Background:Nasal and pharyngeal colonization with Staphylococcus aureus (S. aureus) is a major risk factor for postoperative wound infections, particularly following orthopedic procedures. Preoperative targeted decolonisation reduces surgical site infections (SSIs) and is recommended by several national and international guidelines. However, real-world data on the sustained effectiveness of standardized targeted decolonisation programs in orthopedic surgery remain limited. Objective:To evaluate the long-term effectiveness of a standardized preoperative S. aureus screening and targeted octenidine-based decolonisation protocol in reducing postoperative wound infections among orthopedic patients in a secondary care hospital. Methods:In this retrospective single-center interventional cohort study, all patients undergoing elective hip and knee replacement surgery between 2016 and 2023 were screened preoperatively for S. aureus using nasal and throat swabs. Patients testing positive underwent decolonisation with octenidine-based antiseptics. Postoperative infection rates were compared between a pre-intervention period (January 2016 to August 2021) and a post-intervention period (January 2022 to December 2023). A predefined implementation phase (September to December 2021), during which routine screening and decolonisation procedures were established, was excluded from comparative analyses. Results:Among 436 and 511 screened patients prior to elective hip- and knee replacement in 2022 and 2023, respectively, S. aureus carriage was detected in 18%. Implementation of the targeted decolonisation protocol reduced S. aureus-associated wound infections in our reference hospital from 2.89-0.99 per 100 surgeries during the pre-intervention period (2016-2021) to 0.45-0.00 in 2022 and 2023, respectively. Conclusion:Routine preoperative S. aureus screening followed by targeted octenidine-based decolonisation significantly and sustainably reduced postoperative infection rates. These findings provide robust real-world evidence supporting the integration of standardized S. aureus decolonisation protocols into routine orthopedic practice.
Teaching in the field of “Medical Microbiology, Virology, and Hygiene” focuses on the development of clinical competence in infection medicine, primarily achieved through time- and cost-intensive practical courses, which often compete with other educational offerings. These courses must address the defining feature of transmissibility of infectious agents, with far-reaching consequences for individual patients, their environments, society, animals, and the broader ecosystem (One-Health concept). Understanding the complexity of pathogen-associated risks requires comprehensive knowledge in epidemiology, prevention, diagnostics, and therapy of infectious diseases. Ensuring long-term resilience in the medical profession against the challenges of infectious diseases can only be achieved through fostering infection-related competencies in medical students. Qualified infection diagnostics are a core competence for independent, evidence-based medical practice. Proficiency in rapid and appropriate infection diagnostics is indispensable, as it forms the foundation for rational antimicrobial therapy. This is critical in preventing the misuse of antibiotics, which is the primary cause of the development of multidrug-resistant pathogens. Additionally, rapid infection diagnostics play a central role in controlling outbreaks and interrupting infection chains. In virology, microbiology, and hygiene, prompt medical intervention is likewise essential, as the interpretation of infection diagnostics depends heavily on factors like the timing of infection, clinical context, and pre-existing conditions or vaccinations. Correct sample collection, selection of appropriate tests, and the critical evaluation of microbiological and virological findings are essential medical competencies, which cannot be shifted to self-learning formats but can only be acquired through structured, practice-oriented education including hands-on-training. These competencies are central to infection diagnostics, prevention, and therapy.
Given the global threat of increasing antibiotic resistance, risk factor detection of multi-resistant pathogens is particularly important. This is complicated by different definitions, using the international extended spectrum beta-lactamases (ESBL) definition and the German definition of multidrug-resistant Gram-negative pathogens (MRGN). Although the MRGN definition was primarily introduced for hospital hygiene measures, it is often used in outpatient or semi-inpatient areas. Due to the increasing numbers of outpatient treatments of the healthcare system, corresponding data is necessary for specific hygiene regulations. This study provides MRGN and ESBL data based on a stool examination and a questionnaire evaluation in the period 07/2021-03/2022 of 231 outpatients of Saarland University Medical Center before traveling abroad. There was a 3MRGN prevalence of 2.6% with five Escherichia coli and one Klebsiella pneumoniae and an ESBL prevalence of 5.6% with 13 ESBL Escherichia coli, four of which could also be classified as 3MRGN. These prevalences were compared with MRGN/ESBL prevalences in PubMed and Google Scholar in different areas of the German healthcare system in the period 2013-2024 at the federal state level. The selective literature search revealed geographical differences and missing prevalence data depending on the healthcare sector (outpatient/inpatient) and federal state. Resistance data is often evaluated according to international standards, i.e. according to the ESBL definition. Outpatient MRGN prevalences are hardly known despite the increasing numbers of outpatients of the healthcare system. Due to the scarcity of outpatient data, our study from a travel medicine clinic provides interesting epidemiological data that should be considered in the context of the COVID-19 pandemic.
Since several current clinical guidelines also recommend non-antibiotic therapy of uncomplicated acute cystitis (uAC) in women, research guidelines are needed on conducting clinical trials to demonstrate their efficacy compared to e.g. standard antibiotic therapy. As the mechanism of action of antibiotic and non-antibiotic therapy is different, clinical outcome in such comparative trials must be the main criteria, although the effect of microbiological outcomes on clinical outcome may also be considered. The research guidelines proposed here are adjusted to the current guidelines recommended by the European Medicines Agency (EMA, 2022) and the U.S. Food and Drug Administration (FDA, 2019), using in addition a patient self-reporting questionnaire already clinically validated in many languages for diagnostics of uAC and as a patient-reported outcome measure (PROM) with well-defined thresholds for successful and non-successful clinical outcome. These adapted guidelines could be used in prospective clinical studies comparing e.g. antibacterial and non-antibacterial products for the treatment of women suffering from uAC.
Background: The German Society for Arthroplasty (AE) recommends a single dose of 2,000 mg amoxicillin as an antibiotic prophylaxis to prevent periprosthetic joint infections (PJI) in patients with total hip or knee arthroplasty (THA, TKA) who undergo invasive dental procedures (DP). We searched for evidence to support this recommendation. Materials and methods: We conducted a Medline query and made additional searches based on the literature found in the Medline database. We looked for relevant recommendations on antibiotic prophylaxis (AP) in other countries, as well as for standardized reviews and other studies published after the last reviews on the question of antibiotic prophylaxis for joint implant recipients in connection with dental treatment. Results: In twelve countries, no current guideline recommends general antibiotic prophylaxis for dental procedures, seven guidelines suggest that antibiotic prophylaxis should be considered in patients with risk factors, and five guidelines recommend that antibiotic prophylaxis be considered in conjunction with specific dental procedures that have an increased risk. Three reviews (2012, 2017 and 2020) mostly comprised of low-quality studies, all agreed that there is no direct evidence to indicate AP prior to dental procedures in patients with total joint arthroplasty (TJA). Six new retrospective studies from four countries on three continents, which included a total of more than 200,000 patients with TJA, confirmed the results of earlier studies: PJIs are rare and not significantly associated with DPs, and AP does not significantly reduce the (already low) risk. This applies not only to primary but also to revision TKA. Furthermore, a recent study comprising 61,124 patients with TJA or cardiac conditions who received AP for DP found that 62 (0.1%) experienced serious adverse drug events. Discussion: Even though most studies were conducted retrospectively and are based on insurance data and not on the analysis of individual medical records, it should be noted that there is still no robust evidence showing that dental procedures increase the risk of PJI, nor that AP has a risk-reducing effect both for primary THA and TKA as well as for revision TKA. Therefore, it is suggested that the AE should revise its recommendation, announced in 2022, in order to avoid the risks of unnecessary AP.
We report the first human case of a novel Salmonella enterica serovar Weitmar (8:z41:1,5), isolated from a 41-year-old outpatient with acute diarrhea and fever in Bochum, Germany. Identification involved culture, multiplex PCR, MALDI-TOF MS, biochemical testing, and reference lab serotyping. The strain showed a unique antigenic profile and was confirmed by the WHO Collaborating Centre for Reference and Research on Salmonella. This case illustrates a routine but essential aspect of microbiological surveillance, highlighting how combined diagnostics and international collaboration support the reliable identification of novel Salmonella serovars.
Antibiotic resistance is a major challenge in modern healthcare, as it severely limits the choice of treatment options. In particular, carbapenemase mediated carbapenem resistance in Pseudomonas aeruginosa poses an emerging health risk worldwide. Here, we discovered a hitherto unknown variant of the class A beta-lactamase type GES in a P. aeruginosa strain by whole genome sequencing. This multidrug-resistant strain was isolated from bronchoalveolar lavage samples of a 61-year-old man, who suffered from respiratory insufficiency resulting from pneumonia. Ultimately, the patient succumbed to his condition, as there were no further treatment strategies. Given the high drug resistance of P. aeruginosa and its increasing role in severe infections, the implementation of methods for the rapid detection of carbapenemases is essential for optimizing therapeutic strategies and preventing nosocomial outbreaks.
Background:The number of COVID-19 deaths is an important measure for the impact of the pandemic. However, estimates differ and fuel the debate on COVID-19 as legitimate cause of death. Objective:To study the role of COVID-19 as cause of death. Methods:Double (bridge) coding of all death certificates mentioning COVID-19 in the Dutch cause-of-death registry during the pandemic 2020-2022 (n=51,288). The coding of records by the WHO special instruction for COVID-19 as issued in April 2020 was compared with the coding of the same set of records by the prevailing rules of the ICD-10 and the effect on cause-of-death statistics was studied. Results:When mentioned on a death certificate, COVID-19 was selected as underlying cause of death in 94% of the cases by the WHO special instruction. According to the prevailing ICD-10 coding rules, COVID-19 was the beginning of a causal sequence leading to death in 76% of the cases (General Principle) and when the role of contributing co-morbidity was taken in to account too (Direct Sequel), COVID-19 was the underlying cause of death in 49% of the cases. These different estimates can be explained by a difference in perspective. The WHO special instruction identifies cases from an epidemiological point of view (surveillance), while the prevailing ICD-10 rules identify cases with COVID-19 as a necessary and sufficient cause of death from a medical (pathophysiological) point of view. Conclusion:Different estimates of COVID-19 deaths represent different views on the role of COVID-19 as cause of death, which should be taken in to account when interpreting cause-of-death statistics.
Background: Colistin is a last-resort antibiotic used against infections caused by multidrug-resistant gram-negative organisms, particularly carbapenem-resistant strains. Rising resistance to colistin is a significant global concern. To address this, an Antimicrobial Stewardship (AMS) Program was introduced in our hospital, including pre-authorization protocols for colistin use. Objective: To evaluate the prevalence of colistin-resistant organisms and determine the impact of AMS implementation on their occurrence and associated clinical outcomes. Methods: We conducted a quasi-experimental study at a tertiary care hospital in Pakistan, comparing data from 18 months before and after AMS implementation. Adult patients (>18 years) with confirmed infections due to colistin-resistant Klebsiella pneumoniae, Pseudomonas aeruginosa, or Acinetobacter spp. were included. Clinical and microbiological data were analyzed to assess differences in organism prevalence, mortality, and hospital stay duration. Results: A total of 121 patients met inclusion criteria, with 45 (37.2%) in the pre-AMS period and 76 (62.8%) in the post-AMS period. Klebsiella pneumoniae was the most frequently isolated organism in both groups. The overall in-hospital mortality rate was 34%, and the average length of stay was approximately 20 days, with no significant differences between periods. Despite AMS implementation, colistin resistance prevalence did not decline. Conclusion: While the AMS facilitated better identification and documentation of colistin-resistant infections, it did not significantly reduce their prevalence or associated mortality. Strengthened stewardship measures, continuous compliance monitoring, and alternative therapeutic strategies are needed to curb rising colistin resistance in high-burden settings.
Background:Genital tuberculosis (GTB) is a significant etiological factor of infertility in developing countries such as India; however, it is frequently undiagnosed due to its asymptomatic nature and a lack of standardised protocols. This study aimed to compare the diagnostic efficacy of GeneXpert (CBNAAT) with Ziehl-Neelsen (ZN) staining, Mycobacterial Growth Indicator Tube (MGIT) liquid culture and histopathological examination (HPE). Additionally, the occurrence of GTB in infertile women aged between 18 and 45 years was also determined. Methods:The study comprised 200 infertile women with suspected GTB. Endometrial biopsy samples were collected aseptically and subjected to ZN staining, MGIT liquid culture, GeneXpert testing and HPE and the results were analysed and compared. MGIT was considered the gold standard test in accordance with National TB Elimination Programme (NTEP) recommendations. Results:There were 164 (82%) cases of primary infertility, and 36 (18%) cases of secondary infertility. Out of the 200 samples of endometrial biopsy (EB) specimens, the GeneXpert test detected two positive findings (1%), ZN staining detected two positive results (1%), and MGIT liquid culture as well as HPE detected one positive result (0.5%). GeneXpert demonstrated a sensitivity of 100% (confidence interval (CI) 2.50-100.00%), a specificity of 99.5% (CI 97.23-99.99%), a positive predictive value (PPV) of 50% (CI 12.40-87.60%), and a negative predictive value (NPV) of 100% (CI 98.15-100.00%), with liquid culture as reference. A significant agreement was found between the diagnostic procedures of MGIT and GeneXpert, with a kappa value of 0.66 and a p-value of 0.047 (significant p-value <0.05). Conclusion:The present study is among the few that has utilised GeneXpert to aid in the diagnosis of female genital tuberculosis (FGTB). GeneXpert, being much faster and more feasible than conventional methods such as culture, could be incorporated into the standard evaluation of GTB.
Foodborne campylobacteriosis is the most common cause of bacterial gastroenteritis in Germany. Due to increasing antibiotic resistance in Campylobacter, data of isolates of human origin are published by the European Center for Disease Control and Prevention (ECDC)/European Food Safety Authority (EFSA). However, data on susceptibility to meropenem, an antibiotic of last resort, is not included. Therefore, the minimal inhibitory concentration (MIC) for meropenem was measured in 125 Campylobacter jejuni (Cj) and 57 Campylobacter coli (Cc) isolates isolated from human stool samples between 2020 and 2023, comparing ellipsoid test and broth microdilution. Additionally, we determined the susceptibility of 249 Cj and 84 Cc strains isolated between 2018 and 2023 to erythromycin, ciprofloxacin and oxytetracycline by disk diffusion according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST). For meropenem, the MIC results of 5% Campylobacter isolates were interpreted as resistant. Erythromycin resistance was found in none Cj versus 9 (11%) Cc isolates that were resistant to all three substances. Ciprofloxacin and oxytetracycline resistance were detected in 72 and 41% Cj, and 67 and 70% Cc isolates, respectively. Only 24% Cj and 13% C c isolates were susceptible to all three substances. The dual resistance of ciprofloxacin and oxytetracycline was the most common resistance pattern, observed in 37% Cj and 38% Cc isolates, respectively. None of the isolates was resistant to all four tested substances. Our data underline the need for susceptibility testing of Campylobacter to alternatively used antimicrobial substances in clinical laboratories. The ellipsoid test provides a good alternative for meropenem MIC testing, although borderline isolates should be confirmed using microdilution.
Background: Acute upper respiratory tract infections (URTIs) are frequent causes of medical treatment by general practitioners (GPs). In general, these are viral and self-limiting illnesses, but antibiotics are prescribed. In Germany, fluoroquinolones are not authorised for the indications pharyngitis, laryngitis, tonsillitis and acute bronchitis due to possible serious side effects. This analysis looks at fluoroquinolone prescriptions for URTI by GPs in 2022. Methods: Frequency of fluoroquinolone prescriptions were analysed at case level and regionally using administrative insurance data from the German health insurance company BARMER. We included patients treated in GP practices without relevant concomitant diseases. Results: In 2022, 25% (1,197,568/4,720,786) of insured persons with upper respiratory tract infections (URTI) were prescribed antibiotics. After excluding comorbidities and other risk factors such as previous hospitalisation, the prescription rate for uncomplicated URTIs was calculated to be 6% (80,786/1,365,646). Fluoroquinolones were given in 2.4% of antibiotic prescriptions (1,951/80,786). Nationwide, 3.7% of the GPs prescribed fluoroquinolones, most frequently in the region Brandenburg with 6.6% (74/1,121). Conclusion: This analysis showed that fluoroquinolones are still prescribed for uncomplicated URTI, which must be considered as alarming regarding the nature of the disease and the unfavourable risk-benefit profiles. There were clear regional differences in fluoroquinolone prescribing, indicating potential for improvement in the use of reserve antibiotics for uncomplicated upper respiratory tract infections.
While the majority of Trichosporon spp. isolated in clinical laboratories are typically associated with episodes of colonization or superficial infections, this fungal species has gained recognition as an opportunistic pathogen, leading to invasive infections worldwide. In this article, we present a case series of Trichosporon spp. identified through conventional methods, complemented by MALDI-TOF analysis from a reference institute for a single sample. The reported cases occurred within a confined time frame, and the construction of an epidemic curve suggested a common source with intermittent exposure. Despite the absence of identified breaches in infection prevention and control (IPC) in units with common exposure, this case series underscores the significance of considering Trichosporonosis in the differential diagnoses for post-transplant and chronic kidney disease patients, particularly those undergoing hemodialysis or utilizing Foley's catheter. Notably, research gaps were identified, emphasizing the need for further exploration of factors such as the role of magnesium and prolonged antibiotic usage in the development of invasive Trichosporon infections and newer treatment modalities against biofilm producing yeast like fungi.
The genus , member of the family, comprises over 500 spp. with an ever-evolving taxonomy. These fungi, some highly pathogenic, primarily affect various plants, including major crops like maize, rice, cereals, and potatoes, leading to significant agricultural losses and contributing to human undernutrition in certain regions. Additionally, spp. produce harmful mycotoxins like trichothecenes, fumonisins, zearalenones, etc., posing health risks to animals and humans. These toxins generally transferred to food items can cause diverse issues, including organ failure, cancer, and hormonal disturbances, with effects sometimes appearing years after exposure. The fungi’s vast genetic repertoire enables them to produce a range of virulence factors, leading to infections in both animals and humans, particularly in immunocompromised individuals. spp. can cause systemic infections and local infections like keratitis. Due to limited antifungal effectiveness and biofilm formation, these infections are often challenging to treat with poor outcomes.
is a gram-positive facultative anaerobic agent. It is a human skin colonizer that can be responsible for opportunistic infections in immunocompromised patients. To date, the infections caused by this agent are related to bone, joint, eye, peritoneal dialysis catheters, abscesses or infected vascular grafts. Overall, it has a favorable outcome with good response to vancomycin, teicoplanin or linezolide, and so it has not been considered a concerning pathogenic agent. We present the first case in scientific literature with isolation of in pericardial fluid in the setting of infectious bacterial pericarditis, with an aggressive course and poor evolution.
Background: Mortality is an important indicator for estimating the impact of the COVID-19 pandemic. However, different registrations provide different figures and the question is how to interpret the number of COVID-19 deaths reported. Objective: To study the role of COVID-19 in dying in order to explain the representation of COVID-19 in cause-of-death statistics. Methods: Analysis of all death certificates mentioning COVID-19 in the Dutch cause-of-death registry during the pandemic (n=51,181). The role of COVID-19 as cause of death was studied by the way it was reported on death certificates. A calculation of odds ratios was performed for studying associations between COVID-19 and other reported causes of death.Results: In 24% of the cases COVID-19 was the only cause of death mentioned on a death certificate. In 76% of the cases, one or more other diseases played a role in dying. Three patterns emerged: COVI9 associated with 1. neurodegenerative disorders, 2. chronic respiratory disorders, and 3. metabolic disorders. Of all death certificates mentioning the diseases, COVID-19 was the start of the causal chain leading to death in 45.2% of the cases, while COVID-19 was selected for cause-of-death statistics by special World Health Organization WHO instructions in 93.9% of the cases. Conclusions: Cause-of-death statistics overestimate the role of COVI9 as underlying cause of death. In a majority of the deceased cases, there is an association of COVID-19 with other diseases not captured by cause-of-death statistics reporting (only) one cause of death per deceased. ti-causal approach is needed to evaluate the pandemic and inform health policy.
Uncomplicated cystitis is affecting many women of all ages and has a great impact on the quality of life, especially in women suffering from recurrent, uncomplicated cystitis. By far the most frequent uropathogen, E. coli, may have acquired increasing resistance against a variety of oral antibiotics, which may differ between countries and regions. Therefore, local resistance data are important to be considered. On the other hand, non-antibiotic therapy has also become an option which should be discussed and offered to the patient. In patients suffering from recurrent uncomplicated cystitis, individual risk factors and possible behavioral changes should first be taken into account. Non-antimicrobial prophylactic strategies shown to be successful in well-designed clinical studies are the next options. Long term antibiotic prophylaxis, however, should only be considered as a last option. For some of those patients self-diagnosis and self-treatment may be suitable, e.g. by using a recognized questionnaire.
