Prevalence of multidrug-resistant organisms in refugee patients, medical tourists and domestic patients admitted to a German university hospital

Abstract

BackgroundPatients with contact to healthcare-system in high-prevalence countries (HPC) and refugee patients in hospital settings (REF) have previously been identified to be at risk of carrying multidrug-resistant organisms (MDRO). Comparative studies addressing the epidemiology of MDRO in patients transferred from hospitals abroad (ABROAD) and REF are lacking but are necessary to introduce refined infection control measures.MethodsFrom December 2015 to June 2016, 117 REF, 84 ABROAD and 495 patients admitted to intensive care unit, with no refugee history or pre-treatment abroad (ICU), at University Hospital Frankfurt, Germany (UHF) were screened for MDRO on day of admittance. Data within these groups were compared and set in an epidemiological context.Results52.1% (95% confidence interval = 42.7-61.5) of REF and 41.6% (31.0-52.9) of ABROAD, were positive for at least one MDRGN, respectively. In contrast, 7.9% (5.6-10.6) of ICU were positive for MDRGN. Thereof, 0.9% (0.0-4.7) of REF, 15.5% (8.5-25.0) of ABROAD and 0% (0.0-0.7) of ICU were positive for at least one MDRGN with carbapenem resistance (CR). In total, 19 MDRGN with CR were detected in ABROAD, with the most frequent species with CR being A. baumannii with 42.1% (20.3-66.5). Regarding MRSA, 10.3% (5.4-17.2) of REF, 5.9% (1.9-13.3) of ABROAD and a significantly lower proportion 1.4% (0.6-2.9) of ICU, respectively, were tested positive.ConclusionsBoth REF and ABROAD pose a relevant hospital hygiene risk. High prevalence of MDRGN with CR in ABROAD was observed. Concise screening and infection control guidelines are needed in patient cohorts with increased risk for MDRO carriage.

Hydroclimatic drivers of highly seasonal leptospirosis incidence suggest prominent soil reservoir of pathogenic Leptospira spp. in rural western China

“…Our findings regarding the timescale of associations of leptospirosis and precipitation are consistent with those reported in similar studies in rural settings [7,8,22,57]. On the other hand, we found an association between leptospirosis incidence and wet soils, when prior studies reported associations with indicators for flooding [3,19,26,56].…”

Barriers for tuberculosis case finding in Southwest Ethiopia: A qualitative study

“…As a result, individuals who have symptoms of TB are expected to seek TB diagnostic services by traveling long distance. Hence, the individuals might be delayed or not seek the services at all [12,16]. This could be related to the country's economy in availing TB diagnostic centers at the community level, and poor rural residents not able to afford costs related to transportation and investigations.…”

“…Furthermore, self-treatment, limited community awareness of the risks associated with delayed care seeking and low educational status are all factors significantly associated with delayed TB care seeking. Among those who have not had previous TB treatment, and who have not had a cough for a long duration, there is a delay in TB care seeking [12][13][14][15][16].…”

What we can do? The risk factors for multi-drug resistant infection in pediatric intensive care unit (PICU): a case-control study

“…Usually, the beds in the ICU are very few, and the increase of MDRI makes the medical resources not properly configured. Previous studies [24,25] have concluded that the hospitalization time of patient needs to be strictly controlled, which is one of the effective measures to prevent MDRI. Mechanical ventilation can significantly increase the chance of respiratory infection [26,27].…”