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Burden and spectrum of infectious disease in Germany 2009–2014: a multicentre study from Berlin’s Municipal Hospitals

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Abstract

Purpose

This study aimed at assessing the burden and spectrum of infectious diseases (ID) in a Metropolitan population in Germany.

Methods

A discharge database using ICD-10 codes enabled the identification of hospitalizations with infection-related diagnoses. All hospital admissions between 2009 and 2014 were analysed from 9 municipal hospitals serving approximately one-third of an urban population of 3.5 million people.

Results

We identified 114,168 admissions with a primary (first-listed) ID diagnosis and 220,483 admissions with any-listed ID diagnosis, accounting for 8.9 % [95 % confidence interval (CI) 8.9–9.0 %] and 17.2 % (95 % CI 17.1–17.3) of all 1,284,559 admissions, respectively. Annually, 439,837 bed-days (range 413,707–488,520) were occupied by patients with an ID diagnosis, utilizing 22.8 % of total bed capacity. The median length of stay for patients with primary ID diagnosis and secondary ID diagnosis was 6 days (IQR 3–11) and 10 days (IQR 5–19), respectively. The most common diagnosis across all age groups was “pneumonia” (22.8 and 16.2 % of ID admissions as primary and secondary diagnosis, respectively). In-hospital mortality was 6.8 % (95 % CI 6.6–6.9) and 8.9 % (95 % CI 8.7–9.1) for ID as primary and secondary diagnosis, respectively.

Conclusion

Infectious diseases contribute significantly to the overall burden of disease in a health system caring for an urban German population. In view of the magnitude of ID’s contribution, establishing more specialists in ID medicine and adjusting the reimbursements for managing infection-related admissions should be made a public health priority in Germany.

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References

  1. GBD 2013 Mortality and Causes of Death Collaborators. Mortality and causes of death collaborators. Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2015;385:117–71.

    Article  PubMed Central  Google Scholar 

  2. Petersdorf RG. The doctors’ dilemma. N Engl J Med. 1978;299:628–34.

    Article  CAS  PubMed  Google Scholar 

  3. Fauci AS. Infectious diseases: considerations for the 21st century. Clin Infect Dis. 2001;32:675–85.

    Article  CAS  PubMed  Google Scholar 

  4. http://www.vivantes.de/unternehmen/portrait/. Accessed 01 June 2015.

  5. Welte T, Torres A, Nathwani D. Clinical and economic burden of community-acquired pneumonia among adults in Europe. Thorax. 2012;67:71–9.

    Article  CAS  PubMed  Google Scholar 

  6. Baldo V, Cocchio S, Baldovin T, Buja A, Furlan P, Bertoncello C, Russo F, Saia M. A population-based study on the impact of hospitalization for pneumonia in different age groups. BMC Infect Dis. 2014;14:485.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Centers for Disease Control and Prevention (CDC). Trends in aging—United States and worldwide. MMWR Morb Mortal Wkly Rep. 2003;52:101–4, 6.

    Google Scholar 

  8. Prince MJ, Wu F, Guo Y, Robledo LMG, O’Donnell M, Sullivan R, Yusuf S. The burden of disease in older people and implications for health policy and practice. Lancet. 2015;385:549–62.

    Article  PubMed  Google Scholar 

  9. Wolf S, Leitritz L, Rupp C, Schlöndorff D, Bogner JR. Cost reduction after introduction of a multidisciplinary infectious disease service at a German university hospital. Infection. 2000;28:379–83.

    Article  CAS  PubMed  Google Scholar 

  10. Vehreschild JJ, Morgen G, Cornely OA, Hartmann P, Koch S, Kalka-Moll W, Wyen C, Vehreschild MJ, Lehmann C, Gillor D, Seifert H, Kremer G, Fätkenheuer G, Jung N. Evaluation of an infectious disease consultation programme in a German tertiary care hospital. Infection. 2013;41:1121–8.

    Article  CAS  PubMed  Google Scholar 

  11. Fätkenheuer G, Cornely OA, Kern WV, Salzberger B, Stallmach A, Welte T. Perspectives of infectious diseases in Germany. Dtsch Med Wochenschr. 2015;140:210–2.

    Article  PubMed  Google Scholar 

  12. http://www.aerztekammer-berlin.de/50ueberUns/20_Wer_wir_sind/20_DV/70_TBs/index.html. Accessed 01 June 2015.

  13. http://www.dgi-net.de/index.php/weiterbildung/zertifikat-infektiologe-dgi. Communicated by Prof. W. Kern 01 Feb 2015.

  14. Tissot F, Calandra T, Prod’hom G, Taffe P, Zanetti G, Greub G, Senn L. Mandatory infectious diseases consultation for MRSA bacteremia is associated with reduced mortality. J Infect. 2014;69:226–34.

    Article  CAS  PubMed  Google Scholar 

  15. Rieg S, Peyerl-Hoffmann G, de With K, Theilacker C, Wagner D, Hübner J, Dettenkofer M, Kaasch A, Seifert H, Schneider C, Kern WV. Mortality of S. aureus bacteremia and infectious diseases specialist consultation: a study of 521 patients in Germany. J Infect. 2009;59:232–9.

    Article  PubMed  Google Scholar 

  16. Fries BL, Licitra C, Crespo A, Akhter K, Busowski MT, Salazar D, Wallace MR. Infectious diseases consultation and the management of Staphylococcus aureus bacteremia. Clin Infect Dis. 2014;58:598–9.

    Article  PubMed  Google Scholar 

  17. Forsblom E, Ruotsalainen E, Ollgren J, Järvinen A. Telephone consultation cannot replace bedside infectious disease consultation in the management of Staphylococcus aureus Bacteremia. Clin Infect Dis. 2013;56:527–35.

    Article  CAS  PubMed  Google Scholar 

  18. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2197–223.

    Article  PubMed  Google Scholar 

  19. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2163–96.

    Article  PubMed  Google Scholar 

  20. Kwong JC, Ratnasingham S, Campitelli MA, Daneman N, Deeks SL, Manuel DG, Allen VG, Bayoumi AM, Fazil A, Fisman DN, Gershon AS, Gournis E, Heathcote EJ, Jamieson FB, Jha P, Khan KM, Majowicz SE, Mazzulli T, McGeer AJ, Muller MP, Raut A, Rea E, Remis RS, Shahin R, Wright AJ, Zagorski B, Crowcroft NS. The impact of infection on population health: results of the Ontario burden of infectious diseases study. PLoS One. 2012;7:e44103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Mangen MJ, Plass D, Havelaar AH, Gibbons CL, Cassini A, Mühlberger N, van Lier A, Haagsma JA, Brooke RJ, Lai T, de Waure C, Kramarz P, Kretzschmar ME, BCoDE consortium. The pathogen- and incidence-based DALY approach: an appropriate [corrected] methodology for estimating the burden of infectious diseases. PLoS One. 2013;8:e79740.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Plass D, Mangen MJ, Kraemer A, Pinheiro P, Gilsdorf A, Krause G, Gibbons CL, van Lier A, McDonald SA, Brooke RJ, Kramarz P, Cassini A, Kretzschmar ME. The disease burden of hepatitis B, influenza, measles and salmonellosis in Germany: first results of the burden of communicable diseases in Europe study. Epidemiol Infect. 2014;142:2024–35.

    Article  CAS  PubMed  Google Scholar 

  23. Murray CJ, Ortblad KF, Guinovart C, et al. Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. 2014;384:1005–70.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Kuehne A, Fiebig L, Jansen K, Koschollek C, Santos-Hövener C. Migration and infectious disease surveillance in Germany: analyses of tuberculosis, HIV and syphilis surveillance data. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2015;58(6):560–580. doi:10.1007/s00103-015-2157-y.

    Article  PubMed  Google Scholar 

  25. http://www.rki.de/DE/Content/InfAZ/H/HIVAIDS/Epidemiologie/Daten_und_Berichte/Eckdaten.html Accessed 06 May 2015.

  26. Sarrazin MS, Rosenthal GE. Finding pure and simple truths with administrative data. JAMA. 2012;307:1433–5.

    Article  PubMed  Google Scholar 

  27. Lindenauer PK, Lagu T, Shieh MS, Pekow PS, Rothberg MB. Association of diagnostic coding with trends in hospitalizations and mortality of patients with pneumonia, 2003–2009. JAMA. 2012;307:1405–13.

    Article  CAS  PubMed  Google Scholar 

  28. Phelan PD, Tate R, Webster F, Marshall RP. DRG cost weights—getting it right. Med J Aust. 1998;169:S36–8.

    PubMed  Google Scholar 

  29. G-DRG Definitions-Handbuch Version 2015 Kompaktversion. In GmbH EK, Deutsche Krankenhaus V-G Jan 2015. http://www.g-drg.de/cms/Das_Institut. Accessed 02 July 2015.

  30. Klein-Hitpaß U, Scheller-Kreinsen D. Policy trends and reforms in the German DRG-based hospital payment system. Health Policy. 2015;119:252–7.

    Article  PubMed  Google Scholar 

  31. Madsen KM, Schønheyder HC, Kristensen B, Nielsen GL, Sørensen HT. Can hospital discharge diagnosis be used for surveillance of bacteremia? A data quality study of a Danish Hospital discharge registry. Infect Control Hosp Epidemiol. 1998;19:175–80.

    Article  CAS  PubMed  Google Scholar 

  32. Wang HE, Addis DR, Donnelly JP, Shapiro NI, Griffin RL, Safford MM, Baddley JW. Discharge diagnoses versus medical record review in the identification of community-acquired sepsis. Crit Care. 2015;19:42.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Søgaard KK, Thomsen RW, Schønheyder HC, Søgaard M. Positive predictive values of the International Classification of Diseases, 10th revision diagnoses of Gram-negative septicemia/sepsis and urosepsis for presence of Gram-negative bacteremia. Clin Epidemiol. 2015;7:195–9.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Sharfstein JM. Using health care data to track and improve public health. JAMA. 2015;313:2012–3.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Infectious Diseases, Vivantes Auguste-Viktoria-Klinikum, Rubensstraße 125, 12157, Berlin, Germany

    Juri Katchanov, Kai Wöstmann, Daniela Tominski, Laura Jefferys, Anna Liedtke, Arnim Schneider, Keikawus Arastéh & Hartmut Stocker

  2. Septomics Research Center, Jena University Hospital, Jena, Germany

    Hortense Slevogt

Authors
  1. Juri Katchanov
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  2. Kai Wöstmann
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  3. Daniela Tominski
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Correspondence to Juri Katchanov.

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Katchanov, J., Wöstmann, K., Tominski, D. et al. Burden and spectrum of infectious disease in Germany 2009–2014: a multicentre study from Berlin’s Municipal Hospitals. Infection 44, 187–195 (2016). https://doi.org/10.1007/s15010-015-0834-2

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  • DOI: https://doi.org/10.1007/s15010-015-0834-2

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