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Invasive infections with Mycobacterium chimaera were reported in patients with previous open chest surgery and exposure to contaminated heater-cooler units (HCUs). We present results of the surveillance of clinical cases and of contaminated HCUs as well as environmental investigations in Germany up until February 2016. Clinical infections occurred in five male German cases over 50 years of age (range 53-80). Cases had been exposed to HCUs from one single manufacturer during open chest surgery up to five years prior to onset of symptoms. During environmental investigations, M. chimaera was detected in samples from used HCUs from three different countries and samples from new HCUs as well as in the environment at the manufacturing site of one manufacturer in Germany. Our investigation suggests that at least some of the M. chimaera infections may have been caused by contamination of HCUs at manufacturing site. We recommend that until sustainable measures for safe use of HCUs in operation theatres are implemented, users continue to adhere to instructions for use of HCUs and Field Safety Notices issued by the manufacturer, implement local monitoring for bacterial contamination and continuously check the websites of national and European authorities for current recommendations for the safe operation of HCUs.

To investigate the occurrence of different Klebsiella spp. in aquatic environments, a total of 208 samples of natural surface waters was examined. From half (53%) of these samples, 123 Klebsiella strains were isolated, the most common species being Klebsiella pneumoniae. A comparison of these isolates to a group of 207 clinical K. pneumoniae isolates demonstrated that water isolates of K. pneumoniae, unlike those of K. oxytoca and K. planticola, are as capable as clinical isolates of expressing putative virulence factors such as serum resistance and capsular polysaccharides, pili, and siderophores.

We determined the presence of extended-spectrum-␤-lactamase (ESBL)-producing Escherichia coli among 3,344 study participants from the German community. Intestinal colonization was detected in 211 persons (6.3%), without significant differences among the different age groups. The majority (95.2%) of isolates harbored CTX-M-type ESBL, with CTX-M-15 (46%) and CTX-M-1 (24.2%) as the most common types. The finding of ESBL producers and one isolate additionally producing carbapenemase OXA-244 indicates a risk of dissemination of resistant bacteria outside the hospitals. Escherichia coli strains producing extended-spectrum ␤-lactamases (ESBLs) represent a major threat among the increasing number of drug-resistant Gram-negative bacteria (1). Fecal carriage of ESBL-producing E. coli has been described worldwide in hospitals and the ambulatory care setting (2-6) as well as in the community (7-9). A recent study investigating healthy infection control personnel (n ϭ 231) in Germany revealed that 3.5% are carriers of ESBL-producing E. coli (10). In the present study, we determined the fecal carriage rate of ESBL-producing E. coli in a large sample of persons from the German community, including molecular analysis of the isolates.From October 2009 to November 2012, we collected 3,344 nonreplicate fecal samples from individuals living in seven different areas of Bavaria (Upper Bavaria, 29.2%; Central Franconia, 20.8%; Upper Franconia, 15.0%; Upper Palatinate, 12.0%; Swabia, 10.8%; Lower Franconia, 9.0%; Lower Bavaria, 3.1%), Germany. The median age of the study participants was 32.0 years (range, 0 to 98 years), with a male/female ratio of 0.96. All probands had at the time of investigation a close contact to patients with bacterial gastroenteritis and were subsequently screened for fecal carriage of intestinal bacterial pathogens by 74 local health authorities. However, they did not show any symptoms related to gastroenteritis, and intestinal bacterial pathogens were not detected in any of these study participants. All 3,344 fecal samples were investigated for the presence of ESBL-producing E. coli by inoculation on MacConkey agar supplemented with cefotaxime (1 mg/liter). Identification to the species level was performed using API E strips (bioMérieux, Nürtingen, Germany), and ESBL production was confirmed by the combined disc method (Mast Diagnostica, Rheinfeld, Germany) using cefotaxime and ceftazidime with and without clavulanic acid. Susceptibility testing for 18 antimicrobial substances (ampicillin, cefotaxime, ceftriaxone, ceftazidime, cefepime, cefpodoxime, cefoxitin, ertapenem, imipenem, meropenem, aztreonam, amikacin, gentamicin, tetracycline, chloramphenicol, ciprofloxacin, nalidixic acid, and trimethoprim-sulfamethoxazole) was performed by disc diffusion (Oxoid Ltd., Basingstoke, United Kingdom), and interpretation was done according to EUCAST (http://www.eucast.org/clinical _breakpoints) and CLSI criteria (nalidixic acid, tetracycline) (11). E. coli isolates with the ESBL phenotype were investigated for the pres...

Exposure to human pathogenic viruses in recreational waters has been shown to cause disease outbreaks. In the context of Article 14 of the revised European Bathing Waters Directive 2006/7/EC (rBWD, CEU, 2006) a Europe-wide surveillance study was carried out to determine the frequency of occurrence of two human enteric viruses in recreational waters. Adenoviruses were selected based on their near-universal shedding and environmental survival, and noroviruses (NoV) selected as being the most prevalent gastroenteritis agent worldwide. Concentration of marine and freshwater samples was done by adsorption/elution followed by molecular detection by (RT)-PCR. Out of 1410 samples, 553 (39.2%) were positive for one or more of the target viruses. Adenoviruses, detected in 36.4% of samples, were more prevalent than noroviruses (9.4%), with 3.5% GI and 6.2% GII, some samples being positive for both GI and GII. Of 513 human adenovirus-positive samples, 63 (12.3%) were also norovirus-positive, whereas 69 (7.7%) norovirus-positive samples were adenovirus-negative. More freshwater samples than marine water samples were virus-positive. Out of a small selection of samples tested for adenovirus infectivity, approximately one-quarter were positive. Sixty percent of 132 nested-PCR adenovirus-positive samples analysed by quantitative PCR gave a mean value of over 3000 genome copies per L of water. The simultaneous detection of infectious adenovirus and of adenovirus and NoV by (RT)PCR suggests that the presence of infectious viruses in recreational waters may constitute a public health risk upon exposure. These studies support the case for considering adenoviruses as an indicator of bathing water q