Andreas Conrad

Two time-series analyses of the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus infection and Clostridium difficile infection.

OBJECTIVE To determine the impact of antibiotic consumption and alcohol-based hand disinfection on the incidences of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection and Clostridium difficile infection (CDI). METHODS Two multivariate time-series analyses were performed that used as dependent variables the monthly incidences of nosocomial MRSA infection and CDI at the Freiburg University Medical Center during the period January 2003 through October 2007. The volume of alcohol-based hand rub solution used per month was quantified in liters per 1,000 patient-days. Antibiotic consumption was calculated in terms of the number of defined daily doses per 1,000 patient-days per month. RESULTS The use of alcohol-based hand rub was found to have a significant impact on the incidence of nosocomial MRSA infection (P< .001). The multivariate analysis (R2=0.66) showed that a higher volume of use of alcohol-based hand rub was associated with a lower incidence of nosocomial MRSA infection. Conversely, a higher level of consumption of selected antimicrobial agents was associated with a higher incidence of nosocomial MRSA infection. This analysis showed this relationship was the same for the use of second-generation cephalosporins (P= .023), third-generation cephalosporins (P= .05), fluoroquinolones (P= .01), and lincosamides (P= .05). The multivariate analysis (R2=0.55) showed that a higher level of consumption of third-generation cephalosporins (P= .008), fluoroquinolones (P= .084), and/or macrolides (P= .007) was associated with a higher incidence of CDI. A correlation with use of alcohol-based hand rub was not detected. CONCLUSION In 2 multivariate time-series analyses, we were able to show the impact of hand hygiene and antibiotic use on the incidence of nosocomial MRSA infection, but we found no association between hand hygiene and incidence of CDI.

The impact of antimicrobial drug consumption and alcohol-based hand rub use on the emergence and spread of extended-spectrum β-lactamase-producing strains: a time-series analysis

BACKGROUND The aim of this study was to explore the temporal relationship between the consumption of different antibiotics, alcohol-based hand disinfection and the incidence of nosocomial bacterial strains producing extended-spectrum beta-lactamases (ESBLs). METHODS Time-series analysis was performed based on monthly data available from January 2005 to October 2007. The incidence of nosocomial ESBL (cases/1000 patient-days) was regressed on the different antibiotic agents and the volume of alcohol-based hand rub orders. Antibiotic consumption was defined as monthly defined daily doses (DDD)/1000 patient-days, while alcohol-based hand rub was quantified in litres/1000 patient-days. RESULTS The multivariate analysis showed that using alcohol-based hand rub for hand disinfection had a significant influence on the ESBL incidence (P = 0.002). A higher volume of alcohol-based hand rub use was subsequently associated with a lower incidence of ESBL-producing strains. Additionally, the model showed that temporal increase in the use of third-generation cephalosporins (P = 0.022) and fluoroquinolones (P = 0.001) is, after a time lag of up to 3 months, followed by temporal variations in the incidence of nosocomial ESBLs. Furthermore, the incidence of patients admitted with ESBL was also shown to have an influence on the incidence of nosocomial ESBLs (P < 0.001). The final model explained 75% of the monthly variations in the incidence of nosocomial ESBLs. CONCLUSIONS The analysis identifies selective pressure caused by the use of different antimicrobial agents as a driving factor in the emergence and spread of ESBLs. Furthermore, the study confirms that hand disinfection is key to the prevention of nosocomial ESBLs.

Seasonal and ascending trends in the incidence of carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species in 2 German hospitals.

BACKGROUND Extended-spectrum ß-lactamase (ESBL)-producing strains of bacteria have become a major public health concern. In the present study, the incidence of carriage of ESBL-producing strains was analyzed for general trends and seasonality. METHODS Monthly data on ESBL-producing strains were collected retrospectively at 2 large university hospitals in Germany. The mean monthly temperatures for the 2 settings were collected from Germanys national meteorological service. Multivariable time series analyses were performed to explain variations in the monthly incidence densities of carriage of ESBL-producing bacteria (number of cases involving ESBL-producing Escherichia coli and/or Klebsiella species per 1,000 patient days). For the final models, we incorporated variables for the ascending linear trends and other variables representing the mean monthly temperature. RESULTS Our models demonstrated that there was an increasing trend in the incidences of carriage of ESBL-producing bacteria. In addition, the incidences of carriage of all ESBL-producing bacteria responded positively to the mean temperature, meaning that during the summer, more cases involving ESBL-producing bacteria were detected than during the winter. The same methodology was also applied to the incidence of methicillin-resistant Staphylococcus aureus carriage, but no association was found with the mean temperature. CONCLUSIONS In the present study, we demonstrated that the monthly incidence of carriage of ESBL-producing bacteria was highly correlated with the mean monthly temperature, a fact that should be considered in experimental studies as an additional parameter influencing the incidence of ESBL-producing bacteria.

Broad spectrum antibacterial activity of a mixture of isothiocyanates from nasturtium (Tropaeoli majoris herba) and horseradish (Armoraciae rusticanae radix).

Isothiocyanates have been reported to exert antimicrobial activity. These compounds are found in a licensed native preparation of nasturtium (Tropaeoli majoris herba) and horseradish (Armoraciae rusticanae radix) which is used for treatment of upper respiratory and urinary tract infections. The aim of our investigation was to assess the antimicrobial activity of a mixture of the contained benzyl-, allyl-, and phenylethyl- isothiocyanates against clinically important bacterial and fungal pathogens including antimicrobial resistant isolates. Susceptibility testing was performed by agar-dilution technique. Isothiocyanates were mixed in proportions identical to the licensed drug. Minimum inhibitory- and minimum bactericidal concentrations were assessed. The Minimum inhibitory concentration90 was defined as the concentration which inhibited 90% of the microbial species tested. H. influenzae, M. catarrhalis, S. marcescens, P. vulgaris, and Candida spp. were found to be highly susceptible, with minimum inhibitory concentration90 -values ranging between ≤0.0005% and 0.004% (v/v) of total ITC. Intermediate susceptibilities were observed for S. aureus, S. pyogenes, S. pneumoniae, K. pneumoniae, E. coli and P. aeruginosa, with Minimum inhibitory concentration90 -values ranging between 0.004% and 0.125% (v/v), but with elevated Minimum bactericidal concentrations90-values (2-7 dilution steps above Minimum inhibitory concentration90). Low susceptibilities were determined for viridans streptococci and enterococci. Interestingly, both resistant and non-resistant bacteria were similarly susceptible to the test preparation.

Pelargonium sidoides-Extrakt (EPs® 7630): Zulassung bestätigt Wirksamkeit und Verträglichkeit

SummaryFor centuries the roots of Pelargonium sidoides DC have been used in South African ethno-medicine for the treatment of respiratory diseases. In Germany, a medicinal product containing a special extract of this substance is among the group of self-medication products most widely bought at chemists shops. In December 2005, the Federal Institute for Drugs and Medical Devices (BfArM, Bonn) approved a new license for its use as a drug. The following review focuses on the current pharmacological, toxicological and clinical data covering the efficacy and innocuousness of this drug when administered for the treatment of acute bronchitis.ZusammenfassungWurzelstücke aus Pelargonium sidoides DC werden in der südafrikanischen Ethnomedizin seit Jahrhunderten zur Behandlung von Atemwegserkrankungen angewendet. Ein Fertigarzneimittel mit einem speziellen Extrakt aus dieser Droge zählt gegenwärtig in Deutschland zu den Selbstmedikationspräparaten, die in der Apotheke am häufigsten abgegeben werden. Das Bundesinstitut für Arzneimittel und Medizinprodukte (BfArM, Bonn) hat dem Präparat im Dezember 2005 eine Neuzulassung als Arzneimittel erteilt. Die nachfolgende Übersicht fokussiert sich auf die aktuellen pharmakologischen, toxikologischen und klinischen Daten zur Wirksamkeit und Unbedenklichkeit im neu zugelassenen Anwendungsgebiet akute Bronchitis.

Are short training sessions on hand hygiene effective in preventing hospital-acquired MRSA? A time-series analysis

We tested the impact of short hand hygiene training sessions and bed occupancy rates on the spread of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) using a multivariate time-series analysis. According to our model, bed occupancy rates within general ward and intensive care unit settings correlated positively with the incidence of hospital-acquired MRSA, whereas alcohol-based hand rub use and MRSA showed a negative correlation. Furthermore, our model shows that 2 hand hygiene campaigns based on short training sessions effected a long-run reduction in the incidence of hospital-acquired MRSA.

Extract of Pelargonium sidoides (EPs® 7630) displays anti-infective properties by enhanced phagocytosis and differential modulation of host – bacteria interactions

EPs 7630 is an aqueous-ethanolic extract of the roots of PELARGONIUM SIDOIDES that displays well-documented benefits in the treatment of upper respiratory tract infections (URTI). IN VITRO and animal investigations have revealed various anti-infective properties of EPs 7630. The present review sums up recently published IN VITRO investigations that have shown positive effects on the activity of human peripheral blood phagocytes (PBP) and differential modulation of the interactions between group A streptococci and the hosts epithelial barrier.

Burden of imported cases of infection or colonization with multidrug-resistant organisms in a German university hospital.

in a German University Hospital • Author(s): Elisabeth Meyer, MD; Andreas Conrad, MD; Christian Schneider, MD; Annerose Serr, MD; Regina Babikir; Markus Dettenkofer, MD, PhD Source: Infection Control and Hospital Epidemiology, Vol. 29, No. 12 (December 2008), pp. 1195-1196 Published by: The University of Chicago Press on behalf of The Society for Healthcare Epidemiology of America Stable URL: http://www.jstor.org/stable/10.1086/592409 . Accessed: 14/05/2014 14:53

Correspondence (letter to the editor): Hand hygiene prevents MRSA transmission.

The discovery that disinfecting hands reduces transmission of pathogens is a cornerstone of modern medicine and a crucial quality parameter in the healthcare system. Improving hand hygiene is obligatory for all institutions. We therefore are at a loss to understand why many parties in Germany have chosen not to participate in the national clean hands campaign, “Aktion saubere Hande.” At University Medical Center Freiburg we have observed that linking hand hygiene with skin protection/skin care, as was implemented in collaboration with the occupational health services and the Department of Dermatology, has yielded enormous improvements. Health care workers’ hands are the crucial tools of the trade where treating patients is concerned—hands have to protect patients, but in turn they have to be protected themselves. Additionally, we switched to colouring- and perfume-free products for hand hygiene, because the colouring and perfume in such preparations do not contribute to a product’s effectiveness or tolerability and may even trigger sensitization. Even if skin problems due to hand hygiene are usually caused by irritant-toxic damage, the risk for contact allergies should also be reduced (2). After the switch we again observed a substantial increase in the use of alcohol-based hand rub in our institution—additionally promoted by a series of measures to improve hand hygiene, such as short training sessions, improved access to dispensers, complemented use of wearable dispensers—for example, for transport services. In a recent study, we have shown that increased use of alcohol-based hand rub helps prevent transmission of nosocomial MRSA (3). In addition to improving the quality of medical treatment and patient safety, we were thus able to reduce the time, money, and effort spent on delivering health care.