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Methicillin-ResistantStaphylococcus aureusin German Intensive Care Units During 2000-2003: Data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units). Infect Control Hosp Epidemiol 2016; 27:146-54. [PMID: 16465631 DOI: 10.1086/500619] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 02/28/2005] [Indexed: 11/04/2022]
Abstract
Objectives.The objective of this study was to analyze methicillin-resistantStaphylococcus aureus(MRSA) percentages (defined as the percentage ofS. aureusisolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003).Methods.This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days.Results.From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552S. aureusisolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use (P<.05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%]). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage (P<.05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days.Conclusion.The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.
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Does the Architecture of Hospital Facilities Influence Nosocomial Infection Rates? A Systematic Review. Infect Control Hosp Epidemiol 2015; 25:21-5. [PMID: 14756214 DOI: 10.1086/502286] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:To review the evidence regarding the effects of interventions to improve hospital design and construction on the occurrence of nosocomial infections.Methods:Systematic review of experimental and non-experimental, architectural intervention studies in intensive care units (ICUs), surgical departments, isolation units, and hospitals in general. The studies dated from 1975, and were in English, French, German, Italian, and Spanish. Regardless of format, the studies were identified through seven medical databases, reference lists, and expert consultation.Results:One hundred seventy-eight scientific articles were identified; however, none of these described a meta-analy-sis, systematic review, or randomized, controlled trial. Most of the articles were categorized at the lowest level of evidence (expert judgment or consensus statements). Only 17 described completed concurrent or historical cohort studies matching the inclusion criteria (ICUs, 9; surgical departments, 4; isolation units, 2; hospitals in generai, 2). The interventions generally included a move to other premises or renovation. However, in many studies, the staff-to-patient ratio was also improved. Some studies showed lower infection rates after intervention, but this finding cannot be generalized because of confounding and fre-quently small study populations.Conclusions:The lack of stringent evidence linking hospital design and construction with the prevention of nosocomial infection is partly attributable to the multifactorial nature of these infections, and some improvement will be seen if basic conditions such as the availability of sufficient space, isolation capac-ity, and facilities for handwashing are met. However, to our knowledge, other factors, especially the improper hand hygiene of medical staff, have greater impact.
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Abstract
AbstractNosocomial infections consume a significant amount of the total hospital budget. This article describes some practical aspects for cost reduction in hospital infection control. Within one year total savings of 91.000 DM* could be achieved by discontinuing unnecessary disinfection procedures. Within six years 2,27 million DM could be saved by discontinuing unnecessary infection control procedures or employing cheaper methods. Of the total antibiotic costs 25% can be reduced by certain measures.
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Surveillance of antimicrobial use and antimicrobial resistance in German intensive care units (SARI): a summary of the data from 2001 through 2004. Infection 2007; 34:303-9. [PMID: 17180583 PMCID: PMC2778699 DOI: 10.1007/s15010-006-6619-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2006] [Accepted: 08/22/2006] [Indexed: 11/05/2022]
Abstract
Objective: To report the experience gained over 4 years in working with the German SARI project (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), and to compare SARI with data from the Swedish STRAMA and the US AUR surveillance system. Methods: Prospective unit and laboratory based surveillance was carried out in 40 German ICUs from 2001 through 2004. WHO 2004 definitions of defined daily doses (DDD) per 1,000 patient days (pd) were used to express antimicrobial consumption (AD). Apart from the proportion of resistant isolates (RP), the incidence density of resistant isolates (RD) was calculated on the basis of the number of resistant isolates per 1,000 pd. To determine the changes over time, the Wilcoxon signed rank test for paired samples was used. Results: From 1/2001 through 12/2004, 40 ICUs provided data on 53,399 isolates, a total of 789,569 DDD and 597,592 pd. Total AD ranged from 427 to 2,798, with the median being 1,351. There was no statistically significant change in total antimicrobial use, but a statistically significant decrease was observed in the use of aminoglycosides. RD was highest for MRSA with 4.4 resistant isolates/1,000 pd followed by imipenem resistant Pseudomonas aeruginosa with 1.7 resistant isolates/1,000 pd. The corresponding RPs were 21.5% and 23.2%. Over the 4-year period (2001–2004), significant increases were seen in the RDs of third generation cephalosporin and ciprofloxacin resistant Escherichia coli. In 2004, the mean RD reached 0.28 and 1.41, respectively. In comparison, the RP of selected pathogens was highest in the US ICUs and lowest in Swedish ICUs, with the exception of imipenem resistant P. aeruginosa. Conclusion: Antibiotic consumption remained stable over a period of 4 years, (the mean being 1,321 DDD/1,000 pd). The same applied to the situation regarding resistance in Staphylococcus aureus, enterococci and P. aeruginosa. For most pathogens the RP was higher in SARI ICUs than in Swedish ICUs, but lower than in US ICUs.
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Modified guidelines impact on antibiotic use and costs: duration of treatment for pneumonia in a neurosurgical ICU is reduced. J Antimicrob Chemother 2007; 59:1148-54. [PMID: 17434880 DOI: 10.1093/jac/dkm088] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To evaluate the impact of an intervention to reduce the duration of antibiotic treatment for pneumonia in a neurosurgical intensive care unit (ICU). The usage of antibiotics and the resultant costs were examined using interrupted time series analysis while resistance and device-associated infection rates are also described. METHODS In January 2004, revised guidelines for the use of antibiotics were implemented. As a consequence of this, the duration of antibiotic therapy for nosocomial pneumonia was reduced from 14 to 7 days, while for community-acquired pneumonia the period fell from 10 to 5 days. The effect on the antibiotic use density [AD; expressed as defined daily doses (DDD) per 1000 patient days (pd)] was calculated by segmented regression analysis of interrupted time series for the 24 months prior to (2002 and 2003) and after the intervention (2004 and 2005). RESULTS The intervention was associated with a significant decrease in total AD from 949.8 to 626.7 DDD/1000 pd after the intervention. This was mainly due to reduced consumption of second-generation cephalosporins (-100.6 DDD/1000 pd), imidazoles (- 100.3 DDD/1000 pd), carbapenems (-33.3 DDD/1000 pd), penicillins with beta-lactamase inhibitor (-33.5 DDD/1000 pd) and glycopeptides (-30.2 DDD/1000 pd). Glycopeptide reduction might be associated with a significant decrease in the proportion of methicillin-resistant Staphylococcus aureus (8.4% before and 2.9% after the intervention). Similarly, total antibiotic costs/pd (Euro) showed a significant decrease from 13.16 Euro/pd before to 7.31 euro/pd after the intervention. This is a saving of 5.85 Euro/pd. The incidence of patients dying with pneumonia did not change significantly. CONCLUSIONS The most conservative estimate of segmented regression analysis over a 48 month period showed that halving the duration of treatment for pneumonia results in a reduction of over 30% in antibiotic consumption and costs. Because respiratory infections are most common in ICU patients, interventions targeting a reduction in the duration of treatment of pneumonia might be extremely worthwhile.
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Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant 2007; 39:173-8. [PMID: 17245425 DOI: 10.1038/sj.bmt.1705561] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The purpose of this study was to analyse risk factors for blood stream infection (BSI) and pneumonia in neutropenic patients who have undergone peripheral blood stem-cell transplantation (PBSCT). Data were taken from the ONKO-KISS multicenter surveillance project. Infections were identified using CDC definitions (laboratory-confirmed BSI) and modified criteria for pneumonia in neutropenic patients. The multivariate analysis was performed using the Fine-Gray regression model for the cumulative incidences of the competing events 'infection', 'death' and 'end of neutropenia'. The risk factors investigated were: sex, age, underlying disease and type of transplant. From January 2000 to June 2004, a total of 1699 patients in 20 hospitals were investigated. In the multivariate analysis, male patients had a significantly higher risk of acquiring BSI than female patients (P=0.002). The risk of acquiring BSI is highest in patients with advanced acute myeloid leukaemia (AML). In the univariate and multivariate analysis, unrelated donor allogeneic transplantation constituted a risk factor for pneumonia (P=0.012). ONKO-KISS provides reference data on the incidence of pneumonia and BSI. The increased risk for BSI in males and patients with advanced AML, and the increased risk for pneumonia in unrelated donor allogeneic PBSCT patients should be targeted to prevent infections in these higher risk groups.
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Extract of Pelargonium sidoides (EPs 7630) improves phagocytosis, oxidative burst, and intracellular killing of human peripheral blood phagocytes in vitro. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2007; 14 Suppl 6:46-51. [PMID: 17184983 DOI: 10.1016/j.phymed.2006.11.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Clinical data show that EPs 7630, an aqueous ethanolic extract from the roots of Pelargonium sidoides, can be used for the treatment of upper respiratory tract infections (URTI). The biological effects of the preparation have not been fully investigated. The objective of this study was to examine the impact of EPs 7630 on the activity of human peripheral blood phagocytes (PBP). A whole blood-based, flow cytometric assay was used to simultaneously assess phagocytosis and oxidative burst. Calcein-AM stained Candida albicans (DSM 1386) were used as target organisms. Oxidative burst was measured by addition of dihydroethidium (DHE). Target organisms and whole blood were co-incubated and analyzed after 0, 2, 4, 6, 10, and 30 min. Intracellular killing of the target organisms was evaluated by determining the number of surviving yeast cells after co-incubation of C. albicans and human whole blood. EPs 7630 was applied in therapeutically relevant concentrations between 0 and 30 microg/ml. Compared with controls EPs 7630 increased the number of phagocytosing PBP during the observed time points between 2 and 10 min in a concentration-dependent manner, with a maximum enhancement of 56% at 2 min (p=0.002). The application of EPs 7630 also led to a significant increase in the number of burst-active PBP for all time points observed beyond 2 min (p<0.001). The maximum augmentation was 120% after application of 30 microg/ml EPs 7630 at 4 min. Using a microbiological assay, intracellular killing was also enhanced by EPs 7630. This was expressed by a significant reduction in the number of surviving target organisms (p<0.001). The maximum reduction in viable yeast cells (-31%) was observed after co-incubation for 120 min with the highest concentration of EPs 7630 (30 microg/ml). In conclusion, the positive effects of EPs 7630 on phagocytosis, oxidative burst, and intracellular killing of yeast cells as test organisms are important components of the compound's biological activity. Our findings constitute a valuable contribution to understanding the clinical effects of EPs 7630.
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Stenotrophomonas maltophilia and antibiotic use in German intensive care units: data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units). J Hosp Infect 2006; 64:238-43. [PMID: 16979794 DOI: 10.1016/j.jhin.2006.07.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2006] [Accepted: 07/28/2006] [Indexed: 10/24/2022]
Abstract
Risk factors for the selection of Stenotrophomonas maltophilia were analysed by correlating antimicrobial use and structure parameters (e.g. hospital type) with the incidence density of S. maltophilia and the percentage of S. maltophilia isolated from 39 intensive care units (ICUs). SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units) is a prospective unit- and laboratory-based surveillance system that collects data on the 13 most important organisms responsible for nosocomial infections. The percentage of S. maltophilia among these organisms and the number of S. maltophilia per 1000 patient-days were calculated. The data were subsequently correlated with antibiotic use density calculated in defined daily doses (DDDs) per 1000 patient-days and structure parameters. The data covered a total of 28 266 isolates and 431 351 DDDs. The antibiotic use density ranged from 427 to 2218, with the median being 1346. Over the two-year period, the median of S. maltophilia per 1000 patient-days was 1.4 (range 0-7.6). Calculation of antibiotic use and S. maltophilia per 1000 patient-days showed a significant positive correlation with the use of carbapenems, ceftazidime, glycopeptides and fluoroquinolones, as well as with total antibiotic use. In the multiple logistic regression analysis, carbapenem use and >12 ICU beds were independently and positively associated with a high number of S. maltophilia per 1000 patient-days. Benchmarking data provided for incidence densities of S. maltophilia in ICUs revealed the heterogeneous situation of the burden of S. maltophilia in individual ICUs. The multi-centre data showed that carbapenem use and >12 ICU beds were independent risk factors for the isolation of S. maltophilia.
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Multicentre study of antimicrobial resistance and antibiotic consumption among 6,780 patients with bloodstream infections. Eur J Clin Microbiol Infect Dis 2006; 25:815-7. [PMID: 17066301 DOI: 10.1007/s10096-006-0211-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Is the prevalence of Stenotrophomonas maltophilia isolation and nosocomial infection increasing in intensive care units? Eur J Clin Microbiol Infect Dis 2006; 25:711-4. [PMID: 17021867 DOI: 10.1007/s10096-006-0198-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The study presented here was conducted over a period of 4 years (2001-2004) to investigate changes in the number of S. maltophilia isolates detected per 1,000 patient days and to look at the incidence density of nosocomial infections caused by S. maltophilia. The analysis was based on data provided by 34 German intensive care units participating continuously in the national project "Surveillance of Antimicrobial Use and Resistance in ICUs"; 31 of these ICUs reported nosocomial infections to the German infection surveillance system, KISS, during the study period.
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Antibiotic use in two cohorts of German intensive care units. J Hosp Infect 2006; 64:231-7. [PMID: 16891039 DOI: 10.1016/j.jhin.2006.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 05/23/2006] [Indexed: 11/18/2022]
Abstract
Antibiotic use was evaluated in two cohorts of intensive care units (ICUs) in Germany. One cohort included ICUs participating in a surveillance programme (N=34) collecting antibiotic use and bacterial resistance data, with quarterly feedback. The second ICU cohort was from a cross-sectional study and represented a sample from hospitals in South-west Germany (N=58). Two dose definitions were used. These were the World Health Organization/Anatomical Therapeutic Chemical Classification (ATC) 2001 definition of defined daily dose (DDD), and a definition of recommended daily dose (RDD) that better reflected the currently prescribed dosages of parenteral drugs for hospitalized patients. Data were expressed as DDD or RDD per 100 patient-days. It was determined whether hospital size and affiliation, year of study and ICU type had an influence on overall use of antibiotics. Overall use differed between the two ICU cohorts irrespective of the dose definitions used. High use of antibiotics was primarily associated with hospital affiliation (university vs non-university) and hospital size. Mean overall use of antibiotics in non-university hospital ICUs ranged between 106 and 111 DDD/100 (59 and 67 RDD/100) for different hospital size categories, compared with 140 DDD/100 (87 RDD/100) in university hospital ICUs. In conclusion, in order to compare the use of antibiotics between ICU cohorts and to assess trends over time, data adjustment is required for hospital affiliation and size.
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Temporal changes in bacterial resistance in German intensive care units, 2001–2003: data from the SARI (surveillance of antimicrobial use and antimicrobial resistance in intensive care units) project. J Hosp Infect 2005; 60:348-52. [PMID: 15923060 DOI: 10.1016/j.jhin.2004.12.027] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2004] [Accepted: 12/23/2004] [Indexed: 11/30/2022]
Abstract
Conservative testing revealed a stable antibiotic resistance situation for Staphylococcus aureus, Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae and Enterobacter cloacae in 32 German intensive care units (ICUs) actively participating in the SARI (surveillance of antimicrobial use and antimicrobial resistance in ICUs) project over a three-year period (2001--2003). No significant changes were shown for methicillin-resistant S. aureus (MRSA) (P=0.501; the MRSA rate increased in 18 ICUs and decreased in 14 ICUs). The only exception was an increase in ciprofloxacin-resistant E. coli.
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Abstract
We report on a pseudooutbreak of Burkholderia cepacia because of the use of a contaminated disinfectant during quality controls in a university blood bank. No septic reactions associated with transfusions had been reported in patients over the last 6 months. Analysis of the individual quality control procedures showed that a disinfectant based on a quaternary ammonium compound (QAC) had been used in order to disinfect the rubber stopper of the blood culture bottle. B. cepacia was found in a sample taken from this disinfectant, which was prepared with concentrate and tap water according to the manufacturer's instructions. The four isolates (one in disinfectant and three in blood components) were found to be identical in their biochemical reactions and resistance patterns. QAC-based disinfectants are not efficacious against a part of the spectrum of gram-negatives and are therefore inadequate. After introduction of an alcohol-based preparation, no more cases of B. cepacia contamination have been identified.
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Plasmid-mediated quinolone resistance in isolates obtained in german intensive care units. Antimicrob Agents Chemother 2005; 49:773-5. [PMID: 15673764 PMCID: PMC547280 DOI: 10.1128/aac.49.2.773-775.2005] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Screening of 703 isolates of Enterobacteriaceae, obtained from 34 German intensive care units (ICUs), revealed qnr-positive, integron-containing isolates of Enterobacter sp. and Citrobacter freundii from four patients in 2 German ICUs. This is one of the first reports of qnr-positive strains obtained from patients in Europe.
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Surveillance of nosocomial sepsis and pneumonia in patients with a bone marrow or peripheral blood stem cell transplant: a multicenter project. Clin Infect Dis 2005; 40:926-31. [PMID: 15824981 DOI: 10.1086/428046] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2004] [Accepted: 10/28/2004] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND For surveillance of nosocomial bloodstream infections (BSIs) and pneumonia during neutropenia in adult patients who have undergone bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT), a multicenter study--the Hospital Infection Surveillance System for Patients with Hematologic/Oncologic Malignancies (ONKO-KISS)--was initiated in Germany in 2000. METHODS Nosocomial infections were identified in neutropenic patients by means of Centers for Disease Control and Prevention definitions for laboratory-confirmed BSI and modified criteria for pneumonia. RESULTS During the first 38-month period of the study (i.e., through December 2003), a total of 1899 patients associated with 28,273 neutropenic days were investigated. Of these, 1173 (62%) had undergone allogeneic and 726 (38%) had undergone autologous BMT or PBSCT. The mean duration of neutropenia was 14.9 days (9.6 and 18.1 days after autologous and allogeneic transplantation, respectively). Overall, 395 BSIs and 168 cases of pneumonia were identified. The pooled mean site-specific incidence density per 1000 neutropenic days was 14.0 for BSI (12.4 and 18.9 for the allogeneic and autologous transplantation groups, respectively) and 5.9 for pneumonia (6.1 and 5.6 in the allogeneic and autologous transplantation groups, respectively). After allogeneic transplantation, 22.4 BSIs per 100 patients and 11.0 cases of pneumonia per 100 patients occurred, whereas 18.2 BSIs per 100 patients and 5.4 cases of pneumonia per 100 patients occurred after autologous transplantation. The majority (57%) of pathogens associated with BSI were coagulase-negative staphylococci. CONCLUSIONS The ongoing ONKO-KISS project provides unprecedented reference data about the incidence of pneumonia and sepsis among BMT recipients and PBSCT recipients in Germany. These data will be used for further evaluation of the impact of hygiene measures and therapeutic regimens for these patients.
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Microbiological Diagnostic and Antibiotic Management of Community Aquired and Nosocomial Pneumonias in Intensive Care Units in Germany. Anasthesiol Intensivmed Notfallmed Schmerzther 2005; 40:85-90. [PMID: 15714398 DOI: 10.1055/s-2004-825874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Comparison of economic and environmental impacts between disposable and reusable instruments used for laparoscopic cholecystectomy. Surg Endosc 2004; 19:268-72. [PMID: 15580444 DOI: 10.1007/s00464-003-9232-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2003] [Accepted: 02/17/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The economic and environmental effects were compared between disposable and reusable instruments used for laparoscopic cholecystectomy. Special consideration was given to the processing of reusable instruments in the Miele G 7736 CD MCU washer disinfector and the resultant cost of sterilization. METHODS The instruments frequently used in their disposable form were identified with the help of surgeons. Thus, of all the instruments used for laparoscopic cholecystectomy, the disposable and reusable versions of trocars, scissors, and Veress cannula were compared. RESULTS For the case examined in this study, the performance of laparoscopic cholecystectomy with disposable instruments was 19 times more expensive that for reusable instruments. The higher cost of using disposable instruments is primarily attributable to the purchase price of the instruments. The processing of reusable instruments has little significance in terms of cost, whereas the cost for disposing of disposable instruments is the least significant factor. The number of laparoscopic cholecystectomies performed per year does not substantially influence cost. In the authors' opinion, assessment of the environmental consequences shows that reusable instruments are environmentally advantageous. CONCLUSIONS Considering the upward pressure of costs in hospitals, disposable instruments should be used for laparoscopic cholecystectomy only if they offer clear advantages over reusable instruments.
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[SARI: surveillance of antibiotic use and bacterial resistance in German intensive care units. Correlation between antibiotic use and the emergence of resistance]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2004; 47:345-51. [PMID: 15205777 DOI: 10.1007/s00103-004-0804-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Intensive care units (ICUs) are considered to be high-risk areas for the emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, on the use of antibiotics in ICUs, or on the correlation between antibiotic use and the emergence of resistance. Project SARI (surveillance of antibiotic use and bacterial resistance in ICUs), which as a part of the epidemiological network Spread of Nosocomial Infections and Resistant Pathogens (SIR) is supported by the German Ministry of Science and Education, started in February 2000 and meanwhile includes data on antibiotic use and resistance rates in 38 medical, surgical, and interdisciplinary ICUs. To date (February 2000-June 2003), a total of 1142 months, 413,065 patient days, and 550,288 defined daily doses (DDDs in accordance with the WHO) have been covered with a mean antibiotic usage density (AD) of 1335 DDDs/1000 patient days and resistance data on 37,612 isolates from ICUs. Ciprofloxacin use and MRSA correlate significantly, as do imipenem use and the rate of imipenemresistant P. aeruginosa. The genodiversity of P. aeruginosa is lower in ICUs with high resistance rates and low use of imipenem than in ICUs with high resistance rates and high use. This is an indirect parameter of transmission of identical strains. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).
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Abstract
In view of increasing rates of antibiotic resistance worldwide and decreased research and development of new antibacterial compounds, programmes helping to better understand the complex relationship between antibiotic consumption and emergence of resistance have gained importance. Consequently, in addition to increased support for research projects that establish prospective surveillance and evaluation of antibiotic resistance and antimicrobial drug use, the EU has passed directives addressing political leadership in this respect. Information on antibiotic use in Germany is now available from databases independent from cost-oriented market research studies. This information allows estimation of antibiotic use in ambulatory and hospital care as compared with to other EU countries. According to results of current projects, the frequency of national antibiotic use in ambulatory care in Germany (4948 defined daily doses per 1000 population per year) falls within the lower third of EU countries. Upper boundaries in regional variation in antibiotic use are still much lower than values for high-use countries like France, Spain and Portugal. Hospital antibiotic use, in contrast, appears to be in the range of that reported for other countries. However, only rough estimates of hospital antibiotic use are available for Germany as well as most other EU countries due to data usually derived from non-representative hospital sampling.
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Effects of caspofungin (MK-0991) and anidulafungin (LY303366) on phagocytosis, oxidative burst and killing of Candida albicans by human phagocytes. Eur J Clin Microbiol Infect Dis 2004; 23:729-31. [PMID: 15300456 DOI: 10.1007/s10096-004-1171-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objective of the present study was to investigate the influence of the new echinocandins caspofungin (MK-0991) and anidulafungin (LY303366) on human phagocytes. Phagocytosis, oxidative burst and intracellular killing of Candida albicans were analyzed by flow cytometry. Neither caspofungin nor anidulafungin significantly influenced phagocytosis. Only caspofungin significantly influenced oxidative burst after 15 min of incubation ( P<0.05). Both caspofungin and anidulafungin improved intracellular killing rates of C. albicans after 2 h of incubation (42.4% and 43.2%, respectively, compared to 37.9% in controls; P<0.05). In conclusion, caspofungin significantly improves oxidative burst and intracellular killing, which may be advantageous for clinical therapy.
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Persistent silver disinfectant for the environment: myth and reality. Am J Infect Control 2004; 32:309; author reply 309-11. [PMID: 15320338 DOI: 10.1016/j.ajic.2003.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
The objective of this study was to assess current infection control practice in Europe and its structure, future research priorities, and how infection control should be organised. A questionnaire was sent to 223 hospital infection control physicians throughout Europe, of whom 54 in 18 countries responded. With respect to future research priorities in infection control in Europe, the largest proportion (69%) of the infection control specialists sampled expressed the need for standardisation of surveillance systems for international comparison of nosocomial infection rates. The results of this survey might help to create a basis for standardised guidelines which take into account European-wide interests.
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Discrimination of Klebsiella pneumoniae and Klebsiella oxytoca phylogenetic groups and other Klebsiella species by use of amplified fragment length polymorphism. Res Microbiol 2004; 155:17-23. [PMID: 14759704 DOI: 10.1016/j.resmic.2003.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2003] [Accepted: 09/12/2003] [Indexed: 10/27/2022]
Abstract
Bacteria of the genus Klebsiella are opportunistic pathogens responsible for an increasing number of multiresistant infections in hospitals. The two clinically and epidemiologically most important species, Klebsiella pneumoniae and K. oxytoca, have recently been shown to be subdivided into three and two phylogenetic groups, respectively. The aim of this study was an in depth evaluation of the amplified fragment length polymorphism (AFLP) genetic characterization method for epidemiological and phylogenic analyzes of Klebsiella isolates. First, we investigated the variability of AFLP patterns for Klebsiella strains within and between different outbreaks. Second, by use of carefully characterized phylogenetically representative strains, we examined whether different Klebsiella species and phylogenetic groups can be discriminated using AFLP. Twenty-four strains originating from seven presumed outbreaks and 31 non-associated strains were investigated. The AFLP fingerprints of all epidemiologically associated strains showed three or fewer fragment differences, whereas unrelated strains differed by at least four fragments. Cluster analysis of the AFLP data revealed a very high concordance with the phylogenetic assignation of strains based on the gyrA sequence and ribotyping data. The species K. pneumoniae, K. oxytoca, K. terrigena and the possibly synonymous pair K. planticola/K. ornithinolytica each formed a separate cluster. Similarly, strains of the phylogenetic groups of K. pneumoniae and K. oxytoca fell into their corresponding clusters, with only two exceptions. This study provides a preliminary cut-off value for distinguishing epidemiologically non-related Klebsiella isolates based on AFLP data; it confirms the sharp delineation of the recently identified phylogenetic groups, and demonstrates that AFLP is suitable for identification of Klebsiella species and phylogenetic groups.
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Pathogen growth in herbal teas used in clinical settings: a possible source of nosocomial infection? Am J Infect Control 2004; 32:117-9. [PMID: 15057205 DOI: 10.1016/j.ajic.2003.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In some clinical settings, herbal tea is used in patient care (eg, for oral hygiene). Teabags containing herbal tea were therefore tested with regard to the presence of microbial contamination before and after brewing. In addition, pathogen growth in intentionally contaminated brewed tea was investigated over time. Teabags and brewed tea were highly contaminated (maximum mean values of 1.9 x 10(8) CFU/g raw tea), and it was found that the pathogen load of intentionally contaminated tea increased significantly (by a maximum of 10(5) colony-forming units/mL brewed tea) over time, suggesting a possible risk of patients developing a nosocomial infection when used in patient care.
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Does disinfection of environmental surfaces influence nosocomial infection rates? A systematic review. Am J Infect Control 2004; 32:84-9. [PMID: 15057199 DOI: 10.1016/j.ajic.2003.07.006] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To review the evidence on the effects of disinfection of environmental surfaces in hospitals (as compared with cleaning without use of disinfectants) on the occurrence of nosocomial infections. METHODS Systematic review of experimental and nonexperimental intervention studies dealing with environmental disinfection or cleaning in different health care settings. RESULTS A total of 236 scientific articles were identified. None described a meta-analysis, systematic review, or randomized controlled trial. Only 4 articles described completed cohort studies matching the inclusion criteria. None of these studies showed lower infection rates associated with routine disinfection of surfaces (mainly floors) versus cleaning with detergent only. CONCLUSIONS Disinfectants may pose a danger to staff, patients, and the environment and require special safety precautions. However, targeted disinfection of certain environmental surfaces is in certain instances an established component of hospital infection control. Given the complex, multifactorial nature of nosocomial infections, well-designed studies that systematically investigate the role of surface disinfection are required.
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Surveillance of antimicrobial use and antimicrobial resistance in intensive care units (SARI): 1. Antimicrobial use in German intensive care units. Intensive Care Med 2004; 30:1089-96. [PMID: 15045167 DOI: 10.1007/s00134-004-2266-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2003] [Accepted: 02/26/2004] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To study antimicrobial use for benchmarking and ensuring quality of antimicrobial treatment and to identify risk factors associated with the high use of antimicrobials in German intensive care units (ICUs) through implementation of the SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in ICUs) system. DESIGN Prospective, unit-based surveillance on antimicrobial use from February, 2000, until June, 2002. The data are standardised by use of the defined daily dose (DDD) for each antimicrobial defined by the WHO and by calculating use per 1000 patient days. SETTING The data were obtained from 35 German ICUs and stratified by type of ICU (medical, surgical, interdisciplinary). RESULTS To date, the project covers a total of 266,013 patient days in 744 reported ICU months and 354,356 DDDs. Mean antimicrobial use density (AD) was 1,332 DDD/1000 patient days and was correlated with length of stay. Penicillins with beta-lactamase inhibitor (AD 338.3) and quinolones (155.5) were the antimicrobial group with the highest ADs. Comparison with US ICARE (Intensive Care Antimicrobial Resistance Epidemiology)/AUR (Antimicrobial Use and Resistance) data revealed a higher AD for glycopeptides and 3rd generation cephalosporins in ICARE/AUR ICUs, but a higher AD for carbapenems in German SARI ICUs regardless of the type of ICU. In the multivariate analysis, length of stay was an independent risk factor for an AD above the 75% percentile of the total amount of antimicrobials used (OR 1.96 per day); likewise, for the AD above the 75% percentile of carbapenems (OR 1.90 per day) and penicillins with extended spectrum (OR 2.01 per day). High use of glycopeptides and quinolones (AD >75% percentile) correlated with central venous catheter (CVC) rate (OR 1.14 per CVC day per 100 patient days and 1.16, respectively). CONCLUSION The SARI data on antimicrobials serve ICUs as a benchmark by which to improve the quality of antimicrobial drug administration and for international comparison.
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Re: Marchetti MG, Finzi G, Cugini P, Manfrini M, Salvatorelli G. Hospital use of decontaminating mats. J Hosp Infect 2003;55:68-72. J Hosp Infect 2004; 56:166-7. [PMID: 15019232 DOI: 10.1016/j.jhin.2003.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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[Quality assurance in intensive care medicine. SARI-surveillance on antibiotic use and bacterial resistance in intensive care units]. Anaesthesist 2004; 53:427-33. [PMID: 15004690 DOI: 10.1007/s00101-004-0668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Intensive care units (ICUs) are high risk areas for emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, or on the correlation between antibiotic use and emergence of resistance. Supported by the German Ministry of Science and Education, project SARI (Surveillance on antibiotic use and bacterial resistance in ICUs) started in 02/2000 and now includes data on antibiotic use and resistance rates in 35 medical, surgical and interdisciplinary ICUs. To date (2/2000-12/2002), a total of 939 participant months, 339,461 patient days and 452,282 defined daily doses (DDD) have been covered with a mean antibiotic usage density (AD) of 1,332 DDDs/1,000 patient days and resistance data on 31,189 isolates from ICUs. The design of the project and first results of SARI are presented. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).
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Nosocomial outbreak of norovirus gastroenteritis and investigation of ABO histo-blood group type in infected staff and patients. J Hosp Infect 2004; 56:64-6. [PMID: 14706273 PMCID: PMC7124243 DOI: 10.1016/s0195-6701(03)00296-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The blood groups were analysed of staff and patients (N=45) infected during two nosocomial outbreaks of norovirus gastroenteritis at a German University hospital. Persons with O phenotype were significantly less affected than was expected from the normal distribution of blood group types in Southwest Germany (OR 2.45; 95% CI 1.22-4.95; P=0.01).
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Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units (SARI). Infection 2003; 31:208-15. [PMID: 14562943 DOI: 10.1007/s15010-003-3201-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Data on antibiotic consumption and bacterial resistance are important for benchmarking, ensuring quality of antibiotic treatment and helping to understand the relationship between the use of antibiotics and the emergence of resistance. METHODS The SARI project is an ecological study that has established laboratory-based surveillance in German intensive care units (ICU). Resistance rates of 13 sentinel pathogens are reported and certain alert organisms are sent for genotyping and retesting of antimicrobial resistance. RESULTS The project, initiated in February 2000, now includes 35 ICUs generating a total of 266,013 patient days, 354,356 defined daily doses (DDD) and providing susceptibility data on 21,354 isolates. Pooled antibiotic usage density (AD = DDD/1,000 patient days) was highest for penicillins with lactamase inhibitor (AD 338.3) followed by quinolones (AD 155.5) and second-generation cephalosporins (AD 124.6). Total AD was calculated as 1,337 DDD/1,000 patient days. Resistance rates (RR) for laboratories testing according to the German Industrial Standard (DIN) were 19.3% for methicillin-resistant Staphylococcus aureus (MRSA), 9.5% for ciprofloxacin-resistant Escherichia coli and 25.4% for imipenem-resistant Pseudomonas aeruginosa. 40% of the laboratories did not identify the extended spectrum beta lactamase production of a Klebsiella pneumoniae strain. CONCLUSION Focusing on German ICUs, the SARI surveillance system provides a concept that produces a benchmark for the link between antibiotic resistance and consumption.
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Abstract
A research project sponsored by the EC-LIFE programme was conducted to compare waste management in five different European hospitals. A comparison of the regulations governing current waste management revealed different strategies for defining infectious hospital waste. The differences in the infrastructure were examined and the consequences for waste segregation and disposal were discussed under economic and ecological aspects. In this context the definition of infectious waste is very important.
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Comparative in vitro activity of piperacillin, piperacillin–sulbactam and piperacillin-tazobactam against nosocomial pathogens isolated from intensive care patients. Clin Microbiol Infect 2003; 9:1128-32. [PMID: 14616732 DOI: 10.1046/j.1469-0691.2003.00786.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We investigated the antimicrobial activity of piperacillin-tazobactam versus piperacillin-sulbactam against common nosocomial pathogens (n = 565) isolated from intensive care patients. For Gram-positive bacteria, antimicrobial susceptibilities to the two piperacillin-beta-lactamase inhibitor combinations were almost identical. For Gram-negative bacteria, piperacillin-tazobactam exhibited greater activity against Escherichia coli and Proteus vulgaris than piperacillin-sulbactam. Both combinations, however, were equally effective against the other Enterobacteriaceae and Pseudomonas aeruginosa isolates. Piperacillin-sulbactam exhibited better antimicrobial activity against Acinetobacter baumannii. Our findings might prove important for the appropriate choice of antibiotic therapy with beta-lactam-beta-lactamase inhibitor combinations.
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Abstract
BACKGROUND Nosocomial infections (NIs) are a growing problem in healthcare today. Thus, surveillance of NIs is an important aspect of modern infection control, which aims to improve the quality of care. OBJECTIVES To identify overall and site-specific NI rates in dermatology patients in a German university hospital. METHODS In a prospective study, 1450 patients were surveyed for NIs according to criteria laid down by the Centers for Disease Control and Prevention. Case records were reviewed twice a week, microbiology reports were assessed and the ward staff was consulted. RESULTS Altogether, 37 NIs were identified in 35 patients, of whom two had two NIs. The overall incidence was 2.5 NIs per 100 patients, and the incidence density was 1.9 NIs per 1000 patient days. Twenty-one patients developed superficial surgical site infections (SSIs). Thirteen of the 21 SSIs occurred after surgical removal of basal cell carcinoma (BCC; 172 in total). This represents an infection rate of 7.6% after surgery for BCC. CONCLUSIONS Our data suggest that routine surveillance in dermatological wards is not accorded a high priority. However, surveillance of SSIs, especially following surgery for BCC, may be indicated.
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Surveillance of nosocomial infections in a German university psychiatric hospital. J Hosp Infect 2003; 54:322-3. [PMID: 12919765 DOI: 10.1016/s0195-6701(03)00175-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Influence of mistletoe ( Viscum album) extracts on phagocytosis/burst activity of human phagocytes. Eur J Clin Microbiol Infect Dis 2003; 22:501-3. [PMID: 12884062 DOI: 10.1007/s10096-003-0964-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
The aim of the present study was to examine the in vitro effects of various mistletoe extracts on human phagocytes. Phagocytosis, oxidative burst, and intracellular killing were analyzed by flow cytometry. None of the mistletoe preparations investigated exhibited significant phagocytosis-enhancing properties. Different mistletoe lectin concentrations ranging from 0.025 to 20 ng/ml showed only marginal influence on phagocyte activity. Contrary to the opinion of numerous practitioners of complementary medicine, the mistletoe preparations tested do not enhance phagocytic function.
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Abstract
OBJECTIVE To establish a library typing system appropriate for studying cross-transmission of Escherichia coli. METHODS Eighteen epidemiologically unrelated isolates were genotyped by means of pulsed-field gel electrophoresis (PFGE), random amplified polymorphic DNA (RAPD), repetitive (rep) PCR, and fluorescent amplified fragment length polymorphism (AFLP). Fingerprints were analyzed either by Pearson correlation or, in the case of AFLP, by Dice coefficients employing the novel 'uncertain band' software tool from GelCompar II. During a nine-month period, 112 isolates taken from 93 patients hospitalized in five intensive care units were analyzed by use of the two most discriminative PCR typing methods. RESULTS Genotyping by RAPD and rep-PCR revealed insufficient discrimination. Among 18 epidemiologically unrelated strains with 17 different PFGE patterns, IS3 rep-PCR and AFLP distinguished 10 and 18 types, respectively. Comparison of the different methods for analysis of AFLP fingerprints showed that the Dice coefficients, which ignore 'uncertain bands', offered the best concordance with visual interpretation. Consecutive isolates originating from the same patient differed in less than three fragments. CONCLUSIONS AFLP analysis showed the highest discriminative capacity for PCR typing of E. coli isolates. Analysis of fingerprints employing the Dice coefficients proved the most efficient method for an automated software-based retrieval of visually indistinguishable genotypes in an AFLP fingerprint database.
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Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation. Bone Marrow Transplant 2003; 31:795-801. [PMID: 12732887 DOI: 10.1038/sj.bmt.1703920] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
To identify overall and site-specific rates of nosocomial infections (NIs) during the neutropenic, as compared to the non-neutropenic stage of treatment in adult recipients of allogeneic and autologous bone marrow transplantation (BMT) and peripheral blood stem-cell transplantation (PBSCT), a prospective, 54-month study was started at the Haematological Stem Cell Transplantation Unit of the University Hospital of Freiburg, Germany. NI types were identified using modified CDC definitions. A total of 351 patients (14 256 in-patient days, 5026 neutropenic days) were investigated (316/90% allogeneic, 35/10% autologous; BMT: 119 patients, PBSCT: 234 patients). The mean length of neutropenia was 14.3 days (range: 0-66). Antimicrobial prophylaxis for allogeneic transplantation consisted of ciprofloxacin, trimethoprim/sulpha-methoxazole, fluconazole, and metronidazole. In total, 239 NIs were identified in 169 patients (48.1%), and of these 171 (71.5%) occurred during neutropenia (34.0 NIs per 1000 days at risk). The main pathogens were coagulase-negative staphylococci (36.3%), Clostridium difficile (20.4%), and enterococci (10.0%). Site-specific incidence densities during neutropenia vs non-neutropenia were: 13.9 vs 1.6 bloodstream infections (all central line-associated), 11.9 vs 1.8 pneumonias, 3.0 vs 2.9 gastroenteritis, and 1.6 vs 0.3 urinary tract infections. The greatest number of NI in BMT and PBSCT recipients is acquired during neutropenia, and multicentre surveillance programmes should focus on this.
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Flow cytometric measurements of neutrophil functions: the dependence on the stimulus to cell ratio. FEMS IMMUNOLOGY AND MEDICAL MICROBIOLOGY 2003; 35:147-52. [PMID: 12628551 DOI: 10.1016/s0928-8244(02)00462-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Phagocytosis and antimicrobial killing of neutrophils has been quantitatively determined as a function of the stimulus (Candida albicans) to cell ratio R using two donor collectives containing a total of 115 blood samples. Analysis of the collectives in two different laboratories according to the same flow cytometric protocol for simultaneous measurement of neutrophil functions did not produce statistically significant differences. The number of phagocytosing leukocytes as well as that of killed fungi per leukocyte depends strongly on R. While each phagocytosing neutrophil kills one fungus at low values of R, each neutrophil kills on average 2.5 fungi for large R.
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European guidelines-yes, but how? J Hosp Infect 2003; 53:234. [PMID: 12623328 DOI: 10.1053/jhin.2002.1365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Development and mechanism of fluoroquinolone resistance in Legionella pneumophila. J Antimicrob Chemother 2003; 51:275-80. [PMID: 12562691 DOI: 10.1093/jac/dkg054] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The potential for selection in vitro of Legionella pneumophila mutants resistant to fluoroquinolones was investigated. Six distinct clinical isolates of L. pneumophila were subcultured in subinhibitory concentrations of ciprofloxacin, levofloxacin, clinafloxacin, trovafloxacin and moxifloxacin until MICs increased at least eight-fold. The numbers of serial passages required in microbroth dilution series were determined. The gyrA gene of the six parental strains, and 12 selected mutant strains, was sequenced. The five quinolones differed markedly in their ability to select mutants with decreased susceptibility. The average number of serial passages required was low in the cases of clinafloxacin (n = 10.6), ciprofloxacin and levofloxacin (both n = 13), but notably higher for trovafloxacin (n = 26.6) and moxifloxacin (n = 22.5). Five mutants treated with ciprofloxacin and three treated with moxifloxacin showed Thr83-->Lys or Thr83-->Ile amino acid changes in the gyrA gene. In conclusion, different quinolones lose their antimicrobial effect after a varying number of passages. This study demonstrated, for the first time to our knowledge, that gyrA in L. pneumophila is a possible target of fluoroquinolones.
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Cost-effectiveness of an antiseptic-impregnated central venous catheter in the ICU. Intensive Care Med 2003; 29:139. [PMID: 12528036 DOI: 10.1007/s00134-002-1559-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2002] [Accepted: 10/07/2002] [Indexed: 10/22/2022]
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Commentary regarding the article by Gottwald et al.: "Amalgam disease"--poisoning, allergy, or psychic disorder? Int. J. Hyg. Environ. Health 204, 223-229 (2001). Int J Hyg Environ Health 2003; 206:69-70; author reply 71-3. [PMID: 12621906 DOI: 10.1078/1438-4639-00185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Diversity of Staphylococcus aureus strains isolated from two European regions with different prevalences of methicillin resistance. Eur J Clin Microbiol Infect Dis 2002; 21:880-3. [PMID: 12525924 DOI: 10.1007/s10096-002-0842-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The genodiversity of Staphylococcus aureus isolates from the Nottingham region of the United Kingdom was compared with isolates from the Freiburg region of Germany. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) isolates was higher in Nottingham than in Freiburg. In patients from Nottingham hospitals, 80% of MRSA isolates were classical epidemic MRSA-15, but genotypic variants of epidemic MRSA-15 comprised 72% of isolates from Nottingham community-based patients. In contrast, MRSA isolates from Freiburg showed greater diversity, but 47% and 23% of isolates, respectively, belonged to two predominant MRSA genotypes found in isolates from both hospitalised and community-based patients. The results suggest that genodiversity becomes increasingly more confined in settings with a higher frequency and longer duration of MRSA prevalence.
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Effect of skin disinfection with octenidine dihydrochloride on insertion site colonization of intravascular catheters. Infection 2002; 30:282-5. [PMID: 12382087 DOI: 10.1007/s15010-002-2182-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND We investigated the efficacy of two commercially available, alcohol-based antiseptic solutions in decontaminating the insertion site of central lines. One solution contained the bispyridine octenidine dihydrochloride. PATIENTS AND METHODS Inpatients receiving either a central venous catheter (CVC) or a peripherally inserted central catheter (PICC) were alternately assigned to different skin disinfection regimens at the insertion site: (A) 0.1% octendine dihydrochloride with 30% 1-propanol and 45% 2-propanol, (B) 74% ethanol with 10% 2-propanol. Quantitative skin cultures were obtained from the insertion site at predetermined intervals. RESULTS A total of 60 patients received 12 CVCs and 47 PICCs (no significant difference with respect to gender, age and catheter type). In total, 90 cultures were assessed in each group. The median colony-forming unit (cfu) counts per 24 cm(2) (group A vs B) were 2,270 vs 2,950 before, 20 vs 40 following and 860 vs 1,210 24 h after catheter insertion, respectively. A statistically significant difference in the efficacy of skin decontamination was seen between groups in culture set (3) and in the difference between culture sets (2) and (3) (Wilcoxon rank sum test). CONCLUSION Octenidine/propanol appears to be more effective than alcohol (ethanol/propanol) alone in reducing microflora of the skin at the PICC/CVC insertion site over a 24-h period.
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Abstract
BACKGROUND Although there is consensus in the international literature on the benefits of using perioperative antibiotic prophylaxis (PAP), there is still considerable scope for improving its use in many hospitals. MATERIALS AND METHODS In this study, data on the practice of PAP were recorded in eight German hospitals within the framework of a prospective controlled interventional study for the surveillance and prevention of nosocomial infections. RESULTS A total of 627 surgical procedures (appendectomies, other colorectal procedures, total prosthetic hip replacement) were assessed; 397 with PAP and 224 without PAP; six procedures could not be evaluated. Of the 397 PAP recorded, only 180 (45.3%) were performed correctly in accordance with international standards as a preoperative single dose (19/59 PAP in appendectomies, 72/188 PAP in other colorectal procedures, 89/150 PAP in total prosthetic hip replacement). CONCLUSION There is still great uncertainty regarding the point in time at which PAP should be administered and its duration. Additional efforts are necessary to improve PAP in accordance with published evidence-based guidelines.
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Rapid PCR-based identification of methicillin-resistant Staphylococcus aureus from screening swabs. J Clin Microbiol 2002; 40:1821-3. [PMID: 11980967 PMCID: PMC130653 DOI: 10.1128/jcm.40.5.1821-1823.2002] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2001] [Revised: 08/13/2001] [Accepted: 02/13/2002] [Indexed: 11/20/2022] Open
Abstract
A PCR identification of methicillin-resistant Staphylococcus aureus (MRSA), obviating the need for subculture on agar media, was investigated. The combination of MRSA detection by mecA femB PCR with prior enrichment in selective broth was tested for 439 swabs. PCR identified 36 MRSA-positive samples, in concordance with conventional methods.
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Abstract
BACKGROUND We investigated incremental cost of nosocomial pneumonia (NP) from the perspective of a hospital and health insurance funds. PATIENTS AND METHODS The incremental cost was determined by calculating total costs for pneumonia patients and controls using prospective and retrospective matched-pairs analysis with 29 and 37 matched pairs, respectively. RESULTS Compared to controls, patients who developed pneumonia had to be on artificial ventilation 5 days longer, needed markedly more intensive care with 6.55 additional days in intensive care. Excess cost per pneumonia patient amounted to DM 14,606 (95% CI: DM 5,285-23,927) from the hospital's perspective and to DM 7,988 (95% CI: DM 5,281-10,894) according to statutory insurance charges. According to the retrospective anaLysis carried out on the neurosurgical and neurological intensive care wards, pneumonia patients were ventiLated 5 days longer than patients without pneumonia, needed more intensive care over 30 days and had an additional 14.03 days of intensive care and 10.14 more days in hospital. Excess cost per patient was DM 29,610 (95% CI: DM 23,054-36,174) from the hospitals perspective and DM 18,000 (95% CI: 14,885-21,020) according to the statutory insurance criteria. CONCLUSION The study gives insight into the structure of incremental cost caused by NP and shows that based on a conservative cost calculation the incremental cost per NP patient is higher for the hospital than for health insurance funds which indicates a significant financial deficit for the hospital. Antibiotics and microbiology together only contribute 6.8% to incremental cost. Therefore in a cost saving initiative their close relationship to length of hospitalization must be considered.
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