The SARS-CoV-2 pandemic threatens health care providers and society. For planning of treatment capacities, it is of major importance to obtain reliable information on infection and fatality rates of the novel coronavirus. A German community study, the so-called Heinsberg study, found a 5-fold higher infection rate (and thus a remarkably lower fatality rate) than the officially reported cases suggest. We were interested to examine the SARS-CoV-2-IgG antibody status among clinic staff of a large neurological center in Northern Germany. Blood samples and questionnaires (demographic data, medical history) were collected pseudonymously. In total, 406 out of 525 (77.3%) of our employees participated in the study. The infection rate among the staff was as high as 2.7%. Including drop-outs (missing questionnaire but test result available), the infection rate was even higher (2.9%). Only 36% of the positively tested employees did suffer from flu-like symptoms in 2020. None of the nurseshaving closest and longest contact to patients-were found to be positive. Despite the fact that the infection rate among clinic staff may not be directly compared to the situation in the surrounding county (due to different testing procedures), one might hypothesize that the infection rate could be more than 30-fold higher than the number of officially reported cases for the county of Hameln-Pyrmont. The high rate of IgG-positive, asymptomatic healthcare workers might help to overcome fears in daily work.

Five phase variants (PV1 to PV5) of the well-characterized, slime-producing, methicillin-resistant, pathogenic strain of Staphylococcus epidermidis sensu strictu RP62A (ATCC 35984) were isolated by the Congo red agar method. In comparison with the parent strain, the phase variants showed a different colonial morphology on Congo red agar, a strongly reduced adherence capacity, and decreased levels of resistance to methicillin, oxacillin, and penicillin. All phase variants yielded biochemical reaction patterns and profiles in pulsed-field gel electrophoresis identical to those of parent strain RP62A, indicating a common origin. All phase variants proved to have the capacity to shift back to the original phenotype of parent strain RP62A. A search for the resistance mechanisms of strain RP62A revealed P-lactamase production and the presence of mecA in PV1 to PV5 as well as parent strain RP62A. In Northem blots of total staphylococcal RNA, the phase variants showed no detectable mecA-specific transcription product, whereas parent strain RP62A revealed a strong signal, indicating that mecA transcription is not the mechanism responsible for the decreased methicillin resistance phenotype of phase variants PV1 to PV5.Staphylococcus epidermidis is recognized with increasing frequency as an opportunistic and nosocomial pathogen, particularly in association with infections of prosthetic devices and intravascular catheters. Several investigators have confirmed the presence of an extracellular polysaccharide matrix, called glycocalyx or slime, which is associated with adherence and accumulative growth on smooth surfaces and inhibition of host defenses (5,7,8,13,15,18,22,25,27).Many studies have suggested that slime production is one of the most important virulence factors in the pathogenicity of S. epidermidis (3,6,11,19,20,35). This adherence capacity is known to differ spontaneously among variants of the same parent strain (2-4, 9, 10). Christensen and coworkers (3) recently showed that slime production by S. epidermidis is not a stable phenomenon but undergoes phase variation. The ability to express different slime-producing phenotypes could provide the staphylococci with a greater degree of flexibility for colonizing a range of environments (2,3,9).Using a high-salt (6.5%), low-glucose medium (Memphis agar) for the detection of phenotypic variation, Christensen et al. (3) described phase variants RP62NA of the well-characterized strain RP62A (ATCC 35984). In comparison with the parent strain, the phase variants differed in their colonial morphologies and showed decreased levels of slime production and diminished virulence in a foreign body-associated model of endocarditis. Furthermore, the slime-negative phase variants that were isolated showed a remarkable increase in their susceptibilities to penicillin and oxacillin. This was determined by measuring in agar diffusion tests the mean zone of inhibition of the slime-negative phase variants compared with that of the parent strain, which is resistant to these antibiotics (3...

Multidrug-resistant germs are an increasing problem in neurological and neurosurgical early rehabilitation but reliable data is missing. The present study examined the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram negative germs (MRGN) in a German neurological early rehabilitation facility (BDH Clinic Hessisch Oldendorf). Observation period was 2004-2013 (10 years). MRSA prevalence on admission was 11.4%, MRGN prevalence during rehabilitation 11.8%. A combination of different multidrug-resistant germs (MRSA plus MRGN) was observed in 3.8% of all cases. VRE were first detected in 2009, prevalence was as low as 0.1%. High prevalence of MRSA and MRGN raises major financial, medical, and ethical problems in early rehabilitation facilities. The authors encourage further multi-center studies and suggest a better recompense for this group of patients in the German DRG-system (Diagnosis Related Groups).

Recently we demonstrated that lack of mecA transcription was responsible for the decreased methicillin resistance phenotype of strongly slime-negative Staphylococcus epidermidis phase variants [Mempel M, Feucht H, Ziehbuhr W, Endres M, Laufs R, Grüter L (1994) Antimicrob Agents Chemother 38: 1251-1255]. In the present study we compared the beta-lactam susceptibility and the slime production capacity of 60 phenotypic variants of S. epidermidis parent strain RP62A identified by their colony morphology on congo red agar. We could show that the variable degree of slime production is linked to different levels of beta-lactam susceptibility in intermediate-stage phase variants. The increased deltahemolysin production of slime-negative phase variants may indicate an accessory gene regulator-like control.

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