MRSA in a large German University Hospital: Male gender is a significant risk factor for MRSA acquisition

Background: The continually rising number of hospital acquired infections and particularly MRSA (Methicillin-resistant Staphylococcus aureus) colonization poses a major challenge from both clinical and epidemiological perspectives. The assessment of risk factors is vital in determining the best prevention, diagnosis and treatment strategies

One-day point prevalence of emerging bacterial pathogens in four secondary and five tertiary care German hospitals – results from a pilot study of the German Society for Hospital Hygiene (Deutsche Gesellschaft für Krankenhaushygiene, DGKH)

Objective: Data on the prevalence of emerging bacterial pathogens like extended-spectrum-lactamase-building (ESBL) Gram negative organisms, multiresistant Pseudomonas and Acinetobacter species or toxin-building Clostridium difficile in German hospitals are sparse. To provide data for different regions in Germany, a one-day point prevalence study with five tertiary care hospitals and four secondary care hospitals was conducted on the 10th of February 2010

Infection prevention during anaesthesia ventilation by the use of breathing system filters (BSF): Joint recommendation by German Society of Hospital Hygiene (DGKH) and German Society for Anaesthesiology and Intensive Care (DGAI)

An interdisciplinary working group from the German Society of Hospital Hygiene (DGKH) and the German Society for Anaesthesiology and Intensive Care (DGAI) worked out the following recommendations for infection prevention during anaesthesia by using breathing system filters (BSF). The BSF shall be changed after each patient. The filter retention efficiency for airborne particles is recommended to be >99% (II). The retention performance of BSF for liquids is recommended to be at pressures of at least 60 hPa (=60 mbar) or 20 hPa above the selected maximum ventilation pressure in the anaesthetic system

An epidemic CC1-MRSA-IV clone yields false-negative test results in molecular MRSA identification assays: a note of caution, Austria, Germany, Ireland, 2020

We investigated why a clinical meticillin-resistant Staphylococcus aureus (MRSA) isolate yielded false-negative results with some commercial PCR tests for MRSA detection. We found that an epidemic European CC1-MRSA-IV clone generally exhibits this behaviour. The failure of the assays was attributable to a large insertion in the orfX/SCCmec integration site. To ensure the reliability of molecular MRSA tests, it is vital to monitor emergence of new SCCmec types and junction sites

Molecular typing of ST239-MRSA-III from diverse geographic locations and the evolution of the SCCmec III element during its intercontinental spread

ST239-MRSA-III is probably the oldest truly pandemic MRSA strain, circulating in many countries since the 1970s. It is still frequently isolated in some parts of the world although it has been replaced by other MRSA strains in, e.g., most of Europe. Previous genotyping work (Harris et al., 2010; Castillo-Ramírez et al., 2012) suggested a split in geographically defined clades. In the present study, a collection of 184 ST239-MRSA-III isolates, mainly from countries not covered by the previous studies were characterized using two DNA microarrays (i) targeting an extensive range of typing markers, virulence and resistance genes and (ii) a SCCmec subtyping array. Thirty additional isolates underwent whole-genome sequencing (WGS) and, together with published WGS data for 215 ST239-MRSA-III isolates, were analyzed using in-silico analysis for comparison with the microarray data and with special regard to variation within SCCmec elements. This permitted the assignment of isolates and sequences to 39 different SCCmec III subtypes, and to three major and several minor clades. One clade, characterized by the integration of a transposon into nsaB and by the loss of fnbB and splE was detected among isolates from Turkey, Romania and other Eastern European countries, Russia, Pakistan, and (mainly Northern) China. Another clade, harboring sasX/sesI is widespread in South-East Asia including China/Hong Kong, and surprisingly also in Trinidad & Tobago. A third, related, but sasX/sesI-negative clade occurs not only in Latin America but also in Russia and in the Middle East from where it apparently originated and from where it also was transferred to Ireland. Minor clades exist or existed in Western Europe and Greece, in Portugal, in Australia and New Zealand as well as in the Middle East. Isolates from countries where this strain is not epidemic (such as Germany) frequently are associated with foreign travel and/or hospitalization abroad. The wide dissemination of this strain and the fact that it was able to cause a hospital-borne pandemic that lasted nearly 50 years emphasizes the need for stringent infection prevention and control and admission screening

A Field Guide to Pandemic, Epidemic and Sporadic Clones of Methicillin-Resistant Staphylococcus aureus

In recent years, methicillin-resistant Staphylococcus aureus (MRSA) have become a truly global challenge. In addition to the long-known healthcare-associated clones, novel strains have also emerged outside of the hospital settings, in the community as well as in livestock. The emergence and spread of virulent clones expressing Panton-Valentine leukocidin (PVL) is an additional cause for concern. In order to provide an overview of pandemic, epidemic and sporadic strains, more than 3,000 clinical and veterinary isolates of MRSA mainly from Germany, the United Kingdom, Ireland, France, Malta, Abu Dhabi, Hong Kong, Australia, Trinidad & Tobago as well as some reference strains from the United States have been genotyped by DNA microarray analysis. This technique allowed the assignment of the MRSA isolates to 34 distinct lineages which can be clearly defined based on non-mobile genes. The results were in accordance with data from multilocus sequence typing. More than 100 different strains were distinguished based on affiliation to these lineages, SCCmec type and the presence or absence of PVL. These strains are described here mainly with regard to clinically relevant antimicrobial resistance- and virulence-associated markers, but also in relation to epidemiology and geographic distribution. The findings of the study show a high level of biodiversity among MRSA, especially among strains harbouring SCCmec IV and V elements. The data also indicate a high rate of genetic recombination in MRSA involving SCC elements, bacteriophages or other mobile genetic elements and large-scale chromosomal replacements

A Field Guide to Pandemic, Epidemic and Sporadic Clones of Methicillin-Resistant Staphylococcus aureus

In recent years, methicillin-resistant Staphylococcus aureus (MRSA) have become a truly global challenge. In addition to the long-known healthcare-associated clones, novel strains have also emerged outside of the hospital settings, in the community as well as in livestock. The emergence and spread of virulent clones expressing Panton-Valentine leukocidin (PVL) is an additional cause for concern. In order to provide an overview of pandemic, epidemic and sporadic strains, more than 3,000 clinical and veterinary isolates of MRSA mainly from Germany, the United Kingdom, Ireland, France, Malta, Abu Dhabi, Hong Kong, Australia, Trinidad & Tobago as well as some reference strains from the United States have been genotyped by DNA microarray analysis. This technique allowed the assignment of the MRSA isolates to 34 distinct lineages which can be clearly defined based on non-mobile genes. The results were in accordance with data from multilocus sequence typing. More than 100 different strains were distinguished based on affiliation to these lineages, SCCmec type and the presence or absence of PVL. These strains are described here mainly with regard to clinically relevant antimicrobial resistance- and virulence-associated markers, but also in relation to epidemiology and geographic distribution. The findings of the study show a high level of biodiversity among MRSA, especially among strains harbouring SCCmec IV and V elements. The data also indicate a high rate of genetic recombination in MRSA involving SCC elements, bacteriophages or other mobile genetic elements and large-scale chromosomal replacements

Clonal Replacement of Epidemic Methicillin-Resistant Staphylococcus aureus Strains in a German University Hospital over a Period of Eleven Years

Worldwide, methicillin-resistant Staphylococcus aureus (MRSA) pose an increased risk for healthcare- and communityassociated infections. Since the first report of MRSA in England in 1961, several distinct clones or strains have emerged. Changes within the MRSA population of whole countries, small regions or of single hospitals have been observed with some clones replacing others. In this study, the clonal replacement of MRSA isolates in a South-eastern German tertiary care hospital between 2000 and 2010 is described based on microarray analyses of 778 isolates and at least 50 MRSA per year. Within these eleven years, four common epidemic strains, CC22-MRSA-IV, CC45-MRSA-IV, CC5/ST228-MRSA-I (including a variant with a truncated SCCmec element) and CC5-MRSA-II were identified. The PVL-negative CC22-MRSA-IV strain (Barnim Epidemic Strain, UK-EMRSA-15) was detected for the first time in 2001 and its abundance increased since then to 58.6 % in 2010. CC5-MRSA-II increased from 2 % (2000) to about 30 % (2003), and since then it fluctuates between 23 and 37 % of isolates. CC5/ST228-MRSA-I decreased from about the half of tested isolates (2000) to 2.3 % (2010). A similar trend was observed for CC45-MRSA-IV, which decreased drastically down to 3.4 % in 2010 after reaching a maximum of 62.0 % in 2002. Seventeen other PVL-negative MRSA strains were identified sporadically with no significant trend being observed. Seven PVL-positive MRSA strains were found, but they remained rare during the study period accounting together for 2.7 % o

Evaluierung von OP-Textilien nach hygienischen, ökonomischen und ökologischen Kriterien: Methodische Herangehensweise bei der Evaluierung unter realen praktischen Bedingungen

Der zielgerichtete Einsatz innovativer Operationstextilien ist eine wichtige Maßnahme zur perioperativen Infektionsprophylaxe. Operationsmäntel und -abdecktücher sind den Bereichen Mehrweg- und Einwegprodukte zuzuordnen, mit deren Nutzung ein entsprechender Ressourcenverbrauch sowie Schadstoffbelastung verbunden sind. Den Anwendern ist die Auswahl kostengünstiger und umweltfreundlicher Produkte, gleiche Funktionalität vorausgesetzt, zurzeit nicht möglich, da Operationstextilien bislang in dieser Ganzheitlichkeit noch nicht betrachtet und untersucht worden sind. Das interdisziplinäre Verbundvorhaben befasst sich deshalb mit der ganzheitlichen Evaluierung innovativer Operationstextilien unter realen Praxisbedingungen nach funktionalen, hygienischen sowie ökologisch und ökonomischen Aspekten im Verlaufe ihres Lebenszyklus. Das Verbundvorhaben wird in 4 Teilprojekten mit folgenden wissenschaftlichen Zielstellungen bearbeitet: - Entwicklung einer Methode zur ganzheitlichen Evaluierung von OP-Textilien - Bewertung der Barrierewirkung von OP-Textilien hinsichtlich ihrer Struktur-Eigenschafts-Beziehungen in Abhängigkeit von den Nutzungszyklen - Bewertung der Barrierewirkung von OP-Textilien hinsichtlich ihrer Qualität und Konformität in Abhängigkeit von den Nutzungszyklen - Mikrobiologische und physikalische Untersuchungen zum Einfluss der Struktur von Operationstextilien auf deren Dampfsterilisation unter Praxisbedingungen - Ökonomische und ökologische Aspekte beim Erhalt der Barrierewirkung - Verknüpfung der funktionalen, ökonomischen und ökologischen Bewertungen zur Erstellung von Entscheidungsinstrumenten für den indikationsgerechten Einsatz von OP-Textilien.The specific use of innovative O.R. textiles is an important measure for the perioperative infection prophylaxis. Surgical gowns and drapes are available as single-use and re-usable products. Their use is connected with the corresponding consumption of resources and environmental pollution. At present, the selection of cost-saving and environmental-friendly products with a high level of protection is not possible, because O.R. textiles have not been integral investigated up to now. Hence, the interdisciplinary project is dealing with the holistic evaluation of O.R. textiles according to hygienic, ecological and economic criteria during their life cycle influenced by real conditions in practice. The integrated project consists of 4 sub projects with the following scientific objectives: - developing of a method for the holistic evaluation of O.R. textiles - assessment of the barrier effect of the O.R. textiles in reference to the structure-properties-relations depending on the use cycles - assessment of the barrier effect of the O.R. textiles in reference to the quality and conformity depending on the use cycle - microbiological and physical investigations regarding to the influence of the structure of the O.R. textiles on the steam sterilisation in practice - ecological and economic assessment of reprocessing and preservation of the barrier function depending on the use cycles

Evaluierung von OP-Textilien nach hygienischen, ökonomischen und ökologischen Kriterien: Methodische Herangehensweise bei der Evaluierung unter realen praktischen Bedingungen

Der zielgerichtete Einsatz innovativer Operationstextilien ist eine wichtige Maßnahme zur perioperativen Infektionsprophylaxe. Operationsmäntel und -abdecktücher sind den Bereichen Mehrweg- und Einwegprodukte zuzuordnen, mit deren Nutzung ein entsprechender Ressourcenverbrauch sowie Schadstoffbelastung verbunden sind. Den Anwendern ist die Auswahl kostengünstiger und umweltfreundlicher Produkte, gleiche Funktionalität vorausgesetzt, zurzeit nicht möglich, da Operationstextilien bislang in dieser Ganzheitlichkeit noch nicht betrachtet und untersucht worden sind. Das interdisziplinäre Verbundvorhaben befasst sich deshalb mit der ganzheitlichen Evaluierung innovativer Operationstextilien unter realen Praxisbedingungen nach funktionalen, hygienischen sowie ökologisch und ökonomischen Aspekten im Verlaufe ihres Lebenszyklus. Das Verbundvorhaben wird in 4 Teilprojekten mit folgenden wissenschaftlichen Zielstellungen bearbeitet: - Entwicklung einer Methode zur ganzheitlichen Evaluierung von OP-Textilien - Bewertung der Barrierewirkung von OP-Textilien hinsichtlich ihrer Struktur-Eigenschafts-Beziehungen in Abhängigkeit von den Nutzungszyklen - Bewertung der Barrierewirkung von OP-Textilien hinsichtlich ihrer Qualität und Konformität in Abhängigkeit von den Nutzungszyklen - Mikrobiologische und physikalische Untersuchungen zum Einfluss der Struktur von Operationstextilien auf deren Dampfsterilisation unter Praxisbedingungen - Ökonomische und ökologische Aspekte beim Erhalt der Barrierewirkung - Verknüpfung der funktionalen, ökonomischen und ökologischen Bewertungen zur Erstellung von Entscheidungsinstrumenten für den indikationsgerechten Einsatz von OP-Textilien.The specific use of innovative O.R. textiles is an important measure for the perioperative infection prophylaxis. Surgical gowns and drapes are available as single-use and re-usable products. Their use is connected with the corresponding consumption of resources and environmental pollution. At present, the selection of cost-saving and environmental-friendly products with a high level of protection is not possible, because O.R. textiles have not been integral investigated up to now. Hence, the interdisciplinary project is dealing with the holistic evaluation of O.R. textiles according to hygienic, ecological and economic criteria during their life cycle influenced by real conditions in practice. The integrated project consists of 4 sub projects with the following scientific objectives: - developing of a method for the holistic evaluation of O.R. textiles - assessment of the barrier effect of the O.R. textiles in reference to the structure-properties-relations depending on the use cycles - assessment of the barrier effect of the O.R. textiles in reference to the quality and conformity depending on the use cycle - microbiological and physical investigations regarding to the influence of the structure of the O.R. textiles on the steam sterilisation in practice - ecological and economic assessment of reprocessing and preservation of the barrier function depending on the use cycles