Vancomycin-resistant enterococci (VRE) cause many infections in the healthcare context. Knowledge regarding the epidemiology and burden of VRE infections, however, remains fragmented. We aimed to summarize recent studies on VRE epidemiology and outcomes in hospitals, long-term-care facilities (LTCFs) and nursing homes worldwide based on current epidemiological reports. We searched MEDLINE/PubMed, the Cochrane Library, and Web of Science for observational studies, which reported on VRE faecium and faecalis infections in in-patients published between January 2014 and December 2020. Outcomes were incidence, infection rate, mortality, length of stay (LOS), and healthcare costs. We conducted a meta-analysis on mortality (PROSPERO registration number: CRD42020146389). Of 681 identified publications, 57 studies were included in the analysis. Overall quality of evidence was moderate to low. VRE incidence was rarely and heterogeneously reported. VRE infection rate differed highly (1-55%). The meta-analysis showed a higher mortality for VRE faecium bloodstream infections (BSIs) compared with VSE faecium BSIs (risk ratio, RR 1.46; 95% confidence interval (CI) 1.17-1.82). No difference was observed when comparing VRE faecium vs VRE faecalis BSI (RR 1.00, 95% CI 0.52-1.93). LOS was higher in BSIs caused by E. faecium vs E. faecalis. Only three studies reported healthcare costs. In contrast to previous findings, our meta-analysis of included studies indicates that vancomycin resistance independent of VRE species may be associated with a higher mortality. We identified a lack of standardization in reporting outcomes, information regarding healthcare costs, and state-of-the-art microbiological species identification methodology, which may inform the set-up and reporting of future studies. 2023 Published by Elsevier Ltd on behalf of The Healthcare Infection Society.

BACKGROUND Community-acquired pneumonia (CAP) is a major cause of morbidity and mortality, and chronic obstructive pulmonary disease (COPD) is a frequent comorbidity. The bacterial aetiology of CAP-COPD and its possible associations with serum markers and mortality are incompletely understood. OBJECTIVES 1) To assess the bacterial aetiology of CAP only and CAP-COPD, and 2) to study the association between bacterial aetiology, empirical antibiotic treatment, serum markers and mortality. METHODS Of 1288 patients with CAP (57.0% males, age 59.0 years ± 18.5), 262 (20.3%) fulfilled the diagnostic criteria for COPD. Differences between subgroups were investigated using univariate analyses and corrected for multiple comparisons. RESULTS Streptococcus pneumoniae was the most common pathogen (30.8% CAP only vs. 26.0% CAP-COPD, not significant). Haemophilus influenzae was significantly more frequent in CAP-COPD (5.6% CAP only vs. 26.0% CAP-COPD, P < 0.001). The number given adequate empirical antibiotic treatment was comparable (83.3% CAP only vs. 83.6% CAP-COPD, P > 0.05). The CAP-COPD group had worse CURB-65 and partial pressure of arterial oxygen levels than the CAP only group (P < 0.001). Partial pressure of arterial carbon dioxide levels were increased in CAP-COPD patients without pathogen detection (P < 0.001). Short- (P = 0.011) and long-term mortality (P = 0.006) were highest in CAP-COPD without pathogen detection. CONCLUSION It is important to identify COPD patients with CAP. In particular, those without bacterial pathogen detection have more severe CAP and are at higher risk of dying. Better understanding of the aetiology could contribute to improved management and treatment of CAP in COPD patients.

Durchschnittlich die Hälfte aller Patienten auf europäischen Intensivstationen (ICU) erleidet eine Infektion. Auch auf deutschen ICUs sind hierbei sowohl der Anteil multiresistenter Erreger als auch der Verbrauch von Antibiotika in den letzten Jahren angestiegen. Insbesondere die Therapie von Infektionen, die durch multiresistente Erreger verursacht sind, führt neben verlängerten Intensivaufenthalten und erhöhter Sterblichkeit der Patienten zu hohen logistischen und finanziellen Aufwendungen der Krankenhäuser. Hinzu kommt eine nur zögerliche Entwicklung neuer Antibiotika durch die pharmazeutische Industrie sowie zunehmende Lieferschwierigkeiten etablierter Antiinfektiva. Um diesen Herausforderungen Rechnung zu tragen, erschien 2013 die S3-Leitlinie der AWMF zur Sicherung rationaler Antibiotikaanwendung im Krankenhaus. Wir beschreiben einige wesentliche Aspekte des Antibitic Stewardship (ABS) auf der ICU anhand von konkreten Beispielen, wie auf der Anästhesiologischen Intensivstation des Universitätsklinikums Ulm vorgegangen wird.

Ausbruchsereignisse in Perinatalzentren sind häufig. Die Kenntnis der üblichen lokalen Kolonisationsraten mit fakultativ pathogenen Erregern (FPE) soll die Früherkennung ungewöhnlicher FPE-Häufungen ermöglichen.

In den letzten Jahren wurde bundesweit eine stetige Zunahme von 4MRGN beobachtet. Besonders problematisch stellten sich hierbei Klebsiella spp. sowie Acinetobacter spp. mit der Fähigkeit zur Bildung von Carbapenemasen heraus. Diese Erreger führten in Deutschland bereits zu mehreren nosokomialen Ausbrüchen mit erheblichen Erkrankungs- und Todeszahlen. Um eine Häufung von Carbapenemasebildnern frühzeitig zu erkennen, wird in einigen Bundesländern empfohlen – wie auch vom Referenzzentrum für gramnegative Erreger propagiert- den Nachweis von 4MRGN freiwillig an das zuständige Gesundheitsamt zu melden. In Hessen wurde dies bereits verbindlich verankert. So berichten Heudorf et al. über die Meldung von 243 carbapenembildenden MRGN im Zeitraum von 12 Monaten. Nicht alle dieser Patienten wiesen den klassischen Risikofaktor auf, nämlich die Zuverlegung aus einer außereuropäischen Hochrisikoregion. Für Baden-Württemberg gibt es bisher keine Verpflichtung zur Meldung, die freiwillige Information an unser Gesundheitsamt wird aber beispielsweise vom Universitätsklinikum Ulm schon seit einigen Jahren praktiziert. Begrüßenswert wäre aus infektionspräventiver Sicht in einem ersten Schritt die Einführung einer generellen Meldepflicht an das zuständige Gesundheitsamt beim Nachweis von Carbapenemasebildnern sowie die Etablierung eines Aufnahmescreenings für Risikopatienten. In einem weiteren Schritt sollte dann geregelt werden, in welcher Form die Daten von den Gesundheitsämtern an das RKI weitergegeben werden.

OBJECTIVE:The increasing prevalence of multidrug resistant bacteria is a problem in the inpatient care setting, and in the emergency care system. The aim of this observational, cross-sectional study was to evaluate the prevalence of pathogens on well-defined surfaces in German ambulances that have been designated as 'ready for service'.METHODS:After informed consent was obtained, ambulance surfaces were sampled with agar plates for microbiological examination during an unannounced visit. A standardised questionnaire was used to obtain information regarding the disinfection protocols used at each rescue station.RESULTS:Methicillin resistant staphylococcus aureus contamination was present in 18 sampling surfaces from 11 out of 150 ambulance vehicles (7%) that were designated as ready for service. Contact surfaces directly surrounding patients or staff were most frequently contaminated with pathogens. However, bacterial contamination was not related to annual missions, methods or frequency of disinfection.CONCLUSIONS:In accordance with previous studies, disinfection and cleaning of areas with direct contact to patients or staff seem to be the most challenging. This should also be reflected in disinfection guidelines and the related continuing education.

phänotypische Einteilung gramnegativer Stäbchen gemäß der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) am Robert Koch-Institut (RKI)

Reusable surface disinfectant (SD) tissue dispensers are used in hospitals in many countries because they allow immediate access to soaked tissues for targeted surface decontamination.

PURPOSE:In Germany, reliable data about the prevalence of urogenital Chlamydia trachomatis infections, causative genotypes, as well as corresponding clinical, demographic and behavioural information are sparse. We, therefore, performed a prospective prevalence study including 1,003 sexually active volunteers of a Southern German city.METHODS:Study participants completed a standardised questionnaire and provided first void urine samples for analysis. Our screening strategy included the performance of two nucleic acid amplification tests with different target genes, enabling the detection of the new Swedish variant of C. trachomatis (nvCT). Direct genotyping of positive specimens was performed by sequence analysis of the ompA gene.RESULTS AND CONCLUSION:The overall prevalence of C. trachomatis infection was 4.2 % in women and 4.6 % in men. A relatively high prevalence of 8.3 % was found in men older than 25 years. Never using condoms was an independent risk factor for infection. The most common symptom was discharge; however, 64.5 % of infected females and all of the infected men were asymptomatic, supporting the need for screening programmes. The most frequently encountered genotypes were E (46.5 %), F (20.9 %) and K (14.0 %). Since the nvCT was detected in one female student, this is one of the rare studies that reports on the molecular identification of nvCT apart from Sweden.

BACKGROUND:Pneumococcal pneumonia is still an important cause of mortality. The objective of this study was to compare frequency, clinical presentation, outcome and vaccination status of patients with pneumococcal community-acquired pneumonia (CAP) to CAP due to other or no detected pathogen based on data of the German Network for community-acquired pneumonia (CAPNETZ). METHODS:Demographic, clinical and diagnostic data were recorded using standardized web-based data acquisition. Standardized microbiological sampling and work-up were conducted in each patient. RESULTS:7400 patients with CAP from twelve clinical centers throughout Germany were included. In 2259 patients (32 %) a pathogen was identified, Streptococcus pneumonia being the most frequent (n = 676, 30 % of all patients with identified pathogens). Compared to those with non-pneumococcal pneumonia, patients with pneumococcal pneumonia were more frequently admitted to hospital (80 % vs. 66 %, p < 0.001), had higher CURB score values on admission, had more frequently pleural effusion (19 % vs. 14 %, p = 0.001) and needed more frequently oxygen insufflation (58 % vs. 44 %, p < 0.001). There was no relevant difference in overall mortality. CONCLUSIONS:Pneumococcal pneumonia was associated with a more severe clinical course demanding more medical resources as compared to non-pneumococcal pneumonia.

Ende Dezember 2009 Anfang Januar 2010 ereignete sich der bisher größte epidemische Ausbruch von Legionella-bedingten Pneumonien in Deutschland im Raum Ulm/Neu-Ulm. Nach Bekanntwerden der ersten Fälle wurde eine Arbeitsgruppe von lokalen und Landesbehörden gebildet, die die Koordinierung weiteren Untersuchungen übernahm.

Ende Dezember 2009 bis Ende Januar 2010 ereignete sich in Ulm (Baden-Württemberg) und Neu-Ulm (Bayern) der bislang größte Legionellenausbruch in Deutschland. Insgesamt wurden 64 Erkrankungsfälle bekannt. 60 Patienten mussten stationär im Krankenhaus behandelt werden, und fünf Patienten verstarben an der Infektion. Ausgelöst wurde dieses Geschehen durch ein Nassrückkühlwerk einer Großklimaanlage im Stadtzentrum Ulm. Die Quellensuche gestaltetet sich äußerst schwierig, da diese Anlagen in Deutschland grundsätzlich weder anzeige- noch genehmigungspflichtig sind. Wir berichten im vorliegenden Beitrag über die Quellensuche und die getroffenen Maßnahmen sowie die Kommunikation und Koordination während der Ausbruchsuntersuchung. Regulatorische Maßnahmen, wie sie von der Weltgesundheitsorganisation (WHO) und dem Europäischen Netzwerk für Legionellosen (EWGLI) vorgeschlagen und bereits in zahlreichen anderen europäischen Ländern umgesetzt sind, wären wünschenswert, um solchen Ausbrüchen zukünftig vorbeugen zu können.

Pseudomonas aeruginosa Streptococcus pneumoniae Chlamydia pneumoniae Enterobacteriaceae Pseudomonas aeruginosa

Legionella are present in the environment as well as in biofilms of water installation systems. Most Legionella live in amoebae. More than 51 different species of Legionella have been identified; however, most pneumonias are caused by Legionella pneumophila serogroup 1. Legionnaire's disease has an incidence of about 4% in Germany. Most cases of Legionnaire's disease are sporadic. Microbiological identification of Legionella can be achieved by cultivation of Legionella spp. on specific media, performing of Legionella-specific PCR from respiratory samples, or Legionella urinary antigen testing. Patients with severe underlying diseases, patients receiving immunosuppression, and patients who are heavy smokers have a predisposition to Legionnaire's disease. Men are significantly more often affected. Whereas outpatients show a mild clinical course, mortality for hospitalized patients is 11.2%. It can be assumed that only a minority of cases of Legionnaire's disease is recognized and reported in Germany.

Community-acquired pneumonia is a frequent disease. Case-fatality rate and incidence are increasing with age. The German nation-wide competence network CAPNETZ presents reliable data on aetiology and course of the disease, based on more than 9000 prospectively observed patients. This review discusses current CAPNETZ-publication and their impact on daily clinical practice. The most frequent isolated pathogen isolated was STREPTOCOCCUS PNEUMONIAE. According to CAPNETZ results, the importance of atypical pathogens (i. e. Mycoplasma spp., Chlamydia spp., Legionella spp.) may have been overestimated in older studies: CHLAMYDIA PNEUMONIAE (< 1 %) are rarely found, and the most frequent atypical pathogen, Mycoplasma spp., causes only mild disease in younger patients resulting in a very low case-fatality-rate (0.7 %). Only hospitalized patients with legionella infections are at an increased risk to die. Gram-negative ENTEROBACTERIACEAE and PSEUDOMONAS AERUGINOSA are rare, restricted to high-risk patient groups (e. g. mulitmorbidity, enteral tube feeding), but are associated with an increased case-fatality rate.

Legionellen kommen ubiquitär zumeist in Amöben im Biofilm technisierter Wassersysteme vor. Obwohl zwischenzeitlich mehr als 51 Spezies bekannt sind, werden die meisten Erkrankungen durch Legionella pneumophila Serogruppe 1 verursacht. Klinisch am bedeutsamsten ist die ambulant erworbene Legionellenpneumonie mit einer Inzidenz von etwa 4% in Deutschland. Die meisten Legionellenfälle treten sporadisch auf. Die Diagnostik erfolgt durch die Anzucht von Legionellen auf Spezialmedien, den Nachweis von Legionellen-DNA mittels PCR oder den Nachweis des Legionellen-Urin-Antigens. Prädisponiert sind Patienten mit bestimmten Grunderkrankungen oder unter Immunsuppression sowie schwere Raucher. Männer sind häufiger betroffen. Während ambulant führbare Patienten mit Legionellenpneumonie im Allgemeinen einen milden klinischen Verlauf zeigen, liegt die Sterblichkeit bei hospitalisierten Patienten bei 11,2%. Momentan wird in Deutschland nur ein Bruchteil der Legionellosen diagnostiziert und gemeldet.

Between December 2009 and the end of January 2010, the largest hitherto known outbreak of Legionella in Germany took place in the cities of Ulm and Neu-Ulm. Of a total of 64 patients involved, 60 patients had to be hospitalized, and 5 patients died from the infection. This event was caused by a wet cooling tower of a large air conditioning system in the city center of Ulm. The search for the source of the Legionella emission was extremely difficult, since these plants are neither notifiable nor subject to authorization in Germany. We report about the search for the source and the measures to control the outbreak. We also discuss communication and coordination during these investigations. Regulatory measures as proposed by the World Health Organization (WHO) and the European Network for Legionellosis (EWGLI) and already implemented in numerous other European countries would be desirable to prevent such outbreaks in the future.