F. Schwab

To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units.

OBJECTIVEnTo investigate whether isolating patients with MRSA in private rooms in ICUs (or cohorting) is a protective factor for nosocomial MRSA infection.nnnDESIGNnAssociation between nosocomial MRSA infection rates and ICU structure and process parameters in the German Nosocomial Infection Surveillance System (KISS).nnnSETTINGnTwo hundred twelve ICUs participating in KISS in 2001.nnnMETHODSnIn June 2001, a structured questionnaire was sent to the participating ICUs regarding their preventive measures, their type and size, their patient-to-personnel ratios, and routine cultures. Univariate and multivariate analyses were conducted to identify risk factors for nosocomial MRSA infection.nnnRESULTSnThe questionnaire was completed by 164 (77.4%) of the ICUs. These ICUs had 325 nosocomial MRSA infections in a 5-year period (1997 to 2001). The mean incidence density of nosocomial MRSA infections was 0.3/1,000 patient-days. Ninety-one ICUs (55.5%) did not register any nosocomial MRSA infections during the observation period. Forty-two ICUs had an incidence density of at least 0.3/1,000 patient-days (75th percentile). Surgical ICUs were found to be a risk factor for a nosocomial MRSA infection rate above this threshold. Multivariate analysis found surgical ICUs to be an independent predictor and isolation in private rooms (or cohorts) to be a protective factor (OR, 0.36; CI95, 0.17-0.79).nnnCONCLUSIONnMany (34.4%) of the German ICUs have not isolated MRSA patients in private rooms or cohorts, a procedure associated with lower MRSA infection rates in this study.

Effects of long-term routine use of selective digestive decontamination on antimicrobial resistance

ObjectiveTo assess the distribution of bacterial species and antimicrobial resistance in an ICU during long-term use of selective digestive decontamination (SDD) in the context of national reference data.Design and settingFive-year prospective observational study in axa024-bed interdisciplinary surgical ICU of axa0university hospital (study ICU) participating in the project “Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units” (SARI; reference ICUs).PatientsResistance data were obtained from all patients; patients intubated for at least 2u202fdays received SDD (colistin, tobramycin, amphotericin B).Interventions and measurementsSDD was performed in 1,913 of 7,270 patients. Antimicrobial resistance was examined in 4,597 (study ICU) and 46,346 (reference ICUs) isolates.ResultsMethicillin-resistant Staphylococcus aureus (MRSA) remained stable (2.76 and 2.58 isolates/1000 patient days) in the study ICU; this was below the German average (4.26 isolates/1000 patient days). Aminoglycoside- and betalactam-resistant Gram-negative rods did not increase during SDD use. Aminoglycoside resistance of Pseudomonas aeruginosa was 50% below the mean value of SARI (0.24 vs. 0.52 isolates/1,000 patient days). The relative frequency of enterococci and coagulase-negative staphylococci (CNS) was higher than in the SARI ICUs (23.2% vs. 17.3%, and 25.0% vs. 20.6%, respectively).ConclusionRoutine 5-year-use of SDD was not associated with increased antimicrobial resistance in our ICU with low baseline resistance rates. Vigorous surveillance and control measures to search and destroy MRSA were considered axa0mandatory component of the SDD program. The relative increase in enterococci and CNS is of concern requiring further investigation.

Design of a Surveillance System of Antibiotic Use and Bacterial Resistance in German Intensive Care Units (SARI)

Abstract.Background: Data on antibioticnconsumption and bacterial resistance are important fornbenchmarking, ensuring quality of antibiotic treatment andnhelping to understand the relationship between the use ofnantibiotics and the emergence of resistance.nMethods: The SARI projectnis an ecological study that has established laboratory-basednsurveillance in German intensive care units (ICU). Resistancenrates of 13 sentinel pathogens are reported and certain alertnorganisms are sent for genotyping and retesting of antimicrobialnresistance.nResults: The project,ninitiated in February 2000, now includes 35 ICUs generating antotal of 266,013 patient days, 354,356 defined daily doses (DDD)nand providing susceptibility data on 21,354 isolates. Poolednantibiotic usage density (AD = DDD/1,000 patient days) wasnhighest for penicillins with lactamase inhibitor (AD 338.3)nfollowed by quinolones (AD 155.5) and second-generationncephalosporins (AD 124.6). Total AD was calculated as 1,337nDDD/1,000 patient days. Resistance rates (RR) for laboratoriesntesting according to the German Industrial Standard (DIN) weren19.3% for methicillin-resistant Staphylococcus aureus(MRSA), 9.5% fornciprofloxacinresistant Escherichiancoli and 25.4% for imipenem-resistantnPseudomonas aeruginosa. 40%nof the laboratories did not identify the extended spectrumnβlactamase production of a Klebsiellanpneumoniae strain.nConclusion: Focusing onnGerman ICUs, the SARI surveillance system provides a conceptnthat produces a benchmark for the link between antibioticnresistance and consumption.

Surveillance of Antimicrobial Use and Antimicrobial Resistance in German Intensive Care Units (SARI): A Summary of the Data from 2001 through 2004

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.

Trends in ventilator-associated pneumonia rates within the German nosocomial infection surveillance system (KISS).

OBJECTIVEnTo investigate trends in ventilator-associated pneumonia (VAP) rates during participation in the German nosocomial infection surveillance system (Krankenhaus-Infektions-Surveillance-System [KISS]).nnnMETHODSnA total of 71 ICUs that began participating in KISS in 1999 or later and continued participation for at least 36 months were selected. Beginning with the first month of participation, the pooled mean rate of VAP in the ICUs was calculated for each year of participation. The incidence densities for the 3 years of participation were compared using the Pearson chi (2) test. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. VAP rates were calculated for each ICU and year of participation, and rates for years 1 and 3 were compared using the Wilcoxon test for paired samples.nnnRESULTSnTwenty-nine medical-surgical, 18 medical, 20 surgical, 2 neurosurgical, and 2 pediatric ICUs met the selection criteria. Surveillance data were available on 181,275 patients, for whom there were 613,098 patient-days and 224,138 ventilator-days. A total of 2,043 cases of VAP were reported. The ICUs had a pooled VAP rate of 10.5 cases per 1,000 ventilator-days during year 1 of KISS surveillance. In year 2, the rate decreased by 19%, to 8.7 cases per 1,000 ventilator-days (RR, 0.81 [95% CI, 0.73-0.90]). In year 3, the rate decreased by 24% from year 1, to 8.0 cases per 1,000 ventilator-days (RR, 0.76; 95% CI, 0.68-0.85). Both results were significant (P<.001 by the Pearson chi (2) test). Comparison of the VAP rates of the ICUs did not show a significant difference between years 1 and 3 of KISS participation.nnnCONCLUSIONnSurveillance was associated with a significant reduction in the pooled rate of VAP during years 1-3 of KISS participation.

Surveillance nosokomialer Infektionen in Intensivstationen: Aktuelle Daten und Interpretationen

The German nosocomial infections surveillance system KISS was established in 1996 using a surveillance protocol based on the National Nosocomial Infections Surveillance (NNIS) System. Meanwhile data from a total of 274 intensive care units (ICU) are available, among them 134 interdisciplinary, 71 surgical, 55 medical, 9 neurosurgical and 5 paediatric ICUs. The data comprise about 6,966 surveillance months with more than 500,000 intensive care patients and more than 1.8 million patient days. A total of 6,888 cases of pneumonia and 2,357 cases of central venous catheter (CVC) associated primary bloodstream infections (BSI) were recorded. Ventilator associated pneumonia rates and CVC associated primary BSI rates are presented, stratified according to the type of the ICU and affiliation to a university, a teaching hospital or another type of hospital. The most frequent pathogens associated with ventilator associated pneumonia were S. aureus (24.1%), followed by P. aeruginosa (16.8%) and Klebsiella spp. (12.1%). In the case of CVC associated primary BSI coagulase negative staphylococci dominated (30.9%) followed by S. aureus (15.4%) and Enterococci spp. (11.6%). A remarkable increase of Methicillin Resistant Staphylococcus aureus (MRSA) infections was observed during the period from 1997 to 2002. 19.2% of S. aureus associated pneumonia cases and 25.5% of S. aureus associated primary BSI were due to MRSA. KISS data are useful benchmarks for internal quality management, however a careful interpretation is necessary to stimulate infection control efforts.SummaryThe German nosocomial infections surveillance system KISS was established in 1996 using a surveillance protocol based on the National Nosocomial Infections Surveillance (NNIS) System. Meanwhile data from a total of 274 intensive care units (ICU) are available, among them 134 interdisciplinary, 71, surgical, 55 medical, 9 neurosurgical and 5 paediatric ICUs. The data comprise about 6,966 surveillance months with more than 500,000 intensive care patients and more than 1.8 million patient days. A total of 6,888 cases of pneumonia and 2,357 cases of central venous catheter (CVC) associated primary bloodstream infections (BSI) were recorded.Ventilator associated pneumonia rates and CVC associated primary BSI rates are presented, stratified according to the type of the ICU and affiliation to a university, a teaching hospital or another type of hospital.The most frequent pathogens associated with ventilator associated pneumonia wereS. aureus (24.1%), followed byP. aeruginosa (16.8%) and Klebsiella spp. (12.1%). In the case of CVC associated primary BSI coagulase negative staphylococci dominated (30.9%) followed byS. aureus (15.4%) and Enterococci spp. (11.6%). A remarkable increase of Methicillin Resistant Staphylococcus aureus (MRSA) infections was observed during the period from 1997 to 2002, 19.2% ofS. aureus associated pneumonia cases and 25.5% ofS. aureus associated primary BSI were due to MRSA.KISS data are useful benchmarks for internal quality management, however a careful interpretation is necessary to stimulate infection control efforts.ZusammenfassungDas Krankenhaus-Infektions-Surveillance-System KISS wurde im Jahr 1996 auf der Basis der Methoden des amerikanischen National Nosocomial Infections Surveillance (NNIS) Systemes etabliert. Mittlerweile beinhaltet es Daten von 274 Intensivstationen darunter 134 interdisziplinäre 71 chirurgische, 55 medizinische, 9 neurochirurgische und 5 pädiatrische Intensivstationen. Wir haben einen Überblick über 6966 Beobachtungsmonate mit mehr als 500.000 Intensivpatienten und mehr als 1,8 Millionen Patiententagen. Es wurden 6888 beatmungsassozilierte Pneumonien und 2357 Zentralvenenkatheter (ZVK)-assoziierte Sepsis-Fälle erfasst.Die beatmungsassoziierten Pneumonieraten und ZVK-assoziierten primären Sepsisraten werden nach Art der Intensivstation und Status des zugehörigen Krankenhauses stratifiziert präsentiert.Bei beatmungsassoziierten Pneumonien sindS. aureus die häufigsten Erreger mit einem Anteil von 24,1% aller Fälle, gefolgt vonP. aeruginosa (16,8%) und Klebsiella spp. (12,1%). Im Fall der ZVK-assoziierten Sepsis werden vor allem koagulasenegative Staphylokokken gefunden (30.9%) gefolgt vonS. aureus (15,4%) und Enterococcus spp. (11,6%). Ein bemerkenswerter Anstieg der Methicillin-resistenten Staphylococcus aureus (MRSA) wurde im Zeitraum 1997 bis 2002 beobachtet. Bei denS. aureus-beciigten beatmungsassoziierten Pneumonien beträgt der Anteil der MRSA 19,2%. Bei denS. aureus bedingten Sepsisfällen liegt der MRSA-Anteil bei 25,5%Die KISS-Daten liefern wertvolle Benchmark-Information für das interne Qualitätsmanagement, allerdings ist eine sorgfälitge Interpretation notwendig, um Präventionsmaßnahmen zu stimulieren.

[Less blood culture samples: less infections?].

BACKGROUNDnThe data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU).nnnMETHODSnA questionnaire on the frequency of BCs taken was sent to all ICUs participating in KISS and univariable and multivariable analyses were performed on the results.nnnRESULTSnA total of 223 ICUs provided data. The median number of BC pairs taken in 2006 was 60 with a huge variation from 3.2 to 680 per 1,000 patient days. The mean primary BSI rate was 0.90 per 1,000 patient days and 0.25 BSIs per 1,000 patient days were caused by coagulase negative Staphylococci (CNS). The mean CVC-BSI rate was 1.40 per 1,000 CVC days. In the univariable analysis the blood culture frequency had a significant influence on the CVC-associated BSI rate, considering either all pathogens (p=0.001) or only the subgroup of CNS-related cases (p=0.019). There was also a significant influence of the BC frequency on the CVC-BSI rate considering all pathogens (p=0.004) as well as the subgroup of CNS (p=0.018). Therefore the BC frequency was a significant factor affecting the incidence of BSI and CVC-BSI. According to the multivariable analysis an increase of the BC frequency of 100 BCs per 1,000 patient days leads to a 1.27-fold higher incidence density of CVC-BSI with a 95% confidence interval (95% CI) of 1.01-1.26. A further significant risk factor for CVC-BSI was the length of stay in the ICU with an adjusted incidence rate ratio (IRR) of 1.25 (95% CI 1.15-1.35). To have the status of an interdisciplinary ICU was a significant protective factor (IRR 0.64; 95% CI 0.45-0.92).nnnCONCLUSIONSnIf an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care.ZusammenfassungHintergrundDie Daten des Krankenhaus-Infektions-Surveillance-Systems (KISS) wurden benutzt, um die Assoziation zwischen der Blutkulturproben- (BK-)Abnahmefrequenz und der mit einem zentralen Venenkatheter (ZVK) assoziierten Sepsisrate in Intensivstationen zu untersuchen.Material und MethodenEin Fragebogen bezüglich der BK-Abnahmefrequenz wurde zu allen teilnehmenden KISS-Intensivstationen gesendet. Univariable und multivariable Analysen wurden durchgeführt.ErgebnisseDaten von 223xa0Intensivstationen wurden eingeschlossen. Die mediane Anzahl der BK-Paare im Jahr 2006 betrug 60 mit einer großen Variationsbreite von 3,2–680/1000xa0Patiententage. Ein Anstieg der BK-Frequenz um 100xa0BK/1000xa0Patiententage führte zu einem 1,27-fachen Anstieg der Inzidenzdichte der ZVK-Sepsis (95%-Konfidenzintervall, 95%-KI 1,01–1,26). Ein weiterer signifikanter Risikofaktor für ZVK-Sepsis war die Liegedauer auf der Intensivstation (adjustiertes Inzidenzratenverhältnis 1,25, 95%-KI 1,15–1,35). Der Status einer interdisziplinären Intensivstation war mit einer geringeren Infektionsrate assoziiert.SchlussfolgerungSofern ein externes Benchmarking der Intensivstationen beabsichtigt ist, muss eine Adjustierung der ZVK-assoziierten Sepsisraten entsprechend der BK-Frequenz erfolgen. Eine ausreichende Blutkultivierungsfrequenz sollte sich als Qualitätsparameter in der Intensivmedizin etablieren.AbstractBackgroundThe data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU).MethodsA questionnaire on the frequency of BCs taken was sent to all ICUs participating in KISS and univariable and multivariable analyses were performed on the results.ResultsA total of 223 ICUs provided data. The median number of BC pairs taken in 2006 was 60 with a huge variation from 3.2 to 680 per 1,000 patient days. The mean primary BSI rate was 0.90 per 1,000 patient days and 0.25 BSIs per 1,000 patient days were caused by coagulase negative Staphylococci (CNS). The mean CVC-BSI rate was 1.40 per 1,000 CVC days. In the univariable analysis the blood culture frequency had a significant influence on the CVC-associated BSI rate, considering either all pathogens (p=0.001) or only the subgroup of CNS-related cases (p=0.019). There was also a significant influence of the BC frequency on the CVC-BSI rate considering all pathogens (p=0.004) as well as the subgroup of CNS (p=0.018). Therefore the BC frequency was a significant factor affecting the incidence of BSI and CVC-BSI. According to the multivariable analysis an increase of the BC frequency of 100 BCs per 1,000 patient days leads to a 1.27-fold higher incidence density of CVC-BSI with a 95% confidence interval (95% CI) of 1.01–1.26. A further significant risk factor for CVC-BSI was the length of stay in the ICU with an adjusted incidence rate ratio (IRR) of 1.25 (95% CI 1.15–1.35). To have the status of an interdisciplinary ICU was a significant protective factor (IRR 0.64; 95% CI 0.45–0.92).ConclusionsIf an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care.

Qualitätssicherung in der Intensivmedizin

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).ZusammenfassungIntensivstationen (ITS) sind Hochrisikobereiche für die Entstehung und die Ausbreitung multiresistenter bakterieller Erreger. Bisher gibt es in Deutschland weder repräsentative epidemiologische Daten über Antibiotikaresistenzen auf ITS noch über den prophylaktischen oder therapeutischen Einsatz von Antibiotika auf ITS oder die Korrelation zwischen Antibiotikaverbrauch und Resistenzentwicklung. Im Projekt SARI (Surveillance der Antibiotikaanwendung und bakteriellen Resistenzen auf ITS), das vom Bundesministerium für Bildung und Forschung gefördert wird, werden seit 2/2000 Daten zum Antibiotikaverbrauch und zu Resistenzraten (RR) auf bundesweit mittlerweile 35 interdisziplinären, medizinischen und chirurgischen ITS erfasst. Im Zeitraum von 2/2000–12/2002 wurden in 939xa0Teilnahmemonaten und 339.461 Patiententagen 452.282 Antibiotika-Tages-Dosen (DDD) verabreicht bei einer mittleren Antibiotikaanwendungsdichte (AD) von 1.332xa0DDDs/1.000xa0Patiententage, sowie Resistenzdaten von 31.189xa0Isolaten von ITS erfasst. Studiendesign und erste Ergebnisse von SARI werden in dieser Arbeit vorgestellt. Diese infektionsepidemiologischen Daten von SARI können den ITS Orientierungsdaten für ein verbessertes Antibiotika- und Hygienemanagement liefern (http://www.sari-antibiotika.de).AbstractIntensive 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 1,332xa0DDDs/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).

Wenige Blutkulturproben – wenige Infektionen?@@@Less blood culture samples – less infections?

BACKGROUNDnThe data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU).nnnMETHODSnA questionnaire on the frequency of BCs taken was sent to all ICUs participating in KISS and univariable and multivariable analyses were performed on the results.nnnRESULTSnA total of 223 ICUs provided data. The median number of BC pairs taken in 2006 was 60 with a huge variation from 3.2 to 680 per 1,000 patient days. The mean primary BSI rate was 0.90 per 1,000 patient days and 0.25 BSIs per 1,000 patient days were caused by coagulase negative Staphylococci (CNS). The mean CVC-BSI rate was 1.40 per 1,000 CVC days. In the univariable analysis the blood culture frequency had a significant influence on the CVC-associated BSI rate, considering either all pathogens (p=0.001) or only the subgroup of CNS-related cases (p=0.019). There was also a significant influence of the BC frequency on the CVC-BSI rate considering all pathogens (p=0.004) as well as the subgroup of CNS (p=0.018). Therefore the BC frequency was a significant factor affecting the incidence of BSI and CVC-BSI. According to the multivariable analysis an increase of the BC frequency of 100 BCs per 1,000 patient days leads to a 1.27-fold higher incidence density of CVC-BSI with a 95% confidence interval (95% CI) of 1.01-1.26. A further significant risk factor for CVC-BSI was the length of stay in the ICU with an adjusted incidence rate ratio (IRR) of 1.25 (95% CI 1.15-1.35). To have the status of an interdisciplinary ICU was a significant protective factor (IRR 0.64; 95% CI 0.45-0.92).nnnCONCLUSIONSnIf an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care.ZusammenfassungHintergrundDie Daten des Krankenhaus-Infektions-Surveillance-Systems (KISS) wurden benutzt, um die Assoziation zwischen der Blutkulturproben- (BK-)Abnahmefrequenz und der mit einem zentralen Venenkatheter (ZVK) assoziierten Sepsisrate in Intensivstationen zu untersuchen.Material und MethodenEin Fragebogen bezüglich der BK-Abnahmefrequenz wurde zu allen teilnehmenden KISS-Intensivstationen gesendet. Univariable und multivariable Analysen wurden durchgeführt.ErgebnisseDaten von 223xa0Intensivstationen wurden eingeschlossen. Die mediane Anzahl der BK-Paare im Jahr 2006 betrug 60 mit einer großen Variationsbreite von 3,2–680/1000xa0Patiententage. Ein Anstieg der BK-Frequenz um 100xa0BK/1000xa0Patiententage führte zu einem 1,27-fachen Anstieg der Inzidenzdichte der ZVK-Sepsis (95%-Konfidenzintervall, 95%-KI 1,01–1,26). Ein weiterer signifikanter Risikofaktor für ZVK-Sepsis war die Liegedauer auf der Intensivstation (adjustiertes Inzidenzratenverhältnis 1,25, 95%-KI 1,15–1,35). Der Status einer interdisziplinären Intensivstation war mit einer geringeren Infektionsrate assoziiert.SchlussfolgerungSofern ein externes Benchmarking der Intensivstationen beabsichtigt ist, muss eine Adjustierung der ZVK-assoziierten Sepsisraten entsprechend der BK-Frequenz erfolgen. Eine ausreichende Blutkultivierungsfrequenz sollte sich als Qualitätsparameter in der Intensivmedizin etablieren.AbstractBackgroundThe data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU).MethodsA questionnaire on the frequency of BCs taken was sent to all ICUs participating in KISS and univariable and multivariable analyses were performed on the results.ResultsA total of 223 ICUs provided data. The median number of BC pairs taken in 2006 was 60 with a huge variation from 3.2 to 680 per 1,000 patient days. The mean primary BSI rate was 0.90 per 1,000 patient days and 0.25 BSIs per 1,000 patient days were caused by coagulase negative Staphylococci (CNS). The mean CVC-BSI rate was 1.40 per 1,000 CVC days. In the univariable analysis the blood culture frequency had a significant influence on the CVC-associated BSI rate, considering either all pathogens (p=0.001) or only the subgroup of CNS-related cases (p=0.019). There was also a significant influence of the BC frequency on the CVC-BSI rate considering all pathogens (p=0.004) as well as the subgroup of CNS (p=0.018). Therefore the BC frequency was a significant factor affecting the incidence of BSI and CVC-BSI. According to the multivariable analysis an increase of the BC frequency of 100 BCs per 1,000 patient days leads to a 1.27-fold higher incidence density of CVC-BSI with a 95% confidence interval (95% CI) of 1.01–1.26. A further significant risk factor for CVC-BSI was the length of stay in the ICU with an adjusted incidence rate ratio (IRR) of 1.25 (95% CI 1.15–1.35). To have the status of an interdisciplinary ICU was a significant protective factor (IRR 0.64; 95% CI 0.45–0.92).ConclusionsIf an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care.

[Quality assurance in intensive care medicine. SARI-surveillance on antibiotic use and bacterial resistance in intensive care units].

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).ZusammenfassungIntensivstationen (ITS) sind Hochrisikobereiche für die Entstehung und die Ausbreitung multiresistenter bakterieller Erreger. Bisher gibt es in Deutschland weder repräsentative epidemiologische Daten über Antibiotikaresistenzen auf ITS noch über den prophylaktischen oder therapeutischen Einsatz von Antibiotika auf ITS oder die Korrelation zwischen Antibiotikaverbrauch und Resistenzentwicklung. Im Projekt SARI (Surveillance der Antibiotikaanwendung und bakteriellen Resistenzen auf ITS), das vom Bundesministerium für Bildung und Forschung gefördert wird, werden seit 2/2000 Daten zum Antibiotikaverbrauch und zu Resistenzraten (RR) auf bundesweit mittlerweile 35 interdisziplinären, medizinischen und chirurgischen ITS erfasst. Im Zeitraum von 2/2000–12/2002 wurden in 939xa0Teilnahmemonaten und 339.461 Patiententagen 452.282 Antibiotika-Tages-Dosen (DDD) verabreicht bei einer mittleren Antibiotikaanwendungsdichte (AD) von 1.332xa0DDDs/1.000xa0Patiententage, sowie Resistenzdaten von 31.189xa0Isolaten von ITS erfasst. Studiendesign und erste Ergebnisse von SARI werden in dieser Arbeit vorgestellt. Diese infektionsepidemiologischen Daten von SARI können den ITS Orientierungsdaten für ein verbessertes Antibiotika- und Hygienemanagement liefern (http://www.sari-antibiotika.de).AbstractIntensive 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 1,332xa0DDDs/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).