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Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany.

ABSTRACT: In countries with low endemic Methicillin-resistant Staphylococcus aureus (MRSA) prevalence, identification of risk groups at hospital admission is considered more cost-effective than universal MRSA screening. Predictive statistical models support the selection of suitable stratification factors for effective screening programs. Currently, there are no universal guidelines in Germany for MRSA screening. Instead, a list of criteria is available from the Commission for Hospital Hygiene and Infection Prevention (KRINKO) based on which local strategies should be adopted. We developed and externally validated a model for individual prediction of MRSA carriage at hospital admission in the region of Southeast Lower Saxony based on two prospective studies with universal screening in Braunschweig (n?=?2065) and Wolfsburg (n?=?461). Logistic regression was used for model development. The final model (simplified to an unweighted score) included history of MRSA carriage, care dependency and cancer treatment. In the external validation dataset, the score showed a sensitivity of 78.4% (95% CI: 64.7-88.7%), and a specificity of 70.3% (95% CI: 65.0-75.2%). Of all admitted patients, 25.4% had to be screened if the score was applied. A model based on KRINKO criteria showed similar sensitivity but lower specificity, leading to a considerably higher proportion of patients to be screened (49.5%).

SUBMITTER: Raschpichler G

PROVIDER: S-EPMC7582828 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany.

Raschpichler Gabriele G Raupach-Rosin Heike H Akmatov Manas K MK Castell Stefanie S Rübsamen Nicole N Feier Birgit B Szkopek Sebastian S Bautsch Wilfried W Mikolajczyk Rafael R Karch André A

Scientific reports 20201022 1

In countries with low endemic Methicillin-resistant Staphylococcus aureus (MRSA) prevalence, identification of risk groups at hospital admission is considered more cost-effective than universal MRSA screening. Predictive statistical models support the selection of suitable stratification factors for effective screening programs. Currently, there are no universal guidelines in Germany for MRSA screening. Instead, a list of criteria is available from the Commission for Hospital Hygiene and Infecti ...[more]

PMID: 33093607

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Project description:BACKGROUND:Physician migration has been gaining attention worldwide. In Germany, physician migration became a topic of interest in the context of the discussion about a shortage of physicians, for which one contributing factor may be physicians leaving the country. However, there is a lack of literature on "push" factors causing German physicians to leave. The present study seeks to provide current data in an effort to promote the identification of "push" factors motivating German physicians to emigrate. METHODS:In a cross-sectional survey, all physicians ?40 years of age registered with the State Chamber of Physicians of Saxony, Germany (n?=?5956) were sent a paper-pencil questionnaire examining socio-demographics, job satisfaction, the wish to emigrate, and the likelihood of moving abroad in the near future. Variables associated with the wish to emigrate were assessed with multivariate logistic regression models. RESULTS:Approximately 30% of participants wished to emigrate. The favourite destination countries were Switzerland, Scandinavian countries, and Australia or New Zealand. Of participants wishing to emigrate, approximately 52% thought it likely to emigrate for a limited, and 15% for an unlimited period of time. Participants with the wish to emigrate were significantly less satisfied with their job situation as compared to physicians without the wish to emigrate, the one exception being their "relationship with patients". The three aspects with the highest difference in satisfaction were the overall work situation, followed by work load, and time for family, friends, and leisure activities. Being a woman, being in a relationship, and having children were associated with a lower chance for wishing to emigrate. Higher satisfaction with the factors "work load", "patient care", and "structural aspects" was also associated with a lower chance for wishing to emigrate. CONCLUSIONS:Emigration seems to be a viable option for at least a subset of physicians. Preventive measures should address modifiable determinants associated with an increased chance for wishing to emigrate, such as job satisfaction. Especially satisfaction with the factor "work load" seems to play a crucial role as a "push" factor for physician emigration.

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Project description:BackgroundThe European brown hare (Lepus europaeus) typically resides in open habitats in agriculturally dominated landscapes in Europe. Over recent decades, a widely observed population decline occurred, which was attributed to agricultural intensification. However, with political incentives for specific crops, especially maize for energy production, the habitat went through massive changes. Thus, there is the need to identify parameters that characterize a suitable habitat for the brown hare in today's agricultural lands.ResultsWe modelled European brown hare densities spatially and temporally explicit over 10 years (2005-2014) across an entire federal state. The generalized additive mixed model confirms a constant decline of the European brown hare population in Lower Saxony. Municipalities with a high proportion of grassland and precipitation totaling up to 900 mm are more favored. Woodland showed an approximately linear negative effect. The most important agricultural crop groups such as winter grains and winter oilseed rape showed overall positive effects on hare densities. However, the effect of maize was unimodal, with a positive effect of medium proportions, but a negative effect of very high proportions. The effect of sugar beet was relatively weak but negative. Brown hares were also more abundant in municipalities with a higher density of vixen with litter and municipalities with a high proportion of wildflower strips showed higher brown hare abundance.ConclusionLower Saxony is a diverse federal state with grassland dominated areas in the northwest, more woodland in the east, but intensive arable land in most remaining areas. The European brown hare-a species with a wide ecological potency-shows preferences to both grassland and the most typical arable crop groups such as winter grains and winter oilseed rape. The substantial increase in maize production within the time frame was likely unfavourable and may be one reason for the decline. Nonetheless, political tools such as the agri-environmental scheme "wildflower strips" were beneficial for the brown hare abundance and may be an option to reverse the decline seen over the 10 years.

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Dataset Information

Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany.

Publications

Development and external validation of a clinical prediction model for MRSA carriage at hospital admission in Southeast Lower Saxony, Germany.

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