Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals

Abstract

BackgroundInfections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the 3GCREB infection incidence and compare it to prevalence upon admission. In addition, we aim to describe infections caused by 3GCREB, which are also carbapenem resistant (CRE).MethodsIn 2014–2015, we performed prospective 3GCREB surveillance in clinically relevant patient specimens (screening specimens excluded). Infections counted as hospital-acquired (HAI) when the 3GCREB was detected after the third day following admission, otherwise as community-acquired infection (CAI).ResultsOf 578,420 hospitalized patients under surveillance, 3367 had a 3GCREB infection (0.58%). We observed a similar 3GCREB CAI and HAI incidence (0.28 and 0.31 per 100 patients, respectively). The most frequent pathogen was 3GCR E. coli, in CAI and HAI (0.15 and 0.12 per 100 patients). We observed a CRE CAI incidence of 0.006 and a HAI incidence of 0.008 per 100 patients (0.014 per 1000 patient days).ConclusionsComparing the known 3GCREB admission prevalence of the participating hospitals (9.5%) with the percentage of patients with a 3GCREB infection (0.58%), we conclude the prevalence of 3GCREB in university hospitals to be about 16 times higher than suggested when only patients with 3GCREB infections are considered. Moreover, we find the HAI and CAI incidence caused by CRE in Germany to be relatively low.

Antimicrobial resistance in southern China: results of prospective surveillance in Dongguan city, 2017

“…Incidence proportions of CAI (number per 100 admissions) as well as incidence densities of HCAI (number per 1000 patient-days) due to AMR pathogens were calculated [13]. HCAIs due to E. coli and K. pneumoniae non-susceptible to third-generation cephalosporins (3GC), fluoroquinolones, carbapenems, or any combination of these agents were compared with a multicentre surveillance report, performed in Germany in 2014/2015 [14]. Bloodstream infections due to AMR pathogens were calculated following the EARS-Net protocol for pathogeneresistance combinations [13].…”

“…Healthcare-associated infections due to AMR E. coli and AMR K. pneumoniae were compared with German surveillance data using Pearson's c 2 -test [14]. Bloodstream infections due to MDR pathogens were compared with the EARS-Net data using Fisher's exact test [7].…”

“…Summary reports of CARSS and CHINET are published annually on the official website of the National Health Commission of the People's Republic of China, and in the Chinese Journal of Infection and Chemotherapy [10,11]. From an IPC perspective, there are gaps in reports on infections due to AMR pathogens in Mainland China: (i) most publications in China focus on molecular characteristics rather than on epidemiology [12]; (ii) pooled data on antimicrobial resistance are not de-duplicated [13]; (iii) data on infections due to AMR pathogens are not stratified into HCAI and communityassociated infection (CAI) [14]; and (iv) data analysis does not address AMR combinations [7,11,12].…”

“…The aims of this study were: (i) to summarize incidence proportions of pooled antimicrobial resistance data in Dongguan city of Guangdong province in 2017 and to compare the results with the 2017 CHINET report [11]; (ii) to calculate incidence proportions of CAI and incidence densities of HCAI due to AMR pathogens and to compare the results for HCAI with data from Germany [14]; and (iii) to calculate incidence proportions of bloodstream infection (BSI) due to AMR pathogens in tertiary care hospitals and to compare the results with the 2017 EARS-Net report [7].…”

Prevalence and risk factors of colonisation with vancomycin-resistant Enterococci faecium upon admission to Germany’s largest university hospital

“…Our study is based on a sub-population of the Antibiotic Therapy Optimization Study (ATHOS), which was conducted in six German university hospitals from January 1, 2014 to December 31, 2015 [ 15 ], [ 16 ]. The Charité is one of Europe’s largest university hospitals with about 3,000 beds distributed over three separate clinic sites.…”