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Kosenkow J, Ankert J, Baier M, Kesselmeier M, Pletz MW. COVID-19 outbreak among employees of a German hospital: risk factor analysis based on a follow-up questionnaire and seroprevalence. Infection 2024:10.1007/s15010-024-02220-1. [PMID: 38488974 DOI: 10.1007/s15010-024-02220-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 02/16/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND The Co-FriSero study describes a COVID-19 outbreak at the Friedrichroda hospital in Thuringia, Germany, with 185 beds and 404 employees, at the onset of the pandemic between March 30th, 2020, and April 13th, 2020. This study aimed to analyze potential sources of SARS-CoV-2 transmission amongst hospital employees. METHODS After the outbreak, a comprehensive follow-up was conducted through a questionnaire and a seroprevalence study using two different immunoassays for IgG detection and a third for discordant results. RESULTS PCR screenings confirmed SARS-CoV-2 infection in 25 of 229 employees, with an additional 7 detected through serology. Statistical analysis indicated that direct patient contact, exposure to high flow ventilation in non-isolated rooms, direct contact with colleagues, shared use of recreational rooms, and carpooling were associated with an increased infection risk. Conversely, contact with family and friends, public transportation, public events, and use of locker rooms were not associated with infection. Male gender showed a lower infection likelihood, independent of age and other risk factors. CONCLUSION This study highlights the role of direct patient care and internal staff interactions in the spread of SARS-CoV-2 in the hospital setting. It suggests that non-traditional transmission routes like carpooling require consideration in pandemic preparedness.
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Affiliation(s)
- Jennifer Kosenkow
- Institute for Infectious Diseases and Infection Control and Center for Sepsis Care and Control (CSCC), Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Juliane Ankert
- Institute for Infectious Diseases and Infection Control and Center for Sepsis Care and Control (CSCC), Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Baier
- Institute of Medical Microbiology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Miriam Kesselmeier
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control and Center for Sepsis Care and Control (CSCC), Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany.
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Tobudic S, Bahrs C, Schneider L, Paulussen E, Bartonickova L, Hagel S, Starzengruber P, Burgmann H, Pletz MW. Early treatment response to piperacillin/tazobactam in patients with bloodstream infections caused by non-ESBL ampicillin/sulbactam-resistant Escherichia coli: a binational cohort study. Infection 2023; 51:1749-1758. [PMID: 37462895 PMCID: PMC10665230 DOI: 10.1007/s15010-023-02074-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 07/04/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE This study aimed to compare treatment outcomes for bloodstream infections (BSI) caused by a piperacillin/tazobactam (PIP/TAZ)-susceptible E. coli among three patient groups: BSI caused by ampicillin/sulbactam (AMP/SLB)-resistant isolates treated with PIP/TAZ, BSI caused by AMP/SLB-sensitive isolates treated with PIP/TAZ, and BSI caused by AMP/SLB-resistant isolates treated with another monotherapy. METHODS This retrospective study was conducted in two academic centres in Europe. Adult patients with E. coli BSI were screened from 2014 to 2020. Inclusion criteria were non-ESBL BSI and initial monotherapy for ≥ 72 h. To reduce the expected bias between the patient groups, propensity score matching was performed. The primary outcome was early treatment response after 72 h and required absence of SOFA score increase in ICU/IMC patients, as well as resolution of fever, leukocytosis, and bacteraemia. RESULTS Of the 1707 patients screened, 315 (18.5%) were included in the final analysis. Urinary tract infection was the most common source of BSI (54.9%). Monotherapies other than PIP/TAZ were cephalosporins (48.6%), carbapenems (34.3%), and quinolones (17.1%). Enhanced early treatment response rate was detected (p = 0.04) in patients with BSI caused by AMP/SLB-resistant isolates treated with another monotherapy (74.3%) compared to those treated with PIP/TAZ (57.1%), and was mainly driven by the use of cephalosporins and quinolones (p ≤ 0.03). Clinical success, 28-day mortality, and rate of relapsing BSI did not significantly differ between the groups. CONCLUSIONS Our study suggests that initial use of PIP/TAZ may be associated with reduced early treatment response in E. coli BSI caused by AMP/SLB-resistant isolates compared to alternative monotherapies.
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Affiliation(s)
- Selma Tobudic
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Christina Bahrs
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria.
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany.
| | - Lisa Schneider
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Emilia Paulussen
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Lucie Bartonickova
- Institute of Medical Microbiology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Stefan Hagel
- Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Am Klinikum 1, 07747, Jena, Germany
| | - Peter Starzengruber
- Division of Clinical Microbiology, Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
| | - Mathias W Pletz
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Vienna, Austria
- Center for Sepsis Care and Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
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Kääriäinen S, Harjunmaa U, Hannila-Handelberg T, Ollgren J, Lyytikäinen O. Risk of COVID-19 in different groups of healthcare professionals between February 2020 and June 2021 in Finland: a register-based cohort study. Infect Prev Pract 2023; 5:100297. [PMID: 37560347 PMCID: PMC10406617 DOI: 10.1016/j.infpip.2023.100297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 07/03/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND During the Coronavirus Disease 2019 (COVID-19) pandemic, healthcare workers (HCWs) have been a risk group for COVID-19. AIM To assess the cumulative incidence in different groups of HCWs and the risk factors and outcomes of COVID-19 in HCWs between February 2020 and June 2021 in Finland. METHODS We linked two national registers, National Infectious Diseases Register (NIDR) and Register of Social Welfare and Healthcare Professionals (Terhikki), using national identity codes. COVID-19 cases were identified from NIDR notifications made by laboratories and physicians, and their healthcare professions from Terhikki. We categorized healthcare professions into seven groups and calculated cumulative incidences using Kaplan-Meier estimate during three periods (1/2/2020-30/6/2020, 1/7/2020-31/12/2020, 1/1/2021-30/6/2021). We identified risk factors in a multivariable model using Cox's regression. FINDINGS We identified 8,009 COVID-19-cases among HCWs, with cumulative incidence of 1.79%; 83% were female, median age was 40.9 years (interquartile range, 31.2-51.6). Most COVID-19-cases occurred in nursing assistants (53%) and nurses (17%), with the highest cumulative incidences 2.07% (95%CI, 2.01-2.13%) and 1.82% (95%CI, 1.73-1.91%), respectively. Risk factors were male sex (hazard ratio (HR) 1.2; 95%CI, 1.1-1.3), foreign native language (HR 2.5; 95%CI, 2.2-2.9) and foreign country of birth (HR 1.2; 95%CI, 1.1-1.4). Physician notification data was available for 6,113/8,009 cases (76.3%); 244/6,113 (4.0%) were hospitalized and 37/6,113 (0.6%) in intensive care. CONCLUSION Nurses and nursing assistant, especially men and professionals with foreign background, were at higher risk of COVID-19. This should be specifically addressed during training and implementing infection control measures to protect themselves and patients.
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Affiliation(s)
- Sohvi Kääriäinen
- Finnish Institute for Health and Welfare, Helsinki, Finland
- ECDC Fellowship Programme, Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), Solna, Sweden
| | - Ulla Harjunmaa
- Finnish Institute for Health and Welfare, Helsinki, Finland
| | | | - Jukka Ollgren
- Finnish Institute for Health and Welfare, Helsinki, Finland
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Liebe SH, Walendi A, Brethfeld L. [Recommendations for action for SARS-CoV-2 testing concepts for asymptomatic healthcare workers]. ZENTRALBLATT FUR ARBEITSMEDIZIN, ARBEITSSCHUTZ UND ERGONOMIE 2023; 73:97-111. [PMID: 37197613 PMCID: PMC9975865 DOI: 10.1007/s40664-023-00496-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/11/2023] [Indexed: 03/05/2023]
Abstract
Background and objective When implementing SARS-CoV‑2 testing concepts in healthcare facilities, different laws and regulations of equal rank apply. In the light of experienced impediments in translating legal requirements appropriately into legally secure concepts on an operational level, the objective of this paper was to develop corresponding specific recommendations for action. Methods On the basis of guiding questions on previously identified fields of action, a focus group consisting of representatives of administration, different medical disciplines, and special interest groups discussed critical aspects of implementation using a holistic approach. The transcribed contents were analyzed through inductive development and deductive application of categories. Results All contents of discussion could be matched with the identified categories legal backgrounds, requirements and objectives of testing concepts in healthcare facilities, responsibilities for implementing in operational decision-making chains, and implementing SARS-CoV‑2 testing concepts. Implications The correct implementation of the legal requirements into legally compliant SARS-CoV‑2 testing concepts in healthcare facilities previously required the involvement of ministries, representatives of different medical disciplines and professional associations, employer and employee representatives and data privacy experts as well as representatives of possible cost bearers. In addition, an integrative and enforceable composition of laws and regulations is necessary. Defining objectives for testing concepts is significant for the following operational process flows that need to consider aspects of employee data privacy as well as providing additional personnel for fulfilling the tasks. Also, in future one central issue of healthcare facilities concerns the finding of solutions for IT interfaces for information transfer to employees in accordance with data privacy.
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Affiliation(s)
- Susanne H. Liebe
- Arbeits- und Gesundheitsschutz der Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - Anna Walendi
- Arbeits- und Gesundheitsschutz der Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Deutschland
| | - Lukas Brethfeld
- Arbeits- und Gesundheitsschutz der Hochschulmedizin Dresden, Universitätsklinikum Carl Gustav Carus, Fetscherstr. 74, 01307 Dresden, Deutschland
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Non-patient-related SARS-CoV-2 exposure from colleagues and household members poses the highest infection risk for hospital employees in a German university hospital: follow-up of the prospective Co-HCW seroprevalence study. Infection 2023:10.1007/s15010-023-01995-z. [PMID: 36788173 PMCID: PMC9928590 DOI: 10.1007/s15010-023-01995-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 01/30/2023] [Indexed: 02/16/2023]
Abstract
PURPOSE The Co-HCW study is a prospective, longitudinal, single-center observational study that aims to assess the SARS-CoV-2 seroprevalence and infection status in staff members of Jena University Hospital (JUH) in Jena, Germany. METHODS This follow-up study covers the observation period from 19th May 2020 to 22nd June 2021. At each of the three voluntary study visits, participants filled out a questionnaire regarding their SARS-CoV-2 exposure and provided serum samples to detect specific SARS-CoV-2 antibodies. Participants who were tested positive for antibodies against nucleocapsid and/or spike protein without previous vaccination and/or reported a positive SARS-CoV-2 PCR test were regarded to have been infected with SARS-CoV-2. Multivariable logistic regression modeling was applied to identify potential risk factors for infected compared to non-infected participants. RESULTS Out of 660 participants that were included during the first study visit, 406 participants (61.5%) were eligible for the final analysis as their COVID-19 risk area (high-risk n = 76; intermediate-risk n = 198; low-risk n = 132) did not change during the study. Forty-four participants [10.8%, 95% confidence interval (95%CI) 8.0-14.3%] had evidence of a current or past SARS-CoV-2 infection detected by serology (n = 40) and/or PCR (n = 28). No association between SARS-CoV-2 infection and the COVID-19 risk group according to working place was detected. However, exposure to a SARS-CoV-2 positive household member [adjusted OR (AOR) 4.46, 95% CI 2.06-9.65] or colleague (AOR 2.30, 95%CI 1.10-4.79) was found to significantly increase the risk of a SARS-CoV-2 infection. CONCLUSION Our results demonstrate that non-patient-related SARS-CoV-2 exposure posed the highest infection risk for hospital staff members of JUH.
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Smith-Jeffcoat SE, Sleweon S, Koh M, Khalil GM, Schechter MC, Rebolledo PA, Kasinathan V, Hoffman A, Rossetti R, Shragai T, O'Laughlin K, Espinosa CC, Bankamp B, Bowen MD, Paulick A, Gargis AS, Folster JM, da Silva J, Biedron C, Stewart RJ, Wang YF, Kirking HL, Tate JE. Risk-Factors for Exposure Associated With SARS-CoV-2 Detection After Recent Known or Potential COVID-19 Exposures Among Patients Seeking Medical Care at a Large Urban, Public Hospital in Fulton County, Georgia - A Cross-Sectional Investigation. Front Public Health 2022; 10:809356. [PMID: 35425748 PMCID: PMC9004481 DOI: 10.3389/fpubh.2022.809356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 02/28/2022] [Indexed: 11/13/2022] Open
Abstract
We aimed to describe frequency of COVID-19 exposure risk factors among patients presenting for medical care at an urban, public hospital serving mostly uninsured/Medicare/Medicaid clients and risk factors associated with SARS-CoV-2 infection. Consenting, adult patients seeking care at a public hospital from August to November 2020 were enrolled in this cross-sectional investigation. Saliva, anterior nasal and nasopharyngeal swabs were collected and tested for SARS-CoV-2 using RT-PCR. Participant demographics, close contact, and activities ≤14 days prior to enrollment were collected through interview. Logistic regression was used to identify risk factors associated with testing positive for SARS-CoV-2. Among 1,078 participants, 51.8% were male, 57.0% were aged ≥50 years, 81.3% were non-Hispanic Black, and 7.6% had positive SARS-CoV-2 tests. Only 2.7% reported COVID-19 close contact ≤14 days before enrollment; this group had 6.79 adjusted odds of testing positive (95%CI = 2.78-16.62) than those without a reported exposure. Among participants who did not report COVID-19 close contact, working in proximity to ≥10 people (adjusted OR = 2.17; 95%CI = 1.03-4.55), choir practice (adjusted OR = 11.85; 95%CI = 1.44-97.91), traveling on a plane (adjusted OR = 5.78; 95%CI = 1.70-19.68), and not participating in an essential indoor activity (i.e., grocery shopping, public transit use, or visiting a healthcare facility; adjusted OR = 2.15; 95%CI = 1.07-4.30) were associated with increased odds of testing positive. Among this population of mostly Black, non-Hispanic participants seeking care at a public hospital, we found several activities associated with testing positive for SARS-CoV-2 infection in addition to close contact with a case. Understanding high-risk activities for SARS-CoV-2 infection among different communities is important for issuing awareness and prevention strategies.
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Affiliation(s)
| | - Sadia Sleweon
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Mitsuki Koh
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - George M. Khalil
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Marcos C. Schechter
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | - Paulina A. Rebolledo
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
- Emory University School of Public Health, Hubert Department of Global Health, Atlanta, GA, United States
| | - Vyjayanti Kasinathan
- Emory University School of Medicine, Division of Infectious Diseases, Atlanta, GA, United States
- Grady Memorial Hospital, Atlanta, GA, United States
| | - Adam Hoffman
- Grady Memorial Hospital, Atlanta, GA, United States
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, United States
| | - Rebecca Rossetti
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Talya Shragai
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kevin O'Laughlin
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Bettina Bankamp
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Michael D. Bowen
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Ashley Paulick
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Amy S. Gargis
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Juliana da Silva
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Caitlin Biedron
- Centers for Disease Control and Prevention, Atlanta, GA, United States
| | | | - Yun F. Wang
- Grady Memorial Hospital, Atlanta, GA, United States
- Emory University School of Medicine, Pathology & Laboratory Medicine, Atlanta, GA, United States
| | - Hannah L. Kirking
- Centers for Disease Control and Prevention, Atlanta, GA, United States
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Conoscenti E, Campanella M, Sala A, Di Stefano MC, Vinci D, Lombardo R, Arena G, Ginestra A, Fiolo R, Tuzzolino F, Ippolito A, Martucci G, Enea G, Luca A. Impact of the Organizational Model Adopted during the COVID-19 Pandemic on the Perceived Safety of Intensive Care Unit Staff. J Clin Med 2022; 11:1487. [PMID: 35329813 PMCID: PMC8955264 DOI: 10.3390/jcm11061487] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic had a devastating health, social, and economic effect on the population. Organizational, technical and structural operations aimed at protecting staff, outpatients and inpatients were implemented in an Italian hospital with a COVID-19 dedicated intensive care unit. The impact of the organizational model adopted on the perceived safety among staff was evaluated. METHODS Descriptive, structured and voluntary, anonymous, non-funded, self-administered cross-sectional surveys on the impact of the organizational model adopted during COVID-19 on the perceived safety among staff. RESULTS Response rate to the survey was 67.4% (153 completed surveys). A total of 91 (59%) of respondents had more than three years of ICU experience, while 16 (10%) were employed for less than one year. Group stratification according to profession: 74 nurses (48%); 12 medical-doctors (7%); 11 physiotherapists (7%); 35 nurses-aides (22%); 5 radiology-technicians (3%); 3 housekeeping (1%); 13 other (8%). The organizational model implemented at ISMETT made them feel safe during their workday. A total of 113 (84%) agreed or strongly agreed with the sense of security resulting from the implemented measures. A vast majority of respondents perceived COVID-19 as a dangerous and deadly disease (94%) not only for themselves but even more as vectors towards their families (79%). A total of 55% of staff took isolation measures and moved away from their home by changing personal habits. The organizational model was perceived overall as appropriate (91%) to guarantee their health. CONCLUSION The vast majority of respondents perceived the overall model applied during an unexpected, emergency situation as appropriate.
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Affiliation(s)
- Elena Conoscenti
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Maria Campanella
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Antonino Sala
- Direzione Generale, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (A.S.); (F.T.); (A.L.)
| | - Maria Cristina Di Stefano
- Direzione Sanitaria, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (M.C.D.S.); (D.V.)
| | - Dario Vinci
- Direzione Sanitaria, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (M.C.D.S.); (D.V.)
| | - Rosario Lombardo
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Giuseppe Arena
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Angelo Ginestra
- Ospedale Civico, Via C. Lazzaro 2, 90127 Palermo, Sicily, Italy;
| | - Rosario Fiolo
- Dipartimento BIND, Scuola di Medicina e Chirurgia, Università degli Studi di Palermo, Via del Vespro, 129, 90127 Palermo, Sicily, Italy;
| | - Fabio Tuzzolino
- Direzione Generale, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (A.S.); (F.T.); (A.L.)
| | - Alessia Ippolito
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Gennaro Martucci
- Department of Anesthesia and Intensive Care, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy
| | - Giuseppe Enea
- Direzione delle Professioni Sanitarie, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (E.C.); (M.C.); (R.L.); (G.A.); (A.I.); (G.E.)
| | - Angelo Luca
- Direzione Generale, IRCCS-ISMETT (Istituto Mediterraneo per I Trapianti E Terapie Ad Alta Specializzazione), Via E. Tricomi 5, 90127 Palermo, Sicily, Italy; (A.S.); (F.T.); (A.L.)
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Hildebrandt A, Hökelekli O, Uflacker L, Rudolf H, Paulussen M, Gatermann SG. Seroprevalence of SARS-CoV-2 Antibodies in Employees of Three Hospitals of a Secondary Care Hospital Network in Germany and an Associated Fire Brigade: Results of a Repeated Cross-Sectional Surveillance Study Over 1 Year. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2402. [PMID: 35206589 PMCID: PMC8878380 DOI: 10.3390/ijerph19042402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/06/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023]
Abstract
Healthcare workers (HCWs) are playing a vital role in the current SARS-CoV-2 pandemic. This study investigated how infection spreads within three local hospitals and an associated fire brigade in Germany by testing employees for the presence of SARS-CoV-2 IgG antibodies over one year. The three observational periods corresponded to the initial three pandemic waves: first wave: June-September 2020, second wave: October 2020-January 2021, and third wave: February-June 2021. We analysed 3285 serum samples of 1842 employees, which represents 65.7% of all employees. Altogether, 13.2% employees were seropositive: 194/1411 HCWs (13.7%) and 49/431 non-HCWs (11.4%) with a clear increase of seroprevalence from the first (1.1%) to the second (13.2%) and third (29.3%) pandemic wave. HCWs presumably had an additional occupational risk for infection in the second and third wave due to an increase of infection pressure with more COVID-19 patients treated, showing possible weak points in the recommended infection prevention strategy.
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Affiliation(s)
- Anke Hildebrandt
- St. Vincenz Hospital, Department of Internal Medicine I, 45711 Datteln, Germany; (O.H.); (L.U.)
- Institute of Medical Microbiology, University Hospital Münster, 48149 Münster, Germany
| | - Oktay Hökelekli
- St. Vincenz Hospital, Department of Internal Medicine I, 45711 Datteln, Germany; (O.H.); (L.U.)
| | - Lutz Uflacker
- St. Vincenz Hospital, Department of Internal Medicine I, 45711 Datteln, Germany; (O.H.); (L.U.)
| | - Henrik Rudolf
- Institute for Biostatistics and Informatics in Medicine and Ageing Research, University Medical Center Rostock, 18057 Rostock, Germany;
| | - Michael Paulussen
- Vestische Kinder- und Jugendklinik, Witten/Herdecke University, 45711 Datteln, Germany;
| | - Sören G. Gatermann
- National Reference Center for Multidrug-Resistant Gram-Negative Bacteria, Ruhr University Bochum, 44801 Bochum, Germany;
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Dusefante A, Negro C, D’Agaro P, Segat L, Purpuri A, Cegolon L, Larese Filon F. Occupational Risk Factors for SARS-CoV-2 Infection in Hospital Health Care Workers: A Prospective Nested Case-Control Study. Life (Basel) 2022; 12:life12020263. [PMID: 35207550 PMCID: PMC8874671 DOI: 10.3390/life12020263] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/12/2022] Open
Abstract
Introduction: Health Care Workers (HCWs) are at a particular high risk of SARS-CoV-2 infection due to direct and indirect exposure to COVID-19 patients and Aerosol-Generating Procedures (AGPs). The aim of the study was to assess the risk factors for SARS-CoV-2 infection in HCWs exposed to COVID-19 patients, to evaluate the adherence and effectiveness of Infection Prevention and Control (IPC) measures, to describe the clinical presentation for SARS-CoV-2 infection in HCWs and to determine serological responses in HCWs. Methods: HCWs exposed to COVID-19 patients during the previous 14 days with a confirmed case status were recruited as cases; HCWs exposed to COVID-19 patients during the previous 14 days in the same ward without a suspected/probable/confirmed case status were recruited as controls. Serum samples were collected as soon as possible and after 21–28 days from all participants. Data were collected with a WHO standardized questionnaire as soon as possible and after 21–28 days. Results: All social, occupational and personal variables considered were not associated with an increased risk of SARS-CoV-2 infection. Conclusions: Our study showed a high knowledge of IPC measures and very high PPE use among HCWs.
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Affiliation(s)
- Alex Dusefante
- Clinical Unit of Occupational Medicine, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (C.N.); (A.P.); (F.L.F.)
- Correspondence: (A.D.); (L.C.)
| | - Corrado Negro
- Clinical Unit of Occupational Medicine, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (C.N.); (A.P.); (F.L.F.)
| | - Pierlanfranco D’Agaro
- Hygiene & Public Health Clinical Unit, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy;
- Hygiene & Public Health Clinical Unit, Department of Laboratory, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy;
| | - Ludovica Segat
- Hygiene & Public Health Clinical Unit, Department of Laboratory, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy;
| | - Antonio Purpuri
- Clinical Unit of Occupational Medicine, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (C.N.); (A.P.); (F.L.F.)
| | - Luca Cegolon
- Clinical Unit of Occupational Medicine, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (C.N.); (A.P.); (F.L.F.)
- Public Health Department, University Health Agency Giuliano-Isontina (ASUGI), 34129 Trieste, Italy
- Correspondence: (A.D.); (L.C.)
| | - Francesca Larese Filon
- Clinical Unit of Occupational Medicine, Department of Medical, Surgical & Health Sciences, University of Trieste, 34129 Trieste, Italy; (C.N.); (A.P.); (F.L.F.)
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10
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Honarkar Shafie E, Taheri F, Alijani N, Okhovvat AR, Goudarzi R, Borumandnia N, Aghaghazvini L, Rezayat SM, Jamalimoghadamsiahkali S, Hosseinzadeh-Attar MJ. Effect of nanocurcumin supplementation on the severity of symptoms and length of hospital stay in patients with COVID-19: A randomized double-blind placebo-controlled trial. Phytother Res 2022; 36:1013-1022. [PMID: 35023260 DOI: 10.1002/ptr.7374] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 11/02/2021] [Accepted: 12/27/2021] [Indexed: 12/14/2022]
Abstract
It has been more than a year since the outbreak of COVID-19, and it is still the most critical issue of the healthcare system. Discovering effective strategies to treat infected patients is necessary to decrease the mortality rate. This study aimed to determine the effects of nanocurcumin on the severity of symptoms and length of hospital stay (LOS) in COVID-19 patients. Forty-eight COVID-19 patients were randomly assigned into nanocurcumin (n = 24) and placebo (n = 24) groups receiving 160 mg/day nanocurcumin or placebo capsules for 6 days. Mean differences of O2 saturation were significantly higher in patients who received nanocurcumin supplements (p = 0.02). Also, nanocurcumin treatment significantly reduced the scores of domains 3 and 4 and the total score of Wisconsin Upper Respiratory System Survey (WURSS-24), indicating milder symptoms in the treatment group (p = 0.01, 0.03, and 0.01 respectively). Besides, the LOS in curcumin groups was lower than in the placebo group, although the difference was not statistically significant (6.31 ± 5.26 vs. 8.87 ± 8.12 days; p = 0.416). CBC/differentiate, hs-CRP level and the pulmonary involvement in CT scan were not different between the two groups. As nanocurcumin can be effective in increasing O2 saturation and reducing the severity of symptoms in COVID-19 patients, it could probably be used as a complementary agent to accelerate the recovery of patients.
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Affiliation(s)
- Elaheh Honarkar Shafie
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Fateme Taheri
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Neda Alijani
- Department of Infectious Disease, Shariati Hospital, Tehran university of medical sciences, Tehran, Iran
| | | | - Razieh Goudarzi
- Department of Clinical Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Borumandnia
- Urology and Nephrology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Aghaghazvini
- Department of Radiology, Shariati hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mahdi Rezayat
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
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11
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Hupf J, Burkhardt R, Gessner A, Maier-Stocker C, Zimmermann M, Hanses F, Peterhoff D. [Low incidence of SARS-CoV-2 infections in healthcare workers at a tertiary care hospital : Results of a prospective serological cohort study of the first and second COVID‑19 pandemic wave]. Med Klin Intensivmed Notfmed 2022; 117:639-643. [PMID: 34978585 PMCID: PMC8721941 DOI: 10.1007/s00063-021-00890-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/24/2021] [Accepted: 10/12/2021] [Indexed: 12/04/2022]
Abstract
Hintergrund Mitarbeiter im Gesundheitswesen mit Kontakt zu COVID‑19-Patienten sind einem erhöhten Risiko einer Infektion mit SARS-CoV‑2 ausgesetzt. Ziel dieser seroepidemiologischen Studie war es, das Infektionsrisiko für Klinikmitarbeiter eines Maximalversorgers zu evaluieren. Methodik Im Rahmen einer prospektiven Kohortenstudie wurden von März bis Juli 2020 (1. Welle) bei unmittelbar in der Versorgung von COVID‑19-Patienten eingesetzten Mitarbeitern im Abstand von jeweils 2 Wochen serologische Untersuchungen auf Antikörper gegen SARS-CoV‑2 durchgeführt. Von Dezember 2020 bis Februar 2021 (2. Welle) fand eine erneute Untersuchung des Antikörperstatus statt. Ergebnisse Die Seroprävalenz von Antikörpern gegen SARS-CoV‑2 betrug am Studienende im Februar 2021 5,1 %. Die kumulative Inzidenz betrug nach einer medianen Beobachtungsdauer von 261 Tagen 3,9 %. Schlussfolgerung In der untersuchten Kohorte von Klinikmitarbeitern, die in der Akutversorgung von COVID‑19-Patienten eingesetzt werden, fand sich unter den angewandten Hygiene- und Schutzmaßnahmen ein niedriges und mit der Gesamtbevölkerung vergleichbares Risiko einer SARS-CoV-2-Infektion.
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Affiliation(s)
- Julian Hupf
- Zentrale Notaufnahme, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland.
| | - Ralph Burkhardt
- Institut für Klinische Chemie und Laboratoriumsmedizin, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - André Gessner
- Institut für klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg, Regensburg, Deutschland.,Institut für medizinische Mikrobiologie und Hygiene, Universität Regensburg, Regensburg, Deutschland
| | | | - Markus Zimmermann
- Zentrale Notaufnahme, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland
| | - Frank Hanses
- Zentrale Notaufnahme, Universitätsklinikum Regensburg, 93053, Regensburg, Deutschland.,Abteilung für Krankenhaushygiene und Infektiologie, Universitätsklinikum Regensburg, Regensburg, Deutschland
| | - David Peterhoff
- Institut für klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg, Regensburg, Deutschland.,Institut für medizinische Mikrobiologie und Hygiene, Universität Regensburg, Regensburg, Deutschland
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12
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Hoffmann S, Schiebel J, Hufert F, Gremmels HD, Spallek J. COVID-19 among Healthcare Workers: A Prospective Serological-Epidemiological Cohort Study in a Standard Care Hospital in Rural Germany. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:10999. [PMID: 34682743 PMCID: PMC8535303 DOI: 10.3390/ijerph182010999] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/05/2021] [Accepted: 10/12/2021] [Indexed: 12/13/2022]
Abstract
Healthcare workers (HCW) play a vital role in the SARS-CoV-2 pandemic control. The aim of this study was to assess the prevalence of SARS-CoV-2 antibodies and the risk of COVID-19 infections in a cohort of HCW from four different risk groups (from intensive care unit to administration) of a hospital of a primary care level in rural Germany. The outcomes were monthly measures of antibody seroprevalence over a period of 6 months. Overall, a seroprevalence of 13.41% was determined, with significantly higher prevalence rates among HCW working in areas with more frequent contact to confirmed or suspected cases (30.30%, p = 0.003). The group specific differences in the risk of infection from COVID-19 were detected, as HCW groups with frequent exposure seemed to have an increased risk (RR = 3.18, p = 0.02; CI95 1.09-9.24). The findings contribute to the epidemiological understanding of the virus spread in an unvaccinated population group, which is highly relevant for the pandemic management.
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Affiliation(s)
- Stephanie Hoffmann
- Department of Public Health, Institute of Health, Brandenburg University of Technology Cottbus-Senftenberg, 01968 Senftenberg, Germany;
| | - Juliane Schiebel
- Institute for Clinical Chemistry, Laboratory Diagnostics and Microbiology, Klinikum Niederlausitz GmbH, 01968 Senftenberg, Germany; (J.S.); (H.-D.G.)
| | - Frank Hufert
- Institute of Microbiology and Virology, Brandenburg Medical School Theodor Fontane, 01968 Senftenberg, Germany;
| | - Heinz-Detlef Gremmels
- Institute for Clinical Chemistry, Laboratory Diagnostics and Microbiology, Klinikum Niederlausitz GmbH, 01968 Senftenberg, Germany; (J.S.); (H.-D.G.)
| | - Jacob Spallek
- Department of Public Health, Institute of Health, Brandenburg University of Technology Cottbus-Senftenberg, 01968 Senftenberg, Germany;
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13
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Chou R, Dana T, Buckley DI, Selph S, Fu R, Totten AM. Update Alert 8: Epidemiology of and Risk Factors for Coronavirus Infection in Health Care Workers. Ann Intern Med 2021; 174:W48-W49. [PMID: 33780293 PMCID: PMC8017477 DOI: 10.7326/l21-0143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Roger Chou
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Tracy Dana
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - David I Buckley
- Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Shelley Selph
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
| | - Rongwei Fu
- Pacific Northwest Evidence-based Practice Center and School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon
| | - Annette M Totten
- Pacific Northwest Evidence-based Practice Center and Oregon Health & Science University, Portland, Oregon
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14
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Epstude J, Skiba M, Harsch IA. Antibody titers and rapid antigen testing in elderly patients with SARS-CoV-2 pneumonia vs. staff of ICU and "Covid-19" wards. GMS HYGIENE AND INFECTION CONTROL 2021; 16:Doc11. [PMID: 33796439 PMCID: PMC7982993 DOI: 10.3205/dgkh000382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Aim: The majority of patients hospitalized with COVID-19 are older individuals. Age and the comorbidities typically associated with it usually go hand in hand with a less favorable course of the disease. We were interested in the antibody response in this particular patient group as well as in the results of rapid antigen testing. Methods: In 30 elderly patients (>75 years), antibody titers (IgA and IgG) against COVID-19 were measured, and rapid antigen testing was determined about 3 weeks after the onset of symptoms of SARS-CoV-2 infection. The results were compared with those of a "high-risk" group consisting of "Covid-19" ward regular staff, as well as with "low-risk" staff consisting of members of the intensive care unit (ICU). The antibody titer against SARS-CoV-2 was determined by ELISA (EUROIMMUN™, PerkinElmer, Inc. Company); for rapid antigen testing, we used the SARS-CoV-2 Rapid Antigen test (Roche®). Results: Our investigations demonstrate a robust antibody response in the majority of elderly, comorbid patients about three weeks after the onset of infection. At this timepoint, most of the results of rapid antigen testing were negative. Furthermore, in the group of employees of our clinic ("Covid-19" ward vs. the ICU staff), the prevalence of antibodies was very low and antigen testing was negative in the whole ICU group. Conclusion: Although frequently comorbid, elderly patients are capable of significantly increasing antibodies against COVID-19 about 3 weeks after the onset of infection. Since the viral load can be assumed to have been low at that point, rapid antigen testing was negative in most cases. In the test group of employees of our clinic ("Covid-19" ward vs. the ICU staff), the data demonstrate that - given adequate protective measures - the risk of infection is not higher in a "Covid-19" ward compared to other wards.
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Affiliation(s)
- Jörg Epstude
- Department of Hospital Hygiene, Thuringia Clinic “Georgius Agricola”, Saalfeld/Saale, Germany
| | - Marcin Skiba
- Department of Internal Medicine II, Thuringia Clinic “Georgius Agricola”, Saalfeld/Saale, Germany
| | - Igor Alexander Harsch
- Department of Internal Medicine II, Thuringia Clinic “Georgius Agricola”, Saalfeld/Saale, Germany
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15
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Bahrs C, Kimmig A, Weis S, Ankert J, Hagel S, Maschmann J, Stallmach A, Steiner A, Bauer M, Behringer W, Baier M, Kesselmeier M, Richert C, Zepf F, Walter M, Scherag A, Kiehntopf M, Löffler B, Pletz MW. Prospective surveillance study in a 1,400-bed university hospital: COVID-19 exposure at home was the main risk factor for SARS-CoV-2 point seroprevalence among hospital staff. Transbound Emerg Dis 2021; 69:720-730. [PMID: 33605549 PMCID: PMC8014017 DOI: 10.1111/tbed.14041] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/08/2021] [Accepted: 02/17/2021] [Indexed: 02/06/2023]
Abstract
The Co‐HCW study is a prospective cohort study among hospital staff, including healthcare workers (HCWs) and administration staff, at the Jena University Hospital (JUH), Germany. The objectives of this study were to assess SARS‐CoV‐2 IgG seroprevalence, individual exposure risk factors and compliance of HCWs to wear personal protective equipment (PPE). After the first nosocomial COVID‐19 outbreak at JUH, mandatory masking was implemented on 20th March 2020. We evaluated point seroprevalence using two IgG detecting immunoassays and issued a questionnaire to assess COVID‐19 exposure, clinical symptoms and compliance to wear PPE. Antibody retesting was offered to participants with a divergent result of both immunoassays 5–10 weeks after the first test. Between 19th May and 19th June 2020, we analysed 660 participants [out of 3,228; 20.4%]. Among them, 212 participants (32.1%) had received a previous COVID‐19 test. Four of them (1.9%) reported a positive test result. After recruitment, 18 participants (2.7%) had SARS‐CoV‐2 antibodies in at least one immunoassay. Overall, 21 participants (3.2%) had any evidence of a past or current SARS‐CoV‐2 infection. Among them, 13 (61.9%) were not aware of direct COVID‐19 exposure and 9 (42.9%) did not report any clinical symptoms. COVID‐19 exposure at home (adjusted OR (aOR) with 95% CI: 47.82 (5.49, 416.62)) was associated with SARS‐CoV‐2 seroprevalence. We observed no evidence for an association between seroprevalence and exposure at work (aOR 0.48 (0.13, 1.70)) or with COVID‐19 risk area according to the working place (aOR for intermediate‐risk vs. high‐risk: 1.97 (0.42, 9.22), aOR for low‐risk versus high‐risk: 2.10 (0.40, 11.06); p = .655). Reported compliance of HCWs to wear PPE differed (p < .001) between working in high‐risk (98.3%) and in intermediate‐risk areas (69.8%). In conclusion, compared to administration staff, we observed no additional risk to acquire SARS‐CoV‐2 infections by patient care, probably due to high compliance to wear PPE.
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Affiliation(s)
- Christina Bahrs
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - Aurelia Kimmig
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Sebastian Weis
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.,Department of Anesthesiology and Intensive Care Therapy, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Juliane Ankert
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Jens Maschmann
- Medical Executive Board, Jena University Hospital, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology and Infectious Diseases), Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Andrea Steiner
- Department for Occupational Health, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Michael Bauer
- Department of Anesthesiology and Intensive Care Therapy, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Wilhelm Behringer
- Department of Emergency Medicine, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Michael Baier
- Institute of Medical Microbiology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Miriam Kesselmeier
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Cora Richert
- Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Florian Zepf
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Martin Walter
- Department of Psychiatry and Psychotherapy, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Michael Kiehntopf
- Department of Clinical Chemistry and Laboratory Medicine, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Bettina Löffler
- Institute of Medical Microbiology, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany
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