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  • 1
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    German Medical Science; Düsseldorf, Köln
    In:  50. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (gmds), 12. Jahrestagung der Deutschen Arbeitsgemeinschaft für Epidemiologie; 20050912-20050915; Freiburg im Breisgau; DOC05gmds126 /20050908/
    Publication Date: 2005-09-09
    Keywords: ddc: 610
    Language: English
    Type: conferenceObject
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  • 2
    Keywords: Germany ; screening ; RISK ; SAMPLE ; SAMPLES ; INFECTION ; IMPACT ; RISK-FACTORS ; ASSOCIATION ; HEALTH ; DESIGN ; ESCHERICHIA-COLI ; resistance ; risk factors ; CHILDREN ; INFECTIONS ; PREVALENCE ; YOUNG ; ASSOCIATIONS ; RE ; SIBLINGS ; DETERMINANTS ; RESISTANT ; odds ratio ; RISK-FACTOR ; population-based ; E ; TRANSMISSION ; COMMUNITY ; CONTACT ; HEALTHY-CHILDREN ; URINARY-TRACT-INFECTION ; bacterial ; antibiotic resistance ; ANTIBIOTIC-RESISTANCE ; DAY-CARE-CENTERS ; e.coli ; household ; TRIMETHOPRIM-RESISTANT
    Abstract: Objective: In young children infections with resistant Escherichia coli (E. coli) can lead to life-threatening situations. Epidemiological data on the prevalence and major determinants of carriage of antibiotic resistant E. coli among children in the community setting are sparse. Study Design and Setting: In a population-based study from Germany, stool samples were obtained from children aged 6 months to 4 years attending a pediatrician for a regular health screening (N = 568) or an acute infection (N = 316), as well as from their parents (N = 1,594) and siblings (N = 624). E coli was cultured, and minimal inhibitory concentrations to various antibiotics were tested. We determined prevalences of E. coli resistance to commonly prescribed antibiotics and their association with potential risk factors. Results: Prevalence of E. coli resistance was 16.6%, 8.7%, and 11.6% for ampicillin, cotrimoxazole, and doxycycline, respectively. Strong associations were found with antibiotic resistance among siblings (odds ratios [95% confidence intervals] for ampicillin, doxycycline, and cotrimoxazole resistance: 4.4 [1.8-10.81, 8.0 [3.0-21.2], and 10.8 [3.5-32.71, respectively). Conclusion: Resistance prevalences in this community-based study were much lower than those reported from the clinical sector. Household contacts seem to be the key factor for children's colonization with resistant E. coli in the community setting. (C) 2007 Elsevier Inc. All rights reserved
    Type of Publication: Journal article published
    PubMed ID: 17938057
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  • 3
    Keywords: Germany ; INHIBITION ; THERAPY ; RISK ; RISK-FACTORS ; resistance ; WOMEN ; MEN ; risk factors ; PREVALENCE ; HOSPITALIZATION ; RE ; ANTIBIOTICS ; RESISTANT ; odds ratio ; RISK-FACTOR ; TRANSMISSION ; COMMUNITY ; BACTERIA ; ATTENDING GENERAL-PRACTITIONERS ; HOSPITALS ; TRIMETHOPRIM ; URINARY-TRACT-INFECTIONS
    Abstract: Background: Spread of antibiotic resistance in hospitals is a well-known problem, but studies investigating the importance of factors potentially related to the spread of resistant bacteria in outpatients are sparse. Methods: Stool samples were obtained from 206 healthy couples in a community setting in Southern Germany in 2002 - 2003. E. coli was cultured and minimal inhibition concentrations were tested. Prevalences of E. coli resistance to commonly prescribed antibiotics according to potential risk factors were ascertained. Results: Prevalences of ampicillin resistance were 15.7% and 19.4% for women and men, respectively. About ten percent and 15% of all isolates were resistant to cotrimoxazole and doxycycline, respectively. A partner carrying resistance was the main risk factor for being colonized with resistant E. coli. Odds ratios (95% CI) for ampicillin and cotrimoxazole resistance given carriage of resistant isolates by the partner were 6.9 (3.1 - 15.5) and 3.3 (1.5 - 18.0), respectively. Conclusion: Our data suggest that conjugal transmission may be more important for the spread of antibiotic resistance in the community setting than commonly suspected risk factors such as previous antibiotic intake or hospital contacts
    Type of Publication: Journal article published
    PubMed ID: 16848901
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  • 4
    Keywords: AGENTS ; Germany ; EPIDEMIOLOGY ; SAMPLES ; PATIENT ; culture ; PATTERNS ; HUMANS ; resistance ; PREVALENCE ; ADULT ; methods ; drug therapy ; pharmacology ; FECES ; female ; Male ; ANTIBIOTICS ; RESISTANT ; E ; microbiology ; Aged ; Middle Aged ; isolation & purification ; Ampicillin ; Anti-Bacterial Agents ; Ciprofloxacin ; Doxycycline ; drug effects ; Drug Resistance,Multiple,Bacterial ; Enterococcus faecalis ; Enterococcus faecium ; Gram-Positive Bacterial Infections ; growth & development ; Microbial Sensitivity Tests
    Abstract: PURPOSE: The aim of the study was to assess the prevalence and determinants of antibiotic-resistant Enterococci in a large group of outpatients in Southern Germany. METHODS: Stool samples were collected from 497 unselected patients aged 40-75 years attending general practitioners. Enterococcus faecium (E. faecium) and Enterococcus faecalis (E. faecalis) were cultured and minimal inhibitory concentrations of antibiotics used inside and outside the clinical sector were tested. RESULTS: E. faecium and E. faecalis could be identified and cultured in 60 (12.4%) and 205 (41.2%) of the stool samples, respectively. Under non-selective culture conditions no vancomycin-resistant Enterococcus (VRE) isolate was found. Only E. faecium isolates showed resistance to fluoroquinolones, 40% were resistant to ciprofloxacin. The prevalences of E. faecium resistance to ampicillin and doxycycline were 3.3% and 13.3%, respectively, whereas 0.5% and 29.6% of the E. faecalis isolates were resistant to ampicillin and doxycycline, respectively. Antibiotic use during the last 3 months was significantly associated with antibiotic resistance (to either ampicillin, imipenem, or doxycycline) of E. faecalis isolates (OR: 2.9; CI: 1.2-6.8). CONCLUSIONS: Prevalences of resistance were generally lower than and patterns of resistance were quite different from previous investigations in the clinical setting. Recent antibiotic use was associated with increased colonization with resistant strains
    Type of Publication: Journal article published
    PubMed ID: 16287198
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  • 5
    Keywords: EPIDEMIOLOGY ; IMPACT ; ATTENDING GENERAL-PRACTITIONERS ; INTESTINAL MICROFLORA ; stool samples ; Escherichia coli ; antibiotic resistance ; response to treatment ; AMOXICILLIN ; faecal flora ; FECAL FLORA ; outpatients
    Abstract: There is worldwide concern about the appearance and rise of bacterial resistance to commonly used antibiotics. Although the gut is an important reservoir for resistant Escherichia coli, data from large-scale epidemiological studies concerning the colonisation dynamics of the normal gut flora with resistant E. coli during and after antibiotic therapy are sparse. Accordingly, a large community-based study was conducted to ascertain changes in the prevalence of resistant E. coli during and after antibiotic treatment. Stool samples before, during and after antibiotic therapy were obtained from 541 patients (aged 〉= 40 years) with a febrile infection who attended a general practitioner in southern Germany. The MICs of commonly prescribed antibiotics for E. coli isolates from the stools were determined. The prevalence of resistance to the corresponding antibiotics rose from 18% to 38%, from 29% to 58% and from 33% to 67% during treatment with beta-lactam antibiotics, doxycycline and co-trimoxazole, respectively. Prevalences of resistance in the E. coli isolates also rose for other antibiotic classes. With the exception of co-trimoxazole resistance, prevalences of resistance returned to baseline levels in 〈 2 weeks after the cessation of antibiotic therapy. Thus, there was a substantial, but rapidly reversible, increase in the prevalence of resistant E. coli isolates during antibiotic treatment
    Type of Publication: Journal article published
    PubMed ID: 18005177
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  • 6
    Keywords: BLOOD ; Germany ; COHORT ; DISEASE ; DISEASES ; EPIDEMIOLOGY ; RISK ; SAMPLE ; DRUG ; HEART ; PATIENT ; primary ; RISK-FACTORS ; ASSOCIATION ; NO ; prevention ; lifestyle ; DESIGN ; AGE ; risk factors ; smoking ; lipids ; BLOOD-PRESSURE ; HYPERTENSION ; PREVALENCE ; MANAGEMENT ; GUIDELINES ; CARDIOVASCULAR RISK-FACTORS ; MELLITUS ; ADULT ; ADULTS ; REGRESSION ; POPULATION-BASED COHORT ; RE ; DETERMINANTS ; PHYSICAL-ACTIVITY ; CORONARY-HEART-DISEASE ; LEVEL ; elderly ; pharmacology ; RECOMMENDATIONS ; RISK-FACTOR ; population-based ; ENGLAND ; Diabetes Mellitus ; cardiovascular ; heart disease ; ANTIHYPERTENSIVE MEDICATION ; CARE CLINICS ; MICROVASCULAR COMPLICATIONS
    Abstract: Objective To evaluate the management of cardiovascular risk factors in a population-based cohort of adults with diabetes mellitus in Germany. Design and Measurements For the 9953 participants (50-74 years of age) of the ESTHER study, diabetes mellitus, hypertension, dyslipidemia and the respective medication were documented at baseline by their primary care physician. Blood pressure was taken and lipid levels were determined from a blood sample drawn at recruitment. Lifestyle factors (smoking, BMI, physical activity) were documented by the participants. Prevalence of pharmacotherapy for and control of hypertension and dyslipidemia among diabetic patients with these diagnoses were assessed and determinants were evaluated by multiple logistic regression. Results Diabetes mellitus was present in 1375 participants (14.2%). Almost 78% of diabetic participants had physician diagnosed hypertension, 86.0% received pharmacotherapy, but only 12.8% of those with anti-hypertensive medication achieved blood pressure levels below 130/85 mmHg. Obese participants were more likely to receive anti-hypertensive pharmacotherapy than non-obese ones: adjusted odds ratio (OR, 95% confidence interval (CI): 3.58 (1.86-6.87). Gender had no influence on anti-hypertensive pharmacotherapy. Older diabetic patients with hypertension were less likely to have sufficient blood pressure control than younger ones. Dyslipidemia was documented in 50% of diabetic patients. Diabetic participants with coronary heart disease or hypertension were more likely to receive lipid-lowering pharmacotherapy than those without these conditions (adjusted OR 1.85 (95%CI 1.19-2.89) and 2.59 (95%CI 1.41-4.74), respectively). Conclusions For most elderly with diabetes cardiovascular risk factor management continues to be not in line with recommendations. Copyright (C) 2008 John Wiley & Sons, Ltd
    Type of Publication: Journal article published
    PubMed ID: 18383562
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