High Level of Gastrointestinal Nosocomial Infections in the German Surveillance System, 2002–2008

Abstract

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,Salmonellaspecies, andCampylobacterspecies 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, andSalmonellainfection and more than 5 days after hospitalization forCampylobacterinfection.Results.During the study period, 710,725 norovirus, 394,500 rotavirus, 395,736Salmonella, and 405,234Campylobactergastrointestinal 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 43,348Salmonella, and 645 (2%) of 33,503Campylobactergastrointestinal 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];P< .001) and residents of western states (RR, 1.3 [95% CI, 1.2–1.3];P< .001) and lower risk for female patients (RR, 0.9 [95% CI, 0.9–0.9;P< .001). 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.