@phdthesis{Strauch2011,
  author    = {Strauch, Ulrike},
  title     = {Wassertemperaturbedingte Leistungseinschr{\"a}nkungen konventioneller thermischer Kraftwerke in Deutschland und die Entwicklung rezenter und zuk{\"u}nftiger Flusswassertemperaturen im Kontext des Klimawandels},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-231015},
  school      = {Universit{\"a}t W{\"u}rzburg},
  pages     = {XIX, 223},
  year      = {2011},
  abstract  = {Mit der vorliegenden Arbeit werden konventionelle thermische Kraftwerke an deutschen Fl{\"u}ssen identifiziert, bei denen aufgrund hoher Flusswassertemperaturen im Zusammenhang mit wasserrechtlichen Grenzwerten Leistungseinschr{\"a}nkungen auftraten. Weiterhin wird aufgezeigt, wie sich die Wassertemperaturen der Fl{\"u}sse in der Vergangenheit (rezent) entwickelt haben und wie sie sich zuk{\"u}nftig im Kontext des Klimawandels entwickeln k{\"o}nnten. Mittels Literaturrecherche, Medienanalyse und schriftlicher Befragung wurden konventionelle thermische Kraftwerke identifiziert, welche wassertemperaturbedingte Leistungseinschr{\"a}nkungen verzeichneten. Die meisten dieser Leistungseinschr{\"a}nkungen zwischen 1976 und 2007 zeigen sich bei großen Kraftwerken mit einer elektrischen Bruttoleistung {\"u}ber 300 Megawatt, bei Steinkohle- und Kernkraftwerken, bei Kraftwerken mit Durchlaufk{\"u}hlung und bei solchen, die zwischen 1960 und 1990 in Betrieb gingen. Trendanalysen interpolierter und homogenisierter, rezenter Wassertemperaturzeitreihen deutscher Fl{\"u}sse ergeben positive Trends v. a. im Fr{\"u}hjahr und Sommer. Die Z{\"a}hlstatistik zeigt in den Jahren 1994, 2003 und 2006 die meisten Tage mit sehr hohen und extrem hohen Wassertemperaturen in den Sommermonaten. In diesen Jahren traten gleichzeitig 63 \% aller identifizierter wassertemperaturbedingter Leistungseinschr{\"a}nkungen bei Kraftwerken, meist zwischen Juni und August, auf. F{\"u}r die Trendanalysen und den Mittelwertvergleich simulierter zuk{\"u}nftiger Wassertemperaturzeitreihen wurden drei Szenarien - B1, A1B und A2 sowie drei Zukunftsperioden 2011-2040, 2011/2041-2070, 2011/2071-2100 betrachtet. Es ergeben sich f{\"u}r die Zukunftsperiode 2011-2040 des A1B- oder A2-Szenarios in mindestens einem der Sommermonate eine Erw{\"a}rmung und f{\"u}r das B1-Szenario negative oder keine Trends. Die mittleren Wassertemperaturen der Zukunftsperiode 2011-2040 zeigen in allen drei Szenarien gegen{\"u}ber denen der Klimanormalperiode 1961-1990 positive Unterschiede in mindestens einem der Sommermonate. F{\"u}r die beiden sp{\"a}teren Zukunftsperioden bis 2070 bzw. bis 2100 liegen in allen Wassertemperaturzeitreihen der drei Szenarien im Sommer positive Trends bzw. Differenzen gegen{\"u}ber den mittleren Wassertemperaturen der Klimanormalperiode vor. Durch die Synthese der drei Analysen ist erkennbar, dass Isar, Rhein, Neckar, Saar, Elbe und Weser die meisten Kraftwerksstandorte mit wassertemperaturbedingten Leistungseinschr{\"a}nkungen verzeichnen. Es zeigen sich hier positive Trends sowohl in den rezenten als auch zuk{\"u}nftigen Wassertemperaturen f{\"u}r die Zukunftsperiode 2011-2040 des A1B- und A2-Szenarios in jeweils mindestens einem der Sommermonate. Gegen{\"u}ber den mittleren Wassertemperaturen der Klimanormalperiode liegen f{\"u}r alle drei Szenarien positive Unterschiede der Wassertemperaturen vor. Bei einer Kraftwerkslaufzeit von 40-50 Jahren und einem Kernenergieausstieg 2022 bzw. 2034, werden 48-64 \% bzw. 67-91 \% der Kraftwerke mit wassertemperaturbedingten Leistungseinschr{\"a}nkungen bis 2022 bzw. 2034 außer Betrieb gehen. Bei einer Laufzeitverl{\"a}ngerung w{\"u}rden nach 2022 f{\"u}nf der elf betroffenen Kernkraftwerke weiter am Netz bleiben. Somit kann es wieder zu wassertemperaturbedingten Leistungseinschr{\"a}nkungen kommen. In Deutschland sind nach wie vor große Kraftwerke an Fl{\"u}ssen geplant. Deren K{\"u}hlsysteme m{\"u}ssen entsprechend ausgew{\"a}hlt und konstruiert werden, um der zu erwartenden Erh{\"o}hung der Flusstemperaturen Rechnung zu tragen.},
  subject      = {Deutschland},
  language  = {de}
}
@article{HeinzEidmannAndersonetal.2023,
  author    = {Heinz, Tizian and Eidmann, Annette and Anderson, Philip and Weißenberger, Manuel and Jakuscheit, Axel and Rudert, Maximilian and Stratos, Ioannis},
  title     = {Trends in computer-assisted surgery for total knee arthroplasty in Germany: an analysis based on the operative procedure classification system between 2010 to 2021},
  series = {Journal of Clinical Medicine},
  volume    = {12},
  journal   = {Journal of Clinical Medicine},
  number    = {2},
  issn      = {2077-0383},
  doi       = {10.3390/jcm12020549},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-304879},
  year      = {2023},
  abstract  = {Alignment strategies for primary total knee arthroplasty (TKA) have changed significantly over time with a shift towards a more individualized alignment goal. At the same time, computer-assisted surgery (CAS) has gained interest for intraoperative control and accuracy in implant positioning and limb alignment. Despite the often discussed benefits and drawbacks of robotics and navigation for TKA, the routine use of these new devices on a day-to-day basis remains obscure. Therefore, nationwide hospital billing data based on the Operation Procedure Classification System (OPS) were retrieved from the Federal Statistical Office of Germany for the period from 2010 to 2021. OPS codes for primary total knee arthroplasty (OPS code: 5-822*) were further analyzed regarding the usage of computer navigation (additional OPS code: 5-988) or robotic devices (additional OPS code: 5-987). Gender and age at the time of surgery were also assessed. The results show a total of 2,226,559 primary TKAs were implanted between 2010 and 2021, of which 2,044,914 were performed conventionally (91.84\% of all TKAs). A total of 170,276 TKAs were performed using navigation technique (7.65\% of all TKAs) and another 11,369 TKAs were performed using robotics (0.51\% of all TKAs). For the period from 2018 to 2021, a substantial increase in robot-assisted TKA (R-TKA) was observed, with an average increase rate of 84.74\% per year, while the number of navigated TKAs declined (-3.67\% per year). Computer-assisted surgery, and particularly robotics for TKA, are seeing growing popularity and stepwise translation into routine clinical use in Germany, with a steep increase rate of more than 80\% per year since 2018. Nevertheless, the majority of TKAs are still performed using manual instrumentation, rendering conventional TKA the currently unchanged gold standard.},
  language  = {en}
}
@phdthesis{Woltering2011,
  author    = {Woltering, Manuel},
  title     = {Tourismus und Regionalentwicklung in deutschen Nationalparken: Regionalwirtschaftliche Wirkungsanalyse des Tourismus als Schwerpunkt eines sozio{\"o}konomischen Monitoringsystems},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-71898},
  school      = {Universit{\"a}t W{\"u}rzburg},
  year      = {2011},
  abstract  = {Von den drei aktuell in Deutschland zu unterscheidenden Großschutzgebietskategorien Nationalpark, Naturpark und Biosph{\"a}renreservat stellt der Nationalpark gewiss die h{\"o}chsten Anspr{\"u}che an den Naturschutz. Im Idealfall sollen bis zu drei Viertel der betreffenden Fl{\"a}chen g{\"a}nzlich aus der Nutzung genommen werden. Dieser Nutzungsverzicht hat im Vorfeld einer Gebietsausweisung aufgrund der damit verbundenen {\"o}konomischen Einbußen oftmals Bedenken der lokalen Bev{\"o}lkerung gegen{\"u}ber diesem Fl{\"a}chenschutzinstrument zur Folge. Nationalparke k{\"o}nnen jedoch als Attraktionspunkte im Tourismus durchaus zu einer eigenst{\"a}ndigen Entwicklung l{\"a}ndlich-peripherer Regionen beitragen. Die vorliegende Arbeit untersucht deshalb die Strukturen des Tourismus und dessen {\"o}konomischen Stellenwert in den deutschen Nationalparkregionen. Auf Grundlage einer Typisierung der bestehenden vierzehn Gebiete wurden zun{\"a}chst f{\"u}nf Untersuchungsregionen ausgew{\"a}hlt (Bayerischer Wald, Eifel, Hainich, Kellerwald-Edersee sowie Nieders{\"a}chsisches Wattenmeer), f{\"u}r die mittels des nachfrageseitigen Vorgehens einer Wertsch{\"o}pfungsanalyse die regionalwirtschaftlichen Effekte des Tourismus bestimmt wurden. Darauf aufbauend ist schließlich eine Hochrechnung f{\"u}r den gesamtdeutschen Nationalparktourismus durchgef{\"u}hrt worden. Insgesamt halten sich j{\"a}hrlich demnach etwas mehr als 50 Mio. Besucher in den deutschen Nationalparken auf, die einen touristischen Bruttoumsatz von 2,1 Mrd. € generieren. Daraus resultieren Einkommen in H{\"o}he von ungef{\"a}hr 1,1 Mrd. €, woraus sich ein Einkommens{\"a}quivalent von etwas mehr als 69.000 Personen ableitet. F{\"u}r die vor allem aus regionalpolitischer Sicht relevante Besuchergruppe mit hoher Nationalparkaffinit{\"a}t (= National-parktouristen im engeren Sinn) reduzieren sich diese Werte auf rund 11 Mio. Besucher und 431 Mio. € Bruttoumsatz, was ca. 212 Mio. € Einkommen und ein Einkommens{\"a}quivalent von rund 14.000 Personen bewirkt. Diese Resultate auf Ebene der einzelnen Untersuchungsgebiete stellen dabei lediglich den gegenw{\"a}rtigen Status-quo dar, k{\"o}nnen aber als Grundlage f{\"u}r ein dauerhaftes Monitoring dienen. Dazu ist allerdings von Managementseite der Wille f{\"u}r eine kontinuierliche Bewertung nicht nur der {\"o}kologischen, sondern auch der sozio{\"o}konomischen Entwicklung erforderlich. Der aktuelle Forschungsstand zeigt in dieser Hinsicht noch ein enormes Potenzial. Um eine m{\"o}glichst kosteng{\"u}nstige Variante des eingesetzten Verfahrens zur Erfassung der Besucherstrukturen und des Ausgabeverhaltens der Touristen zu konzipieren, werden Vorschl{\"a}ge f{\"u}r eine m{\"o}gliche Reduzierung des empirischen Aufwands ausgearbeitet. Denn angesichts der bestehenden Budgets deutscher Nationalparkverwaltungen muss es Ziel sein, das bisher wissenschaftlich ausgerichtete Instrumentarium der empirischen Erhebungen zu einem praxisnahen und leicht anwendbaren Vorgehen weiter zu entwickeln und damit f{\"u}r einen Monitoringeinsatz f{\"u}r die Verantwortlichen vor Ort zu optimieren. Nur dadurch k{\"o}nn-ten auf objektiver Basis die Entwicklungen im Nationalparktourismus und folglich der Stellenwert der Schutzgebiete als Stimuli der regionalen Entwicklung mittel- bis langfristig beurteilt werden.},
  subject      = {Nationalpark},
  language  = {de}
}
@article{WiedmannHeuschmannHillmannetal.2014,
  author    = {Wiedmann, Silke and Heuschmann, Peter U. and Hillmann, Steffi and Busse, Otto and Wiethoelter, Horst and Walter, Georg M. and Seidel, Guenter and Misselwitz, Bjoern and Janssen, Alfred and Berger, Klaus and Burmeister, Christoph and Matthias, Christine and Kolominsky-Rabas, Peter and Hermanek, Peter},
  title     = {The Quality of Acute Stroke Care-an Analysis of Evidence-Based Indicators in 260 000 Patients},
  series = {Deutsches {\"A}rzteblatt International},
  volume    = {111},
  journal   = {Deutsches {\"A}rzteblatt International},
  number    = {45},
  issn      = {1866-0452},
  doi       = {10.3238/arztebl.2014.0759},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-114747},
  pages     = {759-765},
  year      = {2014},
  abstract  = {Background: Stroke patients should be cared for in accordance with evidence-based guidelines. The extent of implementation of guidelines for the acute care of stroke patients in Germany has been unclear to date. Methods: The regional quality assurance projects that cooperate in the framework of the German Stroke Registers Study Group (Arbeitsgemeinschaft Deutscher Schlaganfall-Register, ADSR) collected data on the care of stroke patients in 627 hospitals in 2012. The quality of the acute hospital care of patients with stroke or transient ischemic attack (TIA) was assessed on the basis of 15 standardized, evidence-based quality indicators and compared across the nine participating regional quality assurance projects. Results: Data were obtained on more than 260 000 patients nationwide. Intravenous thrombolysis was performed in 59.7\% of eligible ischemic stroke patients patients (range among participating projects, 49.7-63.6\%). Dysphagia screening was documented in 86.2\% (range, 74.8-93.1\%). For the following indicators, the defined targets were not reached for all of Germany: antiaggregation within 48 hours, 93.4\% (range, 86.6-96.4\%); anticoagulation for atrial fibrillation, 77.6\% (range, 72.4-80.1\%); standardized dysphagia screening, 86.2\% (range, 74.8-93.1\%); oral and written information of the patients or their relatives, 86.1\% (range, 75.4-91.5\%). The rate of patients examined or treated by a speech therapist was in the target range. Conclusion: The defined targets were reached for most of the quality indicators. Some indicators, however, varied widely across regional quality assurance projects. This implies that the standardization of care for stroke patients in Germany has not yet been fully achieved.},
  language  = {en}
}
@article{RoseDammGreineretal.2014,
  author    = {Rose, Markus A. and Damm, Oliver and Greiner, Wolfgang and Knuf, Markus and Wutzler, Peter and Liese, Johannes G. and Kr{\"u}ger, Hagen and Wahn, Ulrich and Schaberg, Tom and Schwehm, Markus and Kochmann, Thomas F. and Eichner, Martin},
  title     = {The epidemiological impact of childhood influenza vaccination using live-attenuated influenza vaccine (LAIV) in Germany: predictions of a simulation study},
  series = {BMC Infectious Diseases},
  volume    = {14},
  journal   = {BMC Infectious Diseases},
  number    = {40},
  issn      = {1471-2334},
  doi       = {10.1186/1471-2334-14-40},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-117563},
  year      = {2014},
  abstract  = {Background: Routine annual influenza vaccination is primarily recommended for all persons aged 60 and above and for people with underlying chronic conditions in Germany. Other countries have already adopted additional childhood influenza immunisation programmes. The objective of this study is to determine the potential epidemiological impact of implementing paediatric influenza vaccination using intranasally administered live-attenuated influenza vaccine (LAIV) in Germany. Methods: A deterministic age-structured model is used to simulate the population-level impact of different vaccination strategies on the transmission dynamics of seasonal influenza in Germany. In our base-case analysis, we estimate the effects of adding a LAIV-based immunisation programme targeting children 2 to 17 years of age to the existing influenza vaccination policy. The data used in the model is based on published evidence complemented by expert opinion. Results: In our model, additional vaccination of children 2 to 17 years of age with LAIV leads to the prevention of 23.9 million influenza infections and nearly 16 million symptomatic influenza cases within 10 years. This reduction in burden of disease is not restricted to children. About one third of all adult cases can indirectly be prevented by LAIV immunisation of children. Conclusions: Our results demonstrate that vaccinating children 2-17 years of age is likely associated with a significant reduction in the burden of paediatric influenza. Furthermore, annual routine childhood vaccination against seasonal influenza is expected to decrease the incidence of influenza among adults and older people due to indirect effects of herd protection. In summary, our model provides data supporting the introduction of a paediatric influenza immunisation programme in Germany.},
  language  = {en}
}
@article{ReinermannGessnerAsametal.2019,
  author    = {Reinermann, Sophie and Gessner, Ursula and Asam, Sarah and Kuenzer, Claudia and Dech, Stefan},
  title     = {The Effect of Droughts on Vegetation Condition in Germany: An Analysis Based on Two Decades of Satellite Earth Observation Time Series and Crop Yield Statistics},
  series = {Remote Sensing},
  volume    = {11},
  journal   = {Remote Sensing},
  number    = {15},
  doi       = {10.3390/rs11151783},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-225165},
  pages     = {1783, 1-21},
  year      = {2019},
  abstract  = {Central Europe experienced several droughts in the recent past, such as in the year 2018, which was characterized by extremely low rainfall rates and high temperatures, resulting in substantial agricultural yield losses. Time series of satellite earth observation data enable the characterization of past drought events over large temporal and spatial scales. Within this study, Moderate Resolution Spectroradiometer (MODIS) Enhanced Vegetation Index (EVI) (MOD13Q1) 250 m time series were investigated for the vegetation periods of 2000 to 2018. The spatial and temporal development of vegetation in 2018 was compared to other dry and hot years in Europe, like the drought year 2003. Temporal and spatial inter- and intra-annual patterns of EVI anomalies were analyzed for all of Germany and for its cropland, forest, and grassland areas individually. While vegetation development in spring 2018 was above average, the summer months of 2018 showed negative anomalies in a similar magnitude as in 2003, which was particularly apparent within grassland and cropland areas in Germany. In contrast, the year 2003 showed negative anomalies during the entire growing season. The spatial pattern of vegetation status in 2018 showed high regional variation, with north-eastern Germany mainly affected in June, north-western parts in July, and western Germany in August. The temporal pattern of satellite-derived EVI deviances within the study period 2000-2018 were in good agreement with crop yield statistics for Germany. The study shows that the EVI deviation of the summer months of 2018 were among the most extreme in the study period compared to other years. The spatial pattern and temporal development of vegetation condition between the drought years differ.},
  language  = {en}
}
@techreport{Goldan2020,
  type      = {Working Paper},
  author    = {Goldan, Lea},
  title     = {The Early Career Gender Pay Gap among Doctoral Graduates in Germany},
  doi       = {10.25972/OPUS-21634},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-216347},
  pages     = {24},
  year      = {2020},
  abstract  = {Previous research has shown that female doctoral graduates earn less than male doctoral graduates; how-ever, the determinants of this gender pay gap remain largely unexplored. Therefore, this paper investigates the determinants of the early career gender pay gap among doctoral graduates in Germany. By relying on effects on the supply and demand sides and feedback between them, I theoretically derive determinants of the gender pay gap that comprise doctoral and occupational characteristics. Using data from a representative German panel study of the 2014 doctoral graduation cohort, I analyse the gender pay gap two years after graduation. I apply linear regression on the logarithmic gross monthly earnings and Oaxaca-Blinder de-composition to examine the explanatory contribution of the determinants to the gender pay gap. The anal-yses reveal that female graduates earn 27.2 \% less than male graduates two years after graduation. Male graduates being paid a premium outside academia partly drives this gender pay gap. The considered deter-minants largely explain the overall gender pay gap, the most important determinants being working hours, doctoral subject, industry, professional experience gained after graduation, company size, and academic employment. The results offer new insights on the determinants of the early career gender pay gap among doctoral graduates and thereby shed light on one dimension of gender inequalities in post-doctoral careers.},
  subject      = {Doktor},
  language  = {en}
}
@article{AppelHardaker2021,
  author    = {Appel, Alexandra and Hardaker, Sina},
  title     = {Strategies in Times of Pandemic Crisis — Retailers and Regional Resilience in W{\"u}rzburg, Germany},
  series = {Sustainability},
  volume    = {13},
  journal   = {Sustainability},
  number    = {5},
  issn      = {2071-1050},
  doi       = {10.3390/su13052643},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-233991},
  year      = {2021},
  abstract  = {Research on the COVID-19 crisis and its implications on regional resilience is still in its infancy. To understand resilience on its aggregate level it is important to identify (non)resilient actions of individual actors who comprise regions. As the retail sector among others represents an important factor in an urban regions recovery, we focus on the resilience of (textile) retailers within the city of W{\"u}rzburg in Germany to the COVID-19 pandemic. To address the identified research gap, this paper applies the concept of resilience. Firstly, conducting expert interviews, the individual (textile) retailers' level and their strategies in coping with the crisis is considered. Secondly, conducting a contextual analysis of the German city of W{\"u}rzburg, we wish to contribute to the discussion of how the resilience of a region is influenced inter alia by actors. Our study finds three main strategies on the individual level, with retailers: (1) intending to "bounce back" to a pre-crisis state, (2) reorganising existing practices, as well as (3) closing stores and winding up business. As at the time of research, no conclusions regarding long-term impacts and resilience are possible, the results are limited. Nevertheless, detailed analysis of retailers' strategies contributes to a better understanding of regional resilience.},
  language  = {en}
}
@article{HellenbrandClausSchinketal.2016,
  author    = {Hellenbrand, Wiebke and Claus, Heike and Schink, Susanne and Marcus, Ulrich and Wichmann, Ole and Vogel, Ulrich},
  title     = {Risk of Invasive Meningococcal Disease in Men Who Have Sex with Men: Lessons Learned from an Outbreak in Germany, 2012-2013},
  series = {PLoS ONE},
  volume    = {11},
  journal   = {PLoS ONE},
  number    = {8},
  doi       = {10.1371/journal.pone.0160126},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-166842},
  pages     = {e0160126},
  year      = {2016},
  abstract  = {Background We undertook investigations in response to an invasive meningococcal disease (IMD) outbreak in men who have sex with men (MSM) in Berlin 2012-2013 to better understand meningococcal transmission and IMD risk in MSM. Methods We retrospectively searched for further IMD cases in MSM in Germany through local health departments and undertook exploratory interviews. We performed antigen sequence typing, characterized fHbp and aniA genes of strains with the outbreak finetype and reviewed epidemiologically or spatiotemporally linked cases from 2002-2014. Results Among the 148 IMD-cases notified from 01.01.2012-30.09.2013 in 18-59 year-old men we identified 13 MSM in 6 federal states: 11 serogroup C (MenC, all finetype C:P1.5-1,10-8:F3-6), 2 MenB. Interviews with 7 MSM revealed frequent meeting of multiple partners online or via mobile apps and illicit drug use as potential risk factors. MenC incidence was 13-fold higher in MSM than non-MSM. MenC isolates from 9/11 MSM had a novel fHbp allele 766. All C:P1.5-1,10-8:F3-6 strains from MSM versus 16/23 from non-MSM had intact aniA genes (p = 0.04). Although definitive evidence for transmission among MSM in epidemiological or spatiotemporal clusters in 2002-2014 was lacking, clusters were more frequent in men aged 20-49 years. Molecular analysis of C:P1.5-1,10-8:F3-6 strains revealed cases with intact aniA since 2007, mainly associated with fHbp361, fHbp766 and fHbp813, all involving one or more MSM. Conclusions MenC incidence was elevated in MSM during the study period. Multiple casual sexual contacts and illicit drug use were common in affected MSM. In all strains from MSM we detected an intact aniA gene coding for a nitrite reductase, which permits survival in microanaerobic environments and could play a role in meningococcal transmission in MSM through urogenital colonization. Furthermore, meningococcal transmission among MSM may be sustained over large areas and thus require modified spatiotemporal scanning algorithms for timely detection and control.},
  language  = {en}
}
@article{DuskeClausKroneetal.2024,
  author    = {Duske, Helene and Claus, Heike and Krone, Manuel and L{\^a}m, Thi{\^e}n-Tr{\´i}},
  title     = {Prevalence of piperacillin/tazobactam resistance in invasive \(Haemophilus\) \(influenzae\) in Germany},
  series = {JAC-Antimicrobial Resistance},
  volume    = {6},
  journal   = {JAC-Antimicrobial Resistance},
  number    = {1},
  issn      = {2632-1823},
  doi       = {10.1093/jacamr/dlad148},
  url       = {http://nbn-resolving.de/urn:nbn:de:bvb:20-opus-350424},
  year      = {2024},
  abstract  = {Background Haemophilus influenzae (Hi) is a Gram-negative bacterium that may cause sepsis or meningitis, treatment of which mainly includes β-lactam antibiotics. Since 2019 EUCAST breakpoints for piperacillin/tazobactam have been available. Little is known about the prevalence and mechanisms of piperacillin/tazobactam resistance in Hi. Objectives To provide reliable prevalence data for piperacillin/tazobactam resistance in Hi in Germany, to evaluate different antibiotic susceptibility testing methods and to examine possible resistance mechanisms. Methods According to EUCAST breakpoints, the MIC for piperacillin/tazobactam resistance is >0.25 mg/L. All invasive Hi in Germany from 2019 were examined by gradient agar diffusion (GAD) for piperacillin/tazobactam susceptibility. Piperacillin/tazobactam broth microdilution (BMD), piperacillin GAD on tazobactam-containing agar [piperacillin GAD on Mueller-Hinton agar with horse blood (MH-F)/tazobactam) and piperacillin/tazobactam agar dilution (AD) were used for confirmation. Phenotypic testing was complemented by ftsI sequencing. Results Piperacillin/tazobactam GAD resulted in 2.9\% (21/726) resistant Hi. BMD did not confirm piperacillin/tazobactam resistance. Two strains were found resistant by AD, of which one was also resistant using piperacillin GAD on MH-F/tazobactam. Overall, we found two strains with a piperacillin/tazobactam MIC >0.25 mg/L in at least two different tests (0.3\%). Both were β-lactamase-producing amoxicillin/clavulanate-resistant with PBP3 mutations characterized as group III-like+. Relevant PBP3 mutations occurred in six strains without phenotypic piperacillin/tazobactam resistance. These mutations suggest a reduced efficacy of β-lactam antibiotics in these isolates. Conclusions Piperacillin/tazobactam resistance prevalence in invasive Hi is low in Germany. Reduced susceptibility was correlated with PBP3 mutations, in particular with group III mutations.},
  language  = {en}
}