S Lugauer

Friedrich-Alexander Universität Erlangen-Nürnberg, Erlangen, Bavaria, Germany

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Publications (23)47.72 Total impact

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    ABSTRACT: Background. Rotavirus (RV) is the most common cause of severe diarrhea in children worldwide. Up to the present time only a few systematically evaluated data on the incidence of RV gastroenteritis and its impact on health care in Germany have exited. Therefore a prospective epidemiological study was performed to collect representative data on RV disease in Germany. Method. Six hospitals in five German regions were selected to investigate severe cases of RV gastroenteritis in Germany. From june 1997 until may 1998, stools of all children up to four years of age hospitalized due to symptoms of acute gastroenteritis (AGE), were tested for RV antigen, followed by genotyping of the viruses by PCR. Date of admission, age, and sex were recorded for all patients. Further data on severity and course of the disease, concomitant diagnosis and treatment regimens were collected for a subgroup of patients (n=99) Results. A total of 15.182 children up to 4 years of age were hospitalized at the six participating hospitals. 1521 patients (10,0%) were hospitalized due to an episode of AGE. Of these patients, 626 (41,2%) were RV antigen positive. On the basis of data from the RV season 1997/98, the yearly rate of hospitalization is 7,7 per 1000 children (n=24.149) per year (4,1% of 589.000 hospitalized patients 0–48 months of age). More than 70% of RV cases occurred during the winter season (December 1997–April 1998). The mean duration of hospitalization for RV patients was 4,9 +/−1,9 days. RV cases scored significantly higher for disease severity compared to non-RV cases (p=0,005). Stool samples of 547 patients were analyzed to determine RV G- and P-types. Predominantly RV type G1/P(8) (76%) and G4/P(8) (18%) were detected. Conclusions. In spite of a mild rotavirus winter epidemic in 1997–1998, results from this study demonstrate that RV AGE is a frequent cause of hospitalization for children up to four years of age in Germany.
    No preview · Article · Apr 2014 · Monatsschrift Kinderheilkunde
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    ABSTRACT: Despite a very high level of hygiene in clinics, catheter-associated infections are still considered a critical source of complications in medicine. The “Erlanger Silberkatheter”, based on polyurethanes filled with silver was designed to decrease the number of adhering bacteria on inner and outer catheter surfaces. It was shown that the mechanical properties of the thermo-plastic polyurethanes (TPU) are not negatively influenced by silver particles and the manufacturing process. As silver ions are known to be an effective antimicrobial agent, the rate of silver ions released from the catheter material was measured using anodic stripping voltammetry. Polyurethanes filled with silver release silver ions in concentrations which show an antimicrobial effect according to literature. In vitro and in vivo tests have demonstrated the antimicrobial efficacy of the material developed. The risk of a critical catheter-associated infection after a five day implantation could be reduced by 70 First catheters based on this antimicrobial material are on the market.
    No preview · Chapter · Dec 2005
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    ABSTRACT: Catheters impregnated with silver have been proposed as a means of reducing catheter-related infection. We therefore performed a prospective randomized study to compare a new silver-impregnated central venous catheter (CVC) with a commercially available CVC in a cohort of immunocompromised patients. We studied 157 patients of whom 97 could be analysed. The median indwelling time in the study group (SC) was 10.5 days and 11 days in the control group (CC). The incidence of contamination in the SC group was 15.6 vs 24.6 in the CC group referring to 1000 catheter days. In both groups, we found 6% of catheter-related infections according to the definitions of a published scoring system. The differences between the two groups were not significant. We conclude that the SC decrease the incidence of catheter contamination and may have a positive effect on the reduction of CVC-related infections.
    No preview · Article · Apr 2002 · Journal of Hospital Infection
  • Siegfried Lugauer · Ulrich Heininger · James D Cherry · Klemens Stehr
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    ABSTRACT: The objective of this open study was to monitor the long-term effectiveness of the Lederle-Takeda diphtheria and tetanus toxoids and acellular pertussis antigen(s) (DTaP) vaccine and the Wyeth-Lederle diphtheria and tetanus toxoids and pertussis whole cell (DTP) vaccine in children who had received four doses of vaccine at 3, 4.5, 6 and 15 months of age during a pertussis vaccine efficacy trial from May 1991 to December 1994. After unblinding of the study code, follow-up information was obtained by use of standardised questionnaires twice a year from 1995 to 2000 to detect clinical pertussis and cough illnesses > or = 14 days duration. Physician confirmation was sought for all reported cases. Rates of reported cough illnesses > or = 14 days duration and rates of parent and physician diagnosed pertussis in former DTaP, DTP and diphtheria and tetanus toxoids (DT) recipients were determined and vaccine efficacy was calculated. Nine questionnaires were sent to parents of 2924 study children of whom 349, 1304 and 1271 had originally received DT, DTaP and DTP, respectively. Overall, rates for cough illnesses (per 100 person years) were similar among the vaccine groups suggesting that reporting bias was not a major factor. Calculated efficacy for the 6-year follow-up period based upon physician diagnosed pertussis was 89% (95% CI=79 94) for DTaP and was 92% (95% CI=84-96) for DTP. CONCLUSION: no evidence of decreasing efficacy over time was noted.
    No preview · Article · Apr 2002 · European Journal of Pediatrics

  • No preview · Article · Dec 2001 · DMW - Deutsche Medizinische Wochenschrift
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    ABSTRACT: We compared immunogenicity and reactogenicity of a single dose of DTaP vaccine (containing tetanus and diphtheria toxoids and four acellular pertussis antigens) with conventional Td- or d-vaccines in 180 German adults. Antibody values against diphtheria and tetanus toxin and against the pertussis antigens fimbriae (FIM), filamentous hemagglutinin (FHA) and pertussis toxin (PT) were measured in pre- and post-immunization sera. Reactogenicity was determined by a patient diary card. Pre-immunization antibody values against diphtheria toxin were low in all three vaccine groups. After immunization, > or = 80% of the vaccinees in all three groups were fully protected (> or = 0.1 IU/ml), but geometric mean values were significantly higher in DTaP recipients compared to Td or d recipients (1.65 vs. 0.44 and 0.48, respectively; both P < 0.05). Pre-immunization antibody values against tetanus toxin were high in all three groups, and after immunization 100% of the vaccinees were protected (> or = 0.1 IU/ml). Furthermore, substantial antibody responses against pertussis antigens were elicited in DTaP recipients with geometric mean rises of 22.5, 4.1 and 7.5 for antibodies against FHA, fimbriae and PT, respectively. All three vaccines were well tolerated. Frequency and severity of local reactions were similar between DTaP and Td recipients and even less common in d recipients. Since DTaP did provide a significant boost of anti-pertussis antibodies and a significantly higher anti-diphtheria response than conventional Td vaccine without an increase of side effects, it might be an appropriate candidate for use in adults.
    No preview · Article · Apr 2001 · Vaccine
  • J Klinge · S Lugauer · K Korn · U Heininger · K Stehr
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    ABSTRACT: Children aged 9-11, 12-14 or 15-17 months, respectively were vaccinated with a measles, mumps and rubella (MMR) vaccine and serum antibody responses and reactogenicity were compared. The data of 118 children could be analysed (group 1=9-11 months, n=46; group 2=12-14 months, n=29, group 3, 15-17 months, n=43). The only significant difference observed was for seroconversion against measles virus between group 1 and group 3 (84.8% vs 100%, p=0.012). No serious adverse events were reported. Local side reactions were mild, infrequent and independent of age. Immunisation against MMR is safe and effective even when administered before the currently recommended age of 12 months.
    No preview · Article · Aug 2000 · Vaccine
  • J. Klinge · S. Lugauer · K. Korn · U. Heininger · K. Stehr
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    ABSTRACT: Children aged 9–11, 12–14 or 15–17 months, respectively were vaccinated with a measles, mumps and rubella (MMR) vaccine and serum antibody responses and reactogenicity were compared. The data of 118 children could be analysed (group 1=9–11 months, n=46; group 2=12–14 months, n=29, group 3, 15–17 months, n=43). The only significant difference observed was for seroconversion against measles virus between group 1 and group 3 (84.8% vs 100%, p=0.012). No serious adverse events were reported. Local side reactions were mild, infrequent and independent of age. Immunisation against MMR is safe and effective even when administered before the currently recommended age of 12 months.
    No preview · Article · Jul 2000 · Vaccine
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    ABSTRACT: Objective: A pertussis vaccine efficacy trial included a prospective follow up of all hospitalizations involved. This allowed us to calculate the rates of hospitalization due to acute gastroenteritis in a large cohort of infants and children in Germany. Methods: 10271 healthy children were enrolled at the age of 2-4 months and followed up for a mean of 2.5 years. All hospitalizations during follow-up of the study were registered and letters of discharge from hospital in children with gastroenteritis were evaluated for the present analysis. Results: A total of 179 episodes of hospitalization due to a gastroenteritis were reported in 173 children (total observation years 25284). The mean calculated incidence was 7.1/1000 observation years, with a maximum of 11.2/1000 years in 7-12 month old children. Rotavirus and Salmonella spp. were the most frequently identified agents. Rotavirus infections were most prevalent during the cold season and the maximum incidence was between 7 and 12 months of age. Characteristic symptoms of rotavirus infections were diarrhea (90%), vomiting (85%) and signs of dehydration (58%). In contrast most Salmonella infections occurred between July and September with a peak between 19 and 24 months of age. Salmonella infections were characterized by enteritis (92%), high fever (56% >39°C) and significantly increased values for the c-reactive protein (68%). In this study rotavirus and Salmonella infections leading to hospitalization were associated with febrile seizures in 5% and 12% of cases, respectively. Conclusion: Gastroenteritis frequently leads to hospitalization in previously healthy infants and young children. Rotavirus and Salmonella spp. are the predominant causative agents.
    No preview · Article · Feb 2000
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    ABSTRACT: Objective: A pertussis vaccine efficacy trial included a prospective follow up of all hospitalizations involved. This allowed us to calculate the rates of hospitalization due to acute gastroenteritis in a large cohort of infants and children in Germany. Methods: 10271 healthy children were enrolled at the age of 2–4 months and followed up for a mean of 2.5 years. All hospitalizations during follow-up of the study were registered and letters of discharge from hospital in children with gastroenteritis were evaluated for the present analysis. Results: A total of 179 episodes of hospitalization due to a gastroenteritis were reported in 173 children (total observation years 25284). The mean calculated incidence was 7.1/1000 observation years, with a maximum of 11.2/1000 years in 7–12 month old children. Rotavirus and Salmonella spp. were the most frequently identified agents. Rotavirus infections were most prevalent during the cold season and the maximum incidence was between 7 and 12 months of age. Characteristic symptoms of rotavirus infections were diarrhea (90%), vomiting (85%) and signs of dehydration (58%). In contrast most Salmonella infections occurred between July and September with a peak between 19 and 24 months of age. Salmonella infections were characterized by enteritis (92%), high fever (56% >39°C) and significantly increased values for the c-reactive protein (68%). In this study rotavirus and Salmonella infections leading to hospitalization were associated with febrile seizures in 5% and 12% of cases, respectively. Conclusion: Gastroenteritis frequently leads to hospitalization in previously healthy infants and young children. Rotavirus and Salmonella spp. are the predominant causative agents.
    No preview · Article · Jan 2000 · Monatsschrift Kinderheilkunde
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    ABSTRACT: Without Abstract
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: A central venous catheter with a new form of silver impregnation of the internal and external surfaces was investigated for antimicrobial activity and tolerance in patients in a controlled comparative, prospective and randomized clinical study. Commercially available catheters with no antimicrobial activity were used as controls. One hundred sixty-five catheters were included in the final evaluation. All catheters were percutaneously inserted for the first time with a duration of > or = 5 days and a microbiological examination of the catheter tip. Catheter location (> 90% internal jugular vein), mean duration of catheterization (8-9 days), patients' age and diagnosis were comparable in both groups. Silver-impregnated catheter tips showed an incidence of colonization in 14.2/1000 catheter days and control catheters in 22.8/1000 catheter days. This represents a reduction of 37.7%. Catheter-associated infections were diagnosed in the silver group in 5.26/1000 catheter days and 18.34/1000 catheter days in the control group, indicating a reduction rate of 71.3% (P < 0.05, chi 2-test). No complications or side effects were documented in either group.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: The Erlanger silver catheter consists of a new form of polyurethane, which contains finely dispersed metallic silver. The aim of this study was to establish the biocompatibility of this intravenous catheter by investigating the acute cytotoxicity of extracts from the Erlanger silver catheter on human fibroblasts and lymphocytes. Extracts of the Erlanger silver catheter were not cytotoxic for MRC-5 human fibroblasts nor for sensitized phytohemagglutinin (PHA)-stimulated human lymphocytes. The addition of silver powder of up to 2% by weight to the basic catheter polyurethane Tecothane led to no increase in acute cytotoxicity in comparison with untreated Tecothane. The Erlanger silver catheter is a new intravenous catheter with good biocompatibility.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: To date there have been no standard methods for assessing the thrombogenicity of central venous catheters. A procedure for testing the thrombogenicity of intravenous lines such as the silver-impregnated catheter by continuous blood flow in vitro was therefore developed. For this test, fresh blood was drawn from healthy human donors and anti-coagulated with sodium citrate (1:9). All material tested (catheter tubes with and without silver manufactured in the same way, polyethylene tubes and tubes with potentially thrombogenic material) were perfused through their lumen with anticoagulated blood for up to 31 hours. Blood samples were collected at different times from the test system at sites before and after the perfusion of the test catheters. The hemoglobin concentration, erythrocyte, leukocyte and thrombocyte counts and markers for thrombin activation (thrombin-antithrombin III-complex, F1 + 2)-prothrombin fragments) and for hyperfibrinolysis (d-dimers) were determined. No thrombin activation or signs of hyperfibrinolysis were detected in any material tested. Polyethylene tubes were found to cause hemolysis, as shown by a decrease in hemoglobin content from 15 g% to 4.5 g%. Tecothane tubes with and without silver did not induce hemolysis.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: Metal ions or metal ions in complexes or compounds have been used for centuries to disinfect fluids, solids and tissues. The biocidal effect of silver, with its broad spectrum of activity including bacterial, fungal and viral agents, is particularly well known and the term "oligodynamic activity" was coined for this phenomenon. Silver ions have an affinity to sulfhydryl groups in enzyme systems of the cell wall, through which they interfere with the transmembranous energy transfer and electron transport of bacterial microorganisms. Silver ions also block the respiratory chain of microorganisms reversibly in low concentrations and irreversibly in higher concentrations. Binding to the DNA of bacteria and fungi increases the stability of the bacterial double helix and thus inhibits proliferation. There is no cross resistance with antibiotics and also no induction of antimicrobial resistance by silver ions. The concentrations required for bactericidal activity are in the range 10(-9) mol/l. These concentrations can be achieved in solution by the interaction of metallic silver with electrolytes only if there is a large enough surface of silver. By a novel technology, metallic silver is distributed in submicron particles in polyurethane and results in a concentration of 0.8% in an active surface of 450 cm2/g polyurethane. Polyurethane is hygroscopic and rapidly attracts water; the interaction of electrolyte solutions with the extremely finely distributed silver throughout the polyurethane releases bactericidal concentrations of silver ions over a period of years to the surface of the material. The electronegatively charged surface of bacteria attracts the positively charged silver ions. The concentrations released from the polyurethane are far below the toxic concentrations for humans.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: It is difficult to make the clinical diagnosis of catheter-related infections using the available and established definitions of the HICPAC (Hospital Infection Control Practices Advisory Committee) of the CDC (Centers for Disease Control, definitions of nosocomial infections). The scoring system shown here is a modification of these definitions and has enabled the causal relationship between the catheter and clinical episodes of systemic infections to be quantitatively graded. The scoring system included the following criteria: height and rate of rise of body temperature, attendant shivering, identification of pathogens in blood and/or catheter tip cultures, improvement in the clinical course after catheter removal, signs of catheter exit site inflammation and results of diagnostic tests for other possible sources of infection. These criteria were graded using points and weighted according to their specificity. The comparative evaluation of 65 episodes of systemic infections using the scoring system and the diagnostic criteria of HICPAC showed agreement in 85%. No case was graded "false-negative." In nine of ten false-positive cases additional findings supported the presence of a catheter-associated infection. This scoring system appears, therefore, to be more sensitive than existing diagnostic criteria, without loss of specificity.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: Within the framework of the clinical study of the Erlangen silver catheter 104 silver catheters and 105 control catheters were tested by microbiological culture. This was done by rolling the catheter on a blood agar plate, washing the lumen through with tryptic soy broth (TSB) and, after ultrasound treatment, incubating the catheter tip in TSB as an enrichment culture for detecting very low bacterial counts. There was good agreement in the numbers of colony-forming units (CFU) detected by the roll plate and luminal washout cultures in 92% of the silver and 89% of the control catheters tested. Seventy-six (73%) of the 104 silver catheters showed no bacterial growth and 16 (15%) showed very low bacteria counts (< 15 CFU), or growth only after enrichment, which were attributed in both instances to catheter contamination. Twelve catheter tips (12%) showed significant bacterial counts greater than 15 CFU which were indicative of colonization or catheter-related infection. Corresponding results in the control catheters were 59 (56%), 28 (27%) and 18 (17%), respectively, a higher rate of infection or contamination which was statistically significant (chi-square test: P = 0.04).
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: Central venous long-term catheters offer reliable, large-lumen vascular access with high flow rates for delivery of nutrition or for cell-containing infusions and perfusions. Catheter-associated infections (CAI) pose the greatest threat to such vascular access, despite existing preventive measures. In this article one prospective and one retrospective study of CAI in pediatric therapy are presented. Study I: A retrospective investigation from 1990 through 1995 of 60 conventional long-term catheters in 50 patients. The total number of days in which the catheters were in place was 11,818. The calculated CAI incidence was 1 per 1,000 days of catheter insertion. Bacteriologically demonstrated CAI (identical isolate on the catheter tip and in a blood culture) occurred in three instances (5%). Five cases (8.3%) were diagnosed with a therapy-resistant, septic clinical picture. Study II: A prospective, randomized comparison of long-term silver-impregnated (Erlanger silver catheters) and control catheters (Quinton Instrument Co.) was made with 41 patients (20 with a silver catheter, 21 with a Quinton catheter). To date, the silver catheters have been distinguished by sterile bacteriological findings, whereas three cases of CAI have been demonstrated with the comparative catheters. One patient recently underwent intensive care after becoming unstable with signs of septic shock and demonstrable Pseudomonas aeruginosa, and two other patients manifested coagulase-negative staphylococci on the catheter tips. In three of nine control catheters an incidence of 1.18 per 1,000 days of indwelling catheters was found, whereas no CAI has occurred with the eight microbiologically tested silver catheters.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: The clinical evaluation of venous catheters for catheter-induced infections must conform to a strict biometric methodology. The statistical planning of the study (target population, design, degree of blinding), data management (database design, definition of variables, coding), quality assurance (data inspection at several levels) and the biometric evaluation of the Erlanger silver catheter project are described. The three-step data flow included: 1) primary data from the hospital, 2) relational database, 3) files accessible for statistical evaluation. Two different statistical models were compared: analyzing the first catheter only of a patient in the analysis (independent data) and analyzing several catheters from the same patient (dependent data) by means of the generalized estimating equations (GEE) method. The main result of the study was based on the comparison of both statistical models.
    No preview · Article · Feb 1999 · Infection
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    ABSTRACT: The antimicrobial activity of a silver-impregnated polymer catheter (the Erlanger silver catheter) was demonstrated by determining the microbial adhesion to the surface of the catheter and by measuring the rate of proliferation (viability) of microorganisms at this site. On the surface of a catheter impregnated with silver, according to previously described methods, the bacterial adhesion of Staphylococcus epidermidis is reduced by 28-40%. Bacterial proliferation on the surface of the catheter and biofilm production are also substantially reduced by the elution of free silver ions from the catheter matrix. Bacteriostatic and bactericidal activities can be determined. The antimicrobial efficacy of the silver catheter is not reduced by blood components. There is no loss in antimicrobial activity for weeks after preincubation in water or phosphate buffered saline. The antimicrobial activity depends on the extent of the active silver surface.
    No preview · Article · Feb 1999 · Infection

Publication Stats

473 Citations
47.72 Total Impact Points

Institutions

  • 1999-2014
    • Friedrich-Alexander Universität Erlangen-Nürnberg
      • Department of Paediatrics
      Erlangen, Bavaria, Germany
  • 1998-2002
    • Universitätsklinikum Erlangen
      • Institute of Virology - Clinical and Molecular Virology
      Erlangen, Bavaria, Germany
  • 2001
    • University Children's Hospital Basel
      Bâle, Basel-City, Switzerland