Projects
... current projects in infection prevention and hospital hygiene
... completed projects in infection prevention and hospital hygiene
MolTraX - Molecular Surveillance and Infection Chain Tracing for Local Public Health
NUM - National Research Network for Applied Surveillance
MolTraX will initiate a structured genetic investigation of infection clusters and chains of infection, as well as the effective use of the GenSurv infrastructure by public health services, thereby contributing to the development of more targeted and effective measures for infection prevention and the identification of transmission routes. This will make a decisive contribution to pandemic management at the local level. In addition, the project will pursue the effective use of resources in the public health service on a prototypical basis. MolTraX will increase the ability of local health authorities to make "reactive" use of genomic surveillance, e.g., in the case of suspected outbreaks or superspreading events. This will pave the way for the effective use of genomic surveillance data in the decision-making and communication processes of local health authorities. By expanding the GenSurv infrastructure and integrating local health authorities into the GenSurv infrastructures, MolTraX closes the so-called "genomic surveillance circle" for Germany, thereby increasing the resilience of the German healthcare system to future pandemics.
More information about this project can be found HERE
Contact: Reuter, S.; Schmitt, D.
Project start: July 1, 2022
Project end: December 31, 2023
Project management: Reuter, S
GenSurv - Genomic Pathogen Surveillance and Translational Research
NUM - National Research Network for Applied Surveillance - Second Funding Phase
GenSurv 2022
The GenSurv infrastructure represents the "missing link" between the RKI-based national pathogen genome sequencing activities on the one hand and a federated collaboration of network partners from university medicine on the other, for the effective use of genome data at various levels of the healthcare system, scientific/academic institutions, and public health services. Funding for the 2022 period will enable the provision of a basic infrastructure that will facilitate genomic surveillance of SARS-CoV-2 variants and provide a basis for subsequent expansion to other pathogens. It will enable a substantiated overview, evaluation, and assessment of the pandemic situation, which is expected to continue into 2022 according to all forecasts. In addition, for the particularly important transition phase to an endemic phase, entries, risk constellations, and hot spots will be identified in order to be able to react quickly and also act proactively. Establishing surveillance in endemic corona times is also part of the task.
More information about the project can be found HERE
Contact: Reuter, S.
Project start: January 1, 2022
Project end: December 31, 2024
Project management: Reuter, S
K-STaR: a K-mer-based method for institutional AMF surveillance, infection control, and rapid diagnostics
The aim is to develop a new k-mer based approach for rapid identification of pathogens and possible transmission events within the JPI-EC-AMR Joint Transnational Call "Diagnostics and surveillance of antimicrobial resistance: development of tools, technologies and methods for global use". The main focus is on the development of relevant databases and a methodology that makes identification faster. A sequencer that can be used close to the patient will also contribute to this. The possibility to read antibiotic resistance from the obtained data is also given.
Contact: Reuter, S
Project start: April 1, 2020
Project end: December 31, 2023
Project management: Reuter, S
NeWIS: National health care infrastructures, health care utilization, and patient movements between hospitals: Networks working to improve surveillance
Project description: There is worldwide concern about the emergence and widespread dissemination of AMR "high-risk" clones that carry the genomic determinants for enhanced virulence and resistance. Regional, national, and international surveillance is considered an important component in a strategy to control these strains. However, current surveillance systems are not fit for this purpose, and there is still no good evidence base for deciding which and how many sentinel hospitals should be included in surveillance programs. Previous work coordinated by the lead applicant has shown that AMR "high-risk" clones spread between health care institutions as a result of patient movements. Hospitals thus become connected by patients. Taken together, all connections create a nexus of institutions that can be described as national health care referral networks. Despite their apparent complexity, these networks reveal a simple scaffolding and remarkably consistent properties that lie at the core of national health care infrastructures. These show many of the typical hallmarks of hierarchically distributed networks, with regionality, centrality, scale-freeness, and small world properties. Hence, a quantitative understanding of the network dynamics offers the means for purpose-designed surveillance and better targeted interventions. The current proposal will bring together a critical mass of public health microbiologists, health systems researchers, and social network analysts from Europe and beyond. These experts shall define the data needs, data sources, algorithms, and analysis tools with the aim of identifying a heuristic optimization approach to sentinel site selection. In this way, the proposed project will provide recommendations for the development of surveillance structures that are more parsimonious, cost- and time-effective and provide—through the selection of sampling sites for genomic surveillance by whole genome sequencing (WGS)—the genetic signatures for early, next-generation diagnostics of recently emerging clones. The focus on site selection means that WGS will not be part of this initiative.
NeWis
Contact: Donker T
Project start: April 1, 2019
Project end: December 31, 2023
Project management: Donker, T
COMBACTE-CARE - Combatting Bacterial Resistance in Europe – Carbapenem Resistance
Project description: The objective of the COMBACTE‐CARE project is to understand how patients with carbapenemase‐resistant infections are managed with a focus on best available treatment and clinical outcomes to inform limited population development programmes. Also the project will deliver important clinical and safety data, to support the global development of Aztreonam‐Avibactam (ATM‐AVI) for the treatment of serious bacterial infections caused by multi‐drug resistant (MDR) bacteria expressing a certain type of carbapenemase, a metallo‐β‐lactamase (MBL).
Project start: April 1, 2015
Project end: June 31, 2023
Project manager: Grundmann H
Mathematical modeling of the incidence and variance of COVID-19
... within the population of the catchment areas of the university hospitals in Freiburg, Heidelberg, Mannheim, Tübingen, and Ulm for the purpose of forecasting and managing variable bed, ventilator, personnel, and material requirements.
Objective: The COVID-19 pandemic poses enormous challenges for hospitals. With unpredictable case numbers, the demand for care becomes particularly problematic in intensive care units when the available ventilation capacities are exceeded. The aim of this application is to ensure the security of care at university hospitals in BW in the event of a resurgence of epidemic activity by providing early predictions of the expected patient volume (within reliable confidence intervals).
Contact: Grundmann H, Donker T
Project start: July 1, 2020
Project end: December 31, 2020
Project management: Grundmann H
SafeNet
SafeNet - Digital network as early warning system against risk pathogens
Patient Safety Initiative Baden-Württemberg
Contact persons: Bürkin, F; Hertweck, S.
Project start: July 7, 2020
Project end date: October 17, 2022
Project manager: Grundmann, H
B-FAST: Nationwide Research Network for Applied Surveillance and Testing for COVID-19
AP 3.3
Development of an integrated platform for testing and surveillance strategies for different settings, such as the general population, schools and daycare centers, high-risk areas, and clinics.
The network's consolidated assessments of testing methods and the joint development and evaluation of surveillance approaches will contribute to the development of sustainable, scalable surveillance and testing strategies that can be applied to future pandemics.
Contact: Grundmann, H
Project start: September 1, 2020
Project end: December 31, 2021
Project management: Grundmann, H
GIF: A multicenter study of the evolution and spread of NDM-producing bacteria across bacterial clones and species
Project description:
A multicenter study of the evolution and spread of NDM-producing bacteria across bacterial clones and species Background: The carbapenemases are β-lactamase enzymes that confer resistance to all of the β-lactam antimicrobial classes, including carbapenems, the "agents of last resort". Hence, carbapenemase-producing Enterobacteriaceae (CPE) are a critical threat to public health worldwide. Carbapenemase genes may disseminate either by spread of an epidemic bacterial clone or via horizontal transfer of the gene between different bacteria of the same phylogenetic family (e.g., Enterobacteriaceae). The carbapenemase NDM is one of the most common worldwide, but its evolution and modes of spread in Israel are mostly unknown. A possible explanation is that there has been an inter-family exchange of the blaNDM gene between Acinetobacter baumannii and Enterobacteriaceae. However, inter-family horizontal gene transfer (HGT)has never been traced epidemiologically, nor has it been reported in other antimicrobial resistance (AMR) genes. Objectives: 1) To study the transmission dynamics of the blaNDM gene within each bacterial family, Enterobacteriaceae and A. baumannii, using a combined epidemiological-molecular approach; 2) to study the possibility that A. baumannii serves as a source for transmission of the blaNDM gene to Enterobacteriaceae by HGT; 3) to develop a network analysis of transmission of the blaNDM gene. Methods: This will be an observational, multicenter, molecular-microbiological study performed in three consecutive stages: A) identification of patients and collection of isolates; B) molecular analysis of isolates and a descriptive epidemiological study; C) network analysis of transmission of the blaNDM gene. The first stage of the study will be conducted over 18 months in three tertiary-care centers in the three major cities in Israel: a) Tel-Aviv Sourasky Medical Center (TASMC); b) Rambam Medical Center (RMC); 3) Sha'are Zedek Medical Center (SZMC). Clinical and surveillance cultures will be collected according to the routine infection control and clinical practices at each center and will be analyzed for the presence of NDM-producing enterobacteriaceae (NDME) and A. baumannii (NDMAb). All NDME and NDMAb isolates will be studied by whole genome sequencing (WGS) and the data will be used to define the clonal structure and the blaNDM-related mobile genetic elements (MGE). Transmission events (TE) of NDME/NDMAb will be defined according to combined epidemiological and molecular criteria: 1) Epidemiological: a) the suspected NDME/NDMAb infected patients; and 2) a functional in-vitro study of the conjugation efficiency of the blaNDM-harboring plasmids in and between bacterial species and families. Novelty and importance of the study: The novelty of the proposed study is that, in addition to comparing clonal spread and HGT-mediated transfer of a carbapenemase gene within one bacterial family, we will analyze the transmission within and between two phylogenetic bacterial families. We will incorporate a multi-layer approach of studying AMR transmission: molecular-epidemiological investigation, in vitro study of mechanisms of transmission, characterization of clinical features, and network analysis. Our findings will contribute basic science and will guide interventions to prevent the spread of AMR pathogens. The blaNDM is an ideal AMR gene candidate for this study for the following reasons: 1) it has similar prevalence in the two bacterial populations; 2) it has a distinct resistance phenotype that is easy to identify; 3) it has significant clinical and epidemiological importance.
Contact: Grundmann H, Reuter S
Project start: 2018
Project end: December 31, 2021
Establishing the outbreak detection tool Cluster Alert System - CLAR
Project description: The project TARGETSPREAD focuses on new technologies to support infection control in hospital settings. A tool developed at partener site Berlin is called Cluster Alert System (CLAR) and is a computer-based outbreak detection tool with already establish algorithms to detect low-level outbreaks and outbreaks on different wards with the same pathogen. In 2017, CLAR was successfully established at the University Hospital Cologne. The aim is to establish CLAR at two more DZIF partner sites.
Contact: Grundmann H, Bürkin, F
Project start: February 1, 2019
Project end: January 31, 2020
Project management: Grundmann H
NoSPREAD - Preventing the Spread of MDRO
Project description: The NoSPREAD project takes a translational approach, using both routine microbiological data and modern whole-genome sequencing technology to develop, validate, and implement a computer-assisted early warning system for the early detection of potential nosocomial transmissions and outbreaks of bacterial pathogens. This enables immediate hospital hygiene intervention, allowing rapid outbreak control and preventing further spread, especially of highly resistant nosocomial infectious agents (so-called high-risk clones). This outbreak detection tool is intended to reduce the number and size of nosocomial outbreaks and thus counteract the spread of highly resistant microorganisms. Following implementation of the outbreak detection tool at the two DZIF locations in Berlin and Cologne, it is now to be established at two further DZIF locations.
Contact: Grundmann H
Project start: January 1, 2019
Project end: December 31, 2021
Project management: Grundmann H
In vitro synergistic activity of avibactam-ceftazidime in combination with five other antibiotics against carbapenemase-producing Klebsiella pneumoniae
Project description: Severe infections caused by CPE are usually treated with a combination of two or even more potentially active antibiotics. In fact, in the published case studies, about half the patients treated with ceftazidime-avibactam had received at least one additional antibiotic (see e.g. Shields et al., Clin Infect. Dis, 2016, 63:1615-1618; Temkin et al., Antimicrob Agents Chemother, Epub Jan 2017; Kling et al., Antimicrob Ag Chemother, Epub Mai 2017). Since the patient populations and the infection types were very divergent in these case studies, it cannot be inferred with certainty which combination was the most effective. A combination of antibiotics is expected to be more effective if there was a synetgistic effect between the partners. Therefore, our objective is to examine whether a synergistic effect exists between ceftazidime-avibactam and other antibiotics, e.g., colistin, tigecycline, fosfomycin, gentamycin and amikacin. In this study, whole genome sequencing (WGS) will be used for investigating the emergence and dissemination of resistance genes within the collected representative population of K. pneumoniae. WGS data will be compared with existing resistance gene data bases in order to determine the origin of the isolates.
Contact: Grundmann H
Project start: 2019
Project end: 2019
Project management: Grundmann H
ONKO-KISS
Surveillance of nosocomial infections in bone marrow and blood stem cell transplant departments
Starting in October 2000, the Institute for Environmental Medicine and Hospital Hygiene at the Medical Center – University of Freiburg established a reference database for nosocomial infections in patients undergoing bone marrow transplantation (BMT) or peripheral blood stem cell transplantation (PBSCT) as part of ONKO-KISS. ONKO-KISS is a module of the Hospital Infection Surveillance System (KISS), which was implemented in 1997 by the National Reference Center (NRZ) for Surveillance of Nosocomial Infections.
Initially limited to adult patients, ONKO-KISS was expanded in 2003 to include children aged one year and older. In 2005, the ONKO-KISS_AL module was added. It records patients with acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) who are undergoing chemotherapy.
ONKO-KISS focuses on the prospective recording of sepsis and pneumonia during the neutropenia phase, the period with the highest risk of nosocomial infection for patients. New participants are trained in the recording of nosocomial infections in special introductory courses offered by the IUK in Freiburg. The recorded data is transmitted electronically by the participants to the NRZ in Berlin, which calculates reference data for all participating centers for the various modules once a year. Participants can compare their own infection rates with the reference data for the respective modules. Annual meetings of all participants in Freiburg provide a forum for the exchange of experiences, discussions, and, if necessary, modifications to the protocol.
Further information can be found here.
AMBU-KISS
Surveillance of postoperative wound infections following selected outpatient indicator surgeries
Since the end of 2002, wound infections following outpatient surgeries have been recorded as part of AMBU-KISS. The project center is the Institute for Environmental Medicine and Hospital Hygiene at the Medical Center – University of Freiburg. AMBU-KISS provides reference data for outpatient surgery facilities in private practices and clinics.In collaboration with professional associations, indicator surgeries from various surgical specialties that are frequently performed on an outpatient basis were selected. There are 11 indicator surgeries. These are defined by their OPS-301 procedure codes. The Surgery Theatres (OPZs) participating in AMBU-KISS select one or more indicator surgeries and monitor each patient who undergoes one of these surgeries for 30 days postoperatively, e.g., during follow-up examinations by surgeons in their practices.
For each indicator procedure, the project center calculates the wound infection rate based on the number of wound infections and the number of procedures performed. To ensure the comparability of the data, it is important that all patients who undergo the selected indicator procedure are included in the recording. The recording must not be limited to individual OPS-301 procedure codes within an indicator procedure. Data comparability is achieved through the strict application of CDC (Centers for Disease Control and Prevention) criteria in the diagnosis of wound infections.
In the OP-KISS module, which records wound infections in inpatients, the infection data is stratified according to risk factors during evaluation. Since high-risk patients are significantly underrepresented in outpatient facilities, AMBU-KISS does not record risk factors. Comparative data are the reference data from AMBU-KISS and, insofar as the indicator operation is also recorded in OP-KISS for inpatients, the results of the respective risk group 0 in OP-KISS.
Further information can be found here