NOROVIRUS GASTROENTERITIS IS AN IMPORTANT CAUSE OF NOSOCOMIAL INFECTIONS IN GERMANY

Abstract

Noroviruses are the most important global cause of acute gastroenteritis (AGE). Testing for norovirus in patients hospitalized with AGE is incentivized in Germany because a positive diagnosis impacts reimbursement. We estimated the number of nosocomial infections overall and by age-group for norovirus gastroenteritis (NGE) using federal German databases. All hospitalizations in Germany are registered with the German Federal Statistics Office (DESTATIS). We extracted aggregate data for patients hospitalized with NGE (ICD-10 codes A08.1) as primary or non-primary diagnosis for the period 2007–2012. Cases with a non-primary diagnoses were assumed to be due to nosocomial infection. During the six-year study period and based on our assumption, there were a total of 241,667 nosocomial NGE cases among hospitalized patients in Germany; an average of 40,278 cases per year studied (range 32,259–57,561). In any study year the number of nosocomial NGE cases was 1.3 to 1.7-fold higher than the number of community acquired NGE hospitalizations. The average duration of hospitalization was 3.4 to 4.5-fold longer (17–18 days versus 4–5 days) when NGE was nosocmial compared to community-acquired. Adults of 85 years of age and older suffered the highest rate of nosocomial NGE (range 33.6 to 59.1/10,000 population). We conclude that Noroviruses are an important cause of nosocomial infections among hospitalized patients in Germany. Assuming all non-primary coded NGE episodes to be nosocomial in nature may have lead to an overestimation.