Prevalence of multidrug-resistant organisms in refugee patients admitted to a German university hospital depending on duration of stay in Germany

Reinheimer, Claudia; P, Abdollahi; Zacharowski, Kai; Meybohm, Patrick; Mutlak, Haitham; Klingebiel, Thomas; Wichelhaus, TA; Vaj, Kempf

doi:10.3205/dgkh000323

Cited by 5 publications

(6 citation statements)

References 17 publications

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“…In addition, our results could have been influenced by the low number of participants who had refugee status (n = 27) [ 1 ] or who lived in a care facility (n = 31) [ 2 ], but it seems realistic to assume that the refugees are a minority among children being admitted at AKK. If the proportion of these had been higher, we would probably have had higher MDRO prevalence rates as other studies in Germany have shown among refugees and residents of care facilities [ 9 , 21 , 23 , 37 , 40 ].…”

Section: Discussionmentioning

confidence: 94%

“…It is likely that the concerned participants in this study will develop bacterial infections that require antibiotic treatment, resulting in the development of further resistances within their positive MDRO colonisation status. It is known that positive MDRO colonisation can disappear for several years and return under selection pressure, such as exposure to antibiotics or travel to Africa and Asia [ 7 , 19 , 36 , 37 ]. Moreover, MRSA eradication treatments are available, but currently no therapeutic recommendations for MRGN colonisation exist.…”

Section: Discussionmentioning

confidence: 99%

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High prevalence of multidrug-resistant Gram-negative bacteria carriage in children screened prospectively for multidrug resistant organisms at admission to a paediatric hospital, Hamburg, Germany, September 2018 to May 2019

et al. 2022

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Background Increasing resistance to antibiotics poses medical challenges worldwide. Prospective data on carriage prevalence of multidrug resistant organisms (MDRO) in children at hospital admission are limited and associated risk factors are poorly defined. Aim To determine prevalence of MDRO carriage in children at admission to our paediatric hospital in Hamburg and to identify MDRO carriage risk factors. Methods We prospectively obtained and cultured nasal/throat and inguinal/anal swabs from children (≤ 18 years) at admission between September 2018 and May 2019 to determine prevalence of meticillin-resistant Staphylococcus aureus (MRSA), multidrug-resistant Gram-negative bacteria (MRGN) and vancomycin-resistant enterococcus (VRE) and associated species. We collected medical histories using a questionnaire and evaluated 31 risk factors using logistic regression models. Results MDRO carriage prevalence of 3,964 children was 4.31% (95% confidence interval (CI): 3.69–5.00). MRSA carriage prevalence was 0.68% (95% CI: 0.44–0.99), MRGN prevalence was 3.64% (95% CI: 3.07–4.28) and VRE prevalence 0.08% (95% CI: 0.02–0.22). MDRO carriage was associated with MRGN history (odds ratio (OR): 6.53; 95% CI: 2.58–16.13), chronic condition requiring permanent care (OR: 2.67; 95% CI: 1.07–6.13), antibiotic therapy (OR: 1.92, 95% CI: 1.24–2.94), living in a care facility (OR: 3.34; 95% CI: 0.72–12.44) and refugee status in previous 12 months (OR: 1.91; 95% CI: 0.27–8.02). Compared to established practice, screening using risk-factors had better diagnostic sensitivity (86.13%; 95% CI: 80.89–91.40) and specificity (73.54%; 95% CI: 72.12–74.97). Conclusion MRGN carriage was higher than MRSA and VRE. Extended risk-factor-based admission screening system seems warranted.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

High prevalence of multidrug-resistant Gram-negative bacteria carriage in children screened prospectively for multidrug resistant organisms at admission to a paediatric hospital, Hamburg, Germany, September 2018 to May 2019

et al. 2022

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“…Zur MRE-Prävalenz bei minderjährigen Flüchtlingen liegen mehrere Untersuchungen bei stationär behandelten Patienten in Deutschland vor. Hierbei wurden MRE-Prävalenzen von rund 33 % [ 72 ] sowie in einer anderen Untersuchung eine MRGN-Prävalenz von rund 41 % festgestellt [ 73 ]. Die Prävalenz von MRE liegt bei minderjährigen Flüchtlingen somit deutlich höher als in der deutschen Allgemeinbevölkerung [ 73 ].…”

Section: Begründung Der Vorgeschlagenen Screeninguntersuchungenunclassified

“…Hierbei wurden MRE-Prävalenzen von rund 33 % [ 72 ] sowie in einer anderen Untersuchung eine MRGN-Prävalenz von rund 41 % festgestellt [ 73 ]. Die Prävalenz von MRE liegt bei minderjährigen Flüchtlingen somit deutlich höher als in der deutschen Allgemeinbevölkerung [ 73 ]. Weitere europäische Studien an Flüchtlingen sowohl im Kindes- [ 74 ] als auch im Erwachsenenalter [ 75 ] bestätigen die erhöhte Prävalenz von MRE.…”

Section: Begründung Der Vorgeschlagenen Screeninguntersuchungenunclassified

Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017)

Pfeil¹,

Bialek²,

Heininger

et al. 2022

Monatsschr Kinderheilkd

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Zusammenfassung Hintergrund Mit etwa 190.000 Asylanträgen im Jahr 2021 ist Deutschland das wichtigste Aufnahmeland von Asylsuchenden in Europa. Die vorliegenden Handlungsempfehlungen sollen eine Grundlage für eine evidenzbasierte und zielgerichtete infektiologische Versorgung minderjähriger Flüchtlinge schaffen. Ziele Die Handlungsempfehlungen sollen medizinisches Personal in der Versorgung minderjähriger Flüchtlinge unterstützen, um 1. einen unvollständigen Impfschutz frühzeitig zu erkennen und zu vervollständigen; 2. übliche Infektionskrankheiten zu diagnostizieren und zu behandeln; 3. in Deutschland seltene Infektionskrankheiten frühzeitig zu erkennen und zu therapieren. Material und Methoden Die Handlungsempfehlungen wurden als AWMF-Leitlinie Stufe 1 verfasst. Entsprechend wurden die Empfehlungen durch eine repräsentativ zusammengesetzte Expertengruppe der beteiligten Fachgesellschaften im informellen Konsens erarbeitet und final von den Vorständen der Fachgesellschaften offiziell verabschiedet. Ergebnisse Es werden Empfehlungen ausgesprochen, für den Umfang der Anamnese und der körperlichen Untersuchung minderjähriger Flüchtlinge. Für alle minderjährigen Flüchtlinge werden die Bestimmung eines Differenzialblutbildes sowie Untersuchungen auf Tuberkulose und Hepatitis B empfohlen. Je nach Herkunft und Alter werden weitere gezielte Untersuchungen z. B. auf Hepatitis C, HIV oder Schistosomiasis empfohlen. Zur raschen Vervollständigung des Impfstatus wird eine alters- und indikationsbezogene Priorisierung einzelner Impfungen vorgenommen. Diskussion Angesichts anhaltend hoher Flüchtlingszahlen ist eine weitere Professionalisierung der medizinischen Versorgung minderjähriger Flüchtlinge notwendig. Hierzu sollten die notwendigen strukturellen und personellen Rahmenbedingungen geschaffen werden.

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“…Praziquantel is the drug of choice; and clinical reports address that in CKD stage 1–5, no dose adaptation is necessary. Furthermore, migrants also have a significant risk of carrying multidrug-resistant organisms (MDRO), including multidrug-resistant Gram-negative organisms (MDRGN) and methicillin-resistant Staphylococcus aureus (MRSA) [ 66 ].…”

Section: Diagnostic Proceduresmentioning

confidence: 99%

Urinary tract infections in patients with renal insufficiency and dialysis – epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment

Scherberich

Fünfstück²,

Naber

2021

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Epidemiological studies show an increasing number of patients worldwide suffering from chronic kidney diseases (CKD), which are associated with a risk for progression to end-stage kidney disease (ESKD). CKD patients stage 2–5, patients with regular chronic dialysis treatment (hemo- or peritoneal dialysis), and patients suffering from kidney allograft dysfunction are at high risk to develop infections, e.g. urinary tract infections (UTI) and/or sepsis (urosepsis). These groups show metabolic disturbance, chronic inflammation, and impaired immunocompetence. Escherichia coli is still the most common pathogen in UTI. A wide variety of other pathogens may be involved in UTI. Urological interventions, catheterization, as well as repeated courses of antibiotics contribute to an increased challenge of antimicrobial resistance. The diagnosis of UTI in CKD is based on standard clinical and laboratory criteria. Pyuria (≥10 leucocytes/µl) is more often observed in patients with oligoanuria and low bacterial colony counts. The treatment strategies for this population are based on the same principles as in patients with normal renal function. However, drugs cleared by the kidney or by dialysis membranes need dose adjustment. Antimicrobials with potential systemic toxicity and nephrotoxicity should be administered with caution.

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Prevalence of multidrug-resistant organisms in refugee patients admitted to a German university hospital depending on duration of stay in Germany

Cited by 5 publications

References 17 publications

High prevalence of multidrug-resistant Gram-negative bacteria carriage in children screened prospectively for multidrug resistant organisms at admission to a paediatric hospital, Hamburg, Germany, September 2018 to May 2019

High prevalence of multidrug-resistant Gram-negative bacteria carriage in children screened prospectively for multidrug resistant organisms at admission to a paediatric hospital, Hamburg, Germany, September 2018 to May 2019

Aktualisierte Empfehlungen zur infektiologischen Versorgung von Flüchtlingen im Kindes- und Jugendalter in Deutschland (Stand 30. März 2022), angemeldet als S1-Leitlinie (AWMF-Register Nr. 048-017)

Urinary tract infections in patients with renal insufficiency and dialysis – epidemiology, pathogenesis, clinical symptoms, diagnosis and treatment

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