[InspeCKD - Analysis of the use of diagnostics in patients at high risk for chronic kidney disease in German general practitioner (GP) practices]

BACKGROUND

Despite the high prevalence of chronic kidney disease (CKD) in Germany, only a small proportion of patients are currently diagnosed with CKD. Patients with hypertension, diabetes mellitus, and/or cardiovascular disease have a significantly increased risk of developing CKD and rapid disease progression and should therefore be screened and monitored in accordance with the guidelines.

OBJECTIVES

The aim of this retrospective, cross-sectional study was to gain insights into appropriate diagnosis of patients at risk for CKD in German general practitioner practices.

METHOD

For the analysis of the use of CKD-relevant diagnostics, electronic patient records from German general practitioner practices were analyzed. Adults with hypertension and/or diabetes mellitus and/or cardiovascular disease with a documented observation period of at least one year were included in the study.

RESULTS

Data from a total of 448,837 patients from 1244 general practitioner practices were analyzed. 75.8% of patients had hypertension, 35.1% had cardiovascular disease, and 32.4% had diabetes mellitus. During a mean observation period of 1.7 years, serum creatinine was assessed at least once in 45.5% of patients. A urine dipstick test for albuminuria was performed in 7.9% of patients and in 0.4% of patients, urine albumin-to-creatine ratio (UACR) was measured. Laboratory diagnostics were initiated a little more frequently in high-risk patients compared to the overall cohort.

CONCLUSIONS

The study highlights that despite known risk factors, guideline compliant CKD screening is rarely performed in German general practitioner practices, which implicates the need to increase the awareness of early diagnosis of CKD in patients at risk.

The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007

An outbreak of food poisoning (emetic syndrome) occurred in three kindergartens (A, B and C) in Berlin, Germany, on 3 December 2007 after an excursion during which food was served. We conducted a retrospective cohort study among the kindergarten children and personnel who participated in the trip. The overall attack rate among the 155 participants was 30%. It was 31% among the 137 children (aged two to six years) and 17% among adults (n=18). The consumption of rice pudding was significantly associated with disease. Among those who ate rice pudding, the attack rate was 36%, compared with 0% for non-eaters (relative risk: infinite, p<0.001, aetiological fraction: 100%), but differed significantly between kindergartens A (43%), B (61%) and C (3%), probably because groups were served from different pots. Bacillus cereus sensu stricto was identified from one vomit sample. The clinical and epidemiological characteristics suggest that B. cereus emetic toxin (cereulide) was the causative agent, although it could not be proven in the single vomit isolate. Inadequate food handling most probably led to the outbreak. Single-portion ready-to-eat rice pudding was recommended for subsequent excursions and no further cases of food poisoning occurred.

The proof of the pudding is in the eating: an outbreak of emetic syndrome after a kindergarten excursion, Berlin, Germany, December 2007

An outbreak of food poisoning (emetic syndrome) occurred in three kindergartens (A, B and C) in Berlin, Germany, on 3 December 2007 after an excursion during which food was served. We conducted a retrospective cohort study among the kindergarten children and personnel who participated in the trip. The overall attack rate among the 155 participants was 30%. It was 31% among the 137 children (aged two to six years) and 17% among adults (n=18). The consumption of rice pudding was significantly associated with disease. Among those who ate rice pudding, the attack rate was 36%, compared with 0% for non-eaters (relative risk: infinite, p<0.001, aetiological fraction: 100%), but differed significantly between kindergartens A (43%), B (61%) and C (3%), probably because groups were served from different pots. Bacillus cereus sensu stricto was identified from one vomit sample. The clinical and epidemiological characteristics suggest that B. cereus emetic toxin (cereulide) was the causative agent, although it could not be proven in the single vomit isolate. Inadequate food handling most probably led to the outbreak. Single-portion ready-to-eat rice pudding was recommended for subsequent excursions and no further cases of food poisoning occurred.

[Teleconferences for national surveillance of infectious diseases and public health events in Germany. Evaluation after three quarters in 2009]

Public health threats are increasingly triggered by events which span across international, national and state level jurisdictions. Innovative surveillance methods are needed to ensure adequate and timely response to such threats. In January 2009 the Department of Infectious Disease Epidemiology at the Robert Koch Institute (RKI) established a system of weekly telephone conferences with all competent authorities of the German federal states to identify, discuss and respond to infectious disease events in real-time. A regular and structured platform was developed for use between participants from state level public health authorities, the military and the RKI. During the first three quarters, 46 infectious diseases were covered, including mandatory reports of measles and meningococcal meningitis and outbreaks of cowpox, which does not have to be notified in Germany. Results of a targeted evaluation and a consistently high attendance rate both indicate that the teleconference has met additional needs for supplemental information exchange among participants. The telephone conference has proven to be a useful resource for rapid and direct communication, coordination and evaluation of signals for public health events in Germany.

What is the impact of change in diagnostic test method on surveillance data trends in Chlamydia trachomatis infection?

OBJECTIVE

To describe the impact of change from culture to more sensitive nucleic acid amplification testing (NAAT) tests on the detection of Chlamydia trachomatis in a genitourinary medicine (GUM) clinic population.

METHODS

Data were collected between January 1992 and December 2003 on results of C trachomatis tests on male and female attenders at the Lothian GUM clinic (n = 81 590). Routine diagnosis switched from culture to NAAT methods in September 1998. Association of test result with age, sex, year of test, and test type was analysed using logistic regression.

RESULTS

6.1% (95% CI: 5.7% to 6.5%) of women and 7.1% of men (95% CI: 6.7% to 7.5%) tested positive with culture and 9.9% of women (95% CI: 9.4% to 10.3%) and 11.1% of men (95% CI: 10.7% to 11.5%) tested positive with NAATs. This corresponds to a 56% increase for men (95% CI: 47% to 66%) and 62% for women (95% CI: 50% to 67%). Logistic regression showed that a positive test result was strongly associated with test type with or without adjustment for year of test, sex, and young age.

CONCLUSIONS

The significant increase in chlamydial infections detected following a change from culture to NAATs has important implications for interpretation of trends ascertained from surveillance data. Not all of this can be a direct effect of enhanced sensitivity and there may be indirect effects that improve ascertainment of existing infections. As more laboratories switch to NAATs similar patterns of stepwise increases in positive results are expected and trend analysis based on such surveillance data might thus show an artefactual rise in chlamydia infection rates. Accumulated surveillance data should therefore include timing of introduction of NAAT, so as to take account of under-ascertainment by previous methods.

[Risk factors for abundance of shiga toxin producing Escherichia coli in sewage water]

Shiga toxin producing Escherichia coli (STEC) in sewage influent into surface water are a potential source of human infections with STEC. Eight sewage treatment plants in Bavaria, Germany, were sampled at regular intervals from 2003 to 2004 in order to estimate STEC load and quantify risk factors. 95 of 378 samples (25 %) were tested positive for stx1and/or stx2 with PCR after enrichment culture. STEC elimination after treatment was 44 %. The following risk factors were analysed with logistic regression: location of sewage plant (rural vs. urban), treatment plant technology (two stage vs. three stage treatment) and sampling location (sewage input vs. sewage output). Rural plants had odds-ratios of 1,7 (95 % CI 1.03 - 2.69; p = 0.038) for a positive stx1 and/ or stx2 PCR result, sampling at sewage input of 2.1 (95 %CI 1.28 - 3.36; p = 0.003) and three stage plants of 1.51 (95 % CI 0.94 - 2.44; p = 0.087, not significant). Sampling after rain and after dry spells had no impact on STEC abundance (univariate Chi-square test = 0.01; df1; p = 0.920). Rural sewage plants had higher odds of STEC content. The influence of the sewage plant technology on the STEC load requires further clarification.

HvrBase: compilation of mtDNA control region sequences from primates

HvrBase is a compilation of human and ape mtDNA control region sequences. Sequences and related information on individuals, such as from where the sequences were obtained, is stored in three ASCII files as described previously. Moreover, the collection is also available as Mac/PC database application with a graphical user interface. It can be accessed through the WWW at URL http://www.eva.mpg.de/hvrbase. The current collection comprises 5846 human sequences from hypervariable region I (HVRI) and 2302 human sequences from hypervariable region II (HVRII). From apes, 295 HVRI sequences and 13 HVRII sequences are available.