Hostname: page-component-6766d58669-kl59c Total loading time: 0 Render date: 2026-05-20T13:15:20.375Z Has data issue: false hasContentIssue false
  • English
  • Français

High Level of Gastrointestinal Nosocomial Infections in the German Surveillance System, 2002–2008

Published online by Cambridge University Press:  02 January 2015

Michaela Spackova ,
Doris Altmann ,
Tim Eckmanns ,
Judith Koch  and
Gerard Krause
Michaela Spackova*
Affiliation:
European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
Doris Altmann
Affiliation:
Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
Tim Eckmanns
Affiliation:
Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
Judith Koch
Affiliation:
Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
Gerard Krause
Affiliation:
Robert Koch Institute, Department of Infectious Disease Epidemiology, Berlin, Germany
*
Robert Koch Institute, Department of Infectious Disease Epidemiology, DGZ Ring 1, 13086 Berlin, Germany, (spackova.michaela@gmail.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

Surveillance of nosocomial infections (NIs) is well established in many countries but often does not include gastrointestinal infections. We sought to determine the proportion of NIs among all hospitalized cases for the 4 most prevalent types of gastrointestinal infections in Germany.

Methods.

We analyzed all notifications of laboratory-confirmed or epidemiologically linked gastrointestinal infections due to norovirus, rotavirus, Salmonella species, and Campylobacter species reported to the Robert Koch Institute in Berlin, Germany, from 2002 through 2008. Infections were considered nosocomial if disease onset was more than 2 days after hospitalization for norovirus, rotavirus, and Salmonella infection and more than 5 days after hospitalization for Campylobacter infection.

Results.

During the study period, 710,725 norovirus, 394,500 rotavirus, 395,736 Salmonella, and 405,234 Campylobacter gastrointestinal infections were reported. Excluding cases for which nosocomial status could not be determined, we identified 39,424 (49%) of 80,650 norovirus, 11,592 (14%) of 83,451 rotavirus, 3,432 (8%) of 43,348 Salmonella, and 645 (2%) of 33,503 Campylobacter gastrointestinal infections as definite nosocomial cases. Multivariate analysis confirmed higher risk of gastrointestinal NIs for patients aged more than 70 years (relative risk [RR], 7.0 [95% confidence interval {CI}, 6.7–7.2]; P < .001) and residents of western states (RR, 1.3 [95% CI, 1.2–1.3]; P < .001) and lower risk for female patients (RR, 0.9 [95% CI, 0.9–0.9; P < .001). Yearly NI proportions remained stable except for norovirus.

Conclusions.

The investigated gastrointestinal NIs in Germany do not show a clear trend, but they are at high level, revealing potential for public health action and improvement of hospital infection control mainly among older patients. National prevalence studies on gastrointestinal NIs would be of additional value to give more insight on how and where to improve hospital infection control.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 12 , December 2010 , pp. 1273 - 1278
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

1.Ducei, G, Fabry, J, Nicolle, L, eds. Prevention of hospital-acquired infections: a practical guide. 2nd ed. WHO document WHO/CDS/CSR/EPH/2002.12. World Health Organization (WHO) website, http://www.who.int/csr/resources/publications/whocdscsreph200212.pdf. Published 2002. Accessed October 28, 2010.Google Scholar
2.Garner, JS, larvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988 [published correction appears in Am J Infect Control 1988;16(4):177]. Am J Infect Control 1988;16(3):128-140.Google Scholar
3.Gastmeier, P, Kampf, G, Wischnewski, N, et al.Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 1998;38(1):37–49.CrossRefGoogle ScholarPubMed
4.Lizioli, A, Privitera, G, Alliata, E, et al.Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. J Hosp Infect 2003;54(2):141–148.CrossRefGoogle ScholarPubMed
5.Starakis, I, Marangos, M, Gikas, A, Pediaditis, I, Bassaris, H. Repeated point prevalence survey of nosocomial infections in a Greek university hospital. J Chemother 2002;14(3):272–278.CrossRefGoogle Scholar
6.Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. J Hosp Infect 2000;46(3):186–193.CrossRefGoogle Scholar
7.Faensen, D, Claus, H, Benzler, J, et al.SurvNet@RKI: a multistate electronic reporting system for communicable diseases. Euro Surveill 2006; 11 (4): 100–103.CrossRefGoogle ScholarPubMed
8.Krause, G, Brodhun, B, Altmann, D, Claus, H, Benzler, J. Reliability of case definitions for public health surveillance assessed by round-robin test methodology. BMC Public Health 2006;6:129.Google Scholar
9.Kaplan, JE, Gary, GW, Baron, RC, et al.Epidemiology of Norwalk gastroenteritis and the role of Norwalk virus in outbreaks of acute nonbacterial gastroenteritis. Ann Intern Med 1982;96(6 pt 1):756–761.Google Scholar
10.Hedberg, CW, Osterholm, MT. Outbreaks of food-borne and waterborne viral gastroenteritis. Clin Microbiol Rev 1993;6(3):199–210.Google Scholar
11.Gray, J, Vesikari, T, Van, DP, et al.Rotavirus. J Pediatr Gastroenterol Nutr 2008;46 (suppl 2):S24–S31.Google Scholar
12.Glynn, JR, Palmer, SR. Incubation period, severity of disease, and infecting dose: evidence from a Salmonella outbreak. Am J Epidemiol 1992;136(11):1369–1377.Google Scholar
13.Skirrow, MB. Campylobacter. Lancet 1990;336(8720):921–923.Google Scholar
14.Gleizes, O, Desselberger, U, Tatochenko, V, et al.Nosocomial rotavirus infection in European countries: a review of the epidemiology, severity and economic burden of hospital-acquired rotavirus disease. Pediatr Infect Dis J 2006;25(suppl 1):S12–S21.Google Scholar
15.The Paediatric Rotavirus European Committee (PROTECT). The pae-diatric burden of rotavirus disease in Europe. Epidemiol Infect 2006;134(5): 908–916.Google Scholar
16.Fischer, TK, Bresee, JS, Glass, RI. Rotavirus vaccines and the prevention of hospital-acquired diarrhea in children. Vaccine 2004;22(suppl 1):S49–S54.Google Scholar
17.Ford-Iones, EL, Mindorff, CM, Gold, R, Petrie, M. The incidence of viral-associated diarrhea after admission to a pediatric hospital. Am J Epidemiol 1990;131(4):711–718.Google Scholar
18.Rockx, B, De, WM, Vennema, H, et al.Natural history of human calicivirus infection: a prospective cohort study. Clin Infect Dis 2002;35(3):246–253.Google Scholar
19.Dedman, D, Laurichesse, H, Caul, EO, Wall, PG. Surveillance of small round structured virus (SRSV) infection in England and Wales, 19905. Epidemiol Infect 1998;121(1):139–149.Google Scholar
20.Greenberg, HB, Valdesuso, J, Kapikian, AZ, et al.Prevalence of antibody to the Norwalk virus in various countries. Infect Immun 1979;26(1):270–273.Google Scholar
21.Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2008. Berlin, Germany: Robert Koch-Institute, 2009. Available at: http://www.gapinfo.de/gesundheitsamt/alle/technik/dowload/seuche/allg/infepiJb/Jahrbuch_2008.pdf. Accessed October 29, 2010.Google Scholar
22.Siebenga, JJ, Vennema, H, Zheng, DP, et al.Norovirus illness is a global problem: emergence and spread of norovirus GII.4 variants, 2001-2007. J Infect Dis 2009;200(5):802–812.Google Scholar
23.Kroneman, A, Vennema, H, Harris, J, et al.Increase in norovirus activity reported in Europe. Euro Surveill 2006;11(12):E061214.Google ScholarPubMed
24.Koch, J, Schneider, T, Stark, K, Schreier, E. Norovirus infections in Germany [in German]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006;49(3):296–309.CrossRefGoogle ScholarPubMed
25.Ward, RL, Bernstein, DI, Knowlton, DR, et al.Prevention of surface-tohuman transmission of rotaviruses by treatment with disinfectant spray. J Clin Microbiol 1991;29(9):1991–1996.Google Scholar
26.Zerr, DM, Allpress, AL, Heath, J, Bornemann, R, Bennett, E. Decreasing hospital-associated rotavirus infection: a multidisciplinary hand hygiene campaign in a children's hospital. Pediatr Infect Dis J 2005;24(5):397–403.Google Scholar
27.Ebnöther, C, Tanner, B, Schmid, F, La Rocca, V, Heinzer, I, Bregenzer, T. Impact of an infection control program on the prevalence of nosocomial infections at a tertiary care center in Switzerland. Infect Control Hosp Epidemiol 2008;29(1):38–43.Google Scholar
28.Chadwick, PR, Beards, G, Brown, D, et al.Management of hospital outbreaks of gastro-enteritis due to small roundstructured viruses. J Hosp Infect 2000;45(1):1–10.Google Scholar
29.Barker, J, Vipond, IB, Bloomfield, SF. Effects of cleaning and disinfection in reducing the spread of norovirus contamination via environmental surfaces. J Hosp Infect 2004;58(1):42–49.Google Scholar
30.Gallimore, CI, Cubitt, D, du, PN, Gray, JJ. Asymptomatic and symptomatic excretion of noroviruses during a hospital outbreak of gastroenteritis. J Clin Microbiol 2004;42(5):2271–2274.Google Scholar
31.Koopmans, M. Noroviruses in healthcare settings: a challenging problem. J Hosp Infect 2009;73(4):331–337.Google Scholar