Predictors of colonization with Staphylococcus species among patients scheduled for cardiac and orthopedic interventions at tertiary care hospitals in north-eastern Germany-a prevalence screening study.

As methicillin-resistant Staphylococcus aureus (MRSA) colonization and infection in humans are a global challenge. In Mecklenburg and Western Pomerania (Germany) 1,517 patients who underwent surgical interventions were systematically screened for MRSA and MSSA colonization on the day of hospital admission and discharge. Demographic data, risk factors and colonization status of the (i) nose, (ii) throat, (iii) groin, and (iv) thorax or site of surgical intervention were determined. Of the 1,433 patients who were included for further evaluation, 331 (23.1%) were colonized with MSSA, while only 17 (1.2%) were MRSA carriers on the day of hospital admission. A combination of nose, throat and groin swabs returned a detection rate of 98.3% for MSSA/MRSA. Trauma patients had lower prevalence of MRSA/MSSA (OR 0.524, 95% CI: 0.37-0.75; p < 0.001) than patients with intended orthopedic interventions. Males showed significantly higher nasal S. aureus carrier rates than females (odds ratio (OR) = 1.478; 95% CI: 1.14-1.92; p = 0.003). Nasal S. aureus colonization was less frequent among male smokers as compared to non-smokers (chi2 = 16.801; phi = 0.154; p < 0.001). Age, gender and smoking had a significant influence on S. aureus colonization. Combining at least three different swabbing sites should be considered for standard screening procedure to determine S. aureus colonization at patients scheduled for cardiac or orthopedic interventions at tertiary care hospitals.

[Epidemiology of multidrug-resistant organisms in travellers: Results of a 2-year screening in a German level 1 trauma center]. / Epidemiologie multiresistenter Erreger bei Auslandsreisenden: Ergebnisse nach 2 Jahren Screening an einem Krankenhaus der Maximalversorgung.

INTRODUCTION: Antibiotic resistance has emerged as one of the eminent public health concerns. Infections can cause prolonged illness and are related to a high mortality. Expanding tourism and global travelling is one risk factor for spreading of "superbugs" (multidrug-resistant organisms, MDRO) from endemic countries with less hygiene conditions and an overuse of antibiotics. Persons that have had contact with foreign healthcare systems are at a high risk of being contaminated with these bacteria. Returning home they can transmit them to other patients and release nosocomial infections. MATERIAL AND METHODS: To improve the prevention of nosocomial infections at the Unfallkrankenhaus Berlin (ukb), at the beginning of 2011 the hospital hygiene commission decided to expand the existing testing for methicillin-resistant Staphylococcus aureus (MRSA) to screening of incoming patients with contact to foreign healthcare systems to identify colonization or infection with multidrug-resistant bacteria. RESULTS: In a 24-month period 155 patients were screened for MDROs, 31 patients (20%) were found to be positive, 18 showed colonization,13 patients showed infection and a multifold colonization was found in 10 patients. A total of 26 multiresistant gram-negative resistant rod-shaped bacilli resistant to 3 of the 4 classes of antibiotics (3MRGNs) were detected, 12 cases of 4MRGNs and 9 MRSAs. The average isolation time was 39 days and the calculated costs for isolation of MDRO positive patients were approximately 205,000 €. The average case mix index of MDRO positive patients was 9.54. CONCLUSION: The high percentage of patients with MDROs who had had contact with foreign healthcare systems or stayed in foreign countries shows the importance of screening to identify these persons and thus help avoid nosocomial infections of other patients as well as to protect healthcare workers. No transmissions or nosocomial infections were observed during the study period.

[Significance and prevention of post-operative wound complications]. / Bedeutung und Prävention postoperativer Wundkomplikationen.

Although surgical site infections (SSI) in dermatologic operative procedures are extremely rare, it is important to understand risks and etiological factors to initiate risk assessment and specific preventive measures. SSI commonly are associated with a complicated, long-term and expensive outcome. Typical wound pathogens of these infections include a variety of multiresistant organisms along with Staphylococcus aureus, Staphylococcus epidermidis, hemolytic streptococci and the gram-negative bacilli Escherichia coli and Pseudomonas aeruginosa. Effective hygienic measures as part of an adequate quality management system should consider the critical points in the development of SSI, particularly in the setting of an outpatient dermatologic unit, such as preparation of the operative area, preoperative skin antisepsis, hand hygiene, safe and skilled technique by surgeons, and barrier nursing to prevent spread of pathogens. The baseline infection incidence in dermatologic surgery inherently is low; nevertheless significant improvements can be achieved by implementation of risk-adapted infection control measures.

[Diagnosis and management of peripheral vascular injuries]. / Diagnostik und Management peripherer Gefäßverletzungen.

Peripheral vascular injuries are the cause of high morbidity in trauma patients. Up to 5 % of all patients with injuries of the extremities present with concomitant vascular lesions. While open peripheral vascular injuries are associated with a high mortality at the scene of the accident, closed vascular injuries present the danger of developing critical tissue ischemia with a high risk of amputation and limb loss. Early diagnosis is crucial in order to rapidly restore and maintain adequate blood flow and downstream tissue perfusion. A correct diagnosis and early treatment of peripheral vascular injuries place enormous demands on interdisciplinary teams consisting of emergency physicians, orthopedic surgeons, vascular surgeons, anesthesiologists and radiologists. The top priority in the context of emergency care is hemorrhage control by applying direct pressure and dressings until definitive surgical treatment. Hypovolemic shock, reperfusion injury and compartment syndrome are complications of peripheral vascular injuries that must be recognized and treated in the early stages.

[Influence of culture and religion on the treatment of cancer patients]. / Einfluss von Kultur und Religion auf die Therapie von Krebspatienten.

Religion, which is one of the most important sources of human identity, has so far hardly been taken into account in the clinic. In the largely secularized society of Germany, this has played a highly subordinate role. Currently, however, the development towards a multireligious society is emerging, which will also be reflected in everyday medical care. Disease and mortality in patients can affect different cultural-religious spheres. Although distinction between cultural and religious aspects is possible, it is not necessary for clinical practice. In the situation of oncological therapy, questions may arise which must be answered differently in the religions Christianity, Judaism and Islam and which should be taken into account when selecting therapy. The consideration of cultural-religious rules can intensify the patient's acceptance, but it can also impair it in case of disregard. Such peculiarities can be the separation into male and female spheres or the restriction of certain auxiliary substances or drugs (blood products, narcotics). Kübler-Ross's phase model is suitable for determining where cultural-religious sensitivities should be taken into account in the phases of disease and how cultural-religious offerings can benefit the course of therapy. Due to large individual, regional, cultural and confessional differences, no systematic catalogue of procedures can be provided here. However, knowledge of such differences, more sensitive interaction with patients and their families and cooperation with hospital pastors can strengthen the relationship of trust between doctor and patient and thus improve the conditions for successful oncological therapy. These aspects should not be underestimated when treating people of other faiths in Germany's secular society.

[Who Stays Loyal to Orthopaedics and Trauma Surgery? Results of a Nationwide Survey]. / Wer bleibt nach einer Famulatur in Orthopädie und Unfallchirurgie dem Fachbereich treu? Ergebnisse einer bundesweiten Umfrage.

INTRODUCTION: The general shortage of medical doctors in Germany can also be felt in the area of trauma and orthopaedics. Medical elective placements, in Germany known as "Famulatur", are sensitive interfaces between the theoretical university studies and the practical medical workplace. In this research project, the aim was to study how medical students perceive these types of placements and if it alters their decision making when planning their further career. METHODS: During the summer term of 2012, 9079 medical students answered an online questionnaire. Of these, the subgroup was evaluated that had had a placement of at least 4 weeks in the field of trauma and orthopaedics. Overall, 37 test items about this placement and further career steps were included in this study. Groups were evaluated separately by the item "I am considering a career in trauma and orthopaedics" (PJ-Ja) versus "I am not considering a career in trauma and orthopaedics" (PJ-Nein). RESULTS: Overall 397 students were included in this study; 55 % were female. 267 (67.3 %) stated: "I am considering a career in trauma and orthopaedics"; 130 (32.7 %) were not. There was no significant difference in age or sex between these groups (sex: χ²= 2.50, p = 0.114; age: F[1.93]< 1, p = 0.764). Specific and statistically significant differences between those groups were found in the items team integration, ward climate, qualification of teaching, training for specific knowledge in the field, practical aspects of the tasks performed, general planning and structure of the elective achievement of the teaching goals. DISCUSSION: Knowledge of satisfaction during medical elective placements is essential if one aims to inspire students for a specific medical profession. Instructors who can identify weaknesses and deficits in their training regime can therefore in the future increase the number of medical doctors who choose their speciality. The foundation of personal development has to be laid very early in the career of medical students.

[Infections Associated with Treatment with Hirudo medicinalis - Report of Two Cases and Review of the Literature]. / Infektionen im Zusammenhang mit der Anwendung von Hirudo medicinalis - Zwei Fallberichte und Literaturübersicht.

Medicinal leeches are well-established for promoting venous drainage in transplants/flaps and analgesia in osteoarthritis. Although medicinal leeches are bred and kept under controlled conditions, they are colonised by a genuine species-specific bacterial flora. Therapeutic application of leeches implies skin penetration carrying an a priori risk of infection. We report 2 cases with different indications for medicinal leech therapy. In both cases wound infection occurred in close temporal and spatial correlation or with evidence of a leech-associated germ that could be treated successfully. An unclarified complication rate warrants strict indications for the application of medicinal leeches. Preventive measures are currently tested.