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

Schröder, C.; Schwab, Frank J.; Behnke, Michael; Breier, A.-C.; Maechler, Friederike; Piening, Brar; Dettenkofer, Markus; Geffers, Christine; Gastmeier, Petra

doi:10.1016/j.ijmm.2015.08.034

Cited by 96 publications

(58 citation statements)

References 25 publications

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“…Despite the expected parallel increase of BSI rates a decrease of primary BSI was observed. This underlines our observations of a decreasing trend of BSI rates in ICUs participating in the German hospital infection surveillance system [17]. …”

Section: Resultssupporting

confidence: 83%

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Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Salm

Schwab

Behnke

et al. 2018

Antimicrob Resist Infect Control

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BackgroundBlood cultures (BCs) are the gold standard for diagnosing sepsis and are prerequisite for a targeted antibiotic treatment and essential for patient outcomes. Aim of the study was to analyze the frequency of BCs, the rate of central line-associated bloodstream infections (CLABSIs) and to study the association between both parameters on intensive care units in Germany over time.MethodsCross-sectional studies at two points in time (2006, 2015) on ICUs participating in the German hospital infection surveillance system. CLABSIs were defined according to the Center for Disease Control and Prevention (CDC). Univariable and multivariable analyses were performed using generalized linear models.ResultsA total of 639 ICUs participated in 2006 or 2015 and 90 ICUs (“core group”) in both years. Overall, 2,427,921 patient days from 644,575 patients were analyzed. In the ICU core group the frequency of BCs per 1000 patient days doubled from 57.8 (interquartile range [IQR] 29.8–101.2; 2006) to 128.2 (IQR 71.6–183.2; 2015). In the same time, the pooled median CLABSI rate decreased from 0.8 (IQR 0–1.9; 2006) per 1000 central-line catheter days to 0.2 (IQR 0–0.9; 2015).ConclusionsFrom 2006 to 2015 the frequency of BCs increased on ICUs in Germany and is now within the recommended 100 to 200 BCs sets per 1000 patient days.

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Section: Resultssupporting

confidence: 83%

“…In Germany, the majority of acute care hospitals participate voluntary in the German hospital infection surveillance system (KISS, “Krankenhaus-Infektions-Surveillance-System”) which is a surveillance system with confidential data feedback [17, 18]. Data were included from ICUs participating in KISS.…”

Section: Methodsmentioning

confidence: 99%

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Salm

Schwab

Behnke

et al. 2018

Antimicrob Resist Infect Control

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“…Active infection surveillance is recognized internationally as one of the activities that contribute to the reduction of the incidence of infections in hospitalized neonates [3][4][5][6][7][8][9][10][11][12]. Several active surveillance protocols for HAIs in neonatal intensive care units (NICUs) have been established worldwide, who differs in type of infections/ outcomes and/or patients' population included in the surveillance.…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

“…Several active surveillance protocols for HAIs in neonatal intensive care units (NICUs) have been established worldwide, who differs in type of infections/ outcomes and/or patients' population included in the surveillance. In particular, the neonIN network in UK, the Vermont Oxford Network in USA and the Canadian Neonatal Network HAIs surveillance protocols focus mainly on early-and late-onset sepsis, while the NHSN and the NEO-KISS protocols extend surveillance of HAIs to VAPs and HAPs [10,11]. Also, the majority of HAIs surveillance systems includes all patients' population of NICUs [4-6, 8, 9, 12], while the NEO-KISS system monitors HAIs in infants of BW < 1500 g in NICUs until discharge, until death, or until they reach 1800 g [10,11].…”

Section: (Continued From Previous Page)mentioning

confidence: 99%

Trends, risk factors and outcomes of healthcare-associated infections in a neonatal intensive care unit in Italy during 2013–2017

et al. 2020

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Background: Healthcare-associated infections (HAIs) occur frequently in intensive care units (NICUs). The aim of this study was to analyze the results of surveillance of HAIs in a III level NICU in Naples, Italy during 2013-2017 and to compare with those obtained during 2006-2010. Methods:The surveillance included 1265 neonates of all birth weight (BW) classes with > 2 days NICU stay. Infections were defined using standard Centers for Disease Control and Prevention definitions adapted to neonatal pathology.Results: A total of 125 HAIs were registered during 2013-2017 with a frequency of 9.9% and an incidence density of 3.2 per 1000 patient days. HAIs occurred in all BW classes with a decreasing trend from the lowest to the highest BW classes (p = < 0.001). Central line-associated blood stream infection (CLABSI) was the most frequent infection (69.6%), followed by ventilator associated pneumonia (VAP) (20%), urinary tract infection (UTI) (8.8%) and necrotizing enterocolitis (NEC) (1.6%). Also, CLABSI and VAP incidence density decreased from lower to highest BW classes showing a significant trend (p = 0.007). Most frequent pathogens responsible for CLABSI were: Coagulase-negative staphylococci (CONS) (25.3%), Candida parapsilosis (21.8%), Pseudomonas aeruginosa (5.7), Escherichia coli and Klebsiella pneumoniae (6.8%). No microbiological diagnosis was achieved for 20.7% of CLABSI. Pseudomonas aeruginosa (28%), Stenotrophomonas maltophilia (20%), and CONS (20%) were the most frequent pathogens responsible for VAP. CLABSI incidence density showed no differences between 2006 and 2010 and 2013-2017, while VAP incidence density for the 751-100 g BW class was higher during 2006-2010 than during 2013-2017 (p = 0.006). A higher incidence of the CLABSI caused by Gram positive bacteria (p = 0.002) or by undetermined etiology (p = 0.01) was observed during 2013-2017 than during 2006-2010, while a significant lower incidence of VAP caused by Gram-negative bacteria was found during

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“…SSIs are associated with increased morbidity and mortality, as well as a prolonged hospital stay and a high number of hospital readmissions [2–4]. Active surveillance has proved to be an effective tool in infection control programmes [5–9], although the risk reduction attributed to surveillance varies [8, 10, 11]. The gold standard for SSI surveillance is prospective incidence surveillance [12, 13], which gives accurate and detailed information on the occurrence of new cases within a standardized follow-up period.…”

Section: Introductionmentioning

confidence: 99%

Incidence of surgical site infections cannot be derived reliably from point prevalence survey data in Dutch hospitals

et al. 2017

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SUMMARYThorough studies on whether point prevalence surveys of healthcare-associated infections (HAIs) can be used to reliably estimate incidence of surgical site infections (SSIs) are scarce. We examined this topic using surveillance data of 58 hospitals that participated in two Dutch national surveillances; HAI prevalence and SSI incidence surveillance, respectively. First, we simulated daily prevalences of SSIs from incidence data. Subsequently, Rhame & Sudderth's formula was used to estimate SSI incidence from prevalence. Finally, we developed random-effects models to predict SSI incidence from prevalence and other relevant variables. The prevalences simulated from incidence data indicated that daily prevalence varied greatly. Incidences calculated with Rhame & Sudderth's formula often had values below zero, due to the large number of SSIs occurring post-discharge. Excluding these SSIs, still resulted in poor correlation between calculated and observed incidence. The two models best predicting total incidence and incidence during initial hospital stay both performed poorly (proportion of explained variance of 0·25 and 0·10, respectively). In conclusion, incidence of SSIs cannot be reliably estimated from point prevalence data in Dutch hospitals by any of the applied methods. We therefore conclude that prevalence surveys are not a useful measure to give reliable insight into incidence of SSIs.

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

Cited by 96 publications

References 25 publications

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Nudge to better care - blood cultures and catheter-related bloodstream infections in Germany at two points in time (2006, 2015)

Trends, risk factors and outcomes of healthcare-associated infections in a neonatal intensive care unit in Italy during 2013–2017

Incidence of surgical site infections cannot be derived reliably from point prevalence survey data in Dutch hospitals

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