[The first COVID-19 hotspot in a retirement home in Hamburg]. / Der erste COVID-19-Hotspot in einer Hamburger Senioreneinrichtung: Präventionskonzept, Letalität und Obduktionsbefunde.

Background: Coronavirus disease 2019 (COVID-19), a disease caused by the new coronavirus (SARS-CoV-2), is a particular threat to old people. At the end of March 2020, the first and so far largest outbreak of the disease occurred in a retirement home in Hamburg. Methods: Analysis of procedures in dealing with a residential unit affected by SARS-CoV­2, accommodating a risk group of 60 seniors with dementia is presented as well as a detailed presentation of post-mortem examination results of all 8 deceased tested positive for SARS-CoV­2. Results: Out of 60 residents, 39 were infected by SARS-CoV­2. Due to preventive procedures it was possible to stop further spreading of the infection to other residential areas. In all 8 fatal cases, the autopsy diagnosis was death due to COVID-19. Autopsies revealed all COVID-19 patients to have a fatal (broncho)pneumonia and signs of relevant pre-existing cardiac, renal and pulmonary conditions in all cases. In 75% (n = 6) of the cases a fresh venous thrombosis was found. In 66.7% (n = 4) of the cases thrombotic events were combined with peripheral pulmonary artery thromboembolisms. Conclusion: The cohort of SARS-CoV­2 infected residents of a nursing home is characteristic for clinical and epidemiological features of the new coronavirus disease. Due to a centralized evaluation of all fatalities at the Institute of Legal Medicine in Hamburg, a detailed examination of all deceased positive for SARS-CoV­2 was possible. Thereby, increased case fatality rates of approximately 20% could in all cases be assigned to a relevant number of pre-existing comorbidities of multiple organ systems, which was consistent with the clinical data available.

Rapid identification of the vanA/vanB resistance determinant in Enterococcus sp. from blood cultures using the Cepheid Xpert vanA/vanB cartridge system.

Especially in immunocompromised and intensive care patients VRE sepsis is associated with high mortality. The GeneXpert vanA/vanB assay is marketed for fast molecular surveillance of VRE colonization in peri-anal and rectal swabs. The aim of this study was to evaluate this assay for its usefulness for rapid identification of the vanAB determinant from positive blood cultures. During an evaluation phase, 33/34 blood cultures (negative = 13; vanA = 1; and vanB = 19) were correctly identified. In the validation phase 205/211 blood cultures were correctly identified (negative, n = 160; vanA, n = 2; vanB, n = 43). Sensitivity and specificity calculated from valid tests was 100% (95% CI: 90.2-100%) and 100% (95% CI: 97.1-100%), respectively. The error rate was 2.8%. The Xpert vanA/vanB cartridge is a reliable tool in the rapid molecular identification of the vanA and vanB determinant from positive blood cultures with moderate inhibition rates (2.8%) and high PPV and NPV. However, additional methods for species identification are required.

Tedizolid susceptibility in linezolid- and vancomycin-resistant Enterococcus faecium isolates.

Vancomycin-resistant enterococci (VRE) are of ever-increasing importance, most notably in high-risk patient populations. Therapy options are often limited for these isolates, and apart from tigecycline and daptomycin, oxazolidinone linezolid is frequently administered. The broad usage of linezolid, however, has driven the emergence of linezolid-resistant VRE strains (LR-VRE), further shortening therapeutic options. Second-generation oxazolidinone tedizolid has the advantage of being active against a specific subset of LR-VRE, i.e. isolates expressing the plasmid-encoded chloramphenicol-florfenicol resistance (cfr) gene. Here we tested tedizolid activity in a collection of 30 LR Enterococcus faecium VRE (MIC range 32-256 mg/l) isolated between 2012 and 2015 from clinical and screening specimens. By pulsed field gel electrophoresis (PFGE) isolates were assigned to 16 clonal lineages. In three cases, linezolid-susceptible progenitor isolates of LR-VRE were isolated, thus demonstrating the de-novo emergence of the linezolid-resistant phenotype. PCR did not detect cfr, cfr(B) or novel oxazolidinone resistance gene optrA in LR-VRE. All isolates, however, carried mutations within the 23S rDNA. Compared to linezolid, tedizolid MICs were lower in all isolates (MIC range 2-32 mg/l), but remained above the FDA tedizolid breakpoint for E. faecalis at 0.5 mg/l. Thus, related to the predominant resistance mechanism, tedizolid is of limited value for treatment of most LR-VRE and represents a therapeutic option only for a limited subset of isolates.

Tropheryma whipplei in children with diarrhoea in rural Ghana.

Tropheryma whipplei has been hypothesized to be able to cause diarrhoea, but data from young children are scarce. In this hospital-based case-control study 534 stool samples of children aged between 2 months and 15 years from rural Ghana were analysed for the presence of T. whipplei. Overall stool prevalence of T. whipplei was high (27.5%). Although there was no difference in T. whipplei carriage overall between cases and controls, cases aged between 0 and 12 months carried T. whipplei in their stool twice as often as controls without diarrhoea. The results from this study may support the hypothesis that T. whipplei can cause diarrhoea in first-time infection.

[Surveillance reports on pathogens and their antibiotic resistance patterns - a recommendation for standardization]. / Surveillanceberichte zu Erregern und Antibiotikaresistenzen - eine Empfehlung zur Standardisierung.

Surveillance reports on infectious agents and their antibiotic resistance patterns as well as on the usage of antibiotics are now enforced by law for many medical institutions in Germany. However, specific practice-oriented recommendations concerning the appropriate extent and informative mode of presentation are lacking. This consensus statement resulted from the experience from five German university hospitals in handling data from infection epidemiology and in the various possibilities for the presentation of surveillance reports. The consensus statement provides recommendations for the preparation of the legally demanded surveillance reports, extending the existing regulations. The relevance of statements on frequency and quality of microbiological tests is included. Furthermore, modes for the standardization of the data analysis are suggested in order to achieve a regional and national comparability of the results on a high quality level, similarly to the established standardized surveillance of nosocomial infections. This consensus statement describes the form in which the legally enforced reports can be presented in an informative and standardized way in order to facilitate the deduction and realization of preventive measurements.

Improved detection of bacterial central nervous system infections by use of a broad-range PCR assay.

A universal PCR assay for bacteria and fungi detected meningitis pathogens in 65% of 20 cerebrospinal fluid (CSF) samples from patients with suspected central nervous system (CNS) infections compared to a 35% detection rate by culture and/or microscopy methods. Thus, the PCR assay can improve the diagnosis rate of infective meningitis when standard methods provide a negative result.

ramR mutations in clinical isolates of Klebsiella pneumoniae with reduced susceptibility to tigecycline.

Five Klebsiella pneumoniae isolates with reduced susceptibility to tigecycline (MIC, 2 microg/ml) were analyzed. A gene homologous to ramR of Salmonella enterica was identified in Klebsiella pneumoniae. Sequencing of ramR in the nonsusceptible Klebsiella strains revealed deletions, insertions, and point mutations. Transformation of mutants with wild-type ramR genes, but not with mutant ramR genes, restored susceptibility to tigecycline and repressed overexpression of ramA and acrB. Thus, this study reveals a molecular mechanism for tigecycline resistance in Klebsiella pneumoniae.

Combined ramR mutation and presence of a Tn1721-associated tet(A) variant in a clinical isolate of Salmonella enterica serovar Hadar resistant to tigecycline.

A Salmonella enterica serovar Hadar strain resistant to tigecycline (MIC, 16 microg/ml) was isolated. Molecular characterization revealed the presence of a plasmid-borne tet(A) variant associated with Tn1721 mediating a rise of the MIC for tigecycline when transferred to Escherichia coli. Additionally, a truncating mutation in ramR was detected. Transformation with wild-type ramR but not with the mutated ramR lowered the MIC for tigecycline. Characterization of this Salmonella isolate implicates ramR in resistance to tigecycline.

Expression and functional characterization of gfpmut3.1 and its unstable variants in Staphylococcus epidermidis.

Reporter gene systems are an invaluable tool for investigation of gene transcription activity in eukaryotes and prokaryotes. In order to analyze the temporal and spatial resolution of gene expression patterns in situ and for quantitatively investigating gene expression, the green fluorescent protein (GFP) appears to be especially useful. GFP has been broadly used in various bacterial species, however, there is only limited knowledge about key biological properties in S. epidermidis. Here, the crucial influence of different ribosomal binding sites (RBS) on gfpmut3.1 translation initiation in S. epidermidis 1457 is demonstrated. Only by using the RBS of the delta-hemolysin promoter, after 24 hours a strong fluorescence signal was obtained. The half-life of GFPmut3.1 in S. epidermidis 1457 was significantly shorter than in E. coli (7 h vs. 24 h). GFPmut3.1 derivatives with shorter half-lives (GFP(AAV) and GFP(ASV)) did not reach sufficient quantitative protein levels, and the resulting low fluorescence limits their use as reporter genes in S. epidermidis. This work provides fundamental insights into gfpmut3.1 expression in S. epidermidis and describes the crucial determinants of its biological behavior in this species. In general, this study underlines the need to accurately characterize key biological properties of this transcription marker in gram-positive hosts.

Micromechanics of filopodia mediated capture of pathogens by macrophages.

The biological function of filopodia has been extensively studied while only little work has been done on their mechanical properties. In the present study, we apply magnetic microbeads to explore the capturing and initial step of phagocytosis of pathogens by macrophages through filopodia. Microbeads were covered by the bacterial coat protein invasin which is known to trigger the invasion of the intestine by the bacteria Yersinia enterocolitica. These mimetics of bacteria were placed in the vicinity of J774 mouse macrophages exhibiting long filopodia. The specific adhesion of beads to the tip of a filopodium induced the retraction of the protrusion resulting in the dragging of the bead towards the cell body. The dynamics of the retraction process was analyzed by following the in-plane motion of the bead. We estimated the minimal force developed by filopodia and compared the results with previous magnetic tweezer studies of mechanical force induced growth of protrusions (Vonna et al. 2003). We show that very thin filopodia can generate astonishingly large retraction forces over large distances (>10 microm) and can act as an efficient mechanical tool to detach pathogens adhering on surfaces.

Modulation of Rho GTPases and the actin cytoskeleton by YopT of Yersinia.

Pathogenic Yersinia species evade the innate cellular immune response by injecting antihost effector proteins (Yersinia outer proteins, Yops) into host cells through a type III secretion (TTS) apparatus. One of the six effector Yops, YopT, inactivates the small GTPase RhoA by removing the geranylgeranylated C-terminal cysteine. This cleavage results in release of RhoA from the cell membrane and subsequently in blockage of stress fiber formation. Thus YopT impairs cellular functions associated with cytoskeleton rearrangements.

[Are we being threatened by multiresistant strains of Staphylococcus aureus?]. / Prävention und Therapie von Staphylokokkeninfektionen... bevor sich MRSA & Co. in lhrer Praxis niederlassen.

Multiresistant strains of Staphylococcus aureus (MRSA) are characterized by their virulence and clinical resistance to all known beta-lactam antibiotics. Furthermore, the representatives of most other classes of antibiotics are also proving to be no longer effective. While infections with the usual S. aureus strains can mostly be readily managed with penicillinase-resistant penicillins, the rescue antibiotic vancomycin, as also teicoplanin, in combination with, for example fosfomycin, are required in the treatment of MRSA and S. epidermidis infections. Since infections with S. aureus/MRSA are usually of endogenous origin, decolonization with mupirocin-containing nasal ointment applied as a prophylactic measure in patients with high colonization rates and/or immunosuppression, is of major importance. The best protection against further spread of highly resistant germs, such as MRSA is, in particular, profession hygiene management.

Modulation of Rho GTPases by type III secretion system translocated effectors of Yersinia.

Pathogenic species of the bacterial genus Yersinia subdue the immune system to proliferate and spread within the host organism. For this purpose yersiniae employ a type III secretion apparatus which governs injection of six effector proteins ( Y ersinia outer proteins; Yops) into host cells. Yops control various regulatory and signalling proteins in a unique and highly specific manner. YopE, YopT, and YpkA/YopO modulate the activity of Rho GTP-binding proteins, whereas YopH dephosphorylates phospho-tyrosine residues in focal adhesion proteins. Furthermore, YopP/YopJ and YopM affect cell survival/apoptosis and cell proliferation, respectively. In this review the focus will be on the biochemistry and cellular effects of YopT, YopE, YopO/YpkA, and YopH.

Involvement of the GTPase Rho in the cellular uptake of low density lipoprotein by human skin fibroblasts.

Members of the Rho subfamily of small GTPases have been implicated in the regulation of endocytosis of ligand/receptor complexes localised to clathrin-coated pits. In this paper, we investigated the role of Rho A in the post-receptor regulation of cellular uptake and metabolism of native low density lipoprotein (LDL) by primary human skin fibroblasts. Incubations of cells with the selective Rho GTPase inhibitor C3-transferase (C3T) upregulated the binding, lysosomal degradation and cell accumulation of labelled LDL. The rate of internalisation of surface-bound LDL was also higher in C3T-treated cells. Single cell injections with C3T and dominant active V14Rho confirmed the negative regulation of LDL uptake by Rho. While cells injected with C3T internalised more 1,1'-dioctadecyl-3,3,3',3'-tetramethylindocarbocyanine perchlorate (diI)-labelled LDL, diI-LDL internalisation was dramatically suppressed in cells injected with the constitutively active V14Rho. The negative regulation of LDL uptake by Rho appeared to be independent of changes in the actin cytoskeleton. An increasing number of naturally occurring toxins and serum factors have been shown to influence Rho GTPase signalling cascades. The herein described post-translational regulation of LDL internalisation may modulate cell events occurring subsequent to cellular lipoprotein uptake.

Yersinia enterocolitica invasin triggers phagocytosis via beta1 integrins, CDC42Hs and WASp in macrophages.

The Yersinia outer surface protein invasin binds to beta1 integrins on target cells and has been shown to trigger phagocytic uptake by macrophages. Here, we investigated the role of the actin regulator Wiskott-Aldrich syndrome protein (WASp), its effector the Arp2/3 complex and the Rho-GTPases CDC42Hs, Rac and Rho in invasin/beta1 integrin-triggered phagocytosis. During uptake of invasin-coated latex beads, the alpha5beta1 integrin, WASp and the Arp2/3 complex were recruited to the developing actin-rich phagocytic cups in primary human macrophages. Blockage of beta1 integrins by specific antibodies, inhibition of Arp2/3 function by microinjection of inhibitors or the use of WASp knockout macrophages inhibited phagocytic cup formation and uptake. Furthermore, microinjection of the dominant negative GTPase mutants N17CDC42Hs, N17Rac or the Rho-specific inhibitor C3-transferase into macrophages greatly attenuated invasin-induced formation of cups. These data suggest that during invasin-triggered phagocytosis beta1 integrins activate actin polymerization via CDC42Hs, its effector WASp and the Arp2/3 complex. The contribution of Rac and Rho to phagocytic cup formation also suggests a complex interplay between different Rho GTPases during phagocytosis of pathogens.

Modulation of Rho GTPases and the actin cytoskeleton by Yersinia outer proteins (Yops).

Pathogenic species of the genus Yersinia employ a type III secretion apparatus to inject up to six effector proteins (Yersinia outer proteins; Yops) into host cells. Thereby yersiniae disarm the immune cell system of the host to proliferate extracellularly. At least four of the Yop effectors (YopE, YpkA/YopO, YopT and YopH) are involved in the rearrangement of the actin cytoskeleton: YopE, YopT and YpkA/YopO modulate the activity of actin-regulating Rho GTP-binding proteins, whereas YopH dephosphorylates phospho-tyrosine residues in focal adhesion proteins. In this review we will focus on recent evidence implicating Rho GTPases and the actin cytoskeleton as major targets of Yersinia Yops.