Multiresistente gramnegative Erreger (MRGN) stellen in deutschen Krankenhäusern sowie im ambulanten Sektor ein immer größeres Problem dar. Allerdings gibt es zur Prävalenz im außerklinischen Bereich und zu den Risikofaktoren für eine Besiedlung nur wenige Studien. In der durchgeführten Studie wurden die Prävalenz von MRGN bei Bewohnern von stationären Pflegeeinrichtungen in der Region Weimar, Weimarer Land und Jena sowie Risikofaktoren für eine Besiedlung ermittelt. Im Zeitraum von Mai bis August 2019 wurden tiefe rektale Abstriche bei 307 Bewohnern von 13 Einrichtungen entnommen und mikrobiologisch auf das Vorhandensein von multiresistenten gramnegativen Bakterien untersucht. Mithilfe eines standardisierten Fragebogens wurden Bewohnercharakteristika ermittelt und diese auf ihren Einfluss auf die Wahrscheinlichkeit einer Besiedlung analysiert. In 59 Abstrichen wurden multiresistente Erreger nachgewiesen. Es handelte sich dabei fast ausschließlich um Escherichia coli (95 %). Die gewichtete Prävalenz von Extended-Spectrum-Betalaktamase-Bildnern betrug 19,1 % und von 3MRGN mit einer zusätzlichen Resistenz gegen Fluorchinolone 12,3 %. Es wurden keine 4MRGN, Carbapenemresistenzen oder Carbapenemasen festgestellt. Als möglicher Risikofaktor für eine Besiedlung wurde sowohl in der univariablen als auch der multivariablen Analyse das Vorhandensein einer chronischen Wunde identifiziert (OR: 2,66 [95 %-KI: 1,54–4,60]) sowie zusätzlich in der univariablen Analyse die Notwendigkeit eines Rollstuhls und die Unterbringung in einem Doppelzimmer. Die ermittelte Prävalenz deckt sich mit vorherigen deutschen Studien und zeigt, dass die strikte Einhaltung der Basishygiene bei allen Bewohnern von stationären Pflegeeinrichtungen für eine Vermeidung von Übertragungen entscheidend ist.

In 2010, the highest annual number of human Puumala virus (PUUV) infections was reported in Germany since hantavirus surveillance started in 2001. The increase in annual case numbers was especially marked in western Thuringia. We combined results of case-based hantavirus surveillance in humans and serological and molecular investigations in the rodent reservoir to describe the epidemiological situation and to identify the putative outbreak strain. A 5-fold increase in notified hantavirus cases compared to the previous annual maximum was observed in western Thuringia in 2010. Disease incidence varied tremendously within a small geographical area with case patients' places of residence clustering around beech-dominated broad leaf forest patches. Investigations in the rodent reservoir revealed a novel Puumala virus (PUUV) subtype, which is clearly distinct from strains collected in other PUUV endemic regions of Germany. It can be assumed that in regions in western Thuringia where hantavirus cases occurred in 2010 or previous outbreak years, PUUV has been present in the environment for a long time. Further studies are needed to elucidate the population dynamics and hantavirus prevalence of the rodent reservoir and driving ecological factors.

ABSTRACT Candida glabrata has emerged as the second most common etiologic agent, after Candida albicans, of superficial and invasive candidiasis in adults. Strain typing is essential for epidemiological investigation, but easy-to-use and reliable typing methods are still lacking. We report the use of a multilocus microsatellite typing method with a set of eight markers on a panel of 180 strains, including 136 blood isolates from hospitalized patients and 34 digestive tract isolates from nonhospitalized patients. A total of 44 different alleles were observed, generating 87 distinct genotypes. In addition to perfect reproducibility, typing ability, and stability, the method had a discriminatory power calculated at 0.97 when all 8 markers were associated, making it suitable for tracing strains. In addition, it is shown that digestive tract isolates differed from blood culture isolates by exhibiting a higher genotypic diversity associated with different allelic frequencies and preferentially did not group in clonal complexes (CCs). The demonstration of the occurrence of microevolution in digestive strains supports the idea that C. glabrata can be a persistent commensal of the human gut.

Diseases caused by Aspergillus spp. are difficult to diagnose and thus require supplementary serological assays. This is the result of a selective review of the relevant literature with special regard to recent guidelines. In addition to conventional diagnostic tools (radiology, microscopy, culture) the measurement of the following serological markers is recommended, depending on the clinical type of aspergillosis: Invasive and chronic necrotising aspergillosis: Aspergillus-galactomannan antigen. Test format: EIA using the rat MAb EB-A2. Cut-off 0.5 (index). Monitoring of high risk patients: Twice weekly. Aspergillus-IgG (test format EIA) as confirmatory assay after recovery of the leukocyte function under therapy. Aspergilloma: Aspergillus IgG. Test format: EIA. Allergical aspergillosis: Aspergillus IgE. Test format: RAST. Galactomannan antigen detection rates high in the diagnosis of invasive aspergillosis. The evaluation of Aspergillus nucleic acid amplification assays is pending.

Diseases caused by Aspergillus spp. are difficult to diagnose and thus require supplementory serological assays. This is the result of a selective review of the relevant literature with special regard to recent guidelines. In addition to conventional diagnostic tools (radiology, microscopy, culture) the measurement of the following serological markers is recommended, depending on the clinical type of aspergillosis: Invasive and chronic necrotising aspergillosis: Aspergillus-galactomannan antigen. Test format: EIA using the rat MAb EB-A2. Cut-off 0.5 (index). Monitoring of high risk patients: Twice weekly. Aspergillus-IgG (test format EIA) as confirmatory assay after recovery of the leukocyte function under therapy. Aspergilloma: Aspergillus IgG. Test format: EIA. Allergical aspergillosis: Aspergillus IgE. Test format: RAST. Galactomannan antigen detection rates high in the diagnosis of invasive aspergillosis. The evaluation of Aspergillus nucleic acid amplification assays is pending.