Evaluation des Toxoplasmosescreenings in Oberösterreich im Rahmen der Mutter-Kind-Pass-Vorsorgeuntersuchungen

Sagel U. Evaluation des Toxoplasmosescreenings in Oberösterreich im Rahmen der Mutter-Kind-Pass-Vorsorgeuntersuchungen. Bielefeld: Universitätsbibliothek Bielefeld; 2014.Trotz mehr als drei Jahrzehnten bevölkerungsweiter Toxoplasmosevorsorge für Schwangere in Österreich fehlen belastbare Zahlen zur Indizenz maternaler Infektionen. Aus dem Bundesland Oberösterreich wurden serologische Screeningtests von 63.416 Schwangeren im Zeitraum vom 01.01.2000 bis 31.12.2007 untersucht. Die beobachteten akuten Infektionen sind einer erheblichen Untererfassung unterworfen, weil nur bei 29,8 % der Schwangeren alle drei empfohlenen Vorsorgeuntersuchungen eingehalten wurden. Anhand von zwei Regressionsanalysen wurde die Häufigkeit geschätzt: Eine indirekte Methode auf der Grundlage von altersabhängigen Änderungen in der Seroprävalenz ergab eine Inzidenz von 0,5 % pro Schwangerschaft, jedoch sind erhebliche Bias zu beachten, die zu einer Überschätzung führen. Eine etwas weniger störanfällige, direkte Schätzung mittels Intervall- zensierter Regression ergab eine Inzidenz von 0,17 % pro Schwangerschaft (95 % Konfidenzintervall: 0,13 – 0,21 %). Analysen auf jahreszeitliche Trends weisen eine Häufung von Diagnosen in den Wintermonaten, wahrscheinlich infolge gehäufter Infektionen im Herbst, aus. Das ergibt einen Hinweis auf unbekannte oder unterschätzte Risikofaktoren. Langjährige erhebliche Mängel des Vorsorgeprogramms infolge unzureichender Überwachung, Steuerung und Infrastruktur konnten aufgedeckt werden. Besonders nachteilhaft ist der Umstand, daß das Screening in vielen Fällen große Teile der Schwangerschaft („blinde Zeiträume“) nicht erfaßt hat. Daher wurden viele akute Infektionen nicht zeitnah nachgewiesen und nicht noch in der Schwangerschaft frühzeitig einer prophylaktischen Behandlung zugeführt. Handlungsbedarf für Entscheidungsträger des öffentlichen Gesundheitswesens in Österreich ist zu erkennen und dazu werden konstruktive Vorschläge gemacht

Vancomycin-Resistant Enterococci Outbreak, Germany, and Calculation of Outbreak Start

On the basis of a large outbreak of vancomycin-resistant Enterococcus faecium in a German university hospital, we estimated costs (≈1 million Euros) that could have been avoided by early detection of the imminent outbreak. For this purpose, we demonstrate an easy-to-use statistical method

Incidence of maternal Toxoplasma infections in pregnancy in Upper Austria, 2000-2007

Sagel U, Krämer A, Mikolajczyk RT. Incidence of maternal Toxoplasma infections in pregnancy in Upper Austria, 2000-2007. BMC Infectious Diseases. 2011;11(1): 348.UNLABELLED: ABSTRACT: BACKGROUND: Despite three decades of prenatal screening program for toxoplasmosis in Austria, population-based estimates for the incidence of maternal infections with Toxoplasma gondii during pregnancy are lacking. We studied the incidence of primary maternal infections during pregnancy in the Federal State of Upper Austria. METHODS: Screening tests for 63,416 women and over 90,000 pregnancies (more than 84.5% of pregnancies in the studied region) in the time period between 01.01.2000 and 31.12.2007 were analysed. The incidence of toxoplasmosis was estimated indirectly by binomial and directly by interval censored regression. RESULTS: During the studied period, 66 acute infections (risk of 0.07% per pregnancy) were detected, but only 29.8% of seronegative women were tested at least three times during their pregnancies. The seroprevalence of Toxoplasma antibodies among all tested women was 31%. Indirectly estimated incidence (from differences in prevalence by age) was 0.5% per pregnancy, while directly estimated incidence (interval censored regression) was 0.17% per pregnancy (95% confidence interval: 0.13-0.21%). CONCLUSIONS: Calculating incidence from observed infections results in severe underreporting due to many missed tests and potential diagnostic problems. Using statistical modelling, we estimated primary toxoplasmosis to occur in 0.17% (0.13-0.21%) of all pregnancies in Upper Austria

Using mandatory data collection on multiresistant bacteria for internal surveillance in a hospital

Sagel U, Mikolajczyk RT, Krämer A. Using mandatory data collection on multiresistant bacteria for internal surveillance in a hospital. Methods of Information in Medicine. 2004;43(5):483-485.Objectives: Multiresistant pathogens cause major clinical problems and considerably increase treatment costs. Since 2001 the Protection Against Infection Act (PIA) obligates hospitals in Germany to the documentation of multiresistant bacteria. We analyzed the use of these data for routine internal surveillance. Methods: We used standard data collected for the mandatory documentation and studied consecutive diagnoses of Methicillin-resistant Staphylococcus aureus (MRSA) in a 893-bed tertiary level hospital in North Rhine-Westphalia in Germany. Based on the Poisson distribution for the cumulative yearly incidence of MRSA, we defined a threshold level for an outbreak. Results: During a 12-month time period 80 patients were diagnosed with MRSA. The time structure and spatial distribution of different MRSA phenotypes (defined through specific antibiotic resistance patterns) were consistent with the within-hospital transmission. In the two preceding time periods of 12 months each, 15 respectively 8 patients with MRSA were found. The defined alert threshold level for cumulative yearly incidence was crossed in the beginnings of the outbreak. Conclusion: Monitoring the mandatory data collected on multiresistant bacteria allows the early detection of accumulations suspect for the within-hospital transmission. This knowledge can be used for a fast reaction and breaking off the transmission chains

Mixture Model to Assess the Extent of Cross-Transmission of Multidrug-Resistant Pathogens in Hospitals

Mikolajczyk RT, Kauermann G, Sagel U, Kretzschmar M. Mixture Model to Assess the Extent of Cross-Transmission of Multidrug-Resistant Pathogens in Hospitals. Infection Control and Hospital Epidemiology. 2009;30(8):730-736.OBJECTIVE. Creation of a mixture model based on Poisson processes for assessment of the extent of cross-transmission of multidrug-resistant pathogens in the hospital. METHODS. We propose a 2-component mixture of Poisson processes to describe the time series of detected cases of colonization. The first component describes the admission process of patients with colonization, and the second describes the cross-transmission. The data set used to illustrate the method consists of the routinely collected records for methicillin-resistant Staphylococcus aureus (MRSA), imipenem-resistant Pseudomonas aeruginosa, and multidrug-resistant Acinetobacter baumannii over a period of 3 years in a German tertiary care hospital. RESULTS. For MRSA and multidrug-resistant A. baumannii, cross-transmission was estimated to be responsible for more than 80% of cases; for imipenem-resistant P. aeruginosa, cross-transmission was estimated to be responsible for 59% of cases. For new cases observed within a window of less than 28 days for MRSA and multidrug-resistant A. baumannii or 40 days for imipenem-resistant P. aeruginosa, there was a 50% or greater probability that the cause was cross-transmission. CONCLUSIONS. The proposed method offers a solution to assessing of the extent of cross-transmission, which can be of clinical use. The method can be applied using freely available software (the package FlexMix in R) and it requires relatively little data

Chronic Paracoccidioidomycosis with adrenal involvement mimicking tuberculosis – A case report from Austria

Paracoccidioidomycosis is a systemic fungal infection caused by Paracoccidioides brasiliensis and endemic in certain areas of Central and South America. We report a case of a 62-year-old-man with a complex history of tuberculosis and imaging findings of a cerebral lesion and bilateral adrenal enlargement. Biopsy of adrenal gland revealed Paracoccidioides brasiliensis. This case highlights the importance of travel history for diagnosis of paracoccidioidomycosis in non-endemic areas and emphasizes the clinical and histopathological similarities with tuberculosis