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1.
Artículo en Alemán | MEDLINE | ID: mdl-36750471

RESUMEN

The COVID-19 pandemic once again highlighted the vulnerability of residents of long-term care facilities due to their increased risk of a severe or fatal course of COVID-19. To protect the residents in the face of high incidences of severe acute respiratory syndrome coronavirus 2 (SARS-CoV­2) in the general population, a number of measures for infection protection were recommended, which led to a decrease of COVID-19 case numbers and deaths in the facilities during the pandemic. However, factors in the facilities that hampered the implementation of these measures and represented a significant impact on the health of the residents also became visible.The challenges concern working conditions (e.g., lack of staff, both in general and with corresponding competencies, and work-related stress), the care of residents (e.g., medical and psychosocial), and structural as well as facility-related factors (e.g., facility size).Approaches to these problems indicate that a successful implementation of infection control measures should be part of a concept for redesigning the work and living conditions of the staff and residents of the facilities. It is important to note that infection control should not be planned exclusively with regard to future pandemics, but is of relevance for health risks that already exist in the facilities, such as healthcare-associated infections, antibiotic resistances, or influenza.


Asunto(s)
COVID-19 , Humanos , COVID-19/prevención & control , Pandemias/prevención & control , SARS-CoV-2 , Cuidados a Largo Plazo , Alemania/epidemiología
3.
Lancet Reg Health Eur ; 14: 100303, 2022 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35043103

RESUMEN

BACKGROUND: Outbreaks of coronavirus disease (COVID-19) in hospitals and long-term care facilities (LTCFs) pose serious public health threats. We analysed how frequency and size of SARS-CoV-2 outbreaks in hospitals and LTCFs have altered since the beginning of the pandemic, in particular since the start of the vaccination campaign. METHODS: We used mandatory notification data on SARS-CoV-2 cases in Germany and stratified by outbreak cases in hospitals and LTCFs. German vaccination coverage data were analysed. We studied the association of the occurrence of SARS-CoV-2 outbreaks and outbreak cases with SARS-CoV-2 cases in Germany throughout the four pandemic waves. We built also counterfactual scenarios with the first pandemic wave as the baseline. FINDINGS: By 21 September 2021, there were 4,147,387 SARS-CoV-2 notified cases since March 2020. About 20% of these cases were reported as being related to an outbreak, with 1% of the cases in hospitals and 4% in LTCFs. The median number of outbreak cases in the different phases was smaller (≤5) in hospitals than in LTCFs (>10). In the first and second pandemic waves, we observed strong associations in both facility types between SARS-CoV-2 outbreak cases and total number of notified SARS-CoV-2 cases. However, during the third pandemic wave we observed a decline in outbreak cases in both facility types and only a weak association between outbreak cases and all cases. INTERPRETATION: The vaccination campaign and non-pharmaceutical interventions have been able to protect vulnerable risk groups in hospitals and LTCFs. FUNDING: No specific funding.

4.
Euro Surveill ; 25(22)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32524949

RESUMEN

Residents in long-term care facilities (LTCF) are a vulnerable population group. Coronavirus disease (COVID-19)-related deaths in LTCF residents represent 30-60% of all COVID-19 deaths in many European countries. This situation demands that countries implement local and national testing, infection prevention and control, and monitoring programmes for COVID-19 in LTCF in order to identify clusters early, decrease the spread within and between facilities and reduce the size and severity of outbreaks.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Coronavirus/aislamiento & purificación , Brotes de Enfermedades , Cuidados a Largo Plazo , Casas de Salud , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Anciano , Anciano de 80 o más Años , Betacoronavirus , COVID-19 , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Europa (Continente)/epidemiología , Femenino , Humanos , Masculino , Neumonía Viral/mortalidad , Neumonía Viral/transmisión , Neumonía Viral/virología , SARS-CoV-2 , Poblaciones Vulnerables
7.
J Antimicrob Chemother ; 73(12): 3505-3515, 2018 12 01.
Artículo en Inglés | MEDLINE | ID: mdl-30239728

RESUMEN

Objectives: The features of a newly established, web-based surveillance system for hospital antibiotic consumption are described and data on broad-spectrum antibiotic use in German acute care hospitals are presented. Methods: The watch- and reserve-group antibiotics, two categories of antibiotics derived from the WHO Essential Medicines List comprising key agents for antimicrobial stewardship, were used as a framework for data analysis. The median antibiotic consumption densities (ACDs; DDD/100 patient days) for the years 2015/16 based on data from 137 acute care hospitals have been calculated for whole facilities, ICUs and medical and surgical departments, stratified by type of care. Results: The new web-based system provides real-time surveillance at unit and facility levels, accessible to all relevant stakeholders. User-defined reports are available via an interactive database, various report types support different approaches to analysis, and different complementing quantification measures of antimicrobial consumption are available. Watch- and reserve-group antibiotics accounted for 42% and 2% of total antibiotic use, respectively. Surgical services presented with considerably lower median ACDs of the watch-group antibiotics compared with medical services. Tertiary care hospitals exhibited higher ACDs of the reserve-group antibiotics and carbapenems than primary/secondary care hospitals, while the ACDs of the watch-group antibiotics as a whole did not differ significantly. Comparing the proportional use with other European countries revealed a relatively high use of the watch-group, ranking beyond the 75th percentile. Conclusions: Because of its particular features the new web-based surveillance system is a valuable tool for antimicrobial stewardship. The WHO categories of watch- and reserve-group antibiotics proved to be a useful framework for the analysis of hospital antibiotic consumption data.


Asunto(s)
Antibacterianos/uso terapéutico , Recolección de Datos , Utilización de Medicamentos/estadística & datos numéricos , Internet , Servicios Médicos de Urgencia/métodos , Alemania , Hospitales , Humanos , Unidades de Cuidados Intensivos
8.
Artículo en Alemán | MEDLINE | ID: mdl-29633033

RESUMEN

The German Antimicrobial Resistance Strategy (DART) assigns a key role in combatting and reducing the further development and spread of antimicrobial resistance to the setup and development of instruments for the monitoring and surveillance of antimicrobial resistance and antibiotic consumption. The strategy follows the One Health approach, which targets human and veterinary medicine alike. An ongoing collection of appropriate data on antimicrobial resistance and antibiotic consumption and its distribution in time and space, will provide the basis for the identification of problems, the deduction of interventions, and finally the evaluation of their effectiveness. This article presents an overview of established surveillance systems in human and veterinary medicine with a national scope, including those that enable Germany to meet its own legal commitments as well as those within European and international action plans.


Asunto(s)
Antibacterianos/uso terapéutico , Infecciones Bacterianas/tratamiento farmacológico , Farmacorresistencia Microbiana , Utilización de Medicamentos/tendencias , Medicina Veterinaria/tendencias , Animales , Infecciones Bacterianas/veterinaria , Predicción , Alemania , Humanos , Salud Única/tendencias , Vigilancia de Productos Comercializados/tendencias
9.
J Clin Microbiol ; 50(1): 157-9, 2012 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-22075585

RESUMEN

In this study, the PCR-based DNA strip assay GenoType BC for the identification of bacteria and the resistance genes mecA, vanA, vanB, vanC1, and vanC2/3 directly from positive BacTAlert blood culture bottles was evaluated in a multicenter study. Of a total of 511 positive blood cultures, correct identification percentages for Gram-negative bacteria, Gram-positive bacteria, and the mecA gene were 96.1%, 89.9%, and 92.9%, respectively. Results were available 4 h after growth detection.


Asunto(s)
Bacteriemia/diagnóstico , Bacterias/aislamiento & purificación , Sangre/microbiología , ADN Bacteriano/genética , Resistencia a la Meticilina , Técnicas de Diagnóstico Molecular/métodos , Resistencia a la Vancomicina , Bacteriemia/microbiología , Bacterias/efectos de los fármacos , Bacterias/genética , Técnicas Bacteriológicas/métodos , ADN Bacteriano/aislamiento & purificación , Genes Bacterianos , Humanos , Reacción en Cadena de la Polimerasa/métodos , Sensibilidad y Especificidad , Factores de Tiempo
11.
Emerg Infect Dis ; 14(9): 1443-6, 2008 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-18760016

RESUMEN

Retrospective molecular genetic analysis of 166 Mycobacterium intracellulare isolates showed that 143 (86%) strains could be assigned to Mycobacterium chimaera sp. nov. Of 97 patients from whom M. chimaera sp. nov. was isolated, only 3.3% exhibited mycobacterial lung disease, whereas all M. intracellulare isolates caused severe pulmonary infections.


Asunto(s)
Infecciones por Mycobacterium/microbiología , Mycobacterium/clasificación , Alemania/epidemiología , Humanos , Enfermedades Pulmonares/epidemiología , Enfermedades Pulmonares/microbiología , Infecciones por Mycobacterium/epidemiología
13.
Diagn Microbiol Infect Dis ; 60(1): 99-103, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-17889492

RESUMEN

Culture-negative endocarditis is a frequent problem in cardiology, especially if caused by fastidious organisms. Among these, the diagnostic tools for the detection of Bartonella quintana are still unsatisfactory. In a culture-negative case of suspected endocarditis undergoing aortic valve replacement, polymerase chain reaction amplification and sequencing of the 16S rRNA gene indicated B. quintana infection. To develop a new diagnostic tool, independent from culture and amplification techniques, we designed and optimized an oligonucleotide fluorescence in situ hybridization (FISH) probe specific for B. quintana and suitable for FISH. FISH succeeded in simultaneous visualization and identification of vital microorganisms directly within the aortic valve tissue and in fast and univocal diagnosis of B. quintana endocarditis.


Asunto(s)
Bartonella quintana/aislamiento & purificación , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/microbiología , Hibridación Fluorescente in Situ/métodos , Fiebre de las Trincheras/diagnóstico , Fiebre de las Trincheras/microbiología , Válvula Aórtica/microbiología , Bartonella quintana/genética , ADN Bacteriano/genética , ADN Ribosómico/genética , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , ARN Ribosómico 16S/genética , Análisis de Secuencia de ADN
14.
J Clin Microbiol ; 44(10): 3760-7, 2006 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-17021106

RESUMEN

With fluorescently labeled PNA (peptide nucleic acid) probes targeting 16S rRNA, we established a 3-h fluorescence in situ hybridization (FISH) procedure for specific visualization of members of the Mycobacterium tuberculosis complex, M. leprae, M. avium, and M. kansasii. Probe specificity was tested against a panel of 25 Mycobacterium spp. and 10 gram-positive organisms. After validation, probes were used to identify 52 mycobacterial culture isolates. Results were compared to conventional genotypic identification with amplification-based methods. All isolates (M. tuberculosis complex, n = 24; M. avium, n = 7; M. kansasii, n = 1) were correctly identified by FISH. In addition, the technique was used successfully for visualization of mycobacteria in biopsies from infected humans or animals. In conclusion, PNA-FISH is a fast and accurate tool for species-specific identification of culture-grown mycobacteria and for direct visualization of these organisms in tissue sections. It may be used successfully for both research and clinical microbiology.


Asunto(s)
Hibridación Fluorescente in Situ/métodos , Infecciones por Mycobacterium/diagnóstico , Mycobacterium/clasificación , Ácidos Nucleicos de Péptidos , Humanos , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium/microbiología , Sondas de Ácido Nucleico , Sensibilidad y Especificidad
15.
APMIS ; 112(11-12): 856-85, 2004.
Artículo en Inglés | MEDLINE | ID: mdl-15638841

RESUMEN

This review focuses on clinical bacteriology and by and large does not cover the detection of fungi, viruses or parasites. It discusses two completely different but complementary approaches that may either supplement or replace classic culture-based bacteriology. The latter view may appear provocative in the light of the actual market penetration of molecular genetic testing in clinical bacteriology. Despite its elegance, high specificity and sensitivity, molecular genetic diagnostics has not yet reached the majority of clinical laboratories. The reasons for this are manifold: Many microbiologists and medical technologists are more familiar with classical microbiological methods than with molecular biology techniques. Culture-based methods still represent the work horse of everyday routine. The number of available FDA-approved molecular genetic tests is limited and external quality control is still under development. Finally, it appears difficult to incorporate genetic testing in the routine laboratory setting due to the limited number of samples received or the lack of appropriate resources. However, financial and time constraints, particularly in hospitals as a consequence of budget cuts and reduced length of stay, lead to a demand for significantly shorter turnaround times that cannot be met by culture-dependent diagnosis. As a consequence, smaller laboratories that do not have the technical and personal equipment required for molecular genetic amplification techniques may adopt alternative methods such as fluorescence in situ hybridization (FISH) that combines easy-to-perform molecular hybridization with microscopy, a technique familiar to every microbiologist. FISH is hence one of the technologies presented here. For large hospital or reference laboratories with a high sample volume requiring massive parallel high-throughput testing we discuss matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF) of nucleic acids, a technology that has evolved from the post-genome sequencing era, for high-throughput sequence variation analysis (1, 2).


Asunto(s)
Bacterias/genética , Técnicas Bacteriológicas/métodos , Hibridación Fluorescente in Situ/métodos , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción/métodos , Infecciones Bacterianas/diagnóstico , Infecciones Bacterianas/microbiología , Tracto Gastrointestinal/microbiología , Genoma Bacteriano , Humanos , Boca/microbiología , ARN Bacteriano/química , ARN Bacteriano/genética , ARN Ribosómico 16S/genética , Sistema Respiratorio/microbiología
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