Modellprojekt zur Antibiotikaresistenz-Surveillance in Ostwestfalen-Lippe

Zur Überwachung von Resistenzentwicklungen sind verschiedene internationale und nationale Surveillanceprogramme und interaktive Datenbanken etabliert, in die Daten aus Einrichtungen wie Laboren und Krankenhäusern verschiedener Länder einfließen. Die zentrale Datenbank in Deutschland ist die Antibiotika-Resistenz-Surveillance (ARS) beim RKI, das seinerseits mit internationalen Netzwerken (z. B. ECDC und WHO) verbunden ist. Im Epidemiologischen Bulletin 8/2025 wird ein regionales, klinikübergreifendes Resistenzobservatorium als Modellprojekt vorgestellt. Die strukturierte Zusammenstellung der Resistenzdaten aus den drei Krankenhäusern, die das Universitätsklinikum Ostwestfalen-Lippe bilden, erlaubt eine direkte Vergleichsmöglichkeit zu nationalen Referenzdaten und ist in der Lage, Besonderheiten des regionalen Infektionsgeschehens abzubilden

Vancomycin-resistant enterococci (VRE) in hospital settings across European borders:a scoping review comparing the epidemiology in the Netherlands and Germany

The rising prevalence of vancomycin-resistant enterococci (VRE) is a matter of concern in hospital settings across Europe without a distinct geographical pattern. In this scoping review, we compared the epidemiology of vancomycin-resistant Enterococcus spp. in hospitals in the Netherlands and Germany, between 1991 and 2022. We searched PubMed and summarized the national antibiotic resistance surveillance data of the two countries. We included 46 studies and summarized national surveillance data from the NethMap in the Netherlands, the National Antimicrobial Resistance Surveillance database in Germany, and the EARS-Net data. In total, 12 studies were conducted in hospitals in the Netherlands, 32 were conducted in German hospitals, and an additional two studies were conducted in a cross-border setting. The most significant difference between the two countries was that studies in Germany showed an increasing trend in the prevalence of VRE in hospitals, and no such trend was observed in studies in the Netherlands. Furthermore, in both Dutch and German hospitals, it has been revealed that the molecular epidemiology of VREfm has shifted from a predominance of vanA towards vanB over the years. According to national surveillance reports, vancomycin resistance in Enterococcus faecium clinical isolates fluctuates below 1% in Dutch hospitals, whereas it follows an increasing trend in German hospitals (above 20%), as supported by individual studies. This review demonstrates that VRE is more frequently encountered in German than in Dutch hospitals and discusses the underlying factors for the difference in VRE occurrence in these two neighboring countries by comparing differences in healthcare systems, infection prevention control (IPC) guidelines, and antibiotic use in the Netherlands and Germany

Temporal Trends in Antimicrobial Resistance of Klebsiella pneumoniae in Clinically Affected Canine and Feline Populations in Germany: A 2019-2021 Analysis

Klebsiella (K.) pneumoniae is a major pathogen in human and veterinary medicine, known for its high resistance rates. Comprehensive resistance data are essential to combat global antibiotic resistance. This study aims to (a) document the prevalence of resistant K. pneumoniae and (b) assess the utility of routine laboratory data for passive monitoring. We analyzed a dataset of 175,171 samples from diseased dogs and cats in Germany collected between 2019 and 2021, identifying 1185 K. pneumoniae isolates with measurable minimum inhibitory concentration values. We evaluated resistance rates to a third-generation cephalosporin (cefovecin) (16.3%), chloramphenicol (16.1%), doxycycline (13.9%), enrofloxacin (8.9%), gentamicin (6.0%), nitrofurantoin (24.8%), and sulfamethoxazole-trimethoprim (15.0%). Notably, feline K. pneumoniae isolates from the urinary tract showed a high cefovecin resistance rate of 70.0%. Comparing our findings with third-generation cephalosporin-resistant human isolates from the Antimicrobial Resistance Surveillance database (ARS) maintained by the Robert Koch Institute revealed a lower resistance rate (7.7%). This study presents Germany’s most comprehensive dataset on K. pneumoniae resistance in companion animals over a three-year period. These findings can strengthen national resistance monitoring efforts and enhance data interpretation through substantial datasets

Antimicrobial resistance control in the emergency department: a need for concrete improvement

Background: Rational use of antibiotics (AB) and infection prevention and control (IPC) are key measures for reducing antimicrobial resistance (AMR) in healthcare. Nonetheless, transferring evidence into clinical practice in emergency medicine has proven difficult. The extent to which structural requirements for implementing AMR control exist in German emergency departments (ED) was determined in a survey. Methods: Aspects of antimicrobial stewardship (AMS) and IPC implementation were surveyed within the German Association for Emergency Medicine (Deutsche Gesellschaft interdisziplinare Notfall- und Akutmedizin e.V, DGINA) in 2018. Data were collected using an anonymous online questionnaire on ED characteristics, ED-based-link personnel for IPC and AMS, education and training, process monitoring and specific requirements for AMS and IPC as availability of AMR data and alcohol-based hand rub (AHR) consumption data. Data were analysed descriptively. Results: 66 EDs with in median [interquartile range (IQR)] of 30,900 [23,000; 40,000] patient visits participated in the survey. EDs' healthcare worker (HCW) received regular training on hand hygiene (HH) in 67% and on AMS in 20% of EDs. Surveillance of AHR consumption was performed by 73% EDs, surveillance of AB consumption by 64%. Regular audits on HH were performed in 39%. Training and audit activities, showed no significant variations according to EDs' organizational characteristics. HCWs received immediate feedback of HH performance in 29%, in 23% a regular structured feedback of HH was provided. ED-based physicians with (1) specific IPC responsibilities and training were available in 61%, with (2) AMS training and responsibility in 15%. 83% had ED based IPC link nurses with precise ICP responsibilities in place. Essentially resistance data existed at the hospital level (74%) rather than at ED- or regional level (15% and 14% respectively). Conclusions: Management of AMR varies in German EDs, especially in accordance to hospital size and level of emergency care. IPC seems to receive more attention than AMS. Our data indicate the need for more implementation of regular IPC and AMS training in connection with monitoring and feedback in German EDs

Three Essays in Applied Microeconomics

The first essay investigates the role social environment plays in the development of life satisfaction during childhood and adolescence. Life satisfaction is high among children and declines during adolescence. This decline is steeper among children who grow up in low compared to high socio-economic status (SES) families, resulting in a sizable SES gap at the end of adolescence. A one year mentoring intervention in mid childhood changes the life satisfaction trajectories of low SES children to be very similar to those of high SES children. This result highlights the critical role high-quality relationships play for the formation of life satisfaction during childhood and adolescence. The second essay develops an agent-based simulation model for the spread of infectious diseases. It accounts for heterogeneous and assortative meeting patterns through different contact networks, such as work or schools. This makes it easy to implement different contact reduction policies, such as work from home mandates or school closures. The model also includes a sophisticated model for the demands of rapid antigen and PCR tests. This allows for different and endogenous detection rates over time and between age groups. The third essay uses the previous model to quantify the effects of seasonality, vaccinations and antigen rapid tests during the CoViD-19 pandemic. Most parameters can be calibrated. The remaining are estimated with German infection data from fall 2020 until June 2021 using the method of simulated moments. During this period where vaccination rates rose from 5% to 40%, seasonality and rapid testing had the largest effect on reducing infection numbers. Furthermore, antigen rapid test strategies can substitute contact reduction policies that come at a much larger cost to individuals, society, and the economy

Spatiotemporal modeling of first and second wave outbreak dynamics of COVID-19 in Germany

The COVID-19 pandemic has kept the world in suspense for the past year. In most federal countries such as Germany, locally varying conditions demand for state- or county-level decisions to adapt to the disease dynamics. However, this requires a deep understanding of the mesoscale outbreak dynamics between microscale agent models and macroscale global models. Here, we use a reparameterized SIQRD network model that accounts for local political decisions to predict the spatiotemporal evolution of the pandemic in Germany at county resolution. Our optimized model reproduces state-wise cumulative infections and deaths as reported by the Robert Koch Institute and predicts the development for individual counties at convincing accuracy during both waves in spring and fall of 2020. We demonstrate the dominating effect of local infection seeds and identify effective measures to attenuate the rapid spread. Our model has great potential to support decision makers on a state and community politics level to individually strategize their best way forward during the months to come

Essays in Applied Microeconomics

Three essays in Applied Microeconomics. The first essay describes a detailed agent based model of disease transmission and its application to the Covid-19 pandemic in Germany. The second provides methods for uncertainty quantification in structural economic models and embeds them in a decision theoretic framework. The third applies dynamic latent factor models from the skill formation literature to the context of aging