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Background: In Germany, more than 40% of infants are born to immigrant parents. Increased survival rates of very preterm (below 32 weeks gestation at birth; VP) infants have not resulted in equally improved life chances and quality of life. More information on perinatal variations in outcomes according to social inequalities, migration background, and language barriers is needed. We tested whether mothers' immigrant status and language barriers are associated with perinatal health and short-term neonatal outcomes. Methods: The data are from the national multi-centre German Neonatal Network (GNN) cohort, including VP births from 2009 onwards. In total, 3606 (n = 1738 female) children were assessed, and 919 (n = 449 female) of these children had immigrant backgrounds. Immigrant status was operationalised as a binary variable based on the children's mothers' countries of birth (born in Germany vs. foreign-born). Self-reported home language (L1) was used to calculate the average linguistic distance to German as one continuous variable. Results: Mixed-effects models showed that two out of fourteen effects of interest survived the adjustment for known confounders and accounting for the nestedness of data within birth hospitals. Linguistic distance from mothers' L1s to German was independently associated with diagnoses of preeclampsia (OR = 1.01, 95% CI = [1.00, 1.01]). Infants of foreign-born mothers had higher odds for amniotic infection syndrome (AIS; OR = 1.45 [1.13, 1.86]) than infants of German mothers. Conclusions: Our findings from this large multi-centre longitudinal cohort of VP-born children indicate that maternal immigrant status and language barriers have limited impact on perinatal health and severe neonatal outcomes. This suggests that, regardless of background or language skills, there may be few inequalities in the perinatal health of pregnant women and their newborn preterm infants. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to describe clinical, virological and radiological characteristics as well as treatment strategies and outcomes of immunocompromised patients with persistent SARS-CoV-2 replication. Methods: We performed a retrospective cohort study of immunocompromised patients at the University Medical Center Freiburg between 01/2022 and 05/2023. Patients with substantial immunosuppression and persistent SARS-CoV-2 detection (Ct-value < 30 after 14 days) were included. Results: 36 patients in our cohort reported mainly fever, dyspnoea or continuous cough. Viral load was significantly higher in concurrent samples taken from the lower respiratory tract (Ct-value = 26) than from the upper respiratory tract (Ct-value = 34). Time of detectable viral RNA after start of antiviral treatment was shorter in patients receiving two antivirals (median 15 days vs. 31 days with one antiviral agent). Short-course antiviral therapy (≤ 5 days) was less efficient in reduction of symptoms and viral load than prolonged therapy > 10 days. In 30% (8/27) of patients with repeated CT scans, we found the emergence of chronic pulmonary changes, which were more frequently in patients with B cell depletion (37%, 7/19) compared to patients with organ transplantation (12%, 2/17). Conclusion: Ongoing SARS-CoV-2 replication in the lower respiratory tract is a relevant differential diagnosis in patients with severe immunosuppression and continuous cough, fever or dyspnoea even if nasopharyngeal swabs test negative for SARS-CoV-2. Especially in B cell-depleted patients, this may lead to inflammatory or fibrotic-like pulmonary changes, which are partially reversible after inhibition of viral replication. Antiviral therapy seems to be most effective in combination and over a prolonged period of time of > 10 days. Trial registration number: DRKS 00027299. [ABSTRACT FROM AUTHOR]

In a representative sample of female children and adolescents in Germany, Toxoplasma gondii seroprevalence was 6.3% (95% CI 4.7%-8.0%). With each year of life, the chance of being seropositive increased by 1.2, indicating a strong force of infection. Social status and municipality size were found to be associated with seropositivity. [ABSTRACT FROM AUTHOR]

Introduction: Poor oral hygiene can cause infections and inflammatory diseases. Data on its impact on outcome after lung transplantation (LuTX) is scarce. Most transplant centers have individual standards regarding dental care as there is no clinical guideline. This study's objective was to assess LuTX‐listed patient's dental status and determine its effect on postoperative outcome. Methods: Two hundred patients having undergone LuTX from 2014 to 2019 were selected. Collected data comprised LuTX‐indication, periodontal status, and number of carious teeth/fillings. A preoperative panoramic dental X‐ray and a dentist's consultative clarification were mandatory. Results: 63.5% had carious dental status, differing significantly regarding TX‐indication (p < 0.001; ILD: 41.7% vs. CF: 3.1% of all patients with carious teeth). Mean age at the time of LuTX differed significantly within these groups. Neither preoperative carious dental status nor periodontitis or bone loss deteriorated post‐LuTX survival significantly. No evidence was found that either resulted in a greater number of deaths related to an infectious etiology. Conclusion: This study shows that carious dental status, periodontitis, and bone loss do not affect post‐TX survival. However, literature indicates that they can cause systemic/pulmonary infections that deteriorate post‐LuTX survival. Regarding the absence of standardized guidelines regarding dental care and LuTX, we strongly recommend emphasizing research in this field. [ABSTRACT FROM AUTHOR]

Chamois are mountain ungulates (Artiodactyla: Caprinae) which inhabit several medium- and high-altitude mountain ranges from southern Europe to the Near East. The first findings of Sarcocystis cysts in the musculature of chamois were reported in the 1970s. However, only limited work on the epidemiology of sarcocystosis and the identification of the species of Sarcocystis in chamois has been carried out in the past. The present study aimed to provide, for the first time, data on the prevalence and intensity of Sarcocystis spp. Infection in native Alpine chamois using a histology examination of heart and/or diaphragm tissue samples collected from 216 chamois (40 kids [<1 year] and 176 chamois ranging up to 18 years of age). Sarcocysts were detected in either the heart or diaphragm of 167/216 chamois (77.3%), with 131 of 183 heart samples and 127 of 215 diaphragm samples testing sarcocyst-positive. Of the 181 chamois with both heart and diaphragm samples available (34 kids and 147 older animals), sarcocysts were detected in the heart and/or diaphragm of 142 animals, translating to an overall 78.5% prevalence of Sarcocystis spp. infection (95%CI 72.5–84.4%). Sarcocysts were more frequently recorded in the heart vs. diaphragm (72.4% vs. 56.4%; p = 0.0021), and diaphragm positivity was associated with heart positivity (p = 0.0001). The sarcocyst prevalence (heart and/or diaphragm) was significantly (p < 0.001) lower in the kids than in the older chamois (27.1% vs. 88.6%, respectively); however, it did not differ between the sexes, regardless of the chamois' age (p > 0.3). The intensity of infection was generally low (<10 sarcocysts per cm2 muscle cut) in both heart-positive and diaphragm-positive animals (94.7% and 93.7%, respectively). The heart tissue yielded higher sarcocyst counts than the diaphragm tissue (p < 0.001). Both the heart and diaphragm sarcocyst counts were significantly (p < 0.001) lower in the kids than in the older chamois. Sarcocystis spp. infection was demonstrated to be prevalent in chamois in Germany, but its intensity is apparently low. Further studies are desired to identify the species of Sarcocystis parasitizing the chamois using both phenotypic and molecular characteristics. [ABSTRACT FROM AUTHOR]

Background: Personalized clinical management of spondylodiscitis (SD) and isolated spinal epidural empyema (ISEE) is challenging due to limited evidence of microbiologic findings and their clinical impact during the clinical course of the disease. We aimed to characterize clinico-microbiological and imaging phenotypes of SD and ISEE to provide useful insights that could improve outcomes and potentially modify guidelines. Methods: We performed chart review and collected data on the following parameters: bacterial antibiogram-resistogram, type of primary spinal infection, location of spinal infection, source of infection, method of detection, clinical complications (sepsis, septic embolism, and endocarditis), length of hospital and intensive care unit (ICU) stay, relapse rate, and disease-related mortality in patients with proven pyogenic SD and ISEE treated surgically in a university hospital in Germany between 2002 and 2022. Results: We included data from 187 patients (125 SD, 66.8% and 62 ISEE, 33.2%). Gram-positive bacteria (GPB) were overall more frequently detected than gram-negative bacteria (GNB) (GPB: 162, 86.6% vs. GNB: 25, 13.4%, p < 0.001). Infective endocarditis was caused only by GPB (GPB: 23, 16.5% vs. GNB: 0, 0.0%, p = 0.046). Methicillin-susceptible Staphylococcus aureus was the most frequently isolated strain (MSSA: n = 100, 53.5%), occurred more frequently in the cervical spine compared to other bacteria (OB) (MSSA: 41, 41.0% vs. OB: 18, 20.7%, p = 0.004) and was most frequently detected in patients with skin infection as the primary source of infection (MSSA: 26, 40.6% vs. OB: 11, 16.7%, p = 0.002). Streptococcus spp. and Enterococcus spp. (SE: n = 31, 16.6%) were more often regarded as the cause of endocarditis (SE: 8, 27.6% vs. OB: 15, 11.4%, p = 0.037) and were less frequently detected in intraoperative specimens (SE: 19, 61.3% vs. OB: 138, 88.5%, p < 0.001). Enterobacterales (E: n = 20, 10.7%) were identified more frequently in urinary tract infections (E: 9, 50.0% vs. OB: 4, 3.6%, p < 0.001). Coagulase-negative Staphylococci (CoNS: n = 20, 10.7%) were characterized by a lower prevalence of sepsis (CoNS: 4, 20.0% vs. OB: 90, 53.9%, p = 0.004) and were more frequently detected in intraoperative specimens (CoNS: 20, 100. 0% vs. OB: 137, 82.0%, p = 0.048). Moreover, CoNS-associated cases showed a shorter length of ICU stay (CoNS: 2 [1–18] days vs. OB: 6 [1–53] days, median [interquartile range], p = 0.037), and occurred more frequently due to foreign body-associated infections (CoNS: 8, 61.5% vs. OB: 15, 12.8%, p = 0.008). The presence of methicillin-resistant Staphylococcus aureus (MRSA) prolonged hospital stay by 56 [24–58] days and ICU stay by 16 [1–44] days, whereas patients with Pseudomonas aeruginosa spent only 20 [18–29] days in the hospital and no day in the ICU 0 [0–5] days. Conclusions: Our retrospective cohort study identified distinct bacterial-specific manifestations in pyogenic SD and ISEE regarding clinical course, neuroanatomic targets, method of pathogen detection, and sources of infection. The clinico-microbiological patterns varied depending on the specific pathogens. [ABSTRACT FROM AUTHOR]

Mycobacterium chimaera is a nontuberculous mycobacterium that was identified as causative agent in a global outbreak of severe infections following open-chest cardiothoracic surgery. Heater-cooler units (HCUs), which were contaminated during the manufacturing process, were elucidated as the origin of this outbreak. Regular surveillance of water-containing HCUs used for cardiac surgery was recommended as one preventive measure. We present data on the occurrence of M. chimaera and other mycobacterial pathogens in different HCUs from one surgical center in Germany over a 42-month period. Water samples and swabs from seven different HCUs were taken between 2015 and 2018, and mycobacteria were detected in 50.6% (78/154) of water samples and 21.1% (4/19) of swabs. M. chimaera accounted for the majority of detected pathogens (77/83 isolates in water samples), but other species such as Mycobacterium gordonae were also found. Despite strict adherence to an intensified, regular disinfection procedure, the majority of HCUs remained positive for mycobacteria until the end of the study. In conclusion, additional measures are needed to reduce the risk of intraoperative transmission of M. chimaera , and our observations underscore the inherent infections risks associated with water-containing medical devices. [ABSTRACT FROM AUTHOR]

Purposes: Despite reports of a declining incidence over the last decade, Clostridioides difficile infection (CDI) is still considered the most important healthcare-associated causes of diarrhea worldwide. In Germany, several measures have been taken to observe, report, and influence this development. This report aims to analyze the development of hospital coding for CDI in Germany over the last decade and to use it to estimate the public health burden caused by CDI. Methods: Reports from the Institute for Hospital Remuneration Systems, German Federal Statistical Office (DESTATIS), the Robert-Koch-Institute (RKI), Saxonian authorities and hospital quality reports during 2010–2021 were examined for CDI coding and assessed in a structured expert consultation. Analysis was performed using 2019 versions of Microsoft Excel® and Microsoft Access®. Results: Peaks of 32,203 cases with a primary diagnosis (PD) of CDI and 78,648 cases with a secondary diagnosis (SD) of CDI were observed in 2015. The number of cases had decreased to 15,412 PD cases (− 52.1%) and 40,188 SD cases (− 48.9%) by 2021. These results were paralleled by a similar decline in notifiable severe cases. However, average duration of hospitalization of the cases remained constant during this period. Conclusions: Hospital coding of CDI and notification to authorities has approximately halved from 2015 to 2021. Potential influential factors include hospital hygiene campaigns, implementation of antibiotic stewardship programs, social distancing due to the COVID-19 pandemic, and a decrease in more pathogenic subtypes of bacteria. Further research is necessary to validate the multiple possible drivers for this development. [ABSTRACT FROM AUTHOR]

Background Intestinal microbiome contributes to the pathophysiology of acute gastrointestinal (GI) graft-versus-host disease (GvHD) and loss of microbiome diversity influences the outcome of patients after allogeneic stem cell transplantation (SCT). Systemic broad-spectrum antibiotics have been identified as a major cause of early intestinal dysbiosis. Methods In 2017, our transplant unit at the university hospital in Regensburg changed the antibiotic strategy from a permissive way with initiation of antibiotics in all patients with neutropenic fever independent of the underlying cause and risk to a restrictive use in cases with high likelihood of cytokine release syndrome (eg, after anti-thymocyte globulin [ATG] therapy). We analyzed clinical data and microbiome parameters obtained 7 days after allogeneic SCT from 188 patients with ATG therapy transplanted in 2015/2016 (permissive cohort, n = 101) and 2918/2019 (restrictive cohort, n = 87). Results Restrictive antibiotic treatment postponed the beginning of antibiotic administration from 1.4 ± 7.6 days prior to 1.7 ± 5.5 days after SCT (P =.01) and significantly reduced the duration of antibiotic administration by 5.8 days (P <.001) without increase in infectious complications. Furthermore, we observed beneficial effects of the restrictive strategy compared with the permissive way on microbiome diversity (urinary 3-indoxylsulfate, P =.01; Shannon and Simpson indices, P <.001) and species abundance 7 days post-transplant as well as a positive trend toward a reduced incidence of severe GI GvHD (P =.1). Conclusions Our data indicate that microbiota protection can be achieved by a more careful selection of neutropenic patients qualifying for antibiotic treatment during allogeneic SCT without increased risk of infectious complications. [ABSTRACT FROM AUTHOR]

Objective: Abnormalities of the menstrual cycle were reported after infection with SARS‐CoV‐2 and vaccination against it, but the available data are very heterogeneous, do not reflect intermenstrual variations or regional differences, and their risk factors are missing. Methods: We performed a survey‐based study among 6383 employees and students of Ulm University Hospital in Germany between March 1 and 31, 2021. Attributes of menstrual cycles such as cycle length (CL), menses duration (MD), and bleeding volume (BV) were reported as categorical variables before and after immunization against SARS‐CoV‐2 (first, second, third vaccination or infection). Additionally, the potential risk factors for cycle changes were evaluated and all participants reported the subjective perception of changes, their duration, and time of occurrence. Results: The final analysis included 1726 participants. CL and BV significantly changed after vaccination, but not MD. The subjective perception showed only slight levels of agreement with the objective changes, with the highest Cohen's kappa for CL. The risk factors for the variations in CL were previous cycle irregularities, and risk factors for the changes in BV were age and body mass index. The combination of vaccines (homogenous or heterogeneous) and different types of immunization (infection and vaccination) had no significant effect on cycle irregularities. Conclusion: In summary, immunization against SARS‐CoV‐2 causes changes in the characteristics of the menstrual cycle, which are mostly temporary. The individual risk factors, but not the type of immunization, can affect the mentioned changes. Synopsis: Immunization against SARS‐CoV‐2 (infection/vaccination) can affect all three parameters of the menstrual cycle. The combination of the vaccines is not a risk factor for the irregularities. [ABSTRACT FROM AUTHOR]

Background: Although the burden of the COVID-19 pandemic on global healthcare systems is declining, long-term sequelae such as long COVID syndrome and other disease dynamics not primarily associated with COVID-19 remain a challenge. Recent data suggest that the incidence of non-COVID upper respiratory tract infections (URTI) is increasing sharply in the post-pandemic period, but there is a lack of real-world data from Germany in this respect. Methods: This cross-sectional study evaluated the number of patients with a diagnosis of URTI from the Disease Analyzer database (IQVIA) between January 2019 and December 2022. The number of UTRI diagnoses per practice and the duration of sick leave per patient were compared over time. Results: A total of 1 872 935 individuals (1 403 907 patients from general practices (GP) and 469 028 patients from pediatric offices) were included, 48% of whom were female. The number of URTI patients per practice was significantly higher in 2022 than in 2019 (732 vs 464, 58%, P <.001), and this was observed for both women (56%, P <.001) and men (60%, P <.001). The post-pandemic increase in the number of URTI diagnoses correlated with age and was highest in the age group between 18 and 30 years (22%, P <.001) and lowest in older patients >70 years (3%). In pediatric patients (<18 years), the increase was highest in the age group ≤5 years (89%). Both the number of patients per practice on sick leave due to URTI (184 vs 92) and the average duration of sick leave (+2 days) increased from 2019 to 2022. Conclusion: Our data suggest a dramatic increase in the incidence of URTI among all demographic subgroups in Germany between 2019 and 2022, which was associated with a tremendous impact on socioeconomic variables such as the frequency or duration of sick leave. These data could be of great importance in current pandemic management and the management of future pandemics. [ABSTRACT FROM AUTHOR]

We examine the effectiveness of church service bans in containing the spread of Covid-19 in Germany. We furthermore investigate how differences in the local religious affiliations affect infections and the effectiveness of church bans and other church-related restrictions. We find that, without a ban, infections per capita are higher in districts (Landkreise) with larger shares of religious population. In panel analysis, controlling for district fixed effects and a host of potential confounders, we find that church bans effectively reduce infections. For a ban in place for 14 days before a considered day, the predicted growth factor of infections is lower by 0.9 of its standard deviation. Finally, we show that Easter contributed significantly to the growth of infections in 2020 and 2021. The growth factor of infections was lower in regions with larger shares of Catholics and Protestants during Easter 2020 (when a church ban was in place) but not in 2021 (without a ban). [ABSTRACT FROM AUTHOR]

Severe coronavirus disease 2019 (COVID-19) is associated with hyperinflammation, hypercoagulability and hypoxia. Red blood cells (RBCs) play a key role in microcirculation and hypoxemia and are therefore of special interest in COVID-19 pathophysiology. While this novel disease has claimed the lives of many older patients, it often goes unnoticed or with mild symptoms in children. This study aimed to investigate morphological and mechanical characteristics of RBCs after SARS-CoV-2 infection in children and adolescents by real-time deformability-cytometry (RT-DC), to investigate the relationship between alterations of RBCs and clinical course of COVID-19. Full blood of 121 students from secondary schools in Saxony, Germany, was analyzed. SARS-CoV-2-serostatus was acquired at the same time. Median RBC deformation was significantly increased in SARS-CoV-2-seropositive compared to seronegative children and adolescents, but no difference could be detected when the infection dated back more than 6 months. Median RBC area was the same in seropositive and seronegative adolescents. Our findings of increased median RBC deformation in SARS-CoV-2 seropositive children and adolescents until 6 months post COVID-19 could potentially serve as a progression parameter in the clinical course of the disease with an increased RBC deformation pointing towards a mild course of COVID-19. [ABSTRACT FROM AUTHOR]

Purpose: Antimicrobial resistance poses a major threat to human health globally and antibiotic overuse is a main driver of resistance. Antimicrobial stewardship (AMS) was developed to improve the rationale use of antibiotics. The Choosing Wisely campaign was initiated to ameliorate medical practice through avoidance of unnecessary diagnostic and therapeutic procedures. Our objective was to give an overview on the Choosing Wisely recommendations related to AMS practices from a selection of different countries in order to define future needs. Methods: We evaluated the seven countries already analyzed for Choosing Wisely recommendations related to topics of infectious medicine before. Finally, we included five of the former countries (Australia/New Zealand, Canada, Italy, Switzerland, and USA) and Germany with easily accessible recommendations and selected those related to six categories of AMS as following: diagnostics, indication, choice of antiinfective drugs, dosing, application and duration of therapy. Results: In total, 213 recommendations could be extracted related to AMS for the six countries and were matched to the chosen categories. Interestingly, no recommendations were found for the category "dosing." Topics related to indication and diagnostics were most frequently found with 85 and 78 recommendations, respectively. Perioperative prophylaxis was a frequently addressed issue – both related to application, indication and duration. Avoiding antibiotic treatment of asymptomatic bacteriuria and upper respiratory tract infections were central topics of all countries. Conclusion: AMS is an important strategy to fight increasing resistance and is frequently addressed by Choosing Wisely recommendations of different countries. Similar issues are considered important in the selected countries. [ABSTRACT FROM AUTHOR]

Theodor Escherich (1857–1911) was one of the key players in early paediatric infectious diseases (PID). In fact, he can be regarded as the first paediatric infectious diseases physician and the founder of this subspecialty. During his long years in service for children, he spent 6 years at the Dr von Hauner children's hospital (1884–1890), laying the foundations for PID clinical care and research in Munich. Walter Marget, founder of this journal and co-founder of the German Society for Infectious Diseases (DGI) graduated from medical school in 1946 and practised in Munich since 1967. His tireless efforts went into establishing close links between clinical paediatrics and microbiological diagnostics culminating in the foundation of the Department of Antimicrobial Therapy and Infection Epidemiology at the Dr von Hauner children's hospital. Walter Marget was a key figure for PID in Germany having trained and supported many clinician scientists who followed in his footsteps. This article gives a brief overview of the history of PID in Munich while commemorating Walter Marget and his achievements in this field and for INFECTION. [ABSTRACT FROM AUTHOR]

Introduction: The management of periprosthetic joint infections (PJI) of the lower limb is challenging, and evidence-based recommendations are lacking. The present clinical investigation characterized the pathogens diagnosed in patients who underwent revision surgery for PJI of total hip arthroplasty (THA) and total knee arthroplasty (TKA). Methods: The present study follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The institutional databases of the RWTH University Medical Centre of Aachen, Germany, were accessed. The OPS (operation and procedure codes) 5–823 and 5–821 and the ICD (International Statistical Classification of Diseases and Related Health Problems) codes T84.5, T84.7 or T84.8 were used. All patients with PJI of a previous THA and TKA who underwent revision surgery were retrieved and included for analysis. Results: Data from 346 patients were collected (181 THAs and 165 TKAs). 44% (152 of 346 patients) were women. Overall, the mean age at operation was 67.8 years, and the mean BMI was 29.2 kg/m2. The mean hospitalization length was 23.5 days. 38% (132 of 346) of patients presented a recurrent infection. Conclusion: PJI remain a frequent cause for revisions after total hip and knee arthroplasty. Preoperative synovial fluid aspiration was positive in 37%, intraoperative microbiology was positive in 85%, and bacteraemia was present in 17% of patients. Septic shock was the major cause of in-hospital mortality. The most common cultured pathogens were Staph. epidermidis, Staph. aureus, Enterococcus faecalis, and Methicillin-resistant Staph aureus (MRSA). An improved understanding of PJI pathogens is important to plan treatment strategies and guide the choice of empirical antibiotic regimens in patients presenting with septic THAs and TKAs. Level of Evidence: Level III, retrospective cohort study. [ABSTRACT FROM AUTHOR]

Introduction: Clostridioides difficile infection (CDI) is increasingly recognized as a public health threat at the community level in addition to being one of the most common causes of healthcare-associated infections. In Germany, the epidemiology of CDI is primarily informed by national hospital-based CDI surveillance. We used health claims data from Germany to obtain valuable insights on population-level disease burden and risk factors for CDI. Methods: This was a retrospective cohort study using a representative sample from the InGef research database. Overall and age- and sex-stratified CDI incidence rates were estimated for German adults from 2013 to 2017 using different case definitions (i.e., main, broad, strict), and further stratified by setting (inpatient versus outpatient). Risk factors for CDI were assessed for the 2013–2016 period. Results: The CDI incidence rate was high but declined by 15.3% from 2013 [141 (95% confidence interval, CI 137–145) cases/100,000 person-years] to 2017 [120 (95% CI 116–123)]. Annual CDI incidence rates were higher in female patients and the elderly. The most important risk factors for CDI were chronic inflammatory bowel disease [odds ratio (OR) 4.7, 95% CI 4.0–5.5], chemotherapy (OR 4.7, 95% CI 4.1–5.2), chronic kidney disease (OR 2.9, 95% CI 2.6–3.3), and ciprofloxacin receipt (OR 2.6, 95% CI 2.4–2.8). Conclusions: Despite prevention strategies leading to declining incidence, CDI remains an important public health threat in Germany, with a high burden in the hospital setting and an outpatient epidemiology that is poorly understood. These findings, which are relevant both regionally and globally, can be used as a basis for further research on the full burden of CDI in Germany. [ABSTRACT FROM AUTHOR]

Within primary care, acute respiratory tract infections (ARTIs) are the most common reason for prescribing antibiotics. The aim of the CHANGE-3 study was to investigate how antibiotic prescribing for non-complicated ARTIs can be reduced to a reasonable level. The trial was conducted as a prospective study consisting of a regional public awareness intervention in two regions of Germany and a nested cluster randomised controlled trial (cRCT) of a complex implementation strategy. The study involved 114 primary care practices and comprised an intervention period of six winter months for the nested cRCT and two times six winter months for the regional intervention. The primary outcome was the percentage of antibiotic prescribing for ARTIs between baseline and the two following winter seasons. The regression analysis confirmed a general trend toward the restrained use of antibiotics in German primary care. This trend was found in both groups of the cRCT without significant differences between groups. At the same time, antibiotic prescribing was higher in routine care (with the public campaign only) than in both groups of the cRCT. With regard to secondary outcomes, in the nested cRCT, the prescribing of quinolones was reduced, and the proportion of guideline-recommended antibiotics increased. [ABSTRACT FROM AUTHOR]

Background: Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and one of the leading causes of congenital hearing loss in newborns. The aim of this study was to determine the seroprevalence rate for cytomegalovirus in pregnant women and the rate of CMV serological testing utilised during pregnancy in a rural region in Germany. Methods: Retrospective data on the prevalence of CMV IgG and IgM antibodies were obtained from 3,800 women, identified in the study group of 19,511 pregnant women from outpatient settings whose samples were collected between 1 and 2014 and 30 April 2018. In addition, the serological CMV status in regards to various billing methods was further analyzed. Results: Serological CMV tests were performed in 3,800 (19.5%) out of 19,511 pregnant women. 2,081 (54.8%) of these women were CMV seronegative. Among those, seroconversion rate of 0.37–1.42% was identified. A proportion of 2,710 (14.7%) of all 18,460 women with statutory health insurance made use of the CMV testing as an individual health service. Conclusions: The low uptake of CMV serological testing in the study population covered indicates low risk awareness among pregnant women and their healthcare professionals. Presented seronegativity rates and routine seroconversion rate, demonstrate importance to improve intervention strategy to prevent feto-maternal CMV transmission. [ABSTRACT FROM AUTHOR]

Background: It is not yet entirely clear to what extent vaccine-induced or hybrid i mmunity offers protection from death during the omicron wave of the COVID-19 pandemic in Germany. Methods: In this retrospective study, we evaluated 470 159 cases aged ≥ 60 years in the German federal state of Bavaria who tested positive for SARS-CoV-2 between 1 January and 30 June 2022. Cox models were used to estimate adjusted hazard ratios (aHR) for dying within 60 days of the infection, depending on sex, age, time of infection, and different levels of immunity. Results: Over the period of observation, 3836 COVID-19-associated deaths were registered (case fatality rate 0.82%). The risk of death was significantly lower in cases with a higher level of immunity than in unvaccinated cases (aHR for a full primary level of immunity if reached less than 6 months before the date of the i nfection: 0.30, 95% confidence interval [0.23; 0.39]; if reached more than 6 months before: aHR 0.46 [0.35; 0.60]). A boosted level of immunity lowered the risk of death even further (if reached less than 3 months before the infection: aHR 0.17 [0.15; 0.20]; if reached more than 3 months before: aHR 0.25 [0.21; 0.29]). Conclusion: Among elderly persons in Bavaria, a higher immunity level was associated with a substantial degree of protection against death during the Omicron wave; however, the strength of protection may have diminished somewhat over time. [ABSTRACT FROM AUTHOR]

Background: The surveillance of hospital-acquired infections in Germany is usually conducted via manual chart review; this, however, proves resource intensive and is prone to a certain degree of subjectivity. Documentation based on electronic routine data may present an alternative to manual methods. We compared the data derived via manual chart review to that which was derived from electronic routine data. Methods: Data used for the analyses was obtained from five of the University of Leipzig Medical Center's (ULMC) ICUs. Clinical data was collected according to the Protection against Infection Act (IfSG); documentation thereof was carried out in hospital information systems (HIS) as well as in the ICU-KISS module provided by the National Reference Center for the Surveillance of Nosocomial Infections (NRZ). Algorithmically derived data was generated via an algorithm developed in the EFFECT study; ward-movement data was linked with microbiological test results, generating a data set that allows for evaluation as to whether or not an infection was ICU-acquired. Results: Approximately 75% of MDRO cases and 85% of cases of sepsis/primary bacteremia were classified as ICU-acquired by both manual chart review and EFFECT. Most discrepancies between the manual and algorithmic approaches were due to differentiating definitions regarding the patients' time at risk for acquiring MDRO/bacteremia. Conclusions: The concordance between manual chart review and algorithmically generated data was considerable. This study shows that hospital infection surveillance based on electronically generated routine data may be a worthwhile and sustainable alternative to manual chart review. [ABSTRACT FROM AUTHOR]

The global SARS-CoV-2 pandemic led to a lockdown in team sports in March 2020. Because the risk of virus transmission seems to correlate with the duration of close contacts, data on contact times are necessary to assess the risk of virus transmission in sports. In this study, an optical tracking system was used to determine contact times between players of the two highest men's professional football leagues in Germany in the 2019–20 season and in the first half of the 2020–21 season. Contacts between players were defined as being within a two-metre radius during matches and were differentiated as either match-specific or non-match-specific. In total, 918 matches with 197,087 contacts were analysed. The mean overall contact time of one-to-one situations of 36 s (SD: ± 66) before the lockdown was reduced to 30 s after the lockdown (SD: ± 60) (p < 0.0001). In professional football, contacts between two players infrequently occur within a two-metre radius, averaging less than 35 s. Only 36 player pair contacts lasted for more than 15 min (0.00018%). The mean accumulated contact time per player with all others was 10.6 ± 6.9 min per match, with a decrease from 11.6 ± 7.0 min before the lockdown to 10.0 ± 6.6 min (p < 0.0001) after lockdown in the season 2019-20. The SARS-CoV-2 pandemic has resulted in a reduction in match-specific contacts of 25%. It seems questionable if such short contacts in open-air sports may lead to considerable virus transmission. [ABSTRACT FROM AUTHOR]

Objective: For the 3 Nordic ski disciplines of cross-country skiing, Nordic combined, and ski jumping, data on injuries and illnesses during major sporting events only exist from the Winter Olympics of 2010 to 2018. So far, an investigation has not been conducted during the Nordic World Ski Championships. Design: Prospective cohort study. Setting: Fédération Internationale de Ski (FIS) Nordic World Ski Championships 2021 in Oberstdorf, Germany. Participants: Overall, 663 athletes from 65 nations participated in the FIS Nordic World Ski Championships 2021. The study population included 344 athletes from 32 nations. Interventions: National medical teams were invited to report daily all newly incurred or exacerbated injuries and illnesses. Main Outcome Measures: All reported injuries and illnesses that occurred during the championships from February 23 until March 7, 2021, were analyzed. Injury and illness rates were calculated with 95% confidence intervals (95% CIs). Results: The 32 reporting nations returned 88.4% of the daily report forms. The incidence of injuries was 4.7 (95% CI, 2.4-6.9) per 100 athletes in the 3 Nordic ski disciplines. The incidence of illness was also 4.7 (95% CI, 2.4-6.9) per 100 athletes with a relative proportion of infection-related illnesses of 31.3%. Conclusions: Although the incidence of injuries of the Nordic disciplines was comparable with those of the 2010 to 2018 Winter Olympics, the incidence of illnesses was lower than during the previous 3 Winter Olympic Games with a lower rate of infection-related illnesses. This might be caused by the high hygiene measures due to the coronavirus disease 2019 pandemic. [ABSTRACT FROM AUTHOR]

Myocarditis as cardiac involvement in coronavirus disease 2019 (COVID‐19)‐infection is well known. Real‐world data about incidence in hospitalized COVID‐19‐patients and risk factors for myocarditis in COVID‐19‐patients are sparse. We used the German nationwide inpatient sample to analyze all hospitalized patients with confirmed COVID‐19‐diagnosis in Germany in 2020 and stratified them for myocarditis. Overall, 176 137 hospitalizations (52.3% males, 53.6% aged ≥70 years) with confirmed COVID‐19‐infection were coded in Germany in 2020 and among them, 226 (0.01%) had myocarditis (incidence: 1.28 per 1000 hospitalization‐cases). Absolute numbers of myocarditis increased, while relative numbers decreased with age. COVID‐19‐patients with myocarditis were younger (64.0 [IQR: 43.0/78.0] vs. 71.0 [56.0/82.0], p < 0.001). In‐hospital case‐fatality was 1.3‐fold higher in COVID‐19‐patients with than without myocarditis (24.3% vs. 18.9%, p = 0.012). Myocarditis was independently associated with increased case‐fatality (OR: 1.89 [95% CI: 1.33−2.67], p < 0.001). Independent risk factors for myocarditis were age <70 years (OR: 2.36 [95% CI: 1.72−3.24], p < 0.001), male sex (1.68 [95% CI: 1.28−2.23], p < 0.001), pneumonia (OR: 1.77 [95% CI: 1.30−2.42], p < 0.001), and multisystemic inflammatory COVID‐19‐infection (OR: 10.73 [95% CI: 5.39−21.39], p < 0.001). The incidence of myocarditis in hospitalized COVID‐19‐patients in Germany was 1.28 cases per 1000 hospitalizations in 2020. Risk factors for myocarditis in COVID‐19 were young age, male sex, pneumonia, and multisystemic inflammatory COVID‐19‐infection. Myocarditis was independently associated with increased case‐fatality. [ABSTRACT FROM AUTHOR]

Different feline leukemia virus (FeLV) infection outcomes are possible in cats following natural exposure, such as progressive infections (persistent viremia), regressive infections (transient or no viremia followed by proviral persistence) and abortive infections (presence of only antibodies). Laboratory-based testing is currently required for categorization of infection outcomes in cats. The aim of this study was to evaluate the field performance of a novel, rapid, combination point-of-care (PoC) test kit commercially available in Europe (v-RetroFel®Ag/Ab; 2020–2021 version) to determine different FeLV infection outcomes by concurrent detection of FeLV antigen (p27) and antibodies against FeLV transmembrane envelope protein (p15E). A secondary aim was to evaluate the performance of the same test kit (v-RetroFel®FIV) to determine positive/negative feline immunodeficiency virus (FIV) infection status by the detection of antibodies to FIV capsid protein (p24) and transmembrane glycoprotein (gp40). Two cohorts of domestic cats were recruited and tested with v-RetroFel® using plasma or serum, including cats in Australia (n = 200) and cats in Germany (n = 170). Results from p27 antigen PoC testing, proviral DNA PCR, and neutralizing antibody testing or testing for antibodies against non-glycosylated surface unit envelope protein (p45) were used to assign cats to groups according to different FeLV infection outcomes. Testing with a laboratory-based FeLV p15E antibody ELISA was also performed for comparison. In the first cohort, v-RetroFel®Ag/Ab correctly identified 89% (109/122) FeLV-unexposed cats and 91% (21/23) progressive infections, but no regressive (0/23) or abortive (0/32) infections. In the second cohort, v-RetroFel®Ag/Ab correctly identified 94% (148/158) FeLV-unexposed cats and 100% (4/4) progressive infections, but no regressive (0/2) and only 17% (1/6) abortive infections. There was test agreement between v-RetroFel®Ab and the p15E laboratory ELISA in 58.9% of samples. As a secondary outcome of this study, the sensitivity and specificity of v-RetroFel®FIV testing in cohort 1 were 94.7% (18/19) and 98.3% (178/181), and in cohort 2, 30.0% (3/10) and 100.0% (160/160), respectively. Prior history of FIV vaccination did not produce any false-positive FIV results. In conclusion, v-RetroFel®Ag/Ab (2020–2021 version) was unable to accurately determine different FeLV infection outcomes in the field. Improvements of the test prior to application to field samples are required. [ABSTRACT FROM AUTHOR]

Young dogs are particularly susceptible to infections with endoparasites. The occurrence of endoparasites was investigated in young dogs from Central Germany between July 2020 and July 2022. In total, 386 fecal samples originating from 171 dogs were examined for the prevalence of endoparasites using a combined flotation- and sedimentation technique and conventional PCR. Overall, in 41.2% (159/386) of the examined samples, endoparasites were detected. The most frequently occurring endoparasites were Giardia duodenalis (29%), Cryptosporidium spp. (9.1%), Cystoisospora spp. (7.3%), and Toxocara canis (6%). Sequencing of G. duodenalis positive samples showed that most infections belonged to the host-specific assemblages C (38.4% (43/112)) and D (35.7% (40/112)). The zoonotic assemblage A was identified in 8% (9/112) of the samples. Moreover, mixed infections were observed as follows: C/D in 5 (4.5%), D/A in 4 (3.6%), and C/A in 3 (2.7%) samples. All assemblage A infections were assigned to the potentially zoonotic subassemblage AI. Co-infections of G. duodenalis and Cryptosporidium spp. were observed in 3.1% (12/386) of the samples. Analyzing several host factors for their potential association with endoparasitic infection, the origin of dogs, as well as the living environment were identified as the main risk factors for infection with endoparasites. Overall, this study shows a high infection rate with endoparasites, especially G. duodenalis, in young dogs from Germany. The results of this study contribute to further insight into the distribution and potential risk factors associated with endoparasitic infections, as well as the zoonotic potential these parasites may present. [ABSTRACT FROM AUTHOR]

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There are many discussions in the media about an interval (delay) from the time of the infections to deaths. Apart from the curiosity of the researchers, defining this time interval may, under certain circumstances, be of great organizational and economic importance. The study considers an attempt to determine this difference through the correlations of shifted time series and a specific bootstrapping that allows finding the distance between local maxima on the series under consideration. We consider data from Poland, the USA, India and Germany. The median of the difference's distribution is quite consistent for such diverse countries. The main conclusion of our research is that the searched interval has rather a multimodal form than unambiguously determined. [ABSTRACT FROM AUTHOR]

Purpose: Evidence on the effect of self-protection via social distancing and wearing face-masks on infections during chemotherapy is currently not available. We asked if the occurrence of acute infections during chemotherapy for advanced-stage Hodgkin lymphoma (HL) decreased when COVID-19 protection measures were in effect. Methods: We analyzed the occurrence of infections during all documented eBEACOPP cycles starting between 01 March and 30 June of 2017 to 2020 in patients treated within the GHSG HD21 study in Germany and compared the infection rates and characteristics by logistic regression models and means of descriptive statistics. Results: We analyzed 911 cycles of 313 adult patients treated with 4 to 6 cycles of eBEACOPP. We found a significant decrease in the occurrence of infections during chemotherapy for HL during COVID-19 lockdown from 131 (19.6%) of 670 cycles in 2017–2019 to 30 (12.6%) of 239 cycles during COVID-19 lockdown [OR 0.574 (95% CI 0.354–0.930), P = 0.024]. The strongest effect was evident for unspecified infections with 39 cycles (5.8%) during 2017–2019 in comparison to 5 cycles (2.1%) during COVID-19 lockdown. 20 (24.1%) of 83 patients had an infection during the COVID-19 lockdown versus 99 (43.2%) of 229 patients in the years 2017–2019 (P = 0.0023). Conclusion: The significant decrease of infections during chemotherapy for HL during COVID-19 lockdown reveals the protective measures' potential to shield patients from transmissible pathogens. We conclude that these measures could be recommended for HL patients at risk for infections during chemotherapy. [ABSTRACT FROM AUTHOR]

Background and Objectives: Knowledge about the current spectrum of dermatomycoses is important for diagnosis and therapy., Patients and Methods: A retrospective, monocentric analysis of mucocutaneous fungal infections diagnosed at a large European academic dermatology department in Munich was conducted; 87,229 samples from 48,916 patients from January 1, 2011, to August 30, 2020, were included., Results: Fungi were detected in 11,513 samples from 48,916 (23.54%), and 36 different species were identified. Candida (C.) albicans was the most common pathogen (5,055 detections; 43.91% of all positive samples), followed by Trichophyton (T.) rubrum (3,076 detections; 26.72% of all positive samples) and Candida parapsilosis (923 detections; 8.02% of all positive samples). Rare pathogens such as Trichophyton raubitschekii were also detected. Coinfections with multiple species were detected in 44 cases., Conclusions: Even though C. albicans, T. rubrum, and C. parapsilosis were confirmed as the most common pathogens, rare pathogens should also be considered in clinical practice. The predominant spectrum of fungi differed from that reported in other countries. Furthermore, a difference in the pathogen spectrum could be observed depending on the age group and body site., (© 2024 The Authors. Journal der Deutschen Dermatologischen Gesellschaft published by Wiley‐VCH GmbH on behalf of Deutsche Dermatologische Gesellschaft.)

Background and Aim: Helicobacter pylori (H. pylori) infection is a bacterial disease of the stomach that has been associated with an increased incidence of cholelithiasis. While the updated German guideline emphasizes the relevance of H. pylori as a pathogen and recommends eradication therapy, systematic data on the association between H. pylori infection, its eradication, and the subsequent diagnosis of cholelithiasis in Germany are missing., Methods: A total of 25 416 patients with and 25 416 propensity score-matched individuals without H. pylori infection were identified from the Disease Analyzer database (IQVIA) between 2005 and 2021. A subsequent diagnosis of cholelithiasis was analyzed as a function of H. pylori infection as well as its eradication using Cox regression models., Results: After 10 years of follow-up, 8.0% versus 5.8% of patients with and without H. pylori infection were diagnosed with cholelithiasis (P < 0.001). Regression analysis revealed a significant association between H. pylori infection and cholelithiasis (hazard ratio [HR]: 1.45; 95% confidence interval [CI]: 1.33-1.58), which was stronger in men (HR: 1.63; 95% CI: 1.41-1.90) than in women (HR: 1.36; 95% CI: 1.22-1.52). In terms of eradication therapy, both an eradicated H. pylori infection (HR: 1.48; 95% CI: 1.31-1.67) and a non-eradicated H. pylori infection (HR: 1.41; 95% CI: 1.25-1.60) were associated with a subsequent diagnosis of cholelithiasis., Conclusion: The present study reveals a strong association between H. pylori infection and a subsequent diagnosis of cholelithiasis in a large real-world cohort from Germany. Eradication therapy was not associated with a reduced incidence of cholelithiasis in our cohort., (© 2024 The Authors. Journal of Gastroenterology and Hepatology published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd.)

Background: For Clostridioides difficile infections (CDIs) in Germany no longitudinal multi-centre studies with standardized protocols for diagnosing CDI are available. Recent evaluations of general surveillance databases in Germany indicate a downward trend in CDI rates. We aimed to describe the actual burden and trends of CDI in German university hospitals from 2016 to 2020., Methods: Our study was a prospective multi-centre study covering six German university hospitals. We report the data in total, stratified by year, by medical specialty as well as by CDI severity. Multi-variable regression analyses were performed to assess risk factors for severe CDI., Results: We registered 3780 CDI cases among 1,436,352 patients. The median length of stay (LOS) of CDI cases was 20 days (interquartile range 11-37) compared with a general LOS of 4.2 days. In-hospital all-cause mortality in CDI patients was 11.7% (N = 444/3780), while mortality attributed to CDI was 0.4% (N = 16/3761). CDI recurrence rate was comparatively low at 7.2%. The incidence density of severe healthcare-associated healthcare onset (HAHO)-CDI showed a significant decrease from 2.25/10,000 patient days (pd) in 2016 to 1.49/10,000 pd in 2020 (trend calculation P=0.032)., Conclusions: Compared with a European point-prevalence study in 2013/2014, where overall CDI incidence density was 11.2 cases/10,000 pd in Germany (EUCLID), we see in our study halved overall CDI rates of 5.6 cases/10,000 pd in 2020. Our study shows current data on the distribution of CDI cases in German university hospitals and thus provides international comparative data on the key indicators of CDI., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Periprosthetic joint infection represents a major complication in orthopaedics and trauma surgery. For an ideal management approach, it is important to understand the distinct challenges for all persons involved in the treatment. Therefore, it was aimed at investigating (1) the impact of periprosthetic joint infection (PJI) on the well-being of nursing staff to (2) identify challenges, which could be improved facilitating the management of PJI. Methods: This is a qualitative interview study. In total, 20 nurses of a German university orthopedic trauma center specialized on infectious complications were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between March 2021 and June 2021. Results: Three major themes could be extracted including (i) feelings associated with the management of PJI and the need for emotional support, illustrating the negative emotional impact on nurses, whereby receiving collegial support was perceived as an important coping strategy, (ii) patients' psychological burden, highlighting the nurses' lack of time to address mental issues adequately and, (iii) realization of the severity of PJI and compliance problems. Conclusion: Identified facilitating factors for PJI management include strengthening of mental care in the treatment of PJI, providing opportunities for exchange among multidisciplinary team members and implementing compliance-enhancing strategies. The findings of this study can be beneficial for improving professionals' satisfaction, optimising the work environment, creating organizational structures which enhance opportunities for exchange and preventing mental health issues among the nursing team. [ABSTRACT FROM AUTHOR]

Background Infectious complications are a major cause of morbidity and mortality after kidney transplantation. Methods In this transplant cohort study at the German Center of Infectious Diseases (DZIF), we evaluated all infections occurring during the first year after renal transplantation. We assessed microbial etiology, incidence rates, and temporal occurrence of these infections. Results Of 804 renal transplant recipients (65.2% male, 51 ± 14 years), 439 (54.6%) had 972 infections within the first year after transplantation. Almost half of these infections (47.8%) occurred within the first 3 months. Bacteria were responsible for 66.4% (645/972) of all infections, followed by viral (28.9% [281/972]) and fungal (4.7% [46/972]) pathogens. The urinary tract was the most common site of infection (42.4%). Enterococcus was the most frequently isolated bacterium (20.9%), followed by E. coli (17.6%) and Klebsiella (12.5%). E. coli was the leading pathogen in recipients <50 years of age, whereas Enterococcus predominated in older recipients. Resistant bacteria were responsible for at least 1 infection in 9.5% (76/804) of all recipients. Viral infections occurred in 201 recipients (25.0%). Of these, herpes viruses predominated (140/281 [49.8%]), and cytomegalovirus had the highest incidence rate (12.3%). In the 46 fungal infections, Candida albicans (40.8%) was the most commonly isolated. Other fungal opportunistic pathogens, including Aspergillus fumigatus and Pneumocystis , were rare. Conclusions Renal allograft recipients in Germany experience a high burden of infectious complications in the first year after transplantation. Bacteria were the predominating pathogen, followed by opportunistic infections such as cytomegalovirus. Microbial etiology varied between age groups, and resistant bacteria were identified in 10% of recipients. [ABSTRACT FROM AUTHOR]

Objectives Differential diagnosis in children with prolonged fever is challenging. In particular, differentiating systemic-onset JIA (SJIA) from infectious diseases is difficult. Biomarkers are needed that support the diagnostic work-up. The aim of this study was to validate the usefulness of Myeloid-related protein 8/14 (MRP8/14) measurements in the diagnostic work-up of febrile children and to transfer it to clinical practice. Methods Data for 1110 paediatric patients were included and divided into two cohorts: (cohort A) for validation of MRP8/14 test performance with three different testing systems: the experimental ELISA, commercial ELISA and an innovative (point-of-care test) lateral flow immunoassay (LFIA); (cohort B) to validate the diagnostic accuracy with the two latter assays. Results In cohort A (n  = 940), MRP8/14 was elevated in SJIA (12 110 ± 2650 ng/ml mean ± 95% CI) compared with other diagnoses (including infections and autoinflammatory diseases; 2980 ± 510 ng/ml) irrespective of fever and anti-inflammatory treatment (P  < 0.001). In untreated patients with fever (n  = 195) MRP8/14 levels in SJIA (19 740 ± 5080 ng/ml) were even higher compared with other diagnoses (4590 ± 1160 ng/ml) (P  < 0.001, sensitivity 73%, specificity 90%). In group B1, the performance of the tests was confirmed in untreated patients with fever (n  = 170): commercial ELISA (sensitivity 79%, specificity 89%) and LFIA (sensitivity 84%, specificity 81%). Compared with ferritin, IL-18, ESR, soluble IL-2 receptor and procalcitonin, MRP8/14 showed the best accuracy. Conclusion MRP8/14 serum analyses have been validated as a helpful tool supporting the diagnosis of SJIA in febrile children. The results could be confirmed with commercial ELISA and LFIA enabling a rapid diagnostic point-of-care screening test. [ABSTRACT FROM AUTHOR]

Sika deer (Cervus nippon), which are native to the Japanese islands and the adjacent mainland of eastern Asia, have been introduced into Europe and established free-ranging populations in several countries. Various Sarcocystis species have been identified recently from farmed "mainland sika" deer in Lithuania and native "Japanese sika" deer in Japan. To study the distribution, prevalence and intensity of Sarcocystis infection in free-ranging sika deer outside of their natural range heart and/or diaphragm samples of 311 animals from nine populations in Germany and Austria were examined by histology. Overall, sarcocysts were detected in either heart or diaphragm of 107/311 deer (34.4%) with prevalence ranging roughly from 5 to 50% among the populations. Considering the 263 animals with both heart and diaphragm available, prevalence varied significantly (p < 0.0001) among calves (20.2%), yearlings (40.3%), and adult deer (49.1%) but did not differ between male and female deer (48.3% vs. 43.7%; p = 0.6483). Occurrence of sarcocysts in heart vs. diaphragm indicated a marginal difference (27.8% vs. 20.9%; p = 0.0839). Intensity of infection in all but one heart positive and all diaphragm positive animals was low (< 10 sarcocysts per square centimeter muscle cut). While heart sarcocyst counts of yearlings and adult deer were higher than those of calves and were higher in male compared to female sika deer, diaphragm sarcocyst counts did not differ significantly between age groups and sexes. Sarcocystis infection was demonstrated at variable prevalence in sika deer in all populations but intensity is apparently low. Further studies are needed to identify the species of Sarcocystis infecting sika deer naturalized outside their natural range. [ABSTRACT FROM AUTHOR]

Angiostrongylus vasorum, Crenosoma vulpis, Aelurostrongylus abstrusus and Troglostrongylus brevior can cause severe cardiovascular and pulmonary symptoms in companion animals and wildlife. Recently, these nematodes were reported to spread within Europe and South America. The reasons behind this are still unknown, but obligate gastropod intermediate host populations might play a role. Therefore, lungworm infections in terrestrial slug populations in selected geographic areas of the Federal States of Bavaria and of Baden-Wuerttemberg, Germany, were studied. In total, 517 slugs (462 Arion spp., 51 Deroceras reticulatum, one Limax maximus, and three unknown slug species) were collected in the summer and autumn seasons, artificially digested and microscopically and molecularly analyzed for the presence of metastrongyloid lungworm larvae. Overall, gastropods showed a prevalence of 11.61% (60/517) for A. vasorum, 1.74% (9/517) for A. abstrusus, 0.77% (4/517) for C. vulpis and 0.97% (5/517) for T. brevior infections, respectively. In Obrigheim (Baden-Wuerttemberg), a hyperendemic focus of canine angiostrongylosis was identified. Here, gastropod infection rates rose from 13.60% (17/125) to 62.96% (34/54) within a few months. In total, 25.61% (84/328) of analysed terrestrial gastropods from Baden-Wuerttemberg were positive for metastrongyloids. In contrast, Bavarian gastropods showed a much lower prevalence of 4.76% (9/189). For the first time, the presence of T. brevior was confirmed for Arion spp. in Baden-Wuerttemberg via molecular analyses. Overall, the current data confirm that canine angiostrongylosis occurs in hyperendemic foci in certain geographic areas with high infection rates in intermediate host populations. As a result, the prevalence for a specific region can rise remarkably within a short period of time. Thus, for a better understanding of lungworm epidemiology in Germany and to protect dogs from angiostrongylosis in hyperendemic foci, it seems mandatory to enhance current efforts on Metastrongyloidea-targeted monitoring on a geographical and time span-related level. [ABSTRACT FROM AUTHOR]

We analyzed symptoms and comorbidities as predictors of hospitalization in 710 outpatients in North-East Germany with PCR-confirmed SARS-CoV-2 infection. During the first 3 days of infection, commonly reported symptoms were fatigue (71.8%), arthralgia/myalgia (56.8%), headache (55.1%), and dry cough (51.8%). Loss of smell (anosmia), loss of taste (ageusia), dyspnea, and productive cough were reported with an onset of 4 days. Anosmia or ageusia were reported by only 18% of the participants at day one, but up to 49% between days 7 and 9. Not all participants who reported ageusia also reported anosmia. Individuals suffering from ageusia without anosmia were at highest risk of hospitalization (OR 6.8, 95% CI 2.5–18.1). They also experienced more commonly dyspnea and nausea (OR of 3.0, 2.9, respectively) suggesting pathophysiological connections between these symptoms. Other symptoms significantly associated with increased risk of hospitalization were dyspnea, vomiting, and fever. Among basic parameters and comorbidities, age > 60 years, COPD, prior stroke, diabetes, kidney and cardiac diseases were also associated with increased risk of hospitalization. In conclusion, due to the delayed onset, ageusia and anosmia may be of limited use in differential diagnosis of SARS-CoV-2. However, differentiation between ageusia and anosmia may be useful for evaluating risk for hospitalization. [ABSTRACT FROM AUTHOR]

Biologic psoriasis treatments are differentiated by efficacy, side effects, and other attributes. Determine attributes of biologic psoriasis treatments that drive patients' treatment choices. Respondents (USA: n = 300; Germany: n = 300) with moderate-to-severe psoriasis completed a discrete-choice–experiment survey, choosing between hypothetical treatments characterized by attributes with varying levels: chance of clear skin after 1 year, number of first-year treatments, first-year risks of mild-to-moderate injection site reaction (ISR) and serious infection, and years of proven efficacy/safety. U.S. respondents most valued clear skin (conditional relative importance, 1.88; p <.05). While other attributes were of generally equivalent importance, ISR risk outweighed serious-infection risk (1.06 vs. 0.70; p <.05). German respondents placed greatest importance on ISR risk (1.61; p <.05) and clear skin (1.49; p <.05). Respondents evaluated hypothetical treatments and were recruited from web panels. Clear skin and ISR risk are stronger drivers of treatment choice than injection frequency and infection risk. [ABSTRACT FROM AUTHOR]

An economic model was developed to estimate the cost of negative pressure wound therapy with instillation and dwelling of a topical wound solution vs control therapies. Economic model inputs were means derived from the results of a recently published systematic review and meta‐analysis of 13 comparative studies of negative pressure wound therapy with instillation. Means across studies comprising complex acute and chronic wounds for negative pressure wound therapy‐instillation vs control (negative pressure wound therapy without instillation, gauze dressings, or gentamicin polymethylmethacrylate beads) groups were 1.77 vs 2.69 operating room visits (P =.008) and 9.88 vs 21.80 therapy days (P =.02), respectively. These inputs plus hospital cost data were used to model costs for the United States, Germany, and the United Kingdom. For the United States, Germany, and United Kingdom, respectively, economic model estimates of total potential per patient savings were $33 338, €8467, and £5626 for negative pressure wound therapy‐instillation group vs control, based on assumed number of OR visits during therapy, cost of therapy system, and length of therapy. Model results showed an overall potential cost‐savings with negative pressure wound therapy‐instillation vs control, based on fewer OR visits and shorter therapy duration as reported in the published systematic review and meta‐analysis. [ABSTRACT FROM AUTHOR]

Assessing the infection fatality rate (IFR) of SARS-CoV-2 in a population is a controversial issue. Due to asymptomatic courses of COVID-19, many infections remain undetected. Reported case fatality rates are therefore poor estimates of the IFR. We propose a strategy to estimate the IFR that combines official data on cases and fatalities with data from seroepidemiological studies in infection hotspots. The application of the method yields an estimate of the IFR of wild-type SARS-CoV-2 in Germany during the first wave of the pandemic of 0.83% (95% CI: [0.69%; 0.98%]), notably higher than the estimate reported in the prominent study by Streeck et al. (2020) (0.36% [0.17%; 0.77%]) and closer to that obtained from a world-wide meta analysis (0.68% [0.53%; 0.82%]), where the difference can be explained by Germany's disadvantageous age structure. Provided that suitable data are available, the proposed method can be applied to estimate the IFR of virus variants and other regions. [ABSTRACT FROM AUTHOR]

Respiratory viruses play an important role in asthma exacerbation, and early exposure can be involved in recurrent bronchitis and the development of asthma. The exact mechanism is not fully clarified, and pathogen-to-host interaction studies are warranted to identify biomarkers of exacerbation in the early phase. Only a limited number of international exacerbation cohorts were studied. Here, we have established a local pediatric exacerbation study in Germany consisting of children with asthma or chronic, recurrent bronchitis and analyzed the viriome within the nasopharyngeal swab specimens derived from the entire cohort (n = 141). Interestingly, 41% of exacerbated children had a positive test result for human rhinovirus (HRV)/human enterovirus (HEV), and 14% were positive for respiratory syncytial virus (RSV). HRV was particularly prevalent in asthmatics (56%), wheezers (50%), and atopic (66%) patients. Lymphocytes were decreased in asthmatics and in HRV-infected subjects, and patients allergic to house dust mites were more susceptible to HRV infection. Our study thus confirms HRV infection as a strong 'biomarker' of exacerbated asthma. Further longitudinal studies will show the clinical progress of those children with a history of an RSV or HRV infection. Vaccination strategies and novel treatment guidelines against HRV are urgently needed to protect those high-risk children from a serious course of disease. [ABSTRACT FROM AUTHOR]

Background: Increasing life expectancy and demographic change result in a rising number of geriatric patients, but knowledge about geriatric treatment options and adapted diagnostic pathways is low. Simultaneously, urinary tract infections (UTIs) are common in older people and often difficult to treat. Methods: Patients with a UTI at a urological outpatient department between January 01, 2016, and December 31, 2017, were retrospectively identified in the data system. One thousand one hundred fifteen patients with "N30" and "N39" diagnosis were included in this study, 965 of which were under the age of 75 (group 1) and 150 of which 75 years or older (group 2). Results: Of 150 patients in group 2, 41.6% had nitrite-positive urine (vs. 20.9% in group 1, p < 0.05 in χ2 testing). Patients in group 2 often had indwelling devices (30.3 vs. 6.0%, p < 0.05) and presented a sterile urine culture in only 20.7% (vs. 40.1% in group 1). Regarding calculated antibiotic therapy, there were significant differences concerning prescription of ciprofloxacin (34.9 vs. 25%, p < 0.05) and fosfomycin (12.7 vs. 40.7%, p < 0.05). Conclusion: UTI in geriatric patients should be treated differently than in younger patients because antibiotic resistance is high. The group with indwelling devices is complex. Individual strategies for geriatric patients should be considered. [ABSTRACT FROM AUTHOR]

Tick-borne encephalitis (TBE) is a growing public health problem with increasing incidence and expanding risk areas. Improved prevention requires better understanding of the spatial distribution and ecological determinants of TBE transmission. However, a TBE risk map at sub-district level is still missing for Germany. We investigated the distribution and geo-spatial characteristics of 567 self-reported places of probable TBE infection (POI) from 359 cases notified in 2018–2020 in the study area of Bavaria and Baden-Wuerttemberg, compared to 41 confirmed TBE foci and 1701 random comparator places. We built an ecological niche model to interpolate TBE risk to the entire study area. POI were distributed heterogeneously at sub-district level, as predicted probabilities varied markedly across regions (range 0–93%). POI were spatially associated with abiotic, biotic, and anthropogenic geo-spatial characteristics, including summer precipitation, population density, and annual frost days. The model performed with 69% sensitivity and 63% specificity at an optimised probability threshold (0.28) and an area under the curve of 0.73. We observed high predictive probabilities in small-scale areas, consistent with the known circulation of the TBE virus in spatially restricted microfoci. Supported by further field work, our findings may help identify new TBE foci. Our fine-grained risk map could supplement targeted prevention in risk areas. [ABSTRACT FROM AUTHOR]

The reproductive fitness of female European eels (Anguilla anguilla L.) from the Warnow River, Germany, Baltic Sea region, was evaluated by estimating fecundity and applying a spawning model. Individual fecundity ranged from 1,440,000 to 7,455,000 oocytes and mean relative fecundity equalled 5,956,015 oocytes kg−1. Modelling suggests that 43% of eels hold insufficient energy storages or are within 10% of complete depletion. The fraction of eels with insufficient energy supply increases from 19% to 35% if the effect of parasitic infection is considered. [ABSTRACT FROM AUTHOR]

This case report highlights details of a case of critical acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) with B1.1.7 variant in a 4-year-old girl who died due to pneumonia and pulmonary hemorrhage. The girl was referred to our University ECMO Center from another University hospital for veno-arterial extracorporeal membrane oxygenation (VA-ECMO). In the clinical course, superinfection with Pseudomonas aeruginosa was detected. Virological evidence of herpes simplex sepsis was also obtained in blood samples on her day of death. Transcription polymerase chain reaction (PCR) confirmed SARS-CoV-2 infection in lung tissue. Postmortem computed tomography showed pulmonary hemorrhage with inhomogeneous density values in both lungs. Lung tissue showed no ventilated areas. Autopsy revealed a massively congested lung with evidence of acute respiratory distress syndrome (ARDS) and pneumonia with multiple abscesses. Histopathology showed a mixture of diffuse alveolar injury with hyaline membranes, massive hemorrhage, and bronchopneumonia with multiple granulocytic abscesses. Cardiac examination revealed pericarditis. Suspicion of myocarditis or myocardial infarction could not be confirmed microscopically. To our knowledge, this is the first autopsy-based case report of the death of a previously healthy child due to the new variant B 1.1.7 in Germany. [ABSTRACT FROM AUTHOR]

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SARS-CoV-2 infection rates in children and adolescents are often underestimated due to asymptomatic or oligosymptomatic infections. Seroprevalence studies can reveal the magnitude of "silent" infections in this age group and help to assess the risk of infection for children but also their role in spreading the disease. In total, 2045 children and their parents from the Ruhr region were finally included after the exclusion of drop-outs. Seroconversion rates among children of all age groups increased from 0.5% to 8% during the study period and were about three to fourfold higher than the officially registered PCR-based infection rates. Only 41% recalled symptoms of infection; 59% were asymptomatic. In 51% of the infected children, at least one parent also developed SARS-CoV-2 antibodies. Depending on local incidences, the rates of seroconversion rose to different levels during the study period. Although the dynamics of infection within the study cohort mirrors local incidence, the figure of SARS-CoV-2 infections in children and adolescents appears to be high. Reported contact with SARS-CoV-2-infected individuals in the same household carries a high risk of infection. [ABSTRACT FROM AUTHOR]

Background: Unicompartimental knee arthroplasty (UKA) is a promising and increasing application to treat unicompartimental knee osteoarthritis. However, revision arthroplasty numbers after UKA are unknown. Therefore, aim of this study was to determine the nationwide burden of revision after UKA by answering the following questions: (1) How did numbers of revision UKA procedures developed over the last decade as a function of age and gender? (2) How high is the percentage of revision UKA procedures due to infection? (3) Which therapy strategy was chosen for surgical treatment of aseptic revision UKA? Methods: Revision arthroplasty rates as a function of age, gender, infection and type of prosthesis were quantified based on Operation and Procedure Classification System codes using revision knee arthroplasty data from 2008 to 2018, provided by the Federal Statistical Office of Germany (Destatis). Results: Over the last decade, revision UKA increased by 46.3% up to 3105 procedures in 2018. A trend towards higher numbers in younger patients was observed. Septic interventions constituted 5.7% of all revisions, whereby total procedures increased by 67.1% from 2008 through 2018. The main treatment strategy was an exchange to a bicondylar surface replacement prosthesis, which was done in 63.70% of all cases, followed by exchange to a femoral and tibial shaft-anchored (16.2% of all revisions). Conclusion: The increasing number of revision arthroplasty after UKA in Germany, especially in younger patients and due to infection, underlines the need for future efforts to improve treatment strategies beyond UKA to delay primary arthroplasty and avoid periprosthetic joint infection. [ABSTRACT FROM AUTHOR]