High level of gastrointestinal nosocomial infections in the german surveillance system, 2002-2008.
OBJECTIVE
Surveillance of nosocomial infections (NIs) is well established in many countries but often does not include gastrointestinal infections. We sought to determine the proportion of NIs among all hospitalized cases for the 4 most prevalent types of gastrointestinal infections in Germany.


METHODS
We analyzed all notifications of laboratory-confirmed or epidemiologically linked gastrointestinal infections due to norovirus, rotavirus, Salmonella species, and Campylobacter species reported to the Robert Koch Institute in Berlin, Germany, from 2002 through 2008. Infections were considered nosocomial if disease onset was more than 2 days after hospitalization for norovirus, rotavirus, and Salmonella infection and more than 5 days after hospitalization for Campylobacter infection.


RESULTS
During the study period, 710,725 norovirus, 394,500 rotavirus, 395,736 Salmonella, and 405,234 Campylobacter gastrointestinal infections were reported. Excluding cases for which nosocomial status could not be determined, we identified 39,424 (49%) of 80,650 norovirus, 11,592 (14%) of 83,451 rotavirus, 3,432 (8%) of 43,348 Salmonella, and 645 (2%) of 33,503 Campylobacter gastrointestinal infections as definite nosocomial cases. Multivariate analysis confirmed higher risk of gastrointestinal NIs for patients aged more than 70 years (relative risk [RR], 7.0 [95% confidence interval {CI}, 6.7-7.2]; [Formula: see text]) and residents of western states (RR, 1.3 [95% CI, 1.2-1.3]; [Formula: see text]) and lower risk for female patients (RR, 0.9 [95% CI, 0.9-0.9; [Formula: see text]). Yearly NI proportions remained stable except for norovirus.


CONCLUSIONS
The investigated gastrointestinal NIs in Germany do not show a clear trend, but they are at high level, revealing potential for public health action and improvement of hospital infection control mainly among older patients. National prevalence studies on gastrointestinal NIs would be of additional value to give more insight on how and where to improve hospital infection control.
European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control, Stockholm, Sweden. spackova.michaela@gmail.com
Michaela
M
Spackova
Doris
D
Altmann
Tim
T
Eckmanns
Judith
J
Koch
Gerard
G
Krause
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002167:Campylobacter / Q000302:isolation & purification; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000209:etiology; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005759:Gastroenteritis / Q000453:epidemiology* / Q000382:microbiology*; D005843:Geography; D005858:Germany / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D029322:Norovirus / Q000302:isolation & purification; D012307:Risk Factors; D012401:Rotavirus / Q000302:isolation & purification; D012400:Rotavirus Infections / Q000453:epidemiology* / Q000209:etiology; D012475:Salmonella / Q000302:isolation & purification; D012480:Salmonella Infections / Q000453:epidemiology* / Q000209:etiology; D018571:Sentinel Surveillance; D055815:Young Adult