Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015

Abstract

Many refugees arriving in Germany originate or have travelled through countries with high prevalence of multidrug-resistant Gram-negative organisms. Therefore, all unaccompanied refugee minors (<18 years-old) arriving in Frankfurt am Main between 12 October and 6 November 2015, were screened for multidrug-resistant Enterobacteriaceae in stool samples. Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) were detected in 42 of 119 (35%) individuals, including nine with additional resistance to fluoroquinolones (8% of total screened), thus exceeding the prevalences in the German population by far.

Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June‒December 2015

“…It is hard to estimate the whether the REF population in the UHF setting is representative of the overall refugee population in Germany. However, a study also conducted in Frankfurt am Main but in unaccompanied refugee minors (<18 years-old) in refugee centres also found a high prevalence of ESBL-producing Enterobacteriaceae (35%) even though lower than that in our study [17].…”

Author’s reply: Is there a need for special treatment of refugees at hospital admission?

“…We would like to thank Walter and colleagues for their comment [1] on our respective investigations published in Eurosurveillance [2,3]. While we agree with many of the statements made, we would nevertheless like to clarify the following points:…”

Letter to the editor: Is there a need for special treatment of refugees at hospital admission?

“…In addition, colonisation with ESBLproducing bacteria may also be high in some German populations. For example a study among travellers returning to Germany showed colonisation with ESBLproducing Escherichia coli in 30% [3], which is similar to that seen among refugee minors [2]. Screening is, however, not recommended for travellers returning to Germany.…”

“…To the editor: Two recent publications by Reinheimer et al and Heudorf et al in Eurosurveillance, provided data on multidrug-resistant bacteria obtained from screening of different refugee populations and concluded that additional screening or surveillance for refugees at hospital admission in Germany should be undertaken [1,2]. The high number of people currently migrating to Europe from disaster areas has sparked a debate, whether or not refugees should be screened at hospital admission for colonisation with multidrug-resistant bacteria to limit spread of antibiotic resistance within Europe.…”

“…Given the scarcity of available data in the scientific literature, the recently published articles by Reinheimer et al and Heudorf et al [1,2] are highly interesting. They show that in a sample of 143 adult refugees presenting at a German hospital as well as among 119 unaccompanied refugee minors, colonisation with extended spectrum beta-lactamase (ESBL)-producing bacteria is more frequent than in patients from general German population.…”