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Bernhardt A.,Robert Koch Institute | Sedlacek L.,Institute For Med Mikrobiologie Und Hygiene | Wagner S.,HELIOS Klinikum Emil von Behring | Schwarz C.,Charite - Medical University of Berlin | And 2 more authors.
Journal of Cystic Fibrosis | Year: 2013

Background: Scedosporium and Pseudallescheria species are the second most common lung-colonising fungi in cystic fibrosis (CF) patients. For epidemiological reasons it is important to trace sources of infection, routes of transmission and to determine whether these fungi are transient or permanent colonisers of the respiratory tract. Molecular typing methods like multilocus sequence typing (MLST) help provide this data. Methods: Clinical isolates of the P. boydii complex (including S. apiospermum and P. boydii) from CF patients in different regions of Germany were studied using MLST. Five gene loci, ACT, CAL, RPB2, BT2 and SOD2, were analysed. Results: The S. apiospermum isolates from 34 patients were assigned to 32 sequence types (STs), and the P. boydii isolates from 14 patients to 8 STs. The results revealed that patients can be colonised by individual strains for years. Conclusions: The MLST scheme developed for S. apiospermum and P. boydii is a highly effective tool for epidemiologic studies worldwide. The MLST data are accessible at http://mlst.mycologylab.org/. © 2013 European Cystic Fibrosis Society.

Bauer T.T.,HELIOS Klinikum Emil von Behring | Welte T.,Leibniz University of Hanover | Strauss R.,Friedrich - Alexander - University, Erlangen - Nuremberg | Bischoff H.,Thoraxklinik Heidelberg | And 2 more authors.
Lung | Year: 2013

Objective: We investigated rates and predictors of ventilatory support during hospitalization in seemingly not severely compromised nonsurvivors of community-acquired pneumonia (CAP). Methods: We used the database from the German nationwide mandatory quality assurance program including all hospitalized patients with CAP from 2007 to 2011. We selected a population not residing in nursing homes, not bedridden, and not referred from another hospital. Predictors of ventilatory support were identified using a multivariate analysis. Results: Overall, 563,901 patients (62.3 % of the whole population) were included. Mean age was 69.4 ± 16.6 years; 329,107 (58.4 %) were male. Mortality was 39,895 (7.1 %). A total of 28,410 (5.0 %) received ventilatory support during the hospital course, and 76.3 % of nonsurvivors did not receive ventilatory support (62.6 % of those aged <65 years and 78 % of those aged ≥65 years). Higher age (relative risk (RR) 0.48, 95 % confidence interval (CI) 0.44-0.51), failure to assess gas exchange (RR 0.18, 95 % CI 0.14-0.25) and to administer antibiotics within 8 h of hospitalization (RR 0.48, 95 % CI 0.39-0.59) were predictors of not receiving ventilatory support during hospitalization. Death from CAP occurred significantly earlier in the nonventilated group (8.2 ± 8.9 vs. 13.1 ± 14.1 days; p < 0.0001). Conclusions: The number of nonsurvivors without obvious reasons for withholding ventilatory support is disturbingly high, particularly in younger patients. Both performance predictors for not being ventilated remain ambiguous, because they may reflect either treatment restrictions or deficient clinical performance. Elucidating this ambiguity will be part of the forthcoming update of the quality assurance program. © 2013 Springer Science+Business Media New York.

Ewig S.,Thoraxzentrum Ruhrgebiet Kliniken fur Pneumologie und Infektiologie | Bauer T.,HELIOS Klinikum Emil von Behring | Richter K.,Aqua Institute Gottingen | Szenscenyi J.,Aqua Institute Gottingen | And 3 more authors.
European Respiratory Journal | Year: 2013

C(U)RB-65 (confusion, (urea >7 mol.L-1,) respiratory frequency ≥30 breaths.min-1, systolic blood pressure <90 mmHg or diastolic blood pressure f60 mmHg and age ≥65 years) is now the generally accepted severity score for patients with community-acquired pneumonia (CAP) in Europe. In an observational study based on the large database from the German nationwide performance measurement programme in healthcare quality, including data from all hospitalised patients with CAP during 2008-2010, different CRB-age groups (<50 and <60 years) across the total CAP population and three entities of CAP (younger population aged <65 years, patients aged ≥65 years not residing in nursing homes and those with nursing home-acquired pneumonia (NHAP)) were validated for their potential to predict in-hospital death. 660 594 patients were investigated. Mortality was n593 958 (14.0%). In the total population, CRB-80 had the optimal area under the curve (0.690, 95% CI 0.688-0.691). However, in the younger cohort, CRB-50 performed best (0.730, 95% CI 0.724-0.736), with good identification of low-risk patients (CRB-50 risk class 1: 1.28% deaths, negative predictive value 98.7%). In the elderly, CRB-80 as the optimal age group performed worse (0.663, 95% CI 0.660-0.655 in patients not residing in nursing homes; 0.608, 95% CI 0.605-0.611 in those with NHAP). In the latter group, all CRB-age groups failed to identify low-risk patients (CRB-80 risk class 1: 22.75% deaths, negative predictive value 81.8%). Patients with hospitalised CAP aged <65 years may be assessed by the CRB-50 score. In those aged ≥ 65 years (not NHAP) assessed by the CRB-65 score, low-risk patients are already are at an increased risk of death. In NHAP patients, even the use of CRB-80 does not identify low-risk patients and should be accompanied by the evaluation of functional status and comorbidity. Copyright © ERS 2013.

Timmermann A.,HELIOS Klinikum Emil von Behring | Timmermann A.,University of Gottingen
Anaesthesia | Year: 2011

Supraglottic airway devices (SAD) play an important role in the management of patients with difficult airways. Unlike other alternatives to standard tracheal intubation, e.g. videolaryngoscopy or intubation stylets, they enable ventilation even in patients with difficult facemask ventilation and simultaneous use as a conduit for tracheal intubation. Insertion is usually atraumatic, their use is familiar from elective anaesthesia, and compared with tracheal intubation is easier to learn for users with limited experienced in airway management. Use of SADs during difficult airway management is widely recommended in many guidelines for the operating room and in the pre-hospital setting. Despite numerous studies comparing different SADs in manikins, there are few randomised controlled trials comparing different SADs in patients with difficult airways. Therefore, most safety data come from extended use rather than high quality evidence and claims of efficacy and particularly safety must be interpreted cautiously. © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Teichgraber U.K.,Charite - Medical University of Berlin | Pfitzmann R.,HELIOS Klinikum Emil von Behring | Hofmann H.A.F.,Zentrum fur Portimplantationen
Deutsches Arzteblatt | Year: 2011

Background: Port systems are easy to implant on an in- or outpatient basis and provide reliable, long-lasting central venous access. They are used mainly for cancer patients. Methods: This article is based on a selective literature review, the guidelines of the German Society for Nutrition Medicine and of the European Society for Clinical Nutrition and Metabolism, and the recommendations of the German Society for Pediatric Oncology and Hematology. Results: In modern oncology, central venous port systems are increasingly replacing short-term and permanently tunneled central venous catheters. They are indicated for patients who need long-term intravenous treatment involv ing, e.g., the repeated administration of chemotherapeutic drugs, parenteral nutrition, transfusions, infusions, injections, and/or blood sample collection. Port systems can markedly alleviate the burden of intravenous therapy and thereby improve these patients' quality of life. The planning, preparation, and performance of port system implantation require meticulous attention to detail. The rate of implantation-associated complications is less than 2% in experienced hands; overall complication rates have been reported from 4.3% to as high as 46%. The proper postoperative use and care of the port system are of decisive importance to the outcome. Reported infection rates during port system use range from 0.8% to 7.5% in current clinical studies. Conclusion: The treatment, follow-up care, and rehabilitation of cancer patients are interdisciplinary tasks. Optimal treatment and complication avoidance require a collaborative effort of all of the involved specialists - not just the physician implanting the port system, but also the oncologists, nutritionists, visiting nurses, and other home health care providers. Continuing medical education, too, plays a role in improving outcomes.

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