Abstract
BackgroundInfections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the 3GCREB infection incidence and compare it to prevalence upon admission. In addition, we aim to describe infections caused by 3GCREB, which are also carbapenem resistant (CRE).MethodsIn 2014–2015, we performed prospective 3GCREB surveillance in clinically relevant patient specimens (screening specimens excluded). Infections counted as hospital-acquired (HAI) when the 3GCREB was detected after the third day following admission, otherwise as community-acquired infection (CAI).ResultsOf 578,420 hospitalized patients under surveillance, 3367 had a 3GCREB infection (0.58%). We observed a similar 3GCREB CAI and HAI incidence (0.28 and 0.31 per 100 patients, respectively). The most frequent pathogen was 3GCR E. coli, in CAI and HAI (0.15 and 0.12 per 100 patients). We observed a CRE CAI incidence of 0.006 and a HAI incidence of 0.008 per 100 patients (0.014 per 1000 patient days).ConclusionsComparing the known 3GCREB admission prevalence of the participating hospitals (9.5%) with the percentage of patients with a 3GCREB infection (0.58%), we conclude the prevalence of 3GCREB in university hospitals to be about 16 times higher than suggested when only patients with 3GCREB infections are considered. Moreover, we find the HAI and CAI incidence caused by CRE in Germany to be relatively low.
Highlights
Infections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem
Third generation cephalosporin resistant Enterobacteriaceae (3GCREB) infections are a special threat to patient safety, as resistance may cause a delay in effective antimicrobial therapy and thereby lead to worsening patient outcomes [2]
European Union (EU) surveillance data shows that the 3GC resistance rate of E. coli in blood and cerebrospinal fluid samples has increased in many EU countries (EU mean 2012: 11.9%, 2015: 13.1%) [3]
Summary
Infections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the 3GCREB infection incidence and compare it to prevalence upon admission. Third generation cephalosporin resistant Enterobacteriaceae (3GCREB) infections are a special threat to patient safety, as resistance may cause a delay in effective antimicrobial therapy and thereby lead to worsening patient outcomes [2]. The percentage of hospital-acquired infections (HAI) caused by ESBL-producing Enterobacteriaceae in German ICUs and surgical departments increased as well (2007: 10.9% to 2012: 15.5%) [5]. The ATHOS (Antibiotic Therapy Optimization Study) project aimed at assessing the 3GCREB admission prevalence and 3GCREB incidence of community-acquired and hospital-acquired infections (CAI, HAI) in six German university hospitals in 2014 and 2015. We describe the incidence of 3GCREB infections in the same hospitals and relate the data to the 3GCREB admission prevalence. We analyse the distribution of additional resistance phenotype patterns in those 3GCREB that caused infections
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