Bartonella schoenbuchensis is suspected to cause deer ked dermatitis and febrile diseases in humans. Deer keds (Lipoptena cervi), which infest cervids (e.g., roe deer, fallow deer), are discussed as potential vectors for B. schoenbuchensis. We analyzed the seroprevalence of anti-B. schoenbuchensis immunoglobulin G (IgG) antibodies in sera of forest workers (FW; n = 82) compared to control sera of non-forest workers (NFW; n = 118) from North Rhine-Westphalia, Germany. For this purpose, an immunofluorescence assay (IFA) using Vero E6 cells infected with B. schoenbuchensis was established, and serum titers were assessed. Whole cell lysate of B. schoenbuchensis was introduced for analysis of seroreactivity by western blotting. Immunodominant proteins were identified by liquid chromatography–tandem mass spectrometry. When using human sera, 54.9

Liver cirrhosis is a major global health burden, with acute-on-chronic liver failure (ACLF) being a severe complication associated with high mortality. Systemic inflammation (SI) plays a crucial role in ACLF development, yet indicators for predicting disease progression remain limited. Enterococcus faecium (EF) has been implicated in bacterial translocation and SI, but its clinical relevance in ACLF remains unclear. We analyzed sera of 197 patients from a prospective observational study with acutely decompensated liver cirrhosis versus 234 healthy controls for the presence of EF DNA using RT-qPCR and cytokine analysis of serum samples. Overall, EF DNA was detected in 26% (n = 51, p = 0.001) of the patients, and only in 1.28% (n = 3, p = 0.001) in the control cohort. The positive patient samples were distributed as follows: 12% of patients were with stable decompensated cirrhosis (SDC), 5% of patients were with unstable decompensated cirrhosis (UDC) and 10% in patients were with ACLF. In the latter group, EF positivity significantly correlated with significant elevated leukocyte counts, increased C-reactive protein (CRP), Interleukin-6, and increased bilirubin, Aspartate Aminotransferase (AST), as well as creatinine levels. These findings suggest that the translocation of EF or its DNA, into the systemic circulation may reflect increased intestinal permeability, which is thought to be a key driver of SI and subsequent organ failure in ACLF. Taken together, our findings demonstrate that the presence of EF DNA in serum may contribute to the pathophysiological cascade of ACLF by promoting SI and organ dysfunction, particularly affecting renal function. We therefore propose and hypothesize that the presence of EF DNA in patients’ serum could serve as an indicator of intestinal barrier dysfunction and further underscores the critical role of the gut-liver axis in the development and progression of ACLF.

Background/Objectives: Appendicitis caused by multi-drug-resistant pathogens is associated with significant postoperative morbidity. However, prospective data on the microbial spectrum and its clinical impact remain limited. Methods: Adults with acute appendicitis undergoing surgery between April 2022 and July 2023 were prospectively enrolled at a single university-affiliated institution. Bacterial cultures from appendiceal and rectal swabs were analyzed, and clinical outcomes were assessed. A telephone follow-up was conducted 30 days postoperatively. Results: A total of 105 patients were included. Multi-drug-resistant pathogens were identified in the appendiceal swabs of twenty-nine patients (27.6%), while six patients (5.7%) harbored multi-drug-resistant organisms (MDROs; according to the criteria of the CDC). Rectal swabs revealed MDROs in 11.4% of cases but showed a limited correlation with appendiceal samples, indicating that rectal colonization does not reliably predict the presence of MDROs in appendicitis. Patients with multi-drug-resistant infections had significantly higher postoperative complication rates (31% vs. 10.5%, p = 0.017), including more Clavien–Dindo grade 3 complications (17.2% vs. 2.6%, p = 0.007) and abdominal abscesses (10.3% vs. 1.3%, p = 0.03). These patients required more frequent postoperative antibiotic treatment (65.5% vs. 40.8%, p = 0.03) and therapy adjustments (37.9% vs. 15.8%, p = 0.02). Hospital stays were also prolonged in the multi-drug-resistant group (a median of 4 days and IQR of 5 days vs. a median of 3 days and IQR of 3 days; p = 0.03). Conclusions: Colonization with multi-drug-resistant pathogens in appendicitis is associated with worse clinical outcomes. The intraoperative microbiological analysis of appendiceal swabs in complicated cases may enable targeted antibiotic therapy, potentially shortening hospital stays, optimizing patient management and reducing healthcare costs.

Background/Objectives: Infections with antibiotic-resistant Gram-negative pathogens represent a major global threat to public health. Acinetobacter baumannii is a highly important nosocomial pathogen causing severe and life-threatening infections, like pneumonia, wound infections, or sepsis. It is often resistant even against last-resort antibiotics, such as carbapenems, and can persist in healthcare settings. Artilysin®s are a novel class of endolysins targeted against multidrug-resistant bacteria. Methods: Antibacterial activity of Art-Top3 was determined by broth microdilution, in vitro assays and in the Galleria mellonella infection model. The toxicity of Art-Top3 on red blood cells, endothelial and epithelial cells was analyzed using the MTT assay. Results: Here, we report on a new Artilysin® Art-Top3 that is active against A. baumannii and led to a 105-fold reduction in viable A. baumannii after five minutes of exposure. Art-Top3 showed activity against A. baumannii biofilms in static and dynamic experimental infection models. Furthermore, upon infection with carbapenem-resistant A. baumannii patient isolates, Art-Top3 was able to rescue human primary cells in vitro and larvae of Galleria mellonella in an in vivo infection model. Art-Top3 did not lyse human red blood cells and showed activity in human serum, indicating a low toxicity and high stability of Art-Top3 in vitro. Conclusion: Our findings collectively establish that Art-Top3 might be a candidate for novel therapeutic strategies of infections caused by multidrug-resistant A. baumannii pathogens.

Serodiagnosis of Bartonella infections predominantly relies on immunofluorescence assays (IFA) utilizing antigen preparations derived from bacteria co-cultivated with host cells. We compared the diagnostic performances of whole-cell Bartonella henselae and Bartonella quintana antigens generated in liquid culture with those from cell culture. IFA using liquid culture-derived B. henselae antigens yielded lower IgG antibody titers, and no consistent correlation in IgG titers was observed for B. quintana. We conclude that liquid-cultured Bartonella antigens are inferior to those used in commercially available diagnostics.IMPORTANCEIn this study, we compare the diagnostic performances of Bartonella henselae and Bartonella quintana antigens cultivated in liquid medium with those of antigens derived from cell culture for use in IFA of patient sera. Our results demonstrate that liquid-cultured Bartonella antigens for IFA are less reliable and may lead to false or missed diagnoses. This highlights the importance of using validated, high-quality antigens to ensure accurate and trustworthy results in clinical practice.

Bloodstream infections (BSI) due to Candida spp. significantly contribute to morbidity and mortality among cancer patients. Understanding their clinical course, risk factors, and outcomes compared to bacterial BSI is essential. We aim to elucidate the epidemiology and risk factors associated with Candida BSI compared to bacterial BSI in cancer patients. We analyzed epidemiological data of Candida BSI versus bacterial BSI among cancer patients, primarily with hematological malignancies. Blood cultures were obtained upon clinical suspicion, with species identification by VITEK 2 and MALDI-TOF. Susceptibility testing utilized VITEK 2 or antibiotic gradient tests. Candida BSI was associated with higher 30-day mortality compared to bacterial BSI (Hazard ratio (HR) 4.5, 95

Introduction. Infectious gastroenteritis is a common reason for consulting a physician. Although most cases of gastrointestinal illness are self-limiting, the identification of the etiologic pathogen by stool specimen analysis is important in cases of more severe illness and for epidemiological reasons. Due to the broad range of causative pathogens, the conventional examination of a stool specimen is labour-intensive and usually requires different diagnostic methods. Multiplex PCR tests [e.g. BioFire Gastrointestinal (GI) Panel] allow the rapid detecting of up to 22 pathogens in one test. Hypothesis. Using a multiplex PCR panel to test stool specimens for infectious gastroenteritis pathogens can improve the detection rate, reduce the time-to-result and hands-on time and lower the costs of a microbiology laboratory. Aim. This study was aimed at evaluating the detection rate, the workflow and associated costs of stool specimen management using the BioFire GI Panel versus conventional methods. Methodology. Stool specimens were evaluated prospectively during the routine operation. Pathogen detection rate, hands-on time, time-to-result and material and personnel costs were determined for the BioFire GI Panel and conventional methods—the latter based on physician request and excluding viral testing. Results. Analysing 333 specimens collected between 2019 and 2020, the detection rate of enteropathogens was significantly higher with a positivity rate of 39.9 % using the multiplex PCR panel compared with 15.0 % using the conventional methods. The BioFire GI Panel presented results in a median time of 2.2 h compared with 77.5 h for culture and 22.1 h for antigen testing, noting that no tests were performed at weekends except for toxinogenic Clostridioides difficile . Based on list prices, the BioFire GI Panel was nine times more expensive compared with conventional methods, whereas hands-on-time was significantly lower using the BioFire GI Panel. Conclusion. Multiplex PCR panels are valuable tools for laboratory identification of infectious agents causing diarrhoea. The higher costs of such a multiplex PCR panel might be outweighed by the higher detection rate, ease of handling, rapid results and most likely improved patient management. However, these panels do not provide information on antimicrobial susceptibility testing. Therefore, if this is necessary for targeted therapy or if outbreak monitoring and control is required, specimens must still be cultured.

Background Cats are the primary reservoirs of the bacterium Bartonella henselae , the main cause of cat-scratch disease in humans. The main vector of the bacterium is the cat flea, Ctenocephalides felis . In southeastern Europe, data are lacking on the prevalence of B. henselae infection in cats, the strains of B. henselae involved and the risk factors associated with the infection. Methods Blood samples collected in ethylenediaminetetraacetic acid-containing tubes from 189 domestic cats (156 pet cats and 33 stray cats) from Zagreb, the capital city of Croatia, and 10 counties throughout Croatia were cultured for Bartonella spp. Following culture, bacterial isolates were genotyped at eight loci after using PCR to amplify 16S ribosomal RNA (rRNA) and the internal transcribed spacer region between the 16S and 23S rRNA sequences. Univariate and multivariate logistic regression were used to identify risk factors for B. henselae infection in cats. Results Bartonella spp. was detected in 31 cats (16.4%), and subsequent genotyping at the eight loci revealed B. henselae in all cases. Thirty complete multilocus sequence typing profiles were obtained, and the strains were identified as four sequence types that had been previously reported, namely ST5 (56.7%), ST6 (23.3%), ST1 (13.3%) and ST24 (3.3%), as well as a novel sequence type, ST33 (3.3%). The univariate analysis revealed a significantly higher risk of B. henselae infection in cats residing in coastal areas of Croatia (odds ratio [OR] 2.592, 95% confidence interval [CI] 1.150–5.838; P = 0.0191) and in cats with intestinal parasites (OR 3.207, 95% CI 1.088–9.457; P = 0.0279); a significantly lower risk was identified in cats aged > 1 year (OR 0.356, 95% CI 0.161–0.787; P = 0.0247) and in cats sampled between April and September (OR 0.325, 95% CI 0.147–0.715; P = 0.005). The multivariate analysis that controlled for age showed a positive association with the presence of intestinal parasites (OR 4.241, 95% CI 1.243–14.470; P = 0.0119) and coastal residence (OR 2.567, 95% CI 1.114–5.915; P = 0.0216) implying increased risk of infection, and a negative association with sampling between April and September (OR 0.379, 95% CI 0.169–0.848; P = 0.018) implying a decreased risk of infection. After controlling for the season, an increased risk of infection remained for the coastal region (OR 2.725, 95% CI 1.200–6.186; P = 0.012). Conclusions Bartonella henselae is prevalent throughout Croatia and is a public health threat. Environmental and host factors can significantly affect the risk of infection, and these should be explored in more detail. The presence of intestinal parasites highlights the need to eliminate the flea vector, Ctenocephalides felis , as the most effective approach to control infections in cats and humans. Graphical Abstract

Gram-negative bacterium Acinetobacter sp. Tol 5 exhibits high adhesiveness to various surfaces of general materials, from hydrophobic plastics to hydrophilic glass and metals, via AtaA, an Acinetobacter trimeric autotransporter adhesin Although the adhesion of Tol 5 is nonspecific, Tol 5 cells may have prefer materials for adhesion. Here, we examined the adhesion of Tol 5 and other bacteria expressing different TAAs to various materials, including antiadhesive surfaces. The results highlighted the stickiness of Tol 5 through the action of AtaA, which enabled Tol 5 cells to adhere even to antiadhesive materials, including polytetrafluoroethylene with a low surface free energy, a hydrophilic polymer brush with steric hindrance, and mica with an ultrasmooth surface. Single-cell force spectroscopy as an atomic force microscopy technique revealed the strong cell adhesion force of Tol 5 to these antiadhesive materials. Nevertheless, Tol 5 cells showed a weak adhesion force toward a zwitterionic 2-methacryloyloxyethyl-phosphorylcholine (MPC) polymer-coated surface. Dynamic flow chamber experiments revealed that Tol 5 cells, once attached to the MPC polymer-coated surface, were exfoliated by weak shear stress. The underlying adhesive mechanism was presumed to involve exchangeable, weakly bound water molecules. Our results will contribute to the understanding and control of cell adhesion of Tol 5 for immobilized bioprocess applications and other TAA-expressing pathogenic bacteria of medical importance.

Bartonella schoenbuchensis causes bacteremia in ruminants and is transmitted by deer keds. Here, we report the complete genome sequences of three B. schoenbuchensis strains (L2, L19, and L24) recently isolated from deer keds (Lipoptena fortisetosa) in Czechia.

Acinetobacter baumannii is a pathogenic and multidrug-resistant Gram-negative bacterium that causes severe nosocomial infections. To better understand the mechanism of pathogenesis, we compare the proteomes of uninfected and infected human cells, revealing that transcription factor FOS is the host protein most strongly induced by A. baumannii infection. Pharmacological inhibition of FOS reduces the cytotoxicity of A. baumannii in cell-based models, and similar results are also observed in a mouse infection model. A. baumannii outer membrane vesicles (OMVs) are shown to activate the aryl hydrocarbon receptor (AHR) of host cells by inducing the host enzyme tryptophan-2,3-dioxygenase (TDO), producing the ligand kynurenine, which binds AHR. Following ligand binding, AHR is a direct transcriptional activator of the FOS gene. We propose that A. baumannii infection impacts the host tryptophan metabolism and promotes AHR- and FOS-mediated cytotoxicity of infected cells.

This work presents a ready-to use dry culture device platform for differentiation of bacterial species and testing antibiotic susceptibility conveniently. The study demonstrates that high-volume and scalable production methods such as can reliably manufacture such devices for reproducible in vitro diagnostic testing. This marks a significant advancement compared to similar handmade devices in the literature.Two types of ready-to-use (RTU) devices were produced through printing. One device differentiates bacterial species from urine samples for rapid diagnosis of urinary tract infections (UTI), while the other determines the minimum inhibitory concentration (MIC) of antibiotics against specific bacterial species. The results show performance comparable to standard tests in clinical microbiological laboratories. The differentiation of bacterial species from four UTI samples matched the efficacy of commercial UTI agar plates utilizing chromogenic substrates. The MIC determination for seven bacterial species in three independent tests yielded categorical results consistent with MIC test strips on agar plates as reference standard. Minor errors occurred in 14 % and major errors in 5 % of the tests. No major errors occurred and in 81 % of all tests results were correct and consistent with the reference method.

Summary Background Patients with cirrhosis are susceptible to develop bacterial infections that trigger acute decompensation (AD) and acute‐on‐chronic liver failure (ACLF). Infections with multidrug‐resistant organisms (MDRO) are associated with deleterious outcome. MDRO colonisation frequently proceeds MDRO infections and antibiotic therapy has been associated with MDRO colonisation. Aim The aim of the study was to assess the influence of non‐antibiotic medication contributing to MDRO colonisation. Methods Three hundred twenty‐four patients with AD and ACLF admitted to the ICU of Frankfurt University Hospital with MDRO screening were included. Regression models were performed to identify drugs associated with MDRO colonisation. Another cohort ( n = 129) from Barcelona was included to validate. A third multi‐centre cohort ( n = 203) with metagenomic sequencing data of stool was included to detect antibiotic resistance genes. Results A total of 97 patients (30%) were identified to have MDRO colonisation and 35 of them (11%) developed MDRO infection. Patients with MDRO colonisation had significantly higher risk of MDRO infection than those without ( p = 0.0098). Apart from antibiotic therapy (odds ratio (OR) 2.91, 95%‐confidence interval (CI) 1.82–4.93, p < 0.0001), terlipressin therapy in the previous 14 days was the only independent covariate associated with MDRO colonisation in both cohorts, the overall (OR 9.47, 95%‐CI 2.96–30.23, p < 0.0001) and after propensity score matching (OR 5.30, 95%‐CI 1.22–23.03, p = 0.011). In the second cohort, prior terlipressin therapy was a risk factor for MDRO colonisation (OR 2.49, 95% CI 0.911–6.823, p = 0.075) and associated with risk of MDRO infection during follow‐up ( p = 0.017). The validation cohort demonstrated that antibiotic inactivation genes were significantly associated with terlipressin administration ( p = 0.001). Conclusions Our study reports an increased risk of MDRO colonisation in patients with AD or ACLF, who recently received terlipressin therapy, while other commonly prescribed non‐antibiotic co‐medications had negligible influence. Future prospective trials are needed to confirm these results.

INTRODUCTION: International guidelines suggest different possibilities for drying of endoscopes during reprocessing. Clinical results of these available drying methods are not satisfactory. The aim of this study was to compare the drying cycle of a standard endoscope washer-disinfector (EWD) (standard drying method [SD]) with a shortened mandatory drying by the EWD followed by a special drying device using laminar and turbulent air flow (novel drying method [ND]). METHODS: Sixty endoscopes (duodenoscopes, colonoscocopes, and gastroscopes) from 3 different manufacturers underwent high-level disinfection and drying depending on the randomization group. Operational time of drying was measured for both groups. Residual fluid in the channels was measured using a laboratory scale. After a 14-day storage period, a sample of the endoscope channels was obtained to determine bacterial contamination. RESULTS: ND had significantly fewer residual water in endoscope channels (SD: 90% vs ND: 0%; P < 0.001) after high-level disinfection and drying and less bacterial contamination after storage for 14 days (SD: 47% vs ND: 20%; P = 0.028). Time consumed for drying in ND was also significantly shorter (SD: 16 minutes 4 seconds vs ND: 5 minutes 59 seconds; P < 0.001). DISCUSSION: Drying with a special automatic drying device was superior compared with an EWD's drying program as evidenced by no measurable residual water, reduced microbiological contamination, and a more than 2-fold decrease in operational time. Thus, drying by laminar and turbulent airflow may represent an attractive alternative to the currently used standard approach in the reprocessing process of flexible endoscopes.

Outpatient parenteral antimicrobial therapy (OPAT) is a cost-effective method of administering intravenous antimicrobial therapy. Although OPAT is well established in the UK and US healthcare systems, few centres in Europe perform it. Here we analysed OPAT for the treatment of patients with spinal infections at our institution. In this retrospective study, patients with spinal infection who required intravenous (i.v.) antimicrobial treatment between 2018 and 2021 were analysed. The duration of short-term antimicrobial treatment for skin and soft tissue infections and complex infections requiring long-term antimicrobial treatment, such as spinal bone or joint infections, were analysed. All patients were discharged with a peripherally inserted central catheter (PICC) line. Prior to discharge, all patients received training in the safe administration of their medications via the PICC line. The duration of OPAT and the rate of readmission after OPAT were analysed. For this study a total of 52 patients who were treated via OPAT due to spinal infections were analyzed. In 35 cases (69.2%) complex spinal infection was reason for i.v. antimicrobial therapy. Surgery was required in 23 of these 35 patients (65.7%). The average hospital stay for these patients was 12 ± 6 days. The remaining 17 patients were treated for an infection of the soft tissue or the skin and hospital stay for these patients was on average 8 ± 4 days. Gram-positive organisms were isolated in 64.4%. Staphylococcus aureus followed by other Staphylococcus species, was the most common detected organism. After discharging i.v. antimicrobial treatment was given for an average of 20 ± 14 days. The duration of antimicrobial treatment for soft tissue was 10.8 ± 8 days, and for complex infections 25.1 ± 18 days. The mean follow-up was 21 ± 14 months. There was one case of readmission due to treatment failure. There were no difficulties encountered in implementing OPAT. OPAT is a feasible and effective option for delivering intravenous antimicrobial therapy to patients with spinal infections who can be managed without hospitalisation. OPAT offers patient-centred treatment at home while avoiding the risks associated with hospitalisation, with high levels of patient satisfaction.

Congenital toxoplasmosis can be associated with serious clinical consequences from fetus to adulthood. Hence, early detection is required to minimize severe sequelae through appropriate therapy. We describe the first case of a congenital toxoplasmosis after maternal coinfection with Toxoplasma gondii and severe acute respiratory syndrome coronavirus 2 and the challenging serological diagnosis of the disease in this context. A Caucasian boy was born at 27 weeks 2 days of gestation by cesarean section due to maternal COVID-19-related respiratory failure. Postpartum serological screening of the mother revealed a previously unrecognized active Toxoplasma gondii infection. The premature child initially tested negative for anti- Toxoplasma gondii immunoglobulin A and M antibodies 1, 2 and 4 weeks after birth, whereas immunoglobulin G antibodies were only weakly positive with no evidence of child-specific production. Neither neurological nor ophthalmological abnormalities were detected. Approximately 3 months after birth, serological testing indicated a congenital toxoplasmosis by presence of immunoglobulin A and M, in combination with a child-specific immunoglobulin G synthesis. Additionally, cerebrospinal fluid was tested positive for Toxoplasma gondii DNA. Although no clinical manifestations of congenital toxoplasmosis were detected, an antiparasitic therapy was initiated to minimize the risk of late sequelae. There were no hints for a transplacental transmission of severe acute respiratory syndrome coronavirus 2. This case raises the awareness of possible coinfections with the risk of transplacental transmission in cases of maternal coronavirus disease 2019. The report emphasizes the need for screening vulnerable patients for toxoplasmosis in general and especially in the context of pregnancy. It becomes evident that prematurity can complicate the serological diagnosis of congenital toxoplasmosis due to a delayed antibody response. Repeated testing is recommended to carefully monitor children at risk and especially those with a history of preterm birth.

While microorganisms have evolved to adhere and form biofilms on surfaces, many materials with antiadhesive surfaces have been developed. The Gram-negative bacterium Acinetobacter sp. Tol 5 exhibits high adhesiveness to various surfaces of general materials, from hydrophobic plastics to hydrophilic glasses and metals, via AtaA, an Acinetobacter trimeric autotransporter adhesin (TAA). However, efficient antiadhesive surfaces should prevent the adhesion of Tol 5. Here, we examined the adhesion of Tol 5 and other bacteria expressing different TAAs to antiadhesive surfaces. The results highlighted the stickiness of Tol 5 through the action of AtaA, which enabled Tol 5 cells to adhere even to antiadhesive materials, including polytetrafluoroethylene with a low surface free energy, a hydrophilic polymer brush exerting steric hindrance, and mica with an ultrasmooth surface. Single-cell force spectroscopy as an atomic force microscopy technique revealed the strong cell adhesion force of Tol 5 to these antiadhesive materials. Nevertheless, Tol 5 cells showed a weak adhesion force toward a zwitterionic 2-methacryloyloxyethyl-phosphorylcholine (MPC) polymer-coated surface. Dynamic flow cell experiments revealed that Tol 5 cells, once attached to the MPC polymer-coated surface, were exfoliated by weak shear stress. The underlying adhesive mechanism was presumed to involve exchangeable, weakly bound water molecules, suggesting that a perfect antiadhesive surface needs to possess a high free water fraction.

BACKGROUND:Within the scope of an educational improvement project, the teaching concept of the course hygiene and microbiology at the Goethe-University in Frankfurt was transferred from an organ system-based teaching concept into a case-based teaching concept. Concomitantly, this transformation was qualitatively reviewed to evaluate self-perceived learning success.METHODS:54 participants were included in this qualitative study. 45 students were interviewed in homogeneous focus groups of up to five. Nine physicians were interviewed individually. Following anonymization and transcription, a structured and qualitative text analysis was conducted.RESULTS:Both groups, students and physicians, prefer a case-based teaching concept in hygiene and microbiology, especially in combination with a hands-on approach to learn practical skills. Students taught with the case-based approach were more satisfied and reported better knowledge retention. The practical elements of the course hygiene and microbiology were positively remembered by all participants. Regardless of the teaching concept, the individual lecturer is considered most essential in shaping motivation.CONCLUSIONS:Overall, the implementation of a case-based teaching concept with practical elements in the course hygiene and microbiology increases the ability of medical students to understand the relevance of core knowledge and improves self-perceived learning. The fusion of theoretical and clinical contents elements in the course hygiene and microbiology meets the new national medical licensing regulations in Germany and promises to be a sustainable concept for clinical-theoretical subjects like hygiene and microbiology.

Human lice, Pediculus humanus, can transmit various pathogens, including Bartonella quintana, Borrelia recurrentis, and Rickettsia prowazekii. Xenosurveillance is an epidemiological approach to assessing human infection risks performed by screening vectors of infectious disease agents. In the proof-of-principle study reported herein, the DNA of 23 human lice was collected from the clothes of 30 homeless Ethiopian individuals. These samples were assessed using 16S rRNA gene-specific pan-eubacterial PCR for screening, followed by Bartonella genus 16S-23S internal transcribed spacer (ITS) sequence-specific PCR, Bartonella genus gltA gene-specific PCR, and 16S rRNA gene PCR with specificity for relapsing-fever-associated Borrelia spp. with subsequent sequencing of the amplicons. In one sample, the pan-eubacterial 16S rRNA gene-specific screening PCR, the Bartonella genus 16S-23S ITS sequence-specific PCR, and the Bartonella genus gltA gene-specific PCR allowed for the sequencing of B. quintana-specific amplicons. In two additional samples, Bartonella genus gltA gene-specific PCR also provided sequences showing 100% sequence identity with B. quintana. In total, 3/23 (13.0%) of the assessed lice were found to be positive for B. quintana. Correlating clinical data were not available; however, the assessment confirmed the presence of B. quintana in the local louse population and thus an associated infection pressure. Larger-sized cross-sectional studies seem advisable to more reliably quantify the infection risk of lice-infested local individuals. The need for prevention by providing opportunities to maintain standard hygiene for Ethiopian homeless individuals is stressed by the reported findings, especially in light of the ongoing migration of refugees.

Einleitung Patienten mit Leberzirrhose haben ein hohes Risiko bakterielle Infektionen zu entwickeln – ein häufiger Trigger für eine akute Dekompensation (AD) und die Entwicklung eines akut-auf-chronischen Leberversagens (ACLF). Infektionen mit multiresistenten Erregern (MRE) führen zu einer erhöhten Mortalität und finden sich häufig bei Patienten mit MRE-Kolonisation.