P Gastmeier

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (448)873.08 Total impact

  • L A Denkel, P Gastmeier, R Leistner
    Infection 08/2014; · 2.44 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.
    Infection 08/2014; · 2.44 Impact Factor
  • American journal of infection control. 06/2014;
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    ABSTRACT: Prevention measures reduce central-line-associated bloodstream infections (CLABSIs) but are not always implemented.
    The Journal of hospital infection. 05/2014;
  • 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.
    European Journal of Intensive Care Medicine 05/2014; · 5.17 Impact Factor
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    ABSTRACT: Infections with multiresistant Gram negative pathogens are rising around the world, but many European countries have recently seen a decline in infections due to methicillin resistant Staphylococcus aureus (MRSA). We determined the percentage of nosocomial Staphylococcus aureus infections in Germany that were accounted for by MRSA in the past six years and looked for regional differences in the overall downward trend.
    Deutsches Ärzteblatt international. 05/2014; 111(19):331-6.
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    ABSTRACT: This study aimed to determine the prevalence of and risk factors for colonization with extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) and methicillin-resistant Staphylococcus aureus (MRSA) in very low birth weight (VLBW; <1500 g) infants and their mothers. This investigation was conducted in the perinatal centre at the Charité Berlin between May 2012 and June 2013. VLBW infants and their mothers were screened for colonization with ESBL-E and MRSA. Demographic and clinical data were obtained from the German nationwide surveillance system for nosocomial infections in VLBW infants (NEO-KISS) and used to perform univariate and multivariate analyses. Of 209 VLBW infants, 12 (5.7%) were colonized with ESBL-E. Eighteen of 209 (8.6%) ESBL-E-tested neonates were related to an ESBL-E-positive mother. Univariate analysis, strain typing and multivariate analysis (OR 7.4, 95% CI 2.1-26.7, P = 0.002) identified an ESBL-E-positive mother and maternal-neonatal transmission as a main source of colonization. The prevalence of MRSA was 2.3% (5 of 221) among VLBW infants. One of the 221 (0.5%) MRSA-tested neonates was related to an MRSA-positive mother. No risk factors for transmission of MRSA could be detected in this study. Our study demonstrated that maternal-neonatal transmission of ESBL-E from mother to child is an important risk factor for colonization of VLBW infants. As a consequence, routine ESBL-E screening of neonates and mothers should be considered as a means of reducing neonatal morbidity and mortality.
    Journal of Antimicrobial Chemotherapy 04/2014; · 5.34 Impact Factor
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    ABSTRACT: Among European countries, Germany has one of the highest proportions of vancomycin-resistant Enterococcus faecium bloodstream infections. The aim of this study was to investigate the development of vancomycin-resistant enterococci (VRE) in German hospitals and to consider the regional distribution of VRE in Germany. Data from three components of the German national nosocomial surveillance system (KISS) from the period 2007-12 were used for analysis: ICU-KISS data on nosocomial primary bloodstream infections and urinary tract infections from intensive care units (ICUs); OP-KISS data on surgical site infections from surgical departments; and Pathogen-KISS data concentrating on VRE cases (infections and colonizations) in ICUs. Trends over time were calculated and a map according to German federal states was prepared. Data from up to 645 ICUs and 681 surgical departments for 2 year periods from 2007 to 2012 were analysed. The proportion of VRE increased significantly for surgical site infections (526%; P < 0.01) and bloodstream infections (265%; P < 0.01) and non-significantly for urinary tract infections (278%; P = 0.07). A large subgroup of ICUs also reported VRE cases in the same period, with a significant increase of 282%. The mapping of federal states showed large variation in VRE proportions and incidence rates in a belt of states with significantly higher VRE proportions from west (North Rhine-Westphalia) to east (Saxony). The high overall VRE proportion in Germany is mainly due to the situation in four states. There is an urgent need to analyse the epidemiology of VRE in detail to develop appropriate infection control strategies.
    Journal of Antimicrobial Chemotherapy 03/2014; · 5.34 Impact Factor
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    ABSTRACT: The national German hand hygiene campaign is implementing the WHO patient safety initiative "Clean Care is Safer Care". After 6 years over 1400 health care institutions are participating in the campaign on a voluntary basis. The implementation of the multimodal intervention concept including improvement of alcohol based hand rub availability, the introduction of 2 surveillance methods and of the WHO "My 5 Moments of Hand Hygiene Model" in those health care facilities, participating for several years, increased median hand hygiene compliance by 11% and alcohol based hand rub availability by 61%.
    ains · Anästhesiologie · Intensivmedizin 01/2014; 49(1):30-4. · 0.39 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. 01/2014;
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    Frank Schwab, Petra Gastmeier, Elisabeth Meyer
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    ABSTRACT: We investigated the relationship between average monthly temperature and the most common clinical pathogens causing infections in intensive care patients. A prospective unit-based study in 73 German intensive care units located in 41 different hospitals and 31 different cities with total 188,949 pathogen isolates (102,377 Gram-positives and 86,572 Gram-negatives) from 2001 to 2012. We estimated the relationship between the number of clinical pathogens per month and the average temperature in the month of isolation and in the month prior to isolation while adjusting for confounders and long-term trends using time series analysis. Adjusted incidence rate ratios for temperature parameters were estimated based on generalized estimating equation models which account for clustering effects. The incidence density of Gram-negative pathogens was 15% (IRR 1.15, 95%CI 1.10-1.21) higher at temperatures ≥20°C than at temperatures below 5°C. E. cloacae occurred 43% (IRR = 1.43; 95%CI 1.31-1.56) more frequently at high temperatures, A. baumannii 37% (IRR = 1.37; 95%CI 1.11-1.69), S. maltophilia 32% (IRR = 1.32; 95%CI 1.12-1.57), K. pneumoniae 26% (IRR = 1.26; 95%CI 1.13-1.39), Citrobacter spp. 19% (IRR = 1.19; 95%CI 0.99-1.44) and coagulase-negative staphylococci 13% (IRR = 1.13; 95%CI 1.04-1.22). By contrast, S. pneumoniae 35% (IRR = 0.65; 95%CI 0.50-0.84) less frequently isolated at high temperatures. For each 5°C increase, we observed a 3% (IRR = 1.03; 95%CI 1.02-1.04) increase of Gram-negative pathogens. This increase was highest for A. baumannii with 8% (IRR = 1.08; 95%CI 1.05-1.12) followed by K. pneumoniae, Citrobacter spp. and E. cloacae with 7%. Clinical pathogens vary by incidence density with temperature. Significant higher incidence densities of Gram-negative pathogens were observed during summer whereas S. pneumoniae peaked in winter. There is increasing evidence that different seasonality due to physiologic changes underlies host susceptibility to different bacterial pathogens. Even if the underlying mechanisms are not yet clear, the temperature-dependent seasonality of pathogens has implications for infection control and study design.
    PLoS ONE 01/2014; 9(3):e91105. · 3.73 Impact Factor
  • Zeitschrift für Evidenz Fortbildung und Qualität im Gesundheitswesen 01/2014;
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    ABSTRACT: Background Prevention measures reduce central-line-associated bloodstream infections (CLABSI) 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 CLABSI 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. 01/2014;
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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. 01/2014;
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    ABSTRACT: The rate of infections due to extended-spectrum β-lactamase (ESBL)-producing Escherichia coli is growing worldwide. These infections are suspected to be related to increased mortality. We aimed to estimate the difference in mortality due to bloodstream infections (BSIs) with ESBL-positive and ESBL-negative E. coli isolates and to determine the molecular epidemiology of our ESBL-positive isolates. We performed a cohort study on consecutive patients with E. coli BSI between 2008 and 2010 at the Charité University Hospital. Collected data were ESBL production, basic demographic parameters, and underlying diseases by the Charlson comorbidity index (CCI). The presence of ESBL genes was analyzed by polymerase chain reaction (PCR) and sequencing. Phylogenetic groups of ESBL-positive E. coli were determined by PCR. Risk factors for mortality were analyzed by multivariable regression analysis. We identified 115 patients with BSI due to E. coli with ESBL phenotype and 983 due to ESBL-negative E. coli. Fifty-eight percent (n=67) of the ESBL-positive BSIs were hospital-acquired. Among the 99 isolates that were available for PCR screening and sequencing, we found mainly 87 CTX-M producers, with CTX-M-15 (n=55) and CTX-M-1 (n=21) as the most common types. Parameters significantly associated with mortality were age, CCI, and length of stay before and after onset of BSI. The most common ESBL genotypes in clinical isolates from E. coli BSIs were CTX-M-15 (58%) and CTX-M-1 (22%). ESBL production in clinical E. coli BSI isolates was not related to increased mortality. However, the common occurrence of hospital-acquired BSI due to ESBL-positive E. coli indicates future challenges for hospitals.
    Infection and Drug Resistance 01/2014; 7:57-62.
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    ABSTRACT: Background: Surgical site infections (SSI) are among the most frequent healthcare-associated infections. They impose a substantial burden with increased morbidity and exceeding healthcare costs. Risk factors such as age, diabetes, and smoking status are commonly accounted for in the literature, but few studies address gender differences. Methods: Data from the German Nosocomial Infections Surveillance System (Krankenhaus-Infektions-Surveillance-System (KISS)) from 2005 to 2010 were analysed for cardiac, vascular, visceral, and orthopaedic surgery, with a total of 438,050 surgical pro- cedures and 8,639 SSI. Rates of SSI and isolated pathogens were analysed for gender. Results: Women had a lower rate of SSI (SSI/100 procedures) in abdominal surgery than men (2.92 vs. 4.37; p < 0.001). No gender-specific differences were found in orthopaedic and vascular surgery, while women had a higher risk for SSI in cardiac surgery (5.50 vs. 3.02; p < 0.001). Isolated pathogens showed differences for sensitive Staphylococcus aureus and Pseudomonas aeruginosa, which were more frequent in women (both p = 0.007), while coagu- lase-negative staphylococci occurred more often in men (18.8 vs. 14.0%; p < 0.001). Conclusion: Gender differences in SSI exist and are procedure-specific. The underlying mechanisms need to be further elucidated so that targeted measures for the prevention of SSI can be developed.
    Viszeralmedizin / Visceral Medicine 01/2014; 30:4-4. · 0.07 Impact Factor
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    P Gastmeier, R-P Vonberg
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    ABSTRACT: Two endoscopy-associated nosocomial outbreaks caused by carbapenemase-producing Klebsiella pneumoniae (CPKP) were recently observed in two German hospitals. In this study, we performed a systematic search of the medical literature in order to elucidate the epidemiology of Klebsiella spp. in endoscopy-associated outbreaks. Medline, the Outbreak Database ( http://www.outbreak-database.com ) and reference lists of articles extracted from these databases were screened for descriptions of endoscopy-associated nosocomial outbreaks. The data extracted and analysed were: (1) the type of medical department affected; (2) characterisation of pathogen to species and conspicuous resistance patterns (if applicable); (3) type of endoscope and the grade of its contamination; (4) number and the types of infections; (5) actual cause of the outbreak. A total of seven nosocomial outbreaks were identified, of which six were outbreaks of endoscopic retrograde cholangiopancreatography-related infections and caused by contaminated duodenoscopes. Including our own outbreaks in the analysis, we identified one extended-spectrum beta-lactamase-producing K. pneumoniae strain and six CPKP strains. Insufficient reprocessing after the use of the endoscope was the main reason for subsequent pathogen transmission. There were only two reports of nosocomial outbreaks due to Klebsiella spp. in the first three decades of endoscopic procedures, but seven additional outbreaks of this kind have been reported within the last 4 years. It is very likely that many of such outbreaks have been missed in the past because this pathogen belongs to the physiological gut flora. However, with the emergence of highly resistant (carbapenemase-producing) strains, strict adherence to infection control guidelines is more important than ever.
    Infection 10/2013; · 2.44 Impact Factor
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    ABSTRACT: Little information is available on antibiotic prescription management in German hospitals. The objective of this cross-sectional study was to determine the prevalence and components of antibiotic stewardship measures in German intensive care units (ICUs). A questionnaire survey was sent to all ICUs participating in the German nosocomial infection surveillance system (n = 579) in October 2011. Data on antibiotic management structures were collected and analyzed by structural hospital and ICU factors. The questionnaire was completed by 355 German ICUs (response rate 61 %). Common measures used (>80 % of the ICUs) were personnel restrictions for antibiotic prescriptions, routine access to bacterial resistance data, and pharmacy reports on antibiotic costs and consumption. A small proportion of ICUs (14 %) employed physicians specialized in the prescription of antimicrobial medication. Hospitals with their own microbiological laboratory report participation in surveillance networks for antimicrobial use (34 %) and bacterial resistance (32 %) twice as often as hospitals with external laboratories (15 and 14 %, respectively, p < 0.001). Also, non-profit and public hospitals participate more often in surveillance networks for bacterial resistance than private hospitals (>23 % vs. 11 %, p < 0.05). While the majority of ICUs report to have some antibiotic policies established, the contents and composition of these policies vary. Organizational-level control strategies to improve antibiotic management are common in Germany. However, strategies widely considered effective, such as the systematic cross-institutional surveillance of antimicrobial use and bacterial resistance in a standardized manner or the employment of infectious disease specialists, are scarce. This study provides a benchmark for future antibiotic stewardship programs.
    Infection 10/2013; · 2.44 Impact Factor
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    ABSTRACT: After a single patient was transferred to Leipzig University Hospital from a hospital in Rhodes, Greece, the hospital experienced the largest outbreak due to a KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) strain thus far observed in Germany. Ninety patients hospitalised between July 2010 and October 2012 were affected. In an attempt to eliminate KPC-2-KP from their digestive tracts, 14 consecutive patients (16%) were treated with a short course (7 days) of selective digestive decontamination (SDD), employing colistin (1 million units q.i.d.) and gentamicin (80mg q.i.d.) as oral solutions, and applying colistin/gentamicin gel (0.5g) to the oral cavity. In a retrospective analysis, these 14 SDD patients were compared with the remaining 76 patients harbouring KPC-2-KP. KPC-2-KP carrier status was followed in all 14 SDD patients by submitting stool samples to KPC-specific PCR. The mean follow-up period was 48 days (range 12-103 days). Successful elimination of KPC-2-KP was defined as a minimum of three consecutive negative PCR test results separated by ≥48h each. Decolonisation of KPC-2-KP was achieved in 6/14 patients (43%) after a mean of 21 days (range 12-40 days), but was also observed in 23/76 (30%) of the non-SDD controls (P=0.102). SDD treatment resulted in the development of secondary resistance to colistin (19% increase in resistance rate) and gentamicin (45% increase) in post-treatment isolates. In the control group, no secondary resistance occurred. We conclude that the SDD protocol applied in this study was not sufficiently effective for decolonisation and was associated with resistance development.
    International journal of antimicrobial agents 09/2013; · 3.03 Impact Factor
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    ABSTRACT: In 2011, seventeen years after the first national study on the prevalence of nosocomial infections and antibiotic use in German hospitals, a second national prevalence study was carried out according to the specifications of the European Centre for Disease Prevention and Control (ECDC). The ECDC protocol, containing uniform surveillance definitions and ascertainment methods, was implemented. The only infections counted were those that were active or under treatment with antibiotics on the day of the study. In addition to the representative sample required by the ECDC, which consisted of 46 hospitals, further hospitals participated on a voluntary basis. Data on 41 539 patients in 132 hospitals were analyzed. The prevalence of infections that had arisen during the current hospital stay was 3.8% in the overall group and 3.4% in the representative sample of 9626 patients in 46 hospitals. The prevalence of all nosocomial infections, including those acquired before the current hospital stay and still present upon admission, was 5.1% in both the overall group and the representative sample. The prevalence of antibiotic use on the day of the study was 25.5% and 23.3% in the two groups, respectively. The prevalence of nosocomial infection has not changed since 1994, but the prevalence of antibiotic use has increased. In interpreting these findings, one should bear in mind that confounders may have influenced them in different directions: The mean length of hospital stay is now shorter than in 1994, but the mean age of hospitalized patients is higher.
    Deutsches Ärzteblatt International 09/2013; 110(38):627-33. · 3.54 Impact Factor

Publication Stats

5k Citations
873.08 Total Impact Points

Institutions

  • 1999–2014
    • Charité Universitätsmedizin Berlin
      • Institute of Hygiene and Environmental Medicine
      Berlín, Berlin, Germany
  • 2012
    • Universitätsklinikum Schleswig - Holstein
      Kiel, Schleswig-Holstein, Germany
  • 2011–2012
    • University of Cologne
      • Institute for Medical Microbiology, Immunology and Hygiene
      Köln, North Rhine-Westphalia, Germany
  • 2001–2012
    • Hannover Medical School
      • Institute for Medical Microbiology and Hospital Epidemiology
      Hannover, Lower Saxony, Germany
    • Hochschule Hannover
      Hanover, Lower Saxony, Germany
  • 1996–2012
    • Universitätsklinikum Freiburg
      • • Department of Environmental Health Sciences
      • • Institute of Medical Biometry and Statistics
      Freiburg, Lower Saxony, Germany
  • 2010
    • Universitätsklinikum Jena
      Jena, Thuringia, Germany
    • Robert Koch Institut
      • Department for Infectious Disease Epidemiology
      Berlín, Berlin, Germany
    • Universität Witten/Herdecke
      Witten, North Rhine-Westphalia, Germany
    • Friedrich-Schiller-University Jena
      • Department of Anaesthesiology and Intensive Care Medicine
      Jena, Thuringia, Germany
  • 2005–2010
    • Universitätsklinikum Dresden
      • Medizinische Klinik I
      Dresden, Saxony, Germany
  • 2009
    • Bode Chemie GmbH
      Hamburg, Hamburg, Germany
  • 1996–2009
    • University of Freiburg
      • Institute of Medical Biometry and Medical Informatics
      Freiburg, Lower Saxony, Germany
  • 2008
    • Universität zu Lübeck
      Lübeck Hansestadt, Schleswig-Holstein, Germany
  • 2007
    • Universitätsspital Basel
      Bâle, Basel-City, Switzerland
    • Claude Bernard University Lyon 1
      Villeurbanne, Rhône-Alpes, France
  • 2005–2007
    • National Institute for Public Health and the Environment (RIVM)
      • Centre for Infectious Disease Control (CIb)
      Utrecht, Utrecht, Netherlands
  • 1996–2004
    • Freie Universität Berlin
      • Institute of Institute of Food Hygiene
      Berlin, Land Berlin, Germany
  • 2002
    • University of Veterinary Medicine Hannover
      • Institute of Microbiology
      Hannover, Lower Saxony, Germany
  • 2000
    • Humboldt-Universität zu Berlin
      Berlín, Berlin, Germany