Der indikationsgerechte Einsatz von medizinischen Einmalhandschuhen in der Krankenversorgung: Gibt es hier Handlungsbedarf

Der von der Weltgesundheitsorganisation initiierte „Internationale Tag der Händehygiene“ soll alljährlich am 5. Mai die Aufmerksamkeit auf die Händehygiene vor allem in medizinischen und pfle-gerischen Einrichtungen lenken. Aus diesem Anlass wird in diesem Jahr im Epidemiologischen Bulletin 18/2023 die indikationsgerechte Nutzung medizinischer Einmalhandschuhe in Einrichtungen des Gesundheitswesens thematisiert und auf bestehende Probleme bei der Händehygiene-Compliance hingewiesen.Peer Reviewe

Complete Nucleotide Sequence of a Citrobacter freundii Plasmid Carrying KPC-2 in a Unique Genetic Environment

The complete and annotated nucleotide sequence of a 54,036-bp plasmid harboring a blaKPC-2 gene that is clonally present in Citrobacter isolates from different species is presented. The plasmid belongs to incompatibility group N (IncN) and harbors the class A carbapenemase KPC-2 in a unique genetic environment

Molecular Evidence of Pneumocystis Transmission in Pediatric Transplant Unit

We describe an outbreak of Pneumocystis jirovecii pneumonia in a pediatric renal transplant unit, likely attributable to patient-to-patient transmission. Single-strand conformation polymorphism molecular typing showed that 3 affected patients had acquired the same 2 strains of Pneumocystis, which suggests interhuman infection. An infant with mitochondriopathy was the probable index patient

Исследования гидравлических сопротивлений при движении в трубах золошлаковых тампонажно- закладочных суспензий

Експериментально досліджено залежність гідравлічного опору від швидкості руху та концентрації золошлакових суспензій при течії по трубах. Встановлена критична швидкість руху концентрованих гідросумішей.Dependence of hydraulic resistance is experimentally set from the rate of movement of ash-slag suspensions at a flow on pipes. The critical speed of motion of the concentrated slurries is set

Longitudinal Study of the Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus at a University Hospital

Surveillance for methicillin-resistant Staphylococcus aureus (MRSA) at the University Hospital of Heidelberg revealed an increase in the numbers of newly detected MRSA isolates in recent years. We conducted a study to assess the dynamics of the changes in the MRSA population. Pulsed-field gel electrophoresis (PFGE) typing of MRSA isolates from all patients at the University Hospital of Heidelberg collected between 1993 and 2004 was performed. The microbiology database contained 1,807 entries for newly detected MRSA isolates from 1,301 patients. A total of 1,252 isolates were available for PFGE typing. The isolates could be classified into 109 different PFGE types. Most PFGE types (n = 70) were detected less than five times and showed no evidence of transmission (sporadic strains). They accounted for 8.7% of all isolates, with few variations in frequency over the time. Thirty-seven PFGE types were clustered by time of detection, and transmission of the strains was likely (local epidemic strains). A total of 37.3% of the isolates belonged to this group of strains. The remaining 54.0% of the isolates belonged to only two further PFGE types (endemic strains). One endemic strain accounted for 5.0% of all isolates in 1994 and 68.2% in 2004. A second endemic strain was detected in 1.1% of all isolates in 1998 but in 12.4% in 2004. Statistical analysis of the associations between the kind of strain (sporadic, local epidemic, or endemic) and the patients' characteristics revealed a significant association for age and mode of acquisition. The remarkable increase in the rate of MRSA detection at the University Hospital of Heidelberg is mainly due to the dissemination of two different strains. Infection control measures seemed sufficient to prevent further transmission of some but not all of the strains

Healthcare-associated infections in long-term care facilities (HALT)

Die Ursachen für die Entstehung von Infektionen bei alten Menschen, die in Heimen leben, sind vielfältig. Die oftmals daraus resultierende Antibiotikatherapie kann zudem zu einer Selektion multiresistenter Erreger führen und damit ein zusätzliches Risiko darstellen. Für Deutschland und die meisten europäischen Länder existieren nur einige wenige Prävalenzstudien zu sogenannten healthcare associated infections (HCAI) in Altenpflegeheimen, und eine fortlaufende Dokumentation und Bewertung von HCAI und Antibiotikagaben in Altenpflegeheimen ist nicht etabliert. Daher wurde die europäische Prävalenzstudie HALT (healthcare associated infections in long-term care) entwickelt, die als Ziel hatte, sowohl HCAI als auch den Antibiotikagebrauch und die Antibiotikaresistenz von Erregern in Altenpflegeheimen zu erfassen. Insgesamt haben 73 Einrichtungen aus Deutschland am HALT-Projekt teilgenommen. Die HCAI-Prävalenz für eine wahrscheinliche Infektion (mindestens ein Symptom) lag bei 1,6 (CI 1,09–2,03), für eine gesicherte Infektion gemäß der modifizierten McGeer-Kriterien bei 0,79 (CI 0,62–1,04). Insgesamt wurde eine Antibiotikaprävalenz von 1,15 (CI 0,73–1,57) erfasst. Im vorliegenden Beitrag werden die für Deutschland erhobenen Daten aus dem HALT-Projekt vorgestellt.The development of infections in elderly people living in long-term care facilities may have manifold causes. Infections are often treated with an antibiotic which can trigger the selection of multirestistant microorganisms and, therefore, represents an additional risk factor. In Germany as well as in other European countries, only a few prevalence studies on healthcare-associated infections (HCAI) in long-term care facilities have been performed and there is no continuous surveillance established for HCAI and antibiotic treatment. Therefore, the European prevalence study HALT (healthcare-associated infections in long-term care) was initiated to collect data of HCAI, antibiotic use, and the antibiotic resistance of microorganisms in long-term care facilities. From Germany, 73 institutions participated in the HALT project. The overall prevalence for an optional HCAI (at least one symptom) was 1.6 (CI 1.09–2.03) and for HCAI identified by the modified McGeer criteria 0.79 (CI 0.62–1.04). The overall prevalence for antibiotic use was 1.15 (CI 0.73–1.57). In the present paper, the German results of the HALT project are presented

Comparison of direct cultivation on a selective solid medium, polymerase chain reaction from an enrichment broth, and the BD GeneOhm™ VanR Assay for identification of vancomycin-resistant enterococci in screening specimens

Fast and reliable diagnostics of vancomycin-resistant enterococci (VRE) is an important prerequisite for containing VRE transmission rates and controlling VRE outbreaks among hospital patients. The BD GeneOhm™ VanR Assay (Becton Dickinson Diagnostics, Erembodegem, Belgium) is a real-time polymerase chain reaction (PCR) assay for screening perianal/rectal samples for the presence of vanA or vanB genes that can be associated with VRE. A set of 51 reference strains (vanA–G genotypes) were correctly identified. Performance of the assay was evaluated and compared with culture-based methods and subsequent PCR analysis in 2 university hospitals with a different VRE prevalence. A total of 1786 samples were analyzed. With the use of the BD GeneOhm™ VanR Assay, 88 of 102 vanA-positive specimens, 62 of 67 vanB-positive specimens, 3 of 4 vanA- and vanB-positive specimens, and 1403 of 1613 negative specimens were correctly identified. The overall sensitivity was 93.1%; the specificity was 87.0% mainly due to false-positive vanB results. Results did not differ between study institutions

Vancomycin-resistente Enterokokken (VRE)

Enterokokken (vorrangig E. faecalis, E. faecium) sind bedeutende nosokomiale Erreger, die vor allem bei älteren und/oder immunsupprimierten Patienten auftreten. Sie besitzen ein breites Spektrum an intrinsischen und erworbenen Antibiotikaresistenzen, von denen die übertragbaren Glycopeptidresistenzgenotypen vanA und vanB in Vancomycin-resistenten Enterokokken (VRE; Reservoir: E. faecium) sowie Resistenzen gegen Reserveantibiotika (Linezolid, Tigecyclin) von besonderem Interesse sind. Außerdem zeichnen sich Enterokokken (einschließlich VRE) durch ihre leichte Übertragbarkeit aus und können somit als Indikatorkeim für eine nosokomiale Ausbreitung angesehen werden, wobei Kolonisationen deutlich häufiger auftreten als Infektionen. Seit einigen Jahren liegen die Resistenzhäufigkeiten gegen Vancomycin bei klinischen E.-faecium-Isolaten bei 8–15% auf einem konstanten Niveau (aber mit lokalen und regionalen Schwankungen) und zeigen für Teicoplanin einen leicht rückläufigen Trend. Dies korreliert mit der Verbreitung Hospital-assoziierter vanA- und in den letzten Jahren vanB-positiver E.-faecium-Stämme (Letztere assoziiert mit Teicoplanin-Empfindlichkeit). Die Ursachen für das deutlich zunehmende Auftreten von VanB-E.-faecium-Stämmen sind offenbar multifaktoriell: durch therapeutische Faktoren verursacht (gestiegener Verbrauch an Enterokokken-/VRE-selektierenden Antibiotika in der Vergangenheit) und methodisch bedingt (EUCAST-gesenkte Glycopeptid-MHK-Grenzwerte für Enterokokken; häufigeres und verbessertes VRE-Screening; molekulare diagnostische Verfahren).Enterococci (mainly E. faecalis, E. faecium) are important nosocomial pathogens predominantly affecting older and/or immunocompromised patients. The bacteria possess a broad spectrum of intrinsic and acquired antibiotic resistance properties. Among these, the transferrable glycopeptide resistance of the vanA and vanB genotypes in vancomycin-resistant enterococci (VRE; reservoir: E. faecium) as well as resistance to last resort antibiotics (e.g. linezolid and tigecycline) are of special concern. Enterococci (including VRE) are easily transferred in hospitals; however, colonizations are far more frequent than infections. Resistance frequencies for vancomycin in clinical E. faecium isolates have remained at a relatively constant level of 8–15% (but with local or regional variations) in recent years whereas frequencies for teicoplanin resistance have shown a slight decrease. Glycopeptide resistance trends correlate with a spread of hospital-associated E. faecium strains carrying the vanA and, with rising frequency in recent years, the vanB gene cluster, the latter being associated with teicoplanin susceptibility. This increased occurrence of vanB-positive E. faecium strains may be caused by an increased use of antibiotics selecting enterococci and VRE as well as due to methodological reasons (e.g. reduced EUCAST MIC-breakpoints for glycopeptides; increased use and sensitive performance of chromogenic VRE agars, increased use of molecular diagnostic assays)

Thirty years of VRE in Germany – “expect the unexpected”: The view from the National Reference Centre for Staphylococci and Enterococci

Enterococci are commensals of the intestinal tract of many animals and humans. Of the various known and still unnamed new enterococcal species, only isolates of Enterococcus faecium and Enterococcus faecalis have received increased medical and public health attention. According to textbook knowledge, the majority of infections are caused by E. faecalis. In recent decades, the number of enterococcal infections has increased, with the increase being exclusively associated with a rising number of nosocomial E. faecium infections. This increase has been accompanied by the dissemination of certain hospital-acquired strain variants and an alarming progress in the development of antibiotic resistance namely vancomycin resistance. With this review we focus on a description of the specific situation of vancomycin resistance among clinical E. faecium isolates in Germany over the past 30 years. The present review describes three VRE episodes in Germany, each of which is framed by the beginning and end of the respective decade. The first episode is specified by the first appearance of VRE in 1990 and a country-wide spread of specific vanA-type VRE strains (ST117/CT24) until the late 1990s. The second decade was initially marked by regional clusters and VRE outbreaks in hospitals in South-Western Germany in 2004 and 2005, mainly caused by vanA-type VRE of ST203. Against the background of a certain “basic level” of VRE prevalence throughout Germany, an early shift from the vanA genotype to the vanB genotype in clinical isolates already occurred at the end of the 2000s without much notice. With the beginning of the third decade in 2010, VRE rates in Germany have permanently increased, first in some federal states and soon after country-wide. Besides an increase in VRE prevalence, this decade was marked by a sharp increase in vanB-type resistance and a dominance of a few, novel strain variants like ST192 and later on ST117 (CT71, CT469) and ST80 (CT1065). The largest VRE outbreak, which involved about 2,900 patients and lasted over three years, was caused by a novel and until that time, unknown strain type of ST80/CT1013 (vanB). Across all periods, VRE outbreaks were mainly oligoclonal and strain types varied over space (hospital wards) and time. The spread of VRE strains obviously respects political borders; for instance, both vancomycin-variable enterococci which were highly prevalent in Denmark and ST796 VRE which successfully disseminated in Australia and Switzerland, were still completely absent among German hospital patients, until to date