Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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
See this image and copyright information in PMC

References

    1. O'Driscoll T, Crank CW. Vancomycin-resistant enterococcal infections: epidemiology, clinical manifestations, and optimal management. Infect Drug Resist. 2015;8:217–230. - PMC - PubMed
    1. Werner G, Coque TM, Hammerum AM, Hope R, Hryniewicz W, Johnson A, Klare I, Kristinsson KG, Leclercq R, Lester CH, et al. Emergence and spread of vancomycin resistance among enterococci in Europe. Euro Surveill. 2008;13(47). https://www.eurosurveillance.org/content/10.2807/ese.13.47.19046-en. - DOI - PubMed
    1. Chiang HY, Perencevich EN, Nair R, Nelson RE, Samore M, Khader K, Chorazy ML, Herwaldt LA, Blevins A, Ward MA, et al. Incidence and outcomes associated with infections caused by vancomycin-resistant enterococci in the United States: systematic literature review and meta-analysis. Infect Control Hosp Epidemiol. 2017;38(2):203–215. doi: 10.1017/ice.2016.254. - DOI - PubMed
    1. World Health Organization (WHO): Global priority list of antibiotic-resistant bacteria to guide research, discovery, and development of new antibiotics. Available at http://www.who.int/medicines/publications/WHO-PPL-Short_Summary_25Feb-ET.... Accessed 03 Mar 2017. 2017.
    1. European Centre for Disease Prevention and Control . Antimicrobial resistance surveillance in Europe 2016. Annual report of the European antimicrobial resistance surveillance network (EARS-net) Stockholm: ECDC; 2018.

MeSH terms