Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS)

Abstract

Surveillance systems for hospital infections are reporting increasing rates of extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae in Europe. We aimed to perform a national survey on this trend and on the regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in German hospitals. Data from 2007 to 2012 from two components of the German national nosocomial infection surveillance system were used for this analysis. The data derive from intensive care units and surgical departments. Independent factors determining the proportion of ESBL-positive Enterobacteriaceae among nosocomial infections due to Enterobacteriaceae and changes in its regional distribution (broken down into German federal states) were calculated by regression analysis. From 2007 to 2012, the data showed a significantly increasing proportion of ESBL-positive Enterobacteriaceae in surgical site infections (from 11.46 to 15.38, 134%, p 0.003), urinary tract infections (9.36 to 16.56, 177%, p <0.001) and lower respiratory tract infections (11.91 to 14.70, 123%, p <0.001) due to Enterobacteriaceae. Factors independently associated with a growing proportion were: Thuringia (p 0.009; odds ratio (OR) 1.53), North Rhine-Westphalia (p <0.001; OR 1.41) and general surgery ward (p 0.002; OR 1.47). The proportion of ESBL-positive Enterobacteriaceae in nosocomial infections has significantly increased in Germany over the last 6 years. Hospitals in Central Germany and surgical departments in all of Germany are especially affected by this development.

Current status of postoperative infections after digestive surgery in Japan: The Japan Postoperative Infectious Complications Survey in 2015

“…Antimicrobial‐resistant bacterial infection and colonization, especially after surgery, is a major global clinical problem that is expected to continue to increase in parallel with the increase in the elderly population. The AMR bacterial infection rates in the present survey were lower than those previously reported . VRE or MDR‐GN was not isolated from any of the patients who participated in the present survey.…”

Meta-analysis of proportion estimates of Extended-Spectrum-Beta-Lactamase-producing Enterobacteriaceae in East Africa hospitals

“…pneumoniae, E. coli, others8444NDTanzania [56]2012UniversityBothChildren, adultsPusDDSTK. pneumoniae, E. coli, others2979NDTanzania [36]2007UniversityBothChildren, adultsUrine, pus, blood d PCR-SequencingK. pneumoniae, E. coli, P. aeruginosa, others22735VIM (12.3 %), OXA-48 (4.9 %), KPC (3.5 %), NDM (3.1 %)Tanzania [57]2012UniversityBothChildren, adultsWoundDDSTPseudomonas spp, Proteus spp, K. pneumoniae, E. coli11735NDTanzania [58]2011UniversityBothChildren, adultsWoundDDSTK.…”

“…However the East African proportion is considerably higher than averages reported for resource-rich countries. For instance, the average ESBL proportion estimates reported in a nationwide hospital survey in Germany for 2012 were in the 10 to 15 % range [36]. In 2012, a study for nine US census regions reported ESBL proportion estimates in the 4 to 12 % range [37], while a 9-year survey in Japan recorded a proportion estimate of 6.3 % in 2003 increasing to 10–20 % in 2011 [38].…”

The association of ESBL-producing Enterobacteriaceae (ESBL-E) carriage in humans with pigs

“…Among other factors, we found that ESBL-E carriage was associated with frequent consumption of pork. In addition, data from KISS showed high incidences of nosocomial infections with ESBL-E in North Rhine-Westphalia and Thuringia [3]. Interestingly, these German federal states are associated with high consumption of meat, mainly pork (German National Nutrition Study II, 2008).…”