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Biomedical subjects

M Behnke

Publications and source records attributed to M Behnke.

At least 19 recordsLinked to original sources
PubMed2006

Reduction of surgical site infection rates associated with active surveillance.

OBJECTIVE: To evaluate whether surgical site infection (SSI) rates decrease in surgical departments as a result of performing active SSI surveillance. DESIGN: Retrospective multiple logistic regression analyses. SETTING: A group of 130 surgical departments of German hospitals participating in the Krankenhaus Infektions Surveillance System (KISS). METHODS: Data for 19 categories of operative procedures performed between January 1997 and June 2004 were included (119,114 operations). Active SSI surveillance was performed according to National Nosocomial Infections Surveillance system (NNIS) methods and definitions. Departments' SSI rates were calculated individually for each year of surveillance and for each operative procedure category, taking into account when the individual departments had begun their surveillance activities. Multiple logistic regression analyses on a single operation basis were carried out with stepwise variable selection to predict outcomes for patients with SSI. The variables included were as follows: the department's year of participation, NNIS risk index variables, patients' age and sex, and the hospitals' structural characteristics, such as yearly operation frequency, number of beds, and academic status. RESULTS: For 14 of 19 operative procedure categories analyzed, there was a tendency toward lower SSI rates that was associated with increasing duration of SSI surveillance. In multiple logistic regression analyses of pooled data for all operative procedures, the departments' participation in the surveillance system was a significant independent protective factor. Compared with the surveillance year 1, the SSI risk decreased in year 2 (odds ratio, 0.84; 95% confidence interval, 0.77-0.93) and in year 3 (odds ratio, 0.75; 95% confidence interval, 0.68-0.82), and there was no change in year 4. CONCLUSION: The SSI incidence was reduced by one quarter as a result of the surveillance-induced infection control efforts, which indicates the usefulness of a voluntary surveillance system.

Humans↗
PubMed2006

Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections.

In recent years, several countries have established surveillance systems for nosocomial infections (NIs) on a national basis. Limited information has been published on the effectiveness of these national surveillance systems. The aim of this study was to investigate whether participation in the German national NI surveillance system [Krankenhaus Infektions Surveillance System (KISS)] resulted in reduced rates of NIs. Three major NIs were studied: ventilator-associated pneumonia (VAP) and central-venous-catheter-related primary bloodstream infections (CR-BSIs) in intensive care units (ICUs), and surgical site infections (SSIs) in surgical inpatients. Data were collected from January 1997 until December 2003. Only institutions that had participated in KISS for at least 36 months were considered for analysis. Data from the first 12 months of surveillance were compared with data from the second and third 12-month periods. One hundred and fifty ICUs and 133 surgical departments fulfilled the inclusion criteria. In their first year of participation in KISS, the ICUs had an average VAP rate of 11.2 per 1000 ventilator-days and a CR-BSI rate of 2.1 per 1000 catheter-days. The average SSI rate in the surgical inpatients was 1.6 per 100 operations in their first year of participation. Comparing the infection rates in the third year with the first year, the relative risk (RR) for VAP was 0.71 [95% confidence intervals (CI) 0.66-0.76] and the RR for CR-BSI was 0.80 (95% CI 0.72-0.90). The corresponding RR for SSI was 0.72 [95% CI 0.64-0.80]. Participation in KISS was associated with a significant reduction in these three NIs.

Bacteremia↗
PubMed2006

Use of multistate models to assess prolongation of intensive care unit stay due to nosocomial infection.

BACKGROUND: Reliable data on the costs attributable to nosocomial infection (NI) are crucial to demonstrating the real cost-effectiveness of infection control measures. Several studies investigating this issue with regard to intensive care unit (ICU) patients have probably overestimated, as a result of inappropriate study methods, the part played by NIs in prolonging the length of stay. METHODS: Data from a prospective study of the incidence of NI in 5 ICUs over a period of 18 months formed the basis of this analysis. For describing the temporal dynamics of the data, a multistate model was used. Thus, ICU patients were counted as case patients as soon as an NI was ascertained on any particular day. All patients were then regarded as control subjects as long as they remained free of NI (time-to-event data analysis technique). RESULTS: Admitted patients (n=1,876) were observed for the development of NI over a period of 28,498 patient-days. In total, 431 NIs were ascertained during the study period (incidence density, 15.1 NIs per 1,000 patient-days). The influence of NI as a time-dependent covariate in a proportional hazards model was highly significant (P< .0001, Wald test). NI significantly reduced the discharge hazard (hazard ratio, 0.72 [95% confidence interval, 0.63-0.82])--that is, it prolonged the ICU stay. The mean prolongation of ICU length of stay due to NI (+/- standard error) was estimated to be 5.3+/-1.6 days. CONCLUSIONS: Further studies are required to enable comparison of data on prolongation of ICU length of stay with the results of various study methods.

Aged↗
PubMed2006

Device-associated infection rates for non-intensive care unit patients.

BACKGROUND: Reference data from intensive care units (ICUs) are not applicable to non-ICU patients because of the differences in device use rates, length of stay, and severity of underlying diseases among the patient populations. In contrast to the huge amount of data available for ICU patients, appropriate surveillance data for non-ICU patients have been missing in Germany. OBJECTIVE: To establish a new module ("DEVICE-KISS") of the German Nosocomial Infection Surveillance System for generating stratified reference data for non-ICU wards. SETTING: Non-ICU patients from 42 German hospitals. METHODS: Monthly patient-days, device-days and nosocomial infections (NIs) (using Centers for Disease Control and Prevention definitions) were counted. Device use rates were calculated, and NI rates were stratified by different medical specialities. RESULTS: From July 2002 through June 2004, among the 77 wards, there were a total of 536,955 patient-days and 74,188 device-days (for CVC-associated primary bloodstream infections, there were 181,401 patient-days and 8,317 central vascular catheter [CVC]-days in 29 wards; for urinary catheter-associated urinary tract infections, there were 445,536 patient-days and 65,871 urinary catheter-days in 65 wards) and 483 NIs (36 bloodstream infections and 447 urinary tract infections). The mean device use rates were 4.6 device-days per 100 patient-days for CVCs (29 wards) and 14.8 device-days per 100 patient-days for urinary catheters (65 wards), respectively. Mean device-associated NI rates were 4.3 infections per 1,000 CVC-days for CVC-associated bloodstream infections and 6.8 infections per 1,000 urinary catheter-days for catheter-associated urinary tract infections. CONCLUSIONS: DEVICE-KISS allows non-ICUs to recognize an outlier position with regard to NIs by providing well-founded reference data for non-ICU patients.

Bacteremia↗
PubMed2006

Hand rub consumption and hand hygiene compliance are not indicators of pathogen transmission in intensive care units.

The objective of this study was to investigate whether nosocomial infection (NI) rates, hand hygiene compliance rates and the amount of alcohol-based hand rub used for hand disinfection are useful indicators of pathogen transmission in intensive care units (ICUs), and whether they could be helpful in identifying infection control problems. All isolates of 10 of the most frequent pathogens from patients who were hospitalized in an ICU for >48 h were genotyped to identify transmission episodes in five ICUs. The incidence of transmission was correlated with hand hygiene compliance, hand rub consumption and NI rates. The incidence of transmission episodes varied between 2.8 and 6.8 in the five ICUs. The NI rate was 8.6-22.5 per 1000 patient-days, hand hygiene compliance was 30-47% and hand rub consumption was 57-102 L per 1000 patient-days. There was no correlation between the incidence of transmission episodes and hand rub consumption or hand hygiene compliance. The correlation between transmission rates and NI rates was 0.4 (P = 0.5), and with the exclusion of one ICU, it was 1 (P < 0.01). The incidence of NI is a relatively good indicator for the identification of pathogen transmissions, but hand rub consumption and hand hygiene compliance, at least with the relatively low level of compliance found in this study, are not indicators of pathogen transmission.

Anti-Infective Agents, Local↗
PubMed2005

Reduction of orthopaedic wound infections in 21 hospitals.

INTRODUCTION: The German national nosocomial infections surveillance system (KISS) has been collecting surveillance data from hip and knee prosthesis operations since 1997. The purpose of this article is to investigate whether surveillance and feedback of surgical site infection (SSI) information to the physicians and nurses of participating hospitals lead to reduced SSI rates or not. MATERIALS AND METHODS: Only information from hospitals previously participating for at least 3 years was used for the analysis. Monthly SSI rates were pooled over the 36-month period, beginning in each clinic's case with its first month of participation, the rates then being compared for 12-month periods. Relative risks were calculated for comparison of the SSI rates in the first and third years of participation. A multiple logistic regression analysis with stepwise variable selection was performed to identify significant risk factors, including the year of surveillance after starting surveillance activities. RESULTS: The overall SSI rates were 1.4% for hip prosthesis and 1.0% for knee prosthesis. Fourteen clinics participated in KISS for at least 3 years continuously with HIP prostheses and 21 with knee prostheses. It was possible to include a total of 15,457 hip and 9,011 knee procedures for this analysis. A comparison of data from the first and the third years show a significant SSI reduction with hip procedures, with a relative risk of 0.54 (CI95 0.38-0.77), and a trend towards reduced SSI rates for knee procedures. The multiple logistic regression analysis confirmed that the SSI rate for hip prosthesis was significantly lower in the third year than in the first year of surveillance (OR = 0.57; CI95 0.42-0.78), though for knee prosthesis the level of significance was not achieved. CONCLUSION: A reduction of SSIs following hip and knee prosthesis operations through the introduction of ongoing surveillance and the possibility of using benchmark data for comparison does seem to be possible in many institutions.

Hip Prosthesis↗
PubMed2005

[Incidence of transmission of pathogens in intensive care units. Results of the SIR 3 study].

The objective of this study was to determine the incidence of episodes of transmission of nosocomial pathogens and of those pathogens leading to nosocomial infections. Over a period of 18 months all patients from 5 intensive care units (ICUs) who stayed for more than 2 days were included in this study. Surveillance of nosocomial infections was carried out and all isolates of 10 of the most frequent pathogens in ICUs (indicator pathogens) were collected and typed. A total of 28,498 patient days and 431 nosocomial infections were observed (incidence density 15.1 per 1,000 patient days), among them 278 caused by 1 of the selected indicator pathogens. A total of 141 episodes of transmissions were identified, corresponding to an incidence of episodes of transmission of 5.0 per 1,000 patient days and 41 nosocomial infections were transmission-associated, corresponding to 14.5% of all nosocomial infections. The data of this study demonstrate that even in ICUs with average nosocomial infection rates, some nosocomial infections could be avoided.

Anesthesia↗
PubMed2005

Mortality risk factors with nosocomial Staphylococcus aureus infections in intensive care units: results from the German Nosocomial Infection Surveillance System (KISS).

INTRODUCTION: As the number of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections in German intensive care units increases, the problem of MRSA infection as such is becoming ever more serious. The aim of this study was to investigate whether mortality rates from nosocomial MRSA pneumonia and primary bloodstream infections (BSI) differ significantly from those of nosocomial pneumonia and primary BSI caused by methicillin-susceptible S. aureus (MSSA). METHODS: For the analysis data from the ICU component of the German nosocomial infection surveillance system (KISS) were used (January 1997 to June 2002). To identify mortality risk factors a logistic regression analysis with step-wise variable selection was conducted including all cases of nosocomial S. aureus pneumonia and primary BSI. The possible risk factors that were evaluated were age > median, male gender, time in the ICU before infection > median, type of ICU, type and size of hospital, intubation, CVC use, total parenteral nutrition, year of investigation, infection caused by MRSA. RESULTS: Data from 274 ICUs and 505,487 ICU patients were recorded and a total of 6,888 cases of nosocomial pneumonia and 2,357 cases of primary BSI identified, of which 1,851 cases of S. aureus pneumonia and 378 cases of S. aureus primary BSI were considered for analysis. 59 of the 349 patients with MRSA pneumonia (16.9%) and 105 of the 1,502 patients with MSSA pneumonia (7.0%) died. 16 of the 95 patients with primary MRSA BSI (16.8%) and 17 of the 283 patients with primary MSSA BSI died (6.0%). Four factors were significantly associated with mortality from S. aureus pneumonia, one of them being pneumonia caused by MRSA (OR = 2.62; CI95 1.69-4.02). Only MRSA was significantly associated with death from S. aureus primary BSI (OR = 3.84; CI95 1.51-10.2). CONCLUSION: Nosocomial pneumonia and primary BSI from MRSA may be associated with death, but the cause-effect relationship of severity of illness and MRSA remains to be determined due to the limitations of surveillance data.

Cross Infection↗
PubMed2005

[Mortality in German intensive care units: dying from or with a nosocomial infection?].

OBJECTIVE: To describe mortality from intensive care unit acquired infections in German ICUs. METHODS: The hospital infection surveillance system (KISS = Krankenhaus-Infektions-Surveillance-System) started in Germany in January 1997 as a nationwide surveillance project for the voluntary registration of nosocomial infections. For ICUs reporting focuses on pneumonia and primary bloodstream infections. The data collected for each patient who acquires a nosocomial infection include outcome information. Data of a recent French study and the Statistical Yearbook were used to estimate the annual number of ICU acquired infections contributing to death in Germany. RESULTS: Data from 897 774 ICU patients were considered for the analysis (January 1997-June 2004). ICU mortality of patients with nosocomial pneumonia was 8.8 %, of patients with primary bloodstream infection was 10,9 %. Of the ICU patients with nosocomial pneumonia and primary bloodstream infections about 3554 die annually, in about 1131 cases the nosocomial infection was the cause of death. It may be estimated that the ICU acquired cases of pneumonia and primary bloodstream infection contributed to the death of about 2400 patients annually in Germany. CONCLUSION: Because of the substantial mortality of patients with ICU acquired infections preventive measures have a high priority. Further studies leading to improved infection control measures are very wellcome.

Bacteremia↗
PubMed2001

The search for congenital malformations in newborns with fetal cocaine exposure.

CONTEXT: The association between prenatal cocaine exposure and congenital anomalies is not definitive. OBJECTIVE: To determine whether prenatal cocaine exposure results in an increased number or identifiable pattern of abnormalities. DESIGN: A prospective, longitudinal cohort enrolled between 1991 and 1993. SETTING: Rural public health population delivering at a regional tertiary medical center. PATIENTS: Two hundred seventy-two offspring of 154 prenatally identified crack/cocaine users and 154 nonusing controls were matched on race, parity, location of prenatal care (that related to level of pregnancy risk), and socioeconomic status. Drug use was determined through repeated in-depth histories and urine screens. Infants not examined within 7 days of birth were excluded. OUTCOME MEASURES: Assessments were made by experienced examiners masked to maternal drug history. Included were 16 anthropometric measurements and a checklist of 180 physical features defined and agreed upon in advance. RESULTS: There were no differences on major risk variables between the included and excluded infants. There were significantly more premature infants in the cocaine-exposed group. Cocaine-exposed infants were significantly smaller in birth weight, length, and head circumference but did not differ on remaining anthropometric measurements. There was no difference in type or number of abnormalities identified between the exposed and nonexposed groups. There was no relationship between amount or timing of exposure and any of the outcomes. CONCLUSIONS: This prospective, large-scale, blinded, systematic evaluation for congenital anomalies in prenatally cocaine-exposed children did not identify an increased number or consistent pattern of abnormalities.

Abnormalities, Drug-Induced↗
PubMed2001

Detection of cocaine and its metabolites in breast milk.

A method was developed for measuring cocaine and its metabolites, benzoylecgonine, ecgonine methyl ester, norcocaine, ecgonine ethyl ester, cocaethylene, and m-hydroxybenzoylecgonine, in breast milk by gas chromatography/mass spectrometry. Limits of detection for this method ranged from 2.5 to 10 ng/mL, and limits of quantitation ranged from 5 to 50 ng/mL. For each of the compounds measured by this method, linear response was demonstrated to 750 ng/mL. Breast milk was collected from 11 mothers who admitted to drug use during pregnancy and ten drug-free volunteers serving as control subjects. Cocaine was detected in six of the specimens obtained from drug-exposed subjects, and in none of the drug-free control subjects. In breast milk specimens where cocaine and one or more of its metabolites were detected, the concentration of parent compound was greater than any of the metabolites. The highest cocaine concentration found was over 12 microg/mL. Breast-fed infants of cocaine abusing mothers may be exposed to significant amounts of drug orally.

Adult↗
PubMed2000

The concentration of hydrogen peroxide in exhaled air depends on expiratory flow rate.

Hydrogen peroxide (H2O2) is known to be detectable in exhaled air. The present study aimed to determine whether the concentration of exhaled H2O2 depends on expiratory flow rate in order to make inferences on the site of its production within the lung. Breath condensate was collected in cooled Teflon tubes, at three different expiratorv flow rates, in 15 healthy or mild asthmatic subjects. Tests were repeated 2-5 times to assess reproducibility. Mean+/-SEM concentrations of H2O2 at flow rates of 140, 69 and 48 mL.s(-1) were 0.12+/-0.02, 0.19+/-0.02 and 0.32+/-0.03 microM, respectively. These values differed significantly from each other (p<0.001). For comparison, average coefficients of variability within repeated measurements at each of the three flow rates were 68, 62 and 82%, respectively. These data demonstrate that the concentration of exhaled hydrogen peroxide depends on expiratory flow rate. Since flow dependence is an indicator of production within the airways, this result suggests that, to a large extent, the exhaled hydrogen peroxide originates within the airways. However, even under strictly controlled conditions, a high degree of variability persists, which may limit the usefulness of exhaled hydrogen peroxide as a marker of airway inflammation.

Adult↗
PubMed2000

Home-based exercise is capable of preserving hospital-based improvements in severe chronic obstructive pulmonary disease.

We examined the feasibility of home-based walking training to maintain the benefits of a short-term exercise training in patients with severe chronic obstructive pulmonary disease (COPD). After initial recovery from an exacerbation, 46 patients were randomized into a training and a control group, and 30 patients completed the programme (mean +/- SD FEV1, 36 +/- 7% predicted). The training group performed a 10-day walking training programme in the hospital, followed by a 6-month programme of supervised walking training at home, integrated into daily activities. The control group did not have exercise training in the hospital or at home. Until 6 months after discharge, lung function, exercise performance and symptom scores were assessed. Six-minute walking distance in the training group improved from day 1 to day 10 (P<0.001) and this effect was maintained over 6 months (P<0.001). On average, daily walking distance at home was 2308 m and walking was reported on 157 days. Quality of life (QoL) scores changed significantly over 6 months (P<0.001). The control group showed no significant changes in exercise performance or QoL scores throughout the whole study period. Therefore, (i) significant improvements in exercise performance and Chronic Respiratory Disease Questionnaire (CRQ) scores could be achieved after recovery from an exacerbation and (ii) these improvements were maintained after discharge, when supported by a home-based walking training.

Aged↗
PubMed2000

[Primary leiomyosarcoma of the pulmonary artery--a case report].

A case of a primary pulmonary leiomyosarcoma originating in the right pulmonary artery in a 61-year-old woman is reported. Patient's complaints were non-specific and after non-invasive diagnostics a chronic thromboembolic event was suspected to have occurred a long time ago. During a heart catheter investigation prior to planned surgical embolectomy a small specimen was taken from the pulmonary artery. Histological examination revealed malignant the tumour and by immunohistological staining its smooth muscle differentiation was confirmed. Complete resection of the tumour was achieved by radical surgery, including pneumonectomy and extensive resection of pulmonary vessels with subsequent implantation of a Goretex prosthetic. There was no evidence of recurrence or metastasis of the primary leiomyosarcoma of the pulmonary artery in a 14-month follow-up period after operation.

Biopsy↗
PubMed1999

Cranial ultrasound abnormalities identified at birth: their relationship to perinatal risk and neurobehavioral outcome.

OBJECTIVES: Minor cranial ultrasound abnormalities, such as mild ventricular enlargement, choroid plexus cysts, and subependymal cysts, have been identified in 3% to 5% of the newborn population. Although clinicians generally consider these abnormalities to be insignificant for the outcome of the newborn, few convincing data have been published to support this optimism. The objectives of this study were to identify potential risk factors associated with the identification of cranial ultrasound abnormalities at birth and to determine if the abnormalities were related to neurobehavioral sequelae in the newborn. METHODS: Three hundred eight women were enrolled in this prospective, longitudinal maternal-infant health and development study either at the time they entered the public health care system for prenatal care or at delivery if they had no prenatal care. Each woman participated in an in-depth psychosocial interview at the end of each trimester of pregnancy. Retrospective chart review by experienced medical personnel was used to compile data for the Hobel perinatal risk score for each study participant after delivery. Offspring underwent cranial ultrasound evaluation, the Amiel-Tison Neurologic Assessment, and the Brazelton Neonatal Behavioral Assessment Scale within 96 hours of birth by experienced examiners blinded to any maternal-infant history. RESULTS: Of the 308 women originally enrolled in the study, 301 delivered living infants. Of these, 266 infants (88%) underwent a cranial ultrasound evaluation and are the subject of this article. For the purposes of the current study, infants were divided into those with normal (n = 239) and those with abnormal (n = 27) ultrasound results. Abnormal ultrasound results included the following lesions: subependymal cyst (n = 13); mild ventricular enlargement (n = 6); choroid plexus cysts (n = 3); a combination of cysts and increased ventricular size (n = 2); a 7-mm midline cyst in the superior posterior portion of the third ventricle (n = 1); subependymal hemorrhage and ventricular enlargement (n = 1); and increased ventricular size, subependymal hemorrhage and cysts, and two small, right thalamic calcifications (n = 1). There were no significant differences between those with an abnormal ultrasound and those with a normal ultrasound for birth weight, length, gestational age, rate of prematurity, frequency of nulliparity, or frequency of small for gestational age infants. However, infants with an abnormal ultrasound had a significantly smaller mean head circumference than those with a normal ultrasound (34.5 +/- 1.9 cm vs 33.7 +/- 1.9 cm). The infants with an abnormal ultrasound had a higher median prenatal (50 vs 45), neonatal (14 vs 8), and total (94 vs 77) Hobel risk score but not a higher labor-delivery score. There were no significant differences when these groups were compared on additional risk factors not included in the Hobel scoring system such as race and socioeconomic status. In addition, mothers who used a greater number of drugs during the first trimester of pregnancy were more likely to have an infant with an abnormal ultrasound at birth such that the probability of having an abnormal ultrasound rose to 22% by the time the pregnant women were using four drugs. Neurologic examinations revealed no differences between the infants with normal and abnormal ultrasounds. There were also no group differences for five of the seven Brazelton cluster scores, the excitable or depressed clusters, or eight of the nine qualifier scores. However, infants with abnormal ultrasounds performed significantly better on the habituation (7.3 +/- 0.8 vs 6.6 +/- 1.5) and autonomic regulation (6.5 +/- 0.8 vs 6.0 +/- 1.0) clusters but more poorly on the cost of attention qualifier score (4.9 +/- 1.2 vs 5.5 +/- 1.2) on the Brazelton Neonatal Behavioral Assessment Scale. CONCLUSION: Infants with an abnormal cranial ultrasound at birth had higher perinatal risk scores. (ABSTRACT TRUNCATED)

Brain Diseases↗
PubMed1999

Early development of infants exposed to drugs prenatally.

This article includes a summary and critique of methodological limitations of the peer-reviewed studies of developmental outcome during the first 2 years in children prenatally exposed to the most commonly used drugs of abuse: tobacco, alcohol, marijuana, heroin/methadone, and cocaine. Reported effects vary by specific drug or drug combinations and amount and timing of exposure; however, few thresholds have been established. Drug effects also appear to be exacerbated in children with multiple risks, including poverty, and nonoptimal caregiving environments. Although prenatal exposure to any one drug cannot reliably predict the outcome of an individual child, it may be a marker for an array of variables that can impact development. Appropriate intervention strategies require future research that determines which factors place exposed children at risk and which are protective for optimal development.

Alcoholism↗