospitals using ICD-10-codes at discharge. Inpatient cases with SARS-CoV-2 infection admitted between 03/04/2020 and 07/19/2022 were included irrespective of the reason for hospitalization. All endpoints were timely assigned to admission date for trend analysis. The first pandemic wave was defined by change points in time-series of incident daily infections and compared with different later pandemic phases according to virus type predominance. Results We included 72,459 inpatient cases. Patients hospitalized during the first pandemic wave (03/04/2020-05/05/2020; n = 1,803) were older (68.5 ± 17.2 vs. 64.4 ± 22.6 years, p < 0.01) and severe acute respiratory infections were more prevalent (85.2 vs. 53.3%, p < 0.01). No differences were observed with respect to distribution of sex, but comorbidity burden was higher in the first pandemic wave. The risk of receiving intensive care therapy was reduced in all later pandemic phases as was in-hospital mortality when compared to the first pandemic wave. Trend analysis revealed declines of mean age and Elixhauser comorbidity index over time as well as a decline of the utilization of intensive care therapy, mechanical ventilation and in-hospital mortality. Conclusion Characteristics and outcomes of inpatients with SARS-CoV-2 infection changed throughout the observational period. An ongoing evaluation of trends and care pathways will allow for the assessment of future demands.
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Affiliation(s)
- Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany,*Correspondence: Sebastian König
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Irit Nachtigall
- Department of Preventive Medicine and Hygiene, Helios Hospital Bad Saarow, Bad Saarow, Germany,Department of Anaesthesiology and Operative Intensive Care Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
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Leiner J, Pellissier V, Hohenstein S, König S, Schuler E, Möller R, Nachtigall I, Bonsignore M, Hindricks G, Kuhlen R, Bollmann A. Characteristics and outcomes of COVID-19 patients during B.1.1.529 (Omicron) dominance compared to B.1.617.2 (Delta) in 89 German hospitals. BMC Infect Dis 2022; 22:802. [PMID: 36303111 PMCID: PMC9610359 DOI: 10.1186/s12879-022-07781-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 10/05/2022] [Indexed: 12/03/2022] Open
Abstract
Background The SARS-CoV-2 variant B.1.1.529 (Omicron) was first described in November 2021 and became the dominant variant worldwide. Existing data suggests a reduced disease severity with Omicron infections in comparison to B.1.617.2 (Delta). Differences in characteristics and in-hospital outcomes of COVID-19 patients in Germany during the Omicron period compared to Delta are not thoroughly studied. ICD-10-code-based severe acute respiratory infections (SARI) surveillance represents an integral part of infectious disease control in Germany. Methods Administrative data from 89 German Helios hospitals was retrospectively analysed. Laboratory-confirmed SARS-CoV-2 infections were identified by ICD-10-code U07.1 and SARI cases by ICD-10-codes J09-J22. COVID-19 cases were stratified by concomitant SARI. A nine-week observational period between December 6, 2021 and February 6, 2022 was defined and divided into three phases with respect to the dominating virus variant (Delta, Delta to Omicron transition, Omicron). Regression analyses adjusted for age, gender and Elixhauser comorbidities were applied to assess in-hospital patient outcomes. Results A total cohort of 4,494 inpatients was analysed. Patients in the Omicron dominance period were younger (mean age 47.8 vs. 61.6; p < 0.01), more likely to be female (54.7% vs. 47.5%; p < 0.01) and characterized by a lower comorbidity burden (mean Elixhauser comorbidity index 5.4 vs. 8.2; p < 0.01). Comparing Delta and Omicron periods, patients were at significantly lower risk for intensive care treatment (adjusted odds ratio 0.72 [0.57–0.91]; p = 0.005), mechanical ventilation (adjusted odds ratio 0.42 [0.31–0.57]; p < 0.001), and in-hospital mortality (adjusted odds ratio 0.42 [0.32–0.56]; p < 0.001). This also applied mostly to the separate COVID-SARI group. During the Delta to Omicron transition, case numbers of COVID-19 without SARI exceeded COVID-SARI for the first time in the pandemic’s course. Conclusion Patient characteristics and outcomes differ during the Omicron dominance period as compared to Delta suggesting a reduced disease severity with Omicron infections. SARI surveillance might play a crucial role in assessing disease severity of future SARS-CoV-2 variants. Supplementary information The online version contains supplementary material available at 10.1186/s12879-022-07781-w.
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Affiliation(s)
- Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. .,Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany.
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | - Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
| | | | | | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, Berlin, Germany.,Institute of Hygiene and Environmental Medicine, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | - Marzia Bonsignore
- Department of Infectiology and Infection Prevention, Helios Hospital Duisburg, Duisburg, Germany.,Institute for Medical Laboratory Diagnostics, Center for Clinical and Translational Research, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | | | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Real World Evidence and Health Technology Assessment at Helios Health Institute, Berlin, Germany
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Leiner J, Pellissier V, König S, Hohenstein S, Ueberham L, Nachtigall I, Meier-Hellmann A, Kuhlen R, Hindricks G, Bollmann A. Machine learning-derived prediction of in-hospital mortality in patients with severe acute respiratory infection: analysis of claims data from the German-wide Helios hospital network. Respir Res 2022; 23:264. [PMID: 36151525 PMCID: PMC9502925 DOI: 10.1186/s12931-022-02180-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 09/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe acute respiratory infections (SARI) are the most common infectious causes of death. Previous work regarding mortality prediction models for SARI using machine learning (ML) algorithms that can be useful for both individual risk stratification and quality of care assessment is scarce. We aimed to develop reliable models for mortality prediction in SARI patients utilizing ML algorithms and compare its performances with a classic regression analysis approach. METHODS Administrative data (dataset randomly split 75%/25% for model training/testing) from years 2016-2019 of 86 German Helios hospitals was retrospectively analyzed. Inpatient SARI cases were defined by ICD-codes J09-J22. Three ML algorithms were evaluated and its performance compared to generalized linear models (GLM) by computing receiver operating characteristic area under the curve (AUC) and area under the precision-recall curve (AUPRC). RESULTS The dataset contained 241,988 inpatient SARI cases (75 years or older: 49%; male 56.2%). In-hospital mortality was 11.6%. AUC and AUPRC in the testing dataset were 0.83 and 0.372 for GLM, 0.831 and 0.384 for random forest (RF), 0.834 and 0.382 for single layer neural network (NNET) and 0.834 and 0.389 for extreme gradient boosting (XGBoost). Statistical comparison of ROC AUCs revealed a better performance of NNET and XGBoost as compared to GLM. CONCLUSION ML algorithms for predicting in-hospital mortality were trained and tested on a large real-world administrative dataset of SARI patients and showed good discriminatory performances. Broad application of our models in clinical routine practice can contribute to patients' risk assessment and quality management.
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Affiliation(s)
- Johannes Leiner
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany. .,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany.
| | - Vincent Pellissier
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sebastian König
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Sven Hohenstein
- Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
| | - Laura Ueberham
- Clinic for Cardiology, University Hospital Leipzig, Leipzig, Germany
| | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, Berlin, Germany.,Institute of Hygiene and Environmental Medicine, Charité - Universitaetsmedizin Berlin, Berlin, Germany
| | | | | | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany.,Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany
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Bonsignore M, Hohenstein S, Kodde C, Leiner J, Schwegmann K, Bollmann A, Möller R, Kuhlen R, Nachtigall I. The Disease Course of Hospitalized COVID-19 Patients During the Delta and Omicron Periods in Consideration of Vaccination Status. Dtsch Arztebl Int 2022; 119:605-606. [PMID: 36474339 PMCID: PMC9749846 DOI: 10.3238/arztebl.m2022.0263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 04/26/2022] [Accepted: 06/21/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Marzia Bonsignore
- Department of Infectiology and Hospital Infection Control, Helios Hospital Duisburg,Institute of Medical Laboratory Diagnostics, Center for Clinical and Translational Research, Helios Hospital Wuppertal, Witten/Herdecke University
| | | | - Cathrin Kodde
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin
| | - Johannes Leiner
- Leipzig Heart Institute, Leipzig,Leipzig Heart Institute, University Hospital of Cardiolgoy—Helios Stiftungsprofessur, Department of Rhythmology, Leipzig
| | | | - Andreas Bollmann
- Leipzig Heart Institute, University Hospital of Cardiolgoy—Helios Stiftungsprofessur, Department of Rhythmology, Leipzig
| | | | | | - Irit Nachtigall
- Department of Infectiology and Infection Prevention, Helios Hospital Emil von Behring, Berlin ,Institute of Hygiene and Environmental Medicine, Charité-University Medicine, Berlin
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10
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Bonsignore M, Hohenstein S, Kodde C, Leiner J, Schwegmann K, Bollmann A, Möller R, Kuhlen R, Nachtigall I. Burden of Hospital-acquired SARS-CoV-2 Infections in Germany. J Hosp Infect 2022; 129:82-88. [PMID: 35995339 PMCID: PMC9391075 DOI: 10.1016/j.jhin.2022.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
Background Avoiding in-hospital transmissions has been crucial in the COVID-19 pandemic. Little is known on the extent to which hospital-acquired SARS-CoV-2 variants have caused infections in Germany. Aim To analyse the occurrence and the outcomes of HAI with regard to different SARS-CoV-2 variants. Methods Patients with SARS-CoV-2 infections hospitalized between March 1st, 2020 and May 17th, 2022 in 79 hospitals of the Helios Group were included. Information on patients' characteristics and outcomes were retrieved from claims data. In accordance with the Robert Koch Institute, infections were classified as hospital-acquired when tested positive >6 days after admission and if no information hinted at a different source. Findings In all, 62,875 SARS-CoV-2 patients were analysed, of whom 10.6% had HAI. HAIs represented 14.7% of SARS-CoV-2 inpatients during the Wildtype period, 3.5% during Alpha (odds ratio: 0.21; 95% confidence interval: 0.19–0.24), 8.8% during Delta (2.70; 2.35–3.09) and 10.1% during Omicron (1.10; 1.03–1.19). When age and comorbidities were accounted for, HAI had lower odds for death than community-acquired infections (0.802; 0.740–0.866). Compared to the Wildtype period, HAIs during Omicron were associated with lower odds for ICU (0.78; 0.69–0.88), ventilation (0.47; 0.39–0.56), and death (0.33; 0.28–0.40). Conclusion Hospital-acquired SARS-CoV-2 infections occurred throughout the pandemic, affecting highly vulnerable patients. Although transmissibility increased with newer variants, the proportion of HAIs decreased, indicating improved infection prevention and/or the effect of immunization. Furthermore, the Omicron period was associated with improved outcomes. However, the burden of hospital-acquired SARS-CoV-2 infections remains high.
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Affiliation(s)
- Marzia Bonsignore
- Department of Infectiology and Infection Prevention, Helios Klinikum Duisburg, Duisburg, Germany; Center for Clinical and Translational Research, Helios Universitätsklinikum Wuppertal, University of Witten/Herdecke, Wuppertal, Germany.
| | - Sven Hohenstein
- Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany
| | - Cathrin Kodde
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany.
| | - Johannes Leiner
- Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany
| | - Karin Schwegmann
- Central Department for Hygiene, Helios Kliniken, Hildesheim, Germany
| | - Andreas Bollmann
- Heart Centre Leipzig at University of Leipzig and Helios Health Institute, Berlin, Germany
| | | | | | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany; Charité - Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
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11
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Nachtigall I, Bonsignore M, Hohenstein S, Bollmann A, Günther R, Kodde C, Englisch M, Ahmad-Nejad P, Schröder A, Glenz C, Kuhlen R, Thürmann P, Meier-Hellmann A. Effect of gender, age and vaccine on reactogenicity and incapacity to work after COVID-19 vaccination: a survey among health care workers. BMC Infect Dis 2022; 22:291. [PMID: 35346089 PMCID: PMC8960217 DOI: 10.1186/s12879-022-07284-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 03/15/2022] [Indexed: 01/14/2023] Open
Abstract
Abstract
Background
The aim of our study was to assess the impact the impact of gender and age on reactogenicity to three COVID-19 vaccine products: Biontech/Pfizer (BNT162b2), Moderna (mRNA-1273) and AstraZeneca (ChAdOx). Additional analyses focused on the reduction in working capacity after vaccination and the influence of the time of day when vaccines were administered.
Methods
We conducted a survey on COVID-19 vaccinations and eventual reactions among 73,000 employees of 89 hospitals of the Helios Group. On May 19th, 2021 all employees received an email, inviting all employees who received at least 1 dose of a COVID-19 to participate using an attached link. Additionally, the invitation was posted in the group’s intranet page. Participation was voluntary and non-traceable. The survey was closed on June 21st, 2021.
Results
8375 participants reported on 16,727 vaccinations. Reactogenicity was reported after 74.6% of COVID-19 vaccinations. After 23.0% vaccinations the capacity to work was affected. ChAdOx induced impairing reactogenicity mainly after the prime vaccination (70.5%), while mRNA-1273 led to more pronounced reactions after the second dose (71.6%). Heterologous prime-booster vaccinations with ChAdOx followed by either mRNA-1273 or BNT162b2 were associated with the highest risk for impairment (81.4%). Multivariable analyses identified the factors older age, male gender and vaccine BNT162b as independently associated with lower odds ratio for both, impairing reactogenicity and incapacity to work. In the comparison of vaccine schedules, the heterologous combination ChAdOx + BNT162b or mRNA-1273 was associated with the highest and the homologue prime-booster vaccination with BNT162b with the lowest odds ratios. The time of vaccination had no significant influence.
Conclusions
Around 75% of the COVID-19 vaccinations led to reactogenicity and nearly 25% of them led to one or more days of work loss. Major risk factors were female gender, younger age and the administration of a vaccine other than BNT162b2. When vaccinating a large part of a workforce against COVID-19, especially in professions with a higher proportion of young and women such as health care, employers and employees must be prepared for a noticeable amount of absenteeism. Assuming vaccine effectiveness to be equivalent across the vaccine combinations, to minimize reactogenicity, employees at risk should receive a homologous prime-booster immunisation with BNT162b2.
Trial registration: The study was approved by the Ethic Committee of the Aerztekammer Berlin on May 27th, 2021 (Eth-37/21) and registered in the German Clinical Trials Register (DRKS 00025745). The study was supported by the Helios research grant HCRI-ID 2021-0272.
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12
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Hinkson L, Dame C, Braun T, Nachtigall I, Henrich W. Response to Letter to the editor on: “Never too late? Quadruplets at the age of 65 years”. Arch Gynecol Obstet 2021; 305:1133-1134. [PMID: 34757455 PMCID: PMC8967734 DOI: 10.1007/s00404-021-06256-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 09/14/2021] [Indexed: 10/26/2022]
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13
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Nachtigall I, Bonsignore M, Thürmann P, Hohenstein S, Jóźwiak K, Hauptmann M, Eifert S, Dengler J, Bollmann A, Groesdonk HV, Kuhlen R, Meier-Hellmann A. Sex Differences in Clinical Course and Intensive Care Unit Admission in a National Cohort of Hospitalized Patients with COVID-19. J Clin Med 2021; 10:4954. [PMID: 34768473 PMCID: PMC8584819 DOI: 10.3390/jcm10214954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 10/20/2021] [Accepted: 10/22/2021] [Indexed: 12/29/2022] Open
Abstract
Males have a higher risk for an adverse outcome of COVID-19. The aim of the study was to analyze sex differences in the clinical course with focus on patients who received intensive care. Research was conducted as an observational retrospective cohort study. A group of 23,235 patients from 83 hospitals with PCR-confirmed infection with SARS-CoV-2 between 4 February 2020 and 22 March 2021 were included. Data on symptoms were retrieved from a separate registry, which served as a routine infection control system. Males accounted for 51.4% of all included patients. Males received more intensive care (ratio OR = 1.61, 95% CI = 1.51-1.71) and mechanical ventilation (invasive or noninvasive, OR = 1.87, 95% CI = 1.73-2.01). A model for the prediction of mortality showed that until the age 60 y, mortality increased with age with no substantial difference between sexes. After 60 y, the risk of death increased more in males than in females. At 90 y, females had a predicted mortality risk of 31%, corresponding to males of 84 y. In the intensive care unit (ICU) cohort, females of 90 y had a mortality risk of 46%, equivalent to males of 72 y. Seventy-five percent of males over 90 died, but only 46% of females of the same age. In conclusion, the sex gap was most evident among the oldest in the ICU. Understanding sex-determined differences in COVID-19 can be useful to facilitate individualized treatments.
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Affiliation(s)
- Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, Helios Hospital Emil-von-Behring, 14165 Berlin, Germany
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin, 12203 Berlin, Germany
| | - Marzia Bonsignore
- Center for Hygiene, Evangelische Kliniken Gelsenkirchen, 45879 Gelsenkirchen, Germany;
| | - Petra Thürmann
- Philipp Klee-Institute for Clinical Pharmacology, Helios University Hospital Wuppertal, 42283 Wuppertal, Germany;
- Department of Clinical Pharmacology, University Witten Herdecke Faculty of Health Witten, 58455 Witten, Germany
| | - Sven Hohenstein
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany; (S.H.); (S.E.); (A.B.)
- Leipzig Heart Digital at Leipzig Heart Institute, 04289 Leipzig, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany; (K.J.); (M.H.)
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, 16816 Neuruppin, Germany; (K.J.); (M.H.)
| | - Sandra Eifert
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany; (S.H.); (S.E.); (A.B.)
- Leipzig Heart Digital at Leipzig Heart Institute, 04289 Leipzig, Germany
| | - Julius Dengler
- Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, 15526 Bad Saarow, Germany;
- Department of Neurosurgery, Helios Hospital Bad Saarow, 15526 Bad Saarow, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, 04289 Leipzig, Germany; (S.H.); (S.E.); (A.B.)
- Leipzig Heart Digital at Leipzig Heart Institute, 04289 Leipzig, Germany
| | - Heinrich V. Groesdonk
- Department of Interdisciplinary Intensive and Intermediate Care, Helios Hospital Erfurt, 99089 Erfurt, Germany;
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14
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Nachtigall I, Hohenstein S, Bollmann A, Bonsignore M, Husser D, Kuhlen R, Hellmann AM. Thrombembolic Events in Hospitalized COVID-19 Patients: What is the Role of the Sex? TH Open 2021; 5:e411-e414. [PMID: 34568745 PMCID: PMC8455179 DOI: 10.1055/a-1585-9536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Irit Nachtigall
- Helios Kliniken Ost and Klinikum Emil-von-Behring, Berlin, Germany.,Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig Germany
| | - Sven Hohenstein
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig Germany
| | - Andreas Bollmann
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig Germany
| | - Marzia Bonsignore
- Evangelische Kliniken Gelsenkirchen, Zentrum für Krankenhaushygiene und Infektiologie, Gelsenkirchen, Germany
| | - Daniela Husser
- Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig Germany
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15
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Kodde C, Bonsignore M, Hohenstein S, Kuhlen R, Meier-Hellmann A, Bollmann A, Nachtigall I. Outcomes and proportions of pregnant women during the first and consecutive waves of coronavirus disease 2019: observational cohort study. Clin Microbiol Infect 2021; 27:1863.e1-1863.e4. [PMID: 34508888 PMCID: PMC8425671 DOI: 10.1016/j.cmi.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 08/31/2021] [Accepted: 09/02/2021] [Indexed: 12/04/2022]
Abstract
Objectives It has been suggested that pregnant women were affected more severely during the late wave, as opposed to the early wave of the coronavirus disease 2019 (COVID-19) pandemic. The aim of our study was to compare the proportion of pregnant women among hospitalized women of childbearing age, their rate of intensive care (ICU) admission, need for mechanical ventilation and mortality during the waves. Methods The study is a retrospective analysis of claims data on women of childbearing age (16–49 years) admitted to 76 hospitals with a laboratory-confirmed severe acute respiratory syndrome coronavirus 2 infection. The observation period was divided into first wave (7 March 2020 to 30 September 2020) and second wave (1 October to 17 April 2021). Co-morbidities derived from claims data were summarized in the Elixhauser Co-morbidity Index (ECI). Results A total of 1879 women were included, 532 of whom were pregnant. During the second wave, the proportion of pregnant women was higher (29.3% (484/1650) versus 21.0% (48/229), p < 0.01). They were older (mean ± SD 29.1 ± 5.9 years versus 27 ± 6.3 years, p 0.02 in the first wave) and had comparable co-morbidities (ECI mean ± SD 0.3 ± 3.5 versus –0.2 ± 2.0, p 0.30). Of the pregnant women, 6.2% (3/48) were admitted to ICU during the first wave versus 3.3% (16/484) during the second wave (OR 0.51, 95% CI 0.14–1.83, p 0.30), 2.1% (1/48) were ventilated versus 1.2% (6/484, OR 0.60, 95% CI 0.07–5.23, p 0.64). No deaths were observed among the hospitalized pregnant women in either wave. Conclusions Proportionally more pregnant women with COVID-19 were hospitalized in the second wave compared with the first wave but no more severe outcomes were registered.
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Affiliation(s)
- Cathrin Kodde
- Department of Pneumology, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Marzia Bonsignore
- Centre for Hygiene, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
| | - Sven Hohenstein
- Heart Centre Leipzig at University of Leipzig and Leipzig Heart Institute, Leipzig, Germany
| | | | | | - Andreas Bollmann
- Centre for Hygiene, Evangelische Kliniken Gelsenkirchen, Gelsenkirchen, Germany
| | - Irit Nachtigall
- Department of Infectious Diseases and Infection Prevention, HELIOS Hospital Emil-von-Behring, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany.
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16
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Bonsignore M, Tafelski S, Schwegmann K, Meier-Hellmann A, Witzke O, Nachtigall I. Risk Factors for Vascular Catheter Infections-Findings of a Point-Prevalence Study in 78 Hospitals. Dtsch Arztebl Int 2021; 118:503-504. [PMID: 34526213 DOI: 10.3238/arztebl.m2021.0204] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 10/21/2020] [Accepted: 04/06/2021] [Indexed: 11/27/2022]
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17
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Bonsignore M, Nachtigall I. [Infection Control in Anesthesia]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:474-484. [PMID: 34298568 DOI: 10.1055/a-1249-5093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The anaesthesiological care of patients in the operating room involves many activities that can lead to an infection. Hand hygiene is the most effective single measure for the prevention of nosocomial infections. Hand disinfectant dispensers should be placed within easy reach. When preparing infusions and drugs to be administered intravenously, the introduction of microorganisms cannot be completely ruled out, even if all hygienic requirements are observed. Therefore, parenterals without preservatives may only be removed immediately before administration, not several times from the same container and not for several patients. For punctures for regional anaesthesia and for the placement of vascular catheters, the highest hygiene requirements apply when long seldinger wires are used or when catheters are placed in deep tissue spaces or body cavities. The timely application of antibiotic prophylaxis is one of the most important measures in perioperative infection prevention. Indications and choice of substance should be defined in an in-house guideline. Maintaining a balanced volume, body temperature and blood sugar level contributes to the prophylaxis of surgical site infections. The preparation of an operating room after an operation must always ensure that it does not pose a risk of infection for the following patient - regardless of the pathogens with which the previous patient is infected or colonized. There is no evidence for further measures to separate so-called aseptic and septic operations or of patients with multi-resistant pathogens. In order to be able to take the necessary measures for employee protection in corona-infected patients in the operating room, it is essential to know the current infection status. For example, when a patient is handed over to the OR, a current test result should be checked and documented on the OR checklist.
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18
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Nachtigall I, Tafelski S, Heucke E, Witzke O, Staack A, Recknagel-Friese S, Geffers C, Bonsignore M. Time and personnel requirements for antimicrobial stewardship in small hospitals in a rural area in Germany. J Infect Public Health 2020; 13:1946-1950. [PMID: 33121907 DOI: 10.1016/j.jiph.2020.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/02/2020] [Accepted: 10/05/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In order to control their anti-infectives consumption, hospitals are required to provide multidisciplinary teams comprising among others an infectiologist, a microbiologist and a pharmacist. Small hospitals though often do not dispose of the defaulted personnel. This study illustrates a solution for an antimicrobial stewardship program (ASP) in small community hospitals in a rural area in Germany. METHODS Four hospitals of ca. 200 beds each, jointly hired an antimicrobial stewardship expert to start a common ASP. This expert did rounds on every ward once a week, mostly as chard reviews with the physician in charge. Outside the rounds, he could be consulted by mail. Working time and number of visited patients were documented. Anti-infectives consumption, incidence of Clostridioides difficile infections (CDI) and mortality rates were retrieved from routinely collected data. The intervention period (01/2018-12/2018) was compared to the preintervention period (01/2017-12/2017). RESULTS 3321 patients were visited in the intervention period. In average, 20 patients were seen per day and 20 min were needed per patient/ chard. About 65% of the expert's working time was needed for rounds, 15% for driving between the hospitals. The anti-infectives consumption of the 4 hospitals in the preintervention period amounted to 50 defined daily doses per 100 occupied bed days. The total consumption was reduced by 10% and of quinolones by 36%. The incidence of hospital-acquired CDI receded from 0.14 to 0.07 cases per 100 patient days (-50%, p = 0.001). The overall in-hospital mortality did not change. CONCLUSIONS A single expert was able to implement a successfull ASP in 4 hospitals. While multidisciplinary antimicrobial stewardship teams are ideal for tertiary care hospitals, small hospitals need a more practical solution. This survey shows that one expert can be sufficient for several small hospitals even with the distances in a rural setting.
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Affiliation(s)
- Irit Nachtigall
- Department for Hygiene, Helios Kliniken Ost and Bad Saarow, Pieskower Str. 33, 15526 Bad Saarow, Germany; Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany.
| | - Sascha Tafelski
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt Operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany
| | - Edwin Heucke
- Helios Cluster Saxony-Anhalt, Helios Bördeklinik, Kreiskrankenhaus 4, 39387 Oschersleben, Germany
| | - Oliver Witzke
- Universitätsmedizin Essen, Department of Infectious Diseases, West German Centre of Infectious Diseases, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
| | - Annedore Staack
- Helios Klinik Jerichower Land, August-Bebel-Str. 55a, 39288 Burg, Germany
| | | | - Christine Geffers
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Marzia Bonsignore
- Zentrum für Hygiene, Evangelische Kliniken Gelsenkirchen, Munckelstr. 27, 45879 Gelsenkirchen, Germany.
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19
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Nachtigall I, Lenga P, Jóźwiak K, Thürmann P, Meier-Hellmann A, Kuhlen R, Brederlau J, Bauer T, Tebbenjohanns J, Schwegmann K, Hauptmann M, Dengler J. Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study. Clin Microbiol Infect 2020; 26:1663-1669. [PMID: 32822883 PMCID: PMC7434317 DOI: 10.1016/j.cmi.2020.08.011] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/06/2023]
Abstract
Objectives In Germany the coronavirus disease 2019 (COVID-19) pandemic situation is unique among large European countries in that incidence and case fatality rate are distinctly lower. We describe the clinical course and examine factors associated with outcomes among patients hospitalized with COVID-19 in Germany. Methods In this retrospective cohort study we included patients with COVID-19 admitted to a national network of German hospitals between February 12 and June 12, 2020. We examined demographic characteristics, comorbidities and clinical outcomes. Results We included 1904 patients with a median age of 73 years, 48.5% (924/1904) of whom were female. The mortality rate was 17% (317/1835; 95% confidence interval (95%CI) 16–19), the rate of admission to the intensive care unit (ICU) was 21% (399/1860; 95%CI 20–23), and the rate of invasive mechanical ventilation was 14% (250/1850: 95%CI 12–15). The most prominent risk factors for death were male sex (hazard ratio (HR) 1.45; 95%CI 1.15–1.83), pre-existing lung disease (HR 1.61; 95%CI 1.20–2.16), and increased patient age (HR 4.11 (95%CI 2.57–6.58) for age >79 years versus <60 years). Among patients admitted to the ICU, the mortality rate was 29% (109/374; 95%CI 25–34) and higher in ventilated (33% [77/235; 95%CI 27–39]) than in non-ventilated ICU patients (23%, 32/139; 95%CI 16–30; p < 0.05). Conclusions In this nationwide series of patients hospitalized with COVID-19 in Germany, in-hospital and ICU mortality rates were substantial. The most prominent risk factors for death were male sex, pre-existing lung disease, and greater patient age.
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Affiliation(s)
- Irit Nachtigall
- Department of Preventive Medicine and Hygiene, HELIOS Hospital Bad Saarow, Bad Saarow, Germany; Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Pavlina Lenga
- Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Petra Thürmann
- Philipp Klee-Institute for Clinical Pharmacology, HELIOS University Hospital Wuppertal, Wuppertal, Germany; Department of Clinical Pharmacology, University Witten Herdecke Faculty of Health Witten, Witten, Germany
| | | | | | - Joerg Brederlau
- Department of Intensive Care Medicine, HELIOS Hospital Berlin-Buch, Berlin, Germany
| | - Torsten Bauer
- Respiratory Diseases Clinic Heckeshorn, Department of Pneumology, HELIOS Hospital Emil von Behring Berlin-Zehlendorf, Berlin, Germany
| | | | - Karin Schwegmann
- Central Department of Hygiene, HELIOS Hospital Hildesheim, Hildesheim, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Julius Dengler
- Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.
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Tatzel J, Brinkmann A, Kaltwasser A, Dubb R, Nachtigall I. Anästhesiebezogene Hygiene und Infektionsprävention bei Operationen. Anasthesiol Intensivmed Notfallmed Schmerzther 2020; 55:352-367. [DOI: 10.1055/a-0967-1303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
ZusammenfassungDurch die Prozeduren rund um eine Operation kann beim Patienten eine Vielzahl unterschiedlicher Infektionen entstehen – nicht nur die postoperative Wundinfektion. Die Anästhesie kann einen entscheidenden Beitrag zur Prävention dieser Infektionen leisten. Dieser Artikel führt entlang des Narkoseverlaufs – Narkoseeinleitung, während der Operation und Nachbereitung – durch die anästhesiespezifischen Besonderheiten der Hygiene.
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Tafelski S, Lange M, Wegener F, Gratopp A, Spies C, Wernecke KD, Nachtigall I. Pneumonia in paediatric critical care medicine and the adherence to guidelines. Minerva Pediatr 2019. [PMID: 31621272 DOI: 10.23736/s0026-4946.19.05508-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Different studies in adults reported significant outcome improvement for patients treated with high adherence to guidelines. The present study was initiated to evaluate the impact of adherence to antibiotic prescription guidelines on health outcomes of children on paediatric intensive care unit (PICU) suffering from pneumonia. METHODS This retrospective cohort study was conducted on a paediatric intensive care unit at Charité hospital Berlin. All patients with a length of stay (LOS) >24 hours, age <18 years, antimicrobial therapies and a radiologically confirmed diagnosis of pneumonia according to the "Centers for Disease Control and Prevention" definitions were included during the study period of 2009 and 2010. Adherence to national guidelines was evaluated daily and two groups were defined: Low adherence group (LAG) with a presence of <70% of days with compliant therapy and high adherence group (HAG) with an adherence of ≥70%. RESULTS High adherence was observed in 65 patients compared with 61 in low-adherence group. Number of patients needing invasive ventilation did not vary between HAG and LAG (n=37 vs. n=41; p=0.235). There was a statistically significant shorter duration of ventilation in HAG patients (p=0.031). Time to clinical recovery from pneumonia tended to be shorter in HAG patients (7.5d vs. 10.9d; p=0.07). There was a significant reduction in LOS in HAG patients (9.3d vs. 13.7d; p=0.016). However, mortality appeared comparable between groups. CONCLUSIONS Similar to previous evidence in adult patients children with pneumonia seem to benefit from guideline-based antibiotic therapy. Further studies are needed to explore strategies to improve guideline adherence.
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Affiliation(s)
- Sascha Tafelski
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Martin Lange
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Felix Wegener
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Alexander Gratopp
- Department of Paediatrics Campus Virchow-Klinikum Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Klaus D Wernecke
- Institute of Medical Biometrics, and SOSTANA GmbH Berlin, Germany Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Irit Nachtigall
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany - .,Department of Hygiene and Preventive Medicine, Helios Kliniken Region Middle North and Bad Saarow, Bad Saarow, Germany
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Neubeiser A, Bonsignore M, Tafelski S, Alefelder C, Schwegmann K, Rüden H, Geffers C, Nachtigall I. Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals. J Infect Public Health 2019; 13:204-210. [PMID: 31420314 DOI: 10.1016/j.jiph.2019.07.025] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 07/08/2019] [Accepted: 07/27/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND According to extrapolations, around 35,000 patients in Germany develop hospital acquired infections (HAI) with a multidrug-resistant organism (MDRO) every year, and about 1500 of them die. Previous estimations were based on laboratory data and prevalence studies. Aim of this study was to establish the incidences of hospital acquired MDRO infections and the resulting deaths by expert review. METHODS Data on patients suffering from a hospital acquired MDRO infection were collected from 32 hospitals from all care levels. Records of patients with MDRO infection who died in the year 2016 underwent an onsite review by two experts to determine the impact of the infection, if any, on the cause of death. RESULTS A total of 714,108 in-patients were treated in 32 hospitals participating in the study. Of these patients, 1136 suffered a hospital acquired MDRO infection (1.59 per 1000 patients). 215 patients with an MDRO infection died [0.301 per 1000, (95% CI 0,261-0,341)], but only in 78 cases this was estimated as the cause of death [0.109 per 1000 patients (95% CI 0.085-0.133)]. CONCLUSION By putting the above rates in relation to the total number of in-patients in Germany, it can be rated that around 31,052 patients per year suffer a hospital acquired MDRO infection, and 2132 patients die from it. These results from our reviewer investigation confirm earlier extrapolations.
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Affiliation(s)
- Alicia Neubeiser
- Department for Hygiene, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125 Berlin, Germany
| | - Marzia Bonsignore
- Zentrum für Hygiene, Evangelische Kliniken Gelsenkirchen GmbH, Munckelstr. 27, 45879 Gelsenkirchen, Germany
| | - Sascha Tafelski
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany
| | - Christof Alefelder
- Department for Hygiene, Helios Kliniken West, Universitätsklinik Wuppertal, Heusnerstr. 40, 42283 Wuppertal, Germany
| | - Karin Schwegmann
- Centrale Department for Hygiene, Helios Kliniken, Senator-Braun-Allee 33, 31135 Hildesheim, Germany
| | - Henning Rüden
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Germany
| | - Christine Geffers
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institut für Hygiene und Umweltmedizin, Hindenburgdamm 27, 12203 Berlin, Germany
| | - Irit Nachtigall
- Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Campus Charité Mitte, Charitéplatz 1, 10115 Berlin, Germany; Department for Hygiene, Helios Kliniken Ost and Bad Saarow, Pieskower Str. 33, 15526 Bad Saarow, Germany.
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Doerrfuss JI, Kramer S, Tafelski S, Spies CD, Wernecke KD, Nachtigall I. Frequency, predictive factors and therapy of emergence delirium: data from a large observational clinical trial in a broad spectrum of postoperative pediatric patients. Minerva Anestesiol 2019; 85:617-624. [DOI: 10.23736/s0375-9393.19.13038-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Dalhoff K, Abele-Horn M, Andreas S, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Heußel CP, Höffken G, Kolditz M, Kramme E, Kühl H, Lange C, Mayer K, Nachtigall I, Panning M, Pletz M, Rath PM, Rohde G, Rosseau S, Schaaf B, Schreiter D, Schütte H, Seifert H, Spies C, Welte T. [Epidemiology, Diagnosis and Treatment of Adult Patients with Nosocomial Pneumonia - Update 2017 - S3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy, the German Radiological Society and the Society for Virology]. Pneumologie 2018; 72:15-63. [PMID: 29341032 DOI: 10.1055/s-0043-121734] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However, infections on general wards are increasing. A central issue are infections with multidrug resistant (MDR) pathogens which are difficult to treat in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline update was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and treatment of HAP on the basis of quality of evidence and benefit/risk ratio.This guideline has two parts. First an update on epidemiology, spectrum of pathogens and antimicrobials is provided. In the second part recommendations for the management of diagnosis and treatment are given. New recommendations with respect to imaging, diagnosis of nosocomial viral pneumonia and prolonged infusion of antibacterial drugs have been added. The statements to risk factors for infections with MDR pathogens and recommendations for monotherapy vs combination therapy have been actualised. The importance of structured deescalation concepts and limitation of treatment duration is emphasized.
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Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - M Abele-Horn
- Institut für Hygiene und Mikrobiologie der Universität Würzburg, Würzburg
| | - S Andreas
- Lungenfachklinik Immenhausen, Immenhausen
| | - M Deja
- Charité, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Evangelisches Krankenhaus Herne und Augusta-Kranken-Anstalt Bochum, Herne und Bochum
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin
| | - S Gatermann
- Institut für Hygiene und Mikrobiologie, Abteilung für Medizinische Mikrobiologie, Ruhr-Universität Bochum, Bochum
| | - H Gerlach
- Klinik für Anästhesie, operative Intensivmedizin und Schmerztherapie, Vivantes Klinikum Neukölln, Berlin
| | - B Grabein
- Stabsstelle Klinische Mikrobiologie und Krankenhaushygiene am Klinikum der Universität München, München
| | - C P Heußel
- Thoraxklinik Heidelberg gGmbH, Abteilung für Diagnostische und Interventionelle Radiologie
| | - G Höffken
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - M Kolditz
- Universitätsklinikum Carl Gustav Carus an der TU Dresden, Medizinische Klinik und Poliklinik 1, Fachabteilung für Pneumologie, Dresden
| | - E Kramme
- Medizinische Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck
| | - H Kühl
- St. Bernhard-Hospital Kamp-Lintfort GmbH, Klinik für Radiologie, Kamp-Lintfort
| | - C Lange
- Medizinische Klinik, Forschungszentrum Borstel, Borstel
| | - K Mayer
- Zentrum für Innere Medizin, Medizinische Klinik II, Pneumologie und Intensivmedizin, Universitätsklinikum Gießen und Marburg, Standort Gießen
| | | | - M Panning
- Universitätsklinikum Freiburg, Institut für Medizinische Mikrobiologie und Hygiene, Freiburg
| | - M Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | - P-M Rath
- Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Essen
| | - G Rohde
- Klinikum der Johann Wolfgang Goethe-Universität, Pneumologie/Allergologie, Medizinische Klinik 1, Frankfurt am Main
| | - S Rosseau
- Klinik Ernst von Bergmann Bad Belzig gGmbH, Pneumologisches Beatmungszentrum, Bad Belzig
| | - B Schaaf
- Klinikum Dortmund gGmbH, Medizinischen Klinik, Pneumologie und Infektiologie, Dortmund
| | - D Schreiter
- Helios Park-Klinikum Leipzig GmbH und Herzzentrum Leipzig GmbH, Universitätsklinik, Leipzig
| | - H Schütte
- Klinikum Ernst von Bergmann gGmbH, Klinik für Pneumologie, Potsdam
| | - H Seifert
- Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Klinikum der Universität zu Köln, Köln
| | - C Spies
- Charitè, Universitätsmedizin Berlin, Klinik für Anästhesiologie m. S. operative Intensivmedizin, Campus Virchow Klinikum und Campus Mitte, Berlin
| | - T Welte
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover
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Bonsignore M, Balamitsa E, Nobis C, Tafelski S, Geffers C, Nachtigall I. Antibiotic stewardship an einem Krankenhaus der Grund- und Regelversorgung. Anaesthesist 2018; 67:47-55. [DOI: 10.1007/s00101-017-0399-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Tafelski S, Gratopp A, Richter F, Kramer S, Spies C, Wernecke KD, Nachtigall I. Observational clinical study on organ dysfunction associated with dosing of antibiotics in a Pediatric Intensive Care Unit. Minerva Pediatr 2016; 70:331-339. [PMID: 27830927 DOI: 10.23736/s0026-4946.16.04667-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Medication errors are of concern especially in pediatric patients. This study investigates impact of dosing errors of antibiotics on outcome in critically ill pediatric patients. METHODS Retrospective study including all consecutive patients admitted to one university pediatric intensive care unit (PICU) in 2010 with length of PICU stay >24 hrs, age <18 years and antibiotic therapy. Antibiotic dosages were evaluated for compliance with recommended dosing individually adapted for bodyweight, age and organ function. Primary endpoint was organ dysfunction defined as occurrence of liver injury (LI) or acute kidney injury (AKI) after initiation of antibiotic therapy. AKI was defined as reduced estimated glomerular filtration below 50 mL/min or renal replacement therapy. LI was defined as more than two-fold elevation of liver enzymes. Additionally, duration of PICU stay, ventilation and all-cause PICU mortality were investigated. RESULTS Altogether 305 patients were evaluated with 2577 patient PICU days and 4021 antibiotic dosages. Overall 38.6% of dosages were incorrect according to recommendations and were applied in 130 patients (low-adherence-group). 175 children received antibiotic dosing according to recommendations (high-adherence-group). Patients in the low-adherence-group showed a 7-fold increase in adjusted risk to develop new-onset organ dysfunction (95% CI: 2.1-26.4), needed longer median PICU treatment (7 versus 3 days, P<0.001) and prolonged duration of mechanical ventilation (8 versus 2 days, P<0.001). In subgroup analyses, organ dysfunction and PICU mortality were associated with non-adherence to recommendations. CONCLUSIONS Adherence to a bodyweight- and age-adapted dosage-protocol is associated with less organ dysfunction and a more favorable clinical outcome in pediatric patients.
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Affiliation(s)
- Sascha Tafelski
- Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Alexander Gratopp
- Department for Pediatrics Endocrinology, Charité-Universitaetsmedizin Berlin, Gastroenterology and Metabolic Medicine, Campus Virchow-Klinikum, Berlin, Germany
| | - Florian Richter
- Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Sylvia Kramer
- Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | | | - Irit Nachtigall
- Department of Anesthesiology and Intensive Care Medicine Campus, Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Berlin, Germany - .,Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Waldfriede, Berlin, Germany
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Tafelski S, Kerper LF, Salz AL, Spies C, Reuter E, Nachtigall I, Schäfer M, Krannich A, Krampe H. Prospective clinical observational study evaluating gender-associated differences of preoperative pain intensity. Medicine (Baltimore) 2016; 95:e4077. [PMID: 27399095 PMCID: PMC5058824 DOI: 10.1097/md.0000000000004077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Previous studies reported conflicting results concerning different pain perceptions of men and women. Recent research found higher pain levels in men after major surgery, contrasted by women after minor procedures. This trial investigates differences in self-reported preoperative pain intensity between genders before surgery.Patients were enrolled in 2011 and 2012 presenting for preoperative evaluation at the anesthesiological assessment clinic at Charité University hospital. Out of 5102 patients completing a computer-assisted self-assessment, 3042 surgical patients with any preoperative pain were included into this prospective observational clinical study. Preoperative pain intensity (0-100 VAS, visual analog scale) was evaluated integrating psychological cofactors into analysis.Women reported higher preoperative pain intensity than men with median VAS scores of 30 (25th-75th percentiles: 10-52) versus 21 (10-46) (P < 0.001). Adjusted multiple regression analysis showed that female gender remained statistically significantly associated with higher pain intensity (P < 0.001). Gender differences were consistent across several subgroups especially with varying patterns in elderly. Women scheduled for minor and moderate surgical procedures showed largest differences in overall pain compared to men.This large clinical study observed significantly higher preoperative pain intensity in female surgical patients. This gender difference was larger in the elderly potentially contradicting the current hypothesis of a primary sex-hormone derived effect. The observed variability in specific patient subgroups may help to explain heterogeneous findings of previous studies.
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Affiliation(s)
- Sascha Tafelski
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Léonie F Kerper
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
- Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Hospital Wolfenbuettel gGmbH, Wolfenbuettel
| | - Anna-Lena Salz
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Eva Reuter
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Irit Nachtigall
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
- Department of Anaesthesiology, Intensive Care and Pain Medicine, Hospital Waldfriede, Berlin
| | - Michael Schäfer
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité- Universitaetsmedizin Berlin, Germany
| | - Henning Krampe
- Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin
- Correspondence: Henning Krampe, Department of Anesthesiology and Intensive Care Medicine, Campus Charité Mitte and Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin Charitéplatz 1, 10117 Berlin, Germany (e-mail: )
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Tafelski S, Yi H, Ismaeel F, Krannich A, Spies C, Nachtigall I. Obesity in critically ill patients is associated with increased need of mechanical ventilation but not with mortality. J Infect Public Health 2016; 9:577-85. [PMID: 26754202 DOI: 10.1016/j.jiph.2015.12.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 11/24/2015] [Accepted: 12/11/2015] [Indexed: 10/22/2022] Open
Abstract
Worldwide incidence of obesity is increasing and impaired outcome in postoperative patients has been described. Antibiotic prescribing is complicated by different pharmacology in this population. This study evaluates mortality and morbidity of obese postoperative patients and explores possible relation to antibiotic therapy. Therefore, data obtained in a prospective study in 2009-2010 were analysed. Postoperative patients on 5 ICUs were included with >48h of ICU treatment and documented body-mass-index (BMI). Altogether 451 non-obese patients (BMI<30kg/m(2)) were compared with 130 obese patients including propensity score matching. There was significant heterogeneity of baseline characteristics. ICU-mortality was 7.5% in non-obese and 7.7% in obese patients (p>0.999), but 65.4% of obese patients required mechanical ventilation compared with only 53.2% of non-obese patients (p=0.016). These findings were validated in multivariate regression analyses (adjusted OR for ICU-mortality for obese patients 0.53, 95%-CI 0.188-1.321, p=0.197; adjusted OR for mechanical ventilation 1.841, 95%-CI 1.113-3.076, p=0.018). Results were confirmed by propensity score matching. Therapeutic drug monitoring for vancomycin (TDM) showed that underdosing and overdosing occurred more often in obese patients and sufficient TDM levels were less often achieved. In conclusion, obesity is associated with increased morbidity but ICU mortality is equal compared with a non-obese population. Pharmacological differences might explain observed differences in antibiotic therapy and in obese patients TDM might be especially of importance.
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Affiliation(s)
- Sascha Tafelski
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Hailong Yi
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Fakher Ismaeel
- Department of Gynaecology, Campus Virchow Clinic, Charité Medical University Berlin, Augustenburger Platz 1, Berlin 13353, Germany
| | - Alexander Krannich
- Department of Biostatistics, Clinical Research Unit, Berlin Institute of Health, Charité - University Medicine Berlin, Berlin, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany.
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Affiliation(s)
- Sascha Tafelski
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany
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Koch C, Nachtigall I, Henrich W. Das gebrochene Herz – ein Fall von perinataler Tako Tsubo Kadiomyopathie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rothbart A, Yu P, Müller-Lobeck L, Spies CD, Wernecke KD, Nachtigall I. Peripheral intravenous cannulation with support of infrared laser vein viewing system in a pre-operation setting in pediatric patients. BMC Res Notes 2015; 8:463. [PMID: 26391665 PMCID: PMC4576370 DOI: 10.1186/s13104-015-1431-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Accepted: 09/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous access, a prerequisite for anesthesiological and surgical intervention in pediatric patients, is often difficult to establish and potentially painful. AV300 uses near infrared laser light to improve visibility of peripheral veins and could help cannulating them. The aim of this study was to examine if use of Accuvein(®) AV300 vein viewer could facilitate venous cannulation in children. METHODS From January to March 2011, 238 consecutive pediatric patients (0-17 years) preceding surgical interventions were included. All participants including newborns, infants and children were allocated to groups [control group (124 patients) and intervention group (114 patients)] in a non-random way. Randomization was not feasible because data was acquired retrospectively from a clinical quality management project. In control group, peripheral IV cannulation was performed without supporting device, in intervention group with support of AV300. Time and number of attempts until successful venous cannulation were defined as primary end points. RESULTS Median time until successful cannulation was 2 min (range 0.1-20, quartiles: 25 %: 1; 75 %: 5) in the intervention group and 1 min (range 0.1-18, quartiles: 25 %: 0.2; 75 %: 2) in the control group (p < 0.01). Median number of attempts was higher in the intervention group (2; range 1-6, quartiles: 25 %: 1; 75 %: 3) than in the control group (1; range 1-6, quartiles: 25 %: 1; 75 %: 2, p < 0.01). Rate of cannulations successful at first attempt was 0.45 (51 of 114, 95 % CI 0.35-0.54) in the intervention group and 0.73 (90 of 124, 95 % CI 0.65-0.81) in the control group (p < 0.01). CONCLUSIONS In our study we were not able to reduce neither time nor number of attempts until a successful venous cannulation in children using the vein viewer. Given certain limitations of our study as the lack of randomization and no control for inter-operator variability, the conclusions drawn from it are also limited, but by our results laser-supported cannulation cannot be recommended for standard procedures. TRIAL REGISTRATION ClinicalTrials.gov NCT01434537. Registered 29 July 2011.
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Affiliation(s)
- Andreas Rothbart
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Peng Yu
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Anesthesiology, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China.
| | - Lutz Müller-Lobeck
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. .,Department of Anesthesiology and Intensive Care Medicine, Pediatric Anesthesia, Clinical Center Barnim, Werner Forssmann Hospital, Eberswalde, Germany.
| | - Claudia D Spies
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Klaus-Dieter Wernecke
- Institute of Medical Biometrics and Clinical Epidemiology, Charité-Universitaetsmedizin Berlin, and SOSTANA GmbH Berlin, Berlin, Germany.
| | - Irit Nachtigall
- Department of Anesthesiology and Intensive Care Medicine Campus Charité Mitte and Campus Virchow-Klinikum, Charité-Universitaetsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Hansen J, Reifferscheid F, Nachtigall I. Buchtipps. Anasthesiol Intensivmed Notfallmed Schmerzther 2015. [DOI: 10.1055/s-0041-101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Nachtigall I, Tafelski S, Tamarkin A, Rothbart A, Lange M, Wegener F, Balzer F, Burgos JPL, Wernecke KD, Spies C. Effect of blood-sugar limitation on intensive care mortality: Intragroup evaluation. J Int Med Res 2015; 43:560-72. [PMID: 25998625 DOI: 10.1177/0300060514566651] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 12/11/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the safety profile of blood sugar limits in intensive care unit (ICU) patients. METHODS Adult patients with ICU stay >36 h, more than two blood sugar measurements and antibiotic therapy concordant with locally adapted guidelines were included. For analyses, one study cohort was defined in two ways: as a narrow group, euglycaemic patients' blood sugar levels 80-150 mg/dl; as a moderate group, euglycaemic patients' blood sugar levels 80-180 mg/dl. Dysglycaemia was defined as blood sugar levels <80 mg/dl for >5% of measurements, and >150 mg/dl or >180 mg/dl (narrow or moderate groups, respectively) for >10% of measurements. The primary endpoint was ICU mortality (euglycaemia versus dysglycaemia). RESULTS The study comprised 668 patients. When defined as a narrow group, ICU mortality was 3% (four of 135) euglycaemic versus 10% (54/533) dysglycaemic patients (odds ratio [OR] 3.692, 95% confidence interval [CI] 1.313, 10.382). When defined as a moderate group, ICU mortality was 6% (21/351) euglycaemic versus 12% (37/317) dysglycaemic patients (OR 2.077, 95% CI 1.188, 3.630). Frequency of severe hypoglycaemia (blood sugar <40 mg/dl) was not different between the narrow and moderate euglycaemic ranges. CONCLUSIONS Euglycaemia was associated with lower ICU mortality than dysglycaemia, and incidence of hypoglycaemia was low overall in this study. Based on current published evidence, therapeutic targets should be defined according to individual patient characteristics.
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Affiliation(s)
- Irit Nachtigall
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Sascha Tafelski
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andrey Tamarkin
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Rothbart
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Martin Lange
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Wegener
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Felix Balzer
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jack Poul Luengas Burgos
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Klaus-Dieter Wernecke
- Institute of Medical Biometry, Charité - Universitätsmedizin Berlin and SOSTANA GmbH, Berlin, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Tafelski S, Nachtigall I, Adam T, Bereswill S, Faust J, Tamarkin A, Trefzer T, Deja M, Idelevich EA, Wernecke KD, Becker K, Spies C. Randomized controlled clinical trial evaluating multiplex polymerase chain reaction for pathogen identification and therapy adaptation in critical care patients with pulmonary or abdominal sepsis. J Int Med Res 2015; 43:364-77. [PMID: 25911587 DOI: 10.1177/0300060514561135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/29/2014] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE To determine whether a multiplex polymerase chain reaction (PCR)-based test could reduce the time required for initial pathogen identification in patients in an intensive care unit (ICU) setting. METHODS This double-blind, parallel-group randomized controlled trial** enrolled adults with suspected pulmonary or abdominal sepsis caused by an unknown pathogen. Both the intervention and control groups underwent the standard blood culture (BC) testing, but additional pathogen identification, based on the results of a LightCycler® SeptiFast PCR test, were provided in the intervention group. RESULTS The study enrolled 37 patients in the control group and 41 in the intervention group. Baseline clinical and demographic characteristics were similar in both groups. The PCR-based test identified a pathogen in 10 out of 41 (24.4%) patients in the intervention group, with a mean duration from sampling to providing the information to the ICU of 15.9 h. In the control group, BC results were available after a significantly longer period (38.1 h). CONCLUSION The LightCycler® SeptiFast PCR test demonstrated a significant reduction in the time required for initial pathogen identification, compared with standard BC.
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Affiliation(s)
- Sascha Tafelski
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Thomas Adam
- Institute for Microbiology and Hygiene Berlin, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Stefan Bereswill
- Institute for Microbiology and Hygiene Berlin, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Jana Faust
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Andrey Tamarkin
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Tanja Trefzer
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - Evgeny A Idelevich
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Klaus-Dieter Wernecke
- Institute of Medical Biometry, Charité-Universitaetsmedizin Berlin, Berlin, Germany SOSTANA GmbH, Berlin, Germany
| | - Karsten Becker
- Institute of Medical Microbiology, University Hospital Münster, Münster, Germany
| | - Claudia Spies
- Department of Anaesthesiology and Intensive Care Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Weimann K, Zimmermann M, Spies CD, Wernecke KD, Vicherek O, Nachtigall I, Tafelski S, Weimann A. Intensive Care Infection Score--A new approach to distinguish between infectious and noninfectious processes in intensive care and medicosurgical patients. J Int Med Res 2015; 43:435-51. [PMID: 25850686 DOI: 10.1177/0300060514557711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/03/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Clinicians regularly encounter substantial time delays in diagnosing sepsis and administering appropriate antibiotic treatment. This study investigated the ability of the Intensive Care Infection Score (ICIS) to distinguish between infectious and noninfectious processes, and to assess the justified commencement of antibiotic therapy retrospectively, in line with hospital actual best practice and applied laboratory parameters. METHODS Intensive-care unit (ICU) patients were enrolled in this retrospective, observational study. Clinical data and laboratory parameters were determined daily. The cohort was divided into infected and noninfected patient groups. RESULTS Out of 172 ICU patients, including 72 postoperative patients, the predictive value for infection throughout the first 5 days in 'all patients' and the 'postoperative patient' group was highest for ICIS. An ICIS cut-off value of three could predict infection in postoperative patients with 82.9% sensitivity and 75.1% specificity. ICIS showed the lowest rate of potentially 'falsely encouraged' and 'discouraged' antibiotic therapies for noninfected and for septic postoperative patients, respectively, compared with C-reactive protein, procalcitonin and white blood cell levels. CONCLUSIONS In the ICU, particularly for postoperative patients, ICIS is a reliable marker for the timely identification of infection. ICIS may qualify as a new decision support tool for antibiotic therapy, when interpreted within the clinical context.
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Affiliation(s)
- Karin Weimann
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Mathias Zimmermann
- Department of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany Labor Berlin - Charité Vivantes Services, Berlin, Germany
| | - Claudia D Spies
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | | | - Oldrich Vicherek
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Sascha Tafelski
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Andreas Weimann
- Department of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany Labor Berlin - Charité Vivantes Services, Berlin, Germany
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Tafelski S, Nachtigall I, Troeger U, Deja M, Krannich A, Günzel K, Spies C. Observational clinical study on the effects of different dosing regimens on vancomycin target levels in critically ill patients: Continuous versus intermittent application. J Infect Public Health 2015; 8:355-63. [PMID: 25794497 DOI: 10.1016/j.jiph.2015.01.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Revised: 01/13/2015] [Accepted: 01/23/2015] [Indexed: 12/29/2022] Open
Abstract
Different dosing regimens for vancomycin are in clinical use: intermittent infusion and continuous administration. The intention of using these different dosing regimens is to reduce toxicity, to achieve target levels faster and to avoid treatment failure. The aim of this phase IV study was to compare safety and effectiveness in both administration regimens. The study was conducted in 2010 and 2011 in three postoperative intensive care units (ICUs) in a tertiary care university hospital in Berlin, Germany. Adult patients with vancomycin therapy and therapeutic drug monitoring were included. Out of 675 patients screened, 125 received vancomycin therapy, 39% with intermittent and 61% with continuous administration. Patients with continuous administration achieved target serum levels significantly earlier (median day 3 versus 4, p=0.022) and showed fewer sub-therapeutic serum levels (41% versus 11%, p<0.001). ICU mortality rate, duration of ICU stay and duration of ventilation did not differ between groups. Acute renal failure during the ICU stay occurred in 35% of patients with intermittent infusion versus 26% of patients with continuous application (p=0.324). In conclusion, continuous administration of vancomycin allowed more rapid achievement of targeted drug levels with fewer sub-therapeutic vancomycin levels observed. This might indicate that patients with more severe infections or higher variability in renal function could benefit from this form of administration.
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Affiliation(s)
- S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - I Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Uwe Troeger
- Institute for Clinical Pharmacology, Otto-von-Guericke-Universität, Magdeburg, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
| | - Alexander Krannich
- Department of Biostatistics, Coordination Center for Clinical Trials, Charité - Universitätsmedizin Berlin, Germany
| | - Karsten Günzel
- Department of Urology, Charité - Universitaetsmedizin Berlin, Campus Benjamin-Franklin, Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care, Charité - Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany.
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Tafelski S, Nachtigall I, Stengel S, Wernecke K, Spies C. Comparison of three models for sepsis patient discrimination according to PIRO: predisposition, infection, response and organ dysfunction. Minerva Anestesiol 2015; 81:264-271. [PMID: 25220552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Sepsis remains one of the most challenging burdens of critically ill patients. But for interventional studies significant heterogeneity remains in classifying patients. PIRO (Predisposition, Response, Infection and Organ dysfunction) has been introduced as innovative option for improved patient characterization. Aim of this study was to evaluate precision to predict hospital mortality of three different proposed PIRO classification systems. METHODS Data were prospectively obtained data in five ICUs in a university hospital in Berlin, Germany including adult patients with sepsis. Three different scoring systems were compared using patient characteristics to classify the population according to all cause hospital mortality risk (Moreno- PIRO, Rubulotta- PIRO and Howell-PIRO). RESULTS Two-hundred-seventy-eight sepsis patients were included and reclassified using different PIRO models. All cause hospital mortality was 16.2%. Hospital mortality increased with higher PIRO scores with odds ratios of 1.070 (95% CI 1.041-1.100) for Moreno-PIRO, 1.282 (95% CI 1.079-1.524) for Rubulotta-PIRO and 1.256 (95% CI 1.146-1.367) for Howell-PIRO. Area under the curves for Moreno-PIRO was 0.743 (95% CI: 0.687-0.793), for Rubulotta-PIRO 0.646 (95% CI: 0.587-0.702) and for Howell-PIRO 0.751 (95% CI: 0.696-0.801). Moreno-PIRO and Howell-PIRO were statistically different compared with Rubulotta-PIRO (P=0.046 and P=0.035). CONCLUSION Proposed PIRO classifications demonstrated slight differences between models without prioritization of one approach and all seemed feasible for patient classification. Future PIRO-development is needed to straighten predisposition, infection, and especially the response category.
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Affiliation(s)
- S Tafelski
- Department of Anesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany -
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Heß C, Nachtigall I, Rittner H. Buchtipps. Anasthesiol Intensivmed Notfallmed Schmerzther 2015. [DOI: 10.1055/s-0040-100352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Nachtigall I, Tafelski S, Deja M, Halle E, Grebe MC, Tamarkin A, Rothbart A, Uhrig A, Meyer E, Musial-Bright L, Wernecke KD, Spies C. Long-term effect of computer-assisted decision support for antibiotic treatment in critically ill patients: a prospective 'before/after' cohort study. BMJ Open 2014; 4:e005370. [PMID: 25534209 PMCID: PMC4275685 DOI: 10.1136/bmjopen-2014-005370] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVES Antibiotic resistance has risen dramatically over the past years. For individual patients, adequate initial antibiotic therapy is essential for clinical outcome. Computer-assisted decision support systems (CDSSs) are advocated to support implementation of rational anti-infective treatment strategies based on guidelines. The aim of this study was to evaluate long-term effects after implementation of a CDSS. DESIGN This prospective 'before/after' cohort study was conducted over four observation periods within 5 years. One preinterventional period (pre) was compared with three postinterventional periods: directly after intensive implementation efforts (post1), 2 years (post2) and 3 years (post3) after implementation. SETTING Five anaesthesiological-managed intensive care units (ICU) (one cardiosurgical, one neurosurgical, two interdisciplinary and one intermediate care) at a university hospital. PARTICIPANTS Adult patients with an ICU stay of >48 h were included in the analysis. 1316 patients were included in the analysis for a total of 12,965 ICU days. INTERVENTION Implementation of a CDSS. OUTCOME MEASURES The primary end point was percentage of days with guideline adherence during ICU treatment. Secondary end points were antibiotic-free days and all-cause mortality compared for patients with low versus high guideline adherence. MAIN RESULTS Adherence to guidelines increased from 61% prior to implementation to 92% in post1, decreased in post2 to 76% and remained significantly higher compared with baseline in post3, with 71% (p=0.178). Additionally, antibiotic-free days increased over study periods. At all time periods, mortality for patients with low guideline adherence was higher with 12.3% versus 8% (p=0.014) and an adjusted OR of 1.56 (95% CI 1.05 to 2.31). CONCLUSIONS Implementation of computerised regional adapted guidelines for antibiotic therapy is paralleled with improved adherence. Even without further measures, adherence stayed high for a longer period and was paralleled by reduced antibiotic exposure. Improved guideline adherence was associated with reduced ICU mortality. TRIAL REGISTRATION NUMBER ISRCTN54598675.
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Affiliation(s)
- I Nachtigall
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - M Deja
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - E Halle
- Charité-Universitaetsmedizin Berlin, Institute for Microbiology and Hygiene, Berlin, Germany
| | - M C Grebe
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Tamarkin
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Rothbart
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - A Uhrig
- Department of Internal Medicine, Infectious Diseases and Respiratory Medicine, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - E Meyer
- Charité Universitaetsmedizin Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany
| | - L Musial-Bright
- Department of Cardiology, Charité-Universitaetsmedizin Berlin, Berlin, Germany
| | - K D Wernecke
- Charité-Universitaetsmedizin Berlin, Institute of Medical Biometrics, and SOSTANA GmbH, Berlin, Germany
| | - C Spies
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Nachtigall I, Tafelski S, Günzel K, Uhrig A, Powollik R, Tamarkin A, Wernecke KD, Spies C. Standard operating procedures for antibiotic therapy and the occurrence of acute kidney injury: a prospective, clinical, non-interventional, observational study. Crit Care 2014; 18:R120. [PMID: 24923469 PMCID: PMC4095670 DOI: 10.1186/cc13918] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/28/2014] [Indexed: 12/29/2022]
Abstract
Introduction Acute kidney injury (AKI) occurs in 7% of hospitalized and 66% of Intensive Care Unit (ICU) patients. It increases mortality, hospital length of stay, and costs. The aim of this study was to investigate, whether there is an association between adherence to guidelines (standard operating procedures (SOP)) for potentially nephrotoxic antibiotics and the occurrence of AKI. Methods This study was carried out as a prospective, clinical, non-interventional, observational study. Data collection was performed over a total of 170 days in three ICUs at Charité – Universitaetsmedizin Berlin. A total of 675 patients were included; 163 of these had therapy with vancomycin, gentamicin, or tobramycin; were >18 years; and treated in the ICU for >24 hours. Patients with an adherence to SOP >70% were classified into the high adherence group (HAG) and patients with an adherence of <70% into the low adherence group (LAG). AKI was defined according to RIFLE criteria. Adherence to SOPs was evaluated by retrospective expert audit. Development of AKI was compared between groups with exact Chi2-test and multivariate logistic regression analysis (two-sided P <0.05). Results LAG consisted of 75 patients (46%) versus 88 HAG patients (54%). AKI occurred significantly more often in LAG with 36% versus 21% in HAG (P = 0.035). Basic characteristics were comparable, except an increased rate of soft tissue infections in LAG. Multivariate analysis revealed an odds ratio of 2.5-fold for LAG to develop AKI compared with HAG (95% confidence interval 1.195 to 5.124, P = 0.039). Conclusion Low adherence to SOPs for potentially nephrotoxic antibiotics was associated with a higher occurrence of AKI. Trial registration Current Controlled Trials ISRCTN54598675. Registered 17 August 2007.
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Nachtigall I, Krier C. Buchtipps. Anasthesiol Intensivmed Notfallmed Schmerzther 2014. [DOI: 10.1055/s-0033-1363916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Nachtigall I, Tamarkin A, Tafelski S, Weimann A, Rothbart A, Heim S, Wernecke KD, Spies C. Polymorphisms of the toll-like receptor 2 and 4 genes are associated with faster progression and a more severe course of sepsis in critically ill patients. J Int Med Res 2013; 42:93-110. [PMID: 24366499 DOI: 10.1177/0300060513504358] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To determine whether the Arg753Gln polymorphism of the toll-like receptor 2 (TLR2) gene and the Asp299Gly polymorphism of the TLR4 gene in critically ill patients affect their clinical outcomes. METHODS Medical and surgical patients in three intensive care units (ICU) were enrolled in this prospective study. TLR2 and TLR4 gene polymorphisms were determined using restriction fragment length polymorphism analysis. RESULTS A total of 145 patients were included in this study: 28 patients carried heterozygous mutations (10 in the TLR2 gene, 19 in the TLR4 gene, and one combined) and 117 patients were wild type. Severe sepsis was observed in 33% of wild types (n = 38), 60% of the TLR2 group (n = 6), and 63% of the TLR4 group (n = 12); the difference was significant between the TLR4 and wild type groups. Both TLR groups demonstrated a shorter time-to-onset of severe sepsis or septic shock. Only the TLR4 group demonstrated significant progression towards septic shock compared with the wild type group. Length of ICU stay was significantly prolonged in the TLR4 group compared with the wild type group, but not in the TLR2 group. CONCLUSIONS Two common SNPs of the TLR2 and TLR4 genes--Arg753Gln and Asp299Gly--were associated with a shorter time-to-onset of severe sepsis or septic shock in patients admitted to the ICU.
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Affiliation(s)
- Irit Nachtigall
- Department of Anaesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany
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Dalhoff K, Ewig S, Abele-Horn M, Andreas S, Bauer TT, von Baum H, Deja M, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Höffken G, Kern W, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schütte H, Seifert H, Sitter H, Spies C, Welte T. Adult patients with nosocomial pneumonia: epidemiology, diagnosis, and treatment. Dtsch Arztebl Int 2013; 110:634-40. [PMID: 24133545 DOI: 10.3238/arztebl.2013.0634] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 06/13/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Nosocomial pneumonia is among the most common types of infection in hospitalized patients. The increasing prevalence of multi-drug resistant organisms (MDROs) in recent years points to the need for an up-to-date clinical guideline. METHODS An interdisciplinary S3 guideline was created on the basis of a systematic literature review in the PubMed and Cochrane Library databases, with assessment and grading of the evidence according to the GRADE system. RESULTS 9097 abstracts and 808 articles were screened in full text, and 22 recommendations were issued. It is recommended that any antimicrobial treatment should be preceded by a microbiological diagnostic evaluation with cultures of blood and respiratory samples. The diagnosis of nosocomial pneumonia should be suspected in any patient with a new or worsened pulmonary infiltrate who meets any two of the following three criteria: leucocyte count above 10,000 or below 4000/µL, temperature above 38.3°C, and/or the presence of purulent respiratory secretions. The initially calculated antimicrobial treatment should be begun without delay; it should be oriented to the locally prevailing resistance pattern, and its intensity should be a function of the risk of infection with MDROs. The initial treatment should be combination therapy if there is a high risk of MDRO infection and/or if the patient is in septic shock. In the new guideline, emphasis is laid on a strict de-escalation concept. In particular, antimicrobial treatment usually should not be continued for longer than eight days. CONCLUSION The new guideline's recommendations are intended to encourage rational use of antibiotics, so that antimicrobial treatment will be highly effective while the unnecessary selection of multi-drug-resistant organisms will be avoided.
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Affiliation(s)
- Klaus Dalhoff
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Campus Lübeck
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Nachtigall I, Hansen J, Harding U. Buchtipps. Anasthesiol Intensivmed Notfallmed Schmerzther 2013. [DOI: 10.1055/s-0033-1352499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Hensel M, Reinartz R, Koch C, Nachtigall I, Marnitz R. [Case report: Purulent pericarditis caused by candida species--a rare but life-threatening disease in intensive care medicine]. Anasthesiol Intensivmed Notfallmed Schmerzther 2013; 48:144-9. [PMID: 23589008 DOI: 10.1055/s-0033-1342897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
We report a case of a male patient with drug abuse in his medical history who was hospitalized because of a community acquired pneumonia. Subsequently the patient developed an acute lung injury (ARDS) and a fulminant purulent pericarditis accompanied by a pericardial effusion. Caused by the pericardial tamponade cardiac function was severely restricted. Due to fast diagnosis and immediate adequate therapy such as systemic anti-fungal treatment, pericardiocentesis, percutaneous drainage, and later surgical intervention the patient was treated successfully. This article describes etiology, pathophysiology and symptoms of purulent Candida-pericarditis and gives a review of existing literature regarding this extremely rare disease. In addition therapeutic options are discussed.
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Affiliation(s)
- Mario Hensel
- Abteilung für Anästhesiologie und Intensivmedizin der Park-Klinik Weissensee, Berlin.
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Dalhoff K, Abele-Horn M, Andreas S, Bauer T, von Baum H, Deja M, Ewig S, Gastmeier P, Gatermann S, Gerlach H, Grabein B, Höffken G, Kern WV, Kramme E, Lange C, Lorenz J, Mayer K, Nachtigall I, Pletz M, Rohde G, Rosseau S, Schaaf B, Schaumann R, Schreiter D, Schütte H, Seifert H, Sitter H, Spies C, Welte T. [Epidemiology, diagnosis and treatment of adult patients with nosocomial pneumonia. S-3 Guideline of the German Society for Anaesthesiology and Intensive Care Medicine, the German Society for Infectious Diseases, the German Society for Hygiene and Microbiology, the German Respiratory Society and the Paul-Ehrlich-Society for Chemotherapy]. Pneumologie 2012; 66:707-65. [PMID: 23225407 DOI: 10.1055/s-0032-1325924] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy. This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio. The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.
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Affiliation(s)
- K Dalhoff
- Medizinische Klinik III, Pneumologie und Infektiologie, Universitätsklinikum Schleswig-Holstein, Lübeck.
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Tafelski S, Nachtigall I, Deja M, Tamarkin A, Trefzer T, Halle E, Wernecke KD, Spies C. Computer-assisted decision support for changing practice in severe sepsis and septic shock. J Int Med Res 2011; 38:1605-16. [PMID: 21309474 DOI: 10.1177/147323001003800505] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Computer-assisted decision support systems (CDSS) are designed to improve infection management. The aim of this prospective, clinical pre- and post-intervention study was to investigate the influence of CDSS on infection management of severe sepsis and septic shock in intensive care units (ICUs). Data were collected for a total of 180 days during two study periods in 2006 and 2007. Of the 186 patients with severe sepsis or septic shock, 62 were stratified into a low adherence to infection management standards group (LAG) and 124 were stratified into a high adherence group (HAG). ICU mortality was significantly increased in LAG versus HAG patients (Kaplan-Meier analysis). Following CDSS implementation, adherence to standards increased significantly by 35%, paralleled with improved diagnostics, more antibiotic-free days and a shortened time until antibiotics were administered. In conclusion, adherence to infection standards is beneficial for patients with severe sepsis or septic shock and CDSS is a useful tool to aid adherence.
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Affiliation(s)
- S Tafelski
- Department of Anaesthesiology and Intensive Care, Charité-Universitaetsmedizin Berlin, Berlin, Germany
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Tafelski S, Nachtigall I, Trefzer T, Halle E, Mende H, Briedigkeit L, Martin J, Welte T, Quintel M, Bause H, Geldner G, Schleppers A, Spies C. [Evidence-based anti-infective program "ABx" - Online-program for anti-infective therapy broadens functions for local adaptations]. Anasthesiol Intensivmed Notfallmed Schmerzther 2009; 44:500-1. [PMID: 19629910 DOI: 10.1055/s-0029-1237103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
National and international evidence based recommendations for anti-infective therapies in the intensive care unit are difficult to implement into daily clinical work. However, adequate and early applications of anti-infective therapies are important outcome factors for the clinical course of severe infections. With support of the German Society of Anaesthesiology and Intensive Care Medicine and the Association of German Anaesthesiologists (DGAI/BDA) a web based anti-infective program was developed to address these issues. The program includes interdisciplinary consented evidence based algorithms to help with immediate diagnostics and initial anti-infective therapies. Currently, with the title "ABx local" a subproject is launched to broaden program functions. It unifies current evidence based recommendations and local internal standards or comments on one platform to achieve priority of therapy options e.g. based on resistance patterns.
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Affiliation(s)
- Sascha Tafelski
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin der Charité - Universitätsmedizin Berlin, Campus Charité Mitte und Campus Virchow-Klinikum.
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