[Antibiotic stewardship in a basic care hospital : A retrospective observational study]. / Antibiotic stewardship an einem Krankenhaus der Grund- und Regelversorgung : Eine retrospektive Observationsstudie.

BACKGROUND: In response to the global increase in antibiotic resistance, the concept of antibiotic stewardship (ABS) has become increasingly important in recent years. Several publications have demonstrated the effectiveness of ABS, mainly in university facilities. This retrospective observational study describes the implementation of ABS in a basic care hospital. MATERIAL AND METHODS: Following existing national guidelines, an ABS team was set up and measures were launched. These included: hospital guidelines, teaching, weekly antibiotic ward rounds and the restriction of definite substances. The preinterventional/postinterventional data analysis compared the use of antibiotics and blood culture sets as well as the development of resistance, infection with Clostridium difficile (CDI), costs, mortality and length of hospital stay. RESULTS: The measures introduced led to a significant and continuous decline in total antibiotic use of initially 43 recommended daily doses (RDD)/100 patient days (PD) to 31 RDD/100 PD (p < 0.001). The largest decrease was observed in second generation (2G) cephalosporins (-67.5%), followed by 3G cephalosporins (-52.7%), carbapenems (-42.0%) and quinolones (-38.5%). The resistance rate of E. coli to 3G cephalosporins in blood cultures decreased from 26% to 9% (p = 0.021). The rate of blood cultures taken increased from 1.8 sets/100 PD to 3.2 sets/100 PD (+77%, p < 0.001). The pathogen detection rate, defined as one count when a minimum of one sample taken in a day is positive, also increased significantly from 4.0/1000 PD to 6.8/1000 PD (p < 0.001). The ABS had no effect on the overall mortality, the mean dwell time, and the preintervention low CDI incidence. CONCLUSION: The preinterventional/postinterventional comparison showed a significant reduction in the overall consumption of antibiotics with a redistribution in favor of antibiotics with a lower resistance selection. At the same time, the resistance rate of E. coli decreased. The increase of the blood culture rate indicates the optimization of diagnostic procedures. This ABS program had to be established with reduced resources but this seems to have been compensated by the more personal contact addressing the care takers and short chain of commands, as is possible in smaller hospitals. Presumably, the structure of basic care hospitals is particularly suitable for concepts covering entire hospitals. Further clusters of randomized studies are necessary to confirm this.

Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance.

OBJECTIVE: To describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS). METHOD: The epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight infants (NEO-KISS) and surgical site infections (OP-KISS) in the period from 2006 to 2013. In addition, risk factor analyses were performed for the most important infections of ICU-KISS, NEO-KISS and OP-KISS. RESULTS: Data from a total of 3,454,778 ICU patients from 913 ICUs, 618,816 non-ICU patients from 142 non-ICU wards, 53,676 VLBW from 241 neonatal intensive care units (NICU) and 1,005,064 surgical patients from operative departments from 550 hospitals were used for analysis. Compared with baseline data, a significant reduction of primary bloodstream infections (PBSI) and lower respiratory tract infections (LRTI) was observed in ICUs with the maximum effect in year 5 (or longer participation) (incidence rate ratio 0.60 (CI95 0.50-0.72) and 0.61 (CI95 0.52-0.71) respectively). A significant reduction of PBSI and LRTI was also observed in NEO-KISS when comparing the baseline situation with the 5th year of participation (hazard ratio 0.70 (CI95 0.64-0.76) and 0.43 (CI95 0.35-0.52)). The effect was smaller in operative departments after the introduction of OP-KISS (OR 0.80; CI95 0.64-1.02 in year 5 or later for all procedure types combined). Due to the large database, it has not only been possible to confirm well-known risk factors for HAI, but also to identify some new interesting risk factors like seasonal and volume effects. CONCLUSIONS: Participating in a national surveillance system and using surveillance data for internal quality management leads to substantial reduction of HAI. In addition, a surveillance system can identify otherwise not recognized risk factors which should - if possible - be considered for infection control management and for risk adjustment in the benchmarking process.

Prevalence of carbapenem-resistant organisms and other Gram-negative MDRO in German ICUs: first results from the national nosocomial infection surveillance system (KISS).

PURPOSE: Standardized prevalence and incidence data on carbapenem-resistant organisms (CRO) and, as a relevant subgroup, carbapenem-resistant Enterobacteriaceae (CRE) are scarce. CRO-surveillance within the German nosocomial infection surveillance system (KISS) aims to provide epidemiological surveillance data on CRO colonizations and infections. METHODS: CRO-surveillance is part of a KISS-module for the surveillance of multidrug-resistant organisms (MDRO). MDRO-KISS methods require surveillance of all patients admitted to the ward and standardized documentation of imported and ICU-acquired cases. Data on all MDRO-carriers including colonization and infection with MDRO are collected. All presented data were routine data collected from January 1st 2013 until December 1st 2013 in accordance with the German Protection against Infection Act (IfSG). RESULTS: 341 ICUs submitted data on MDRO during the first year. In total, 5,171 cases of multidrug-resistant Gram-negative bacteria (MRGN) were identified. 848 were CRO (16%). 325 CRO-cases were acquired within the ICU (38%), and 373 CRO-patients had an infection (44%). CRO-prevalence was 0.29 per 100 patients. Acquisition rate of MRGN was 1.32 per 1,000 patient days. This rate is more than doubled the acquisition rates of other MDRO under surveillance within MDRO-KISS (0.57 MRSA, 0.49 VRE). CRO-acquisition rate was 0.3 per 1,000 patient days. Incidence density of MRGN infections bacteria was 0.58 per 1,000 patient days (CRO 0.15/1,000 patient days). CONCLUSIONS: To date, CRO are common in German ICUs and the relatively large proportions of ICU-acquired CRO and infections emphasize their potential to cause outbreaks. High MRGN infection rates and high ESBL prevalence data from clinical studies suggest a lack of MRGN identification in asymptomatic carriers.

Costs and prolonged length of stay of central venous catheter-associated bloodstream infections (CVC BSI): a matched prospective cohort study.

PURPOSE: Central venous catheter-associated bloodstream infections (CVC BSI) are a common and serious complication among critically ill patients on intensive care units (ICUs), but also result in a financial burden for the health care system. Our aim was to determine the additional costs and length of stay (LOS) of patients with ICU-acquired CVC BSI. METHODS: We used the surveillance method of the German nosocomial infection surveillance system (Krankenhaus Infections Surveillance System, KISS) to find cases of CVC BSI. The associated costs of CVC BSI were estimated as true costs generated within our hospital. We used a matched cohort design, comparing patients with CVC BSI and patients without BSI. The study period was from January to December 2010. Patients were matched by age, sex, and Simplified Acute Physiology Score (SAPS). The LOS in the ICU of control patients needed to be at least as long as that of CVC BSI patients before the onset of CVC BSI. RESULTS: We matched 40 CVC BSI patients to 40 patients without BSI. The median hospital costs for CVC BSI patients were significantly higher than for patients without BSI (60,445 € vs. 35,730 €; p = 0.006) and the CVC BSI patients stayed longer in the hospital than patients without CVC BSI (44 days vs. 30 days; p = 0.110). The median attributable costs per CVC BSI was 29,909 € (p = 0.006) and the median attributable LOS was 7 days (p = 0.006). CONCLUSION: CVC BSI is associated with increased hospital costs and prolonged hospital stay. Hospital management should implement control measurements to keep the incidence of CVC BSI as low as possible.

How many outbreaks of nosocomial infections occur in German neonatal intensive care units annually?

BACKGROUND: Outbreaks on neonatal intensive care units (NICUs) achieve huge media interest, but the real number of neonatal outbreaks within a country is unknown. METHOD: This calculation is based on the data of the component for nosocomial infections in very low birth weight (VLBW) infants of the German national nosocomial infection surveillance system (NEO-KISS) from 2006 to 2011. Almost all German NICUs caring for VLBW infants participated in this surveillance system. A cluster was defined and an outbreak was assumed when at least two cases of severe neonatal infection (bloodstream infection, pneumonia) occurred within a defined time interval in one center with the same pathogen species in different patients. Four different intervals were used for calculation: 14, 30, 60, and 90 days. Infections with coagulase-negative staphylococci (CoNS) were excluded. RESULTS: A total of 228 NICUs provided data in the six-year study period. A total of 37,038 VLBW infants and 1,361,950 patient days were used for the calculation. 7,405 severe neonatal infections occurred, and a microbiological detection of the pathogen was successful in 2,084 cases. Altogether, between 121 and 280 outbreaks were calculated according to the different time intervals used. Most outbreaks were due to Staphylococcus aureus, followed by Enterococcus spp. and Enterobacter spp. CONCLUSION: It can be assumed that at least between 26 and 61 neonatal outbreaks with at least two severe infections take place in German NICUs per year. The actual number seems to be higher because only laboratory-confirmed infections in a subgroup of patients were used for the analysis.

Antibiotic stewardship in Germany: a cross-sectional questionnaire survey of 355 intensive care units.

PURPOSE: Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs). METHODS: A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors. RESULTS: The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05). CONCLUSIONS: While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.

Nosocomial infections in very low birthweight infants in Germany: current data from the National Surveillance System NEO-KISS.

BACKGROUND: Infants with very low birthweight (< 1 500 g, VLBW) are at increased risk for nosocomial infections (NI). In 2 000, we implemented a surveillance system for VLBW infants in Germany: NEO-KISS. In 2005, a joint committee of healthcare providers and insurance companies required German neonatology departments to participate. As a result, NEO-KISS is now a nationwide surveillance system for NI in VLBW infants. PATIENTS AND METHODS: We present NEO-KISS data collected between 2007 and 2011 by 228 neonatology departments. Rates of sepsis, pneumonia and necrotising enterocolitis (NEC) were calculated. In order to evaluate the department-specific infection rate we introduced a new indicator: the Standardised Infection Rate (SIR). The SIR considers the department-specific patient distribution (based on the patients' birthweight) and describes the ratio of observed and expected infections (calculated from the reference data for this individual patient distribution). The data presented comprise 33 048 VLBW infants.The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days. RESULTS AND CONCLUSION: The incidence of pneumonia among mechanically ventilated patients was 2.7/1 000 ventilator days. The incidence of NEC was 0.8. The SIR showed strong variation among the participating departments. It is an excellent tool for identifying outliers in nosocomial infection rates and for stimulating activities to decrease the risk of nosocomial infections.

No increase in primary nosocomial candidemia in 682 German intensive care units during 2006 to 2011.

We evaluated the epidemiology of and trends in primary nosocomial candidemia within a network of 682 German intensive care units (ICUs) during 2006 to 2011. Nosocomial laboratory-confirmed bloodstream infection (NLCBI) was diagnosed using standard definitions from the United States Centers for Disease Control and Prevention. Incidences were calculated by NLCBI per 1,000 patients and incidence densities per 1,000 patient-days and per 1,000 central-line days. In the 682 ICUs, there were 2,220,803 patients, 7,943,615 patient-days and 5,363,026 central-line days. A total of 381 of the 6,666 NLCBIs were associated with Candida albicans, 142 with non-albicans Candida. Non-albicans Candida made up 26% of all the Candida isolates. The mean incidence density of Candida central line-associated NLCBIs was 0.09 per 1,000 central-line days and remained unchanged between 2006 and 2011. Crude ICU mortality was 21.9% for C. albicans and 29.7% for non-albicans Candida. Candida was the fourth leading cause of primary NLCBIs, accounting for 6.5% of all bloodstream infections acquired in ICUs. Based on an incidence density of 0.07 per 1,000 patient-days, extrapolation of our data resulted in 465 primary nosocomial Candida NLCBIs in German ICUs per year. Our data show that there was no increase in primary Candida NLCBIs during 2006 to 2011.

Sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection: a retrospective analysis of 552 ICUs.

BACKGROUND: Sinks in hospitals are a possible reservoir for healthcare-related pathogens. They have been identified as a source of nosocomial outbreaks in intensive care units (ICU); however, their role in non-outbreak settings remains unclear. AIM: To investigate whether sinks in ICU patient rooms are associated with a higher incidence of hospital-acquired infection (HAI). METHODS: This analysis used surveillance data from the ICU component of the German nosocomial infection surveillance system (KISS) from 2017 to 2020. Between September and October 2021, all participating ICUs were surveyed about the presence of sinks in their patient rooms. The ICUs were then divided into two groups: the no-sink group (NSG) and the sink group (SG). Primary and secondary outcomes were total HAIs and HAIs associated with Pseudomonas aeruginosa (HAI-PA). FINDINGS: In total, 552 ICUs (NSG N=80, SG N=472) provided data about sinks, total HAIs and HAI-PA. The incidence density per 1000 patient-days of total HAIs was higher in ICUs in the SG (3.97 vs 3.2). The incidence density of HAI-PA was also higher in the SG (0.43 vs 0.34). The risk of HAIs associated with all pathogens [incidence rate ratio (IRR)=1.24, 95% confidence interval (CI) 1.03-1.50] and the risk of lower respiratory tract infections associated with P. aeruginosa (IRR=1.44, 95% CI 1.10-1.90) were higher in ICUs with sinks in patient rooms. After adjusting for confounders, sinks were found to be an independent risk factor for HAI (adjusted IRR 1.21, 95% CI 1.01-1.45). CONCLUSIONS: Sinks in patient rooms are associated with a higher number of HAIs per patient-day in the ICU. This should be considered when planning new ICUs or renovating existing ones.

Implementation of a new surveillance system for dialysis-associated infection events in outpatient dialysis facilities in Germany.

INTRODUCTION: Patients receiving maintenance haemodialysis are at risk of catheter-related infections. Up to now, there has been no standardized surveillance tool in Germany to evaluate infection events in haemodialysis outpatients. As such, this study aimed to implement an online-based surveillance tool in outpatient dialysis facilities, and to report the first national surveillance data for haemodialysis patients in Germany from October 2019 until September 2021. METHODS: Outpatient dialysis facilities reported three types of dialysis-associated infection event (DAIE): bloodstream infections, intravenous antimicrobial starts, and local access site infections. Denominator data were provided by the number of haemodialysis treatments at each facility per month. DAIE rates stratified by vascular access type were calculated. RESULTS: In total, 43 outpatient dialysis facilities reported 723 DAIEs, including 63 bloodstream infections, 439 intravenous antimicrobial starts, and 221 local access site infections. The overall incidence of DAIEs was 0.51 per 1000 dialysis treatments (723/1,413,457) during the surveillance period. The overall incidence of DAIEs was 0.13 per 1000 dialysis treatments among patients with arteriovenous fistulas (AVFs; 126/990,392), 0.41 per 1000 dialysis treatments among patients with arteriovenous grafts (41/99,499), and 1.68 per 1000 dialysis treatments among patients with central venous catheters (CVCs; 535/318,757). The rate ratio of DAIEs between CVC and AVF rates was 13.2 (95% confidence interval 10.9-16.0; P<0.001). DISCUSSION: These 2-year infection data represent the first standardized data of outpatient dialysis facilities in Germany. Rates of infection were highest among patients with CVCs compared with other vascular access types. This online-based surveillance tool may be helpful to identify effective targets for infection prevention measures in haemodialysis patients.

[Healthcare-associated infection rates: measuring and comparing. Experiences from the German National Nosocomial Infection Surveillance System (KISS) and from other surveillance systems]. / Nosokomiale Infektionsraten: Messen und Vergleichen. Erfahrungen mit dem Krankenhaus-Infektions-Surveillance-System (KISS) und anderen Surveillance-Systemen.

Surveillance of nosocomial infections is meanwhile a cornerstone of infection prevention activities in hospitals. The objective of this article is to compare healthcare-associated infection rates in intensive care patients, neonatal intensive care patients and operated patients (ICU-KISS, OP-KISS, NEO-KISS) of the German nosocomial infection surveillance system (KISS) with the corresponding data of the US American National Healthcare Safety Network (NHSN) and the European Centre for Disease Prevention and Control (ECDC). In general, the methodological differences among the three surveillance systems are minor but there are some exceptions. Therefore, differences between countries have to be interpreted very carefully as they may be due to differences in diagnostics, patient mix, types of interventions, length of stay, selection of participating hospitals, post-discharge surveillance activities and interpretation of case definitions. Organizational aspects, such as mandatory participation with public disclosure on infection rates may also have an impact.

Prolonged duration of operation: an indicator of complicated surgery or of surgical (mis)management?

PURPOSE: The aim of this study was to investigate whether a prolonged operative time should be regarded as an indicator of quality problems in operating rooms or as patient-specific risk factors when analyzing surgical site infection (SSI) rates. METHOD: Data from the SSI component of the German national nosocomial infection surveillance system (KISS) were used to address this question. Eight procedure categories tracked by at least 30 departments participating in KISS were included in the analysis, namely, hip (2 types) and knee prosthesis, breast surgery, hernia repair, C-section, cholecystectomy and colon operations. Various multiple logistic regression analyses were performed for each procedure category to predict duration of operation. Patient factors (sex, age, American Society of Anesthesiologists score, wound contamination class) and hospital factors (hospital status, size, annual volume) were considered. The area under the receiver operating characteristic (ROC) curve was used to evaluate predictive power including patient- and hospital-based factors. RESULTS: A total of 253,454 operations were included in the analysis. In general, the predictive power of the model including all variables for the different procedure types was relatively low (C-index range: 0.57-0.63) and not much higher than that of the models including only patient-based or only hospital-based variables, respectively. The predictive power for the duration of operative time based on the model including only hospital-based variables was as good as or better than that of the model including only patient-based factors. CONCLUSION: Duration of operation is at least partially determined by hospital factors and, consequently, should be used as a quality indicator to compare SSI infections between hospitals, rather than being used as a patient factor to adjust comparisons between hospitals.

[Less blood culture samples: less infections?]. / Wenige Blutkulturproben - wenige Infektionen?

BACKGROUND: The data of the German hospital nosocomial infection surveillance system (KISS) were used to investigate the association between the frequency of blood cultures (BC) and central venous catheter associated bloodstream infection (CVC-BSI) rates in intensive care units (ICU). METHODS: A questionnaire on the frequency of BCs taken was sent to all ICUs participating in KISS and univariable and multivariable analyses were performed on the results. RESULTS: A total of 223 ICUs provided data. The median number of BC pairs taken in 2006 was 60 with a huge variation from 3.2 to 680 per 1,000 patient days. The mean primary BSI rate was 0.90 per 1,000 patient days and 0.25 BSIs per 1,000 patient days were caused by coagulase negative Staphylococci (CNS). The mean CVC-BSI rate was 1.40 per 1,000 CVC days. In the univariable analysis the blood culture frequency had a significant influence on the CVC-associated BSI rate, considering either all pathogens (p=0.001) or only the subgroup of CNS-related cases (p=0.019). There was also a significant influence of the BC frequency on the CVC-BSI rate considering all pathogens (p=0.004) as well as the subgroup of CNS (p=0.018). Therefore the BC frequency was a significant factor affecting the incidence of BSI and CVC-BSI. According to the multivariable analysis an increase of the BC frequency of 100 BCs per 1,000 patient days leads to a 1.27-fold higher incidence density of CVC-BSI with a 95% confidence interval (95% CI) of 1.01-1.26. A further significant risk factor for CVC-BSI was the length of stay in the ICU with an adjusted incidence rate ratio (IRR) of 1.25 (95% CI 1.15-1.35). To have the status of an interdisciplinary ICU was a significant protective factor (IRR 0.64; 95% CI 0.45-0.92). CONCLUSIONS: If an external benchmarking of ICU CVC-BSI rates is intended an adjustment according to the BC frequency is necessary. The BC frequency itself should be established as a quality indicator in intensive care.

[Quality management for preventing healthcare-acquired infections. The importance of surveillance]. / Qualitätsmanagement zur Infektionsprävention im Krankenhaus. Die Bedeutung der Surveillance.

Healthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.

Management of peripheral venous catheters and implementation of guidelines in Germany: a national survey.

BACKGROUND: Due to their frequent use, peripheral venous catheters (PVCs) are of importance in terms of catheter-related infections and their prevention. In 2017, revised national guidelines for the prevention of PVC-related infections were published in Germany. AIM: To describe PVC handling practices and assess the implementation of national guidelines for the prevention of PVC-related infections in German acute care hospitals, 10 months after their release. METHODS: An online survey on the management of PVCs in hospital wards was conducted. For this, 1191 acute care hospitals participating in the national surveillance system for healthcare-associated infections in Germany were invited to participate. Each hospital was asked to complete the survey for an intensive care unit (ICU), as well as a medical ward and a surgical ward. Participation in the survey was voluntary. FINDINGS: In total, 701 hospitals (response rate 59%) participated and provided data on 1449 wards (599 ICUs, 446 medical wards, 404 surgical wards). Approximately 43% of wards reported that they had implemented the new national guidelines where necessary. Structured surveillance for PVC-associated infections was established in only 21% of wards. While 94% of wards reported the inclusion of aspects of PVC handling in their general infection prevention education, questions on the training methods yielded diverse results. Approximately 59% of wards reported that they did not routinely use a combination of alcohol and a remanant disinfectant for skin disinfection before PVC insertion. CONCLUSION: Generally, PVC management in Germany is well organized. However, potential for improvement was identified, particularly considering surveillance and implementation of selected national guidelines.

Decrease of methicillin resistance in Staphylococcus aureus in nosocomial infections in Germany-a prospective analysis over 10 years.

OBJECTIVES: Methicillin resistant Staphylococcus aureus (MRSA) remains an important cause of healthcare-associated infections. Here, we describe the development of methicillin-resistant isolates among nosocomial Staphylococcus aureus (SA) infections in Germany between 2007 and 2016. METHODS: We analyzed data from the voluntary German national nosocomial Infection Surveillance System. Data on bloodstream infections (BSI) and lower respiratory tract infections (LRTI) were derived from intensive care units (ICU), whereas data on surgical site infections (SSI) were collected from surgical departments (SD). Univariate analysis was performed on trend of proportion, while multivariable logistic regression was performed to identify risk factors for MRSA-infections. RESULTS: Data of 1218 ICU and 1,556 SD were included. Overall, a decrease in the proportion of MRSA among all nosocomial SA-infections from 32.8% to 20.0% was noted. MRSA decreased from 37.1% to 21.8% (p = 0.01) for BSI, from 38.7% to 19.2% for LTRI (p < 0.01) and. from 21.1% to 7.4% (p < 0.01) in SSI. Logistic regression revealed that SA-infections in Mecklenburg Western-Pomerania were more likely caused by MRSA (Odds ratio (OR): 2.5; 95% CI: 1.7, 3.6). CONCLUSION: We observed a significant reduction of the proportion of nosocomial Staphylococcus aureus infections due to MRSA in Germany over the course of the last 10 years.

Time-trends for Gram-negative and multidrug-resistant Gram-positive bacteria associated with nosocomial infections in German intensive care units between 2000 and 2005.

This study analysed the time-trends for bacteria associated with nosocomial lower respiratory tract infections (LRTIs), bloodstream infections (BSIs) and urinary tract infections (UTIs) that were reported to the German Nosocomial Infection Surveillance System for intensive care units (ICUs). Data concerning 19 822 nosocomial infections were submitted by 139 ICUs between 2000 and 2005. There was a significant increase in the proportion of Gram-negative bacteria causing LRTIs (from 63.9% to 68.4%) and UTIs (from 65.3% to 68.6%). The proportion of BSIs caused by Gram-negative bacteria declined significantly, from 36.4% to 22.7%. The frequency of methicillin-resistant Staphylococcus aureus among all S. aureus isolates increased from 19.8% to 37.2%.

Incidence of healthcare-associated infections in high-risk neonates: results from the German surveillance system for very-low-birthweight infants.

Infants with birthweight <1500g (VLBW) are at high risk of healthcare-associated infection (HAI). We present surveillance data from the NEO-KISS surveillance system, collected between 2000 and 2005 by 52 neonatology departments in Germany. Infants were stratified into two birthweight categories (<1000 and 1000-1499 g), and rates of nosocomial bloodstream infection (BSI), nosocomial pneumonia and necrotising enterocolitis (NEC) were calculated. The data presented comprise 8677 VLBW and 339,972 patient-days. The incidence of bloodstream infection was 6.5 per 1000 patient-days (8.5 and 4.0 according to birthweight category). The incidence of central venous catheter (CVC)-associated BSI was 11.1 per 1000 CVC-days and the incidence of peripheral venous catheter (PVC)-associated BSI was 7.8 per 1000 PVC-days. The incidence of pneumonia was 0.9 per 1000 patient-days (1.3 and 0.4 according to birthweight category). The incidence of pneumonia among intubated patients was 2.7 per 1000 ventilator-days, while the incidence of pneumonia among patients receiving continuous nasel positive airway pressure (CPAP) was 1.0 per 1000 CPAP-days. The incidence of NEC was 0.9 per 1000 patient-days (1.1 and 0.6 according to birthweight category). HAI is frequent among VLBW and shows wide variation between neonatology departments. Preventive strategies to reduce infections in these infants should be prioritised.

Hospital ownership: a risk factor for nosocomial infection rates?

BACKGROUND: In some countries, a relationship between hospital ownership and the occurrence of healthcare-associated infection (HCAI) rates has been described. AIM: To investigate the association between hospital ownership and occurrence of HCAI in Germany. METHODS: Five different components of the German national nosocomial infection surveillance system were analysed with regard to the influence of hospital ownership in the period 2014-2016. Endpoints included ventilator-associated pneumonia, central-venous-catheter-associated bloodstream infections, urinary-catheter-associated urinary tract infections, surgical site infections (SSI) following hip prosthesis and colon surgery, meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile infections (CDI) and hand rub consumption per 1000 patient-days. Three hospital ownership types (public, non-profit and private) were analysed using univariate and multi-variate methods. FINDINGS: The distribution of hospitals according to the three ownership types was similar in all components. In total, 661 intensive care units (ICUs), 149 departments performing colon procedures, and 349 departments performing hip prosthesis were included. In addition, 568 hospitals provided their MRSA rates and 236 provided their CDI rates, and 1833 ICUs and 12,934 non-ICUs provided their hand rub consumption data. In general, the differences between the hospital types were rather small and not significant for the ICUs. In the multi-variate analysis, public hospitals had a lower SSI rate following hip prosthesis (odds ratio 0.80, 95% confidence interval 0.65-0.99). CONCLUSION: Hospital ownership was not found to have a major influence on the incidence of HCAI in Germany.