Tim Eckmanns
Robert Koch Institute
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Featured researches published by Tim Eckmanns.
Infection Control and Hospital Epidemiology | 2006
Tim Eckmanns; Jan Bessert; Michael Behnke; Petra Gastmeier; Henning Rüden
OBJECTIVE To determine the influence the Hawthorne effect has on compliance with antiseptic hand rub (AHR) use among healthcare personnel. DESIGN Observational study. SETTING Five intensive care units of a university hospital in Berlin, Germany. PARTICIPANTS Medical personnel were monitored in 2 periods regarding compliance with AHR use when there were indications for AHR use. In the first period, the personnel had no knowledge of being observed. The second observation period was announced to the staff of the intensive care units in advance and information about what the observer would be monitoring was provided. Potential confounders of compliance with AHR use included occupational groups (nurses, physicians, and other healthcare workers), intensive care units, and indications for AHR use before or after any procedure. RESULTS Data were collected from 2,808 indications for AHR use. The overall rate of compliance was 29% (95% confidence interval, 26%-32%) in the first period and 45% (95% confidence interval, 43%-47%) in the second period. A logistic regression analysis with potential confounders revealed a significant odds ratio for the comparison between period 2 and period 1. The differences in compliance with AHR use were statistically significant (P<.001) between the occupational groups (nurses had the highest compliance and physicians had middle compliance) and between indication for AHR use before procedures and indication for AHR use after procedures. CONCLUSIONS The Hawthorne effect has a marked influence on compliance with AHR use, with a 55% increase of compliance with overt observation. This result is consistent throughout subgroups. The rate of compliance with AHR use may in fact be lower than we thought because of results from studies that did not take the Hawthorne effect into account. The results of this study underline the necessity for infection control teams to be on wards as often as possible.
Eurosurveillance | 2010
Ole Wichmann; Petra Stöcker; Gabriele Poggensee; Doris Altmann; Dietmar Walter; Wiebke Hellenbrand; Gérard Krause; Tim Eckmanns
During the 2009 influenza pandemic, a monovalent AS03-adjuvanted vaccine was almost exclusively used in Germany for immunisation against the 2009 pandemic influenza A(H1N1) virus. One-dose vaccination was recommended for all age groups. We applied the screening method for the rapid assessment of vaccine effectiveness (VE) based on reported data of vaccinated and unvaccinated pandemic influenza cases and vaccination coverage estimates. Preliminary results demonstrate excellent VE in persons aged 14-59 years (96.8%; 95% confidence interval (CI): 95.2-97.9) and moderately high VE in those 60 years or older (83.3%; 95% CI: 71.0-90.5).
International Journal of Antimicrobial Agents | 2013
Christoph Lübbert; Sarah Faucheux; Diana Becker-Rux; Sven Laudi; Axel Dürrbeck; Thilo Busch; Petra Gastmeier; Tim Eckmanns; Arne C. Rodloff; Udo Kaisers
After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80 mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5 g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12-103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48 h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12-40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P = 0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development.
PLOS ONE | 2011
Yanina Balabanova; Andreas Gilsdorf; Silke Buda; Reinhard Burger; Tim Eckmanns; Barbara Gärtner; Uwe Groß; Walter Haas; Osamah Hamouda; Johannes Hübner; Thomas Jänisch; Manfred Kist; Michael H. Kramer; Thomas Ledig; Martin Mielke; Matthias Pulz; Klaus Stark; Norbert Suttorp; Uta Ulbrich; Ole Wichmann; Gérard Krause
Introduction To establish strategic priorities for the German national public health institute (RKI) and guide the institutes mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research. Methods We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied. We ranked the pathogens according to the total weighted score and divided them into four priority groups. Results 127 pathogens were scored. Eighty-six experts participated in the weighting; “Case fatality rate” was rated as the most important criterion. Twenty-six pathogens were ranked in the highest priority group; among those were pathogens with internationally recognised importance (e.g., Human Immunodeficiency Virus, Mycobacterium tuberculosis, Influenza virus, Hepatitis C virus, Neisseria meningitides), pathogens frequently causing large outbreaks (e.g., Campylobacter spp.), and nosocomial pathogens associated with antimicrobial resistance. Other pathogens in the highest priority group included Helicobacter pylori, Respiratory Syncytial Virus, Varicella zoster virus and Hantavirus. Discussion While several pathogens from the highest priority group already have a high profile in national and international health policy documents, high scores for other pathogens (e.g., Helicobacter pylori, Respiratory syncytial virus or Hantavirus) indicate a possible under-recognised importance within the current German public health framework. A process to strengthen respective surveillance systems and research has been started. The prioritization methodology has worked well; its modular structure makes it potentially useful for other settings.
Emerging Infectious Diseases | 2008
F. Burckhardt; Anett Friedrich; Dietmar Beier; Tim Eckmanns
To the Editor: Vonberg et al. (1) recently commented on the increase of Clostridium difficile seen in US hospitals by using discharge diagnoses and confirmed the observation from the United States (2) with hospital discharge data from Germany during 2000 through 2004. C. difficile ribotype 027 has recently been isolated in Germany (3). We further contribute to the assessment of C. difficile as an emerging threat by looking at population surveillance data. C. difficile is not a federal notifiable disease in Germany, which limits our ability to analyze national surveillance trends. However, in 2002 the state of Saxony implemented additional mandatory surveillance of community- and hospital-acquired infectious enteritis caused by laboratory-confirmed C. difficile. To check for an increase in notifications due to reporting bias of gastroenteric diseases, we compared the quarterly incidence data from 2002 through 2006 with data on Salmonella spp. infections (usually reported by local general practitioners) and rotavirus and norovirus infections (both usually reported by clinics). The potential problem of reporting bias for gastroenteric diseases has been addressed recently (4). Information about age and sex of C. difficile patients was available for 2006 only. Quarterly incidences for C. difficile in Saxony were from 1.7–3.8 per 100,000 population in 2002 and 2003 and continued to increase to 14.8 cases per 100,000 population in 2006 (Figure). This constitutes a 6-fold increase of the yearly average of C. difficile incidence rates between 2002 and 2006. The third quarter of 2005 experienced a sharp drop that could not be explained retrospectively and might have resulted from transition to new procedures for data collection and management. Figure Quarterly incidence per 100,000 population of Clostridium difficile infections compared with gastroenteric infections caused by Salmonella spp., rotaviruses, and noroviruses in Saxony, Germany, 2002–2006. Note the log scale on the y axis. Gastroenteric infections showed clear seasonality with a slightly decreasing yearly trend for Salmonella spp. and seasonal values from 13.8 cases per 100,000 in winter to summer peaks of 56.8. Rotavirus infections displayed an even stronger seasonality, with values from 7.0 cases per 100,000 in summer to winter peaks of 140.3. Norovirus infections peaked again during winter, at 137.2 cases per 100,000 but had as few as 11.0 cases per 100,000 during summer. Notification does not suggest reporting bias of gastroenteric infections. Elderly persons, i.e., those >65 years of age, were affected most by C. difficile infections; this age group accounted for 1,506 (65%) of all cases (n = 2,306) in 2006. The 45- to 64-year age group had the next highest number of cases, 451 (20%). Men and women were affected equally in the different age groups; slightly more women (n = 805) than men (n = 701) with C. difficile infection were >65 years of age. According to state and local health departments, there were no major health campaigns since 2004 that might have selectively increased awareness for C. difficile notification. Our results show a continuous increase of cases that even reaches seasonal notification levels of Salmonella spp. and Rotavirus infections, but the increase is difficult to explain entirely by changes in reporting behavior. We emphasize the role of individual German states in setting additional surveillance targets for public health. Given the epidemic potential and the severity of the disease, especially among the elderly, surveillance of C. difficile should be introduced throughout Germany along with enhanced prevention and treatment strategies (5).
PLOS ONE | 2012
Birgit Walther; Julia Hermes; Christiane Cuny; Lothar H. Wieler; Szilvia Vincze; Yassmin Abou Elnaga; Ivonne Stamm; Peter A. Kopp; Barbara Kohn; Wolfgang Witte; Andreas Jansen; Franz Josef Conraths; Torsten Semmler; Tim Eckmanns; Antina Lübke-Becker
Background Since the relationship between dogs and their owners has changed, and dogs moved from being working dogs to family members in post-industrial countries, we hypothesized that zoonotic transmission of opportunistic pathogens like coagulase positive staphylococci (CPS) is likely between dogs and their owners. Methodology/Principal Findings CPS- nasal carriage, different aspects of human-to-dog relationship as well as potential interspecies transmission risk factors were investigated by offering nasal swabs and a questionnaire to dog owners (108) and their dogs (108) at a dog show in 2009. S. aureus was found in swabs of 20 (18.5%) humans and two dogs (1.8%), and spa types which correspond to well known human S. aureus lineages dominated (e.g. CC45, CC30 and CC22). Multilocus sequence typing (MLST) of the two canine strains revealed ST72 and ST2065 (single locus variant of ST34). Fifteen dogs (13.9%) and six owners (5.6%) harboured S. pseudintermedius, including one mecA-positive human isolate (MRSP). Pulsed field gel electrophoresis (PFGE) revealed that one dog/owner pair harboured indistinguishable S. pseudintermedius- isolates of ST33. Ten (48%) of the 21 S. pseudintermedius-isolates showed resistance towards more than one antimicrobial class. 88.9% of the dog owners reported to allow at least one dog into the house, 68.5% allow the dog(s) to rest on the sofa, 39.8% allow their dogs to come onto the bed, 93.5% let them lick their hands and 52.8% let them lick their face. Bivariate analysis of putative risk factors revealed that dog owners who keep more than two dogs have a significantly higher chance of being colonized with S. pseudintermedius than those who keep 1–2 dogs (p<0.05). Conclusions/Recommendations In conclusion, CPS transmission between dog owners and their dogs is possible. Further investigation regarding interspecies transmission and the diverse adaptive pathways influencing the epidemiology of CPS (including MRSA and MRSP) in different hosts is needed.
Milbank Quarterly | 2014
Edward Velasco; Tumacha Agheneza; Kerstin Denecke; Göran Kirchner; Tim Eckmanns
Context: The exchange of health information on the Internet has been heralded as an opportunity to improve public health surveillance. In a field that has traditionally relied on an established system of mandatory and voluntary reporting of known infectious diseases by doctors and laboratories to governmental agencies, innovations in social media and so-called user-generated information could lead to faster recognition of cases of infectious disease. More direct access to such data could enable surveillance epidemiologists to detect potential public health threats such as rare, new diseases or early-level warnings for epidemics. But how useful are data from social media and the Internet, and what is the potential to enhance surveillance? The challenges of using these emerging surveillance systems for infectious disease epidemiology, including the specific resources needed, technical requirements, and acceptability to public health practitioners and policymakers, have wide-reaching implications for public health surveillance in the 21st century. Methods: This article divides public health surveillance into indicator-based surveillance and event-based surveillance and provides an overview of each. We did an exhaustive review of published articles indexed in the databases PubMed, Scopus, and Scirus between 1990 and 2011 covering contemporary event-based systems for infectious disease surveillance. Findings: Our literature review uncovered no event-based surveillance systems currently used in national surveillance programs. While much has been done to develop event-based surveillance, the existing systems have limitations. Accordingly, there is a need for further development of automated technologies that monitor health-related information on the Internet, especially to handle large amounts of data and to prevent information overload. The dissemination to health authorities of new information about health events is not always efficient and could be improved. No comprehensive evaluations show whether event-based surveillance systems have been integrated into actual epidemiological work during real-time health events. Conclusions: The acceptability of data from the Internet and social media as a regular part of public health surveillance programs varies and is related to a circular challenge: the willingness to integrate is rooted in a lack of effectiveness studies, yet such effectiveness can be proved only through a structured evaluation of integrated systems. Issues related to changing technical and social paradigms in both individual perceptions of and interactions with personal health data, as well as social media and other data from the Internet, must be further addressed before such information can be integrated into official surveillance systems.
PLOS ONE | 2013
Ulrich Nübel; Matthias Nachtnebel; Gerhard Falkenhorst; Justus Benzler; Jochen Hecht; Michael Kube; Felix Bröcker; Karin Moelling; Christoph Bührer; Petra Gastmeier; Brar Piening; Michael Behnke; Manuel Dehnert; Franziska Layer; Wolfgang Witte; Tim Eckmanns
Background Methicillin-resistant Staphylococcus aureus (MRSA) may cause prolonged outbreaks of infections in neonatal intensive care units (NICUs). While the specific factors favouring MRSA spread on neonatal wards are not well understood, colonized infants, their relatives, or health-care workers may all be sources for MRSA transmission. Whole-genome sequencing may provide a new tool for elucidating transmission pathways of MRSA at a local scale. Methods and Findings We applied whole-genome sequencing to trace MRSA spread in a NICU and performed a case-control study to identify risk factors for MRSA transmission. MRSA genomes had accumulated sequence variation sufficiently fast to reflect epidemiological linkage among individual patients, between infants and their mothers, and between infants and staff members, such that the relevance of individual nurses’ nasal MRSA colonization for prolonged transmission could be evaluated. In addition to confirming previously reported risk factors, we identified an increased risk of transmission from infants with as yet unknown MRSA colonisation, in contrast to known MRSA-positive infants. Conclusions The integration of epidemiological (temporal, spatial) and genomic data enabled the phylogenetic testing of several hypotheses on specific MRSA transmission routes within a neonatal intensive-care unit. The pronounced risk of transmission emanating from undetected MRSA carriers suggested that increasing the frequency or speed of microbiological diagnostics could help to reduce transmission of MRSA.
Infection | 2016
F. Allerberger; Steffen Amann; P. Apfalter; Hans Reinhard Brodt; Tim Eckmanns; Matthias Fellhauer; H. K. Geiss; O. Janata; Robert Krause; S. W. Lemmen; Elisabeth Meyer; H. Mittermayer; U. Porsche; E. Presterl; Stefan Reuter; Bhanu Sinha; R. Strauß; Agnes Wechsler-Fördös; C. Wenisch; Winfried V. Kern
IntroductionIn the time of increasing resistance and paucity of new drug development there is a growing need for strategies to enhance rational use of antibiotics in German and Austrian hospitals. An evidence-based guideline on recommendations for implementation of antibiotic stewardship (ABS) programmes was developed by the German Society for Infectious Diseases in association with the following societies, associations and institutions: German Society of Hospital Pharmacists, German Society for Hygiene and Microbiology, Paul Ehrlich Society for Chemotherapy, The Austrian Association of Hospital Pharmacists, Austrian Society for Infectious Diseases and Tropical Medicine, Austrian Society for Antimicrobial Chemotherapy, Robert Koch Institute.Materials and methodsA structured literature research was performed in the databases EMBASE, BIOSIS, MEDLINE and The Cochrane Library from January 2006 to November 2010 with an update to April 2012 (MEDLINE and The Cochrane Library). The grading of recommendations in relation to their evidence is according to the AWMF Guidance Manual and Rules for Guideline Development.ConclusionThe guideline provides the grounds for rational use of antibiotics in hospital to counteract antimicrobial resistance and to improve the quality of care of patients with infections by maximising clinical outcomes while minimising toxicity. Requirements for a successful implementation of ABS programmes as well as core and supplemental ABS strategies are outlined. The German version of the guideline was published by the German Association of the Scientific Medical Societies (AWMF) in December 2013.
PLOS Medicine | 2016
Alessandro Cassini; Diamantis Plachouras; Tim Eckmanns; Muna Abu Sin; Hans-Peter Blank; Tanja Ducomble; Sebastian Haller; Thomas Harder; Anja Klingeberg; Madlen Sixtensson; Edward Velasco; Bettina Weiß; Piotr Kramarz; Dominique L. Monnet; Mirjam Kretzschmar; Carl Suetens
Background Estimating the burden of healthcare-associated infections (HAIs) compared to other communicable diseases is an ongoing challenge given the need for good quality data on the incidence of these infections and the involved comorbidities. Based on the methodology of the Burden of Communicable Diseases in Europe (BCoDE) project and 2011–2012 data from the European Centre for Disease Prevention and Control (ECDC) point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals, we estimated the burden of six common HAIs. Methods and Findings The included HAIs were healthcare-associated pneumonia (HAP), healthcare-associated urinary tract infection (HA UTI), surgical site infection (SSI), healthcare-associated Clostridium difficile infection (HA CDI), healthcare-associated neonatal sepsis, and healthcare-associated primary bloodstream infection (HA primary BSI). The burden of these HAIs was measured in disability-adjusted life years (DALYs). Evidence relating to the disease progression pathway of each type of HAI was collected through systematic literature reviews, in order to estimate the risks attributable to HAIs. For each of the six HAIs, gender and age group prevalence from the ECDC PPS was converted into incidence rates by applying the Rhame and Sudderth formula. We adjusted for reduced life expectancy within the hospital population using three severity groups based on McCabe score data from the ECDC PPS. We estimated that 2,609,911 new cases of HAI occur every year in the European Union and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA primary BSI were associated with the highest burden and represented more than 60% of the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of burden of disease. HAP and HA primary BSI were associated with the highest burden because of their high severity. The cumulative burden of the six HAIs was higher than the total burden of all other 32 communicable diseases included in the BCoDE 2009–2013 study. The main limitations of the study are the variability in the parameter estimates, in particular the disease models’ case fatalities, and the use of the Rhame and Sudderth formula for estimating incident number of cases from prevalence data. Conclusions We estimated the EU/EEA burden of HAIs in DALYs in 2011–2012 using a transparent and evidence-based approach that allows for combining estimates of morbidity and of mortality in order to compare with other diseases and to inform a comprehensive ranking suitable for prioritization. Our results highlight the high burden of HAIs and the need for increased efforts for their prevention and control. Furthermore, our model should allow for estimations of the potential benefit of preventive measures on the burden of HAIs in the EU/EEA.