Mortality attributable to hospital acquired infections with multidrug-resistant bacteria in a large group of German hospitals.

Background: According to extrapolations, around 35,000 patients in Germany develop hospital acquired infections (HAI) with a multidrug-resistant organism (MDRO) every year, and about 1500 of them die. Previous estimations were based on laboratory data and prevalence studies. Aim of this study was to establish the incidences of hospital acquired MDRO infections and the resulting deaths by expert review.

Representativeness of the surveillance data in the intensive care unit component of the German nosocomial infections surveillance system.

Objective: To assess the representativeness of the data in the Krankenhaus Infektions Surveillance System (KISS), which is a nosocomial infections surveillance system for intensive care units (ICUs) in Germany.

Design: Prospective and retrospective surveillance study.

Setting: Medical-surgical ICUs in Germany.

Use of central venous catheter and peripheral venous catheter as risk factors for nosocomial bloodstream infection in very-low-birth-weight infants.

Objective: To describe the relationship between the use of central and peripheral venous catheters and the risk of nosocomial, primary, laboratory-confirmed bloodstream infection (BSI) for neonates with a birth weight less than 1,500 g (very-low-birth-weight [VLBW] infants).

Methods: Cox proportional hazard regression analysis with time-dependent variable was used to determine the risk factors for the occurrence of BSI in a cohort of VLBW infants. We analyzed previously collected surveillance data from the German national nosocomial surveillance system for VLBW infants.

Is there an association between nosocomial infection rates and bacterial cross transmissions?

Objective: Surveillance data of nosocomial infection rates are increasingly used for public reporting and interhospital comparisons. Approximately 15% of nosocomial infections on intensive care units are the result of patient-to-patient transmissions of the causative organisms. These exogenous infections could be prevented by adherence to basic infection control measures.

Outbreak of carbapenem-resistant Acinetobacter baumannii carrying the carbapenemase OXA-23 in a German university medical centre.

A prolonged outbreak of carbapenem-resistant Acinetobacter baumannii in a German university medical centre in 2006 was investigated; the investigation included a descriptive epidemiological analysis, a case-control study, environmental sampling, molecular typing of A. baumannii isolates using PFGE and repetitive-sequence-based PCR (rep-PCR) typing, and detection of OXA-type carbapenemases by multiplex PCR. Thirty-two patients acquired the outbreak strain in five intensive care units (ICUs) and two regular wards at a tertiary care hospital within 10 months.

Early- and late-onset pneumonia: is this still a useful classification?

The choice of empirical treatment of nosocomial pneumonia in the intensive-care unit (ICU) used to rely on the interval after the start of mechanical ventilation. Nowadays, however, the question of whether in fact there is a difference in the distribution of causative pathogens is under debate. Data from 308 ICUs from the German National Nosocomial Infection Surveillance System, including information on relevant pathogens isolated in 11,285 cases of nosocomial pneumonia from 1997 to 2004, were used for our evaluation.

Ten years of KISS: the most important requirements for success.

Ten years ago, in January 1997, data collection for the German national nosocomial infection surveillance system was established, which is known by the acronym KISS (Krankenhaus-Infektions-Surveillance-System). Meanwhile KISS was able to demonstrate a beneficial effect from ongoing surveillance activities and appropriate feedback to the users in combination with reference data for ventilator associated pneumonia, primary bloodstream infections and surgical site infections. Significant reductions of infection rates between 20-30% over 3 years periods in the components for intensive care units, operative departments and neonatal intensive care units were demonstrated.

Operating room ventilation with laminar airflow shows no protective effect on the surgical site infection rate in orthopedic and abdominal surgery.

Objective: To evaluate whether operating room (OR) ventilation with (vertical) laminar airflow impacts on surgical site infection (SSI) rates.

Design: Retrospective cohort-study based on routine surveillance data.

Patients And Methods: Sixty-three surgical departments participating voluntarily in the German national nosocomial infections surveillance system "KISS" were included (a total of 99,230 operations).

Risk factors for the development of nosocomial pneumonia and mortality on intensive care units: application of competing risks models.

Introduction: Pneumonia is a very common nosocomial infection in intensive care units (ICUs). Many studies have investigated risk factors for the development of infection and its consequences. However, the evaluation in most of theses studies disregards the fact that there are additional competing events, such as discharge or death.

Transmission-associated nosocomial infections: prolongation of intensive care unit stay and risk factor analysis using multistate models.

Background: Almost all studies investigating prolongation of stay because of nosocomial infections (NI) took into account all cases of NI, regardless whether they were associated with transmission of nosocomial pathogens (and therefore preventable) or not. We investigated the prolongation of intensive care unit (ICU) length of stay (LOS) because of transmission-associated NI (TANI) in a prospective study on 5 ICUs with normal NI rates over an 18-month period.

Methods: All clinical isolates and nose swabs were collected at admission.

Antifungal use in intensive care units.

Objectives: To provide benchmarking data on antifungal use in intensive care units (ICUs), to analyse risk factors and to look for correlations with antibiotic use data and structure parameters.

Methods: Antimicrobial use data for 13 ICUs were obtained from computerized databases from January 2004 through June 2005. Antimicrobial usage density (AD) is expressed as daily defined doses/1000 patient-days.

Modified guidelines impact on antibiotic use and costs: duration of treatment for pneumonia in a neurosurgical ICU is reduced.

Objectives: To evaluate the impact of an intervention to reduce the duration of antibiotic treatment for pneumonia in a neurosurgical intensive care unit (ICU). The usage of antibiotics and the resultant costs were examined using interrupted time series analysis while resistance and device-associated infection rates are also described.

Methods: In January 2004, revised guidelines for the use of antibiotics were implemented.

Outbreaks in neonatal intensive care units - they are not like others.

Background: Outbreaks of health care-associated infections in neonatal intensive care units (NICUs) are frequent and have received more attention in medical literature than outbreaks from other types of intensive care units (ICUs). The objective of this systematic review was to identify differences between outbreaks of health care-associated infections in NICUs and other ICUs as reported to date in the medical literature.

Methods: Screening the outbreak database (http://www.

Usefulness of severity-of-illness scores based on admission data only in nosocomial infection surveillance systems.

Background: Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs).

Objective: To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI.

Development of a surveillance system for methicillin-resistant Staphylococcus aureus in German hospitals.

Objective: To determine the appropriate method to calculate the rate of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization (hereafter, MRSA rates) for interhospital comparisons, such that the large number of patients who are already MRSA positive on admission is taken into account.

Design: A prospective, multicenter, hospital-based surveillance of MRSA-positive case patients from January through December 2004.

Setting: Data from 31 hospitals participating in the German national nosocomial infections surveillance system (KISS) were recorded during routine surveillance by the infection control team at each hospital.

Where should one search when confronted with outbreaks of nosocomial infection?

The outbreak database (http://www.outbreak-database.com), containing 1561 records of nosocomial outbreaks published in the medical literature in a systematic format, was used to identify the most frequent outbreak sources for the entire database as well as for specific outbreak pathogens.

How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation.

A systematic search was performed to identify outbreaks of methicillin-resistant Staphylococcus aureus infection and colonization caused by healthcare workers (HCWs). Of 191 outbreaks identified, 11 had strong epidemiological evidence that HCWs were the source. In 3 of these outbreaks, asymptomatic carriers were the cause.

Compliance with antiseptic hand rub use in intensive care units: the Hawthorne effect.

Objective: To determine the influence the Hawthorne effect has on compliance with antiseptic hand rub (AHR) use among healthcare personnel.

Design: Observational study.

Setting: Five intensive care units of a university hospital in Berlin, Germany.

The influence of high-efficiency particulate air filtration on mortality and fungal infection among highly immunosuppressed patients: a systematic review.

Background: Patients with hematological malignancies who are treated with intensive chemotherapy or who receive bone marrow transplants are exposed to an increased risk of developing nosocomial fungal infections. The aim of this systematic review was to compare the effectiveness of high-efficiency particulate air (HEPA) filtration with that of non-HEPA filtration in decreasing the rates of mortality and fungal infection among patients with diagnosed hematological malignancies and neutropenia or among patients with bone marrow transplants.

Methods: Articles identified in a Medline search, guidelines, and books, as well as the bibliographies of review articles, monographs, and the articles identified by Medline, were researched.

Evaluation of six agglutination tests for Staphylococcus aureus identification depending upon local prevalence of meticillin-resistant S. aureus (MRSA).

Most routine laboratory detection of Staphylococcus aureus isolates is based on rapid agglutination test systems. Failure of agglutination assays to identify meticillin-resistant S. aureus strains (MRSA) has been demonstrated.

The burden of MRSA in four German university hospitals.

In the last few years, a dramatic increase of Methicillin-resistant Staphylococcus aureus (MRSA) detection in German hospitals can be recognized. Under this enormous pressure it is very important for infection control teams to assess the epidemiologic situation correctly. Therefore, a prospective multicenter hospital-based surveillance of MRSA cases was executed in four university hospitals with 1017-1333 beds in Germany.

How many infections are caused by patient-to-patient transmission in intensive care units?

Objective: The proportion of intensive care unit (ICU)-acquired infections that are a consequence of nosocomial cross-transmission between patients in tertiary ICUs is unknown. Such information would be useful for the implementation of appropriate infection control measures.

Design: A prospective cohort study during 18 months.

How outbreaks can contribute to prevention of nosocomial infection: analysis of 1,022 outbreaks.

Objective: To describe the epidemiology of nosocomial outbreaks published in the scientific literature.

Design: Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002.

Methods: Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database.

AMBU-KISS: quality control in ambulatory surgery.

Background: Cost-containment measures have led to a constant increase in the number of patients cared for as outpatients. Several studies have demonstrated that surgical site infections result in considerable morbidity and excess health care costs from extended duration of hospitalization and antibiotic use.

Objective: AMBU-KISS is a protocol designed to create a reference database on surgical site infections for institutions involved in ambulatory surgery.