The objective of the study was to describe systemic bacterial infections occurring in acutely ill and hospitalized children in a rural region in Ghana, regarding frequency, incidence, antimicrobial susceptibility patterns and associations with anthropometrical data.Blood cultures were performed in all children below the age of five years, who were admitted to Agogo Presbyterian Hospital (APH), Asante Region, Ghana, between September 2007 and July 2009. Medical history and anthropometrical data were assessed using a standardized questionnaire at admission. Incidences were calculated after considering the coverage population adjusted for village-dependent health-seeking behavior.Among 1,196 hospitalized children, 19.9% (n = 238) were blood culture positive. The four most frequent isolated pathogens were nontyphoidal salmonellae (NTS) (53.3%; n = 129), Staphylococcus aureus (13.2%; n = 32), Streptococcus pneumoniae (9.1%; n = 22) and Salmonella ser. Typhi (7.0%; n = 17). Yearly cumulative incidence of bacteremia was 46.6 cases/1,000 (CI 40.9–52.2). Yearly cumulative incidences per 1,000 of the four most frequent isolates were 25.2 (CI 21.1–29.4) for NTS, 6.3 (CI 4.1–8.4) for S. aureus, 4.3 (CI 2.5–6.1) for S. pneumoniae and 3.3 (CI 1.8–4.9) for Salmonella ser. Typhi. Wasting was positively associated with bacteremia and systemic NTS bloodstream infection. Children older than three months had more often NTS bacteremia than younger children. Ninety-eight percent of NTS and 100% of Salmonella ser. Typhi isolates were susceptible to ciprofloxacin, whereas both tested 100% susceptible to ceftriaxone. Seventy-seven percent of NTS and 65% of Salmonella ser. Typhi isolates were multi-drug resistant (MDR). Systemic bacterial infections in nearly 20% of hospitalized children underline the need for microbiological diagnostics, to guide targeted antimicrobial treatment and prevention of bacteremia. If microbiological diagnostics are lacking, calculated antimicrobial treatment of severely ill children in malaria-endemic areas should be considered.

Background: Numerous trials have demonstrated high efficacy and safety of artemisinin-based combination therapy (ACT) under supervised treatment. In contrast, effectiveness studies comparing different types of ACT applied unsupervised are scarce. The aim of this study was to compare effectiveness, tolerability and acceptance of artesunate plus amodiaquine (ASAQ) against that of artemether-lumefantrine (AL) in Ghanaian children with uncomplicated Plasmodium falciparum malaria.

Differentiation of infectious causes in severely ill children is essential but challenging in sub- Saharan Africa. The aim of the study was to determine clinical indicators that are able to identify bacterial co-infections in P. falciparum infected children in rural Ghana. In total, 1,915 severely ill children below the age of 15 years were recruited at Agogo Presbyterian Hospital in Ghana between May 2007 and February 2011. In 771 (40%) of the children malaria parasites were detected. This group was analyzed for indicators of bacterial co-infections using bivariate and multivariate regression analyses with 24 socio-economic variables, 16 terms describing medical history and anthropometrical information and 68 variables describing clinical symptoms. The variables were tested for sensitivity, specificity, positive predictive value and negative predictive value. In 46 (6.0%) of the children with malaria infection, bacterial co-infection was detected. The most frequent pathogens were non-typhoid salmonellae (45.7%), followed by Streptococcus spp. (13.0%). Coughing, dehydration, splenomegaly, severe anemia and leukocytosis were positively associated with bacteremia. Domestic hygiene and exclusive breastfeeding is negatively associated with bacteremia. In cases of high parasitemia (>10,000/μl), a significant association with bacteremia was found for splenomegaly (OR 8.8; CI 1.6–48.9), dehydration (OR 18.2; CI 2.0–166.0) and coughing (OR 9.0; CI 0.7–118.6). In children with low parasitemia, associations with bacteremia were found for vomiting (OR 4.7; CI 1.4–15.8), severe anemia (OR 3.3; CI 1.0–11.1) and leukocytosis (OR 6.8 CI 1.9–24.2). Clinical signs of impaired microcirculation were negatively associated with bacteremia. Ceftriaxone achieved best coverage of isolated pathogens. The results demonstrate the limitation of clinical symptoms to determine bacterial co-infections in P. falciparum infected children. Best clinical indicators are dependent on the parasitemia level. Even with a moderate sensitivity of >60%, only low positive predictive values can be obtained due to low prevalence of bacteremia. Rapid testing for distinguishing parasitemia and bacteremia is essential.

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Hamburg 4 Zentrum für Rehabilitationsmedizin, BG Unfallkrankenhaus Hamburg 5 Forschungsprojekt "Rettungskette Offshore Wind (ROW)", BG Unfallkrankenhaus Hamburg In der deutschen Nord-und Ostsee wurden im Zuge des Ausbaus erneuerbarer Energien seit einigen Jahren Offshore-Windparks (OWP, Abb. 1) geplant, errichtet und in Betrieb genommen. Mit Stand 31.12.2014 speisen 258 OffshoreWindenergieanlagen mit einer Gesamtleistung von 1049,2 Megawatt Strom ein [1]. Schätzun-gen zufolge ist damit zu rechnen, dass zukünftig mehr als 1000 Menschen permanent in den OWPs tätig sein werden [2]. Eine besondere Herausforderung ist dabei der Umgang mit den spezifischen Arbeits-und Rahmenbedingungen, wobei die teilweise große Küstenentfernung der Installa tionen im Vordergrund steht. In Bezug auf Arbeitsschutz-und Notfallkonzepte ergeben sich dadurch einige Besonderheiten. Ein profesIn dieser vorläufigen retrospektiven Untersuchung wurden 319 medizinische Vorfälle bei Bau und Betrieb deutscher Offshore-Windparks, welche im Zeitraum 2008 bis 2012 stattfanden, analysiert. Diese unterteilten sich in 190 Unfallverletzungen, 123 Erkrankungen und 4 Todesfälle. Auch wenn außer den 4 Todesfällen schwere lebensbedrohliche Unfallverletzungen oder Erkrankungen in dieser Untersuchung nicht identifiziert werden konnten, wurde dennoch in jedem vierten bis fünften Fall eine Evakuierung mittels Schiff oder Hubschrauber durchgeführt. Dies verdeutlicht die Sinnhaftigkeit und Notwendigkeit einer funktionierenden Rettungskette. Insbesondere die betriebliche Erste Hilfe bedarf in diesem Zusammenhang einer gesonderten Betrachtung, da ihr aufgrund des erheblich verlängerten Zeitintervalls bis zum Eintreffen professioneller Hilfe eine herausragende Bedeutung zukommt. Um Limitationen, die sich bei der retrospektiven Analyse ergeben haben, zukünf-tig zu vermeiden, wurde die Entwicklung eines Registers (Zentrales Medizinisches Offshore Register, ZeMOR) im Sinne einer prospektiv-systematischen Datenerfassung initiiert. Abb. 1 Offshore-Windpark. Quelle: D. Hory, BG Unfallkrankenhaus Hamburg Heruntergeladen von: Nanyang Technological University NTU. Urheberrechtlich geschützt.