Molecular surveillance of multidrug-resistant Gram-negative bacteria in Ukrainian patients, Germany, March to June 2022.

BackgroundSince the beginning of the war in Ukraine in February 2022, Ukrainians have been seeking shelter in other European countries.AimWe aimed to investigate the prevalence and the molecular epidemiology of multidrug-resistant Gram-negative (MDRGN) bacteria and meticillin-resistant Staphylococcus aureus (MRSA) in Ukrainian patients at admittance to the University Hospital Frankfurt, Germany.MethodsWe performed screening and observational analysis of all patients from March until June 2022. Genomes of MDRGN isolates were analysed for antimicrobial resistance, virulence genes and phylogenetic relatedness.ResultsWe included 103 patients (median age: 39 ±â€¯23.7 years), 57 of whom were female (55.3%; 95% confidence interval (CI): 45.2-5.1). Patients were most frequently admitted to the Department of Paediatrics (29/103; 28.2%; 95% CI: 19.7-37.9). We found 34 MDRGN isolates in 17 of 103 patients (16.5%; 95% CI: 9.9-25.1). Ten patients carried 21 carbapenem-resistant (CR) bacteria, five of them more than one CR isolate. Four of six patients with war-related injuries carried eight CR isolates. In six of 10 patients, CR isolates caused infections. Genomic characterisation revealed that the CR isolates harboured at least one carbapenemase gene, bla NDM-1 being the most frequent (n = 10). Core genome and plasmid analysis revealed no epidemiological connection between most of these isolates. Hypervirulence marker genes were found in five of six Klebsiella pneumoniae CR isolates. No MRSA was found.ConclusionHospitals should consider infection control strategies to cover the elevated prevalence of MDRGN bacteria in Ukrainian patients with war-related injuries and/or hospital pre-treatment and to prevent the spread of hypervirulent CR isolates.

[Multidrug Resistant Organisms (MDRO) in Rehabilitation: Prevalence and Risk Factors for MRGN and VRE]. / Multiresistente Erreger (MRE) in der Rehabilitation: Prävalenz und Risikofaktoren für MRGN und VRE.

BACKGROUND: After a first large-scale study on multi-drug resistant organisms (MDRO) in rehabilitation facilities in 2014, the Rhine-Main network on MDRO carried out another investigation in 2019. With regard to the recently published KRINKO recommendations on multidrug resistant enterococci, now vancomycin -resistant enterococci (VRE) and multi-drug resistant gram-negative pathogens (3MRGN and 4MRGN, i. e. gramnegative organisms resistant against 3 resp. 4 groups of antiinfectiva) were investigated. MATERIAL AND METHODS: A total of 16 hospitals took part, including one clinic for early neurological rehabilitation (ENR). Patient participation was voluntary. Rectal swabs were analyzed in a medical-microbiological laboratory (certified according to DIN ISO 15189) using standard methods (including MALDI-TOF-MS and VITEK 2 resistance testing according to EUCAST). By using the standardized questionnaire of the Europe-wide HALT examination (healthcare associated infections in long-term care facilities), patient characteristics (age, gender, hospital, surgical and MDRO medical history, Medical devices, current antibiotic therapy etc.) were collected. RESULTS: 928 patients took part in the study, 895 from general rehabilitation facilities (GR) and 33 from early neurological rehabilitation (ENR). 65% of GR patients (ENR 100%) had been hospitalized in the previous 6 months, 29% (ENR 100%) of the patients had been admitted directly from a hospital, 22% (ENR 64%) had received antibiotic therapy in the last 3 months. Medical devices were rarely used in GR patients with 1% overall, but often in the ENR with 61% urinary catheters and 36% vascular catheters. 2.2% (ENR 33.3%) of GR patients were colonized with VRE and 6.7% (ENR 18.2%) with 3MRGN; one patient exhibited a 4MRGN (ENR 0). DISCUSSION: Compared to our previous study, there were no significant changes in the patient characteristics. The VRE prevalence was low at 3.3%, the prevalence of 3MRGN was higher compared to 2014 (7.1% vs. 3.6%). Risk factors for VRE and 3MRGN colonization (significant increased odds ratio) were: history of hospital treatment and an increased need for care due to restricted mobility, incontinence and disorientation. In addition, previous antibiotic treatment and skin barrier injuries due to Medical devices or wounds were detected as further risk factors for VRE colonization.

Noninvasive screening identifies patients at risk for spontaneous bacterial peritonitis caused by multidrug-resistant organisms.

BACKGROUND AND AIMS: Spontaneous bacterial peritonitis (SBP) is a severe complication of decompensated cirrhosis. The prevalence of multidrug-resistant organisms (MDROs) in patients with cirrhosis is increasing. Identification of patients at risk for SBP due to MDROs (ie, SBP with the evidence of MDROs or Stenotrophomonas maltophilia in ascitic culture, MDRO-SBP) is crucial to the early adaptation of antibiotic treatment in such patients. We therefore investigated whether MDROs found in ascitic cultures can also be found in specimens determined by noninvasive screening procedures. PATIENTS AND METHODS: This retrospective study was conducted at the liver center of the University Hospital Frankfurt, Germany. Between 2011 and 2016, patients with cirrhosis were included upon diagnosis of SBP and sample collection of aerobic/anaerobic ascitic cultures. Furthermore, the performance of at least one complete MDRO screening was mandatory for study inclusion. RESULTS: Of 133 patients diagnosed with SBP, 75 (56.4%) had culture-positive SBP and 22 (16.5%) had MDRO-SBP. Multidrug-resistant Escherichia coli (10/22; 45.5%) and vancomycin-resistant enterococci (7/22; 36.4%) resembled the major causatives of MDRO-SBP. Rectal swabs identified MDROs in 17 of 22 patients (77.3%) who developed MDRO-SBP with a time-dependent sensitivity of 77% and 87% after 30 and 90 days upon testing, while negative predictive value was 83% and 76%, respectively. The majority of patients were included from intensive care unit or intermediate care unit. CONCLUSION: MDRO screening may serve as a noninvasive diagnostic tool to identify patients at risk for MDRO-SBP. Patients with decompensated cirrhosis should be screened for MDROs from the first day of inpatient treatment onward.

Severe infection with multidrug-resistant Salmonella choleraesuis in a young patient with primary sclerosing cholangitis.

Massive global spread of multidrug-resistant (MDR) Salmonella spp. expressing extended-spectrum beta-lactamase (ESBL) and additional resistance to fluoroquinolones has often been attributed to high international mobility as well as excessive use of oral antibiotics in livestock farming. However, MDR Salmonella spp. have not been mentioned as a widespread pathogen in clinical settings so far. We demonstrate the case of a 25-year-old male with primary sclerosing cholangitis who tested positive for MDR Salmonella enterica serotype Choleraesuis expressing ESBL and fluoroquinolone resistance. The pathogen was supposedly acquired during a trip to Thailand, causing severe fever, cholangitis and pancreatitis. To our knowledge, this is the first report of Salmonella enterica serotype Choleraesuis in Europe expressing such a multidrug resistance pattern. ESBL resistance of Salmonella enterica spp. should be considered in patients with obstructive biliary tract pathology and travel history in endemic countries.

Influence of antibiotic-regimens on intensive-care unit-mortality and liver-cirrhosis as risk factor.

AIM: To assess the rate of infection, appropriateness of antimicrobial-therapy and mortality on intensive care unit (ICU). Special focus was drawn on patients with liver cirrhosis. METHODS: The study was approved by the local ethical committee. All patients admitted to the Internal Medicine-ICU between April 1, 2007 and December 31, 2009 were included. Data were extracted retrospectively from all patients using patient charts and electronic documentations on infection, microbiological laboratory reports, diagnosis and therapy. Due to the large hepatology department and liver transplantation center, special interest was on the subgroup of patients with liver cirrhosis. The primary statistical-endpoint was the evaluation of the influence of appropriate versus inappropriate antimicrobial-therapy on in-hospital-mortality. RESULTS: Charts of 1979 patients were available. The overall infection-rate was 53%. Multiresistant-bacteria were present in 23% of patients with infection and were associated with increased mortality (P < 0.000001). Patients with infection had significantly increased in-hospital-mortality (34% vs 17%, P < 0.000001). Only 9% of patients with infection received inappropriate initial antimicrobial-therapy, no influence on mortality was observed. Independent risk-factors for in-hospital-mortality were the presence of septic-shock, prior chemotherapy for malignoma and infection with Pseudomonas spp. Infection and mortality-rate among 175 patients with liver-cirrhosis was significantly higher than in patients without liver-cirrhosis. Infection increased mortality 2.24-fold in patients with cirrhosis. Patients with liver cirrhosis were at an increased risk to receive inappropriate initial antimicrobial therapy. CONCLUSION: The results of the present study report the successful implementation of early-goal-directed therapy. Liver cirrhosis patients are at increased risk of infection, mortality and to receive inappropriate therapy. Increasing burden are multiresistant-bacteria.