Winfried Ebner

Surveillance of nosocomial infections in a neurology intensive care unit

Abstract To identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurological intensive care therapy, a prospective study was started in 1997 in the ten-bed neurological intensive-care unit (NICU) of the University Hospital of Freiburg, Germany. Case records and microbiology reports were reviewed twice a week, and ward staff were consulted. NI were defined according to the Center for Disease Control and Prevention (CDC) criteria and were categorised by specific infection site. Within 30 months, 505 patients with a total of 4,873 patient days were studied (mean length of stay: 9.6 days). 122 NI were identified in 96 patients (74 patients with one, 18 with two and 4 with three infections. An incidence of 24.2/100 patients and incidence density of 25.0/1,000 patient days of NI in the neurological ICU were documented. Site-specific incidence rates and incidence densities were: 1.4 bloodstream infections per 100 patients (1.9 central line-associated BSIs per 1,000 central line-days), 11.7 pneumonias per 100 patients (20.4 ventilator-associated pneumonias per 1,000 ventilator-days), 8.7 urinary tract infections per 100 patients (10.0 urinary catheter-associated urinary track infections (UTIs) per 1,000 urinary catheter-days). Additionally, 0.4 cases of meningitis, 0.8 ventriculitis, and 1.2 other infections (catheter-related local infection, diarrhea) were documented per 1,000 patient days. 15 % of nosocomial pathogens were A. baumannii (due to a outbreak of an nosocomial pneumonia with A. baumannii ), 13 % S. aureus, 10 % E. coli, 7 % CNS, 7 % Bacteroides spp., 7% Enterobacter spp., 6, 5% Klebsiella spp., 5.9 % enterococci, 5.9 % streptococci, and 4.7 % Pseudomonas spp. In eight cases of NI no pathogen could be isolated. In future, data on NI in NICUs should be assessed in greater detail, both to improve the quality of care and serve as a basis for identification and implementation of the most effective measures by which to prevent these infections in patients receiving intensive neurological care.

The Practice of Perioperative Antibiotic Prophylaxis in Eight German Hospitals

AbstractBackground: 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 te 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.

Nosocomial outbreak of norovirus gastroenteritis and investigation of ABO histo-blood group type in infected staff and patients

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).

Cost Efficacy of Tazobactam/Piperacillin versus Imipenem/Cilastatin in the Treatment of Intra-Abdominal Infection

AbstractObjective: To compare the cost, efficacy and cost efficacy of tazobactam/piperacillin and imipenem/cilastatin in the treatment of intra-abdominal infection. Design: The analysis was retrospective and based on a decision tree. Effectiveness data were obtained from 19 published clinical trials. Direct costs were quantified per patient from the time the decision was made to administer the antibacterial to the end of the first course of treatment or the end of a subsequent course of treatment, if required. The primary end-pointwas the cost per successfully treated patient. The cost per life saved was also analysed. Various follow-up times were taken into account. Perspective: German National Health Insurance funds. Study population: 1744 patients with intra-abdominal infection. Interventions: Tazobactam/piperacillin (total daily dosage of 13.5 g/day) and imipenem/cilastatin (total daily dosage of 1.5 to 4 g/day). The mean duration of treatment varied from 5.5 to 8.2 days for tazobactam/piperacillin and 5 to 9.4 days for imipenem/cilastatin. Main outcome measure and results: Compared with imipenem/cilastatin, treatment with tazobactam/piperacillin was more effective and the overall treatment costs were lower. In the base-case analysis, the cost-efficacy ratio (cost per successfully treated patient) was 7881 German deutschmarks (DM) for tazobactam/piperacillin and DM11 390 for imipenem/cilastatin. The incremental cost-efficacy ratio (per life saved) varied between -DM72 567 and -DM350 738 for tazobactam/piperacillin. Sensitivity analyses revealed that the results were robust against various assumptions on cost parameters, clinical outcomes and length of treatment. All costs reflect 1998 values;

Characterisation of nosocomial and community-acquired influenza in a large university hospital during two consecutive influenza seasons.

US1 = DM1.85. Conclusions: This study suggests that compared with imipenem/cilastatin, tazobactam/piperacillin is more cost efficacious in the treatment of intra-abdominal infections and that it offers a cost advantage through fewer relapses and lower daily therapeutic costs.

Sinnvolle und nicht sinnvolle Hygienemaßnahmen

Abstract Background Nosocomial influenza is increasingly recognized as an important public health threat causing considerable morbidity and mortality each year. However, data on nosocomial influenza is usually collected during outbreaks only and clinical information of nosocomial influenza is sparsely available. Objectives To systematically analyse the distribution of nosocomial and community-acquired influenza and epidemiological characteristics in a tertiary care unit in two consecutive seasons. Study design A retrospective observational study was conducted to identify and characterise cases of nosocomial and community-acquired influenza at Freiburg University hospital from 1 January 2013 to 30 April 2014. A validated multiplex RT-PCR to detect influenza virus and other respiratory pathogens was used throughout. Clinical information was retrieved from the hospital-based information system. Results Overall, 218 patients with laboratory-confirmed influenza were included (179 in the first, 39 patients in the second season). A rate of 20% of nosocomial influenza was observed throughout. A fatal outcome was recorded for 9% of nosocomial cases, which were mainly associated with influenza virus A(H1N1)pdm09. Nosocomial influenza occurred in all age groups, but fatalities were only observed in patients ≥18 years. Patients with nosocomial influenza were significantly older, underwent therapy for blood malignancies and immunosuppressive regimens more frequently, and received solid organ transplantation more often compared to community-acquired patients. Conclusions Despite the different distribution of virus subtypes and epidemiological properties between both influenza seasons, the rate of nosocomial cases remained similar. Systematic detection and targeted prevention measures seem mandatory to minimize nosocomial influenza.

Reduktion der Keimbelastung in HNO-Behandlungseinheiten durch Membranfilter?

Obwohl die Zahl nosokomialer (= im Krankenhaus erworbener) Infektionen in HNO-Kliniken im Vergleich zu anderen Fächern gering ist, bedeutet dies nicht, dass es bei der Versorgung von HNO-Patienten keine Infektionsgefahren gibt, denen mit adäquaten Hygienemaßnahmen begegnet werden muss. Im Folgenden werden sinnvolle und nicht sinnvolle Maßnahmen für die Hygiene im HNO-Bereich zusammengefasst. Gerade die Konzentration auf sinnvolle Hygienemaßnahmen und das Weglassen sinnloser Hygienerituale stellen einen wichtigen Beitrag zur ökonomischen und ökologischen Qualitätssicherung in Krankenhaus und Praxis dar.

Gastrointestinale Infektionen: Risikofaktoren, Erreger und Hygienemaßnahmen

Die Verkeimung von Trinkwasser beim Transport in Schlauchsystemen kann bei prädisponierten Personen gesundheitsschädigend sein. Von besonderer Bedeutung ist dies bei medizinischen Geräten, da dort bedeutsame Keimreservoire mit pathogenen oder fakultativ pathogenen Keime gefunden werden. In der vorliegenden Arbeit wird aufgezeigt, welchen Einfluss der Einsatz eines sterilen Keimfilters (Pall N 66 -Posidyne) in einer HNO-Behandlungseinheit auf die Qualität des Wassers für Ohrspülungen im klinischen Alltag hat. Der Einsatz des Keimfilters an 5 HNO-Behandlungseinheiten (niedergelassene HNO-Ärzte, Krankenhaus-Ambulanzen) konnte eine deutliche Keimreduktion, in vielen Fällen sogar Keimelimination erreichen.

Hals-Nasen-Ohren-Heilkunde: Hygienische Maßnahmen

Gastrointestinale Infektionen und infektiose Durchfallerkrankungen gehoren nach Schatzungen der WHO immer noch zu den zehn haufigsten Todesursachen weltweit. Eine Vielzahl von bakteriellen, viralen und in Europa seltener auch parasitaren Erregern muss als Verursacher in Betracht gezogen werden. Symptomatisch werden diese Infektionen unter anderem durch Durchfalle, Erbrechen, Krampfe und Fieber, die in sehr unterschiedlicher Auspragung auftreten und insbesondere bei Kleinkindern und Mangelernahrung durch Elektrolytverschiebungen und Flussigkeitsverluste sogar lebensbedrohliche Zustande hervorrufen konnen. Clostridien, Noro- und Rotaviren sind als nosokomiale Infektionserreger von besonderer Bedeutung.

Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study

Die Zahl nosokomialer Infektionen in HNO-Heilkunde ist im Vergleich zu anderen Fachern eher gering. Dennoch sind in der Patientenversorgung Infektionsgefahren zu beachten, denen mit adaquaten Hygienemasnahmen begegnet werden muss. Gerade die Konzentration auf sinnvolle Hygienemasnahmen und das Weglassen sinnloser Hygienerituale stellen einen wichtigen Beitrag zur okonomischen und okologischen Qualitatssicherung in Krankenhaus und Praxis dar.