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Observational Study
. 2018 Dec 27:7:159.
doi: 10.1186/s13756-018-0452-8. eCollection 2018.

Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals

Anna M Rohde  1   2 , Janine Zweigner  1   2   3 , Miriam Wiese-Posselt  1   2 , Frank Schwab  1   2 , Michael Behnke  1   2 , Axel Kola  1   2 , Birgit Obermann  1   4 , Johannes K-M Knobloch  1   4   5 , Susanne Feihl  1   6 , Christiane Querbach  1   6 , Friedemann Gebhardt  1   6 , Alexander Mischnik  1   7 , Vera Ihle  1   7 , Wiebke Schröder  1   8 , Sabina Armean  1   8 , Silke Peter  1   9 , Evelina Tacconelli  1   8 , Axel Hamprecht  1   10 , Harald Seifert  1   10 , Maria J G T Vehreschild  1   11 , Winfried V Kern  1   7 , Petra Gastmeier  1   2 ; DZIF-ATHOS study group
Collaborators, Affiliations
Observational Study

Incidence of infections due to third generation cephalosporin-resistant Enterobacteriaceae - a prospective multicentre cohort study in six German university hospitals

Anna M Rohde et al. Antimicrob Resist Infect Control. .

Abstract

Background: 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. In addition, we aim to describe infections caused by 3GCREB, which are also carbapenem resistant (CRE).

Methods: In 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).

Results: Of 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).

Conclusions: Comparing 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.

Keywords: CRE; Carbapenem; Community-acquired infections; E. coli; ESBL; Enterobacter spp.; Fluoroquinolone; Gram-negative; Hospital-acquired infections; Klebsiella spp..

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Conflict of interest statement

The ethics committee at Charité, University Medicine Berlin, Germany, approved this study (EA/018/14). Surveillance was performed in accordance with the German Infection Protection Act and did not require patient consent.(9).Not applicable.No competing interests unless stated. MJGTV is a consultant to: Alb Fils Kliniken, Astellas Pharma, MaaT Pharma, MSD/Merck; has served with the speakers’ bureau of: Astellas Pharma, Basilea, Gilead Sciences, Merck/MSD, Organobalance and Pfizer; received research funding from: 3 M, Astellas Pharma, DaVolterra, Gilead Sciences, Merck/MSD, Morphochem, Organobalance, and Seres Therapeutics. HS reports grants from Bundesministerium für Bildung und Forschung (BMBF), the German Center for Infection Research (DZIF), Cubist, and Novartis, and personal fees from Astellas-Basilea, Cubist, Durata, Genentech, Gilead, MSD, Roche Pharma, and Tetraphase. JKMK received research and travel grants from Novartis, bioMérieux, Bayer Vital, and Alere and served as consultant or speaker for bioMérieux, Novartis,and Pfizer. JZ received a speaker’s honorarium from Pfizer.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow chart of third generation cephalosporin resistant Enterobacteriaceae (3GCREB) cases (a) and infections (b). a) Readmission followed by 3GCREB detection created a second case. b) Each case could represent several infections but only one per infection type
Fig. 2
Fig. 2
Relative species distribution in third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) infections, stratified for infection type and acquisition, ATHOS project, 2014–2015, Germany. a “Other infections” includes all infection types other than: SSI = surgical site infection, UTI = urinary tract infection, LRTI = lower respiratory tract infection, BSI = bloodstream infection. CA = community-acquired, HA = hospital-acquired. b “Other Enterobacteriaceae species” include Cedecea, Hafnia, Morganella, Pantoea, Proteus, Providencia, Raoultella, and Serratia species. Χ2-tests (5 × 2 table) were performed for each infection type to test for differences between CAI and HAI
Fig. 3
Fig. 3
Relative distribution of resistance phenotypes of third generation cephalosporin-resistant (3GCR) E. coli (a) and Klebsiella spp. (b) depending on infection type and acquisition, ATHOS project, 2014–2015, Germany. a “Other infections” includes all infection types other than: SSI = surgical site infection, UTI = urinary tract infection, LRTI = lower respiratory tract infection, BSI = bloodstream infection. 3GCR = third generation cephalosporin resistance, FQR = fluoroquinolone resistance, CR = carbapenem resistance, 3GCR + CR = carbapenem-resistant Enterobacteriaceae (CRE), CA = community-acquired, HA = hospital-acquired. Fishers exact-tests (2 × 2 table, carbapenem-resistant versus -susceptible) were performed for each infection type to test for differences between CAI and HAI, p < 0.05 was considered significant. “n.d.” = not defined, p-value cannot be calculated due to missing events in both groups
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