Entdeckung eines Pseudoausbruches mit Carbapenem-resistenten Acinetobacter baumannii

Am Nationalen Referenzzentrum für gramnegative Krankenhauserreger wurde im November und Dezember 2020 das gehäufte Auftreten von Isolaten des Acinetobacter baumannii-Komplex mit Carbapenemresistenz beobachtet. Der Beitrag beschreibt die in Kooperation mit dem Robert Koch-Institut durchgeführte Ausbruchsuntersuchung und die Aufklärung als Pseudoausbruch.Peer Reviewe

Baseline study for improving diagnostic stewardship at secondary health care facilities in Nigeria

Background: Blood culture diagnostics are critical tools for sepsis management and antimicrobial resistance (AMR) surveillance. A baseline study was conducted to assess reported sepsis case finding, blood culture diagnostics, antimicrobial susceptibility testing (AST) and antimicrobial use at secondary health care facilities to inform the development of diagnostic stewardship improvement strategies in Nigeria. Methods: A cross-sectional online survey was conducted among 25 public secondary health care facilities in Abuja, Federal Capital Territory (FCT) and Lagos State in Nigeria to evaluate the capacity for pathogen identification and AST. Data were then prospectively extracted on all patients with reported suspected sepsis from electronic medical records from selected departments at two facilities in the Federal Capital Territory from October 2020 to May 2021 to further assess practices concerning sepsis case-finding, clinical examination findings, samples requested, and laboratory test results. Data were descriptively analysed, and a multivariate logistic regression analysis was conducted to determine factors associated with blood culture requests. Results: In the online survey, 32% (8/25) of facilities reported performing blood cultures. Only one had access to a clinical microbiologist, and 28% (7/25) and 4% (1/25) used standard bacterial organisms for quality control of media and quality control strains for AST, respectively. At the two facilities where data abstraction was performed, the incidence of suspected sepsis cases reported was 7.1% (2924/41066). A majority of these patients came from the paediatrics department and were outpatients, and the median age was two years. Most did not have vital signs and major foci of infection documented. Blood cultures were only requested for 2.7% (80/2924) of patients, of which twelve were positive for bacteria, mainly Staphylococcus aureus. No clinical breakpoints were used for AST. Inpatients (adjusted odds ratio [aOR]: 7.5, 95% CI: 4.6–12.3) and patients from the urban health care facility (aOR:16.9, 95% CI: 8.1–41.4) were significantly more likely to have a blood culture requested. Conclusion: Low blood culture utilisation remains a key challenge in Nigeria. This has implications for patient care, AMR surveillance and antibiotic use. Diagnostic stewardship strategies should focus on improving access to clinical microbiology expertise, practical guidance on sepsis case finding and improving blood culture utilisation and diagnostics.Peer Reviewe

Virushepatitis B und D im Jahr 2017

Anlässlich des Welt-Hepatitis-Tags am 28. Juli hat das Robert Koch-Institut zwei Ausgaben des Epidemiologischen Bulletins zu Hepatitis veröffentlicht, nach der Ausgabe 29 zu Hepatitis C ist am 26. Juli 2018 die Ausgabe 30 zur Situation bei Hepatitis B und D erschienen. Hepatitis B wird sexuell, durch Blut oder von der Mutter auf das Kind übertragen. Hepatitis B ist eine weltweit beim Menschen vorkommende, durch Hepatitis-B-Viren ausgelöste Leberentzündung, die vorwiegend sexuell und durch Kontakt mit kontaminiertem Blut oder anderen Körperflüssigkeiten übertragen wird. Bei Erwachsenen verläuft sie in 5 bis 10 Prozent der Fälle chronisch und kann in eine Leberzirrhose oder ein Leberzellkarzinom übergehen. Bei einer Infektion im frühen Kindesalter verlaufen circa 90 Prozent der Fälle chronisch. Vor einer Hepatitis B kann man sich mit einer effektiven Impfung schützen, die in Deutschland für alle Kinder und Jugendlichen und bestimmte Gruppen mit erhöhtem Risiko empfohlen ist. Die Impfquoten sind allerdings noch unzureichend. Das Hepatitis-D-Virus benötigt für die Infektion die Hülle des Hepatitis-B-Virus. Hepatitis D tritt somit stets zusammen mit Hepatitis B auf und führt in 70 bis 90 % der Fälle zu schweren chronischen Verläufen.Peer Reviewe

Implications of a change in case definition and screening of asylum seekers for hepatitis B surveillance in Germany in 2015 and 2016

Since 2015, the number of hepatitis B virus (HBV) cases increased substantially in Germany. In 2015, a more sensitive HBV case definition was introduced. This coincided with an asylum seeker influx with differing screening strategies. Information on the asylum seeker status has been collected since 09/2015. We investigated this increase to interpret HBV notification data in Germany. We compared HBV surveillance data from 2010–2013 (baseline) with 2015–2016, excluding 2014 due to beginning of asylum seeker influx. We estimated the excess above the mean case number (baseline) using Poisson regression and compared asylum seeker cases and the excess of cases with the unknown asylum seeker status. HBV cases increased from 1855 (mean baseline) to 3873 (2015) and 3466 (2016) with 1903 asylum seeker cases and 1099 excess-cases with the unknown asylum seeker status in 2015–2016. Cases only fulfilling the changed case definition increased from 60% (1119) in baseline to 81% (P < 0.01) in 2015–2016; 69% of asylum seeker cases and 61% of excess-cases were males <40 years compared to 27% (baseline) (P < 0.01). Changed case definition increased the number of cases in official statistics substantially. Demographic and geographical distributions suggest that screening of asylum seekers increased the case numbers even to a higher extent than surveillance data indicates.Peer Reviewe

Virushepatitis B und D im Jahr 2016

Infektionen mit Hepatitis-B-Viren (HBV) gehören zu den häufigsten Infektionskrankheiten weltweit. Im Fall eines chronischen Verlaufs zählen sie zu den bedeutendsten Ursachen von Leberzirrhose und Leberzellkarzinom. Der Tod infolge eines Leberzellkarzinoms rangiert weltweit auf Platz zwei der krebsbedingten Todesursachen. Nach Schätzungen der Weltgesundheitsorganisation (WHO) sterben jährlich 887.000 Menschen weltweit an Hepatitis B.1,2 Wenngleich Deutschland in Bezug auf die Allgemeinbevölkerung zu den Niedrigprävalenzregionen zählt, sind auch hier vulnerable Gruppen besonders betroffen. Die Priorisierung des HBV auf Rangplatz vier von 127 infektiösen Erregern verdeutlicht die Relevanz für die nationale Surveillance.3 Auch die WHO hat durch ihren Aktionsplan gegen Virushepatitis die Aufmerksamkeit für Hepatitis B erhöht. Ziel des Plans ist die Eliminierung der Virushepatitis als eine Bedrohung der öffentlichen Gesundheit bis 2030.4 Neben der individuellen Krankheitslast ergibt sich damit eine erhebliche gesundheitspolitische und ökonomische Bedeutung

Genome-based analysis of Carbapenemase-producing Klebsiella pneumoniae isolates from German hospital patients, 2008-2014

Background By using whole genome sequence data we aimed at describing a population snapshot of carbapenemase-producing K. pneumoniae isolated from hospitalized patients in Germany between 2008 and 2014. Methods We selected a representative subset of 107 carbapenemase-producing K. pneumoniae clinical isolates possessing the four most prevalent carbapenemase types in Germany (KPC-2, KPC-3, OXA-48, NDM-1). Isolates were processed via illumina NGS. Data were analysed using different SNP-based mapping and de-novo assembly approaches. Relevant information was extracted from NGS data (antibiotic resistance determinants, wzi gene/cps type, virulence genes). NGS data from the present study were also compared with 238 genome data from two previous international studies on K. pneumoniae. Results NGS-based analyses revealed a preferred prevalence of KPC-2-producing ST258 and KPC-3-producing ST512 isolates. OXA-48, being the most prevalent carbapenemase type in Germany, was associated with various K. pneumoniae strain types; most of them possessing IncL/M plasmid replicons suggesting a preferred dissemination of blaOXA-48 via this well-known plasmid type. Clusters ST15, ST147, ST258, and ST512 demonstrated an intermingled subset structure consisting of German and other European K. pneumoniae isolates. ST23 being the most frequent MLST type in Asia was found only once in Germany. This latter isolate contained an almost complete set of virulence genes and a K1 capsule suggesting occurrence of a hypervirulent ST23 strain producing OXA-48 in Germany. Conclusions Our study results suggest prevalence of “classical” K. pneumonaie strain types associated with widely distributed carbapenemase genes such as ST258/KPC-2 or ST512/KPC-3 also in Germany. The finding of a supposed hypervirulent and OXA-48-producing ST23 K. pneumoniae isolates outside Asia is highly worrisome and requires intense molecular surveillance.Peer Reviewe

Implementation of Automated Blood Culture With Quality Assurance in a Resource-Limited Setting

Background: Blood cultures (BC) have a high clinical relevance and are a priority specimen for surveillance of antimicrobial resistance. Manual BC are still most frequently used in resource-limited settings. Data on automated BC performance in Africa are scarce. We implemented automated BC at a surveillance site of the African Network for improved Diagnostics, Epidemiology and Management of Common Infectious Agents (ANDEMIA). Methods: Between June 2017 and January 2018, pairs of automated BC (BacT/ALERT®FA Plus) and manual BC (brain-heart infusion broth) were compared at a University hospital in Bouaké, Côte d'Ivoire. BC were inoculated each with a target blood volume of 10 ml from the same venipuncture. Automated BC were incubated for up to 5 days, manual BC for up to 10 days. Terminal subcultures were performed for manual BC only. The two systems were compared regarding yield, contamination, and turnaround time. For quality assurance, isolates were retested in a German routine microbiological laboratory. Results: BC sampling was increased from on average 24 BC to 63 BC per month. A total of 337 matched pairs of BC were included. Automated BC was positive in 36.5%, manual BC in 24.0% (p-value < 0.01), proportion of contamination was 47.9 and 43.8%, respectively (p-value = 1.0). Turnaround time of positive BC was shortened by 2.5 days with automated compared to manual BC (p < 0.01). Most common detected pathogens in both systems were Klebsiella spp. (26.0%) and Staphylococcus aureus (18.2%). Most contaminants were members of the skin flora. Retesting of 162 isolates was concordant in 79.6% on family level. Conclusions: Implementing automated BC in a resource-limited setting is possible and improves microbiological diagnostic performance. Automated BC increased yield and shortened turnaround times. Regular training and mentorship of clinicians has to be intensified to increase number and quality of BC. Pre-analytical training to improve diagnostic stewardship is essential when implementing a new microbiological method. Retesting highlighted that manual identification and antimicrobial susceptibility testing can be of good quality and sustainable. The implementation of automated tools should be decided individually according to economic considerations, number of samples, stable supply chain of consumables, and technical sustainability.Peer Reviewe

Disentangling outbreaks using whole-genome sequencing: concurrent multistate outbreaks of Salmonella Kottbus in Germany, 2017

In June 2017, an outbreak of Salmonella Kottbus infection was suspected in Germany. We investigated the outbreak with whole-genome sequencing (WGS) and a case–control study. Forty-six isolates from 69 cases were subtyped. Three WGS clusters were identified: cluster 1 (n = 36), cluster 2 (n = 5) and cluster 3 (n = 3). Compared to controls, cluster 1 cases more frequently consumed raw smoked ham (odds ratio (OR) 10, 95% confidence interval (CI) 1.2–88) bought at supermarket chain X (OR 36, 95% CI 4–356; 9/10 consumed ham Y). All four cluster 2 cases interviewed had consumed quail eggs. Timely WGS was invaluable in distinguishing concurrent outbreaks of a rare Salmonella serotype.Peer Reviewe

Additional file 1: of Carbapenem non-susceptibility of Klebsiella pneumoniae isolates in hospitals from 2011 to 2016, data from the German Antimicrobial Resistance Surveillance (ARS)

Appendix S1. List of laboratories that participate in ARS and contributed data to this analysis. Appendix S2. Geographical distribution of hospitals contributing data to the analysis. Appendix S3. Klebsiella pneumoniae isolates by year and location of hospital in Germany, 2011–2016. Appendix S4. Klebsiella pneumoniae isolates by patient and hospital characteristics in Germany 2011–2016. Appendix S5. Numbers of K. pneumoniae isolates in Germany 2011–2016 included in the analysis stratified by standards used for interpretation of antimicrobial susceptibility testing. Appendix S6. Carbapenem non-susceptibility of K. pneumoniae isolates in Germany 2011–2016 that were tested against all three carbapenems. Appendix S7. Cross-resistance of K. pneumoniae isolates non-susceptible to one carbapenem to other carbapenems restricted to isolates tested against all three carbapenems, Germany 2011–2016. Appendix S8. Sensitivity analyses to investigate the trend of carbapenem non-susceptibility over time. Appendix S9. Proportions of carbapenem non-susceptibility in K. pneumoniae isolates across substrata, Germany 2011–2016. Appendix S10. Uni- and multivariable analyses for carbapenem non-susceptibility of K. pneumoniae isolates stratified by age and sex, Germany 2011–2016. (DOCX 464 kb

Additional file 2: of Genome-based analysis of Carbapenemase-producing Klebsiella pneumoniae isolates from German hospital patients, 2008-2014

Table S1. Metadata of the 107 German carbapenemase-producing, clinical Klebsiella isolates, 2008-2014. Isolates were ordered by carbapenemase type. For more information see main text document. (XLSX 54 kb