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Negrin VL, La Colla NS, Schwab F, Domini C, Botté SE. Evaluating metal phytorremediation and biondication potential of Spartina alterniflora in a South American estuary. Mar Environ Res 2024; 193:106292. [PMID: 38064897 DOI: 10.1016/j.marenvres.2023.106292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 11/29/2023] [Indexed: 01/02/2024]
Abstract
Soil metal pollution has been widely studied in salt marshes but mainly regarding non-essential metals. The aim of this study was to assess the levels of two essential metals (Fe and Mn) and one non-essential one (Cd) in Spartina alterniflora salt marshes in a South American estuary in order to evaluate the potential of this species as a phytoremediator and/or bioindicator of Fe, Mn and Cd and to analyze the distribution of these metals according to the edaphic conditions. The metals present in the soils varied among the three sites studied according to the content of organic matter and fine sediments. In comparison with other Spartina-dominated salt marshes worldwide, in this study Fe and Mn were approximately in the same range, whereas Cd levels were always lower, with a high number of samples below the method detection limit (MDL). All metals were highly correlated with each other suggesting an association of Cd with Mn and Fe oxides/hydroxides or sulfides and/or a common anthropogenic source. Metals in plant tissues also varied from site to site and between the aboveground and belowground tissues. Compared to the metal levels in Spartina tissues in other salt marshes, our levels of Fe and Mn were in the same range, whereas the Cd levels were lower, among most samples, especially those from aboveground tissues that were below the MDL. The bioconcentration factor (metal in belowground tissues/metal in soil) was always lower than one for Fe and Mn meaning that there is no accumulation of these metals in belowground tissues, but this factor for Cd was sometimes higher than one, even as high as 3.45, implying that S. alterniflora can accumulate this metal in its tissues, pointing to a potential role of this species in Cd phytoremediation. Translocation factors (metal in aboveground tissues/metal in belowground tissues) were always lower than one for Fe and could not be calculated for Cd but were usually higher than one for Mn, showing the role of this element in photosynthetic tissues and a possible function of this species for phytoextraction of Mn. In most samples the Fe levels in plant tissues were higher than the permissible levels reported in the literature, suggesting a potential role of S. alterniflora in Fe phytoremediation. No correlation was observed between metal concentrations in soils and aboveground tissues; therefore, S.alterniflora is not a good bioindicator for the metals studied. Although our results are not conclusive, they reinforce the importance of local edaphic conditions on the behavior of metals in salt marshes and shed light on the potential role of S. alterniflora in the phytoremediation of highly toxic metals such as Cd or poorly studied metals such as Fe and Mn.
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Affiliation(s)
- V L Negrin
- Instituto Argentino de Oceanografía (IADO-CONICET/UNS), Camino La Carrindanga Km 7.5, (8000) Bahía Blanca, Buenos Aires, Argentina; Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, San Juan 670, (8000) Bahía Blanca, Buenos Aires, Argentina.
| | - N S La Colla
- Instituto Argentino de Oceanografía (IADO-CONICET/UNS), Camino La Carrindanga Km 7.5, (8000) Bahía Blanca, Buenos Aires, Argentina; Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, San Juan 670, (8000) Bahía Blanca, Buenos Aires, Argentina
| | - F Schwab
- Instituto Argentino de Oceanografía (IADO-CONICET/UNS), Camino La Carrindanga Km 7.5, (8000) Bahía Blanca, Buenos Aires, Argentina
| | - C Domini
- INQUISUR, Departamento de Química, Universidad Nacional del Sur (UNS)-CONICET, Av. Alem 1253, 8000, Bahía Blanca, Argentina
| | - S E Botté
- Instituto Argentino de Oceanografía (IADO-CONICET/UNS), Camino La Carrindanga Km 7.5, (8000) Bahía Blanca, Buenos Aires, Argentina; Departamento de Biología, Bioquímica y Farmacia, Universidad Nacional del Sur, San Juan 670, (8000) Bahía Blanca, Buenos Aires, Argentina
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Weikert B, Kramer TS, Schwab F, Graf-Allgeier C, Clausmeyer JO, Wolke SI, Gastmeier P, Geffers C. Implementation of a new surveillance system for dialysis-associated infection events in outpatient dialysis facilities in Germany. J Hosp Infect 2023; 142:67-73. [PMID: 37734681 DOI: 10.1016/j.jhin.2023.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Patients receiving maintenance haemodialysis are at risk of catheter-related infections. Up to now, there has been no standardized surveillance tool in Germany to evaluate infection events in haemodialysis outpatients. As such, this study aimed to implement an online-based surveillance tool in outpatient dialysis facilities, and to report the first national surveillance data for haemodialysis patients in Germany from October 2019 until September 2021. METHODS Outpatient dialysis facilities reported three types of dialysis-associated infection event (DAIE): bloodstream infections, intravenous antimicrobial starts, and local access site infections. Denominator data were provided by the number of haemodialysis treatments at each facility per month. DAIE rates stratified by vascular access type were calculated. RESULTS In total, 43 outpatient dialysis facilities reported 723 DAIEs, including 63 bloodstream infections, 439 intravenous antimicrobial starts, and 221 local access site infections. The overall incidence of DAIEs was 0.51 per 1000 dialysis treatments (723/1,413,457) during the surveillance period. The overall incidence of DAIEs was 0.13 per 1000 dialysis treatments among patients with arteriovenous fistulas (AVFs; 126/990,392), 0.41 per 1000 dialysis treatments among patients with arteriovenous grafts (41/99,499), and 1.68 per 1000 dialysis treatments among patients with central venous catheters (CVCs; 535/318,757). The rate ratio of DAIEs between CVC and AVF rates was 13.2 (95% confidence interval 10.9-16.0; P<0.001). DISCUSSION These 2-year infection data represent the first standardized data of outpatient dialysis facilities in Germany. Rates of infection were highest among patients with CVCs compared with other vascular access types. This online-based surveillance tool may be helpful to identify effective targets for infection prevention measures in haemodialysis patients.
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Affiliation(s)
- B Weikert
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany.
| | - T S Kramer
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany
| | - C Graf-Allgeier
- Patienten Heimversorgung Gemeinnützige Stiftung, Bad Homburg, Germany
| | - J-O Clausmeyer
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany
| | - S I Wolke
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany
| | - C Geffers
- Institute of Hygiene and Environmental Medicine, Charité - University Hospital Berlin, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital Berlin, Berlin, Germany
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Fucini GB, Geffers C, Schwab F, Behnke M, Sunder W, Moellmann J, Gastmeier P. Sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection: a retrospective analysis of 552 ICUs. J Hosp Infect 2023; 139:99-105. [PMID: 37308060 DOI: 10.1016/j.jhin.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sinks in hospitals are a possible reservoir for healthcare-related pathogens. They have been identified as a source of nosocomial outbreaks in intensive care units (ICU); however, their role in non-outbreak settings remains unclear. AIM To investigate whether sinks in ICU patient rooms are associated with a higher incidence of hospital-acquired infection (HAI). METHODS This analysis used surveillance data from the ICU component of the German nosocomial infection surveillance system (KISS) from 2017 to 2020. Between September and October 2021, all participating ICUs were surveyed about the presence of sinks in their patient rooms. The ICUs were then divided into two groups: the no-sink group (NSG) and the sink group (SG). Primary and secondary outcomes were total HAIs and HAIs associated with Pseudomonas aeruginosa (HAI-PA). FINDINGS In total, 552 ICUs (NSG N=80, SG N=472) provided data about sinks, total HAIs and HAI-PA. The incidence density per 1000 patient-days of total HAIs was higher in ICUs in the SG (3.97 vs 3.2). The incidence density of HAI-PA was also higher in the SG (0.43 vs 0.34). The risk of HAIs associated with all pathogens [incidence rate ratio (IRR)=1.24, 95% confidence interval (CI) 1.03-1.50] and the risk of lower respiratory tract infections associated with P. aeruginosa (IRR=1.44, 95% CI 1.10-1.90) were higher in ICUs with sinks in patient rooms. After adjusting for confounders, sinks were found to be an independent risk factor for HAI (adjusted IRR 1.21, 95% CI 1.01-1.45). CONCLUSIONS Sinks in patient rooms are associated with a higher number of HAIs per patient-day in the ICU. This should be considered when planning new ICUs or renovating existing ones.
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Affiliation(s)
- G-B Fucini
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - C Geffers
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - M Behnke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - W Sunder
- Institute of Construction Design, Industrial and Health Care Building, Technische Universität Carolo Wilhelmina zu Braunschweig, Braunschweig, Germany
| | - J Moellmann
- Institute of Construction Design, Industrial and Health Care Building, Technische Universität Carolo Wilhelmina zu Braunschweig, Braunschweig, Germany
| | - P Gastmeier
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
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Mrziglod L, Saydan S, Schwab F, Zohlnhöfer-Momm D, Gastmeier P, Hansen S. Reducing urinary catheter use in geriatric patients - results of a single-center champion-led intervention. BMC Infect Dis 2023; 23:94. [PMID: 36788487 PMCID: PMC9930210 DOI: 10.1186/s12879-023-08064-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Indwelling urinary tract catheters (UTC) are a well-known risk factor for urinary tract infections (UTI). Because geriatric patients are at high risk of infection, an intervention with a focus on appropriate and minimal UTC use was introduced in 4 acute care geriatric wards. METHODS Between 11/2018 and 1/2020, unit-based data on UTC use and nosocomial UTI was collected in accordance with the methods of the German national surveillance system KISS. From 6/2019 to 1/2020, a champion-led intervention was implemented which focused on: (i) feedback of surveillance data, (ii) education and training in aseptic UTC insertion and maintenance, (iii) HCW's daily assessment of UTC necessity based on a checklist and (iv) timely removal of unnecessary UTCs. UTC use, incidence, and incidence densities for catheter-associated UTI (CAUTI) were calculated before and during the intervention. In addition, we analyzed adherence to a scheduled daily assessment of UTC necessity. Rate ratios (RR) with 95% confidence intervals (95%CI) were calculated. Differences based on the quality of checklist completion were evaluated using the Kruskal Wallis test. RESULTS We analyzed the data of 3,564 patients with a total 53,954 patient days, 9,208 UTC days, and 61 CAUTI. Surveillance data showed a significant decrease in the pooled UTC utilization rate from 19.1/100 patient days to 15.2/100 patient days (RR = 0.80, 95%CI 0.77-0.83, p < 0.001). CAUTI per 100 patients dropped from 2.07 to 1.40 (RR = 0.68, 95%CI 0.41-1.12, p = 0.1279). Overall, 373 patients received a UTC during the intervention. Of those patients 351 patients had an UTC ≥ 2 days. The analysis of these patients showed that 186 patients (53%) received a checklist as part of their chart for daily evaluation of UTC necessity. 43 (23.1%) of the completed checklists were of good quality; 143 (76.9%) were of poor quality. Patients in the group whose checklists were of good quality had fewer UTC days (median 7 UTC days IQR (3-11)) than patients whose checklists were of poor quality (11 UTC days IQR (6-16), p = 0.001). CONCLUSION We conclude that a champion-led, surveillance-based intervention reduces the use of UTC among geriatric patients. Further research is needed to determine to what extent the use of checklists in daily medical UTC assessment affects the prevention of CAUTI. The fact that patients whose checklists were completed well had fewer UTC days should encourage a conscientious and thorough daily review of the need for UTC.
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Affiliation(s)
- L Mrziglod
- grid.6363.00000 0001 2218 4662Department of Infectious Diseases and Respiratory Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,Department of Internal Medicine - Geriatrics, Vivantes Wenckebach Klinikum, Berlin, Germany
| | - S Saydan
- grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - D Zohlnhöfer-Momm
- Department of Internal Medicine - Geriatrics, Vivantes Wenckebach Klinikum, Berlin, Germany
| | - P Gastmeier
- grid.6363.00000 0001 2218 4662Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany ,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany
| | - S Hansen
- Institute of Hygiene and Environmental Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany. .,German National Reference Center for Surveillance of Nosocomial Infections, Berlin, Germany.
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Graefe F, Schwab F, Tunn R. Double-layered anterior colporrhaphy (DAC)-video and mid-term follow-up of 60 patients. Int Urogynecol J 2023; 34:297-300. [PMID: 35576014 PMCID: PMC9109656 DOI: 10.1007/s00192-022-05216-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 04/25/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Anterior colporrhaphy (AC) exhibits high recurrence rates, and this issue is not appropriately addressed by alloplastic material, which often necessitates reoperation. Aiming to improve the anatomical cure rate, we implemented double-layered anterior colporrhaphy (DAC). With a retrospective investigation, precise description and video of the surgical technique, we want to contribute to the development of native tissue anterior repair. METHODS Women treated by DAC and vaginal hysterectomy were included. Primary outcome was anatomic cure defined as prolapse < stage 2. Secondary outcomes were complication rate, resolution of postvoid residual urine, reoperation for prolapse and patient satisfaction. Follow-up encompassed a clinical gynecologic examination, the German Pelvic Floor Questionnaire and a response scale for postoperative quality of life (QoL). The key difference between DAC and AC is the continuous suture followed by the traditional interrupted sutures. RESULTS One hundred one patients were eligible, and 60 patients attended follow-up. Cure was achieved in 49 cases (81.7%) of cystocele with a median follow-up of 19.3 months. Fifty-five patients (91.7%) indicated an improvement in QoL. CONCLUSIONS We observed high anatomic cure rate and satisfaction after DAC. With description and video of the technique, it is reproducible and comparable to other methods. Randomized controlled trials should follow.
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Affiliation(s)
- F Graefe
- German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | - F Schwab
- Department of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - R Tunn
- German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany
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Zimmermann M, Zenk M, Breuer K, Schwab F, Ströhle S, Pemsel F, Keßler P, Greber J, Flentje M, Polat B. PO-1231 Deep inspiration breath-hold in breast cancer radiotherapy using a laser beam based gating system. Radiother Oncol 2022. [DOI: 10.1016/s0167-8140(22)03195-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Liu Y, Dash A, Krez A, Kim HJ, Cunningham M, Schwab F, Hughes A, Carlson B, Samuel A, Marty E, Moore H, McMahon DJ, Carrino JA, Bockman RS, Stein EM. Low volumetric bone density is a risk factor for early complications after spine fusion surgery. Osteoporos Int 2020; 31:647-654. [PMID: 31919536 DOI: 10.1007/s00198-019-05245-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/20/2019] [Indexed: 12/17/2022]
Abstract
UNLABELLED This study aims to investigate lumbar spine (LS) volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. INTRODUCTION Lumbar spine (LS) fusion surgery is increasingly performed worldwide. Complications after fusion result in significant morbidity and healthcare costs. Multiple factors, including osteoporosis, have been suggested to contribute to risk of complications and re-operation. However, most studies have used DXA, which is subject to artifact in patients with spine pathology, and none have investigated the relationship between BMD and timing of post-operative complications. This study aims to investigate LS volumetric bone density (vBMD) as a risk factor for complications (pseudoarthrosis, instrumentation failure, adjacent fractures), re-operation, and time to complication after fusion. METHODS We evaluated a cohort of 359 patients who had initial LS fusion surgery at our institution, had pre-operative LS CTs and post-operative imaging available for review. Demographic factors, smoking status, vBMD, and details of surgical procedure were related to likelihood and timing of post-operative complications. RESULTS Mean age was 60 ± 14 years, vBMD 122 ± 37 g/cm3. Median follow-up was 11 months. Skeletal complications occurred in 47 patients (13%); 34 patients (10%) required re-operation. Low vBMD (directly measured and estimated using HU) and smoking were associated with increased risk of skeletal complications. Each increase in baseline vBMD of 10 g/cm3 decreased the complication hazard and increased the complication-free duration in time-to-event analysis (hazard ratio 0.91, 95% CI 0.83-0.98, p < 0.02). CONCLUSIONS Low vBMD was a significant risk factor for early post-operative complications in patients undergoing LS fusion. Prospective studies are needed to confirm these findings and to elucidate the optimal timing for follow-up and strategies for prevention of post-operative complications in this population.
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Affiliation(s)
- Y Liu
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Department of Medicine, Lahey Clinic, Burlington, MA, USA
| | - A Dash
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - A Krez
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - H J Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - M Cunningham
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - F Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - A Hughes
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - B Carlson
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedics, University of Kansas Medical Center, Kansas City, KS, USA
| | - A Samuel
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - E Marty
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
| | - H Moore
- Weill Cornell Medical College, New York, NY, USA
| | - D J McMahon
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - J A Carrino
- Department of Radiology, Hospital for Special Surgery, New York, NY, USA
| | - R S Bockman
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
| | - E M Stein
- Division of Endocrinology and Metabolic Bone Disease, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
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Denkel LA, Maechler F, Schwab F, Kola A, Weber A, Gastmeier P, Pfäfflin F, Weber S, Werner G, Pfeifer Y, Pietsch M, Leistner R. Infections caused by extended-spectrum β-lactamase-producing Enterobacterales after rectal colonization with ESBL-producing Escherichia coli or Klebsiella pneumoniae. Clin Microbiol Infect 2019; 26:1046-1051. [PMID: 31809805 DOI: 10.1016/j.cmi.2019.11.025] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/24/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Infections as a result of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) are considered infections with a high public health burden. In this study, we aimed to identify incidences of and risk factors for healthcare-associated infections (HAIs) after rectal colonization with ESBL-producing Escherichia coli (ESBL-EC) or Klebsiella pneumoniae (ESBL-KP). METHODS This prospective cohort study was performed in 2014 and 2015. Patients colonized with ESBL-EC or ESBL-KP were monitored for subsequent HAI with ESBL-E and other pathogens. In the case of an ESBL-E infection, rectal and clinical isolates were compared using pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing (WGS) for ESBL-KP isolates. Proportional hazard models were applied to identify risk factors for HAIs, and to analyse competing risks. RESULTS Among all patients admitted to the hospital during the study period, 13.6% were rectally screened for third-generation cephalosporin-resistant Enterobacterales (3GCREB). A total of 2386 rectal carriers of ESBL-EC and 585 of ESBL-KP were included in the study. Incidence density (ID) for HAI with ESBL-E was 2.74 per 1000 patient days at risk (95% confidence interval (CI) 2.16-3.43) among carriers of ESBL-EC, while it was 4.44 per 1000 patient days at risk (95% CI 3.17-6.04) among carriers of ESBL-KP. In contrast, ID for HAI with other pathogens was 4.36 per 1000 patient days at risk (95% CI 3.62-5.21) among carriers of ESBL-EC, and 5.00 per 1000 patient days at risk (95% CI 3.64-6.69) among carriers of ESBL-KP. Cox proportional hazard regression analyses identified colonization with ESBL-KP (HR = 1.58, 95% CI 1.068-2.325) compared with ESBL-EC as independent risk factor for HAI with ESBL-E. The results were consistent over all competing risk analyses. CONCLUSIONS Clinicians should be aware of the increased risk of ESBL-E infections among patients colonized with ESBL-KP compared with ESBL-EC that might be caused by underlying diseases, higher pathogenicity of ESBL-KP and other factors.
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Affiliation(s)
- L A Denkel
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Maechler
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Kola
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - A Weber
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - F Pfäfflin
- Department of Infectious Diseases and Respiratory Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - S Weber
- Institute of Medical Biometry and Statistics (IMBI), Faculty of Medicine and Medical Centre University of Freiburg, Freiburg, Germany
| | - G Werner
- Unit of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - Y Pfeifer
- Unit of Nosocomial Pathogens and Antibiotic Resistances, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - M Pietsch
- Unit of Enteropathogenic Bacteria and Legionella, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, Wernigerode, Germany
| | - R Leistner
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany; National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany.
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9
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Schwab F, Thissen H, Wolff KD, Götz C, Boskov M, Cameron N, Nagel K, van Griensven M, Kolk A, Bissinger O. Bone regeneration and angiogenesis after reconstruction of the mandible by using bioactive biodegradable scaffolds. Int J Oral Maxillofac Surg 2019. [DOI: 10.1016/j.ijom.2019.03.456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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10
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Pepke W, Almansour H, Lafage R, Diebo BG, Wiedenhöfer B, Schwab F, Lafage V, Akbar M. Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients. BMC Surg 2019; 19:7. [PMID: 30646880 PMCID: PMC6334400 DOI: 10.1186/s12893-019-0471-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Accepted: 01/04/2019] [Indexed: 01/05/2023] Open
Abstract
Background Several studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS). Methods Baseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment. Results Stratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA. Conclusions In surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment.
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Affiliation(s)
- W Pepke
- Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr.200a, 69118, Heidelberg, Germany
| | - H Almansour
- Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr.200a, 69118, Heidelberg, Germany
| | - R Lafage
- Hospital for Special Surgery, New York, NY, USA
| | - B G Diebo
- Department of Orthopaedic Surgery, State University of New York, Downstate Medical Center, Brooklyn, NY, USA
| | - B Wiedenhöfer
- Spine Surgery, ATOS Clinic Heidelberg, Bismarckstr. 9-15, 69115, Heidelberg, Germany
| | - F Schwab
- Hospital for Special Surgery, New York, NY, USA
| | - V Lafage
- Hospital for Special Surgery, New York, NY, USA
| | - M Akbar
- Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, Schlierbacher Landstr.200a, 69118, Heidelberg, Germany.
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11
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Marschke J, Reisenauer C, Mikkola T, Schwab F, Tunn R, Hübner M. Intraoperative variations of the retropubic TVT-procedure and their immediate and mid-term effects on patients' outcome. A prospective randomized controlled multicenter trial. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- J Marschke
- Deutsches Beckenbodenzentrum, St. Hedwig-Krankenhaus, Urogynäkologie, Berlin, Deutschland
| | - C Reisenauer
- Universitätsklinikum Tübingen, Department für Frauengesundheit, Tübingen, Deutschland
| | - T Mikkola
- Universitätsklinikum Helsinki, Gynäkologie und Geburtshilfe, Helsinki, Finnland
| | - F Schwab
- Charité – Universitätsmedizin Berlin, Institut für Hygiene und Umweltmedizin, Berlin, Deutschland
| | - R Tunn
- Deutsches Beckenbodenzentrum, St. Hedwig-Krankenhaus, Urogynäkologie, Berlin, Deutschland
| | - M Hübner
- Lindenhofgruppe, Frauenzentrum Bern, Bern, Schweiz
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12
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Hansen S, Schwab F, Gastmeier P, Zingg W. Association of national and hospital factors to hospitals' alcohol-based handrub consumption in Europe: results of the European PROHIBIT study. Clin Microbiol Infect 2017; 24:778.e1-778.e6. [PMID: 29074159 DOI: 10.1016/j.cmi.2017.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Hand hygiene is considered the most effective way to reduce the transmission of (multidrug-resistant) organisms and to prevent healthcare-associated infections. Hand rubbing with alcohol-based handrub (AHR) has become the reference standard for hand hygiene. Data on AHR consumption are easy to obtain and can serve as an approximation for hand hygiene compliance. As described earlier, AHR consumption varies among European hospitals. In the current study the role of various hospital and country indicators for AHR consumption is analysed. METHODS As part of the European Prevention of Hospital Infections by Intervention and Training (PROHIBIT) project hospital-based data on infection prevention and control (IPC) structure and organization and hospital-wide AHR consumption were obtained from acute care hospitals. National indicators such as income, public health expenditure, national hand hygiene campaigns, IPC training and the six Hofstede dimensions were identified. Univariable and multivariable linear regression analyses using generalized linear models were performed to estimate the association between AHR consumption and indicators at both hospital and country levels. RESULTS Data from 232 hospitals from 22 European countries were analysed. Multivariate risk factor analysis showed independent associations between AHR consumption and private and university-affiliated hospitals (multiplicative effect, 95% CI: 1.76, 1.21-2.55; and 1.39, 1.17-1.64, respectively), high-income countries (3.61, 2.94-4.43), and countries offering national curricula for the training of IPC nurses (3.77, 2.32-6.13). However, no cultural dimension was independently associated with AHR consumption. CONCLUSION Country indicators such as high-income, national training on IPC, and hospital type and status are positively associated with AHR consumption in Europe.
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Affiliation(s)
- S Hansen
- Charité-University Medicine Berlin, Institute for Hygiene, Berlin, Germany.
| | - F Schwab
- Charité-University Medicine Berlin, Institute for Hygiene, Berlin, Germany
| | - P Gastmeier
- Charité-University Medicine Berlin, Institute for Hygiene, Berlin, Germany
| | - W Zingg
- University of Geneva Hospitals, Infection Control Programme, Geneva, Switzerland
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13
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Schwertner-Tiepelmann N, Hagedorn-Wiesner A, Erschig C, Beilecke K, Schwab F, Tunn R. Clinical relevance of neurological evaluation in patients suffering urinary retention in the absence of subvesical obstruction. Arch Gynecol Obstet 2017; 296:1017-1025. [PMID: 28900705 DOI: 10.1007/s00404-017-4519-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 09/04/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Clinical relevance of neurological evaluation in patients suffered urinary retention in the absence of subvesical obstruction. Determining whether (1) women complaining residual bladder volume without prolapse and obstruction always suffer pudendal nerve damage; (2) neurogenic damage can be linked to patients history/clinical examination; (3) therapy alters regarding to neurological findings; and (4) electromyography (EMG) of musculus sphincter ani externus (MSAE) can be omitted with electronically stimulated pudendal nerve latency (ESPL) as the standard investigation. METHODS Women with urinary retention without ≥stage 2 prolapse or obstruction have neurological investigation including vaginally and anally pudendal terminal nerve latency (PTNL) (>2.4 ms considered abnormal) and EMG seen 7/2005-04/2010. RESULTS (1) 148/180 (82.2%) suffered at least moderate neurogenic damage and (2) severe neurogenic damage occurs with urge odds ratio (OR) = 3.1 or age (OR = 3.2). Correlations: spasticity with therapy changes (OR = 11.1), latencies. (a) Anally: (i) right and peripheral neuropathy (PNP) (OR = 2.5), chemotherapy (OR = 5.0); (ii) left and PNP (OR = 3.9), chemotherapy (OR = 4.8); (iii) left or right with PNP (OR = 3.9), chemotherapy (OR = 6.8); and (iv) left and right with chemotherapy (OR = 5.0). (b) Vaginally: (i) right with age >60 (OR = 3.2), radical operation (OR = 10.6); (ii) left with diabetes mellitus (OR = 2.5); and (iii) left or right with age (OR = 3.3), radical operation (OR = 8.7). (3) 19.6% therapy changes (36 patients). (4) Neither EMG nor ESPL can be replaced one by another (p = 0.12 anal, p = 0.05 vaginal). CONCLUSION Red flags are neurogenic damage, age >60, chemotherapy, PNP, radical operation or diabetes. In unclear situations, EMG and ESPL need to be performed to gain relevant information.
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Affiliation(s)
- N Schwertner-Tiepelmann
- Department of Urogynecology, German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany.
| | | | - C Erschig
- Department of Surgery, Auguste-Victoria-Hospital, Berlin, Germany
| | - K Beilecke
- Department of Urogynecology, German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité, Berlin, Germany
| | - R Tunn
- Department of Urogynecology, German Pelvic Floor Center, St. Hedwig Hospital, Große Hamburger Straße 5-11, 10115, Berlin, Germany
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14
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Maechler F, Geffers C, Schwab F, Peña Diaz LA, Behnke M, Gastmeier P. [Development of antimicrobial resistance in Germany : What is the current situation?]. Med Klin Intensivmed Notfmed 2017; 112:186-191. [PMID: 28378152 DOI: 10.1007/s00063-017-0272-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/13/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The frequency of multidrug-resistant organisms (MDRO) is increasing in Germany and worldwide. OBJECTIVES Presentation of MDRO resistance rates and prevalence in Germany MATERIALS AND METHODS: Results from the Antibiotic Resistance Surveillance (ARS) and Hospital Infection Surveillance Systems (Krankenhausinfektions-Surveillance-Systems, KISS) and from recent prevalence surveys are presented. RESULTS MRSA-resistance rates and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) have remained at a stable level over the last few years. In contrast, vancomycin-resistant enterococci (VRE) and multidrug-resistant gramnegative (MRGN) bacteria have increased considerably. VRE prevalence has more than tripled in the past 5 years, and Escherichia coli resistant to third-generation cephalosporins, acylureidopenicillins, and fluoroquinolones increased by 43% in 2015 compared with the previous year. CONCLUSIONS New policies to control MDRO should focus on VRE and the heterogeneous group of MRGN bacteria. In the case of the latter, the different bacterial species' characteristics should be taken into consideration.
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Affiliation(s)
- F Maechler
- Institut für Hygiene und Umweltmedizin, Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland.
| | - C Geffers
- Institut für Hygiene und Umweltmedizin, Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland
| | - F Schwab
- Institut für Hygiene und Umweltmedizin, Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland
| | - L-A Peña Diaz
- Institut für Hygiene und Umweltmedizin, Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland
| | - M Behnke
- Institut für Hygiene und Umweltmedizin, Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland
| | - P Gastmeier
- Institut für Hygiene und Umweltmedizin, Nationales Referenzzentrum für die Surveillance von Nosokomialen Infektionen, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Deutschland
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15
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Arbeiter F, Abou-Sena A, Averhals J, Böttcher T, Chen Y, Dolensky B, Fischer U, Heinzel A, Heinzel V, Heupel T, Jacquet P, Klein C, Klix A, Kondo K, Konrad J, Lindau R, Möslang A, Muche A, Piecha H, Rolli R, Schlindwein G, Schubert P, Schwab F, Zinn K. Design description and validation results for the IFMIF High Flux Test Module as outcome of the EVEDA phase. Nuclear Materials and Energy 2016. [DOI: 10.1016/j.nme.2016.04.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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16
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Stiller A, Schröder C, Gropmann A, Schwab F, Behnke M, Geffers C, Sunder W, Holzhausen J, Gastmeier P. ICU ward design and nosocomial infection rates: a cross-sectional study in Germany. J Hosp Infect 2016; 95:71-75. [PMID: 27884473 DOI: 10.1016/j.jhin.2016.10.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 10/12/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is increasing interest in the effects of hospital and ward design on multi-faceted infection control. Definitive evidence is rare and the state of knowledge about current ward design is lacking. OBJECTIVE To collect data on the current status of ward design for intensive care units (ICUs) and to analyse associations between particular design factors and nosocomial infection rates. METHODS In 2015, operational infrastructure data were collected via an online questionnaire from ICUs participating voluntarily in the German nosocomial infection surveillance system (KISS). A multi-variate analysis was subsequently undertaken with nosocomial infection rates from the KISS database from 2014 to 2015. FINDINGS In total, 534 ICUs submitted data about their operational infrastructure. Of these, 27.1% of beds were hosted in single-bed rooms with a median size of 18m2 (interquartile range 15-21m2), and 73.5% of all ICU beds had a hand rub dispenser nearby. The authors were able to match 266 ICUs in the multi-variate analysis. ICUs with openable windows in patient rooms were associated with lower device-associated lower respiratory tract infections [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.58-0.90]. ICUs with >40% two-bed rooms were associated with lower primary bloodstream infection rates (OR 0.66, 95% CI 0.51-0.86). CONCLUSION Only minor associations were found between design factors and ICU infection rates. Most were surrogates for other risk factors.
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Affiliation(s)
- A Stiller
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany.
| | - C Schröder
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany
| | - A Gropmann
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany
| | - M Behnke
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany
| | - C Geffers
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany
| | - W Sunder
- Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina Braunschweig, Germany
| | - J Holzhausen
- Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina Braunschweig, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, German National Reference Centre for the Surveillance of Nosocomial infections, Berlin, Germany
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17
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Leistner R, Bloch A, Gastmeier P, Schwab F. E. coli bacteremia in comparison to K. pneumoniae bacteremia: influence of pathogen species and ESBL production on 7-day mortality. Antimicrob Resist Infect Control 2016; 5:37. [PMID: 27777758 PMCID: PMC5070161 DOI: 10.1186/s13756-016-0138-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/03/2016] [Indexed: 12/04/2022] Open
Abstract
In a previous study, we demonstrated prolonged length of hospital stay in cases of extended-spectrum beta-lactamase (ESBL)-positive K. pneumoniae bacteremia compared to bacteremia cases due to E. coli (ESBL-positive and –negative) and ESBL-negative K. pneumoniae. The overall mortality was significantly higher in bacteremia cases resulting from ESBL-positive pathogens but also in K. pneumoniae cases disregarding ESBL-production. In order to examine whether pathogen species rather than multidrug resistance might affect mortality risk, we reanalyzed our dataset that includes 1.851 cases of bacteremia.
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Affiliation(s)
- R Leistner
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ; National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - A Bloch
- Department of Medical and Financial Controlling, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ; National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany ; National Reference Center for the Surveillance of Nosocomial Infections, Berlin, Germany
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18
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Marschke J, Schwertner-Tiepelmann N, Pax C, Schwab F, Tunn R. Vaginale Prolapshysterektomie mit Scheidengrundfixation und Zystozelenkorrektur – was ist genug und wieviel ist zuviel? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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19
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Schwab F, Redling K, Siebert M, Schötzau A, Schoenenberger CA, Zanetti-Dällenbach R. Ultrasound BI-RADS classification and real-time elastography Tsukuba score assessment of breast lesions: inter-and intraobserver agreement. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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20
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Schwertner-Tiepelmann N, Marschke J, Hagedorn A, Erschig C, Schwab F, Beilecke K, Tunn R. Die klinische Bedeutung von EMG und Pudenduslatenzmessung bei Harnblasenentleerungsstörung ohne subvesikale Obstruktion. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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21
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Hamprecht A, Rohde AM, Behnke M, Feihl S, Gastmeier P, Gebhardt F, Kern WV, Knobloch JK, Mischnik A, Obermann B, Querbach C, Peter S, Schneider C, Schröder W, Schwab F, Tacconelli E, Wiese-Posselt M, Wille T, Willmann M, Seifert H, Zweigner J. Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors. J Antimicrob Chemother 2016; 71:2957-63. [PMID: 27317445 DOI: 10.1093/jac/dkw216] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 05/09/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objectives of this study were to prospectively assess the rectal carriage rate of third-generation cephalosporin-resistant Enterobacteriaceae (3GCREB) in non-ICU patients on hospital admission and to investigate resistance mechanisms and risk factors for carriage. METHODS Adult patients were screened for 3GCREB carriage at six German tertiary care hospitals in 2014 using rectal swabs or stool samples. 3GCREB isolates were characterized by phenotypic and molecular methods. Each patient answered a questionnaire about potential risk factors for colonization with MDR organisms (MDROs). Univariable and multivariable risk factor analyses were performed to identify factors associated with 3GCREB carriage. RESULTS Of 4376 patients, 416 (9.5%) were 3GCREB carriers. Escherichia coli was the predominant species (79.1%). ESBLs of the CTX-M-1 group (67.3%) and the CTX-M-9 group (16.8%) were the most frequent β-lactamases. Five patients (0.11%) were colonized with carbapenemase-producing Enterobacteriaceae. The following risk factors were significantly associated with 3GCREB colonization in the multivariable analysis (P < 0.05): centre; previous MDRO colonization (OR = 2.12); antibiotic use within the previous 6 months (OR = 2.09); travel outside Europe (OR = 2.24); stay in a long-term care facility (OR = 1.33); and treatment of gastroesophageal reflux disease (GERD) (OR = 1.22). CONCLUSIONS To our knowledge, this is the largest admission prevalence study of 3GCREB in Europe. The observed prevalence of 9.5% 3GCREB carriage was higher than previously reported and differed significantly among centres. In addition to previously identified risk factors, the treatment of GERD proved to be an independent risk factor for 3GCREB colonization.
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Affiliation(s)
- A Hamprecht
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - A M Rohde
- German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - M Behnke
- German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - S Feihl
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - P Gastmeier
- German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - F Gebhardt
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - W V Kern
- German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Freiburg, Germany
| | - J K Knobloch
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - A Mischnik
- German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Medicine II, University Medical Center Freiburg, Freiburg, Germany
| | - B Obermann
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, University Hospital Schleswig-Holstein, Lübeck, Germany
| | - C Querbach
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, Technische Universität München, Munich, Germany
| | - S Peter
- German Center for Infection Research (DZIF), Germany Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - C Schneider
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - W Schröder
- German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - F Schwab
- German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - E Tacconelli
- German Center for Infection Research (DZIF), Germany Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - M Wiese-Posselt
- German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - T Wille
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - M Willmann
- German Center for Infection Research (DZIF), Germany Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - H Seifert
- German Center for Infection Research (DZIF), Germany Institute for Medical Microbiology, Immunology and Hygiene, University Hospital Cologne, Cologne, Germany
| | - J Zweigner
- German Center for Infection Research (DZIF), Germany Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
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Decker S, Müller CW, Omar M, Krettek C, Schwab F, Trobisch PD. [Sagittal Balance of the Spine--Clinical Importance and Radiographic Assessment]. Z Orthop Unfall 2015; 154:128-33. [PMID: 26670303 DOI: 10.1055/s-0041-109327] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Sagittal deformities of the spine frequently result in back pain, as patients have to expend much energy in compensation. The sagittal alignment of the spine is defined by its curvatures (lordosis and kyphosis) relative to the position of the pelvis. Diagnostic assessment is based on full spine a. p. and lateral X-rays. The sagittal balance is primarily described by different angles that can be measured, e.g. lumbar lordosis, pelvic incidence, pelvic tilt and thoracic kyphosis. The quality of life can best be estimated by subtracting lumbar lordosis from the pelvic incidence. However, initial evaluation of the sagittal balance can also be based on the sagittal vertical axis. The severity of imbalance can be described by the sagittal vertical axis and the pelvic tilt, but surgical therapy necessitates a more profound analysis, which can be based on the SRS-Schwab classification.
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Affiliation(s)
- S Decker
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - C W Müller
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - M Omar
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - C Krettek
- Unfallchirurgische Klinik, Medizinische Hochschule Hannover
| | - F Schwab
- Langone Medical Center, New York University, United States
| | - P D Trobisch
- Wirbelsäulenchirurgie, Eifelklinik St. Brigida, Simmerath
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Wiese-Possselt M, Zweígner J, Rohde AM, Schwab F, Kern W, Seifert H, Gastmeier P. Prevalence of colonisation with vancomycin-resistant enterococci on admission - a cross-sectional study in 6 German university hospitals, 2014. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475132 DOI: 10.1186/2047-2994-4-s1-p198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Karch A, Castell S, Geffers C, Schwab F, Brunkhorst FM, Gastmeier P, Mikolajczyk RT. Defining Reference Range for Blood Culture Rates – an Analysis within the German Hospital Infection Surveillance System (KISS). Int J Epidemiol 2015. [DOI: 10.1093/ije/dyv096.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hansen S, Zingg W, Ahmad R, Kyratsis Y, Behnke M, Schwab F, Pittet D, Gastmeier P. Organization of infection control in European hospitals. J Hosp Infect 2015; 91:338-45. [PMID: 26542950 DOI: 10.1016/j.jhin.2015.07.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Prevention of Hospital Infections by Intervention and Training (PROHIBIT) survey was initiated to investigate the status of healthcare-associated infection (HCAI) prevention across Europe. AIM This paper presents the methodology of the quantitative PROHIBIT survey and outlines the findings on infection control (IC) structure and organization including management's support at the hospital level. METHODS Hospitals in 34 countries were invited to participate between September 2011 and March 2012. Respondents included IC personnel and hospital management. FINDINGS Data from 309 hospitals in 24 countries were analysed. Hospitals had a median (interquartile range) of four IC nurses (2-6) and one IC doctor (0-2) per 1000 beds. Almost all hospitals (96%) had defined IC objectives, which mainly addressed hand hygiene (87%), healthcare-associated infection reduction (84%), and antibiotic stewardship (66%). Senior management provided leadership walk rounds in about half of hospitals, most often in Eastern and Northern Europe, 65% and 64%, respectively. In the majority of hospitals (71%), sanctions were not employed for repeated violations of IC practices. Use of sanctions varied significantly by region (P < 0.001), but not by countries' healthcare expenditure. CONCLUSION There is great variance in IC staffing and policies across Europe. Some areas of practice, such as hand hygiene, seem to receive considerably more attention than others that are equally important, such as antibiotic stewardship. Programmes in IC suffer from deficiencies in human resources and local policies, ubiquitous factors that negatively impact on IC effectiveness. Strengthening of IC policies in European hospitals should be a public health priority.
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Affiliation(s)
- S Hansen
- Charité - University Medicine Berlin, Institute for Hygiene, Germany.
| | - W Zingg
- University of Geneva Hospitals, Infection Control Programme, Switzerland
| | - R Ahmad
- Imperial College Healthcare NHS Trust, London, UK
| | - Y Kyratsis
- School of Health Sciences, City University London, UK
| | - M Behnke
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | - F Schwab
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
| | - D Pittet
- University of Geneva Hospitals, Infection Control Programme, Switzerland
| | - P Gastmeier
- Charité - University Medicine Berlin, Institute for Hygiene, Germany
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Ferrero E, Lafage R, Challier V, Diebo B, Guigui P, Mazda K, Schwab F, Skalli W, Lafage V. Clinical and stereoradiographic analysis of adult spinal deformity with and without rotatory subluxation. Orthop Traumatol Surg Res 2015; 101:613-8. [PMID: 26194209 DOI: 10.1016/j.otsr.2015.04.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 04/13/2015] [Accepted: 04/28/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory subluxation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis. Stereoradiography, recently developed for medical applications, provides full-body standing radiographs and 3D reconstruction of the spine, with low radiation dose. HYPOTHESIS 3D stereoradiography improves analysis of RS and of its relations with transverse plane and spinopelvic parameters and clinical impact. MATERIAL AND METHODS One hundred and thirty adults with lumbar ASD and full-spine EOS® radiographs (EOS Imaging, Paris, France) were included. Spinopelvic sagittal parameters and lateral listhesis in the coronal plane were measured. The transverse plane study parameters were: apical axial vertebral rotation (apex AVR), axial intervertebral rotation (AIR) and torsion index (TI). Two groups were compared: with RS (lateral listhesis>5mm) and without RS (without lateral listhesis exceeding 5mm: non-RS). Correlations between radiologic and clinical data were assessed. RESULTS RS patients were significantly older, with larger Cobb angle (37.4° vs. 26.6°, P=0.0001), more severe sagittal deformity, and greater apex AVR and TI (respectively: 22.9° vs. 11.3°, P<0.001; and 41.0° vs. 19.9°, P<0.001). Ten percent of patients had AIR>10° without visible RS on 2D radiographs. RS patients reported significantly more frequent low back pain and radiculalgia. DISCUSSION In this EOS® study, ASD patients with RS had greater coronal curvature and sagittal and transverse deformity, as well as greater pain. Further transverse plane analysis could allow earlier diagnosis and prognosis to guide management. LEVEL OF EVIDENCE 4, retrospective study.
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Affiliation(s)
- E Ferrero
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA; Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, université Paris V, AP-HP, 20, rue Leblanc, 75015 Paris, France; Laboratoire de biomécanique, Arts et Métiers Paris Tech, boulevard de l'Hôpital, 75013 Paris, France.
| | - R Lafage
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - V Challier
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - B Diebo
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - P Guigui
- Service de chirurgie orthopédique, hôpital européen Georges-Pompidou, université Paris V, AP-HP, 20, rue Leblanc, 75015 Paris, France
| | - K Mazda
- Service de chirurgie, hôpital universitaire Robert-Debré, boulevard Sérurier, 75019 Paris, France
| | - F Schwab
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
| | - W Skalli
- Laboratoire de biomécanique, Arts et Métiers Paris Tech, boulevard de l'Hôpital, 75013 Paris, France
| | - V Lafage
- Orthopaedic Department, Hospital for Joint Disease, 15th East Street, New York, 10003, USA
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Schröder C, Schwab F, Behnke M, Breier AC, Maechler F, Piening B, Dettenkofer M, Geffers C, Gastmeier P. Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance. Int J Med Microbiol 2015; 305:799-806. [PMID: 26358916 DOI: 10.1016/j.ijmm.2015.08.034] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE To describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS). METHOD The epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight infants (NEO-KISS) and surgical site infections (OP-KISS) in the period from 2006 to 2013. In addition, risk factor analyses were performed for the most important infections of ICU-KISS, NEO-KISS and OP-KISS. RESULTS Data from a total of 3,454,778 ICU patients from 913 ICUs, 618,816 non-ICU patients from 142 non-ICU wards, 53,676 VLBW from 241 neonatal intensive care units (NICU) and 1,005,064 surgical patients from operative departments from 550 hospitals were used for analysis. Compared with baseline data, a significant reduction of primary bloodstream infections (PBSI) and lower respiratory tract infections (LRTI) was observed in ICUs with the maximum effect in year 5 (or longer participation) (incidence rate ratio 0.60 (CI95 0.50-0.72) and 0.61 (CI95 0.52-0.71) respectively). A significant reduction of PBSI and LRTI was also observed in NEO-KISS when comparing the baseline situation with the 5th year of participation (hazard ratio 0.70 (CI95 0.64-0.76) and 0.43 (CI95 0.35-0.52)). The effect was smaller in operative departments after the introduction of OP-KISS (OR 0.80; CI95 0.64-1.02 in year 5 or later for all procedure types combined). Due to the large database, it has not only been possible to confirm well-known risk factors for HAI, but also to identify some new interesting risk factors like seasonal and volume effects. CONCLUSIONS Participating in a national surveillance system and using surveillance data for internal quality management leads to substantial reduction of HAI. In addition, a surveillance system can identify otherwise not recognized risk factors which should - if possible - be considered for infection control management and for risk adjustment in the benchmarking process.
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Affiliation(s)
- C Schröder
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany.
| | - F Schwab
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - M Behnke
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - A-C Breier
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - F Maechler
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - B Piening
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - M Dettenkofer
- Institute for Environmental Medicine and Hospital Hygiene, University Medical Centre Freiburg, Germany
| | - C Geffers
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
| | - P Gastmeier
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany
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Schröder C, Behnke M, Gastmeier P, Schwab F, Geffers C. Case vignettes to evaluate the accuracy of identifying healthcare-associated infections by surveillance persons. J Hosp Infect 2015; 90:322-6. [DOI: 10.1016/j.jhin.2015.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/08/2015] [Indexed: 10/24/2022]
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Schneider S, Zweigner J, Schwab F, Behnke M, Meyer E, Gastmeier P. Antimicrobial prescription behavior in 16 German intensive care units: room for improvement in pneumonia therapy. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474706 DOI: 10.1186/2047-2994-4-s1-o2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Zuschneid I, Schwab F, Geffers C, Behnke M, Rüden H, Gastmeier P. Trends in Ventilator-Associated Pneumonia Rates Within the German Nosocomial Infection Surveillance System (KISS). Infect Control Hosp Epidemiol 2015; 28:314-8. [PMID: 17326022 DOI: 10.1086/507823] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2005] [Accepted: 07/25/2005] [Indexed: 11/04/2022]
Abstract
Objective.To investigate trends in ventilator-associated pneumonia (VAP) rates during participation in the German nosocomial infection surveillance system (Krankenhaus-Infektions-Surveillance-System [KISS]).Methods.A total of 71 ICUs that began participating in KISS in 1999 or later and continued participation for at least 36 months were selected. Beginning with the first month of participation, the pooled mean rate of VAP in the ICUs was calculated for each year of participation. The incidence densities for the 3 years of participation were compared using the Pearson x2 test. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. VAP rates were calculated for each ICU and year of participation, and rates for years 1 and 3 were compared using the Wilcoxon test for paired samples.Results.Twenty-nine medical-surgical, 18 medical, 20 surgical, 2 neurosurgical, and 2 pediatric ICUs met the selection criteria. Surveillance data were available on 181,275 patients, for whom there were 613,098 patient-days and 224,138 ventilator-days. A total of 2,043 cases of VAP were reported. The ICUs had a pooled VAP rate of 10.5 cases per 1,000 ventilator-days during year 1 of KISS surveillance. In year 2, the rate decreased by 19%, to 8.7 cases per 1,000 ventilator-days (RR, 0.81 [95% CI, 0.73-0.90]). In year 3, the rate decreased by 24% from year 1, to 8.0 cases per 1,000 ventilator-days (RR, 0.76; 95% CI, 0.68-0.85). Both results were significant (P < .001 by the Pearson x2 test). Comparison of the VAP rates of the ICUs did not show a significant difference between years 1 and 3 of KISS participation.Conclusion.Surveillance was associated with a significant reduction in the pooled rate of VAP during years 1-3 of KISS participation.
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Affiliation(s)
- I Zuschneid
- Institute of Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Germany
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Leistner R, Gürntke S, Sakellariou C, Denkel LA, Bloch A, Gastmeier P, Schwab F. Bloodstream infection due to extended-spectrum beta-lactamase (ESBL)-positive K. pneumoniae and E. coli: an analysis of the disease burden in a large cohort. Infection 2014; 42:991-7. [PMID: 25100555 DOI: 10.1007/s15010-014-0670-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 07/22/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE The burden of extended-spectrum beta-lactamase (ESBL)-positive Enterobacteriaceae (ESBL-E) is growing worldwide. We aimed to determine the financial disease burden attributable to ESBL-positive species in cases of bloodstream infection (BSI) due to K. pneumoniae and E. coli. METHODS We conducted a cohort study on patients with BSI due to K. pneumoniae or E. coli between 2008 and 2011 in our institution. Data were collected on true hospital costs, length of stay (LOS), basic demographic parameters, underlying diseases as Charlson comorbidity index (CCI) and ESBL positivity of the pathogens. Multivariable regression analysis on hospital costs and length of stay was performed. RESULTS Overall we found 1,851 consecutive cases of ESBL-E BSI, 352 (19.0%) cases of K. pneumoniae BSI and 1,499 (81.0%) cases of E. coli BSI. Sixty-six of E. coli BSI (18.8%) and 178 of K. pneumoniae BSI (11.9%) cases were due to ESBL-positive isolates, respectively (p = 0.001). 830 (44.8%) cases were hospital-onset, 215 (61.1%) of the K. pneumoniae and 615 (41.0%) of the E. coli cases (p < 0.001). In-hospital mortality was overall 19.8, 25.0% in K. pneumoniae cases and 18.5% in E. coli cases (p = 0.006). Increased hospital costs and length of stay were significantly associated to BSI with ESBL-positive K. pneumoniae. CONCLUSION In contrast to BSI due to ESBL-positive E. coli, cases of ESBL-positive K. pneumoniae BSI were associated with significantly increased costs and length of stay. Infection prevention measures should differentiate between both pathogens.
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Affiliation(s)
- R Leistner
- Institute of Hygiene and Environmental Medicine, National Reference Center for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany,
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Hansen S, Schwab F, Schneider S, Sohr D, Gastmeier P, Geffers C. Time-series analysis to observe the impact of a centrally organized educational intervention on the prevention of central-line-associated bloodstream infections in 32 German intensive care units. J Hosp Infect 2014; 87:220-6. [DOI: 10.1016/j.jhin.2014.04.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 04/17/2014] [Indexed: 10/25/2022]
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Lange U, Schwab F, Müller-Ladner U, Dischereit G. Wirkung iterativer Ganzkörperhyperthermie mit wassergefilterter Infrarot-A-Strahlung bei Arthritis psoriatica – eine kontrollierte, randomisierte, prospektive Studie. AKTUEL RHEUMATOL 2014. [DOI: 10.1055/s-0034-1383589] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- U. Lange
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie, Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | - F. Schwab
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie, Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
| | - U. Müller-Ladner
- Abteilung für Rheumatologie und klinische Immunologie, Kerckhoff-Klinik, Justus-Liebig-Universität Gießen, Bad Nauheim
| | - G. Dischereit
- Rheumatologie, Klinische Immunologie, Physikalische Medizin und Osteologie, Kerckhoff-Klinik, Universität Gießen, Bad Nauheim
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Moal B, Raya J, Jolivet E, Schwab F, Blondel B, Lafage V, Skalli W. Validation of 3D spino-pelvic muscle reconstructions based on dedicated MRI sequences for fat-water quantification. Ing Rech Biomed 2014. [DOI: 10.1016/j.irbm.2013.12.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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van West H, Hodgson B, Parent E, Samuel S, Hodgson B, Ferland C, Soroceanu A, Soroceanu A, Protopsaltis T, Protopsaltis T, Radovanovic I, Amritanand R, Shamji M, Haugo K, Malham G, Jarzem P, Rampersaud Y, Tomkins-Lane C, Manson N, Malham G, Rampersaud Y, Malham G, Malham G, King V, Goldstein C, Fisher C, Fehlings M, Fisher C, Wong E, Sardar Z, Christie S, Patel A, Pinkoski C, Ahn H, Drew B, Dvorak M, Pezeshki P, Altaf F, Wilde P, Rampersaud Y, Sparrey C, Tetreault L, Fehlings M, Tetreault L, Rampersaud R, Jack A, Johnstone R, Fernandes A, Urquhart J, Morokoff A, Manson N, Tomkins-Lane C, Phan P, Evaniew N, Shamji M, Manson J, Rampersaud Y, Nault ML, St-Pierre GH, Larouche J, Lewis S, Wilgenbusch C, Lewis S, Rampersaud Y, Johnson R, Cushnie D, Sridharan S, Street J, Gregg C, Missiuna P, Abraham E, Abraham E, Manson N, Huang E, Passmore S, Mac-Thiong JM, Labelle H, Moulin D, Turgeon I, Roy-Beaudry M, Bourassa N, Petit Y, Parent. S, Chabot S, Westover L, Hill D, Moreau M, Hedden D, Lou E, Adeeb. S, Smith M, Bridge C, Hsu B, Gray. R, Group PORSCHES, Saran N, Mac-Thiong JM, Stone L, Ouellet. J, Protopsaltis T, Terran J, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Schwab F, Lafage V, Protopsaltis T, Ames C, Bess S, Smith J, Errico. T, Schwab F, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Hostin R, Hart R, Burton D, Ames C, Shaffrey C, Bess S, Errico T, Lafage. V, Terran J, Soroceanu A, Bronsard N, Smith J, Klineberg E, Mundis G, Kim HJ, Hostin R, Hart R, Shaffrey C, Bess S, Ames C, Schwab F, Lafage. V, Urquhart J, Gananapathy V, Siddiqi F, Gurr K, Bailey C, Ravi B, David K, Rampersaud. R, Tu Y, Salter. M, Nichol H, Fourney D, Kelly. M, Parker R, Ellis N, Blecher C, Chow F, Claydon. M, Sardar Z, Alexander D, Oxner W, Plessis SD, Yee A, Wai. E, Lewis S, Davey J, Gandhi R, Mahomed. N, Hu R, Thomas K, Hepler C, Choi K, Rowed K, Haig. A, Lam. K, Parker R, Blecher C, Seex. K, Perruccio A, Gandhi R, Program. UHNA, Ellis N, Parker R, Goss B, Blecher C, Ballok. Z, Parker R, Ellis N, Chan P, Varma. D, Swart A, Winder M, Varga PP, Gokaslan Z, Boriani S, Luzzati A, Rhines L, Fisher C, Chou D, Williams R, Dekutoski M, Quraishi N, Bettegowda C, Kawahara N, Fehlings. M, Versteeg A, Boriani S, Varga PP, Dekutoski M, Luzzati A, Gokaslan Z, Williams R, Reynolds J, Fehlings M, Bettegowda C, Rhines. L, Zamorano J, Nater A, Tetrault L, Varga P, Gokaslan Z, Boriani S, Fisher C, Rhines L, Bettegowda C, Kawahara N, Chou. D, Fehlings M, Kopjar B, Vaccaro A, Arnold P, Schuster J, Finkelstein J, Rhines L, Dekutoski M, Gokaslan Z, France. J, Whyne C, Singh D, Ford. M, Aldebeyan W, Ouellet J, Steffen T, Beckman L, Weber M, Jarzem. P, Kwon B, Ahn H, Bailey C, Fehlings M, Fourney D, Gagnon D, Tsai E, Tsui D, Parent S, Chen J, Dvorak M, Noonan V, Rivers C, Network RHSCIR, Batke J, Lenehan B, Fisher C, Dvorak M, Street. J, Fox R, Nataraj A, Bailey C, Christie S, Duggal N, Fehlings M, Finkelstein J, Fourney D, Hurlbert R, Kwon B, Townson A, Tsai E, Attabib N, Chen J, Dvorak M, Noonan V, Rivers C, Network. RHSCIR, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Kwon B, Parent S, Tsai E, Dvorak M, Noonan V, Rivers C, Shen T, Network. RHSCIR, Fisher C, Kwon B, Drew B, Fehlings M, Paquet J, Ahn H, Attabib N, Bailey C, Christie S, Duggal N, Finkelstein J, Fourney D, Hurlbert R, Johnson M, Mac-Thiong JM, Parent S, Tsai E, Fallah N, Noonan V, Rivers C, Network RHSCIR, Davidson S, McCann C, Akens M, Murphy K, Whyne C, Sherar M, Yee. A, Belanger L, Ronco J, Dea N, Paquette S, Boyd M, Street J, Fisher C, Dvorak M, Kwon B, Gonzalvo A, Fitt G, Liew S, de la Harpe D, Turner P, Rogers M, Bidos A, Fanti C, Young B, Drew B, Puskas. D, Tam H, Manansala S, Nosov V, Delva M, Alshafai N, Kopjar B, Tan G, Arnold P, Fehlings. M, Kopjar B, Arnold P, Ibrahim A, Tetrault. L, Kopjar B, Arnold P, Fehlings. M, Sundararajan K, Eng. S, St-Pierre G, Nataraj A, Urquhart J, Rosas-Arellano P, Tallon C, Gurr K, Siddiqi F, Bailey S, Bailey C, Sundararajan K, Rampersaud. R, Rosa-Arellano P, Tallon C, Bailey S, Gurr K, Bailey. C, Parker R, Milili L, Goss B, Malham. G, Green A, McKeon M, Abraham. E, Lafave L, Parnell J, Rempel J, Moriartey S, Andreas Y, Wilson P, Hepler C, Ray H, Hu. R, Ploumis A, Hess K, Wood. K, Yarascavitch B, Madden K, Ghert M, Drew B, Bhandari M, Kwok D, Tu YS, Salter. M, Hadlow. A, Tso P, Walker K, Lewis S, Davey J, Mahomed N, Coyte. P, Mac-Thiong JM, Roy-Beaudry M, Turgeon I, Labelle H, deGuise J, Parent. S, Jack A, Fox R, Nataraj A, Paquette S, Leroux T, Yee A, Ahn H, Broad R, Fisher C, Hall H, Nataraj A, Hedden D, Christie S, Carey T, Mehta V, Fehlings M, Wadey. V, Dear T, Hashem. M, Fourney D, Goldstein S, Bodrogi A, Lipkus M, Dear T, Keshen S, Veillette C, Gandhi R, Adams D, Briggs N, Davey J, Fehlings M, Lau J, Lewis S, Magtoto R, Marshall K, Massicotte E, Ogilvie-Harris D, Sarro A, Syed K, Mohamed. N, Perera S, Taha A, Urquhart J, Gurr K, Siddiqi F, Bailey C, Thomas K, Cho R, Swamy G, Power C, Henari S, Lenehan. B, McIntosh G, Hall H, Hoffman. C, Karachi A, Pazionis T, AlShaya O, Green A, McKeon M, Manson. N, Green A, McKeon M, Manson. N, Green A, McKeon M, Murray J, Abraham. E, Thomas K, Suttor S, Goyal T, Littlewood J, Bains I, Bouchard J, Hu R, Jacobs B, Cho R, Swamy G, Johnson M, Pelleck V, Amad Y, Ramos E, Glazebrook C. Combined Spine Conference of the Canadian Spine Society New Zealand Orthopaedic Spine Society, Spine Society of Australia: Fairmont Château Lake Louise, Lake, Louise, Alberta, Tuesday, Feb. 25 to Saturday, Mar. 1, 20141.1.01 The use of suspension radiographs to predict LIV tilt.1.1.02 Surgical correction of adolescent idiopathic scoliosis without fusion: an animal model.1.1.03 Are full torso surface topography postural measurements more sensitive to change than back only parameters in adolescents with idiopathic scoliosis and a main thoracic curve?1.2.04 Restoration of thoracic kyphosis in adolescent idiopathic kyphosis: comparative radiographic analysis of round versus rail rods.1.2.05 Scoliosis surgery in spastic quadriplegic cerebral palsy: Is fusion to the pelvis always necessary? A 4–18-year follow-up study.1.2.06 Identification and validation of pain-related biomarkers surrounding spinal surgery in adolescents.1.3.07 Cervical sagittal deformity develops after PJK in adult throacolumbar deformity correction: radiographic analysis using a novel global sagittal angular parameter, the CTPA.1.3.08 Impact of obesity on complications and patient-reported outcomes in adult spinal deformity surgery.1.3.09 The T1 pelvic angle, a novel radiographic measure of sagittal deformity, accounts for both pelvic retroversion and truncal inclination and correlates strongly with HRQOL.1.4.10 Determining cervical sagittal deformity when it is concurrent with thoracolumbar deformity.1.4.11 The influence of sagittal balance and pelvic parameters on the outcome of surgically treated patients with degenerative spondylolisthesis.1.4.12 Predictors of degenerative spondylolisthesis and loading translation in surgical lumbar spinal stenosis patients.2.1.13 Mechanical allodynia following disc herniation requires intraneural macrophage infiltration and can be blocked by systemic selenium delivery or attenuation of BDNF activity.2.1.14 The effect of alanyl-glutamine on epidural fibrosis in a rat laminectomy model.2.1.15 Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.2.2.16 2-year results of a Canadian, multicentre, blinded, pilot study of a novel peptide in promoting lumbar spine fusion.2.2.17 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: long-term change in health-related quality of life.2.2.18 Changes in objectively measured walking performance, function, and pain following surgery for spondylolisthesis and lumbar spinal stenosis.2.3.19 A prospective multicentre observational data-monitored study of minimally invasive fusion to treat degenerative lumbar disorders: complications and outcomes at 1-year follow-up.2.3.20 Assessment and classification of subsidence in lateral interbody fusion using serial computed tomography.2.3.21 Predictors of willingness to undergo spinal and orthopaedic surgery after surgical consultation.2.4.22 Indirect foraminal decompression is independent of facet arthropathy in extreme lateral interbody fusion.2.4.23 Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.2.4.24 Tantalum trabecular metal implants in anterior cervical corpectomy and fusion.3.1.25 Hemangiomas of the spine: results of surgical management and prognostic variables for local recurrence and mortality in a multicentre study.3.1.26 Chondrosarcomas of the spine: prognostic variables for local recurrence and mortality in a multicentre study.3.1.27 Risk factors for recurrence of surgically treated spine schwannomas: analysis of 169 patients from a multicentre international database.3.2.28 Survival pattern and the effect of surgery on health related quality of life and functional outcome in patients with metastatic epidural spinal cord compression from lung cancer — the AOSpine North America prospective multicentre study.3.2.29 A biomechanical assessment of kyphoplasty as a stand-alone treatment in a human cadaveric burst fracture model.3.2.30 What is safer in incompetent vertebrae with posterior wall defects, kyphoplasty or vertebroplasty: a study in vertebral analogs.3.3.31 Feasibility of recruiting subjects for acute spinal cord injury (SCI) clinical trials in Canada.3.3.32 Prospective analysis of adverse events in elderly patients with traumatic spinal cord injury.3.3.33 Does traction before surgery influence time to neural decompression in patients with spinal cord injury?3.4.34 Current treatment of individuals with traumatic spinal cord injury: Do we need age-specific guidelines?3.4.35 Current surgical practice for traumatic spinal cord injury in Canada.3.4.36 The importance of “time to surgery” for traumatic spinal cord injured patients: results from an ambispective Canadian cohort of 949 patients.3.5.37 Assessment of a novel coil-shaped radiofrequency probe in the porcine spine.3.5.38 The effect of norepinephrine and dopamine on cerebrospinal fluid pressure after acute spinal cord injury.3.5.39 The learning curve of pedicle screw placement: How many screws are enough?4.1.40 Preliminary report from the Ontario Inter-professional Spine Assessment and Education Clinics (ISAEC).4.1.41 A surrogate model of the spinal cord complex for simulating bony impingement.4.1.42 Clinical and surgical predictors of specific complications following surgery for the treatment of degenerative cervical myelopathy: results from the multicentre, prospective AOSpine international study on 479 patients.4.2.43 Outcomes of surgical management of cervical spondylotic myelopathy: results of the prospective, multicentre, AOSpine international study in 479 patients.4.2.44 A clinical prediction rule for clinical outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international AOSpine prospective multicentre data set of 757 subjects.4.2.45 The prevalence and impact of low back and leg pain among aging Canadians: a cross-sectional survey.4.3.46 Adjacent segment pathology: Progressive disease course or a product of iatrogenic fusion?4.3.47 Natural history of degenerative lumbar spondylolisthesis in patients with spinal stenosis.4.3.48 Changes in self-reported clinical status and health care utilization during wait time for surgical spine consultation: a prospective observational study.4.3.49 The Canadian surgical wait list for lumbar degenerative spinal stenosis has a detrimental effect on patient outcomes.4.3.50 Segmental lordosis is independent of interbody cage position in XLIF.4.3.51 Elevated patient BMI does not negatively affect self-reported outcomes of thoracolumbar surgery.1.5.52 The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI): development and pilot.1.5.53 Study evaluating the variability of surgical strategy planning for patients with adult spinal deformity.1.5.54 Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality.1.5.55 Peripheral hypersensitivity to subthreshold stimuli persists after resolution of acute experimental disc-herniation neuropathy.1.5.56 Radiation induced lumbar spinal osteonecrosis: case report and literature review.1.5.57 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: Part 2 — estimated lifetime incremental cost-utility ratios.1.5.58 A predictive model of progression for adolescent idiopathic scoliosis based on 3D spine parameters at first visit.1.5.59 Development of a clinical prediction model for surgical decision making in patients with degenerative lumbar spine disease.2.5.60 Canadian spine surgery fellowship education: evaluating opportunity in developing a nationally based training curriculum.2.5.61 Pedicle subtraction osteotomy for severe proximal thoracic junctional kyphosis.2.5.62 A comparison of spine surgery referrals triaged through a multidisciplinary care pathway versus conventional referrals.2.5.63 Results and complications of posterior-based 3 column osteotomies in patients with previously fused spinal deformities.2.5.64 Orthopaedic Surgical AdVerse Event Severity (Ortho-SAVES) system: identifying opportunities for improved patient safety and resource utilization.2.5.65 Spontaneous spinal extra-axial haematomas — surgical experience in Otago and Southland 2011–2013.2.5.66 Obesity and spinal epidural lipomatosis in cauda equina syndrome.2.5.67 Factors affecting restoration of lumbar lordosis in adult degenerative scoliosis patients treated with lateral trans-psoas interbody fusion.3.6.68 Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design.3.6.69 Postsurgical rehabilitation patients have similar fear avoidance behaviour levels as those in nonoperative care.3.6.70 Outcomes of surgical treatment of adolescent spondyloptosis: a case series.3.6.71 Surgical success in primary versus revision thoracolumbar spine surgery.3.6.72 The effect of smoking on subjective patient outcomes in thoracolumbar surgery.3.6.73 Modelling patient recovery to predict outcomes following elective thoracolumbar surgery for degenerative pathologies.3.6.74 Outcomes from trans-psoas versus open approaches in the treatment of adult degenerative scoliosis.3.6.75 Lumbar spinal stenosis and presurgical assessment: the impact of walking induced strain on a performance-based outcome measure. Can J Surg 2014. [DOI: 10.1503/cjs.005614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Gastmeier P, Behnke M, Breier AC, Piening B, Schwab F, Dettenkofer M, Geffers C. [Healthcare-associated infection rates: measuring and comparing. Experiences from the German National Nosocomial Infection Surveillance System (KISS) and from other surveillance systems]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 55:1363-9. [PMID: 23114434 DOI: 10.1007/s00103-012-1551-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Surveillance of nosocomial infections is meanwhile a cornerstone of infection prevention activities in hospitals. The objective of this article is to compare healthcare-associated infection rates in intensive care patients, neonatal intensive care patients and operated patients (ICU-KISS, OP-KISS, NEO-KISS) of the German nosocomial infection surveillance system (KISS) with the corresponding data of the US American National Healthcare Safety Network (NHSN) and the European Centre for Disease Prevention and Control (ECDC). In general, the methodological differences among the three surveillance systems are minor but there are some exceptions. Therefore, differences between countries have to be interpreted very carefully as they may be due to differences in diagnostics, patient mix, types of interventions, length of stay, selection of participating hospitals, post-discharge surveillance activities and interpretation of case definitions. Organizational aspects, such as mandatory participation with public disclosure on infection rates may also have an impact.
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Affiliation(s)
- P Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité- Universitätsmedizin Berlin, Hindenburgdamm 27, Berlin, Germany.
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Hansen S, Schwab F, Schneider S, Sohr D, Gastmeier P, Geffers C. [Deficits in central venous catheter associated bloodstream infection]. Dtsch Med Wochenschr 2013; 138:1711-6. [PMID: 23934589 DOI: 10.1055/s-0033-1349437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Intensive care units (ICUs) with high rates of central venous catheter (CVC) -associated bloodstream infections (BSI) were invited to implement a bundle on BSI prevention during an educational programme which was created by the German national reference center for surveillance of nosocomial infections (NRZ). Training of health care workers (HCWs) was the main component and will be presented in the following. METHODS The intervention was realized by local infection control staff from April 2006 to March 2007. Modules were lecture, script and poster. Before the intervention HCWs completed an anonymous multiple choice questionnaire about BSI prevention measures. Lectures could be modified in accordance to the ICUs knowledge of prevention measures. Processes and CVC-BSI rates were surveyed and analysed before and after the intervention and also during an additional 24-months follow-up period. RESULTS Thirty-two ICUs with 1,622 HCWs realized the intervention. Knowledge of BSI prevention of 1,251 HCWs was assessed. Knowledge gaps could predominantly be shown for the favored insertion site and the changing intervals of intravenous tubing for aqueous infusions. One third of HCWs said that a daily CVC's dressing change was indicated. After the intervention ICUs showed a significant decrease in the pooled CVC-BSI rate. ICUs showed a significant decrease of the pooled CVC-BSI rate during the follow-up. CONCLUSION In this first assessment of more than 1,200 HCWs' knowledge of BSI prevention in German ICUs knowledge gaps could be identified. During the 12-months intervention the implementation of evidence based IC recommendations improved and the pooled CVC-BSI rate decreased significantly.
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Affiliation(s)
- S Hansen
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Berlin.
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Hansen S, Schwab F, Behnke M, Geffers C, Gastmeier P. Umsetzung nationaler Empfehlungen zur Prävention zentraler Gefäßkatheter-assoziierter Infektionen auf deutschen Intensivstationen. Dtsch Med Wochenschr 2013; 138:1706-10. [DOI: 10.1055/s-0033-1349439] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- S. Hansen
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin
| | - F. Schwab
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin
| | - M. Behnke
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin
| | - C. Geffers
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin
| | - P. Gastmeier
- Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin
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Schwab F, Geffers C, Piening B, Haller S, Eckmanns T, Gastmeier P. How many outbreaks of nosocomial infections occur in German neonatal intensive care units annually? Infection 2013; 42:73-8. [PMID: 23913358 DOI: 10.1007/s15010-013-0516-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 07/22/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Outbreaks on neonatal intensive care units (NICUs) achieve huge media interest, but the real number of neonatal outbreaks within a country is unknown. METHOD This calculation is based on the data of the component for nosocomial infections in very low birth weight (VLBW) infants of the German national nosocomial infection surveillance system (NEO-KISS) from 2006 to 2011. Almost all German NICUs caring for VLBW infants participated in this surveillance system. A cluster was defined and an outbreak was assumed when at least two cases of severe neonatal infection (bloodstream infection, pneumonia) occurred within a defined time interval in one center with the same pathogen species in different patients. Four different intervals were used for calculation: 14, 30, 60, and 90 days. Infections with coagulase-negative staphylococci (CoNS) were excluded. RESULTS A total of 228 NICUs provided data in the six-year study period. A total of 37,038 VLBW infants and 1,361,950 patient days were used for the calculation. 7,405 severe neonatal infections occurred, and a microbiological detection of the pathogen was successful in 2,084 cases. Altogether, between 121 and 280 outbreaks were calculated according to the different time intervals used. Most outbreaks were due to Staphylococcus aureus, followed by Enterococcus spp. and Enterobacter spp. CONCLUSION It can be assumed that at least between 26 and 61 neonatal outbreaks with at least two severe infections take place in German NICUs per year. The actual number seems to be higher because only laboratory-confirmed infections in a subgroup of patients were used for the analysis.
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Affiliation(s)
- F Schwab
- Institute for Hygiene and Environmental Medicine, Charité - University Medicine Berlin, Hindenburgdamm 27, 12203, Berlin, Germany,
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Schwarz F, Schwab F, Beckmann BM, Schuessler F, Zinsser D, Gölz T, Kääb S, Reiser MF, Theisen D. [Magnetic resonance imaging of hypertrophic cardiomyopathy : evaluation of diastolic function]. Radiologe 2013; 53:15-23. [PMID: 23338245 DOI: 10.1007/s00117-012-2381-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) has a prevalence of approximately 0.2% and is clinically asymptomatic in many patients or presents with unspecific symptoms. This explains the importance of imaging for the diagnosis of HCM as well as for the assessment of the clinical course. The definitive finding in HCM is myocardial hypertrophy with thickening of the ventricular wall ≥ 15 mm. While echocardiography is an excellent screening tool magnetic resonance imaging (MRI) allows a comprehensive analysis of the heart in HCM. This includes a detailed analysis of the distribution and extent of myocardial hypertrophy, a thorough evaluation of systolic and diastolic cardiac function, the assessment of the presence and extent of dynamic outflow tract obstruction as well as the description of the systolic anterior motion (SAM) phenomenon of the mitral valve with secondary mitral insufficiency. When contrast material is administered, additional information about myocardial perfusion as well as the presence and extent of myocardial fibrosis can be obtained. This study compared systolic functional parameters as well as end systolic and end diastolic wall thickness of patients with and without diastolic dysfunction.
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Affiliation(s)
- F Schwarz
- Institut für Klinische Radiologie, Klinikum der Ludwig-Maximilians-Universität München, Campus Grosshadern, Deutschland.
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Leistner R, Piening B, Gastmeier P, Geffers C, Schwab F. P241: Nosocomial infections in very low birthweight infants in germany: current data from the national surveillance system neo-kiss. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688213 DOI: 10.1186/2047-2994-2-s1-p241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Schneider S, Schwab F, Gastmeier P, Meyer E. O050: Antibiotics in 70 German intensive care units: risk factors for high overall consumption. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687820 DOI: 10.1186/2047-2994-2-s1-o50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Meyer E, Geffers C, Gastmeier P, Schwab F. No increase in primary nosocomial candidemia in 682 German intensive care units during 2006 to 2011. Euro Surveill 2013. [DOI: 10.2807/ese.18.24.20505-en] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- E Meyer
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - C Geffers
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany
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Meyer E, Geffers C, Gastmeier P, Schwab F. No increase in primary nosocomial candidemia in 682 German intensive care units during 2006 to 2011. Euro Surveill 2013; 18:20505. [PMID: 23787164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
We evaluated the epidemiology of and trends in primary nosocomial candidemia within a network of 682 German intensive care units (ICUs) during 2006 to 2011. Nosocomial laboratory-confirmed bloodstream infection (NLCBI) was diagnosed using standard definitions from the United States Centers for Disease Control and Prevention. Incidences were calculated by NLCBI per 1,000 patients and incidence densities per 1,000 patient-days and per 1,000 central-line days. In the 682 ICUs, there were 2,220,803 patients, 7,943,615 patient-days and 5,363,026 central-line days. A total of 381 of the 6,666 NLCBIs were associated with Candida albicans, 142 with non-albicans Candida. Non-albicans Candida made up 26% of all the Candida isolates. The mean incidence density of Candida central line-associated NLCBIs was 0.09 per 1,000 central-line days and remained unchanged between 2006 and 2011. Crude ICU mortality was 21.9% for C. albicans and 29.7% for non-albicans Candida. Candida was the fourth leading cause of primary NLCBIs, accounting for 6.5% of all bloodstream infections acquired in ICUs. Based on an incidence density of 0.07 per 1,000 patient-days, extrapolation of our data resulted in 465 primary nosocomial Candida NLCBIs in German ICUs per year. Our data show that there was no increase in primary Candida NLCBIs during 2006 to 2011.
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Affiliation(s)
- E Meyer
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany.
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Maechler F, Schwab F, Meyer E, Geffers C, Leistner R, Gastmeier P. P096: Antibiotic stewardship in intensive care units: a cross sectional study of 355 ICUs in Germany. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688414 DOI: 10.1186/2047-2994-2-s1-p96] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Leistner R, Meyer E, Gastmeier P, Dem P, Pfeifer Y, Eller C, Schwab F. O045: Acquisition of extended-spectrum beta-lactamase (ESBL) positive E.coli in the community: the impact of cultural background and diet. Antimicrob Resist Infect Control 2013. [PMCID: PMC3687987 DOI: 10.1186/2047-2994-2-s1-o45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Leistner R, Piening B, Gastmeier P, Geffers C, Schwab F. Nosocomial infections in very low birthweight infants in Germany: current data from the National Surveillance System NEO-KISS. Klin Padiatr 2013; 225:75-80. [PMID: 23526612 DOI: 10.1055/s-0033-1334886] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Infants with very low birthweight (< 1 500 g, VLBW) are at increased risk for nosocomial infections (NI). In 2 000, we implemented a surveillance system for VLBW infants in Germany: NEO-KISS. In 2005, a joint committee of healthcare providers and insurance companies required German neonatology departments to participate. As a result, NEO-KISS is now a nationwide surveillance system for NI in VLBW infants. PATIENTS AND METHODS We present NEO-KISS data collected between 2007 and 2011 by 228 neonatology departments. Rates of sepsis, pneumonia and necrotising enterocolitis (NEC) were calculated. In order to evaluate the department-specific infection rate we introduced a new indicator: the Standardised Infection Rate (SIR). The SIR considers the department-specific patient distribution (based on the patients' birthweight) and describes the ratio of observed and expected infections (calculated from the reference data for this individual patient distribution). The data presented comprise 33 048 VLBW infants.The incidence density of CVC-associated sepsis 8.6 per 1 000 CVC-days. RESULTS AND CONCLUSION The incidence of pneumonia among mechanically ventilated patients was 2.7/1 000 ventilator days. The incidence of NEC was 0.8. The SIR showed strong variation among the participating departments. It is an excellent tool for identifying outliers in nosocomial infection rates and for stimulating activities to decrease the risk of nosocomial infections.
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Affiliation(s)
- R Leistner
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections
| | - B Piening
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections
| | - P Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections
| | - C Geffers
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections
| | - F Schwab
- Institute of Hygiene and Environmental Medicine, Charité University Medicine Berlin, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections
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Akbar M, Dreher T, Schwab F, Omlor G, Wang H, Bruckner T, Carstens C, Wiedenhöfer B. Evaluation des sagittalen Profils nach operativer Therapie der thorakalen adoleszenten idiopathischen Skoliose Lenke Typ 1. Orthopäde 2013; 42:150-6. [DOI: 10.1007/s00132-012-2060-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Pilant WL, Knopoff L, Schwab F. Transmission and reflection of surface waves at a corner: 3. Rayleigh waves (experimental). ACTA ACUST UNITED AC 2012. [DOI: 10.1029/jz069i002p00291] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Blondel B, Lafage V, Farcy JP, Schwab F, Bollini G, Jouve JL. Influence of screw type on initial coronal and sagittal radiological correction with hybrid constructs in adolescent idiopathic scoliosis. Correction priorities. Orthop Traumatol Surg Res 2012; 98:873-8. [PMID: 23146286 DOI: 10.1016/j.otsr.2012.09.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Revised: 08/01/2012] [Accepted: 09/11/2012] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pedicle screw constructs for spinal instrumentation in patients with adolescent idiopathic scoliosis (AIS) are effective in providing coronal plane correction but can result in loss of kyphosis, which in turn can lead to loss of lordosis. Hybrid constructs have been found superior over pedicle screw constructs in terms of thoracic kyphosis restoration. In this study, our objective was to compare outcomes with monoaxial versus polyaxial screws in an AIS population treated with hybrid constructs. HYPOTHESIS Monoaxial screws provide better correction in the coronal plane but result in loss of thoracic kyphosis, whereas thoracic kyphosis is preserved when polyaxial screws are used. MATERIAL AND METHODS We retrospectively analysed data from 60 patients (mean age, 15years) with Lenke 1, 2, or 3 AIS treated using a hybrid construct with self-retaining bilaminar hook claws cranially, pedicle screws between the last instrumented vertebra and T11 caudally, and sublaminar universal clamps between the two extremities of the construct. Monoaxial screws were used in the first 30 patients (MS group) and polyaxial screws in the next 30 patients (PS group). Student's t test was performed to compare the two groups in terms of thoracic Cobb angle correction and T4-T12 kyphosis 3 months after surgery. RESULTS No significant preoperative differences were found between the two groups. At last follow-up, the residual Cobb angle was significantly greater in the PS group than in the MS group (20.3° versus 15°) with a percentage of correction of 72.1% in the MS group versus 64.8% in the PS group. In the sagittal plane, the thoracic kyphosis was significantly greater in the PS group than in the MS group (26.6° versus 23°). DISCUSSION This preliminary study shows that, even within a population managed using hybrid constructs, which are associated with less iatrogenic hypokyphosis, differences exist according to the technique used. The importance of sagittal spinal balance has been abundantly documented in the literature, and sagittal malalignment, particularly due to iatrogenic factors, is associated with poorer clinical outcomes in adults with spinal deformities. Therefore, there is a critical need to determine whether the treatment priority is optimal correction in the coronal plane or in the sagittal plane. We believe that the main focus should be sagittal plane correction, even at the expense of a slight decrease in coronal plane correction. Long-term studies are needed to confirm our preliminary findings.
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Affiliation(s)
- B Blondel
- École doctorale 463, sciences du mouvement humain, UMR CNRS 6233, université Aix-Marseille, Marseille, France.
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