P Gastmeier

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (495)1022.82 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Carbapenemase-producing Enterobacteriaceae (CPE) have become a major problem for healthcare systems worldwide. While the first reports from European hospitals described the introduction of CPE from endemic countries, there is now a growing number of reports describing outbreaks of CPE in European hospitals. Here we report an outbreak of Carbapenem-resistant K. pneumoniae in a German University hospital which was in part associated to duodenoscopy. Between December 6, 2012 and January 10, 2013, carbapenem-resistant K. pneumoniae (CRKP) was cultured from 12 patients staying on 4 different wards. The amplification of carbapenemase genes by multiplex PCR showed presence of the bla OXA-48 gene. Molecular typing confirmed the identity of all 12 isolates. Reviewing the medical records of CRKP cases revealed that there was a spatial relationship between 6 of the cases which were located on the same wards. The remaining 6 cases were all related to endoscopic retrograde cholangiopancreatography (ERCP) which was performed with the same duodenoscope. The outbreak ended after the endoscope was sent to the manufacturer for maintenance. Though the outbreak strain was also disseminated to patients who did not undergo ERCP and environmental sources or medical personnel also contributed to the outbreak, the gut of colonized patients is the main source for CPE. Therefore, accurate and stringent reprocessing of endoscopic instruments is extremely important, which is especially true for more complex instruments like the duodenoscope (TJF Q180V series) involved in the outbreak described here.
    12/2015; 4(1). DOI:10.1186/s13756-015-0049-4
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    ABSTRACT: Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected. Copyright © 2015. Published by Elsevier GmbH.
    International journal of medical microbiology: IJMM 08/2015; DOI:10.1016/j.ijmm.2015.08.033 · 3.42 Impact Factor
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    ABSTRACT: Health care-associated infections by multidrug-resistant bacteria constitute one of the greatest challenges to modern medicine. Bacterial pathogens devise various mechanisms to withstand the activity of a wide range of antimicrobial compounds, among which the acquisition of carbapenemases is one of the most concerning. In Klebsiella pneumoniae the dissemination of the carbapenemase KPC is tightly connected to the global spread of certain clonal lineages. Although antibiotic resistance is a key driver for the global distribution of epidemic high-risk clones, there seem to be other adaptive traits that may explain their success. Here, we exploited the power of deep transcriptome profiling (RNA-seq) to shed light on the transcriptomic landscape of 37 clinical K. pneumoniae isolates of diverse phylogenetic origins. We identified a large set of 3346 genes which was expressed in all isolates. While the core-transcriptome profiles varied substantially between groups of different sequence types, they were more homogenous among isolates of the same sequence type. We furthermore linked the detailed information on differentially expressed genes with the clinically relevant phenotypes of biofilm formation and bacterial virulence. This allowed for the identification of a diminished expression of biofilm-specific genes within the low biofilm producing ST258 isolates as a sequence type-specific trait. This article is protected by copyright. All rights reserved.
    Environmental Microbiology 08/2015; DOI:10.1111/1462-2920.13016 · 6.24 Impact Factor
  • Journal of Antimicrobial Chemotherapy 07/2015; DOI:10.1093/jac/dkv219 · 5.44 Impact Factor
  • Petra Gastmeier · Christine Geffers
    Krankenhaushygiene up2date 04/2015; 8(01):41-47. DOI:10.1055/s-0034-1391963
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    ABSTRACT: OBJECTIVE To quantify the Hawthorne effect of hand hygiene performance among healthcare workers using direct observation. DESIGN Prospective observational study. SETTING Intensive care unit, university hospital. METHODS Direct observation of hand hygiene compliance over 48 audits of 2 hours each. Simultaneously, hand hygiene events (HHEs) were recorded using electronic alcohol-based handrub dispensers. Directly observed and electronically recorded HHEs during the 2 hours of direct observation were compared using Spearman correlations and Bland-Altman plots. To quantify the Hawthorne effect, we compared the number of electronically recorded HHEs during the direct observation periods with the re-scaled electronically recorded HHEs in the 6 remaining hours of the 8-hour working shift. RESULTS A total of 3,978 opportunities for hand hygiene were observed during the 96 hours of direct observation. Hand hygiene compliance was 51% (95% CI, 49%-53%). There was a strong positive correlation between directly observed compliance and electronically recorded HHEs (ρ=0.68 [95% CI, 0.49-0.81], P<.0001). In the 384 hours under surveillance, 4,180 HHEs were recorded by the electronic dispensers. Of those, 2,029 HHEs were recorded during the 96 hours in which direct observation was also performed, and 2,151 HHEs were performed in the remaining 288 hours of the same working shift that were not under direct observation. Healthcare workers performed 8 HHEs per hour when not under observation compared with 21 HHEs per hour during observation. CONCLUSIONS Directly and electronically observed HHEs were in agreement. We observed a marked influence of the Hawthorne effect on hand hygiene performance. Infect Control Hosp Epidemiol 2015;00(0):1-6.
    Infection Control and Hospital Epidemiology 04/2015; 36(08):1-6. DOI:10.1017/ice.2015.93 · 3.94 Impact Factor
  • Ralf-Peter Vonberg · Petra Gastmeier
    Infection Control and Hospital Epidemiology 03/2015; 36(07):1-2. DOI:10.1017/ice.2015.58 · 3.94 Impact Factor
  • C. Schröder · M. Behnke · P. Gastmeier · F. Schwab · C. Geffers
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    ABSTRACT: National surveillance systems depend on accurate and reproducible diagnosis of infections. To investigate the effect of accuracy of diagnosing healthcare-associated infections (HCAIs) on HCAI rates in a national healthcare-associated surveillance system. Data from the validation process from the intensive care unit (ICU) surveillance component of the German Krankenhaus Infektions Surveillance System (KISS; Hospital Infection Surveillance System) were used to calculate the accuracy of diagnosing HCAI for each individual surveillance person (SP) responsible for surveillance of HCAI in the ICU of his or her hospital. Multivariate analyses were performed to identify factors that were attributed to surveillance accuracy. A total of 189 SPs responsible for surveillance in 218 ICUs assessed 30 case vignettes. The chance of belonging to the group of SPs with high accuracy was increased by being a physician (odds ratio: 3.14; P = 0.02) and by being an external SP (odds ratio: 4.69; P ≤ 0.01). ICU HCAI rates depend on the sensitivity of the ICU's SP [incidence rate ratio (IRR): 1.28 (1.07, 1.53); P ≤ 0.01]. High sensitivity increases healthcare-associated urinary tract infection rates [IRR: 1.33 (1.02, 1.75); P = 0.03] and bloodstream infection rates [IRR: 1.33 (1.06, 1.68); P = 0.01]. High specificity was not a significant factor. In light of the link between sensitivity of diagnosing HCAI by case vignettes and the ICU HCAI rates, this validation method can be recommended for validation of other surveillance systems. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.
    Journal of Hospital Infection 02/2015; 90(4). DOI:10.1016/j.jhin.2015.01.014 · 2.78 Impact Factor
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    ABSTRACT: - Überarbeitete Handlungsempfehlung des AK Regionalanästhesie der Deutschen Gesellschaft für Anästhesiologie (DGAI) („Die 10 Gebote“)
    Anasthesiologie und Intensivmedizin 01/2015; 56:34-40. · 0.42 Impact Factor
  • Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 12/2014; 108(1). DOI:10.1016/j.zefq.2014.01.004
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    ABSTRACT: Early and appropriate blood culture sampling is recommended as standard of care in patients with suspected bloodstream infections (BSI), but is rarely taken into account when quality indicators for BSI are evaluated. To date, sampling of about 100-200 blood culture sets per 1,000 patient-days is recommended as the target range for blood culture rates. However, the empirical basis of this recommendation is not clear. The aim of the current study was to analyze the association between blood culture rates and observed BSI rates and to derive a reference threshold for blood culture rates in Intensive Care Units (ICUs). This study is based on data from 223 ICUs taking part in the German hospital infection surveillance system. We applied locally weighted regression and segmented Poisson regression to assess the association between blood culture rates and BSI rates. Below 80-90 blood culture sets per 1000 patient-days, observed BSI rates increased with increasing blood culture rates, while there was no further increase above this threshold. Segmented Poisson regression located the threshold at 87 (95% confidence interval 54-120) blood culture sets per 1000 patient-days. Only one third of the investigated ICUs displayed blood culture rates above this threshold. We provided empirical justification for a blood culture target threshold in ICUs. In the majority of the studied ICUs, blood culture sampling rates were below this threshold. This suggests that a substantial fraction of BSI cases might remain undetected; reporting observed BSI rates as a quality indicator without sufficiently high blood culture rates might be misleading. Copyright © 2014, American Society for Microbiology. All Rights Reserved.
    Journal of Clinical Microbiology 12/2014; 53(2). DOI:10.1128/JCM.02944-14 · 4.23 Impact Factor
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    ABSTRACT: The prevalence of extended-spectrum beta-lactamase (ESBL)-positive Klebsiella pneumoniae is growing worldwide. Infections with these bacteria are suspected to be related to increased mortality. We aimed to estimate the distribution of ESBL genotypes and to assess the impact on mortality associated with ESBL positivity in cases of bloodstream infection (BSI) due to K. pneumoniae. We performed a cohort study on patients with K. pneumoniae BSI between 2008 and 2011. Presence of ESBL genes was analyzed by PCR and sequencing. Risk factors for mortality were analyzed by Cox-proportional hazard regression. We identified 286 ESBL-negative (81%) and 66 (19%) ESBL-positive cases. 97% (n = 64) of the ESBL-positive isolates were susceptible for meropenem. The most common ESBL genotypes were CTX-M-15 (60%), SHV-5 (27%) and CTX-M-3 (5%). Significant risk factors for mortality were chronic pulmonary disease (HR 1.747) and moderate/severe renal disease (HR 2.572). ESBL positivity was not associated with increased mortality.
    Journal of Infection and Chemotherapy 12/2014; 20(12). DOI:10.1016/j.jiac.2014.08.012 · 1.38 Impact Factor
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    ABSTRACT: Purpose Standardized prevalence and incidence data on carbapenem-resistant organisms (CRO) and, as a relevant subgroup, carbapenem-resistant Enterobacteriaceae (CRE) are scarce. CRO-surveillance within the German nosocomial infection surveillance system (KISS) aims to provide epidemiological surveillance data on CRO colonizations and infections. Methods CRO-surveillance is part of a KISS-module for the surveillance of multidrug-resistant organisms (MDRO). MDRO-KISS methods require surveillance of all patients admitted to the ward and standardized documentation of imported and ICU-acquired cases. Data on all MDRO-carriers including colonization and infection with MDRO are collected. All presented data were routine data collected from January 1st 2013 until December 1st 2013 in accordance with the German Protection against Infection Act (IfSG). Results 341 ICUs submitted data on MDRO during the first year. In total, 5,171 cases of multidrug-resistant Gram-negative bacteria (MRGN) were identified. 848 were CRO (16 %). 325 CRO-cases were acquired within the ICU (38 %), and 373 CRO-patients had an infection (44 %). CRO-prevalence was 0.29 per 100 patients. Acquisition rate of MRGN was 1.32 per 1,000 patient days. This rate is more than doubled the acquisition rates of other MDRO under surveillance within MDRO-KISS (0.57 MRSA, 0.49 VRE). CRO-acquisition rate was 0.3 per 1,000 patient days. Incidence density of MRGN infections bacteria was 0.58 per 1,000 patient days (CRO 0.15/1,000 patient days). Conclusions To date, CRO are common in German ICUs and the relatively large proportions of ICU-acquired CRO and infections emphasize their potential to cause outbreaks. High MRGN infection rates and high ESBL prevalence data from clinical studies suggest a lack of MRGN identification in asymptomatic carriers.
    Infection 11/2014; 43(2). DOI:10.1007/s15010-014-0701-6 · 2.86 Impact Factor
  • P Bischoff · C Geffers · P Gastmeier
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    ABSTRACT: Medical personnel in intensive care units (ICU) deal with critically ill patients and a high work load. Patients face a higher risk of acquiring a nosocomial infection during their ICU stay. Especially, invasively ventilated patients are threatened. A catheter-related bloodstream infection might even lead to more severe complications. The number of multiresistant pathogens continues to rise; thus, comprehensive infection control measures are crucial to avoid pathogen transmission and infection. The most important measure is hand disinfection. With a proper personnel-patient ratio, educational programs, and infection control bundles, it is possible to reduce infection rates and enhance compliance among health care workers.
    Medizinische Klinik - Intensivmedizin und Notfallmedizin 11/2014; 109(8):627-39. DOI:10.1007/s00063-014-0438-0 · 0.42 Impact Factor
  • L A Denkel · P Gastmeier · R Leistner
    Infection 08/2014; 42(5). DOI:10.1007/s15010-014-0680-7 · 2.86 Impact Factor
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    ABSTRACT: 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. 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. 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. 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.
    Infection 08/2014; 42(6). DOI:10.1007/s15010-014-0670-9 · 2.86 Impact Factor
  • American Journal of Infection Control 06/2014; 42(8). DOI:10.1016/j.ajic.2014.04.022 · 2.33 Impact Factor
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    ABSTRACT: The prevalence of infections with extended-spectrum β-lactamase (ESBL)-producing bacteria is increasing worldwide. The economic burden of this development has not yet been sufficiently studied. Therefore, this study on hospital costs and length of stay (LoS) associated with cases of bloodstream infection (BSI) due to ESBL-producing Escherichia coli was performed. A matched case–control study of patients with E. coli BSI between 2008 and 2010 in Charité University Hospital (Berlin, Germany) was performed. Cases were patients with ESBL-producing E. coli BSI and controls were patients with ESBL-negative E. coli BSI. Cases and controls were matched in a 1:1 ratio by age ±5 years, sex, underlying co-morbidities, LoS before BSI onset, and discharge year. In total, 1098 consecutive patients with E. coli BSI were identified, comprising 115 (10.5%) ESBL-positive and 983 (89.5%) ESBL-negative. Of the 115 ESBL-positive infections 67 (58.3%) were hospital-acquired in contrast to 382/983 (38.9%) of the ESBL-negative infections (P < 0.001). After matching for confounders, there were no significant differences in costs, LoS or mortality between ESBL-positive and ESBL-negative E. coli BSIs. In conclusion, patients with BSI due to ESBL-producing E. coli were neither more costly nor stayed longer in the hospital than patients with BSI due to ESBL-negative E. coli.
    Journal of Global Antimicrobial Resistance 06/2014; 2(2). DOI:10.1016/j.jgar.2014.01.005
  • S Hansen · F Schwab · S Schneider · D Sohr · P Gastmeier · C Geffers
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    ABSTRACT: Background: Prevention measures reduce central-line-associated bloodstream infections (CLABSIs) but are not always implemented. Aim: To investigate the effect of a central educational programme in German intensive care units (ICUs) on CLABSI rates. Methods: Thirty-two German ICUs with CLABSI rates greater than or equal to the national average were compared with two control groups containing 277 and 67 ICUs. Processes and CLABSI rates were surveyed before, during and two years after the implementation of a year-long intervention programme. Segmented regression analysis of interrupted time series using generalized linear models was performed to estimate the association between the number of CLABSIs per month and time, intervention and other confounders, with the clustering effect within an ICU taken into account. Findings: In total, 508 cases of CLABSI were observed over 266,471 central line (CL)-days. At baseline, the pooled mean CLABSI rate was 2.29 per 1000 CL-days, and this decreased significantly to 1.64 per 1000 CL-days in the follow-up period. Compared with baseline, the relative risk for CLABSI was 0.88 [95% confidence interval (CI) 0.70-1.11] for the intervention period and 0.72 (95% CI 0.58-0.88) for the follow-up period. No changes were observed in either control group. Following successful implementation of the programme, ICUs showed a significant decrease in CLABSI rates. Although rates were already decreasing prior to implementation of the intervention, the invitation to participate in the study, and increased general awareness of CLABSI prevention through use of the comprehensive multi-modal training materials may have had a beneficial effect on practice.
    Journal of Hospital Infection 05/2014; 87(4). DOI:10.1016/j.jhin.2014.04.010 · 2.78 Impact Factor
  • Jan Beyersmann · Petra Gastmeier · Martin Schumacher
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    ABSTRACT: Incidence of ICU events is mostly measured in one of two ways which differ by the denominator only. Either the number of incident events divided by the number of ICU patients is reported or the number of incident events per 1,000 ICU days is calculated. The difference is relevant, but a connection is rarely made. We give an example where pneumonia diagnosis on admission has no effect on one measure of mortality incidence, but increases the other. We demonstrate how to connect the two measures of incidence. The conclusion is that so-called 'competing incidences' should also be reported.
    Intensive Care Medicine 05/2014; 40(6). DOI:10.1007/s00134-014-3279-7 · 7.21 Impact Factor

Publication Stats

7k Citations
1,022.82 Total Impact Points


  • 1999–2015
    • Charité Universitätsmedizin Berlin
      • Institute of Hygiene and Environmental Medicine
      Berlín, Berlin, Germany
  • 2014
    • Universität Ulm
      • Institute of Solid State Physics
      Ulm, Baden-Württemberg, Germany
  • 2001–2011
    • Hannover Medical School
      • Institute for Medical Microbiology and Hospital Epidemiology
      Hanover, Lower Saxony, Germany
    • Hochschule Hannover
      Hanover, Lower Saxony, Germany
    • University Hospital RWTH Aachen
      • Department of Neurology
      Aachen, North Rhine-Westphalia, Germany
  • 2009
    • Universitätsklinikum Dresden
      • Medizinische Klinik I
      Dresden, Saxony, Germany
  • 2008
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
  • 1996–2008
    • Universitätsklinikum Freiburg
      • Department of Environmental Health Sciences
      Freiburg, Lower Saxony, Germany
  • 2007
    • National Institute for Public Health and the Environment (RIVM)
      • Centre for Infectious Disease Control (CIb)
      Utrecht, Utrecht, Netherlands
    • Belgian Scientific Institute for Public Health
      Bruxelles, Brussels Capital, Belgium
  • 2000–2007
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany
  • 2006
    • University of Veterinary Medicine Hannover
      Hanover, Lower Saxony, Germany
    • University of Leeds
      Leeds, England, United Kingdom
  • 1996–2006
    • University of Freiburg
      • Institute of Medical Biometry and Medical Informatics
      Freiburg, Baden-Württemberg, Germany
  • 2003
    • Hanover Hospital
      Хановер, Pennsylvania, United States
  • 1996–2002
    • Freie Universität Berlin
      • Institute of Institute of Food Hygiene
      Berlín, Berlin, Germany