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Wahl A, Fischer MA, Klaper K, Müller A, Borgmann S, Friesen J, Hunfeld KP, Ilmberger A, Kolbe-Busch S, Kresken M, Lippmann N, Lübbert C, Marschner M, Neumann B, Pfennigwerth N, Probst-Kepper M, Rödel J, Schulze MH, Zautner AE, Werner G, Pfeifer Y. Presence of hypervirulence-associated determinants in Klebsiella pneumoniae from hospitalised patients in Germany. Int J Med Microbiol 2024; 314:151601. [PMID: 38359735 DOI: 10.1016/j.ijmm.2024.151601] [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: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Klebsiella (K.) pneumoniae is a ubiquitous Gram-negative bacterium and a common coloniser of animals and humans. Today, K. pneumoniae is one of the most persistent nosocomial pathogens worldwide and poses a severe threat/burden to public health by causing urinary tract infections, pneumonia and bloodstream infections. Infections mainly affect immunocompromised individuals and hospitalised patients. In recent years, a new type of K. pneumoniae has emerged associated with community-acquired infections such as pyogenic liver abscess in otherwise healthy individuals and is therefore termed hypervirulent K. pneumoniae (hvKp). The aim of this study was the characterisation of K. pneumoniae isolates with properties of hypervirulence from Germany. METHODS A set of 62 potentially hypervirulent K. pneumoniae isolates from human patients was compiled. Inclusion criteria were the presence of at least one determinant that has been previously associated with hypervirulence: (I) clinical manifestation, (II) a positive string test as a marker for hypermucoviscosity, and (III) presence of virulence associated genes rmpA and/or rmpA2 and/or magA. Phenotypic characterisation of the isolates included antimicrobial resistance testing by broth microdilution. Whole genome sequencing (WGS) was performed using Illumina® MiSeq/NextSeq to investigate the genetic repertoire such as multi-locus sequence types (ST), capsule types (K), further virulence associated genes and resistance genes of the collected isolates. For selected isolates long-read sequencing was applied and plasmid sequences with resistance and virulence determinants were compared. RESULTS WGS analyses confirmed presence of several signature genes for hvKp. Among them, the most prevalent were the siderophore loci iuc and ybt and the capsule regulator genes rmpA and rmpA2. The most dominant ST among the hvKp isolates were ST395 capsule type K2 and ST395 capsule type K5; both have been described previously and were confirmed by our data as multidrug-resistant (MDR) isolates. ST23 capsule type K1 was the second most abundant ST in this study; this ST has been described as commonly associated with hypervirulence. In general, resistance to beta-lactams caused by the production of extended-spectrum beta-lactamases (ESBL) and carbapenemases was observed frequently in our isolates, confirming the threatening rise of MDR-hvKp strains. CONCLUSIONS Our study results show that K. pneumoniae strains that carry several determinants of hypervirulence are present for many years in Germany. The detection of carbapenemase genes and hypervirulence associated genes on the same plasmid is highly problematic and requires intensified screening and molecular surveillance. However, the non-uniform definition of hvKp complicates their detection. Testing for hypermucoviscosity alone is not specific enough to identify hvKp. Thus, we suggest that the classification of hvKp should be applied to isolates that not only fulfil phenotypical criteria (severe clinical manifestations, hypermucoviscosity) but also (I) the presence of at least two virulence loci e.g. iuc and ybt, and (II) the presence of rmpA and/or rmpA2.
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Affiliation(s)
- Anika Wahl
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Martin A Fischer
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Kathleen Klaper
- Robert Koch Institute, Department of Sexually transmitted bacterial Pathogens (STI) and HIV, Berlin, Germany
| | - Annelie Müller
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Stefan Borgmann
- Klinikum Ingolstadt, Department of Infectious Diseases and Infection Control, Ingolstadt, Germany
| | | | - Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Medical Faculty, Goethe University, Frankfurt am Main, Germany
| | | | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Medical Center, Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Michael Kresken
- Paul-Ehrlich-Gesellschaft für Infektionstherapie e. V., Cologne, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Christoph Lübbert
- Interdisciplinary Center for Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany; Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | | | - Bernd Neumann
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Niels Pfennigwerth
- German National Reference Centre for Multidrug-Resistant Gram-Negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | | | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Marco H Schulze
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany
| | - Andreas E Zautner
- Institute of Medical Microbiology and Hospital Hygiene, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany; Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Guido Werner
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Yvonne Pfeifer
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany.
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Keil V, Schaumburg T, Buchta F, Luz JK, Kolbe-Busch S, Chaberny IF, von Lengerke T. Improving leadership skills of infection prevention and control teams by psychological empowerment: study protocol for a cluster randomised controlled trial (IP-POWER). BMJ Open 2024; 14:e083806. [PMID: 38346888 PMCID: PMC10862334 DOI: 10.1136/bmjopen-2023-083806] [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] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 01/25/2024] [Indexed: 02/15/2024] Open
Abstract
INTRODUCTION Infection prevention and control (IPC) teams are routinely confronted with intense emotions in their daily work, as they are involved in many change processes with front-line medical staff, for example, when promoting compliance with basic IPC measures. In addition, they are confronted with challenges due to their role as intermediaries. Based on former research, this study aims to empower IPC teams to promote clinicians' compliance through interventions focusing on the IPC teams' leadership skills. METHODS AND ANALYSIS The IP-POWER study (Infection Prevention with head and heart: Psychological empowerment of IPC teams), a multicentre, two-arm, non-blinded, cluster-randomised controlled trial with a parallel waiting control group, is planned to be conducted in Germany as of February to November 2024. A group of 10 voluntary hospitals is going to participate in a multistage intervention programme, including 2 days of intense psychological training; 5 hospitals will be randomly assigned to the waiting control group. After the workshops, there will be a 12-week follow-up period during which the contents learnt within the workshops can be applied and internalised into IPC practice. The proposed outcomes (both self-assessed and other-assessed leadership competencies of IPC team members and their task profiles, perceived workload, motivation to act in order to implement IP measures and goal attainment) are going to be collected with an online questionnaire, followed by an analysis with IBM SPSS (Statistics 29 (or later)) using descriptive analyses and multiple linear regressions. Additionally, as external data sources, hand hygiene compliance rates from the study hospitals' monitoring systems will be analysed using χ² tests. ETHICS AND DISSEMINATION This study was reviewed and approved by the ethics committee of the University of Leipzig (184/23-ek; vote from 4 July 2023). Findings will be disseminated via peer-review publications, and national and international conference presentations. TRIAL REGISTRATION NUMBER DRKS00031879.
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Affiliation(s)
- Valentine Keil
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Tiffany Schaumburg
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Frederike Buchta
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - J Katrin Luz
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Susanne Kolbe-Busch
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
| | - Iris Freya Chaberny
- University of Leipzig Medical Center, Institute of Hygiene, Hospital Epidemiology and Environmental Health, Leipzig, Germany
- Christian-Albrecht University of Kiel, University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - Thomas von Lengerke
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
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Mehdorn M, Kolbe-Busch S, Lippmann N, Moulla Y, Scheuermann U, Jansen-Winkeln B, Chaberny IF, Gockel I, Kassahun WT. Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery. Langenbecks Arch Surg 2023; 408:230. [PMID: 37301803 PMCID: PMC10257639 DOI: 10.1007/s00423-023-02961-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Superficial surgical site infections (SSI) are a common complication after abdominal surgery. Additionally, multidrug-resistant organisms (MDRO) have shown an increasing spread in recent years with a growing importance for health care. As there is varying evidence on the importance of MDRO in different surgical fields and countries as causative agents of SSI, we report our findings of MDRO-caused SSI. METHODS We assembled an institutional wound register spanning the years 2015-2018 including all patients with abdominal surgery and SSI only, including demographics, procedure-related data, microbiological data from screenings, and body fluid samples. The cohort was examined for the frequency of different MDRO in screenings, body fluids, and wound swabs and assessed for risk factors for MDRO-positive SSI. RESULTS A total of 138 out of 494 patients in the register were positive for MDRO, and of those, 61 had an MDRO isolated from their wound, mainly multidrug-resistant Enterobacterales (58.1%) followed by vancomycin-resistant Enterococcus spp. (19.7%). As 73.2% of all MDRO-carrying patients had positive rectal swabs, rectal colonization could be identified as the main risk factor for an SSI caused by a MDRO with an odds ratio (OR) of 4.407 (95% CI 1.782-10.896, p = 0.001). Secondly, a postoperative ICU stay was also associated with an MDRO-positive SSI (OR 3.73; 95% CI 1.397-9.982; p = 0.009). CONCLUSION The rectal colonization status with MDRO should be taken into account in abdominal surgery regarding SSI prevention strategies. Trial registration Retrospectively registered in the German register for clinical trials (DRKS) 19th December 2019, registration number DRKS00019058.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Woubet Tefera Kassahun
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Kolbe-Busch S, Chaberny IF. [Resource conservation from the perspective of infection prevention]. Chirurgie (Heidelb) 2023; 94:220-229. [PMID: 36592189 DOI: 10.1007/s00104-022-01784-8] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Procedures to prevent surgical site infections require a high input of human, technical and natural resources. This paper explores ways to optimize the use of resources in caring for patients who undergo a surgical procedure without compromising patient safety. METHODS Review of the contribution of selected procedures for infection prevention in surgical patients considering current evidence and recommendations by comparing current guidelines and results of clinical trials. Analysis of interventions to implement and increase compliance. RESULTS Knowledge of current evidence-based recommendations enables not only the identification of procedures with proven effect on infection prevention but also those that are ineffective and thus dispensable. There is still need for further controlled studies, e.g. on the use of antiseptics, that can confirm the evidence level of preventive procedures. Infection surveillance in combination with process and compliance monitoring by infection prevention specialists with a feedback system to healthcare workers are suitable control instruments for infection control management. In the case of increased infection rates, the implementation of evidence-based recommended measures through tailored bundle interventions is successful. Technical measures to maintain environmental conditions must be included in the control process. CONCLUSION The reduction of healthcare-associated infections by implementing tailored interventions of infection prevention measures and elimination of ineffective procedures conserves resources and promotes patient safety.
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Affiliation(s)
- Susanne Kolbe-Busch
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland.
| | - Iris F Chaberny
- Institut für Hygiene, Krankenhaushygiene und Umweltmedizin, Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig, Liebigstr. 22, 04103, Leipzig, Deutschland
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Rusinovich V, Rusinovich Y, Chaberny IF, Kolbe-Busch S. Compliance assessment regarding the PVC management on normal wards of a university hospital. GMS Hyg Infect Control 2023; 18:Doc04. [PMID: 36875331 PMCID: PMC9978455 DOI: 10.3205/dgkh000430] [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] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
Objective The risk of peripheral venous catheter (PVC) infections in inpatients is often underestimated, even if it is lower than that for central venous catheters. Guidelines for the prevention of PVC-associated infections describe the evidence-based management of PVCs. The aims of this study were the development of standardized methods for compliance assessment regarding PVC management and the evaluation of self-reported knowledge and implementations among healthcare providers regarding PVC care. Method We developed a checklist based on the recommendation of the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch Institute (KRINKO) Berlin for the standardized evaluation of PVC management. The following parameters were collected and evaluated: condition of the puncture site, condition of the bandage, presence of an extension set, presence of a plug, and documentation. The checklist was applied in 14 normal wards in 2019. After feedback of the ward staff on the results, it was applied again in 2020 in the same wards. For retrospective data analysis, we used a newly developed PVC-quality index. After the second evaluation in 2020, we carried out an anonymous survey among the healthcare providers. Results The evaluation of 627 indwelling PVCs showed a significant increase in compliance related to the presence of an extension set (p=0.049) and documentation (p<0.001) in the 2nd year. The quality index increased in 12 out of 14 wards. The participants of the survey were aware of the in-house standard "Prevention of vascular catheter-associated infections", with a mean score of 4.98 on a Likert scale (1=not aware, 7=completely aware). The main barrier to implementation of the preventive measures was the time factor. Survey participants were more aware of PVC placement than PVC care. Conclusion The PVC quality index is a valuable tool for the assessment of compliance regarding PVC management in daily practice. Feedback from the ward staff on the results of compliance assessment improves PVC management, but the outcome is very heterogeneous.
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Affiliation(s)
- Volha Rusinovich
- Institute of Hygiene, Hospital Epidemiology and Environmental Health, University of Leipzig Medical, Germany
| | - Yury Rusinovich
- Department of Visceral, Transplant, Thoracic, and Vascular Surgery at University of Leipzig Medical, Germany
| | - Iris F. Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Health, University of Leipzig Medical, Germany
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Health, University of Leipzig Medical, Germany
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Demleitner AF, Wolff AW, Erber J, Gebhardt F, Westenberg E, Winkler AS, Kolbe-Busch S, Chaberny IF, Lingor P. Best practice approaches to outpatient management of people living with Parkinson's disease during the COVID-19 pandemic. J Neural Transm (Vienna) 2022; 129:1377-1385. [PMID: 35244753 PMCID: PMC8895054 DOI: 10.1007/s00702-022-02484-7] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 02/24/2022] [Indexed: 11/26/2022]
Abstract
The prevalence of Parkinson’s disease (PD) is rising, rendering it one of the most common neurodegenerative diseases. Treatment and monitoring of patients require regular specialized in- and outpatient care. Patients with PD are more likely to have a complicated disease course if they become infected with severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2). Regular in-hospital appointments place these patients at risk of exposure to SARS-CoV-2 due to travel and contact with other patients and staff. However, guidelines for the management of outpatients with PD during times of increased risk of infection are currently lacking. These are urgently needed to conduct risk–benefit evaluations to recommend the best medical treatment. This article discusses best practice approaches based on the current literature, as suggested by the multidisciplinary Network of University Medicine (NUM) in Germany. These include measures such as mask-wearing, hand hygiene, social distancing measures, and appropriate testing strategies in outpatient settings, which can minimize the risk of exposure. Furthermore, the urgency of appointments should be considered. Visits of low urgency may be conducted by general practitioners or via telemedicine consultations, whereas in-person presentation is required in case of moderate and high urgency visits. Classification of urgency should be carried out by skilled medical staff, and telemedicine (telephone or video consultations) may be a useful tool in this situation. The currently approved vaccines against SARS-CoV-2 are safe and effective for patients with PD and play a key role in minimizing infection risk for patients with PD.
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Affiliation(s)
- Antonia F Demleitner
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andreas W Wolff
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Johanna Erber
- Department of Internal Medicine II, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Friedemann Gebhardt
- Department of Hospital Hygiene, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Erica Westenberg
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Global Health, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
| | - Andrea S Winkler
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
- Center for Global Health, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany
- Centre for Global Health, Institute of Health and Society, School of Medicine, University of Oslo, Oslo, Norway
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Paul Lingor
- Department of Neurology, School of Medicine, University Hospital München rechts der Isar, Technical University of Munich, Munich, Germany.
- DZNE, German Center for Neurodegenerative Diseases, Munich, Germany.
- Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.
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von Lengerke T, Tomsic I, Krosta KME, Ebadi E, Keil V, Buchta F, Luz JK, Schaumburg T, Kolbe-Busch S, Chaberny IF. Tailoring implementation interventions of different order in infection prevention and control: A cascadic logic model (IPC-CASCADE). Front Health Serv 2022; 2:960854. [PMID: 36925806 PMCID: PMC10012664 DOI: 10.3389/frhs.2022.960854] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/21/2022] [Indexed: 01/19/2023]
Abstract
Implementation interventions in infection prevention and control (IPC) differ by recipients. The two target groups are healthcare workers directly involved in patient care ("frontline") and IPC professionals as proxy agents, that is, implementation support practitioners. While both types of implementation interventions aim to promote compliance with clinical interventions to prevent healthcare-associated infections (HAI), their tailoring may be vastly different, for example, due to different behavioural outcomes. Additionally, IPC teams, as recipients of empowering tailored interventions, are under-researched. To overcome this gap and improve conceptual clarity, we proposed a cascadic logic model for tailored IPC interventions (IPC-CASCADE). In the model, we distinguished between interventions by IPC professionals targeting clinicians and those targeting IPC professionals (first- and second-order implementation interventions, respectively). Tailoring implies selecting behaviour change techniques matched to prospectively-assessed determinants of either clinician compliance (in first-order interventions) or interventions by IPC professionals for frontline workers (in second-order interventions). This interventional cascade is embedded in the prevailing healthcare system. IPC-CASCADE is horizontally structured over time and vertically structured by hierarchy or leadership roles. IPC-CASCADE aims to highlight the potential of increasing the impact of tailored interventions by IPC professionals for clinicians (to improve their compliance) via tailored interventions for IPC professionals (to improve their work as proxy agents). It underlines the links that IPC professionals define between macro contexts (healthcare and hospitals) and frontline workers in HAI prevention. It is specific, i.e., "tailored" to IPC, and expected to assist implementation science to better conceptualise tailoring.
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Affiliation(s)
- Thomas von Lengerke
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Ivonne Tomsic
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Karolin M E Krosta
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany
| | - Ella Ebadi
- Institute for Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Center for Laboratory Medicine, Hannover, Germany
| | - Valentine Keil
- Department of Medical Psychology, Hannover Medical School, Center for Public Health and Health Care, Hannover, Germany.,Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Frederike Buchta
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - J Katrin Luz
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Tiffany Schaumburg
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Hospital, Interdisciplinary Center for Infectious Medicine, Leipzig, Germany
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Walker A, Houwaart T, Finzer P, Ehlkes L, Tyshaieva A, Damagnez M, Strelow D, Duplessis A, Nicolai J, Wienemann T, Tamayo T, Kohns Vasconcelos M, Hülse L, Hoffmann K, Lübke N, Hauka S, Andree M, Däumer MP, Thielen A, Kolbe-Busch S, Göbels K, Zotz R, Pfeffer K, Timm J, Dilthey AT. Characterization of SARS-CoV-2 infection clusters based on integrated genomic surveillance, outbreak analysis and contact tracing in an urban setting. Clin Infect Dis 2021; 74:1039-1046. [PMID: 34181711 PMCID: PMC8406867 DOI: 10.1093/cid/ciab588] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [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: 04/19/2021] [Indexed: 01/02/2023] Open
Abstract
Background Tracing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission chains is still a major challenge for public health authorities, when incidental contacts are not recalled or are not perceived as potential risk contacts. Viral sequencing can address key questions about SARS-CoV-2 evolution and may support reconstruction of viral transmission networks by integration of molecular epidemiology into classical contact tracing. Methods In collaboration with local public health authorities, we set up an integrated system of genomic surveillance in an urban setting, combining a) viral surveillance sequencing, b) genetically based identification of infection clusters in the population, c) integration of public health authority contact tracing data, and d) a user-friendly dashboard application as a central data analysis platform. Results Application of the integrated system from August to December 2020 enabled a characterization of viral population structure, analysis of 4 outbreaks at a maximum care hospital, and genetically based identification of 5 putative population infection clusters, all of which were confirmed by contact tracing. The system contributed to the development of improved hospital infection control and prevention measures and enabled the identification of previously unrecognized transmission chains, involving a martial arts gym and establishing a link between the hospital to the local population. Conclusions Integrated systems of genomic surveillance could contribute to the monitoring and, potentially, improved management of SARS-CoV-2 transmission in the population.
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Affiliation(s)
- Andreas Walker
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Torsten Houwaart
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Patrick Finzer
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Zotz
- Klimas, Düsseldorf, Germany
| | - Lutz Ehlkes
- Düsseldorf Health Department (Gesundheitsamt Düsseldorf), Düsseldorf, Germany
| | - Alona Tyshaieva
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Maximilian Damagnez
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Daniel Strelow
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Ashley Duplessis
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jessica Nicolai
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Tobias Wienemann
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Teresa Tamayo
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kohns Vasconcelos
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Lisanna Hülse
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | - Nadine Lübke
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Sandra Hauka
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Marcel Andree
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | | | | | - Susanne Kolbe-Busch
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Klaus Göbels
- Düsseldorf Health Department (Gesundheitsamt Düsseldorf), Düsseldorf, Germany
| | | | - Klaus Pfeffer
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Jörg Timm
- Institute of Virology, University Hospital Düsseldorf, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Alexander T Dilthey
- Institute of Medical Microbiology and Hospital Hygiene, Heinrich Heine University Düsseldorf, Düsseldorf, Germany.,Institute of Medical Statistics and Computational Biology, University of Cologne, Cologne, Germany.,Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), University of Cologne, Cologne, Germany
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9
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Wendel AF, Meyer S, Deenen R, Köhrer K, Kolbe-Busch S, Pfeffer K, Willmann M, Kaasch AJ, MacKenzie CR. Long-Term, Low-Frequency Cluster of a German-Imipenemase-1-Producing Enterobacter hormaechei ssp. steigerwaltii ST89 in a Tertiary Care Hospital in Germany. Microb Drug Resist 2018; 24:1305-1315. [PMID: 29750595 DOI: 10.1089/mdr.2017.0433] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 02/06/2023] Open
Abstract
Enterobacter cloacae complex is a common cause of hospital outbreaks. A retrospective and prospective molecular analysis of carbapenem-resistant clinical isolates in a tertiary care center demonstrated an outbreak of a German-imipenemase-1 (GIM-1) metallo-beta-lactamase-producing Enterobacter hormaechei ssp. steigerwaltii affecting 23 patients between 2009 and 2016. Thirty-three isolates were sequence type 89 by conventional multilocus sequence typing (MLST) and displayed a maximum difference of 49 out of 3,643 targets in the ad-hoc core-genome MLST (cgMLST) scheme (SeqSphere+ software; Ridom, Münster, Germany). The relatedness of all isolates was confirmed by further maximum-likelihood phylogeny. One clonal complex of highly related isolates (≤15 allele difference in cgMLST) contained 17 patients, but epidemiological data only suggested five transmission events. The blaGIM-1-gene was embedded in a class-1-integron (In770) and the Tn21-subgroup transposon Tn6216 (KC511628) on a 25-kb plasmid. Environmental screening detected one colonized sink trap in a service room. The outbreak was self-limited as no further blaGIM-1-positive E. hormaechei has been isolated since 2016. Routine molecular screening of carbapenem-nonsusceptible gram-negative isolates detected a long-term, low-frequency outbreak of a GIM-1-producing E. hormaechei ssp. steigerwaltii clone. This highlights the necessity of molecular surveillance.
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Affiliation(s)
- Andreas F Wendel
- 1 Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Sebastian Meyer
- 1 Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - René Deenen
- 2 Medical Faculty, Biological and Medical Research Center (BMFZ), Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Karl Köhrer
- 2 Medical Faculty, Biological and Medical Research Center (BMFZ), Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Susanne Kolbe-Busch
- 1 Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Klaus Pfeffer
- 1 Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Matthias Willmann
- 3 Institute of Medical Microbiology and Hygiene, University of Tübingen , Tübingen, Germany
| | - Achim J Kaasch
- 1 Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
| | - Colin R MacKenzie
- 1 Institute of Medical Microbiology and Hospital Hygiene, University Hospital, Heinrich-Heine-University Düsseldorf , Düsseldorf, Germany
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Daniels-Haardt I, Kolbe-Busch S, Zysk G, Nguyen T, Jurke A, Schulze-Röbbecke R. Onlinetool zur infektionshygienischen Überwachung von Krankenhäusern. Gesundheitswesen 2014. [DOI: 10.1055/s-0034-1371578] [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: 10/19/2022]
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11
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Goldmann BU, Langenbrink L, Matschuck G, Heeschen C, Kolbe-Busch S, Niederau C, Katz N, Wenserit C, Lestin HG, Brinker K, Kuhrt E, Tebbe U, Spanuth E, Hamm CW. Quantitative bedside testing of troponin T: is it equal to laboratory testing? The Cardiac Reader Troponin T (CARE T) study. Clin Lab 2004; 50:1-10. [PMID: 15000216] [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: 04/29/2023]
Abstract
The progressive evolution of cardiac marker testing in patients with acute coronary syndromes has extended their role into risk stratification and guidance of therapeutic regimen. To provide utilization of cardiac markers around the clock and facilitate the diagnostic work-up of patients with acute chest pain in the emergency room, a point-of-care system for quantitative troponin T and myoglobin testing in whole blood samples was developed. Aim of this multicenter study was to evaluate bedside quantitative determination of myoglobin and troponin T in chest pain patients in a clinical routine setting. Five hospitals in Germany were contributing to blood sampling and 741 patients were included four hours (median) after onset of cardiac pain. Comparison between the rapid test and the established laboratory-based method showed a sufficient agreement of results with a correlation of r = 0.89 (Y = 0.856x + 0.029) for troponin T and r = 0.912 (Y= +1.145x + 3.457) for myoglobin. Diagnostic sensitivity and prognostic power of the troponin T results obtained in the emergency unit were thoroughly equivalent to the laboratory-based method. The results show that the cardiac reader system represents a promising alternative to central laboratory testing with an accuracy sufficiently for rapid decision making in the emergency room. Myoglobin results in this study did not add supplementary information to the cardiac reader troponin result. However, point-of-care testing of troponin T is advantageous whenever marker results could positively effect initial triage decisions and interventional management choices.
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Affiliation(s)
- Britta U Goldmann
- Med Clinic III/Division of Cardiology, University Hospital Eppendorf, Hamburg, Germany.
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Kolbe-Busch S, Lotz J, Hafner G, Blanckaert NJC, Claeys G, Togni G, Carlsen J, Röddiger R, Thomas L. Multicenter evaluation of a fully mechanized soluble transferrin receptor assay on the Hitachi and cobas integra analyzers. the determination of reference ranges. Clin Chem Lab Med 2002; 40:529-36. [PMID: 12113300 DOI: 10.1515/cclm.2002.091] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Soluble transferrin receptor (sTfR) is reported to be a reliable marker for the diagnosis of iron deficiency, especially when iron metabolism is influenced by inflammatory disorders such as infection, chronic inflammation and cancer-related anemia. In the present multicenter study the analytical performance of a recently introduced, latex-enhanced immunoturbidimetric assay for the determination of soluble transferrin receptor (Tina quant [a] sTfR, Roche Diagnostics) on different fully mechanized analyzers such as Hitachi 917 and 911, and Cobas Integra 400 and 700 was evaluated. Within-run and between-run imprecision showed good results (CV<5% and <7%, respectively). The assay was found to be linear over a wide measuring range (0.4-35 mg/l). Endogenous substances did not interfere with the test results. Comparison of serum sTfR concentrations with those of heparinized plasma revealed good correlation (r>0.976). Method comparison with an existing fully mechanized method as well as with ELISA tests for sTfR showed very good correlation (r>0.987). Because of the lack of international standardization the results differed from each other up to 2.5-fold. The 95% of serum levels in healthy individuals ranged from 1.9 to 4.4 mg/l (n=427). However, the reference ranges should be reported in a sex-dependent manner, as 2.2-5.0 mg/l for men (n=211) and as 1.9-4.4 mg/l for premenopausal (n=216) and postmenopausal (n=45) women. The Tina quant [a] sTfR assay enables the precise, accurate, rapid and convenient determination of sTfR concentrations for routine clinical chemistry purposes.
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Affiliation(s)
- Susanne Kolbe-Busch
- Institut für Klinische Chemie und Laboratoriumsdiagnostik, Universitätsklinikum Düsseldorf, Germany.
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14
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Fischer DC, Haubeck HD, Eich K, Kolbe-Busch S, Stöcker G, Stuhlsatz HW, Greiling H. A novel keratan sulphate domain preferentially expressed on the large aggregating proteoglycan from human articular cartilage is recognized by the monoclonal antibody 3D12/H7. Biochem J 1996; 318 ( Pt 3):1051-6. [PMID: 8836155 PMCID: PMC1217722 DOI: 10.1042/bj3181051] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 02/02/2023]
Abstract
Monoclonal antibodies (mAbs) were prepared against aggrecan which has been isolated from human articular cartilage and purified by several chromatographic steps. One of these mAbs, the aggrecan-specific mAb 3D12/H7, was selected for further characterization. The data presented indicate that this mAb recognizes a novel domain of keratan sulphate chains from aggrecan: (1) immunochemical staining of aggrecan is abolished by treatment with keratanase/keratanase II, but not with keratanase or chondroitin sulphate lyase AC/ABC; (2) after chemical deglycosylation of aggrecan no staining of the core-protein was observed; (3) different immunochemical reactivity was observed against keratan sulphates from articular cartilage, intervertebral disc and cornea for the mAbs 3D12/H7 and 5D4. For further characterization of the epitope, reduced and 3H-labelled keratan sulphate chains were prepared. In an IEF-gel-shift assay it was shown that the 3H-labelled oligosaccharides obtained after keratanase digestion of reduced and 3H-labelled keratan sulphate chains were recognized by the mAb 3D12/H7. Thus it can be concluded that the mAb 3D12/H7 recognizes an epitope in the linkage region present in, at least some, keratan sulphate chains of the large aggregating proteoglycan from human articular cartilage. Moreover, this domain seems to be expressed preferentially on those keratan sulphate chains which occur in the chondroitin sulphate-rich region of aggrecan, since the antibody does not recognize the keratan sulphate-rich region obtained after combined chondroitinase AC/ABC and trypsin digestion of aggrecan.
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Affiliation(s)
- D C Fischer
- Institut für Klinische Chemie und Pathobiochemie, Aachen, Germany
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Fischer DC, Kolbe-Busch S, Stöcker G, Hoffmann A, Haubeck HD. Development of enzyme immunoassays specific for keratan sulphate- and core-protein-epitopes of the large aggregating proteoglycan from human articular cartilage. Eur J Clin Chem Clin Biochem 1994; 32:285-91. [PMID: 7518698 DOI: 10.1515/cclm.1994.32.4.285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In the course of chronic inflammatory and degenerative joint diseases proteoglycans are degraded by the action of proteases and oxygen radicals. Therefore, proteoglycan fragments, released from cartilage into the peripheral blood, might be useful markers of cartilage degradation. Sensitive enzyme immunoassays are useful for the detection of these proteoglycan fragments in serum. We therefore developed specific monoclonal antibodies against the large aggregating proteoglycan (aggrecan), which has been isolated and purified from human articular cartilage. Two monoclonal antibodies which recognize a novel cartilage-specific epitope on the keratan sulphate chain of aggrecan (mAb 4B3/D10) and an epitope of the core-protein of aggrecan (4G4/A10) were selected for the development of competitive enzyme-immunoassays. These assays allow the sensitive and specific detection of cartilage-derived proteoglycan fragments, not only in synovial fluid but also in serum. They can now be used for the study of inflammatory and degenerative joint diseases.
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Affiliation(s)
- D C Fischer
- Institut für Klinische Chemie und Pathobiochemie, RWTH Aachen, Germany
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