P Gastmeier

Charité Universitätsmedizin Berlin, Berlín, Berlin, Germany

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Publications (469)974.84 Total impact

  • [Show abstract] [Hide abstract]
    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; · 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; · 1.38 Impact Factor
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    ABSTRACT: 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.
    Infection 11/2014; · 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.
  • L A Denkel, P Gastmeier, R Leistner
    Infection 08/2014; · 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.
    Infection 08/2014; · 2.86 Impact Factor
  • American Journal of Infection Control 06/2014; · 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;
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    ABSTRACT: Prevention measures reduce central-line-associated bloodstream infections (CLABSIs) but are not always implemented.
    Journal of Hospital Infection 05/2014; · 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.
    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
  • Source
    Petra Gastmeier
    Frontiers in Microbiology 03/2014; 5:81. · 3.94 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 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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    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
  • Source
    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. · 3.53 Impact Factor

Publication Stats

5k Citations
974.84 Total Impact Points


  • 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