W V Kern

Universitätsklinikum Freiburg, Freiburg an der Elbe, Lower Saxony, Germany

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Publications (127)291.41 Total impact

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    ABSTRACT: Prescription of third-generation cephalosporins and fluoroquinolones has been linked to an increasing incidence of gram-negative bacteria producing extended-spectrum beta-lactamases, methicillin-resistant Staphylococcus aureus and nosocomial infection with Clostridium difficile. Antibiotic stewardship (ABS) programmes offer evidence-based tools to control antibiotic prescription rates and thereby influence the incidence of nosocomial infection and contain the development of multidrug-resistant bacteria, but there is limited experience with such programmes at community hospitals.
    Infection 10/2014; DOI:10.1007/s15010-014-0693-2 · 2.86 Impact Factor
  • DMW - Deutsche Medizinische Wochenschrift 10/2014; 139(40):1999-2002. DOI:10.1055/s-0034-1387287 · 0.55 Impact Factor
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    ABSTRACT: Sunday , 07 September 2014 Hall B2-29 Session 109 12:50-14:40 TP Thematic Poster Session : The epidemiology of respiratory infections and lung cancer P1066 Annual prevalence and treatment estimates of nontuberculous mycobacterial pulmonary disease in Europe: A NTM-NET collaborative study Background: The prevalence of nontuberculous mycobacterial pulmonary disease (NTMPD) has been increasing in Europe; yet, comprehensive analyses and reliable estimates on treatment practices are lacking. We developed methods to assess annual prevalence, and used chart audits to evaluate treatment practices in 5 European countries (EU5): United Kingdom (UK), France, Germany, Italy, and Spain. Methods: NTMPD patients diagnosed annually was estimated by a 2-round Delphi method. A representative sample of physicians extracted treatment information from records of NTMPD patients with a confirmed diagnosis of Mycobacterium avium complex (MAC) or M. abscessus pulmonary disease. Results: Approximately 88% of all physicians contacted and 62% (446) with qualified patients participated. Pulmonologists made up the largest group of study physicians (Italy 17%, UK 38%). In EU5 most NTMPD patients are male (73%) and have a history of smoking (75%); COPD is the most common comorbidity (33%). MAC was the predominant species reported (79%). NTMPD estimated annual prevalence in EU5 ranged from 5.9 (Spain) to 6.5/100,000 (UK). A wide regional heterogeneity within countries was noted, particularly in France (Parisian region [13.6/100,000] vs Southwest region [1.3/100,000]). Logistic regression analysis showed that the decision to treat was most dependent on country (odds ratio = 6.2, Spain vs France) and severity of presenting symptoms (odds ratio = 1.9, severe vs mild). Conclusions: Annual prevalence of NTMPD is uniform on a per capita basis in EU5, but heterogeneous within different regions. The percentage of patients treated varies widely by country and severity.
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    Congress for Infectious Disease and Tropical Medicine, Cologne, Germany; 06/2014
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    ABSTRACT: Simple, valid, and evidence-based indicators to measure the quality of antimicrobial prescribing in acute-care hospitals are urgently needed and increasingly requested by policymakers. The aim of this study was to develop new consensus quality indicators (QIs) for hospital antibiotic stewardship (ABS) and infection management which will be further evaluated for internal quality management and external quality assessment in Germany. Based on an extensive literature review, the Austrian-German hospital ABS Guideline Committee and selected members of the German ABS Expert Network discussed and drafted a list of 99 potential indicators for hospitals that reflect structural prerequisites for ABS (35 items), ABS core activities (18 items), additional ABS measures (5 items), and process of care indicators (both generic and disease-specific-12 and 29 items, respectively). Questionnaires were mailed to German ABS experts and healthcare professionals with further education in ABS. Participants scored (on a nine-point Likert scale) relevance (clinical, ecological/resistance, economical/expenses) and presumed practicability (six categories: clarity of definition, effort to collect data, barrier to implementation, verifiability, suitability for external quality assessment, quality gap), taking into account their local work environment. The scores were processed according to the RAND/UCLA appropriateness method, and QIs were judged relevant if the median (clinical + ecological and/or economical) scores were >6. The indicators thus assessed to be potentially relevant were then filtered according to their practicability. Highly relevant QIs with borderline practicability scores and items with disagreements and overlapping areas were re-discussed in a final multidisciplinary panel consensus workshop convened in November 2012. Of the 340 questionnaires that were mailed, 75 questionnaires were completed and returned. Of 99 initially proposed items, 32 were excluded due to insufficient scores. Of the remaining 67 items, 21 structural and 21 process of care QIs were finally selected, including four QIs with high clinical and ecological but limited economical relevance, and three QIs with high clinical and economical but limited ecological relevance. Among the selected QIs, efforts to collect data and implementation barriers were scored as suboptimal in many cases. A catalog of consensus structural and process of care ABS-QIs was established. These should undergo further pilot and feasibility studies in the German hospital healthcare sector. The panelists were most critical regarding resource use/complexity issues and presumed implementation barriers. How this may limit applicability of QIs remains to be determined.
    Infection 12/2013; 42(2). DOI:10.1007/s15010-013-0559-z · 2.86 Impact Factor
  • H Stocker, W V Kern
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    ABSTRACT: Owing to its activity against multidrug-resistant gram-negative bacteria, colistin (like other older antibiotics) is experiencing a surprising resurgence. In the 50 years following its discovery, little effort was put into studying its dosing and pharmacodynamic properties. Recent data have been filling the gaps, and individualized dosing recommendations targeting an optimal AUC/MIC ratio have been published. According to these data, pharmacokinetic targets will clearly be missed without exceeding the currently recommended dosages. Even the highest doses studied so far do not universally result in sufficient drug levels. Therefore, colistin remains a last-resort drug which should be used in combination with other antibiotics only. Regardless of the presence of resistance, carbapenems seem to be the most promising combination partners.
    Der Internist 07/2013; 54(8). DOI:10.1007/s00108-012-3141-3 · 0.27 Impact Factor
  • Der Internist 07/2013; 54(8). DOI:10.1007/s00108-012-3138-y · 0.27 Impact Factor
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    ABSTRACT: Nach der Neufassung des § 23 Abs. 4 Infektionsschutzgesetz (IfSG, Juli 2011) besteht für Krankenhäuser und Einrichtungen für ambulantes Operieren die Verpflichtung, eine kontinuierliche Überwachung des Antibiotika-Verbrauchs zu etablieren. Dies soll dazu beitragen, den Einsatz von Antibiotika zu optimieren und somit der Entwicklung und Ausbreitung von resistenten Erregern entgegenzuwirken. Das Robert Koch-Institut (RKI) hat nach § 4 Abs. 2 Nr. 2b IfSG die Aufgabe, Art und Umfang der zu erfassenden Daten festzulegen. Im vorliegenden Beitrag werden die nach Diskussion mit Vertretern verschiedener Fachgesellschaften entstandenen Vorgaben des RKI, die unter dem Titel „Festlegung der Daten zu Art und Umfang des Antibiotika-Verbrauchs in Krankenhäusern nach § 23 Abs. 4 Satz 2 IfSG“ veröffentlicht wurden, näher ausgeführt und erläutert (Robert Koch-Institut, Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 59, 2013). Im Sinne eines möglichst einheitlichen Vorgehens folgt die Erfassung des Antibiotika-Verbrauchs methodisch dem Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD)-Klassifikations-System der WHO, das in nationalen und europäischen Surveillance-Systemen standardmäßig genutzt wird. Zielgröße ist die Antibiotika-Verbrauchsdichte, d. h. die Menge des Antibiotika-Verbrauchs in definierten Tagesdosen (DDD) bezogen auf 100 Patiententage bzw. Fälle. Es wird festgelegt, welche Antiinfektiva in die Surveillance einbezogen werden sollen, für welche Krankenhausorganisationseinheiten die Verbrauchsdichten kalkuliert und in welchen zeitlichen Intervallen die Analysen durchgeführt werden sollen. Darüber hinaus werden Möglichkeiten der Bewertung von Antibiotika-Verbrauchsdaten aufgezeigt.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 07/2013; 56(7). DOI:10.1007/s00103-013-1764-8 · 1.01 Impact Factor
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    ABSTRACT: According to § 23 paragraph 4 of the German Infection Prevention Act (IfSG; July 2011), hospitals and clinics for ambulatory surgery are obliged to establish a continuous monitoring system of antibiotic consumption. This is aimed at contributing to an optimization of antibiotic prescription practices in order to confine the development and spread of resistant pathogens. The general requirements (restricted to hospitals) on the method and extent of data collection are provided by the national public health institution after discussion with representatives of various professional societies (Robert Koch-Institut, Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 59, 2013). The article aims to clarify these specifications and to provide background details. In agreement with national and European surveillance systems, the Anatomical Therapeutic Chemical (ATC)/Defined Daily Dose (DDD) classification system recommended by the WHO should be used as reference standard. Antibiotic consumption should be expressed as the number of DDDs per 100 patient days and per 100 admissions. The categories of antimicrobials and hospital organizational units to be monitored and the time intervals in which analyses should be conducted are determined. Furthermore, various approaches of data assessment are described.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 07/2013; 56(7):903-912. · 1.01 Impact Factor
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    ABSTRACT: Antimicrobial peptides are an integral part of innate immunity, and contribute to the protection of human skin from Staphylococcus aureus colonization and infection. We sought to investigate whether the expression of the eccrine sweat-derived staphylocidal antimicrobial peptide dermcidin might influence S. aureus colonization or recurrent skin and soft-tissue infections (SSTIs). Eccrine sweat was collected from 18 patients with recurrent S. aureus SSTIs, 28 patients who were intermittent or permanent S. aureus carriers, and 32 noncarriers. Expression and proteolytic degradation of dermcidin was investigated using ELISA and surface-enhanced laser desorption ionization time-of-flight mass spectrometry (SELDI-TOF-MS). We found no significant differences in the overall amount or the proteolytic degradation pattern of dermcidin-derived peptides between healthy noncarriers, intermittent and permanent carriers, and patients with recurrent S. aureus SSTIs. S. aureus colonization or recurrent SSTIs do not seem to be associated with diminished dermcidin expression in eccrine sweat.
    Clinical and Experimental Dermatology 06/2013; 39(2). DOI:10.1111/ced.12189 · 1.23 Impact Factor
  • W V Kern
    DMW - Deutsche Medizinische Wochenschrift 06/2013; 138(23):1217-1220. DOI:10.1055/s-0033-1343228 · 0.55 Impact Factor
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    ABSTRACT: Bakteriämie und Sepsis stellen im klinischen Alltag ein häufiges Problem dar. Von einer Bakteriämie spricht man bei kulturellem Nachweis von Bakterien im Blut. Es handelt sich um einen mikrobiologischen Befund, nicht um eine Diagnose. Die Sepsis dagegen ist eine klinische Diagnose, die weiter spezifiziert werden muss, wobei Kliniker, Epidemiologen und Mikrobiologen weiterhin unterschiedliche Definitionen und Terminologien verwenden. Diese Unterschiede zu kennen, ist für das Studium der Literatur und die Einordnung von Ergebnissen unabdingbar. Epidemiologische Studien belegen eine europaweite Zunahme der Bakteriämierate, sowohl im grampositiven als auch im gramnegativen Bereich. Die Ursache wird in der Zunahme der invasiven Diagnostik und Therapie bei gleichzeitig zunehmend multimorbiden und älter werdenden Patienten vermutet. Der vorliegende Beitrag liefert eine aktuelle Übersicht über wichtige diagnostische und therapeutische Aspekte der Sepsis und Bakteriämie.
    Der Internist 04/2013; 54(4). DOI:10.1007/s00108-012-3185-4 · 0.27 Impact Factor
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    ABSTRACT: OBJECTIVES: Early broad-spectrum antimicrobial treatment reduces mortality in patients with septic shock. In a multicenter, prospective observational study, we explored whether delayed appropriate antimicrobial therapy (AAT) influences outcome in Staphylococcus aureus bloodstream infection (SAB). METHODS: Two hundred and fifty-six patients with SAB from ten German study centers were enrolled and followed for 3 months. Predisposing factors, clinical features, diagnostic procedures, antimicrobial therapy, and outcome were recorded. The appropriateness of antimicrobial therapy was judged by a trained physician based on in vitro activity, dosage, and duration of therapy. Therapy was considered to be delayed when more than 24 h elapsed between the first positive blood culture and the start of appropriate therapy. The association of delayed therapy with overall mortality and SAB-related events (i.e., attributable mortality or late SAB-related complications) was assessed by crosstabulation and propensity score-based logistic regression. RESULTS: One hundred and sixty-eight patients received AAT during their hospital stay, of whom 42 (25 %) received delayed AAT. The overall mortality and the occurrence of severe sepsis or septic shock were lower in patients with delayed AAT, pointing towards confounding by indication. Adjusted 90-day mortality (adjusted odds ratio [OR] 0.91, 95 % confidence interval [CI] [0.39-2.13], p 0.82) and SAB-related events (adjusted OR 1.46, 95 % CI [0.47-4.51], p 0.52) also failed to show a significant impact of delayed AAT on outcome. CONCLUSION: In patients with SAB, early AAT may not improve survival. However, confounding by indication is a major challenge when analyzing and interpreting observational studies on the impact of delayed AAT.
    Infection 03/2013; 41(5). DOI:10.1007/s15010-013-0428-9 · 2.86 Impact Factor
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    ABSTRACT: Bacteremia and sepsis are common problems in clinical practice. Bacteremia is the presence of bacteria in the blood, hence a microbiological finding. Sepsis is a clinical diagnosis needing further specification regarding focus of infection and etiologic pathogen, whereupon clinicians, epidemiologists and microbiologists apply different definitions and terminology. Knowing these differences is important when reading and interpreting the literature. Studies show a pan-European increase in the rate of bacteremia, both Gram-negative and Gram-positive. Reasons for this are an increase in invasive diagnostics and therapy, going along with increasing age of patients. Bacteremic infections are frequently healthcare related. This article illustrates recent aspects in diagnosis and therapy of sepsis and bacteremia.
    Der Internist 03/2013; · 0.27 Impact Factor
  • W V Kern
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    ABSTRACT: The 2011 EHEC/HUS outbreak created uncertainty regarding the previous recommendations of withholding antibiotic therapy and regarding rational measures for prevention of invasive meningococcal disease after treatment with the monoclonal antibody eculizumab. For both these areas, an expert panel of the German Society for Infectious Diseases in cooperation with representatives of other learned societies and health institutions has drafted and consented guidelines that were published online on 1 June 2011 (i.e., ~10 days after the peak of the epidemic) and 4 June 2011. A summary of the guidelines in English was made available online on 4 June 2011. The time until ad hoc guidelines are made publicly available should and can be shortened in similar scenarios in the future. To this end-among other things-scientific societies in Germany linked to infectious diseases and medical microbiology have established a permanent working group called AFIM. This working group will facilitate timely identification and appointment of experts and expert panels, and will make use of new ways of rapid and effective sharing and dissemination of knowledge and ad hoc guidelines in the medical community and public domain if needed. In the case of disease outbreaks, immediate telephone conferences among all professionals involved, close cooperation between institutions and expert groups, and avoidance of premature unconsented information and press releases will be critical. We expect that proceeding in this way will also have a major impact on proper planning, professional design, and adequate analysis of clinical studies and endpoints appropriate for the outbreak situation.
    Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 01/2013; 56(1):87-94. DOI:10.1007/s00103-012-1577-1 · 1.01 Impact Factor
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    ABSTRACT: Nosocomial pneumonia (HAP) is a frequent complication of hospital care. Most data are available on ventilator-associated pneumonia. However infections on general wards are also increasing. A central issue are infections with multi drug resistant (MDR) pathogens which are difficult to treat particularly in the empirical setting potentially leading to inappropriate use of antimicrobial therapy.This guideline was compiled by an interdisciplinary group on the basis of a systematic literature review. Recommendations are made according to GRADE giving guidance for the diagnosis and therapy of HAP on the basis of quality of evidence and benefit/risk ratio.The guideline has two parts. First an update on epidemiology, spectrum of pathogens and antiinfectives is provided. In the second part recommendations for the management of diagnosis and treatment are given. Proper microbiologic work up is emphasized for knowledge of the local patterns of microbiology and drug susceptibility. Moreover this is the optimal basis for deescalation in the individual patient. The intensity of antimicrobial therapy is guided by the risk of infections with MDR. Structured deescalation concepts and strict limitation of treatment duration should lead to reduced selection pressure.
    Pneumologie 12/2012; 66(12):707-65. DOI:10.1055/s-0032-1325924

Publication Stats

2k Citations
291.41 Total Impact Points

Institutions

  • 2005–2014
    • Universitätsklinikum Freiburg
      • Department of Environmental Health Sciences
      Freiburg an der Elbe, Lower Saxony, Germany
  • 2013
    • Universitätsklinikum Jena
      • Zentrum für Infektionsmedizin und Krankenhaushygiene
      Jena, Thuringia, Germany
    • Deutsche Gesellschaft für pädiatrische Infektiologie e.V.
      Berlín, Berlin, Germany
  • 2002–2013
    • University of Freiburg
      Freiburg, Baden-Württemberg, Germany
  • 2008
    • University of Cologne
      • Institute for Medical Microbiology, Immunology and Hygiene
      Köln, North Rhine-Westphalia, Germany
  • 2004
    • University Hospital of Lausanne
      • Service des maladies infectieuses
      Lausanne, VD, Switzerland
  • 1998–2000
    • Tufts University
      • Center for Adaptation Genetics and Drug Resistance
      Boston, GA, United States
  • 1997
    • Universitätsklinikum Tübingen
      Tübingen, Baden-Württemberg, Germany
  • 1996
    • Queen's University
      • Department of Oncology
      Kingston, Ontario, Canada
  • 1987–1996
    • Universität Ulm
      • • Clinic of Internal Medicine II
      • • Department of Internal Medicine
      Ulm, Baden-Württemberg, Germany