A prolonged outbreak of carbapenem-resistant Acinetobacter baumannii in a German university medical centre in 2006 was investigated; the investigation included a descriptive epidemiological analysis, a case-control study, environmental sampling, molecular typing of A. baumannii isolates using PFGE and repetitive-sequence-based PCR (rep-PCR) typing, and detection of OXA-type carbapenemases by multiplex PCR. Thirty-two patients acquired the outbreak strain in five intensive care units (ICUs) and two regular wards at a tertiary care hospital within 10 months. The outbreak strain was resistant to penicillins, cephalosporins, ciprofloxacin, gentamicin, tobramycin, imipenem and meropenem, and carried the bla OXA-23 -like gene. Based on PFGE and rep-PCR typing, it was shown to be related to the pan-European A. baumannii clone II. The most likely mode of transmission was cross-transmission from colonized or infected patients via the hands of health-care workers, with the severity of disease and intensity of care (therapeutic intervention scoring system 28 score .median) being independently associated with acquisition of the outbreak strain (odds ratio 6.67, 95 % confidence interval 1. 55-36.56). Control of the outbreak was achieved by enforcement of standard precautions, education of personnel, screening of ICU patients for carbapenem-resistant A. baumannii and cohorting of patients. This is believed to be the first report of an outbreak of A. baumannii carrying the carbapenemase OXA-23 in Germany.

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A total of 18,249 appendectomies, 32,912 herniorrhaphies, 42,949 cholecystectomies and 19,523 colon operations were analysed. The overall surgical site infection rate was significantly higher (2.6-fold) for the open approach compared to laparoscopically performed appendectomies. For herniorrhaphies, cholecystectomies and colon operations the corresponding odds ratios were 3.40, 3.22 and 1.20 respectively. Whenever possible a laparoscopic approach should be used.