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. 2018 Apr 24:7:54.
doi: 10.1186/s13756-018-0353-x. eCollection 2018.

Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany - 10 years of surveillance

Cornelius Remschmidt  1   2 , Christin Schröder  1   2 , Michael Behnke  1   2 , Petra Gastmeier  1   2 , Christine Geffers  1   2 , Tobias Siegfried Kramer  1   2
Affiliations

Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany - 10 years of surveillance

Cornelius Remschmidt et al. Antimicrob Resist Infect Control. .

Abstract

Background: Enterococci are frequent pathogens causing nosocomial infections in Germany. Infections due to strains with vancomycin resistance are high when compared with other European states. Therefore, the study aimed to describe the recent progression of nosocomial infections due to vancomycin-resistant enterococci (VRE) in Germany.

Methods: We analyzed data from two components of the German national nosocomial infection surveillance system for the period 2007-2016. For primary bloodstream infections (BSIs) and urinary tract infections (UTIs) we used data from intensive care units and for surgical site infections (SSIs) data from surgical departments. In a sensitivity analysis, we considered only data from participants that participated continuously from 2007 to 2016 ("core group"). We calculated proportions of VRE among all nosocomial enterococcal infections with 95% confidence intervals (95% CIs) and trends over time. A multivariable logistic regression was used to compare occurrence of VRE proportions among German federal states.

Results: Enterococcal infections from 857 ICUs and 1119 surgical departments were analyzed. On ICUs, the proportion of vancomycin resistance in enterococci causing nosocomial infections significantly increased for BSIs from 5.9 to 16.7% and for UTIs from 2.9 to 9.9%; for surgical site infections, the proportion of VRE increased from 0.9 to 5.2% (P < 0.001 for all). In the core group, the increase of VRE was more pronounced in ICUs (BSIs: 5.5 to 21.6%; UTIs: 2 to 11.2%) but was not seen in surgical departments (SSIs: 1.5 to 2.8%). Compared with the most populous German federal state North Rhine Westphalia, enterococcal infections in Hesse (Odds Ratio (OR) 2.3, 95% CI 1.7-3.1), Saxony (OR 2.5, 95% CI 1.8-3.5) and Thuringia (OR 1.9, 95% CI 1.4-2.6) were more likely to be caused by vancomycin-resistant strains.

Conclusion: In Germany, the proportion of VRE in nosocomial infection due to enterococci is still increasing. It remains unclear, why a large variation in the proportion of VRE exists between German federal states.

Keywords: Epidemiology; Multiresistant; Surveillance; Vancomycin-resistant enterococci.

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Conflict of interest statement

For this study, we analyzed aggregated and anonymous data that were collected by the hospital in accordance with the German “Protection against Infection Act”, §23. Therefore, ethical approval and informed consent were not required and institutional review boards were not consulted.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Time trend for percentage of vancomycin-resistant entercoccal (VRE) infections according to the German national nosocomial infection surveillance system (KISS), by infection site
Fig. 2
Fig. 2
Time trend for percentage of vancomycin-resistant enterococcal (VRE) infections according to the German national nosocomial infection surveillance system (KISS), by infection site. Data from wards that participated continuously from 2007 to 2016 (“core group”)
Fig. 3
Fig. 3
Distribution of the proportion of vancomycin-resistant entercoccal (VRE) infections among German federal states according to data from the German national nosocomial infection surveillance system (KISS) 2007–2016
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