Background In September 2018, Burkholderia cepacia complex (BCC) infections of three patients associated with exposure to a mouthwash solution (MWS) were notified to the Robert Koch Institute (RKI). As the product was still in the market and scale of the outbreak unclear a nation-wide investigation was initiated. Methods We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme. Results In total, 36 patients from six hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed two distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from four hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia). Conclusion The combined clinical, epidemiological and microbiological investigation, including whole genome analysis, allowed for uncovering a supraregional BCC outbreak in healthcare settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018 the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.

Background Antimicrobial resistance (AMR) causes substantial health and economic burden to individuals, healthcare systems and societies globally. Understanding the temporal relationship between antibiotic consumption and antibiotic resistance in hospitalized patients can better inform antibiotic stewardship activities and the time frame for their evaluation. Objectives This systematic review examined the temporal relationship between antibiotic use and development of antibiotic resistance for 42 pre-defined antibiotic and pathogen combinations in hospitalized adults in Europe. Methods Searches in MEDLINE, Embase, Cochrane Library and NIHR Centre for Reviews and Dissemination were undertaken from 2000 to August 2021. Pathogens of interest were Escherichia coli, Klebsiella pneumoniae, Streptococcus pneumoniae, Staphylococcus aureus, Enterococcus faecium, CoNS, Pseudomonas aeruginosa and Acinetobacter baumannii complex. Results Twenty-eight ecological studies and one individual-level study were included. Ecological studies were predominantly retrospective in design (19 studies) and of reasonable (20 studies) to high (8 studies) methodological quality. Of the eight pathogens of interest, no relevant data were identified for S. pneumoniae and CoNS. Across all pathogens, the time-lag data from the 28 ecological studies showed a similar pattern, with the majority of studies reporting lags ranging from 0 to 6 months. Conclusions Development of antibiotic resistance for the investigated antibiotic/pathogen combinations tends to occur over 0 to 6 months following exposure within European hospitals. This information could inform planning of antibiotic stewardship activities in hospital settings.

ZusammenfassungDie COVID-19-Pandemie hat die Vulnerabilität der Alten- und Pflegeheimbewohnenden aufgrund ihres erhöhten Risikos für einen schwerwiegenden oder tödlichen COVID-19-Verlauf verdeutlicht. Um die Bewohnenden in den Einrichtungen in Anbetracht hoher Inzidenzen von severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) in der Gesamtbevölkerung zu schützen, wurde eine Reihe von Infektionsschutzmaßnahmen empfohlen, die im Verlauf der Pandemie zu einem Rückgang der COVID-19-Fälle und -Todesfälle in den Einrichtungen geführt haben. Gleichzeitig hat sich jedoch gezeigt, dass in Alten- und Pflegeheimen häufig einige Faktoren existieren, welche die Umsetzung von Infektionsschutzmaßnahmen erschweren und einen erheblichen Einfluss auf die Gesundheit der Bewohnenden ausüben.Herausforderungen ergeben sich vor allem durch die Arbeitsbedingungen (Mangel an Personal grundsätzlich und mit entsprechenden Qualifikationen, arbeitsbedingte Belastungen), durch die Versorgung der Bewohnenden (medizinisch und psychosozial) sowie durch strukturelle und einrichtungsspezifische Faktoren (u. a. Größe von Heimen).Lösungskonzepte für diese Probleme zeigen, dass die Umsetzung von Infektionsschutzmaßnahmen nicht für sich alleine steht, sondern als Teil eines Konzeptes zur Neugestaltung der Arbeits‑, Wohn- und Lebensbereiche der Beschäftigten und der Bewohnenden der Einrichtungen betrachtet werden sollte. Dabei gilt es, den Infektionsschutz in Alten- und Pflegeheimen nicht ausschließlich in Hinblick auf zukünftige Pandemien zu planen, sondern dessen Relevanz auch für bereits jetzt bestehende Gesundheitsgefahren, wie nosokomiale Infektionen, Antibiotikaresistenzen oder Influenza, zu beachten.