Aktuelle Aspekte zur Definition und Diagnostik der Sepsis und Antibiotikaresistenz

Die Krankenhaussterblichkeit von Patienten mit sekundärer Sepsis ist mit ca. 40 % unverändert hoch. Aufgrund methodischer Mängel der bisher verwendeten Definitionen fehlen jedoch valide Daten zur Epidemiologie der sekundären Sepsis, welche Vergleiche im nationalen und internationalen Kontext ermöglichen. Seit 2016 stehen neue klinische diagnostische Werkzeuge zur Verfügung, die auch für das Sepsisscreening außerhalb von Intensivstationen geeignet sind. Um der hohen Sterblichkeit der nosokomial verursachten Sepsis zu begegnen, sind auf diesem Gebiet neue Ansätze in der Früherkennung bei Risikopatienten erforderlich. Eine ausreichende Blutkulturabnahmerate sowie eine hohe präanalytische Qualität sollten als Grundlage der Qualitätssicherung gerade im Bereich der nosokomialen Blutstrominfektionen etabliert werden, da ansonsten das Risiko eines Surveillance-Bias besteht. Daten der laborbasierten Antibiotika-Resistenz-Surveillance (ARS) zeigen für MRSA in den letzten vier Jahren für Blutkulturisolate einen rückläufigen Trend. Im gramnegativen Bereich wird über diesen Zeitraum für viele der Erreger-Antibiotikakombinationen eine relativ stabile Resistenzsituation beobachtet.Peer Reviewe

Results from the First 12 Months of the National Surveillance of Healthcare Associated Outbreaks in Germany, 2011/2012

Background: In August 2011, the German Protection against Infection Act was amended, mandating the reporting of healthcare associated infection (HAI) outbreak notifications by all healthcare workers in Germany via local public health authorities and federal states to the Robert Koch Institute (RKI). Objective: To describe the reported HAI-outbreaks and the surveillance system’s structure and capabilities. Methods: Information on each outbreak was collected using standard paper forms and notified to RKI. Notifications were screened daily and regularly analysed. Results: Between November 2011 and November 2012, 1,326 paper forms notified 578 HAI-outbreaks, between 7 and 116 outbreaks per month. The main causative agent was norovirus (n = 414/578; 72%). Among the 108 outbreaks caused by bacteria, the most frequent pathogens were Clostridium difficile (25%) Klebsiella spp. (19%) and Staphylococcus spp. (19%). Multidrug-resistant bacteria were responsible for 54/108 (50%) bacterial outbreaks. Hospitals were affected most frequently (485/578; 84%). Hospital outbreaks due to bacteria were mostly reported from intensive care units (ICUs) (45%), followed by internal medicine wards (16%). Conclusion: The mandatory HAI-outbreak surveillance system describes common outbreaks. Pathogens with a particular high potential to cause large or severe outbreaks may be identified, enabling us to further focus research and preventive measures. Increasing the sensitivity and reliability of the data collection further will facilitate identification of outbreaks able to increase in size and severity, and guide specific control measures to interrupt their propagation

Risk Factors for Hantavirus Infection in Germany, 2005

In 2005, a marked increase in hantavirus infections was observed in Germany. Large cities and areas where hantaviruses were not known to be endemic were affected. A case–control study identified the following independent risk factors for infection: occupational exposure for construction workers, living <100 m from forested areas, and exposure to mice

COSIK – COVID-19-Surveillance in Krankenhäusern

Um die Belastung der Krankenhäuser durch die COVID-19-Pandemie darzustellen und auch nosokomiale SARS-CoV-2-Infektionen zu erfassen, hat das RKI in Zusammenarbeit mit dem Nationalen Referenzzentrum für die Surveillance von nosokomialen Infektionen an der Charité Berlin eine systematische Krankenhaus-Surveillance von SARS-CoV-2-Infektionen in Deutschland, COSIK, entwickelt

The zoonotic potential of Clostridium difficile from small companion animals and their owners

Background: Clostridium difficile infections (CDI) in humans range from asymptomatic carriage to life-threatening intestinal disease. Findings on C. difficile in various animal species and an overlap in ribotypes (RTs) suggest potential zoonotic transmission. However, the impact of animals for human CDI remains unclear. Methods: In a large-scale survey we collected 1,447 fecal samples to determine the occurrence of C. difficile in small companion animals (dogs and cats) and their owners and to assess potential epidemiological links within the community. The Germany-wide survey was conducted from July 2012-August 2013. PCR ribotyping, Multilocus VNTR Analysis (MLVA) and PCR detection of toxin genes were used to characterize isolated C. difficile strains. A database was defined and logistic regression used to identify putative factors associated with fecal shedding of C. difficile. Results: In total, 1,418 samples met the inclusion criteria. The isolation rates for small companion animals and their owners within the community were similarly low with 3.0% (25/840) and 2.9% (17/578), respectively. PCR ribotyping revealed eight and twelve different RTs in animals and humans, respectively, whereas three RTs were isolated in both, humans and animals. RT 014/0, a well-known human hospital-associated lineage, was predominantly detected in animal samples. Moreover, the potentially highly pathogenic RTs 027 and 078 were isolated from dogs. Even though, C. difficile did not occur simultaneously in animals and humans sharing the same household. The results of the epidemiological analysis of factors associated with fecal shedding of C. difficile support the hypothesis of a zoonotic potential. Conclusions: Molecular characterization and epidemiological analysis revealed that the zoonotic risk for C. difficile associated with dogs and cats within the community is low but cannot be excluded

Spektrum diagnostischer Proben zum Nachweis von SARS-CoV-2

Prinzipiell können zum Nachweis von SARS-CoV-2 bei nicht beatmeten Patientinnen und Patienten Pro¬ben von mehreren Orten entnommen werden. Methode der Wahl ist der vom Fachpersonal entnommene oropharyngeale, nasopharyngeale oder kombinierte Abstrich. Diese Proben können jedoch auch von Patientinnen und Patienten selbst abgenommen werden, was zahlreiche Vorteile birgt (z. B. die Vermeidung einer Virusübertragung auf das Personal). Das Epidemiologische Bulletin 17/2021 gibt anhand einer Literaturübersicht und Studienergebnissen des RKI einen Überblick über die prinzipiell zur Verfügung stehenden Probenahmeorte und -modi. Darüber hinaus werden von Patientinnen und Patienten selbst abgenommene Proben in Hinblick auf Praktikabilität und Akzeptanz mit den vom Fachpersonal abgenommenen Proben vergleichen

Decline in the proportion of methicillin resistance among Staphylococcus aureus isolates from non-invasive samples and in outpatient settings, and changes in the co-resistance profiles: an analysis of data collected within the Antimicrobial Resistance Surveillance Network, Germany 2010 to 2015

Background: Recent analysis of trends of non-invasive infections with methicillin resistant Staphylococcus aureus (MRSA), of trends of MRSA infections in outpatient settings and of co-resistance profiles of MRSA isolates are scarce or lacking in Germany. Methods: We analysed data from the Antimicrobial Resistance Surveillance Network (ARS). We included in the analysis the first isolate of S. aureus per patient and year, which had a valid test result for oxacillin resistance and which was not a screening sample. We limited the analysis to isolates from facilities, which contributed to ARS for all six years between 2010 and 2015. We compared the proportion of methicillin resistance among S. aureus isolates by calendar year using Chi-square and Fisher’s exact test. We corrected for multiple testing using the Bonferroni correction. We stratified the analysis by sample type including various non-invasive sample types and by type of care (e.g. hospital versus outpatient clinic). We also analysed the non-susceptibility of MRSA to selected antibiotics. Results: The analysis included 148,561 S. aureus isolates. The distribution of these isolates by sex, age, region, sample type, clinical speciality and type of care remained relatively stable over the six years analysed. The proportion of MRSA among S. aureus isolates decreased continuously from 16% in 2010 to 10% in 2015. This decrease was seen for all types of care and for the majority of sample types, including the outpatient clinic (12 to 8%), as well as blood culture (19 to 9%), urine samples (25 to 15%), swabs (14 to 9%), respiratory samples (22 to 11%) and lesions (15 to 10%). The non-susceptibility of MRSA isolates to tobramycin (47 to 32%), ciprofloxacin (95 to 89%), moxifloxacin (94 to 84%), clindamycin (80 to 71%) and erythromycin (81 to 72%) declined markedly, but it increased for tetracyclines (6 to 9%) and gentamicin (3 to 6%). Non-susceptibility of MRSA to linezolid, teicoplanin, tigecycline and vancomycin remained rare. Conclusion: This analysis indicates that the incidence of MRSA infections declined in a variety of settings in Germany between 2010 and 2015 and that the co-resistance profiles of MRSA isolates changed markedly

Eigenschaften, Häufigkeit und Verbreitung von Vancomycin-resistenten Enterokokken in Deutschland – Update

Vancomycin-resistente Enterokokken (VRE) gehören zu den in Deutschland gemäß § 23 Abs. 4 IfSG zu erfassenden Erregern und werden in vielen deutschen Kliniken häufig beobachtet. Der Nachweis von VRE ist in den zurückliegenden Jahren auf einem stabil hohen Niveau in Deutschland und bewegt sich leicht oberhalb des EU-Durchschnitts. Die Krankheitslast durch invasive VRE-Infektionen ist hingegen nachweislich ansteigend. Das Nationale Referenzzentrum für Staphylokokken und Enterokokken beobachtet diese Entwicklungen und berichtet über die Situation von VRE und Enterokokken mit besonderen Antibiotikaresistenzen im Zeitraum 2021/2022. Darüber hinaus wird auf allgemeine VRE-Resistenzsta¬tistiken nationaler Erhebungssysteme und -studien hingewiesen.Peer Reviewe