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Salmanton-García J, Bruns C, Rutz J, Albertsmeier M, Ankert J, Bernard L, Bataille C, Couvé-Deacon E, Fernández-Ferrer M, Fortún J, Galar A, Grill E, Guimard T, Classen AY, Vehreschild JJ, Stemler J, Naendrup JH, Hampl J, Tallon B, Sprute R, Horcajada JP, Mollar-Maseres J, Muñoz P, Pletz MW, Serracino-Inglott F, Soriano A, Vilz TO, Seifert H, Cornely OA, Mellinghoff SC, Liss BJ, Wingen-Heimann SM. Costs and resource utilization patterns in surgical site infections: a pre-COVID-19 perspective from France, Germany, Spain, and the UK. J Hosp Infect 2024; 147:123-132. [PMID: 38467251 DOI: 10.1016/j.jhin.2024.02.019] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/30/2024] [Accepted: 02/06/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Surgical site infections (SSIs), mainly caused by Staphylococcus aureus, pose a significant economic burden in Europe, leading to increased hospitalization duration, mortality, and treatment costs, particularly with drug-resistant strains such as meticillin-resistant S. aureus. AIM To conduct a case-control study on the economic impact of S. aureus SSI in adult surgical patients across high-volume centres in France, Germany, Spain, and the UK, aiming to assess the overall and procedure-specific burden across Europe. METHODS The SALT study is a multinational, retrospective cohort study with a nested case-control analysis focused on S. aureus SSI in Europe. The study included participants from France, Germany, Italy, Spain, and the UK who underwent invasive surgery in 2016 and employed a micro-costing approach to evaluate health economic factors, matching S. aureus SSI cases with controls. FINDINGS In 2016, among 178,904 surgical patients in five European countries, 764 developed S. aureus SSI. Matching 744 cases to controls, the study revealed that S. aureus SSI cases incurred higher immediate hospitalization costs (€8,810), compared to controls (€6,032). Additionally, S. aureus SSI cases exhibited increased costs for readmissions within the first year post surgery (€7,961.6 versus €5,298.6), with significant differences observed. Factors associated with increased surgery-related costs included the cost of hospitalization immediately after surgery, first intensive care unit (ICU) admission within 12 months, and hospital readmission within 12 months, as identified through multivariable analysis. CONCLUSION The higher rates of hospitalization, ICU admissions, and readmissions among S. aureus SSI cases highlight the severity of these infections and their impact on healthcare costs, emphasizing the potential benefits of evidence-based infection control measures and improved patient care to mitigate the economic burden.
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Affiliation(s)
- J Salmanton-García
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - C Bruns
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - J Rutz
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany
| | - M Albertsmeier
- Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität Munich, Munich, Germany
| | - J Ankert
- Institute of Infectious Diseases and Infection Control, University Hospital Jena, Jena, Germany
| | - L Bernard
- Service de Médecine Interne et Maladies Infectieuses, Centre Hospitalier Régional Universitaire de Tours, Tours, France
| | - C Bataille
- INSERM, CHU Limoges, UMR 1092, Université Limoges, Limoges, France
| | - E Couvé-Deacon
- INSERM, CHU Limoges, UMR 1092, Université Limoges, Limoges, France
| | - M Fernández-Ferrer
- Hospital del Mar-IMIM, Universitat Pompeu Fabra, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, CIBERINFEC, Madrid, Spain
| | - J Fortún
- Ramón y Cajal University Hospital, CIBERINFEC, IRYCIS, Madrid, Spain
| | - A Galar
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - E Grill
- Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU), Munich, Germany
| | - T Guimard
- Service de Médecine Post-Urgence, CH Départemental de Vendée, La Roche Sur Yon, France
| | - A Y Classen
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - J J Vehreschild
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - J Stemler
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - J-H Naendrup
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - J Hampl
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - B Tallon
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - R Sprute
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - J P Horcajada
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, CIBERINFEC, Madrid, Spain; Hospital del Mar-IMIM, Universitat Pompeu Fabra, Barcelona, Spain
| | - J Mollar-Maseres
- Preventive Medicine Department, La Fe University and Polytechnic Hospital, Valencia, Spain
| | - P Muñoz
- Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M W Pletz
- Institute of Infectious Diseases and Infection Control, University Hospital Jena, Jena, Germany
| | | | - A Soriano
- Hospital Clínic de Barcelona, IDIBAPS, University of Barcelona, CIBERINFEC, Barcelona, Spain
| | - T O Vilz
- Klinik und Poliklinik für Allgemein-, Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Bonn, Venusberg Campus 1, Bonn, Germany
| | - H Seifert
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - O A Cornely
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - S C Mellinghoff
- Faculty of Medicine and University Hospital Cologne, Institute of Translational Research, Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany; Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany.
| | - B J Liss
- Department I of Internal Medicine, Helios University Hospital Wuppertal, Wuppertal, Germany; School of Medi-Cine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - S M Wingen-Heimann
- Department I of Internal Medicine, Center for Integrated Oncology Aachen Bonn-Cologne Duesseldorf (CIO ABCD) and Excellence Center for Medical Mycology, University of Cologne, Cologne, Germany; FOM University of Applied Sciences, Essen, Germany
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Espíndola R, Vella V, Benito N, Mur I, Tedeschi S, Zamparini E, Hendriks JGE, Sorlí L, Murillo O, Soldevila L, Scarborough M, Scarborough C, Kluytmans J, Ferrari MC, Pletz MW, McNamara I, Escudero-Sanchez R, Arvieux C, Batailler C, Dauchy FA, Liu WY, Lora-Tamayo J, Praena J, Ustianowski A, Cinconze E, Pellegrini M, Bagnoli F, Rodríguez-Baño J, Del-Toro-López MD. Incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infection in European hospitals: the COMBACTE-NET ARTHR-IS multi-centre study. J Hosp Infect 2023; 142:9-17. [PMID: 37797656 DOI: 10.1016/j.jhin.2023.09.012] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND The aim of this study was to estimate the incidence, associated disease burden and healthcare utilization due to Staphylococcus aureus prosthetic joint infections (SA-PJI) after primary hip and knee arthroplasty in European centres. METHODS This study was conducted in patients who underwent primary hip and knee arthroplasty in 19 European hospitals between 2014 and 2016. The global incidence of PJI and SA-PJI was calculated. The associated disease burden was measured indirectly as infection-related mortality plus loss of function. For healthcare utilization, number and duration of hospitalizations, number and type of surgical procedures, duration of antibiotic treatments, and number of outpatient visits were collected. Subgroup and regression analyses were used to evaluate the impact of SA-PJI on healthcare utilization, controlling for confounding variables. RESULTS The incidence of PJI caused by any micro-organism was 1.41%, and 0.40% for SA-PJI. Among SA-PJI, 20.7% were due to MRSA with substantial regional differences, and were more frequent in partial hip arthroplasty (PHA). Related deaths and loss of function occurred in 7.0% and 10.2% of SA-PJI cases, respectively, and were higher in patients with PHA. Compared with patients without PJI, patients with SA-PJI had a mean of 1.4 more readmissions, 25.1 more days of hospitalization, underwent 1.8 more surgical procedures, and had 5.4 more outpatient visits, controlling for confounding variables. Healthcare utilization was higher in patients who failed surgical treatment of SA-PJI. CONCLUSIONS This study confirmed that the SA-PJI burden is high, especially in PHA, and provided a solid basis for planning interventions to prevent SA-PJI.
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Affiliation(s)
- R Espíndola
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain
| | - V Vella
- GlaxoSmithKline (GSK), Siena, Italy
| | - N Benito
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; University of Queensland, UQ Centre for Clinical Research, Brisbane, Australia
| | - I Mur
- Infectious Diseases Unit, Hospital de la Santa Creu i Sant Pau/Sant Pau Institute for Biomedical Research, Barcelona, Spain
| | - S Tedeschi
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy; Infectious Diseases Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | - E Zamparini
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - J G E Hendriks
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands
| | - L Sorlí
- Department of Infectious Diseases, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - O Murillo
- Department of Infectious Diseases, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - L Soldevila
- Department of Infectious Diseases, Hospital Universitari Bellvitge, IDIBELL, Barcelona, Spain
| | - M Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Scarborough
- Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - J Kluytmans
- Department of Infection Control, Amphia Hospital, Breda, The Netherlands; Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - M C Ferrari
- Prosthetic-Joint Replacement Unit, Humanitas Research Hospital, Milano, Italy
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - I McNamara
- Department of Orthopaedics, Norfolk and Norwich University Hospital, Norwich, UK
| | - R Escudero-Sanchez
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Infectious Diseases, Instituto Ramón y Cajal de Investigación Sanitaria, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - C Arvieux
- Department of Infectious Diseases, Centre Hospitalier Universitaire de Rennes, Rennes, France
| | - C Batailler
- Orthopedic Surgery Department, Croix Rousse Hospital, Lyon, France
| | - F-A Dauchy
- Department of Infectious and Tropical Diseases, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France
| | - W-Y Liu
- Department of Orthopaedic Surgery & Trauma, Máxima MC, Eindhoven, The Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital, Eindhoven, The Netherlands
| | - J Lora-Tamayo
- Department of Internal Medicine (CIBERINFEC-CIBER de Enfermedades Infecciosas), Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Praena
- Clinical Unit of Infectious Diseases and Microbiology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - A Ustianowski
- Infectious Diseases Unit, North Manchester General Hospital, Manchester, UK
| | | | | | | | - J Rodríguez-Baño
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Sevilla, Spain
| | - M-D Del-Toro-López
- Infectious Diseases and Microbiology Clinical Unit, Hospital Universitario Virgen Macarena, Seville, Spain; Biomedicine Institute of Sevilla (IBiS)/CSIC, Seville, Spain; Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain; Department of Medicine, University of Sevilla, Spain.
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Panchyrz I, Hoffmann J, Harst L, Pohl S, Bauer M, Blaschke S, Bodenstein M, Engelhart S, Gärtner B, Graf J, Hanses F, Held HC, Hinzmann D, Khan N, Kleber C, Kolibay F, Kubulus D, Liske S, Oberfeld J, Pletz MW, Prückner S, Rohde G, Spinner CD, Stehr S, Willam C, Schmitt J. [Measures and Recommendations for Ensuring Adequate Inpatient Care Capacities for Pandemic Management within a Region: Results of a Hybrid Delphi Method]. Gesundheitswesen 2023; 85:1173-1182. [PMID: 37604173 DOI: 10.1055/a-2109-9882] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Since the beginning of the pandemic in spring 2020, inpatient healthcare has been under enormous burden, which is reflected especially in overworked staff, imprecise bed planning and/or data transfer. According to the recommendation of the Science Council, university clinics should play a controlling role in regional healthcare and act in conjunction with surrounding hospitals and practices. METHODS In September 2021, 31 representatives from 18 university hospitals were invited to a hybrid Delphi study with a total of 4 survey rounds to discuss criteria for effective inpatient care in a pandemic situation, which were extracted from previous expert interviews. Criteria that were classified as very important/relevant by≥75% of the participants in the first round of the survey (consensus definition) were then further summarized in 4 different small groups. In a third Delphi round, all participants came together again to discuss the results of the small group discussions. Subsequently, these were prioritized as Optional ("can"), Desirable ("should") or Necessary ("must") recommendations. RESULTS Of the invited clinical experts, 21 (67.7%) participated in at least one Delphi round. In an online survey (1st Delphi round), 233 criteria were agreed upon and reduced to 84 criteria for future pandemic management in four thematic small group discussions (2nd Delphi round) and divided into the small groups as follows: "Crisis Management and Crisis Plans" (n=20), "Human Resources Management and Internal Communication" (n=16), "Regional Integration and External Communication" (n=24) and "Capacity Management and Case & Care" (n=24). In the following group discussion (3rd Delphi round), the criteria were further modified and agreed upon by the experts, so that in the end result, there were 23 essential requirements and recommendations for effective inpatient care in a pandemic situation. CONCLUSION The results draw attention to key demands of clinical representatives, for example, comprehensive digitization, standardization of processes and better (supra) regional networking in order to be able to guarantee needs-based care even under pandemic conditions. The present consensus recommendations can serve as guidelines for future pandemic management in the inpatient care sector.
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Affiliation(s)
- Ivonne Panchyrz
- TU Dresden, Universitätsklinikum Carl Gustav Carus Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Germany
| | - Julia Hoffmann
- TU Dresden, Universitätsklinikum Carl Gustav Carus Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Germany
| | - Lorenz Harst
- TU Dresden, Universitätsklinikum Carl Gustav Carus Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Germany
| | - Solveig Pohl
- TU Dresden, Universitätsklinikum Carl Gustav Carus Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Germany
| | - Michael Bauer
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Sabine Blaschke
- Zentrale Notaufnahme (ZNA), Universitätsmedizin Göttingen, Gottingen, Germany
| | - Marc Bodenstein
- Klinik für Anästhesiologie, JGU Universitätsmedizin Mainz, Mainz, Germany
| | - Steffen Engelhart
- Institut für Hygiene und Public Health, Universitätsklinikum Bonn, Bonn, Germany
| | - Barbara Gärtner
- Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Jürgen Graf
- Ärztlicher Direktor und Vorstandsvorsitzender des Universitätsklinikum Frankfurt, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Frank Hanses
- Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Germany
| | - Hanns-Christoph Held
- Klinik für Viszeral-, Thorax- und Gefäßchirurgie, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | - Dominik Hinzmann
- Klinik für Anästhesiologie und Intensivmedizin, Klinikum rechts der Isar der Technischen Universität München, Munchen, Germany
| | - Naseer Khan
- Stabsstelle Zentrales Patientenmanagement, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christian Kleber
- Klinik und Poliklinik für Orthopädie, Unfallchirurgie und Plastische Chirurgie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Felix Kolibay
- Stabsabteilung Klinikangelegenheiten und Krisenmanagement, Uniklinik Köln, Koln, Germany
| | - Darius Kubulus
- Zentrales OP-Management (ZOPM), Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Stefanie Liske
- Stabsstelle Unternehmensentwicklung und Prozessmanagement, Universitätsklinikum Magdeburg, Magdeburg, Germany
| | - Jörg Oberfeld
- Geschäftsbereich Medizinisches Management, Universitätsklinikum Münster, Münster, Germany
| | - Mathias Wilhelm Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Germany
| | - Stephan Prückner
- Institut für Notfallmedizin und Medizinmanagement (INM), Klinikum der Ludwig-Maximilians-Universität München (LMU), Munchen, Germany
| | - Gernot Rohde
- Medizinische Klinik 1 - Pneumologie und Allergologie, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christoph D Spinner
- Klinik und Poliklinik für Innere Medizin II, Klinikum rechts der Isar der Technischen Universitat Munchen, München, Germany
| | - Sebastian Stehr
- Klinik und Poliklinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Carsten Willam
- Nephrologie und Intensivmedizin, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Jochen Schmitt
- Zentrum für Evidenzbasierte Gesundheitsversorgung, Universitätsklinikum Carl Gustav Carus Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Germany
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Pletz MW, Bahrs C, Nitschmann S. [Vaccination against respiratory syncytial virus]. Inn Med (Heidelb) 2023; 64:907-910. [PMID: 37561182 DOI: 10.1007/s00108-023-01552-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/05/2023] [Indexed: 08/11/2023]
Affiliation(s)
- M W Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Am Klinikum 1, 07747, Jena, Deutschland.
| | - C Bahrs
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Am Klinikum 1, 07747, Jena, Deutschland
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Thomas Schleenvoigt B, Ankert J, Stocker H, Stoehr A, Lehmann C, Schulz C, Wesselmann H, Bickel M, Haberl A, Degen O, Pletz MW, Seybold U, Stephan C. [HIV First Diagnoses in Germany in 2014 - A Regional Analysis]. Gesundheitswesen 2022; 84:e45-e52. [PMID: 35176792 DOI: 10.1055/a-1665-6762] [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: 10/19/2022]
Abstract
BACKGROUND Information on testing units in health care is scarce, particularly the group of late-presenters among the HIV-first diagnoses is still a challenge in Germany. AIM Analysis of the impact of testing units on and reasons for the prevalence of HIV-first diagnoses and late presentation, taking 2014 for illustrative purposes. MATERIAL AND METHODS Cross-sectional analysis of all individuals, treated in the Network HIV-Regional who were first diagnosed with HIV in 2014; patient characteristics, demographic and clinical data, including information on HIV testing were collected retrospectively and in a decentralised manner, pseudonymized and statistically evaluated. RESULTS A total of 971 individuals with HIV-first diagnosis from 31 specialised care centres throughout Germany (15 hospitals, 16 private practices) represented 27.5% of all National HIV-first diagnoses -registrations from Robert Koch Institute for 2014, with similar results for CD4-cell count and HIV-transmission risk. The most common test site was a hospital (34.8%), followed by the office of a family doctor (19.6%) and medical specialist (16.1%). If the first diagnosis was established in hospital, then the patients were on average older than those tested on an ambulant care basis (42 vs. 37 years, p=0.001); moreover, the HI-viral load was higher (585 vs. 270 thousand copies/mL, p<0.001) and the CD4-cell count lower (265 vs. 414/µL, p<0.001). In 208/971 individuals with first diagnosis, at least one AIDS-defining disease was found, most frequently pneumocystis-pneumonia (43.8%), candidiasis (36.5%) and Kaposi sarcoma (10.6%). A regional comparison revealed that in eastern Germany, for first diagnosed HIV-patients were younger, had a higher HIV-RNA viral load and also more often clinical AIDS. CONCLUSION This analysis of HIV-Regional for 2014 enables a deeper insight into HIV first diagnoses, on the eve of the introduction of important prevention tools in Germany, e. g., HIV home testing and pre-exposure prophylaxis. This cross-sectional analysis was representative for Germany and underscores the importance of specialised hospitals, in particular for eastern Germany, and furthermore the involvement of late-presenters into HIV health care.
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Affiliation(s)
| | - Juliane Ankert
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - Hartmut Stocker
- Klinik für Infektiologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Deutschland
| | - Albrecht Stoehr
- ifi Studien und Projekte GmbH, Asklepios Klinik Sankt Georg, Hamburg, Deutschland
| | - Clara Lehmann
- Infektionsschutzzentrum (ISZ) & Infektionsambulanz, Klinik für Innere Medizin I, Universitätsklinikum Köln, Köln, Deutschland
| | - Christian Schulz
- Medizinische Klinik und Poliklinik 2, Klinikum der Universität München, München, Deutschland
| | - Hans Wesselmann
- HIV-Ambulanz-Praxis des Amb. Gesundheitszentrums der Charité am Campus Virchow-Klinikum, Charité Universitätsmedizin Berlin, Berlin, Deutschland
| | | | - Annette Haberl
- Ambulanzzentrum des UKE GmbH, Bereich Infektiologie, Hamburg, Deutschland
| | - Olaf Degen
- Ambulanzzentrum des UKE GmbH, Bereich Infektiologie, Hamburg, Deutschland
| | - Mathias Wilhelm Pletz
- Institut für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - Ulrich Seybold
- Sektion Klinische Infektiologie, Medizinische Klinik und Poliklinik IV, Klinikum der Universität München, München, Deutschland
| | - Christoph Stephan
- Medizinische Klinik II, HIVCENTER, Universitätsklinikum Frankfurt Zentrum der Inneren Medizin, Frankfurt am Main, Deutschland
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6
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Diab M, Franz M, Hagel S, Guenther A, Struve A, Kuehn H, Ibrahim K, Jahnecke M, Sigusch H, Ebelt H, Faerber G, Lehmann T, Schulze PC, Pletz MW, Doenst T. The impact of establishing a regional infective endocarditis (IE) network on pre-operative IE-related complications and on post-operative outcome. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1721] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Infective endocarditis (IE) requires a high degree of suspicion and advanced level of multidisciplinary management. In 2015, the European guidelines recommended the formation of an endocarditis-team (ET) for optimal treatment of IE. In 2011, we already established an ET within the hospital that was only consulted on demand for certain patients. Since 2015, ET has been increasingly involved in the management of almost all patients with IE. In addition, we established in 2015 a statewide endocarditis- (E) network for the referring hospitals.
Purpose
We investigated the effect of E-network on reducing referral latency and pre-operative IE-related complications. We also investigated the adherence to the ET management recommendations in our hospital and its impact on post-operative stroke and mortality.
Methods
We retrospectively analyzed data from patients operated for IE in our center between 01/2007 and 03/2018. We conducted univariate analysis using Chi-square or Fisher's exact test, Multivariate logistic regression models for in-hospital mortality and post-operative stroke, and Kaplan-Meier estimate of 5-years survival.
Results
Among 630 patients operated for IE in our center, 409 (65%) underwent surgery in the 1st era before 12/2014. S. aureus IE was more frequent in the second era (34% vs 25%, p<0.001). The median time from the onset of symptoms to referral in the 2nd era was halved compared to the first one [7 days (IQR 2–19) vs 15 days (IQR 6–35)]. Patients in the 2nd era were admitted with less IE-related complications, i.e. less preoperative stroke (14% vs 27%, p<0.001), less heart failure (45% vs 69%, p<0.001) less cardiac abscesses (24% vs 34%, p=0.018), less acute renal insufficiency requiring hemodialysis (8% vs 14%, p=0.026). The lack of ET management recommendations was an independent predictor for in-hospital mortality (adjusted OR: 2.13, 95% CI: 1.27–3.53, p=0.004) and post-operative stroke (adjusted OR: 2.23, 95% CI: 1.12–4.39, p=0.02), and was associated with worse 5-years survival (59% compared to 40%, log rank<0.001).
Conclusion
Endocarditis-network led to earlier referral of patients, which resulted in less IE-related complications on admission. Lack of ET management recommendations was an independent predictor for post-operative stroke, in-hospital mortality and was associated with worse 5-years survival.
Funding Acknowledgement
Type of funding sources: None. Figure 1Figure 2
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Affiliation(s)
- M Diab
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - M Franz
- University Hospital Jena, Department of Cardiology and Internal Medicine, Jena, Germany
| | - S Hagel
- University Hospital Jena, Institute for Infectious Diseases and Infection Control, Jena, Germany
| | - A Guenther
- University Hospital Jena, Department of Neurology, Jena, Germany
| | - A Struve
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - H Kuehn
- Thueringen-Kliniken Georgius Agricola, Department of Internal Medicine III, Saalfeld, Germany
| | - K Ibrahim
- Hospital Chemnitz, Department of Internal Medicine I, Chemnitz, Germany
| | - M Jahnecke
- St. Georg Hospital, Department of Internal Medicine I, Eisenach, Germany
| | - H Sigusch
- Heinrich-Braun-Hospital, Department of Internal Medicine I, Zwickau, Germany
| | - H Ebelt
- Catholic Hospital St. Johann Nepomuk, Department of Internal Medicine II, Erfurt, Germany
| | - G Faerber
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - T Lehmann
- University Hospital Jena, Department of Medical Statistics, Computer Science and Data Science, Jena, Germany
| | - P C Schulze
- University Hospital Jena, Department of Cardiology and Internal Medicine, Jena, Germany
| | - M W Pletz
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
| | - T Doenst
- University Hospital Jena, Department of Cardiothoracic Surgery, Jena, Germany
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7
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Braeken DCW, Essig A, Panning M, Hoerster R, Nawrocki M, Dalhoff K, Suttorp N, Welte T, Pletz MW, Witzenrath M, Rohde GGU, Rupp J. Shift in bacterial etiology from the CAPNETZ cohort in patients with community-acquired pneumonia: data over more than a decade. Infection 2021; 49:533-537. [PMID: 33774804 PMCID: PMC8159805 DOI: 10.1007/s15010-021-01605-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 12/13/2020] [Accepted: 03/09/2021] [Indexed: 12/25/2022]
Abstract
To determine the most relevant pathogens for CAP in Germany, patients with radiologically confirmed pulmonary infiltrates and at least one clinical sign of lung infection were prospectively recruited within the CAPNETZ cohort from 2004 until 2016. In 990 out of 4.672 patients (21%) receiving complete diagnostics the most prominent change of pathogens was a decrease of S. pneumoniae (58% in 2004 to 37.5% in 2016; p ≤ 0.001, ρ = − 0.148) and an increase of H. influenzae (12.2% to 20.8%; p = 0.001, ρ = 0.104).
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Affiliation(s)
- D C W Braeken
- Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, the Netherlands
| | - A Essig
- Institute of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | - M Panning
- Institute of Virology, University Medical Center-University of Freiburg, Freiburg, Germany
| | - R Hoerster
- Medical Clinic III, Pulmonology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | | | - K Dalhoff
- Medical Clinic III, Pulmonology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - N Suttorp
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Infectious Diseases and Pulmonary Medicine and Division of Pulmonary Inflammation, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - T Welte
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Pneumology and German Center for Lung Research (DZL), Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - M W Pletz
- CAPNETZ STIFTUNG, Hannover, Germany.,Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - M Witzenrath
- CAPNETZ STIFTUNG, Hannover, Germany.,Department of Infectious Diseases and Pulmonary Medicine and Division of Pulmonary Inflammation, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - G G U Rohde
- CAPNETZ STIFTUNG, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Medical Clinic I, Goethe University Hospital, Frankfurt/Main, Germany
| | - J Rupp
- CAPNETZ STIFTUNG, Hannover, Germany. .,Department of Infectious Diseases and Microbiology, University Hospital of Schleswig-Holstein/Campus Lübeck, University of Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
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8
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Weis S, Kesselmeier M, Davis JS, Morris AM, Lee S, Scherag A, Hagel S, Pletz MW. Cefazolin versus anti-staphylococcal penicillins for the treatment of patients with Staphylococcus aureus bacteraemia. Clin Microbiol Infect 2019; 25:818-827. [PMID: 30928559 DOI: 10.1016/j.cmi.2019.03.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [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: 10/21/2018] [Revised: 03/02/2019] [Accepted: 03/09/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND For patients with bacteraemia caused by methicillin-sensitive Staphylococcus aureus anti-staphylococcal penicillins (ASPs) or cefazolin are agents of choice. While ASPs are potentially nephrotoxic, cefazolin may be less effective in some S. aureus strains due to an inoculum effect. OBJECTIVES To perform a systematic literature review and meta-analysis assessing current evidence comparing cefazolin with ASPs for patients with S. aureus bacteraemia (SAB). METHODS We searched MEDLINE, ISI Web of Science (Science Citation Index Expanded) and the Cochrane Database as well as clinicaltrials.gov from inception to 26 June 2018. All studies investigating the effects of cefazolin versus ASP in patients with methicillin-sensitive SAB were eligible for inclusion regardless of study design, publication status or language. Additional information was requested by direct author contact. A meta-analysis to estimate relative risks (RRs) with the corresponding 95% confidence intervals (CIs) was performed. Statistical heterogeneity was estimated using I2. The primary endpoint was 90-day all-cause mortality. The Newcastle-Ottawa Scale (NOS) and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were used for study and data quality assessment. RESULTS Fourteen non-randomized studies were included. Seven reported the primary endpoint (RR 0.71 (0.50, 1.02), low quality of evidence). Cefazolin treatment may be associated with lower 30-day mortality rates (RR 0.70 (0.54, 0.91), low quality of evidence) and less nephrotoxicity (RR 0.36 (0.21, 0.59), (low quality of evidence)). We are uncertain whether cefazolin and ASP differ regarding treatment failure/relapse as the quality of the evidence has been assessed as very low (RR of 0.84 (0.59, 1.18)). For patients with endocarditis (RR 0.71 (0.12, 4.05)) or abscesses (RR 1.17 (0.30, 4.63)), cefazolin treatment may be associated with equal 30-day and 90-day mortality (low quality of evidence). CONCLUSIONS Cefazolin seemed to be at least equally as effective as ASPs while being associated with less nephrotoxicity.
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Affiliation(s)
- S Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany.
| | - M Kesselmeier
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany
| | - J S Davis
- Global and Tropical Health Division, Menzies School of Health Research, Darwin, NT, Australia; Department of Infectious Diseases, John Hunter Hospital, Newcastle, NSW, Australia
| | - A M Morris
- Department of Medicine, Division of Infectious Diseases, Sinai Health System, University Health Network, University of Toronto, Canada
| | - S Lee
- Department of Internal Medicine, Pusan National University School of Medicine and Medical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - A Scherag
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, CSCC, Jena University Hospital, Jena, Germany; Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany
| | - S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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9
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Ewig S, Kolditz M, Pletz MW, Chalmers J. Healthcare-associated pneumonia: is there any reason to continue to utilize this label in 2019? Clin Microbiol Infect 2019; 25:1173-1179. [PMID: 30825674 DOI: 10.1016/j.cmi.2019.02.022] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 11/04/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is an ongoing controversy on the role of the healthcare-associated pneumonia (HCAP) label in the treatment of patients with pneumonia. OBJECTIVE To provide an update of the literature on patients meeting criteria for HCAP between 2014 and 2018. SOURCES The review is based on a systematic literature search using PubMed-Central full-text archive of biomedical and life sciences literature at the U.S. National Institutes of Health's National Library of Medicine (NIH/NLM). CONTENT Studies compared clinical characteristics of patients with HCAP and community-acquired pneumonia (CAP). HCAP patients were older and had a higher comorbidity. Mortality rates in HCAP varied from 5% to 33%, but seemed lower than those cited in the initial reports. Criteria behind the HCAP classification differed considerably within populations. Microbial patterns differed in that there was a higher incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa, and, to a lesser extent, enterobacteriaceae. Definitions and rates of multidrug-resistant (MDR) pneumonia also varied considerably. Broad-spectrum guideline-concordant treatment did not reduce mortality in four observational studies. The HCAP criteria performed poorly as a predictive tool to identify MDR pneumonia or pathogens not covered by treatment for CAP. A new score (Drug Resistance in Pneumonia, DRIP) outperformed HCAP in the prediction of MDR pathogens. Comorbidity and functional status, but not different microbial patterns, seem to account for increased mortality. IMPLICATIONS HCAP should no longer be used to identify patients at risk of MDR pathogens. The use of validated predictive scores along with implementation of de-escalation strategies and careful individual assessment of comorbidity and functional status seem superior strategies for clinical management.
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Affiliation(s)
- S Ewig
- Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, Herne und Bochum, Germany.
| | - M Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - J Chalmers
- Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
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10
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Kolditz M, Schmitt J, Pletz MW, Tesch F. Prävention von Pneumonien. Das Gesundheitswesen 2018. [DOI: 10.1055/s-0038-1667698] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kolditz
- Technische Universität, Universitätsklinikum Carl Gustav Carus, Medizinische Klinik I, Pneumonie, Dresden, Deutschland
| | - J Schmitt
- Technische Universität, Medizinische Fakultät Carl Gustav Carus, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
| | - MW Pletz
- Universitätsklinikum, Institut für Infektionsmedizin und Krankenhaushygiene, Jena, Deutschland
| | - F Tesch
- Technische Universität, Medizinische Fakultät Carl Gustav Carus, Zentrum für Evidenzbasierte Gesundheitsversorgung, Dresden, Deutschland
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11
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Richter DC, Heininger A, Brenner T, Hochreiter M, Bernhard M, Briegel J, Dubler S, Grabein B, Hecker A, Krüger WA, Mayer K, Pletz MW, Störzinger D, Pinder N, Hoppe-Tichy T, Weiterer S, Zimmermann S, Brinkmann A, Weigand MA, Lichtenstern C. [Bacterial sepsis : Diagnostics and calculated antibiotic therapy]. Anaesthesist 2018; 66:737-761. [PMID: 28980026 DOI: 10.1007/s00101-017-0363-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
The mortality of patients with sepsis and septic shock is still unacceptably high. An effective antibiotic treatment within 1 h of recognition of sepsis is an important target of sepsis treatment. Delays lead to an increase in mortality; therefore, structured treatment concepts form a rational foundation, taking relevant diagnostic and treatment steps into consideration. In addition to the assumed focus and individual risks of each patient, local resistance patterns and specific problem pathogens must be taken into account for selection of anti-infection treatment. Many pathophysiological alterations influence the pharmacokinetics of antibiotics during sepsis. The principle of standard dosing should be abandoned and replaced by an individual treatment approach with stronger weighting of the pharmacokinetics/pharmacodynamics (PK/PD) index of the substance groups. Although this is not yet the clinical standard, prolonged (or continuous) infusion of beta-lactam antibiotics and therapeutic drug monitoring (TDM) can help to achieve defined PK targets. Prolonged infusion is sufficient without TDM but for continuous infusion TDM is basically necessary. A further argument for individual PK/PD-oriented antibiotic approaches is the increasing number of infections due to multidrug resistant pathogens (MDR) in the intensive care unit. For effective treatment antibiotic stewardship teams (ABS team) are becoming more established. Interdisciplinary cooperation of the ABS team with infectiologists, microbiologists and clinical pharmacists leads not only to a rational administration of antibiotics but also has a positive influence on the outcome. The gold standards for pathogen detection are still culture-based detection and microbiological resistance testing for the various antibiotic groups. Despite the rapid investigation time, novel polymerase chain reaction (PCR)-based procedures for pathogen identification and resistance determination, are currently only an adjunct to routine sepsis diagnostics due to the limited number of studies, high costs and limited availability. In complicated septic courses with multiple anti-infective treatment or recurrent sepsis, PCR-based procedures can be used in addition to therapy monitoring and diagnostics. Novel antibiotics represent potent alternatives in the treatment of MDR infections. Due to the often defined spectrum of pathogens and the practically absent resistance, they are suitable for targeted treatment of severe MDR infections (therapy escalation).
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Affiliation(s)
- D C Richter
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland.
| | - A Heininger
- Zentrum für Infektiologie, Sektion für Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - T Brenner
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Hochreiter
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - M Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - J Briegel
- Klinik für Anästhesiologie, Klinikum der Universität München, München, Deutschland
| | - S Dubler
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - B Grabein
- Stabsstelle "Klinische Mikrobiologie und Krankenhaushygiene", Klinikum der Universität München, München, Deutschland
| | - A Hecker
- Klinik für Allgemein‑, Viszeral‑, Thorax‑, Transplantations- und Kinderchirurgie, Universitätsklinikum Gießen und Marburg, Standort Gießen, Gießen, Deutschland
| | - W A Krüger
- Klinik für Anästhesiologie und operative Intensivmedizin, Gesundheitsverbund Landkreis Konstanz, Klinikum Konstanz, Konstanz, Deutschland
| | - K Mayer
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - D Störzinger
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - N Pinder
- Apotheke des Universitätsklinikums Heidelberg, Heidelberg, Deutschland
| | - T Hoppe-Tichy
- Zentrum für Infektiologie, Sektion für Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - S Weiterer
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - S Zimmermann
- Zentrum für Infektiologie, Sektion für Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Brinkmann
- Klinik für Anästhesie, operative Intensivmedizin und spezielle Schmerztherapie, Klinikum Heidenheim, Heidenheim, Deutschland
| | - M A Weigand
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
| | - Christoph Lichtenstern
- Klinik für Anästhesiologie, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Deutschland
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12
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Hagel S, Ludewig K, Pletz MW, Frosinski J, Moeser A, Wolkewitz M, Gastmeier P, Harbarth S, Brunkhorst FM, Kesselmeier M, Scherag A. Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: a prospective interventional study. Clin Microbiol Infect 2018; 25:462-468. [PMID: 30036671 DOI: 10.1016/j.cmi.2018.07.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [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: 04/27/2018] [Revised: 07/03/2018] [Accepted: 07/07/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVES To evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs). METHODS Prospective, quasi-experimental study with two surveillance periods (September 2011 to August 2012; May 2013 to August 2014). Starting October 2012, the ICP included hand hygiene promotion and bundle implementation for common HAIs. We applied segmented mixed-effects Poisson regression and multi-state models. We reported adjusted incidence rate ratios (aIRR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI). RESULTS Overall, 62 154 patients were under surveillance, with 1568 HAIs identified in 1170 patients (4.3 per 100 admissions) in the first and 2336 HAIs identified in 1711 patients (4.9 per 100 admissions) in the second surveillance period. No differences were found in the overall HAI incidence rates between the periods in the general wards (aIRR 1.29, 95% CI 0.78-2.15) and intensive care units (ICUs) (aIRR 0.59, 95% CI 0.27-1.31). However, the HAI incidence rate was declining in the ICUs after starting the ICP (aIRR 0.98, 95% CI 0.97-1.00 per 1-week increment), in contrast to general wards (aIRR 1.01, 95% CI 1.00-1.02). A reduction in severe HAIs (aIRR 0.13, 95% CI 0.05-0.32) and a lower probability of HAI-associated in-hospital deaths (aHR 0.56, 95% CI 0.31-0.99) were observed in the second period in the ICUs. CONCLUSIONS There was no overall reduction in HAIs after implementation of the ICP. However, there was a significant reduction in severe HAIs in ICUs. Whether this difference was a consequence of the ICP or improvement in HAI case management is not clear.
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Affiliation(s)
- S Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
| | - K Ludewig
- Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anaesthesiology and Intensive Care Therapy, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - J Frosinski
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - A Moeser
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Jena University Hospital, Jena, Germany
| | - M Wolkewitz
- Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Centre-University of Freiburg, Freiburg, Germany; Freiburg Centre of Data Analysis and Modelling, University of Freiburg, Freiburg, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Medical School and WHO Collaborating Centre, Geneva, Switzerland
| | - F M Brunkhorst
- Centre for Clinical Studies Jena, Jena University Hospital, Jena, Germany
| | - M Kesselmeier
- Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - A Scherag
- Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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13
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Braeken DCW, Franssen FME, von Baum H, Schütte H, Pletz MW, Rupp J, Stassen F, Mooij MJ, Rohde GGU. Bacterial aetiology and mortality in COPD patients with CAP: results from the German Competence Network, CAPNETZ. Int J Tuberc Lung Dis 2018; 21:236-243. [PMID: 28234091 DOI: 10.5588/ijtld.16.0567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood. OBJECTIVES 1) To assess the bacterial aetiology of CAP only and CAP-COPD, and 2) to study the association between bacterial aetiology, empirical antibiotic treatment, serum markers and mortality. METHODS Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons. RESULTS Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P < 0.001). The number given adequate empirical antibiotic treatment was comparable (83.3% CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P < 0.001). Partial pressure of arterial carbon dioxide levels were increased in CAP-COPD patients without pathogen detection (P < 0.001). Short- (P = 0.011) and long-term mortality (P = 0.006) were highest in CAP-COPD without pathogen detection. CONCLUSION It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.
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Affiliation(s)
- D C W Braeken
- Department of Research and Education, CIRO, Horn, Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - F M E Franssen
- Department of Research and Education, CIRO, Horn, Department of Respiratory Medicine, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - H von Baum
- Department of Medical Microbiology and Hygiene, University Hospital of Ulm, Ulm, Germany
| | - H Schütte
- Department of Internal Medicine/Infectious Diseases and Respiratory Medicine, Ernst von Bergmann Klinikum, Potsdam, CAPNETZ Stiftung, Hannover, Germany
| | - M W Pletz
- CAPNETZ Stiftung, Hannover, Center for Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - J Rupp
- CAPNETZ Stiftung, Hannover, Department of Molecular and Clinical Infectious Diseases, University of Lübeck, Lübeck, Germany
| | - F Stassen
- Department of Medical Microbiology, MUMC+, Maastricht, The Netherlands
| | - M J Mooij
- Department of Medical Microbiology, MUMC+, Maastricht, The Netherlands
| | - G G U Rohde
- Department of Research and Education, CIRO, Horn, CAPNETZ Stiftung, Hannover, Germany
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14
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Hoerr V, Franz M, Pletz MW, Diab M, Niemann S, Faber C, Doenst T, Schulze PC, Deinhardt-Emmer S, Löffler B. S. aureus endocarditis: Clinical aspects and experimental approaches. Int J Med Microbiol 2018. [PMID: 29526448 DOI: 10.1016/j.ijmm.2018.02.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening disease, caused by septic vegetations and inflammatory foci on the surface of the endothelium and the valves. Due to its complex and often indecisive presentation the mortality rate is still about 30%. Most frequently bacterial microorganisms entering the bloodstream are the underlying origin of the intracardiac infection. While the disease was primarily restricted to younger patients suffering from rheumatic heart streptococci infections, new at risk categories for Staphylococcus (S.) aureus infections arose over the last years. Rising patient age, increasing drug resistance, intensive treatment conditions such as renal hemodialysis, immunosuppression and long term indwelling central venous catheters but also the application of modern cardiac device implants and valve prosthesis have led to emerging incidences of S. aureus IE in health care settings and community. The aetiologic change has impact on the pathophysiology of IE, the clinical presentation and the overall patient management. Despite intensive research on appropriate in vitro and in vivo models of IE and gained knowledge about the fundamental mechanisms in the formation of bacterial vegetations and extracardiac complications, improved understanding of relevant bacterial virulence factors and triggered host immune responses is required to help developing novel antipathogenic treatment strategies and pathogen specific diagnostic markers. In this review, we summarize and discuss the two main areas affected by the changing patient demographics and provide first, recent knowledge about the pathogenic strategies of S. aureus in the induction of IE, including available experimental models of IE used to study host-pathogen interactions and diagnostic and therapeutic targets. In a second focus we present diagnostic (imaging) regimens for patients with S. aureus IE according to current guidelines as well as treatment strategies and surgical recommendations.
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Affiliation(s)
- V Hoerr
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany.
| | - M Franz
- Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - M Diab
- Department of Cardiothoracic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Niemann
- Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany
| | - C Faber
- Department of Clinical Radiology, University Hospital Münster, Albert-Schweitzer-Campus 1, Building A16, 48149 Münster, Germany
| | - T Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - P C Schulze
- Department of Internal Medicine I, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - S Deinhardt-Emmer
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
| | - B Löffler
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747 Jena, Germany
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15
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Sobke A, Makarewicz O, Baier M, Bär C, Pfister W, Gatermann SG, Pletz MW, Forstner C. Empirical treatment of lower urinary tract infections in the face of spreading multidrug resistance: in vitro study on the effectiveness of nitroxoline. Int J Antimicrob Agents 2017; 51:213-220. [PMID: 29111434 DOI: 10.1016/j.ijantimicag.2017.10.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 08/21/2017] [Revised: 10/18/2017] [Accepted: 10/21/2017] [Indexed: 10/18/2022]
Abstract
The spread of antimicrobial resistance challenges the empirical treatment of urinary tract infections (UTIs). Among others, nitrofurantoin is recommended for first-line treatment, but acceptance among clinicians is limited due to chronic nitrofurantoin-induced lung toxicity and insufficient coverage of Enterobacteriaceae other than Escherichia coli. Nitroxoline appears to be an alternative to nitrofurantoin owing to its favourable safety profile, however data on its current in vitro susceptibility are sparse. In this study, susceptibility to nitroxoline was tested against 3012 urinary clinical isolates (including multidrug-resistant bacteria and Candida spp.) by disk diffusion test and/or broth microdilution. At least 91% of all Gram-negatives (n = 2000), Gram-positives (n = 403) and yeasts (n = 132) had inhibition zone diameters for nitroxoline ≥18 mm. Except for Pseudomonas aeruginosa, nitroxoline MIC90 values were ≤16 mg/L and were 2- to >16-fold lower compared with nitrofurantoin. In extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus (MRSA), MIC90 values of nitroxoline were two-fold higher compared with non-ESBL-producing enterobacteria and methicillin-susceptible S. aureus (MSSA). The in vitro efficacies of nitroxoline and nitrofurantoin against ATCC strains of E. coli, Enterococcus faecalis and Proteus mirabilis were compared by time-kill curves in Mueller-Hinton broth and artificial urine. Nitroxoline was non-inferior against E. coli, P. mirabilis and E. faecalis in artificial urine. In conclusion, nitroxoline showed a broad antimicrobial spectrum, with inhibition zone diameters and MICs of nitroxoline well below the EUCAST breakpoint for E. coli for most organisms, and thus may also be a target for therapy of uncomplicated UTIs.
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Affiliation(s)
- A Sobke
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - O Makarewicz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - M Baier
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Bär
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - W Pfister
- Institute of Medical Microbiology, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - S G Gatermann
- Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801, Bochum, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany
| | - C Forstner
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Am Klinikum 1, 07747, Jena, Germany; Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
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16
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Grote U, Schleenvoigt BT, Happle C, Dopfer C, Wetzke M, Ahrenstorf G, Holst H, Pletz MW, Schmidt RE, Behrens GM, Jablonka A. Norovirus outbreaks in german refugee camps in 2015. Z Gastroenterol 2017; 55:997-1003. [PMID: 29020698 DOI: 10.1055/s-0043-109701] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Purpose Refugees often live in confined housing conditions with shared kitchen and sanitary facilities, rendering susceptible to communicable diseases. We here describe the outbreak, spread and self-limiting nature of a norovirus outbreak in a German refugee camp in the winter of 2015. Methods During a norovirus outbreak, data on clinical symptoms, nationality and living conditions was obtained in a refugee camp in northern Germany in the winter of 2015. Furthermore secondary data on norovirus outbreaks in 2015 was assessed. Results Amongst n = 982 refugees, n = 36 patients (3.7 %) presented with acute norovirus gastroenteritis. The vast majority of cases were children, only the first patient was admitted to the hospital. Intensified hygiene measures were implemented on day 2 of the outbreak, but new cases peaked on day 21 and occurred until one month after the first case. Different cultural backgrounds, eating habits and hygiene standards amongst the refugees made it particularly challenging to implement stringent isolation and hygiene measures. Despite these predisposing factors, only minor norovirus outbreaks were reported in refugee camps in 2015. Conclusion Adults refugees had a low attack rate of symptomatic norovirus infection, while small children are at high risk. Infection spreads despite hygiene measures and camp sites and staff should be prepared for the particular challenges of such situations with a particular focus on cultural-background specific implementation of hygiene measures.
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Affiliation(s)
- Ulrike Grote
- Department of Hematology and Oncology, Hannover Medical School, Hannover, Germany
| | | | - Christine Happle
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Christian Dopfer
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Martin Wetzke
- Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Hannover, Germany
| | - Gerrit Ahrenstorf
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Hannover, Germany
| | - Hanna Holst
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Hannover, Germany
| | - Mathias Wilhelm Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Reinhold Ernst Schmidt
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Hannover, Germany
| | - Georg Mn Behrens
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Hannover, Germany
| | - Alexandra Jablonka
- Department of Clinical Immunology and Rheumatology, Hannover Medical School, Hannover, Germany.,German Center for Infection Research, Hannover, Germany
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17
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Kolditz M, Schmitt J, Pletz MW, Tesch F. Impact of pneumococcal polysaccharide vaccine on incidence and mortality after pneumonia in adults aged ≥60 years-a population-based retrospective cohort study. Clin Microbiol Infect 2017; 24:500-504. [PMID: 28830805 DOI: 10.1016/j.cmi.2017.08.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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: 07/02/2017] [Revised: 08/11/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The 23-valent pneumococcal polysaccharide vaccine (PPV) is recommended for prevention of pneumococcal diseases in adults at risk. Few data exist on time-, age- and sex-dependent vaccine effectiveness on outcomes in pneumonia. METHODS We performed a population-based cohort study including adults ≥60 years of age (n = 738 927) based on statutory health insurance data from 2005 to 2011. Primary outcomes were all-cause pneumonia incidence and 30-day all-cause mortality. Pneumonia was identified by International Classification of Diseases, 10th Revision, German Modification (ICD-10-GM) codes, with ambulatory cases validated by antibiotic prescription within 7 days. The effect of PPV within 5 years was analysed after propensity score-based matching (three controls per case with PPV vaccination) including comorbidities, care status, age, sex and influenza vaccination. Evaluations were stratified by age group, sex and time of PPV. RESULTS Two-year incidence of all-cause pneumonia in 213 431 vaccinated individuals was 7501 (3.51%) of 213 431 vs. 23 243 (3.63%) of 640 293 in matched controls (difference -0.11, 95% confidence interval (CI) -0.22 to -0.002, p 0.046). After sex-dependent analysis, PPV effectiveness on pneumonia incidence was observed only in women (difference -0.15, 95% CI -0.28 to -0.02, p 0.02). Thirty-day mortality in vaccinated individuals with pneumonia was 1302 (17.36%) of 7501 vs. 4267 (18.96%) of 22 503 in matched controls (difference -1.60%, 95% CI -2.83 to -0.38, p 0.011). After analysis according to age group, significant mortality reduction was present only in adults aged 60 to 79 years (difference -2.31, 95% CI -3.79 to -0.83, p 0.002). Year of PPV vaccination showed no effect on outcomes. CONCLUSIONS The findings support consideration of sex and age dependence of PPV effectiveness in future studies.
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Affiliation(s)
- M Kolditz
- Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany.
| | - J Schmitt
- Dresden University Centre for Evidence-Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - F Tesch
- Dresden University Centre for Evidence-Based Healthcare, Medical Faculty, Technische Universität Dresden, Dresden, Germany
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18
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Njeru J, Tomaso H, Mertens K, Henning K, Wareth G, Heller R, Kariuki S, Fèvre EM, Neubauer H, Pletz MW. Serological evidence of Francisella tularensis in febrile patients seeking treatment at remote hospitals, northeastern Kenya, 2014-2015. New Microbes New Infect 2017; 19:62-66. [PMID: 28721222 PMCID: PMC5498284 DOI: 10.1016/j.nmni.2017.05.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/16/2017] [Accepted: 05/29/2017] [Indexed: 11/02/2022] Open
Abstract
Tularaemia is a highly contagious infectious zoonosis caused by the bacterial agent Francisella tularensis. The aim of this study was to investigate the presence of antibodies to F. tularensis in febrile patients in northeastern Kenya. During 2014-2015, 730 patients were screened for anti-F. tularensis antibodies using a combination of ELISA and Western blot. Twenty-seven (3.7%) individuals were positive for F. tularensis. Tularaemia was not suspected by the treating clinicians in any of them. Our results suggest that tularaemia may be present in Kenya but remain unreported, and emphasizes the need for local clinicians to broaden their diagnostic repertoire when evaluating patients with undifferentiated febrile illness.
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Affiliation(s)
- J Njeru
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institute, Jena, Germany.,Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.,Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - H Tomaso
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institute, Jena, Germany
| | - K Mertens
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institute, Jena, Germany
| | - K Henning
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institute, Jena, Germany
| | - G Wareth
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institute, Jena, Germany.,Faculty of Veterinary Medicine, Benha University, Moshtohor, Egypt
| | - R Heller
- Institute for Molecular Cell Biology, Center for Molecular Biomedicine, Friedrich Schiller University of Jena, Jena, Germany
| | - S Kariuki
- Centre for Microbiology Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - E M Fèvre
- Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.,International Livestock Research Institute, Nairobi, Kenya
| | - H Neubauer
- Institute of Bacterial Infections and Zoonoses, Friedrich-Loeffler-Institute, Jena, Germany
| | - M W Pletz
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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19
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Holtfreter MC, Neubauer H, Groten T, El-Adawy H, Pastuschek J, Richter J, Häussinger D, Pletz MW, Schleenvoigt BT. Improvement of a tissue maceration technique for the determination of placental involvement in schistosomiasis. PLoS Negl Trop Dis 2017; 11:e0005551. [PMID: 28437474 PMCID: PMC5402960 DOI: 10.1371/journal.pntd.0005551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 04/04/2017] [Indexed: 11/19/2022] Open
Abstract
Schistosomiasis in pregnancy may cause low birth weight, prematurity and stillbirth of the offspring. The placenta of pregnant women might be involved when schistosome ova are trapped in placental tissue. Standard histopathological methods only allow the examination of a limited amount of placental tissue and are therefore not sufficiently sensitive. Thus, placental schistosomiasis remains underdiagnosed and its role in contributing to schistosomiasis-associated pregnancy outcomes remains unclear. Here we investigated an advanced maceration method in order to recover a maximum number of schistosome ova from the placenta. We examined the effect of different potassium hydroxide (KOH) concentrations and different tissue fixatives with respect to maceration success and egg morphology. Placental tissue was kept either in 0.9% saline, 5% formalin or 70% ethanol and was macerated together with Schistosoma mansoni infested mouse livers and KOH 4% or 10%, respectively. We found that placenta maceration using 4% KOH at 37°C for 24 h was the most effective method: placental tissue was completely digested, egg morphology was well preserved and alkaline concentration was the lowest. Ethanol proved to be the best fixative for this method. Here we propose an improved maceration technique in terms of sensitivity, safety and required skills, which may enable its wider use also in endemic areas. This technique may contribute to clarifying the role of placental involvement in pregnant women with schistosomiasis. Schistosomiasis in pregnant women is associated with prematurity, low birth weight and stillbirth of the fetus. Schistosome eggs may be trapped in the placental tissue and, thus, contribute to fetal harm. As the placenta is a large organ, current microscopic histopathological examinations commonly lack sensitivity. The yield of schistosome eggs can be increased by the use of tissue maceration. However, the applied maceration procedures are labor intensive, time-consuming and cumbersome. To develop an improved maceration technique in terms of sensitivity, safety and required skills which enable its wider use in endemic areas we examined the effect of different potassium hydroxide (KOH) concentrations and different tissue fixatives with respect to maceration success and egg morphology. Placenta maceration using 4% KOH at 37°C for 24 h was the most effective method: placental tissue was completely digested, egg morphology was well preserved and alkaline concentration was the lowest. This improved technique may contribute to clarify the role of placental involvement in pregnant women with schistosomiasis.
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Affiliation(s)
- Martha Charlotte Holtfreter
- Tropical Medicine Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Heinrich Neubauer
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Tanja Groten
- Department of Gynaecology and Obstetrics, Jena University Hospital, Jena, Germany
| | - Hosny El-Adawy
- Friedrich-Loeffler-Institut, Federal Research Institute for Animal Health, Institute of Bacterial Infections and Zoonoses, Jena, Germany
| | - Jana Pastuschek
- Department of Gynaecology and Obstetrics, Jena University Hospital, Jena, Germany
| | - Joachim Richter
- Institute of Tropical Medicine and International Public Health, Charité Universitätsmedizin, Berlin, Germany
| | - Dieter Häussinger
- Tropical Medicine Unit, Department of Gastroenterology, Hepatology and Infectious Diseases, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Mathias Wilhelm Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
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20
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Schleenvoigt BT, Rupp J, Rohde G, Rockstroh JK, Fätkenheuer G, Pletz MW. [Strategies for the Treatment of Community-Acquired Pneumonia in HIV-Positive Patients]. Pneumologie 2017; 71:207-214. [PMID: 28407674 DOI: 10.1055/s-0043-101254] [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: 10/19/2022]
Abstract
Study purpose According to the Robert Koch Institute, 84,700 people in Germany suffer from HIV infection. One-third of the affected persons is over 50 years old. In Germany, community-acquired pneumonia (CAP) is a widespread disease with more than 250,000 cases per year. Incidence and mortality increase with the age of the affected individuals. For this reason, diagnostic and therapeutic strategies are needed to guide medical care of HIV-infected patients presenting with CAP. Methodology HIV therapists were interviewed about their diagnostic approach, risk stratification strategy and therapeutic approach to HIV-associated community-acquired pneumonia (HIV +/CAP) using a questionnaire. 56 completed questionnaires were analysed. Results Half of the respondents reported that CAP occurred in 1 to 5 % of HIV-infected individuals per year. This indicates an estimated number of up to 4200 HIV +/CAP cases per year in Germany - a much higher number than expected from the literature. 58.9 % of respondents considered that the pathogenic spectrum did not differ in HIV +/CAP from non-HIV/CAP. 80.3 % of respondents applied the same antibiotic regimens in HIV +/CAP as used in patients with non-HIV/CAP. Conclusion Even though over 40 % of HIV therapists agree that the pathogenic spectrum of HIV +/CAP differs from that of non-HIV/CAP, over 80 % of therapists managed these patients in accordance with the S3-guidelines for non-immunocompromised CAP-patients, because specific guidelines for the treatment of HIV +/CAP are lacking. Since specific data on the aetiology and the clinical course of HIV +/CAP depending, for instance, on CD4-count and antiretroviral therapy are missing, we feel that the clinical course of HIV +/CAP should be further analysed in the context of prospective cohort studies.
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Affiliation(s)
- B T Schleenvoigt
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
| | | | | | - J K Rockstroh
- Medizinische Klinik und Poliklinik I, Universitätsklinik Bonn, Bonn
| | - G Fätkenheuer
- Klinik für Innere Medizin I, Universitätsklinikum Köln, Köln und Deutsches Zentrum für Infektionsforschung (DZIF) Partnerstandort Bonn-Köln
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21
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Weis S, Hagel S, Schmitz RPH, Scherag A, Brunkhorst FM, Forstner C, Löffler B, Pletz MW. Study on the utility of a statewide counselling programme for improving mortality outcomes of patients with Staphylococcus aureus bacteraemia in Thuringia (SUPPORT): a study protocol of a cluster-randomised crossover trial. BMJ Open 2017; 7:e013976. [PMID: 28391236 PMCID: PMC5775453 DOI: 10.1136/bmjopen-2016-013976] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Staphylococcus aureus bacteraemia (SAB) is a frequent infection with high mortality rates. It requires specific diagnostic and therapeutic management such as prolonged intravenous administration of antibiotics and aggressive search for and control of infectious sources. Underestimation of disease severity frequently results in delayed or inappropriate management of patients with SAB leading to increased mortality rates. According to observational studies, patient counselling by infectious disease consultants (IDC) improves survival and reduces the length of hospital stay as well as complication rates. In many countries, IDC are available only in some tertiary hospitals. In this trial, we aim to demonstrate that the outcome of patients with SAB in small and medium size hospitals that do not employ IDC can be improved by unsolicited ID phone counselling. The SUPPORT trial will be the first cluster-randomised controlled multicentre trial addressing this question. METHODS AND ANALYSIS SUPPORT is a single-blinded, multicentre interventional, cluster-randomised, controlled crossover trial with a minimum of 15 centres that will include 250 patients with SAB who will receive unsolicited IDC counselling and 250 who will receive standard of care. Reporting of SAB will be conducted by an electronic real-time blood culture registry established for the German Federal state of Thuringia (ALERTSNet) or directly by participating centres in order to minimise time delay before counselling. Mortality, disease course and complications will be monitored for 90 days with 30-day all-cause mortality rates as the primary outcome. Generalised linear mixed modelling will be used to detect the difference between the intervention sequences. We expect improved outcome of patients with SAB after IDC. ETHICS AND DISSEMINATION We obtained ethics approval from the Ethics committee of the Jena University Hospital and from the Ethics committee of the State Chamber of Physicians of Thuringia. Results will be published in a peer-reviewed journal and additionally disseminated through public media. TRIAL REGISTRATION NUMBER DRKS00010135.
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Affiliation(s)
- S Weis
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
| | - S Hagel
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - R P H Schmitz
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - A Scherag
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - F M Brunkhorst
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
- Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany
- Center for Clinical Studies, Jena University Hospital, Jena, Germany
| | - C Forstner
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Department of Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - B Löffler
- Institute for Medical Microbiology, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Center for Infectious Disease and Infection Control, Jena University Hospital, Jena, Germany
- Center for Sepsis Control and Care, Jena University Hospital, Jena, Germany
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Weis S, Kimmig A, Hagel S, Pletz MW. [Antibiotic stewardship and Staphylococcus aureus Bacteremia]. Med Klin Intensivmed Notfmed 2017; 112:192-198. [PMID: 28378151 DOI: 10.1007/s00063-017-0270-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 01/06/2017] [Accepted: 02/13/2017] [Indexed: 01/01/2023]
Abstract
Rates of antibiotic resistance are increasing worldwide and impact on the treatment of patients with bacterial infections. A broad and uncritical application in inpatient and outpatient settings as well as in agriculture has been recognized as the main driving force. Antibiotic stewardship (ABS) programs aim at countering this worrisome development using various direct interventions such as infectious disease counseling. Blood stream infections caused by Staphylococcus (S.) aureus are severe infections associated with high mortality rates. ABS interventions such as de-eskalation of the antibiotic regimen or application of narrow-spectrum beta-lactam antibiotics can significantly reduce mortality rates. In this review, we discuss the importance of ABS programs and infectious disease counseling for the treatment of S. aureus blood stream infection.
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Affiliation(s)
- S Weis
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland.
- Center for Sepsis Control and Care, Universitätsklinikum Jena, Jena, Deutschland.
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Jena, Jena, Deutschland.
| | - A Kimmig
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
| | - S Hagel
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
- Center for Sepsis Control and Care, Universitätsklinikum Jena, Jena, Deutschland
| | - M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Am Klinikum 1, 07740, Jena, Deutschland
- Center for Sepsis Control and Care, Universitätsklinikum Jena, Jena, Deutschland
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23
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Reiser M, Scherag A, Forstner C, Brunkhorst FM, Harbarth S, Doenst T, Pletz MW, Hagel S. Effect of pre-operative octenidine nasal ointment and showering on surgical site infections in patients undergoing cardiac surgery. J Hosp Infect 2016; 95:137-143. [PMID: 28109620 DOI: 10.1016/j.jhin.2016.11.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [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: 10/04/2016] [Accepted: 11/11/2016] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To evaluate the effect of pre-operative octenidine (OCT) decolonization on surgical site infection (SSI) rates. DESIGN Before-and-after cohort study. PATIENTS Patients undergoing an elective isolated coronary artery bypass graft (CABG) procedure: control group (1st January to 31st December 2013), N=475; intervention group (1st January to 31st December 2014), N=428. INTERVENTIONS The intervention consisted of nasal application of OCT ointment three times daily, beginning on the day before surgery, and showering the night before and on the day of surgery with OCT soap. RESULTS A median sternotomy was performed in 805 (89.1%) patients and a minimally invasive direct coronary artery bypass procedure was performed in 98 (10.9%) patients. Overall, there was no difference in SSI rates between the control and intervention groups (15.4% vs 13.3%, P=0.39). The rate of harvest site SSIs was significantly lower in patients in the intervention group (2.5% vs 0.5%, P=0.01). Patients who had undergone a median sternotomy in the intervention group had a significantly lower rate of organ/space sternal SSIs (1.9% vs 0.3%, P=0.04). However, there was a trend towards an increased rate of deep incisional sternal SSIs (1.2% vs 2.9%, P=0.08). Multi-variate analysis did not identify a significant protective effect of the intervention (odds ratio 0.79, 95% confidence interval 0.53-1.15, P=0.27). CONCLUSIONS Pre-operative decolonization with OCT did not reduce overall SSI rates in patients undergoing an elective isolated CABG procedure, but significantly decreased harvest site and organ/space sternal SSIs. Randomized controlled trials, including controlled patient adherence to the intervention, are required to confirm these observations and to determine the clinical utility of OCT in pre-operative decolonization.
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Affiliation(s)
- M Reiser
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - A Scherag
- Integrated Research and Treatment Centre, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany
| | - C Forstner
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Department of Internal Medicine I, Division of Infectious Diseases and Tropical Medicine, Medical University of Vienna, Vienna, Austria
| | - F M Brunkhorst
- Centre for Clinical Studies Jena, Jena University Hospital, Jena, Germany
| | - S Harbarth
- Infection Control Programme, Geneva University Hospitals and Medical School, Geneva, Switzerland
| | - T Doenst
- Department of Cardiothoracic Surgery, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - S Hagel
- Centre for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Integrated Research and Treatment Centre, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
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24
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Rüddel J, Schleenvoigt BT, Schüler E, Schmidt C, Pletz MW, Stallmach A. Yellow fever vaccination during treatment with infliximab in a patient with ulcerative colitis: A case report. Z Gastroenterol 2016; 54:1081-4. [PMID: 27612222 DOI: 10.1055/s-0042-109871] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We report the case of a 59-year-old patient who accidentally underwent live vaccination against yellow fever during continuous treatment with the TNF-α-antibody (AB) infliximab for ulcerative colitis. The clinical course showed fever of short duration and elevation of liver enzymes without further clinical complications. Yellow fever viremia was not detectable and protective antibodies were developed. A primary vaccination against yellow fever under infliximab has not been reported in the literature before, although vaccination is an important topic in IBD. Live vaccinations, like Stamaril(®) against yellow fever, are contraindicated during TNF-α-AB treatment. Treatment regimens containing TNF-α-AB are of growing importance, not only in gastroenterology, but also in rheumatology and dermatology. We discuss this topic by presenting our case and reviewing the current literature.
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Affiliation(s)
- J Rüddel
- Department of Internal Medicine IV, Department of Gastroenterology, Hepatology and Infectious Disease, Jena University Hospital, Jena, Germany
| | - B T Schleenvoigt
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - E Schüler
- Health Office, City of Erfurt, Erfurt, Germany
| | - C Schmidt
- Department of Internal Medicine IV, Department of Gastroenterology, Hepatology and Infectious Disease, Jena University Hospital, Jena, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - A Stallmach
- Department of Internal Medicine IV, Department of Gastroenterology, Hepatology and Infectious Disease, Jena University Hospital, Jena, Germany
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25
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Njeru J, Henning K, Pletz MW, Heller R, Neubauer H. Q fever is an old and neglected zoonotic disease in Kenya: a systematic review. BMC Public Health 2016; 16:297. [PMID: 27048480 PMCID: PMC4822290 DOI: 10.1186/s12889-016-2929-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [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: 08/25/2015] [Accepted: 03/06/2016] [Indexed: 12/15/2022] Open
Abstract
Background Q fever is a neglected zoonosis caused by the bacterium Coxiella burnetii. The knowledge of the epidemiology of Q fever in Kenya is limited with no attention to control and prevention programs. The purpose of this review is to understand the situation of Q fever in human and animal populations in Kenya in the past 60 years, and help identify future research priorities for the country. Methods Databases were searched for national and international scientific studies or reports on Q fever. We included studies and reports published between 1950 and 2015 if they reported on Q fever prevalence, incidence, and infection control programs in Kenya. Data were extracted with respect to studies on prevalence of Coxiella infections, study design, study region, the study populations involved, and sorted according to the year of the study. Results We identified 15 studies and reports which qualified for data extraction. Human seroprevalence studies revealed evidence of C. burnetii infections ranging from 3 to 35.8 % in all regions in which surveys were made and two Q fever outbreak episodes. Coxiella burnetii infections found in cattle 7.4–51.1 %, sheep 6.7–20 %, camels 20–46 %, and goats 20–46 % revealed variation based on ecoregions and the year of study. Farming and lack of protective clothing were associated with increased seropositivity among humans. However, high quality data is lacking on Q fever awareness, underlying cultural-economic factors influencing C. burnetii infection, and how the pathogen cycles may be embedded in livestock production and management systems in the economically and ecologically different Kenyan regions. We found no studies on national disease incidence estimates or disease surveillance and control efforts. Conclusion Coxiella burnetii infections are common in human and in a wide range of animal populations but are still unrecognized and underestimated thus presenting a significant human and animal health threat in Kenya. The factors influencing pathogen transmission, persistence and spread are poorly understood. Integrated disease surveillance and prevention/control programs are needed in Kenya.
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Affiliation(s)
- J Njeru
- Institute of Bacterial Infections and Zoonosis, Friedrich-Loeffler-Institut, 07743, Jena, Germany. .,Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740, Jena, Germany. .,Centre for Microbiology Research (CMR), Kenya Medical Research Institute, P. O. Box 19464-00202, Nairobi, Kenya.
| | - K Henning
- Institute of Bacterial Infections and Zoonosis, Friedrich-Loeffler-Institut, 07743, Jena, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, 07740, Jena, Germany
| | - R Heller
- Center for Molecular Biomedicine, Institute for Molecular Cell Biology, Friedrich Schiller University Jena, 07745, Jena, Germany
| | - H Neubauer
- Institute of Bacterial Infections and Zoonosis, Friedrich-Loeffler-Institut, 07743, Jena, Germany
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26
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Fätkenheuer G, Kwetkat A, Pletz MW, Schelling J, Schulz RJ, van der Linden M, Welte T. [Prevention in the elderly: position paper on pneumococcal vaccinations. Results of an expert workshop on 15 November 2013 in Cologne, Germany]. Z Gerontol Geriatr 2015; 47:302-9. [PMID: 24850498 DOI: 10.1007/s00391-014-0650-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Infections due to pneumococci especially in the elderly are vastly underestimated, e.g., because non-invasive infections such as pneumonia may appear with only few symptoms. Sequential vaccination with the pneumococcal conjugate vaccine PCV13, followed by the 23-valent polysaccharide vaccine, is considered as the best preventive measure for individual protection, even though clinical study data demonstrating the efficacy of this sequence are not yet available. Increase of "awareness" by use of computer-based reminder functions may result in a significant improvement of vaccination compliance.
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Affiliation(s)
- G Fätkenheuer
- Klinik I für Innere Medizin, Infektiologie, Uniklinik Köln, Köln, Deutschland
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27
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Moeser A, Pletz MW, Hagel S, Kroegel C, Stallmach A. Lung disease and ulcerative colitis--mesalazine-induced bronchiolitis obliterans with organizing pneumonia or pulmonary manifestation of inflammatory bowel disease? Z Gastroenterol 2015; 53:1091-8. [PMID: 26367026 DOI: 10.1055/s-0041-103377] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Ulcerative colitis can be associated with numerous extraintestinal organ manifestations. Pulmonary disease in inflammatory bowel disease (IBD) is supposed to be a rare entity and has to be distinguished from infectious complications and side-effects of medications used in the treatment of IBD. We present the case of a 20-year-old male patient with ulcerative colitis and a 4-week history of respiratory symptoms, malaise, fever and respiratory insufficiency under a medication with mesalazine. Computed tomography showed bilateral subpleural consolidations, bronchoscopy revealed signs of acute bronchitis. The diagnostic work-up ruled out an infectious cause. Under the tentative diagnosis of a mesalazine-induced bronchiolitis obliterans with organizing pneumonia (BOOP) the medication with mesalazine was withdrawn and the patient received a corticosteroid trial. The symptoms quickly improved and prednisone was tapered and stopped after 6 months. Unexpectedly, lung function after complete resolution of respiratory symptoms revealed a residual obstructive ventilatory defect that might be due to an asymptomatic pulmonary manifestation of ulcerative colitis. A review of the literature shows that pulmonary manifestations in IBD as well as pulmonary toxicity of mesalazine might not be as rare as expected and should be included as differential diagnoses in the work-up of respiratory symptoms in patients with IBD. A pragmatic therapeutic approach is reasonable in critically ill patients as it is not always easy to distinguish both entities.
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Affiliation(s)
- A Moeser
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - M W Pletz
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - S Hagel
- Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - C Kroegel
- Clinic of Internal Medicine I, Department of Pneumology and Allergy/Immunology, Jena University Hospital, Jena, Germany
| | - A Stallmach
- Clinic of Internal Medicine IV, Jena University Hospital, Jena, Germany
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28
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Kwetkat A, Hagel S, Forstner C, Pletz MW. [Pneumococcal vaccination for prevention of pneumonia]. Z Gerontol Geriatr 2015; 48:614-8. [PMID: 25877774 DOI: 10.1007/s00391-015-0887-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
Aging of the immune system, so-called immunosenescence, is well documented as the cause of increased infection rates and severe, often complicated courses of infections in older adults. This is particularly true for pneumococcal pneumonia in older adults; therefore, the standing committee on vaccination of the Robert Koch Institute (STIKO) recommends a once only vaccination with 23-valent pneumococcal polysaccharide vaccine for all persons aged 60 years and over. Furthermore, the 13-valent pneumococcal conjugate vaccine is also available for administration in adults and is recommended by the STIKO for particular indications. The advantage of the pneumococcal conjugate vaccine is the additional induction of a T-cell dependent immune response that leads to good immunogenicity despite immunosenescence. Initial data from a recent randomized controlled trial, so far only presented at conferences, confirm that the conjugate vaccine also provides protection against non-bacteremic pneumococcal pneumonia, which is not provided by the polysaccharide vaccine. Thus, there are two vaccines for prevention of pneumococcal diseases: one with a broader range of serotype coverage but with an uncertain protection against non-bacteremic pneumococcal pneumonia and another one with less serotype coverage but more effective protection. Vaccination of children with the conjugate vaccine also leads to a rapid decrease of infections by the 13 vaccine serotypes even in adults because of herd protection effects. For prevention of pneumonia in older adults the additional benefit of a concurrent application of influenza vaccine and pneumococcal vaccine should be considered.
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Affiliation(s)
- A Kwetkat
- Klinik für Geriatrie, Universitätsklinikum Jena, Bachstr. 18, 07743, Jena, Deutschland.
| | - S Hagel
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
| | - C Forstner
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland.,Universitätsklinik für Innere Medizin I, Klin. Abt. f. Infektionen und Tropenmedizin, Medizinische Universität Wien, Wien, Österreich
| | - M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena, Deutschland
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Rademacher J, de Roux A, Pletz MW, Bange FC, Suhling H, Welte T, Ringshausen FC. Prädiktoren eines Lungenfunktionsverlustes bei klinisch stabilen erwachsenen Patienten mit Non-CF-Bronchiektasen. Pneumologie 2015. [DOI: 10.1055/s-0035-1544616] [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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30
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Affiliation(s)
- M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
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31
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Schleenvoigt BT, Hagel S, Baier M, Esser S, Pletz MW. [35-year-old patient with unclear dermatological finding]. Dtsch Med Wochenschr 2014; 139:2339-40. [PMID: 25369044 DOI: 10.1055/s-0034-1387306] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- B T Schleenvoigt
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
| | - S Hagel
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
| | - M Baier
- Institut für Medizinische Mikrobiologie, Universitäts- klinikum Jena
| | - S Esser
- Kinik für Dermatologie und Venerologie, Universitäts- klinikum Essen
| | - M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
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32
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Schleenvoigt BT, Baier M, Hagel S, Forstner C, Kötsche R, Pletz MW. Ross River virus infection in a Thuringian traveller returning from south-east Australia. Infection 2014; 43:229-30. [PMID: 25380568 DOI: 10.1007/s15010-014-0695-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 10/11/2014] [Indexed: 11/30/2022]
Abstract
Ross River virus (RRV) is an arbovirus transmitted by Aedes and Culex mosquitos. It is endemic in Australia, New Zealand and south-east Asia. Clinical manifestation rates in adults range about 20-40%. Symptoms involve arthralgia, myalgia, lymphadenopathy, fever and rash. Here we report a case of RRV in a Thuringian traveller who visited the urban South-East of Australia.
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Affiliation(s)
- B T Schleenvoigt
- Center for Infectious Diseases and Infection Control, Jena University Hospital, Erlanger Allee 101, Thuringia, 07740, Jena, Germany,
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Abstract
The best measure to prevent infections of the respiratory tract is the use of vaccines against important respiratory tract pathogens. The Standing Vaccination Committee at the Robert Koch Institute recommends not only children but also adult vaccination against pneumococci, influenza A/B and Bordetella pertussis, because of a high disease burden. In the present review the clinical significance and safety of those vaccinations as well as advantages and disadvantages of the currently available vaccines are discussed.
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Affiliation(s)
- C Forstner
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
| | - M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena
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34
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Ringshausen FC, de Roux A, Pletz MW, Hämäläinen N, Welte T, Rademacher J. Bronchiectasis-Associated Hospitalizations in Germany, 2005 – 2011: A Population-Based Study of Disease Burden and Trends. Pneumologie 2014. [DOI: 10.1055/s-0034-1376839] [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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35
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Affiliation(s)
- M W Pletz
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Integriertes Forschungs- und Behandlungszentrum, Sepsis und Sepsisfolgen, CSCC, Universitätsklinikum Jena, Jena.
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36
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Hagel S, Ludewig K, Frosinski J, Hutagalung R, Porzelius C, Gastmeier P, Harbarth S, Pletz MW, Brunkhorst FM. [Effectiveness of a hospital-wide educational programme for infection control to reduce the rate of health-care associated infections and related sepsis (ALERTS)--methods and interim results]. Dtsch Med Wochenschr 2013; 138:1717-22. [PMID: 23934590 DOI: 10.1055/s-0033-1349481] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIM Health care associated infections (HAIs) are one of the most frequent complications of hospital care, associated with increased morbidity, mortality and considerable extra costs for the health care system. The overarching objective of the ALERTS study is to demonstrate the feasibility of a hospitalwide programme to reduce the burden of HAIs and related sepsis of at least 20 %. METHODS Prospective, quasi-experimental study covering all acute care units (27 general wards, 4 ICUs, overall 809 beds) at Jena University Hospital. Surveillance for HAIs is performed by computerized antibiotic monitoring in patients with risk factors for HAIs (i. e. intravenous and urinary catheters, surgery) on a daily basis. Following the first surveillance period a multifaceted, pragmatic infection control programme, aimed at proper hand hygiene and bundles for the prevention of the four most common HAIs will be implemented. Subsequently, a second surveillance period lasting 18 months will be conducted to measure the effect of the infection control programme, starting in May 2013. RESULTS Interim results for the first surveillance period (09/2011 to 08/2012) are presented. During this period, 30,631 patients were admitted to the participating departments. According to CDC definitions we identified 1,637 HAIs, resulting in an overall incidence of 5.3 %. Based on clinical evaluation only, irrespective of the CDC definitions, an additional 944 HAIs were detected (overall HAI rate, 8.4 % [n =2581]). A substantial proportion of patients had HAI associated severe sepsis or septic shock (lower respiratory tract infection, n = 279 [37 %]; surgical site infection, n = 114 [25 %]; primary sepsis, n = 110 [32 %]; urinary tract infection, n = 46 [8 %]; other, n = 87 [22 %]). CONCLUSION Our numbers reveal that a high number of HAIs are missed using CDC-definitions and therefore the magnitude of the problem might be underestimated. Furthermore, a high percentage of HAIs progress from localized infection to severe sepsis or septic shock, requiring ICU treatment.
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Affiliation(s)
- S Hagel
- Zentrum für Infektionsmedizin und Krankenhaushygiene, Universitätsklinikum Jena, Jena
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Ghanem H, Hagel S, Keller P, Prochnau D, Stallmach A, Pletz MW. [A 22-year-old patient from Ghana with fever and reduced CD4 T-cell count]. Internist (Berl) 2013; 54:100-4. [PMID: 23318543 DOI: 10.1007/s00108-012-3159-6] [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
A 22-year-old patient from Ghana without relevant co-morbidities was admitted twice with fever of unknown origin and reduced CD4 T-cell count. During the second hospital stay, after prolonged incubation of blood cultures and detection of vegetations on the mitral valve in a transesophageal echocardiogram, infectious endocarditis with Aggregatibacter aphrophilus was diagnosed. Treatment according to European guidelines resulted in resolution of the fever, dissolution of the mitral valve vegetations and recovery of CD4 T-cell count.
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Affiliation(s)
- H Ghanem
- Klinik für Innere Medizin II, Abteilung für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Jena, Deutschland
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Reuken PA, Pletz MW, Baier M, Pfister W, Stallmach A, Bruns T. Emergence of spontaneous bacterial peritonitis due to enterococci - risk factors and outcome in a 12-year retrospective study. Aliment Pharmacol Ther 2012; 35:1199-208. [PMID: 22449290 DOI: 10.1111/j.1365-2036.2012.05076.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2012] [Revised: 02/02/2012] [Accepted: 03/05/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND Third-generation cephalosporins (TGC) constitute the empirical first-line therapy for spontaneous bacterial peritonitis (SBP). Hospitalisation, invasive procedures and use of antibiotics may challenge this concept due to an increase in enterococci and other TGC-resistant microorganisms. AIM To determine prevalence, risk factors and outcome of ascitic fluid infections caused by enterococci. METHODS All independent episodes of culture-positive ascitic fluid between 2000 and 2011 in a German tertiary centre were analysed retrospectively. RESULTS Out of 244 positive ascitic fluid cultures, 90 episodes of monomicrobial SBP and 25 episodes of monomicrobial bacterascites (BA) in patients with decompensated cirrhosis were identified. Enterococcus spp. were isolated in 32 (28%) episodes. We noticed a profound increase in the frequency of enterococcal infection over the study period from 11% to 35% (P = 0.007). Univariate risk factors for enterococcal SBP/BA included nosocomial infection (OR = 4.56; 95% CI 1.90-10.97), previous use of antibiotics (OR = 5.63; 95% CI 1.81-17.49) and recent gastrointestinal endoscopy (OR = 3.17; 95% CI 1.33-7.54). Nosocomial infection (OR = 3.29; P = 0.011) and recent antibiotic therapy (OR = 3.88; P = 0.025) remained independent risk factors for enterococcal infection in multivariate logistic regression and these factors contributed also to the model when only SBP cases were considered. In subjects with monomicrobial SBP who were treated with TGC or ciprofloxacin, the probability of 90-day survival was 12% in enterococcal infection compared to 50% in non-enterococcal SBP (P = 0.022 in log-rank test). CONCLUSION Because of the increasing prevalence of enterococcal spontaneous bacterial peritonitis and its poor prognosis when treated inappropriately, clinicians should consider empirical therapy with anti-enterococcal antibiotics for patients with risk factors.
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Affiliation(s)
- P A Reuken
- Division of Gastroenterology, Hepatology and Infectious Diseases, Department of Internal Medicine II, Jena University Hospital, Friedrich Schiller University, Germany
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Kolditz M, Höffken G, Martus P, Rohde G, Schütte H, Bals R, Suttorp H, Pletz MW. Cortisol im Serum ist unabhängig vom CRB-65 Score und inflammatorischen Biomarkern mit einer ungünstigen Prognose bei CAP assoziiert. Pneumologie 2012. [DOI: 10.1055/s-0032-1302829] [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: 10/28/2022]
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Ringshausen FC, Pletz MW, de Roux A, Welte T, Rademacher J. Ätiologie und Mikrobiologie von Non-CF-Bronchiektasen: Erfahrungen eines einzelnen Zentrums. Pneumologie 2012. [DOI: 10.1055/s-0032-1302835] [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: 10/28/2022]
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Lepper PM, Ott SR, Nüesch E, Eynatten MV, Schumann C, Pletz MW, Welte T, Bauer TT, Suttorp N, Jüni P, Bals R, Rohde G. Admission Serum Glucose Levels: An Independent Risk Factor predicting Short- and Long-term Mortality in Community Acquired Pneumonia. Pneumologie 2012. [DOI: 10.1055/s-0032-1302728] [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: 10/28/2022]
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Rademacher J, Pletz MW, de Roux A, Welte T, Ringshausen FC. Therapie von Patienten mit Non-CF-Bronchiektasen: eine Bestandsaufnahme. Pneumologie 2012. [DOI: 10.1055/s-0032-1302529] [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: 10/28/2022]
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Schleenvoigt BT, Stallmach A, Pletz MW. Tenofovir induced acute kidney injury in a patient with unilateral renal agenesis despite initially non-impaired renal function. Eur J Med Res 2011; 16:564. [PMID: 22112365 PMCID: PMC3351902 DOI: 10.1186/2047-783x-16-12-564] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Nephrotoxicity is observed in 1.6 % of patients treated with tenofovir disoproxil fumarat (Fux 2007).
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Affiliation(s)
- B T Schleenvoigt
- Division of Gastroenterology, Hepatology and Infectious Diseases, Jena University Hospital, Germany
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Kolditz M, Höffken G, Martus P, Rohde G, Schütte H, Bals R, Suttorp N, Pletz MW. Cortisol im Serum ist unabhängig vom CRB-65 Score und inflammatorischen Biomarkern mit einer ungünstigen Prognose bei CAP assoziiert. Pneumologie 2011. [DOI: 10.1055/s-0031-1296119] [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: 10/14/2022]
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Rademacher J, Pletz MW, de Roux A, Welte T, Ringshausen FC. Ätiologie, Mikrobiologie und Therapie von Non-CF-Bronchiektasen: Erfahrungen eines einzelnen Zentrums. Pneumologie 2011. [DOI: 10.1055/s-0031-1296136] [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: 10/14/2022]
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Reuken PA, Bruns T, Zimmer B, Michael A, Brunkhorst FM, Pletz MW, Stallmach A. Recurrent fever and bacteraemia after endoscopic variceal haemostasis with cyanoacrylate: a case report. Infection 2011; 40:351-3. [PMID: 22002735 DOI: 10.1007/s15010-011-0207-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2011] [Accepted: 09/27/2011] [Indexed: 02/07/2023]
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Ott SR, Hauptmeier BM, Ernen C, Lepper PM, Nüesch E, Pletz MW, Hecht J, Welte T, Bauer TT. Treatment failure in pneumonia: impact of antibiotic treatment and cost analysis. Eur Respir J 2011; 39:611-8. [PMID: 21965229 DOI: 10.1183/09031936.00098411] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The aim of this study was to investigate treatment failure (TF) in hospitalised community-acquired pneumonia (CAP) patients with regard to initial antibiotic treatment and economic impact. CAP patients were included in two open, prospective multicentre studies assessing the direct costs for in-patient treatment. Patients received treatment either with moxifloxacin (MFX) or a nonstandardised antibiotic therapy. Any change in antibiotic therapy after >72 h of treatment to a broadened antibiotic spectrum was considered as TF. Overall, 1,236 patients (mean ± SD age 69.6 ± 16.8 yrs, 691 (55.9%) male) were included. TF occurred in 197 (15.9%) subjects and led to longer hospital stay (15.4 ± 7.3 days versus 9.8 ± 4.2 days; p < 0.001) and increased median treatment costs (€2,206 versus €1,284; p<0.001). 596 (48.2%) patients received MFX and witnessed less TF (10.9% versus 20.6%; p < 0.001). After controlling for confounders in multivariate analysis, adjusted risk of TF was clearly reduced in MFX as compared with β-lactam monotherapy (adjusted OR for MFX 0.43, 95% CI 0.27-0.68) and was more comparable with a β-lactam plus macrolide combination (BLM) (OR 0.68, 95% CI 0.38-1.21). In hospitalised CAP, TF is frequent and leads to prolonged hospital stay and increased treatment costs. Initial treatment with MFX or BLM is a possible strategy to prevent TF, and may thus reduce treatment costs.
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Affiliation(s)
- S R Ott
- Dept of Respiratory Medicine, University Hospital Berne, Inselspital and University of Berne, 3010 Berne, Switzerland.
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Ott S, Kolditz M, Rohde G, Buchheidt D, Vesenbeckh S, de Roux A, Bauer TT, Pletz MW. Pulmonale Infektionen durch Nocardien bei 21 Patienten. Pneumologie 2011. [DOI: 10.1055/s-0031-1272162] [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: 10/18/2022]
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Ott SR, Lepper PM, Hauptmeier B, Bals R, Pletz MW, Schumann C, Steininger C, Kleines M, Geerdes-Fenge H. [The impact of viruses in lower respiratory tract infections of the adult. Part III: therapy and prevention]. Pneumologie 2010; 64:115-23. [PMID: 20143283 DOI: 10.1055/s-0029-1215189] [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: 10/19/2022]
Abstract
In industrialized countries respiratory tract infections are one of the most common reasons for medical consultations. It is assumed that almost one third of these infections include the lower respiratory tract (LRTI), e. g. acute bronchitis, acute exacerbation of chronic obstructive pulmonary disease (COPD), community- or hospital-acquired pneumonia and influenza. Due to a lack of sufficient and valid investigations to prove the presence of respiratory viruses their impact in the pathogenesis of lower respiratory tract infection has probably been underestimated for a long time. Therefore, there might have been many cases of unnecessary antibiotic treatment, especially in cases of acute bronchitis or acute exacerbations of COPD, because of an assumed bacteriological cause. With the introduction of more sensitive investigational procedures, such as polymerase chain reaction, it is possible to sufficiently prove respiratory viruses and therefore illuminate their role in the pathogenesis of lower respiratory tract infections of the adult. We have reviewed the current literature on the impact of viruses in lower respiratory tract infections to elucidate the role of viruses in the pathogenesis of lower respiratory tract infections. The preceding parts of this series provided an introduction to the frequently found viruses, pathogenesis, and diagnostic procedures (part I) as well as common viral infections of the lower respiratory tract (part II). The present 3 (rd) part deals with therapy for and prevention of viral LRTI.
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Affiliation(s)
- S R Ott
- Helios Klinikum Emil von Behring, Zentrum für Pneumologie und Thoraxchirurgie Heckeshorn, Klinik für Pneumologie, Berlin.
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