57 research outputs found
Epidemiologie Vancomycin-resistenter Enterokokken in Krankenhäusern in Deutschland
Die vorliegende Habilitationsschrift beschäftigt sich mit der Epidemiologie Vancomycin-resistenter Enterokokken in Deutschland. Dabei wird gezeigt, dass die VRE-Rate unter Enterokokken-Infektionen in den letzten Jahren in deutschen Krankenhäusern kontinuierlich zugenommen hat. Besonders ausgeprägt ist dieser Anstieg auf Intensivstationen, wo im Jahr 2016 bereits jede sechste Enterokokken-Blutstrominfektion (BSI) durch VRE bedingt war. Dieser kontinuierliche Anstieg wird aufgrund der höheren Liegedauer und einer erhöhten Letalität bei einer Enterokokken-BSI mit Vancomycin-sensiblen und Vancomycin-resistenten E. faecium im Vergleich zu E. faecalis auch enorme Auswirkungen auf die Kosten des Gesundheitssystems haben.
Die Ergebnisse dieser Arbeit zeigen weiterhin, dass die zunehmende Anwendung spezifischer Breitspektrumantibiotika aber auch die zunehmende VRE-Prävalenz bei Patienten in Krankenhäusern die Ausbreitung von VRE weiter begünstigen. Dies unterstreicht die Notwendigkeit der Implementierung von Antibiotic Stewardship-Teams und von krankenhaushygienischen Maßnahmen. Aufgrund des komplexen Selektionsprozesses von VRE, der persistierenden Kolonisierung im Gastrointestinaltrakt sowie fehlender effektiver Dekolonisationsmaßnahmen sind die bei MRSA erfolgreichen Präventionsmaßnahmen bei VRE nicht ausreichend und müssen weiter diskutiert und angepasst werden. Um die Epidemiologie von VRE, regionalen Unterschiede und die Ausbreitungswege relevanter klonaler Linien besser zu verstehen, sollte außerdem die mikrobiologische Diagnostik und insbesondere die Genotypisierung von Enterokokken weiter intensiviert werden
Application of the screening method to monitor influenza vaccine effectiveness among the elderly in Germany
Background: Elderly people are at increased risk for severe influenza illness and constitute therefore a major target-group for seasonal influenza vaccination in most industrialized countries. The aim of this study was to estimate influenza vaccine effectiveness (VE) among individuals aged 60+ years over three seasons and to assess if the screening method is a suitable tool to monitor influenza VE in this particular target-group in Germany. Methods: We identified laboratory-confirmed influenza cases aged 60+ years through the national communicable disease reporting system for seasons 2010/11, 2011/12 and 2012/13. Vaccination coverage (VC) data were retrieved from a database of health insurance claims representing ~85% of the total German population. We applied the screening method to calculate influenza subtype-specific VE and compared our results with VE estimates from other observational studies in Europe. Results: In total, 7,156 laboratory-confirmed influenza cases were included. VE against all influenza types ranged between 49% (95% confidence interval [CI]: 39–56) in 2011/12 and 80% (95% CI: 76-83%) in 2010/11. In 2010/11 subtype-specific VE against influenza A(H1N1)pdm and B was 76% and 84%, respectively. In the following seasons, VE against influenza A(H1N1)pdm, A(H3N2) and B was 87%, -9% , 74% (2011/12), and 74%, 39%, 73% (2012/13). VE was higher among hospitalized compared to non-hospitalized influenza A cases. Seventeen observational studies from Europe reporting subtype-specific VE among the elderly were identified for the respective seasons (all applying the test-negative design) and showed comparable subtype-specific VE estimates. Conclusions: According to our study, influenza vaccination provided moderate protection against laboratory-confirmed influenza A(H1N1)pdm and B in individuals aged 60+ but no or only little protection against A(H3N2). Higher VE among hospitalized cases might indicate higher protection against severe influenza disease. Based on the available data, the screening method allowed us to assess subtype-specific VE in hospitalized and non-hospitalized elderly persons. Since controlling for several important confounders was not possible, the applied method only provided crude VE estimates. However, given the precise VC-data and the large number of cases, the screening method provided results being in line with VE estimates from other observational studies in Europe that applied a different study design
implications for HPV vaccination policies
Background In Germany, immunization against human papillomaviruses (HPV) is
free of charge for all females aged 12 to 17 years. Since HPV infection rates
rise soon after first intercourse, immunization against HPV should be
completed before sexual debut. Knowledge of country-specific data on age at
first intercourse and related risk factors is important to optimize prevention
of HPV and other sexually transmitted infections. Therefore, the primary aim
of this study was to describe sexual behavior in young women in Germany.
Secondary aims were to identify factors that are (i) associated with younger
age at first intercourse and (ii) with HPV vaccine uptake. Methods Between
2010 and 2012, we conducted a cross-sectional study among randomly selected
women aged 20 to 25 years in Germany. We used a structured, self-administered
questionnaire to collect sociodemographic data, information on sexual habits
such as age at first intercourse, and information on HPV vaccine uptake. We
used univariate and multivariate logistic regression analyses to identify
factors associated with younger age at first intercourse and with HPV vaccine
uptake. Results A total of 823 women (response rate: 14.2%) participated, 785
(95.4%) of which reported having had intercourse already. 70% of these women
experienced first intercourse before the age of 18 years. However, less than
5% were younger than 14 years at sexual debut. Younger age at first
intercourse was independently associated with a higher number of sexual
partners, smoking, and past pregnancies. HPV vaccine uptake was associated
with higher education, whereas smoking and a migrant background reduced the
chance of being vaccinated. Conclusion In Germany, only a small proportion of
women experienced first intercourse before the age of 14 years. Younger age at
first intercourse was associated with behavior that might increase the risk of
HPV infections or other sexually transmitted infections. Therefore, to
optimize the HPV vaccination strategy, HPV vaccination series should be
completed before the age of 14 years in Germany
An ecologic study
Background: Vancomycin-resistant enterococci (VRE) are among the most common
antimicrobial-resistant pathogens causing nosocomial infections. Although
antibiotic use has been identified as a risk factor for VRE, it remains
unclear which antimicrobial agents particularly facilitate VRE selection.
Here, we assessed whether use of specific antimicrobial agents is
independently associated with healthcare-associated (HA) VRE rates in a
university hospital setting in Berlin, Germany . Methods: We conducted the
study between January 2014 and December 2015 at the Charité-university
hospital of Berlin, Germany. From the hospital pharmacy, we extracted data for
all antibacterials for systemic use (anatomical therapeutic chemical
(ATC)-classification J01) and calculated ward specific antibiotic consumption
in defined daily doses (DDDs) per 100 patient-days (PD). We used the
microbiology laboratory database to identify all patients with isolation of
invasive or non-invasive VRE and calculated HA-VRE incidence as nosocomial
VRE-cases per 100 patients and HA-VRE incidence density as nosocomial VRE-
cases per 1000 PD. We defined VRE isolates as hospital-acquired if they were
identified three days or later after hospital admission and otherwise as
community-acquired (CA-VRE). We performed univariable and multivariable
regression analyses to estimate the association of the frequency of HA-VRE per
month with antibiotic use and other parameters such as length of stay, type of
ward or presence of at least one CA-VRE on ward. In a second analysis, we
considered only patients with VRE infections. Results: We included data from
204,054 patients with 948,380 PD from 61 wards. Overall, 1430 VRE-cases were
identified of which 409 (28.6%) were considered hospital-acquired (HA). We
found that carbapenem use in the current month and prior-month use of
glycopeptides increased the risk for HA-VRE by 1% per 1 DDD/100 PD and 3% per
1 DDD/100 PD, respectively. However, when only VRE from clinical samples were
considered, only glycopeptide use showed a statistically significant
association. In both models, detection of at least one patient with CA-VRE on
a ward in the current month significantly increased the risk of HA-VRE,
thereby indicating nosocomial spread of VRE. Conclusions: Our findings suggest
that the risk of HA-VRE is associated with specific antimicrobial agents.
Prudent use of these antimicrobial agents might reduce nosocomial VRE rates.
That appearance of at least one CA-VRE case on the ward increased the risk of
HA-VRE detection highlights the importance of strict hand hygiene practices to
interrupt person-to-person transmission of VRE
Human Papillomavirus prevalence and probable first effects of vaccination in 20 to 25 year-old women in Germany: a population-based cross-sectional study via home-based self-sampling
BACKGROUND: Estimates of Human Papillomavirus (HPV) prevalence in a population prior to and after HPV vaccine introduction are essential to evaluate the short-term impact of vaccination. METHODS: Between 2010 and 2012 we conducted a population-based cross-sectional study in Germany to determine HPV prevalence, genotype distribution and risk factors for HPV-infection in women aged 20-25 years. Women were recruited by a two-step cluster sampling approach. A home-based self-collection of cervicovaginal lavages was used. Specimens were analysed using a general primer GP5+/GP6+-based polymerase chain reaction and genotyped for 18 high-risk and 6 low-risk HPV- strains by Luminex-based multiplexed genotyping. RESULTS: Among 787 included women, 512 were not vaccinated against HPV. In the non-vaccinated population, HPV prevalence of any type was 38.1%, with HPV 16 (19.5%) being the most prevalent genotype. Prevalence of any high-risk type was 34.4%, and in 17.4% of all women, more than one genotype was identified. A higher number of lifetime sexual partners and low educational status were independently associated with HPV-infection. In 223 vaccinated women, prevalence of HPV 16/18 was significantly lower compared to non-vaccinated women (13.9% vs. 22.5%, p = 0.007). When stratifying by age groups, this difference was only significant in women aged 20-21 years, who at time of vaccination were on average younger and had less previous sexual contacts than women aged 22-25 years. CONCLUSION: We demonstrate a high prevalence of high-risk HPV genotypes in non-vaccinated women living in Germany that can be potentially prevented by vaccination. Probable first vaccination effects on the HPV prevalence were observed in women who were vaccinated at younger age. This finding reinforces the recommendation to vaccinate girls in early adolescence
Background paper to the recommendation for routine rotavirus vaccination of infants in Germany
Two rotavirus (RV) vaccines were introduced to the European market in 2006. To support the decision-making process of the German Standing Committee on Vaccination ("Ständige Impfkommission", STIKO) regarding adoption of routine RV vaccination into the national vaccination schedule in Germany relevant scientific background was reviewed. According to STIKO’s Standard Operating Procedures for the development of evidence-based vaccination recommendations, a set of key questions was addressed and systematic reviews were performed with a focus on the efficacy, effectiveness, impact and safety of RV vaccines. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was applied to assess the quality of available evidence. Data from 5 randomized controlled trials demonstrated a high efficacy of RV vaccines in preventing severe RV-associated gastroenteritis (91%) and hospitalization (92%) in settings comparable to Germany. Post-marketing observational studies confirmed these findings. In several countries, impact studies suggest that age groups not eligible for vaccination might also benefit from herd effects and demonstrated a decrease in the number of nosocomial RV infections after RV vaccine introduction. The vaccines were considered safe, except for a slightly increased risk of intussusception shortly after the first dose, corresponding to 1-2 additional cases per 100,000 infants vaccinated (relative risk =1.21, 95% confidence interval [CI] 0.68-2.14). RV case-fatality is extremely low in Germany. However, RV incidence among children age
The role of facemasks and hand hygiene in the prevention of influenza transmission in households: results from a cluster randomised trial; Berlin, Germany, 2009-2011
Background: Previous controlled studies on the effect of non-pharmaceutical interventions (NPI) - namely the use of facemasks and intensified hand hygiene - in preventing household transmission of influenza have not produced definitive results. We aimed to investigate efficacy, acceptability, and tolerability of NPI in households with influenza index patients. Methods: We conducted a cluster randomized controlled trial during the pandemic season 2009/10 and the ensuing influenza season 2010/11. We included households with an influenza positive index case in the absence of further respiratory illness within the preceding 14 days. Study arms were wearing a facemask and practicing intensified hand hygiene (MH group), wearing facemasks only (M group) and none of the two (control group). Main outcome measure was laboratory confirmed influenza infection in a household contact. We used daily questionnaires to examine adherence and tolerability of the interventions. Results: We recruited 84 households (30 control, 26 M and 28 MH households) with 82, 69 and 67 household contacts, respectively. In 2009/10 all 41 index cases had a influenza A (H1N1) pdm09 infection, in 2010/11 24 had an A (H1N1) pdm09 and 20 had a B infection. The total secondary attack rate was 16% (35/218). In intention-totreat analysis there was no statistically significant effect of the M and MH interventions on secondary infections. When analysing only households where intervention was implemented within 36 h after symptom onset of the index case, secondary infection in the pooled M and MH groups was significantly lower compared to the control group (adjusted odds ratio 0.16, 95% CI, 0.03-0.92). In a per-protocol analysis odds ratios were significantly reduced among participants of the M group (adjusted odds ratio, 0.30, 95% CI, 0.10-0.94). With the exception of MH index cases in 2010/11 adherence was good for adults and children, contacts and index cases. Conclusions: Results suggest that household transmission of influenza can be reduced by the use of NPI, such as facemasks and intensified hand hygiene, when implemented early and used diligently. Concerns about acceptability and tolerability of the interventions should not be a reason against their recommendation
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