Clinical relevance of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin susceptible Staphylococcus aureus (MSSA) for mothers during pregnancy.

PURPOSE: The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated. METHODS: From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included. RESULTS: Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p < 0.05). MSSA colonization was significantly associated with self-reported respiratory diseases during pregnancy (p < 0.05), but AMRB/MSSA colonization was not statistically associated with other types of infection. CONCLUSION: Our results demonstrate a low overall rate of colonization with AMRB/MSSA, as well as a low percentage of colonized pregnant women who developed infections. Multiparous women are at higher risk for colonization with MSSA/MRSA or ESBL. Because the prevalence of AMRB/MSSA is low, this study suggests that general screening of pregnant women without risk factors is not recommended.

Evaluation of sampling locations in pregnant women and newborns for the detection of colonisation with antibiotic-resistant bacteria.

Up to now, little has been known about the prevalence and clinical relevance of colonisation of asymptomatic pregnant women with methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli. In this two-centre cross-sectional study, we evaluated the performance and importance of screening at different times and different locations for colonisation in pregnant women and newborns. Between October 2013 and December 2015, four samples were collected from pregnant women, two from newborns at birth and three from 3-day-old newborns. Samples were screened on culturing media and were confirmed with molecular methods. MSSA was used as a surrogate for MRSA, as the two share most microbiologic characteristics and colonisation patterns. Of 763 pregnant women, 14.5% (111) were colonised with MSSA, 0.4% (3) with MRSA and 2.6% (20) with ESBL-producing E. coli. Of 658 newborns, 0.9% (10) were colonised with MSSA at birth and 13.1% (70) at 3 days old, 0.5% (3) were colonised with MRSA and 2.6% (17) with ESBL-producing E. coli. Nasal sampling identified 91.0% of MSSA-colonised pregnant women and 60.0% of newborns. In newborns, nasal and umbilical sampling at 3 days after birth discovered 84.0% of colonised cases. For ESBL-producing E. coli, the perianal region was positive in all colonised pregnant women and in 88.2% of colonised newborns. Combining nasal and perianal swabs is optimal when screening for antibiotic-resistant bacteria in pregnant women. Nasal, perianal and umbilical sample collection from 3-day-old newborns significantly increased the sensitivity compared to screening immediately after birth.

[Taking Care of Asylum Seekers: Occupational Health Aspects with a Special Focus on Vaccination]. / Arbeitsmedizinische Aspekte und Impfschutz beim Umgang mit Asylbewerbern.

Employees and volunteers often feel insecure about the potential transmission of infectious diseases when taking care of asylum seekers. It could be shown that overall only a minor risk of infection emanates from asylum seekers. However, aspects of occupational health and vaccination should be kept in mind.Besides the standard vaccination the Standing Committee on Vaccination (STIKO) recommends for occupational indication, which is given for employees and volunteers in asylum facilities, vaccination against hepatitis A, hepatitis B, polio (if the last vaccination was more than 10 years before) as well as influenza (seasonal).According to the German Occupational Safety and Health Act taking care of the employer has to determine which exposures might occur at the workplace (risk assessment) and define necessary protection measures. Depending on task and exposure when taking care of asylum seekers different acts (e. g. biological agents regulation) and technical guidelines for the handling biological agents (e. g. TRBA 250 or TRBA 500) have to be applied.The Bavarian Health and Food Safety Authority (LGL) has published several information sheets regarding "asylum seekers and health management" for employees and volunteers from the non-medical as well as the medical area (www.lgl.bayern.de search term "Asylbewerber"). With theses publications insecurities in taking care of asylum seekers should be prevented. Furthermore the employer gets support in the implementation of legal obligations to ensure occupational safety for the employees.

Possible human-to-human transmission of toxigenic Corynebacterium ulcerans.

Toxigenic Corynebacterium ulcerans is an emerging cause of diphtheria. In contrast to the classical diphtheria pathogen C. diphtheriae, human-to-human transmission of this primarily zoonotic pathogen has not been clearly documented. Here we report on a two-person cluster suggesting an initial zoonotic and a subsequent human-to-human transmission event.

[Nasal, pulmonary, and abomasal aspergillosis (Aspergillus fumigatus) in a calf]. / Nasale, pulmonale und abomasale Aspergillose (Aspergillus fumigatus) bei einem Kalb.

This study presents a case of nasal aspergillosis in a 17-days old calf (German Fleckvieh): it had been admitted moribund to the Clinic for Ruminants of the University of Munich, and died after a short time. Pathologically, the calf was diagnosed with purulent-necrotizing rhinitis, necrotizing pneumonia, and diphtheroid-necrotizing abomasitis. Histologically, fungal elements were found in all the localizations mentioned before, and mycologically, Aspergillus fumigatus was cultured from nasal cavity. Pathogenesis is discussed.

Corynebacterium species nasal carriage in pigs and their farmers in Bavaria, Germany: implications for public health.

Reports on cases of human diphtheria caused by toxigenic Corynebacterium ulcerans that were linked to occupational swine contact as well as isolation of C ulcerans from wild boars have suggested that pigs might serve as reservoir for human infections. Therefore, a prevalence study on Corynebacterium species nasal carriage in pigs and their farmers was performed between August 1 and December 31, 2009, in 41 swine farms from Bavaria, Germany. All 411 asymptomatic pigs and 29 of 30 healthy farmers were colonised with Corynebacterium strains of up to 11 different species. No potentially toxigenic Corynebacterium strain was isolated either from the pigs or from their farmers, respectively. The patterns of the species composition in the pigs and the farmers were very similar, suggesting a potential transmission of strains between animals and humans.

Occurrence of zoonotic clostridia and Yersinia in healthy cattle.

Zoonotic pathogens are a frequent cause of disease worldwide. This study was designed to determine the occurrence of Clostridium difficile, Clostridium botulinum, and Yersinia enterocolitica in cattle in southern Bavaria, Germany. The study population included 49 farms; 34 were dairy farms (30 also fattening beef cattle) and 15 were solely beef cattle farms. Fecal and dust samples were collected from summer 2011 to summer 2012 and analyzed using a combination of enrichment procedures and real-time PCR. For the detection of C. difficile, samples were screened for the presence of the tpi gene and toxin genes tcdA, tcdB, and cdtA. Samples also were screened for genes for C. botulinum toxins A through F and for the ail gene of Y. enterocolitica. Of 506 samples, C. difficile genes were found in 29 samples (5.7%): 25 samples from dairy farms and 4 samples from beef cattle farms. Toxin genes were identified in 17 samples, with toxigenic profiles of A(+)B(+)CDT(-), A(+)B(-)CDT(+), and A(+)B(+)CDT(+). C. botulinum toxin genes were not detected in fecal samples from cattle, but the gene for toxin B was detected in 1 (0.8%) of 125 dust samples. Y. enterocolitica genes were found in 6 (1.6%) of 382 fecal samples from three dairy farms and one beef cattle farm. This study revealed that C. difficile and Y. enterocolitica are rare on cattle farms in Bavaria, Germany. In contrast to results of previous studies, C. botulinum was not detected in fecal samples but was found very rarely in dust samples from the cattle environment.

Prevalence of extended-spectrum ß-lactamase-producing Escherichia coli on Bavarian dairy and beef cattle farms.

Extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli strains are believed to be widely distributed among humans and animals; however, to date, there are only few studies that support this assumption on a regional or countrywide scale. Therefore, a study was designed to assess the prevalence of ESBL-producing E. coli in dairy cows and beef cattle in the southern part of Bavaria, Germany. The study population included 30 mixed dairy and beef cattle farms and 15 beef cattle farms. Fecal samples, boot swabs, and dust samples were analyzed for ESBL-producing E. coli using selective media. PCR was performed to screen for CTX-M and ampC resistance genes. A total of 598 samples yielded 196 (32.8%) that contained ESBL-producing E. coli, originating from 39 (86.7%) of 45 farms. Samples obtained from mixed farms were significantly more likely to be ESBL-producing E. coli positive than samples from beef cattle farms (fecal samples, P < 0.001; boot swabs, P = 0.014; and dust samples, P = 0.041). A total of 183 isolates (93.4%) of 196 ESBL-producing E. coli-positive strains harbored CTX-M genes, CTX-M group 1 being the most frequently found group. Forty-six additional isolates contained ampC genes, and 5 of the 46 isolates expressed a blaCMY-2 gene. The study shows that ESBL-producing E. coli strains are commonly found on Bavarian dairy and beef cattle farms. Moreover, to our knowledge, this is the first report of the occurrence of blaCMY-2 in cattle in Germany.

Two cases of cutaneous diphtheria associated with occupational pig contact in Germany.

In 2010, two independent cases of cutaneous diphtheria caused by toxigenic C. ulcerans were identified in Germany. Both patients had intense occupational contact with pigs. Diagnostic work-up comprising biochemical differentiation, rpoB sequencing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) analysis, real-time tox PCR and Elek test as well as public health measures including an intensified source tracing involving 83 asymptomatic pigs of an associated pig farm are presented.

Fatal anthrax infection in a heroin user from southern Germany, June 2012.

Blood cultures from a heroin user who died in June 2012, a few hours after hospital admission, due to acute septic disease, revealed the presence of Bacillus anthracis. This report describes the extended diagnosis by MALDI-TOF and real-time PCR and rapid confirmation of the anthrax infection through reference laboratories. Physicians and diagnostic laboratories were informed and alerted efficiently through the reporting channels of German public health institutions, which is essential for the prevention of further cases.

Culture and molecular method for detection of Mycobacterium tuberculosis complex and Mycobacterium avium subsp. paratuberculosis in milk and dairy products.

A combined molecular and cultural method for the detection of the Mycobacterium tuberculosis complex (MTBC) and Mycobacterium avium subsp. paratuberculosis was developed and tested with artificially contaminated milk and dairy products. Results indicate that the method can be used for a reliable detection as a basis for first risk assessments.

Matrix-assisted laser desorption/ionisation time-of-flight (MALDI-TOF) mass spectrometry as a tool for rapid diagnosis of potentially toxigenic Corynebacterium species in the laboratory management of diphtheria-associated bacteria.

The rapid identification of the potentially toxigenic Corynebacterium species, C. diphtheriae, C. ulcerans and C. pseudotuberculosis is essential for diagnosis and treatment of diphtheria and diphtheria-like diseases. We used matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDIT-OF MS) in comparison with classical microbiological and molecular methods on 116 Corynebacterium strains. All 90 potentially toxigenic Corynebacterium strains collected by the German National Consiliary Laboratory on Diphtheria in a period of more than ten years were correctly identified by MALDI-TOF MS. We propose an algorithm for fast and reliable diagnosis of diphtheria incorporating MALDI-TOF MS, real-time tox PCR and Elek testing.

Metabolites of Monascus ruber in silages.

A total of 233 silages were examined and found that Monascus ruber was present in 43 samples with counts between 1 x 10(3) and 9 x 10(6) colony-forming units (CFU)/g (mean: 2 x 10(5) CFU/g). Monacolin K(L) and the hydroxy acid monacolin K(A) were detected by liquid chromatography-mass spectrometry in 45 and 50 of 233 samples at levels ranging from 25-15 600 and 28-65 400 microg/kg, respectively. Citrinin was found with high-performance liquid chromatography-fluorescence detection (FLD) in 14 (6%) samples, the concentrations varied between 2.4 and 64.2 microg/kg. The concentrations of citrinin were low and toxic effects are not anticipated. Monacolin K(A) and monacolin K(L) occur frequently and in considerable amounts in silages. These metabolites are believed to influence the metabolic activity of rumen anaerobic fungi resulting in a poorer digestion of crude fibre.

Isolation of Vibrio alginolyticus from seawater aquaria.

The seawater bacterium Vibrio alginolyticus was detected in 5 of 20 water samples from seawater aquaria (from 3 of 5 units) and also from the surface of diseased stony corals. A total of 45 isolates were differentiated biochemically, of which 13 isolates (29%) proved to be V. alginolyticus. All those strains produced the virulence factors caseinase and lipase, 11 strains amylase and gelatinase. 7 strains showed lecithinase activity and 2 strains produced hemolysins. All examined strains showed a marked toxicity to vero cells proven by the MTT-bioassay, but no toxicity to plant cells with the saline alga Asteromonas gracilis as model. The isolates were mostly resistant to beta-lactam antibiotics, macrolides and lincomycin. However, they proved to be susceptible to aminoglycoside- and polypeptide-antibiotics as well as to tetracyclines, chloramphenicol, florfenicol, enrofloxacin and sulfamethoxazol-trimethoprim. The possible participation of this bacterium in the bleaching and dying of stony corals is mentioned as well as its role as human pathogen.

Mycophenolic acid in silage.

We examined 233 silage samples and found that molds were present in 206 samples with counts between 1 x 10(3) and 8.9 x 10(7) (mean, 4.7 x 10(6)) CFU/g. Mycophenolic acid, a metabolite of Penicillium roqueforti, was detected by liquid chromatography-mass spectrometry in 74 (32%) of these samples at levels ranging from 20 to 35,000 (mean, 1,400) microg/kg. This compound has well-known immunosuppressive properties, so feeding with contaminated silage may promote the development of infectious diseases in livestock.

[Resistance of bovine and porcine Pasteurella to florfenicol and other antibiotics]. / Zur Resistenz boviner und porciner Pasteurellen gegenüber Florfenicol und anderen Antibiotika.

The resistance pattern of 221 (89 bovine, 132 porcine) pasteurella strains isolated in 1996 against 16 antibiotics or chemotherapeutics was determined by agar diffusion. Pasteurella haemolytica showed a higher level of resistance compared to Pasteurella multocida; porcine strains were more resistant than bovine strains. Over 90% of porcine Pasteurella multocida were sensible to penicillin G, ampicillin, cephalothin, polymyxin B, enrofloxacin, chloramphenicol and florfenicol. In addition, bovine strains were at least 90% sensible to oxacillin, erythromycin, gentamycin and sulfmethoxazole-trimethoprim. More than 90% of porcine Pasteurella haemolytica were classified as sensible to polymyxin B, enrofloxacin und florfenicol; bovine strains to cephalothin, neomycin und chloramphenicol as well. In 1996, 2 years after the chloramphenicol ban for food rendering animals, only 6.3% of bovine pasteurella strains proved to be resistant against chloramphenicol compared to a 16.27% fraction in 1994. The mean MIC-values of florfenicol against pasteurella spp. were nearly the same in bovine and porcine isolates with 0.53 microgram/ml and 0.52 microgram/ml respectively. Pasteurella haemolytica, however, showed higher MIC-values (0.68 microgram/ml in bovine, 0.70 microgram/ml in porcine isolates) than Pasteurella multocida with 0.47 microgram/ml in bovine and 0.51 microgram/ml in porcine strains. No isolate had a MIC of florfenicol greater than 1.0 microgram/ml, all pasteurella strains were classified sensible to florfenicol.

[Food hygiene aspects in the production of food fish in fishing]. / Lebensmittelhygienische Aspekte bei der Gewinnung von Speisefischen in der Angelfischerei.

The development of the aerob-mesophilic bacteria on epidermis and peritoneum of 68 barbels was determined at 0, 4 and 8 hours after slaughtering. Therefore, one group of 34 animals was stored at 15.3 degrees C, an other equal one at 21.6 degrees C. A change in germ counts per cm2 could be seen in none of the groups during the first 4 hours. However, unrefrigerated carcasses showed an increase of bacteria up to 5-fold between the 4th and 8th hour, whereas in the refrigerated group no change occurred during that time, too. Rinsing the fish after slaughtering resulted in a decrease of the initial bacterial counts by up to 65.4% and so in significantly lower germ loads at the end of the storage time. These results were confirmed by contaminating 24 rainbow trout with Salmonella Infantis artificially. The frequency of detection did not change in refrigerated fish over 8 hours, while nearly doubling in unrefrigerated ones. Moreover, it could be shown that a Salmonella-concentration of only 30 CFU per 100 ml water was sufficient for contaminating fish in detectable grades. The study leads to the conclusion that the storage of instantly slaughtered fish in a common thermobox with freezing elements is suited for preserving its microbiological status for at least 8 hours. The caging of living fish after capture, which must be regarded critically under the aspect of treating animals in a humane way, seems therefore unnecessary.

Expression of the hepatitis B surface antigen (HbsAg) under the control of mMT-I promoter in transgenic mice can be induced by zinc sulphate, dexamethasone and lipopolysaccharide.

SUMMARY: Metallothionein genes can be induced in vivo by heavy metals, glucocorticoids, and toxins. In all transgenic mice carrying the MT-I promoter, that have been reported so far, induction by glucocorticoids failed. This study reports two mouse lines, transgenic for the murine MT-I-HBV (hepatitis B virus; map position site: 30-1986) construct, which secrete the viral surface antigen (HBsAg) in their serum. In both lines, males produce more HBsAg than females, and in all cases the MT-I promoter can be induced by dexamethasone, lipopolysaccharide (LPS), and heavy metals. A glucocorticoid-responsive element, which is situated in the HBV fragment used, can explain the dexamethasone induction of the MT-I promoter. ZUSAMMENFASSUNG: Expression des Hepatitis B oberflächen Antigens (HBsAg) unter Kontrolle des mMT-I Promoters kann in transgenen Mäusen durch Zink Sulfat, Dexamethason und Lipopolysacchariden induziert werden Metallothioneingene werden in vivo durch Schwermetalle, Glucocorticoide und Toxine induziert. Soweit bisher bekannt, konnte jedoch in transgenen Mäusen mit dem MT-I-Promotor keine Expression durch Glucocorticioide beobachtet werden. Wir berichten hier von zwei transgenen Mäuselinien mit dem murinen MT-I-Promotor, der das Oberflächenantigen des Hepatitis B Virus (HbsAg, map position site 30-1986) exprimierte. In beiden Linien produzierten die männlichen Tiere mehr HBsAg im Blutserum als die weiblichen. Ohne Ausnahme reagierte der MT-I-Promotor bei Applikation von Dexamethason, Lipopolysaccharid (LPS) und Schwermetall. Ein Glucocorticoid-responsives Element in den HBV-Sequenzen kann die Induktion des MT-I-Promotors erklären.