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Zusammenfassung Ziel Ziel der Arbeit ist die systematische und evidenzbasierte Generierung und Beantwortung von Frequently asked questions (FAQs) zum Umgang mit multiresistenten Erregern (MRE) an der Schnittstelle von Veterinär-und Humanmedizin für den öffentlichen Gesundheitsdienst (ÖGD) sowie für die Allgemeinbevölkerung. Methodik Zur Ermittlung des Informationsbedürfnisses der Bevölkerung wurden zu fünf Erhebungszeitpunkten leitfadengestützte Experteninterviews mit Veterinär-und Humanmedizinern durchgeführt. Zusätzlich wurden in zwei Fachzeitschriften über das Projekt informiert sowie Mediziner dazu aufgerufen offene Fragen aus dem Arbeitsalltag zum Umgang mit Tieren hinsichtlich MRE, einzureichen. Die. Ergebnisse der Interviews und Projektaufrufe wurden in Kategorien gegliedert und häufig genannte Themen wurden als FAQs aufbereitet. Die Beantwortung der FAQs erfolgte mit einer systematischen Literaturrecherche in den Datenbanken Pubmed und Wiley Online Library. Innerhalb eines Expertengremiums wurden die FAQ-Entwürfe anschließend diskutiert und bei widersprüchlichem Forschungsstand ein Konsens erarbeitet. Im Anschluss wurden die FAQs von Humanmedizinern des ÖGD evaluiert. Ergebnisse Insgesamt wurden neun FAQs generiert. Neben dem Stand der Forschung, wurden Empfehlungen für den privaten, nicht-medizinischen Umgang mit MRE an der Schnittstelle von Human-und Veterinärmedizin ausgesprochen. Die Empfehlungen sind abhängig von den Eigenschaften des jeweiligen Settings, bei dem Menschen und Tiere aufeinandertreffen sowie der Art des Tierkontakts. So wurden unterschiedliche Empfehlungen für den Umgang mit MRE bei Heimtieren, bei Nutztieren, bei Tieren in Gemeinschaftseinrichtungen, sowie bei Therapietieren ausgesprochen. Als wichtigste Maßnahme gegen eine Verbreitung von MRE zwischen Menschen und Tieren hat sich das regelmäßige und sorgfältige Händewaschen erwiesen. Schlussfolgerung Um die Qualität der FAQs gewährleisten zu können, wurden diese multimodal generiert und beantwortet. Einschränkungen in der Qualität zeigten sich bei der Literaturrecherche. Nicht alle eingereichten Themenbereiche konnten mit der zur Verfügung stehenden Literatur bearbeitet werden. In der Zukunft sollten die FAQs kontinuierlich aktualisiert und erweitert werden.

The prevalence of antimicrobial-resistant bacteria and methicillin-sensitive Staphylococcus aureus (MSSA) in healthy newborns and the role of maternal transmission are scarcely discussed. The objec...

The aims of this work were the systematic and evidence-based generation and answering of frequently asked questions (FAQ) regarding contact with multi-drug resistant pathogens (MDR) including aspects of veterinary and human medicine for the public health service (PHS) and the general population.In order to determine the information needs of the population, guideline-based expert interviews with veterinarians and physicians were conducted in five surveys. In addition, information about the project was published in two journals and the participants were asked to submit open questions from their daily routine with respect to MDR. The results of the interviews and project calls were divided into categories, and frequently mentioned topics were prepared as FAQ. For answering the FAQ, a systematic literature search in the databases Pubmed and Wiley Online Library was conducted. A panel of experts subsequently evaluated the FAQ drafts, and a consensus was reached in case of conflicting results. Thereafter, the FAQs were evaluated by physicians and veterinarians of the PHS.Nine FAQs were generated in total. In addition to a survey of the current state of research, recommendations were made for private dealing with non-medical contact with MDR at the interface of human and veterinary medicine. The recommendations depended on the respective setting and the type of animal contact. Different recommendations were given for the handling of MDR in pets, farm animals, animals in communal facilities and animals used for animal-assisted therapies. The most important measure against the spread of MDR between humans and animals proved to be regular and careful handwashing.Mixed methods were used to ensure the quality of the FAQ. Limitations were found in the literature search. Not all submitted questions could be answered with the available literature. In the future, the FAQ should be continuously updated and extended.ZIEL: Ziel der Arbeit ist die systematische und evidenzbasierte Generierung und Beantwortung von Frequently asked questions (FAQs) zum Umgang mit multiresistenten Erregern (MRE) an der Schnittstelle von Veterinär-und Humanmedizin für den öffentlichen Gesundheitsdienst (ÖGD) sowie für die Allgemeinbevölkerung.Zur Ermittlung des Informationsbedürfnisses der Bevölkerung wurden zu fünf Erhebungszeitpunkten leitfadengestützte Experteninterviews mit Veterinär-und Humanmedizinern durchgeführt. Zusätzlich wurden in zwei Fachzeitschriften über das Projekt informiert sowie Mediziner dazu aufgerufen offene Fragen aus dem Arbeitsalltag zum Umgang mit Tieren hinsichtlich MRE, einzureichen. Die. Ergebnisse der Interviews und Projektaufrufe wurden in Kategorien gegliedert und häufig genannte Themen wurden als FAQs aufbereitet. Die Beantwortung der FAQs erfolgte mit einer systematischen Literaturrecherche in den Datenbanken Pubmed und Wiley Online Library. Innerhalb eines Expertengremiums wurden die FAQ-Entwürfe anschließend diskutiert und bei widersprüchlichem Forschungsstand ein Konsens erarbeitet. Im Anschluss wurden die FAQs von Humanmedizinern des ÖGD evaluiert.Insgesamt wurden neun FAQs generiert. Neben dem Stand der Forschung, wurden Empfehlungen für den privaten, nicht-medizinischen Umgang mit MRE an der Schnittstelle von Human-und Veterinärmedizin ausgesprochen. Die Empfehlungen sind abhängig von den Eigenschaften des jeweiligen Settings, bei dem Menschen und Tiere aufeinandertreffen sowie der Art des Tierkontakts. So wurden unterschiedliche Empfehlungen für den Umgang mit MRE bei Heimtieren, bei Nutztieren, bei Tieren in Gemeinschaftseinrichtungen, sowie bei Therapietieren ausgesprochen. Als wichtigste Maßnahme gegen eine Verbreitung von MRE zwischen Menschen und Tieren hat sich das regelmäßige und sorgfältige Händewaschen erwiesen.Um die Qualität der FAQs gewährleisten zu können, wurden diese multimodal generiert und beantwortet. Einschränkungen in der Qualität zeigten sich bei der Literaturrecherche. Nicht alle eingereichten Themenbereiche konnten mit der zur Verfügung stehenden Literatur bearbeitet werden. In der Zukunft sollten die FAQs kontinuierlich aktualisiert und erweitert werden.

Toxigenic Corynebacterium ulcerans may cause both respiratory and cutaneous diphtheria in humans. As a zoonotic emerging pathogen it has been isolated from a wide variety of animals living in captivity, such as livestock, pet, zoo and research animals and additionally in a large number of different wild animals. Here we report the isolation of tox-positive C. ulcerans in four hedgehogs with cutaneous diphtheria and pneumonia, respectively.

Summary Background In December, 2019, the newly identified severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged in Wuhan, China, causing COVID-19, a respiratory disease presenting with fever, cough, and often pneumonia. WHO has set the strategic objective to interrupt spread of SARS-CoV-2 worldwide. An outbreak in Bavaria, Germany, starting at the end of January, 2020, provided the opportunity to study transmission events, incubation period, and secondary attack rates. Methods A case was defined as a person with SARS-CoV-2 infection confirmed by RT-PCR. Case interviews were done to describe timing of onset and nature of symptoms and to identify and classify contacts as high risk (had cumulative face-to-face contact with a confirmed case for ≥15 min, direct contact with secretions or body fluids of a patient with confirmed COVID-19, or, in the case of health-care workers, had worked within 2 m of a patient with confirmed COVID-19 without personal protective equipment) or low risk (all other contacts). High-risk contacts were ordered to stay at home in quarantine for 14 days and were actively followed up and monitored for symptoms, and low-risk contacts were tested upon self-reporting of symptoms. We defined fever and cough as specific symptoms, and defined a prodromal phase as the presence of non-specific symptoms for at least 1 day before the onset of specific symptoms. Whole genome sequencing was used to confirm epidemiological links and clarify transmission events where contact histories were ambiguous; integration with epidemiological data enabled precise reconstruction of exposure events and incubation periods. Secondary attack rates were calculated as the number of cases divided by the number of contacts, using Fisher's exact test for the 95% CIs. Findings Patient 0 was a Chinese resident who visited Germany for professional reasons. 16 subsequent cases, often with mild and non-specific symptoms, emerged in four transmission generations. Signature mutations in the viral genome occurred upon foundation of generation 2, as well as in one case pertaining to generation 4. The median incubation period was 4·0 days (IQR 2·3–4·3) and the median serial interval was 4·0 days (3·0–5·0). Transmission events were likely to have occurred presymptomatically for one case (possibly five more), at the day of symptom onset for four cases (possibly five more), and the remainder after the day of symptom onset or unknown. One or two cases resulted from contact with a case during the prodromal phase. Secondary attack rates were 75·0% (95% CI 19·0–99·0; three of four people) among members of a household cluster in common isolation, 10·0% (1·2–32·0; two of 20) among household contacts only together until isolation of the patient, and 5·1% (2·6–8·9; 11 of 217) among non-household, high-risk contacts. Interpretation Although patients in our study presented with predominately mild, non-specific symptoms, infectiousness before or on the day of symptom onset was substantial. Additionally, the incubation period was often very short and false-negative tests occurred. These results suggest that although the outbreak was controlled, successful long-term and global containment of COVID-19 could be difficult to achieve. Funding All authors are employed and all expenses covered by governmental, federal state, or other publicly funded institutions.

Background Diphtheria is mainly caused by diphtheria-toxin-producing strains of Corynebacterium diphtheriae and Corynebacterium ulcerans. The recommended first-line antibiotic is penicillin or erythromycin, but reliable susceptibility data are scarce. Objectives To define WT MIC distributions of 12 antimicrobial agents and provide data for the determination of tentative epidemiological cut-off values (TECOFFs) for potentially toxigenic corynebacteria and to evaluate the potential usefulness of a gradient test (Etest) for susceptibility testing of penicillin, erythromycin and clindamycin. Methods For the 421 human or veterinary isolates from the period 2011–17, MICs of 12 antimicrobial agents were determined. Etest performance was evaluated for penicillin, erythromycin and clindamycin. Results MIC distributions were characterized and TECOFFs could be set for 11 out of 24 antibiotic/species combinations. The current EUCAST clinical breakpoints, predominantly determined for Corynebacterium species other than C. diphtheriae and C. ulcerans, divide the WT MIC distributions of penicillin and clindamycin, thereby making reproducible susceptibility testing of C. diphtheriae and C. ulcerans difficult. For erythromycin, 4% of C. diphtheriae and 2% of C. ulcerans had MICs higher than those for WT isolates. Phenotypically detectable resistance to other antibiotics was rare. Etest underestimated MICs of penicillin and lower concentrations needed to be included for erythromycin, while for clindamycin the Etest was not a good surrogate method. Conclusions MIC distributions based on reference broth microdilution for potentially toxigenic Corynebacterium spp. were developed. For five and six agents, TECOFFs were suggested for C. diphtheriae and C. ulcerans, respectively, but for Corynebacterium pseudotuberculosis the number of isolates was too low.

Background: In December 2019, a newly identified coronavirus (SARS-CoV-2) emerged in Wuhan, China, causing respiratory disease (COVID-19) presenting with fever

Resistance to third-generation cephalosporins and other beta-lactam antibiotics is of major concern for animal and human health. Knowledge of the prevalence of resistant bacteria in primary production is an important element to estimate transmission along the stages in the food production chain and the exposure of the human population. The primary objective of this study was to determine the prevalence of cefotaxime-resistant commensal E. coli in dairy and beef cattle production units throughout Germany. Secondarily, the association between management factors and the presence of cefotaxime resistance was investigated. In total, 60 beef cattle and 52 dairy cattle production units all over Germany were included. Cefotaxime-resistant E. coli were isolated from at least one sample in 70% (95% CI: 58–83%) of the farms keeping beef cattle and 85% (95% CI: 75–94%) of the farms keeping dairy cattle. The sample prevalence was 35% (161/455; 95% CI: 31–40%) and 48% (156/323; 95% CI: 43–54%), respectively. Most factors associated with resistance to cefotaxime indicate that less intensive production results in a lower number of positive samples. For beef cattle, antimicrobial treatment of the whole animal group was significantly associated with an increased proportion of samples containing cefotaxime resistant E. coli. In addition, our results indicate that better hygiene management could improve the resistance situation on cattle farms.

Seit November 2012 wurden in Suddeutschland gehauft humane Listeriosefalle mit einem bestimmten Listerien-Feintypmuster (PFGE Typ 13a/54, NGS-Clustertyp 1248) beobachtet. Da die Listeriose als klassische Zoonose gilt und die Ubertragung im Wesentlichen durch den Verzehr von mit Listeria (L.) monocytogenes kontaminierten Lebensmitteln erfolgt, versuchten die zustandigen Gesundheitsbehorden durch umfassende Befragungen eine gemeinsame Expositionsquelle bei den erkrankten Personen zu ermitteln. Allerdings war es lange Zeit trotz umfangreicher epidemiologischer Untersuchungen nicht moglich, die Ursache der Erkrankungen auf eine bestimmte Lebensmittelkategorie einzugrenzen, die Herkunft des Erregers blieb unklar. Mitte Marz 2016 wurde allerdings bei einer im Rahmen des amtlichen Probenplans auf Einzelhandelsebene entnommenen Probe von „Original bayerisches Wacholderwammerl“ am Bayerischen Landesamt fur Gesundheit und Lebensmittelsicherheit (LGL) L. monocytogenes in hoher Keimzahl festgestellt. Es erfolgte ein Ruckruf der betroffenen Ware, das gewonnene Isolat wurde zur weitergehenden Typisierung an das Bundesinstitut fur Risikobewertung (BfR) weitergeleitet. Dort wurde im Rahmen der Typisierung das gleiche NGS-Muster wie bei den Patienten-Isolaten nachgewiesen, so dass sich erstmalig ein Lebensmittel dem humanen Ausbruchsgeschehen zuordnen lies. Bei weiteren Probenahmen von Wammerl-Produkten der betroffenen Betriebsstatte sowohl im Betrieb selbst als auch im Einzelhandel wurden direkt im Anschluss an den Ruckruf ebenfalls L. monocytogenes-Stamme mit einem zum Ausbruchstamm identischen PFGE- und NGS-Muster isoliert. Auch epidemiologische Erkenntnisse zu dem Produkt des betroffenen Betriebes deuteten darauf hin, dass mit hoher Wahrscheinlichkeit ein Zusammenhang der Erkrankungsfalle mit Produkten aus dem betroffenen Betrieb besteht.

Background In 2017, a food-borne Salmonella Agona outbreak caused by infant milk products from a French supplier occurred in Europe. Simultaneously, S. Agona was detected in animal feed samples in Bavaria. Aim Using next generation sequencing (NGS) and three data analysis methods, this study’s objectives were to verify clonality of the Bavarian feed strains, rule out their connection to the outbreak, explore the genetic diversity of Bavarian S. Agona isolates from 1993 to 2018 and compare the analysis approaches employed, for practicality and ability to delineate outbreaks caused by the genetically monomorphic Agona serovar. Methods In this observational retrospective study, three 2017 Bavarian feed isolates were compared to a French outbreak isolate and 48 S. Agona isolates from our strain collections. The later included human, food, feed, veterinary and environmental isolates, of which 28 were epidemiologically outbreak related. All isolates were subjected to NGS and analysed by: (i) a publicly available species-specific core genome multilocus sequence typing (cgMLST) scheme, (ii) single nucleotide polymorphism phylogeny and (iii) an in-house serovar-specific cgMLST scheme. Using additional international S. Agona outbreak NGS data, the cluster resolution capacity of the two cgMLST schemes was assessed. Results We could prove clonality of the feed isolates and exclude their relation to the French outbreak. All approaches confirmed former Bavarian epidemiological clusters. Conclusion Even for S. Agona, species-level cgMLST can produce reasonable resolution, being standardisable by public health laboratories. For single samples or homogeneous sample sets, higher resolution by serovar-specific cgMLST or SNP genotyping can facilitate outbreak investigations.

In September 2018, a child who had returned from Somalia to Germany presented with cutaneous diphtheria by toxigenic Corynebacterium diphtheriae biovar mitis. The child’s sibling had superinfected insect bites harbouring also toxigenic C. diphtheriae. Next generation sequencing (NGS) revealed the same strain in both patients suggesting very recent human-to-human transmission. Epidemiological and NGS data suggest that the two cutaneous diphtheria cases constitute the first outbreak by toxigenic C. diphtheriae in Germany since the 1980s.

The impact of colonization with antimicrobial-resistant bacteria (AMRB) and methicillin-sensitive Staphylococcus aureus (MSSA) of healthy pregnant women is not described in detail in Germany. In this study, we screened for MSSA and AMRB, especially for methicillin-resistant S. aureus (MRSA) as well as extended-spectrum beta-lactamase (ESBL)-producing E. coli. Potential risk factors for colonization with AMRB/MSSA and the potential effects of colonization with these on the obstetric population were investigated. From October 2013 until December 2015 pregnant women were screened before birth for colonization with AMRB/MSSA from the mammillae, nose, perianal and vaginal area. Before birth, the expectant mother was administered a standardized interview questionnaire by a trained interviewer. Data from the hospital admission records were also included. Samples from 651 pregnant women were analyzed. Colonization with MSSA was detected in 14.3% (n = 93), AMRB in 3.5% [(n = 23); MRSA: n = 3/ESBL: n = 20]. Significantly more colonization of AMRB/MSSA could be detected in women who had previously given birth compared to women who were nulliparous (p

Background and aim As a consequence of socioeconomic and political crises in many parts of the world, many European Union/European Economic Area (EU/EEA) countries have faced an increasing number of migrants. In the German federal state of Bavaria, a mandatory health screening approach is implemented, where individuals applying for asylum have to undergo a medical examination that includes serological testing for HIV and hepatitis B, screening for tuberculosis, and until September 2015, stool examination for Salmonella spp. and Shigella spp.. Methods: Data from mandatory screening of all first-time asylum seekers in Bavaria in 2015 was extracted from the mandatory notification and laboratory information system and evaluated. Results: The HIV positivity and hepatitis B surface antigen (HBsAg) positivity rate of tested samples from asylum seekers were 0.3% and 3.3%, respectively, while detection rate of active tuberculosis was between 0.22% and 0.38%. The rates for HIV, hepatitis B, and tuberculosis among asylum seekers were similar to the corresponding prevalence rates in most of their respective countries of birth. Only 47 Salmonella spp. (0.1%) were isolated from stool samples: 45 enteric and two typhoid serovars. Beyond mandatory screening, louse-borne relapsing fever was found in 40 individuals. Conclusions: These results show that mandatory screening during 2015 in Bavaria yielded overall low positivity rates for all tested infectious diseases in asylum seekers. A focus of mandatory screening on specific diseases in asylum seekers originating from countries with higher prevalence of those diseases could facilitate early diagnosis and provision of treatment to affected individuals while saving resources.

Beim Umgang mit Asylbewerbern bestehen haufig bei den Beschaftigten und den freiwilligen Helfern Unsicherheiten im Hinblick auf eine mogliche Ubertragung von Infektionskrankheiten. Obwohl gezeigt werden konnte, dass insgesamt nur ein geringes Infektionsrisiko von Asylbewerbern ausgeht, sollten arbeitsmedizinische Aspekte und Impfschutz nicht auser Acht gelassen werden. Die Standige Impfkommission (STIKO) empfiehlt neben den Standardimpfungen bei beruflicher Indikation, die fur Mitarbeiterinnen/Mitarbeiter (inkl. bspw. ehrenamtliche Helferinnen und Helfer) in den Einrichtungen gegeben ist, Impfungen gegen Hepatitis A, Hepatitis B, Auffrischimpfung gegen Polio (falls letzte Impfung vor mehr als 10 Jahren) sowie Influenza (in der Saison). Im Bereich des Arbeitsschutzes hat laut Arbeitsschutzgesetz der Arbeitgeber die am Arbeitsplatz auftretenden Gefahrdungen fachkundig zu ermitteln (Gefahrdungsbeurteilung) und die notwendigen Schutzmasnahmen festzulegen. Je nach Tatigkeit und Gefahrdung beim Umgang mit Asylbewerbern konnen unterschiedliche Verordnungen (wie z. B. die Biostoffverordnung) und technische Regeln fur biologische Arbeitsstoffe (wie z. B. die TRBA 250 oder TRBA 500) Anwendung finden. Das Bayerische Landesamt fur Gesundheit und Lebensmittelsicherheit (LGL) hat verschiedene Merkblatter zum Thema „Asylbewerber und Gesundheitsmanagement“ fur Beschaftigte und freiwillige Helfer aus dem nicht-medizinischen Bereich sowie aus dem Bereich medizinischer Untersuchungen oder Behandlungen veroffentlicht ( www.lgl.bayern.de Suchwort „Asylbewerber“). Mit diesen Veroffentlichungen wirkt das LGL Unsicherheiten im Umgang mit Asylbewerbern bei beruflichem, aber auch ehrenamtlichem Kontakt, entgegen. Gleichzeitig erhalt der Arbeitgeber Unterstutzung bei der Umsetzung seiner gesetzlichen Verpflichtungen, den Arbeitsschutz fur seine Mitarbeiter zu gewahrleisten.

Resistance to β-lactam antibiotics, including third-generation cephalosporins, is of major concern for animal and human health. In this study, extended-spectrum β-lactamase (ESBL) / plasmid-mediated AmpC (pAmpC) β-lactamase -producing Escherichia coli isolates from German livestock farms were characterised and associations of these isolate characteristics with farm-related factors were investigated across different types of livestock. A total of 469 isolates originating from 150 farms (34 broiler farms, 38 fattening pig farms, 43 dairy cattle farms, 35 beef cattle farms) was included in the analyses. ESBL-gene family, phylogroup and phenotypic antimicrobial susceptibility for several antimicrobial agents were determined. This data was used to define different profiles characterising the isolates. Multivariate analyses using a distance-based non-parametric approach were performed to investigate associations between the profiles of the isolates and farm-related factors (e.g. management, husbandry, and environment of the farms). Co-occurrence of ESBL-gene families were not found in any of the isolates analysed. Sixty-eight percent of the isolates carried blaCTX-M variant genes. The frequency of phylogroups was as follows: A (55%), B1 (35%), D (17%) and B2 (3%). The most frequent phenotypic non-wildtype profile was non-wildtype status of solely cefepime (27%). Profiles of isolates from broilers differed substantially from those of other isolates. Associations between farm-related factors and characteristics profiles differed, depending on the isolate characteristics included in the analyses. Some factors describing the farm environment, like waterfowl in the surrounding of the farm, were associated with all tested profiles. The epidemiological method applied defines distances between isolates on basis of isolate characteristics data and is capable of analysing associations between isolate characteristics and epidemiological factors. As additional data, such as plasmid characteristics, gene type, or sequence information could be included in future studies, the method is suitable to identify points of action to reduce the occurrence of antimicrobial resistant bacteria.

A European multi-country outbreak of Salmonella Enteritidis phage type (PT) 14b occurred from March to November 2014 associated with the consumption of eggs. The outbreak involved more than 400 human cases from France, Luxembourg, Austria and the United Kingdom. In 2016–2017, it has been re-evaluated combining recent epidemiological results with latest molecular data. The outbreak was traced back to one large Bavarian egg producer with four distinct premises, three located in Bavaria, one in the Czech Republic. The outbreak isolates of S. Enteritidis PT 14b were grouped into three closely related clades by whole genome sequencing. Two of these clades could be referred to two Bavarian premises of the egg producer on the basis of epidemiological and molecular data, while epidemiological data presumably linked the third clade to another premises of the egg producer. Interestingly and in contrast to the situation in other European countries where several outbreaks were documented, all notified 91 laboratory-confirmed cases of S. Enteritidis PT 14b from Bavaria were sporadic, singular cases not belonging to any epidemiological outbreaks. In conclusion, as demonstrated here, the resolution of food-related outbreaks with such a high discriminatory power is rare in outbreak investigation.

Objective Antimicrobial resistant bacteria (AMR) are of public health and economic relevance. However, there is a lack of data regarding AMR colonization in pregnant women and in newborns. Furthermore, there are few studies analyzing hospital’s net income (revenues and costs). Study design The cross-sectional study took place in two Bavarian clinics. Available data regarding women and newborns were collected using a standardized questionnaire, personal IDs and medical records in addition to AMR/MSSA screening. Economic data consisted of estimated hospitalization costs, calculated using a billing system called G-DRG (German-Diagnosis Related Groups) as well as real hospitalization costs (e.g. staff, medical and non-medical infrastructure costs). Results Data from 635 pregnant women and 566 newborns were included. While AMR colonization has shown no significant association with clinical complications, or net hospital income; primipara status and medical condition during pregnancy did. AMR colonization did not have a significant influence on the health status of pregnant women or of the newborns. Net hospital income for pregnant women was mostly negative in 2014. In 2014 and 2015 the majority of the cases had a net income between ±€ 1000. Newborns with clinical complications differed significantly in Apgar score at 1 min, weight, body length and AMR colonization of the pregnant woman and/or the newborn (p Conclusion Results indicate that colonization does not lead to increased costs during hospitalization considering real hospitalization costs as well as G-DRG estimated costs. Both DRG groups had similar MSSA and AMR prevalence and health status. In future studies, a Centralized Cost Accounting as billing method and an improved possibility of AMR coding in G-DRG catalog would be desirable.

Germany has been officially free of bovine tuberculosis since 1996. However, in the last years there has been an increase of bovine tuberculosis cases, particularly in the southern part of Germany, in the Allgau region. As a consequence a one-time tuberculosis surveillance program was revisited with different premortal and postmortal tests. The aim of this paper was to estimate diagnostic sensitivities and specificities of the different tests used within this surveillance program. In the absence of a perfect test with 100% sensitivity and 100% specificity, thus in the absence of a gold standard, a Bayesian latent class approach with two different datasets was performed. The first dataset included 389 animals, tested with single intra-dermal comparative cervical tuberculin (SICCT) test, PCR and pathology; the second dataset contained 175 animals, tested with single intra-dermal cervical tuberculin (SICT) test, Bovigam® assay, pathology and culture. Two-way conditional dependencies were considered within the models. Additionally, inter-laboratory agreement (five officially approved laboratories) of the Bovigam® assay was assessed with Cohen's kappa test (21 blood samples). The results are given in posterior means and 95% credibility intervals. The specificities of the SICT test, SICCT test, PCR and pathology ranged between 75.8% [68.8–82.2%] and 99.0% [96.8–100%]. The Bovigam® assay stood out with a very low specificity (6.9% [3.6–11.1%]), though it had the highest sensitivity (95.7% [91.3–99.2%]). The sensitivities of the SICCT test, PCR, SICT test, pathology and culture varied from 57.8% [48.0–67.6%] to 88.9% [65.5–99.7%]. The prevalences were 19.8% [14.6–26.5%] (three-test dataset) and 7.7% [4.2–12.3%] (four-test dataset). Among all pairwise comparisons the highest agreement was 0.62 [0.15–1]). In conclusion, the specificity of the Bovigam® assay and the inter-laboratory agreement were lower than expected.

Up to now, little has been known about the prevalence and clinical relevance of colonisation of asymptomatic pregnant women with methicillin-susceptible Staphylococcus aureus (MSSA), methicillin-resistant S. aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. In this two-centre cross-sectional study, we evaluated the performance and importance of screening at different times and different locations for colonisation in pregnant women and newborns. Between October 2013 and December 2015, four samples were collected from pregnant women, two from newborns at birth and three from 3-day-old newborns. Samples were screened on culturing media and were confirmed with molecular methods. MSSA was used as a surrogate for MRSA, as the two share most microbiologic characteristics and colonisation patterns. Of 763 pregnant women, 14.5% (111) were colonised with MSSA, 0.4% (3) with MRSA and 2.6% (20) with ESBL-producing E. coli. Of 658 newborns, 0.9% (10) were colonised with MSSA at birth and 13.1% (70) at 3 days old, 0.5% (3) were colonised with MRSA and 2.6% (17) with ESBL-producing E. coli. Nasal sampling identified 91.0% of MSSA-colonised pregnant women and 60.0% of newborns. In newborns, nasal and umbilical sampling at 3 days after birth discovered 84.0% of colonised cases. For ESBL-producing E. coli, the perianal region was positive in all colonised pregnant women and in 88.2% of colonised newborns. Combining nasal and perianal swabs is optimal when screening for antibiotic-resistant bacteria in pregnant women. Nasal, perianal and umbilical sample collection from 3-day-old newborns significantly increased the sensitivity compared to screening immediately after birth.

Ampicillin and vancomycin are important antibiotics for the therapy of Enterococcus faecalis infections. The ampicillin resistance gene pbp5 is intrinsic in Enterococcus faecium. The vanC1 gene confers resistance to vancomycin and serves as a species marker for Enterococcus gallinarum. Both genes are chromosomally located. Resistance to ampicillin and vancomycin was determined in 484 E. faecalis of human and porcine origin by microdilution. Since E. faecalis are highly skilled to acquire resistance genes, all strains were investigated for the presence of pbp5 (and, in positive strains, for the penicillin-binding protein synthesis repressor gene psr) and vanC1 (and, in positive strains, for vanXYc and vanT) by using polymerase chain reaction (PCR). One porcine and one human isolate were phenotypically resistant to ampicillin; no strain was vancomycin resistant. Four E. faecalis (3/1 of porcine/human origin) carried pbp5 (MIC=1 mg/L), and four porcine strains were vanC1 positive (minimum inhibitory concentration [MIC]=1 mg/L). Real-time reverse transcriptase (RT)-PCR revealed that the genes were not expressed. The psr gene was absent in the four pbp5-positive strains; the vanXYc gene was absent in the four vanC1-positive strains. However, vanT of the vanC gene cluster was detected in two vanC1-positive strains. To our knowledge, this is the first report on the presence of pbp5, identical with the "E. faecium pbp5 gene," and of vanC1/vanT in E. faecalis. Even if resistance is not expressed in these strains, this study shows that E. faecalis have a strong ability to acquire resistance genes-and potentially to spread them to other bacteria. Therefore, close monitoring of this species should be continued.

The SARS-epidemic of 2002/2003 with worldwide 8.096 cases and 774 fatalities was the first pandemia of the 21Der SARS-Seuchenzug in den Jahren 2002 und 2003 mit weltweit 8.096 Erkrankten und 774 Toten war die erste Pandemie des 21. Jahrhunderts. SARS, das severe acute respiratory syndrome, nahm in Südchina seinen Ausgang und verbreitete sich über Südostasien schließlich auf alle 5 Kontinente. Es verursachte beim Menschen schwere Pneumonien mit Lungenversagen und enterischer Beteiligung. Auslöser war ein neuartiges Coronavirus (SARS-CoV), das von Fledermäusen auf fleischfressende Kleinsäuger und von diesen auf den Menschen übertragen wurde. Die dabei stattgehabten Mutationen des viralen Rezeptorgens führten nicht nur zur Infektion des Menschen, sondern vermittelten auch die Übertragbarkeit von Mensch zu Mensch. Die SARS-Pandemie kann daher als Modell für eine emerging disease angesehen werden.

Leptospirosis is a zoonotic disease with global distribution, caused by spirochaetes of the genus Leptospira. Transmission of Leptospira interrogans serovar Icterohaemorrhagiae, the causative agent of Weil's disease, to humans usually results from exposure to the urine of infected, but mostly asymptomatic, rodents, either by direct contact or indirectly through contaminated soil or water. Although regarded as a re-emerging infectious disease, human leptospirosis is probably underdiagnosed due to its often unspecific clinical appearance and difficulties in culturing leptospires. Therefore, more rapid and specific diagnostic procedures are needed. Here we describe a novel real-time quantitative PCR system developed for the accurate and fast diagnosis of pathogenic Leptospira spp. Its usefulness in the management of a patient with rat bite-associated multiorgan failure is demonstrated.

Clostridium perfringens is a Gram-positive, anaerobic bacterium. The strains are classified into five types (type A to E), depending on the ability to produce alpha-, beta-, epsiloon and iota-toxin, but food-poisonings are mostly caused by C. perfringens type A isolates. Ingestion of contaminated food is followed by gastrointestinal disease, when enzyme-resistant C. perfringens enterotoxins (CpE) are set free during sporulation. In most cases the bacterium has to grow up to more than 106 cfu/g food to cause a gastrointestinal disease (BVET, 2005; BfR, 2005). Cultural methods, normally used for the detection of C. perfringens, are not able to differentiate isolates into the five different toxin types. This is the reason, why the detection of C. perfringens in food under the present legal regulations can only used as an indication for inadequate production hygiene or a toxin-infection with contaminated food as source. For the detection of the toxin genes to differentiate C. perfringens in five different toxin types, three duplex real-time-PCR assays for the routine diagnostic were developed and validated. The assays can be used for quick detection and easy classification of C. perfringens isolates and as a rapid screening-system in suspected cases of C. perfringens food-poisonings.

Enterohaemorrhagic Escherichia coli (EHEC) are among the most important bacterial causes of food-borne gastrointestinal infections in Germany. Because of the occurrence of post-infectious syndromes leading to severe organic damages and even death particularly among children, and with respect to the very low infection dose, EHEC may not be present in 25 g of consumable food. In this study, the PCR method enlisted in the Official Collection of Methods established pursuant to Article 64 of the German Food and Feed Law (Lebensmittel- und Futtergesetzbuch, LFGB) and a real-time PCR procedure were compared regarding their diagnostic outcome using both isolated DNA and routine samples samples (sent in for human and/or veterinary microbiological diagnostics as well as for environmental water and/or food diagnostics). The real-time PCR procedure showed a higher sensitivity in both diagnostic settings. A positive result by bacterial culture, however, which is needed for an assessement according to the Food and Feed Law regulations was not achieved in all real time- PCR positive probes.

Severe necrotizing fasciitis was diagnosed in a 53-year-old man in Germany in 2012. Toxigenic Corynebacterium ulcerans was grown from a wound swab sample. One of the patient´s 2 dogs was found to harbor a toxigenic C. ulcerans strain. Results of next generation sequencing of both isolates supported recent zoonotic transmission of this bacterial pathogen.

A combined molecular and cultural method for the detection of the Mycobacterium tuberculosis complex (MTBC) and Mycobacterium avium subsp. paratuberculosis was developed and tested with artificially contaminated milk and dairy products. Results indicate that the method can be used for a reliable detection as a basis for first risk assessments.

The seawater bacterium Vibrio alginolyticus was detected in 5 of 20 water samples from seawater aquaria (from 3 of 5 units) and also from the surface of diseased stony corals. A total of 45 isolates were differentiated biochemically, of which 13 isolates (29%) proved to be V. alginolyticus. All those strains produced the virulence factors caseinase and lipase, 11 strains amylase and gelatinase. 7 strains showed lecithinase activity and 2 strains produced hemolysins. All examined strains showed a marked toxicity to vero cells proven by the MTT-bioassay, but no toxicity to plant cells with the saline alga Asteromonas gracilis as model. The isolates were mostly resistant to beta-lactam antibiotics, macrolides and lincomycin. However, they proved to be susceptible to aminoglycoside- and polypeptide-antibiotics as well as to tetracyclines, chloramphenicol, florfenicol, enrofloxacin and sulfamethoxazol-trimethoprim. The possible participation of this bacterium in the bleaching and dying of stony corals is mentioned as well as its role as human pathogen.

Background Tularemia is a zoonotic disease caused by Francisella tularensis that has been found in many different vertebrates. In Germany most human infections are caused by contact with infected European brown hares (Lepus europaeus). The aim of this study was to elucidate the epidemiology of tularemia in hares using phenotypic and genotypic characteristics of F. tularensis. Results Cultivation of F. tularensis subsp. holarctica bacteria from organ material was successful in 31 of 52 hares that had a positive PCR result targeting the Ft-M19 locus. 17 isolates were sensitive to erythromycin and 14 were resistant. Analysis of VNTR loci (Ft-M3, Ft-M6 and Ft-M24), INDELs (Ftind33, Ftind38, Ftind49, RD23) and SNPs (B.17, B.18, B.19, and B.20) was shown to be useful to investigate the genetic relatedness of Francisella strains in this set of strains. The 14 erythromycin resistant isolates were assigned to clade B.I, and 16 erythromycin sensitive isolates to clade B.IV and one isolate was found to belong to clade B.II. MALDI-TOF mass spectrometry (MS) was useful to discriminate strains to the subspecies level. Conclusions F. tularensis seems to be a re-emerging pathogen in Germany. The pathogen can easily be identified using PCR assays. Isolates can also be identified within one hour using MALDI-TOF MS in laboratories where specific PCR assays are not established. Further analysis of strains requires genotyping tools. The results from this study indicate a geographical segregation of the phylogenetic clade B.I and B.IV, where B.I strains localize primarily within eastern Germany and B.IV strains within western Germany. This phylogeographical pattern coincides with the distribution of biovar I (erythromycin sensitive) and biovar II (erythromycin resistance) strains. When time and costs are limiting parameters small numbers of isolates can be analysed using PCR assays combined with DNA sequencing with a focus on genetic loci that are most likely discriminatory among strains found in a specific area. In perspective, whole genome data will have to be investigated especially when terrorist attack strains need to be tracked to their genetic and geographical sources.

Tissue culture cells' metabolism and viability are measured by the mitochondrial reduction rate of a yellow tetrazolium salt (MTT) to blue formazan crystalls in the MTT-bioassay. Thus the MTT-bioassay is a standardizable and reproducible bioassay for measuring cytotoxicity or cytostimulation. It is shown that the MTT-bioassay is also very suitable for determining bacterial cytotoxins using Escherichia coli's Shiga-like toxins as example. 177 strains ofE.coli, isolated from carcasses and organs of cattle, are classified biochemically and tested for cytotoxin production by means of the MTT-bioassay. One of these strains is recognized as producer of Shiga-like toxin 2. 4 Enterohemolysin-producing strains ofE.coli are cultivated from a feces sample of a diarrhoeic nubian ibex and identified as Shiga-like toxin 1 producers by help of the MTT-bioassay.

Summary In 2010, two independent cases of cutaneous diphtheria caused by toxigenic C. ulcerans were identified in Germany. Both patients had intense occupational contact with pigs. Diagnostic work-up comprising biochemical differentiation, rpoB sequencing, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) analysis, real-time tox PCR and Elek test as well as public health measures including an intensified source tracing involving 83 asymptomatic pigs of an associated pig farm are presented.

The rapid identification of the potentially toxigenic Corynebacterium species, C. diphtheriae, C. ulcerans and C. pseudotuberculosis is essential for diagnosis and treatment of diphtheria and diphtheria-like diseases. We used matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry (MALDI-TOF MS) in comparison with classical microbiological and molecular methods on 116 Corynebacterium strains. All 90 potentially toxigenic Corynebacterium strains collected by the German National Consiliary Laboratory on Diphtheria in a period of more than ten years were correctly identified by MALDI-TOF MS. We propose an algorithm for fast and reliable diagnosis of diphtheria incorporating MALDI-TOF MS, real-time tox PCR and Elek testing.

We examined 233 silage samples and found that molds were present in 206 samples with counts between 1 × 10 3 and 8.9 × 10 7 (mean, 4.7 × 10 6 ) CFU/g. Mycophenolic acid, a metabolite of Penicillium roqueforti , was detected by liquid chromatography-mass spectrometry in 74 (32%) of these samples at levels ranging from 20 to 35,000 (mean, 1,400) μg/kg. This compound has well-known immunosuppressive properties, so feeding with contaminated silage may promote the development of infectious diseases in livestock.

To the Editor: Toxigenic Corynebacterium ulcerans may cause a zoonotic infection similar to diphtheria caused by C. diphtheriae. Previously, dairy cattle were considered to be the main reservoir for C. ulcerans (1), but recent publications suggest pet dogs and pet cats as carriers (cats often show bilateral nasal discharge) (2). We report a case of severe C. ulcerans diphtheria-like disease in a person who had had contact with pigs. In December 2007, a previously healthy 56-year-old female farmer was admitted to the Ear, Nose and Throat Department of the University Hospital Erlangen with a 1-week history of sore throat and progressive dysphagia. She did not report fever and had not received prior treatment with antimicrobial drugs. She had thick, whitish pseudomembranes on her uvula, pharynx, and both tonsils. Endoscopic examination of her larynx and hypopharynx showed that both vocal cords were mobile and the mucosa was erythematous. Enlarged cervical lymph nodes were palpable on both sides of her neck. She had no signs of cranial nerve palsies. Her temperature was 36.5°C. Because of the extensive oropharyngeal pseudomembranes, diphtheria was suspected and diphtheria antitoxin (30,000 IU) was administered intramuscularly. The patient was isolated and received intravenous penicillin (5 million units 4×/day). A pharyngeal swab obtained from below the whitish pseudomembranes grew toxigenic C. ulcerans. Species identification was achieved by biochemical differentiation (API Coryne code 0111326), rpoB sequencing (3), and MALDI-TOF analysis (Microflex LT and Biotyper 2.0 Software; Bruker Daltonics, Bremen, Germany). Toxigenicity of the strain, named KL126, was verified by using a C. diphtheriae tox–PCR (4–6), a C. ulcerans tox–specific PCR (4), and the Elek test as described previously (4,5). The tox sequence (GenBank accession no. {"type":"entrez-nucleotide","attrs":{"text":"FJ858272","term_id":"238817560","term_text":"FJ858272"}}FJ858272) differs from 2 other published C. ulcerans tox sequences ({"type":"entrez-nucleotide","attrs":{"text":"AB304279.1","term_id":"167216113","term_text":"AB304279.1"}}AB304279.1 and {"type":"entrez-nucleotide","attrs":{"text":"AY703827.1","term_id":"56694206","term_text":"AY703827.1"}}AY703827.1) at only 3 bp. The patient recovered quickly, and the pseudomembranes vanished within 2 days. However, because an allergic rash had developed after her third day of treatment with penicillin, antimicrobial drug treatment was switched to intravenous erythromycin (500 mg 4×/d). When 1 day later the standardized antibiogram showed resistance to erythromycin, the patient received intravenous ceftriaxone (2 g 1×/d) for 12 days. Seven days after initiation of antimicrobial drug therapy, pharyngeal swabs were taken on 3 consecutive days. Because C. ulcerans no longer grew on culture, the patient was discharged from the hospital. However, 2 days later she was readmitted to hospital for severe polyneuropathy with neuralgia and weakness of both arms, acute difficulty swallowing, and hoarseness. Signs of cardiomyopathy, including sinus bradycardia and grade I atrioventricular block, were present. The patient recovered after symptomatic treatment and returned home after 2 weeks. According to her records, the patient had received a basic vaccination against diphtheria in 1960 and a booster in 1998. The literature describes the classic animal sources for toxigenic C. ulcerans as dairy cattle with mastitis (1). Since 2005, toxigenic C. ulcerans carriage in companion animals, e.g., pet cats and dogs, has been reported (2). Two cases of transmission of a toxigenic C. ulcerans strain from pet dogs to their immunocompromised female owners have been documented in France (7,8). In 2008, toxigenic C. ulcerans in 2 dead killer whales from a Japanese zoo was reported (9). To determine the source of our patient’s illness, an outbreak investigation involving her family and their farm animals was conducted. Their medium-sized pig-breeding farm was located in a remote rural village surrounded by woods; they raised ≈500 pigs in a nonindustrialized manner, and no piglets were purchased from outside the farm. Pharyngeal swabs of 3 family members, 19 pigs, and the farm dog were analyzed for C. ulcerans. Although all family members and the dog were negative for C. ulcerans, 1 of the 19 asymptomatic pigs harbored a toxigenic strain of C. ulcerans. Sequencing of rpoB and tox showed 100% homology between the human and the pig strains. Ribotyping (10) confirmed this result, suggesting the identity of both strains; the obtained ribotype is similar to the reported U1 ribotype profile found in humans and cats (2). We report proven transmission of a toxigenic C. ulcerans strain between a livestock animal and a human, as well as harboring of toxigenic C. ulcerans in pigs. Introduction of C. ulcerans from wild animals seems unlikely because the barn doors were reportedly closed at all times. Because handling of C. ulcerans–infected pigs may lead to diphtheria-like illnesses, studies of toxigenic C. ulcerans carriage among pigs are needed. Similar to our case, diphtheria-like disease caused by an erythromycin- and clindamycin-resistant toxigenic C. ulcerans strain in a US patient has been recently (in 2008) reported (1). Because current recommendations based on C. diphtheriae–caused disease consider erythromycin as the second-line option for treatment or postexposure prophylaxis, these findings highlight the importance of antimicrobial-drug susceptibility testing of toxigenic C. ulcerans strains.

In a woman with MRSA, recurrent deep abscesses resolved only after treatment of the family's MRSA-positive cat.

To the Editor: Enterohemorrhagic Escherichia coli (EHEC) can cause severe hemorrhagic colitis characterized by gastrointestinal symptoms and bloody diarrhea as well as hemolytic uremic syndrome (1). Cattle and small ruminants are the major natural reservoir of these foodborne pathogens (1,2). Human infections may also develop after direct contact with cows, goats, sheep, and deer (1). Although domestic dogs and cats are known as rare EHEC carriers (3,4), no human EHEC infections associated with pet contact have been reported. Here we report the first case of an EHEC strain infecting both a child and her domestic cat. A 2-year-old girl with bloody diarrhea and vomiting subsequently tested positive for EHEC serotype O145:H–. The isolated strain harbored the pathogenicity-associated genes stx1, stx2, eae, and hly, as tested by PCR. An enterohemolytic phenotype was also present. After notification of the local health authority, a rigorous search for the possible source of the girl’s infection was started. When asked for instances of animal contact, her parents mentioned the family cat, which the girl often handled. The cat is restricted to the house, has no contact with other animals, and is fed only canned catfood. The animal strictly uses a litter box, which is cleaned regularly by the parents. No gastrointestinal symptoms in the cat were recorded. Repeated stool samples from the cat grew a strain of EHEC O145:H– that showed the identical pathogenicity gene pattern as the girl’s isolate. Moreover, a restriction fragment length polymorphism analysis proved the clonal identity of both strains. Because both the girl and the cat continuously excreted the EHEC strain, the cat was assumed to be a possible source of the girl’s infection or reinfection. The cat’s’ infection was treated with probiotics, but the child’s EHEC positivity did not change. After 3 months, the girl spontaneously stopped excreting EHEC, while the cat’s stool samples remained EHEC positive. The cat was then treated by peroral autovaccination with the heat-inactivated EHEC strain for 10 consecutive days and subsequently stopped shedding EHEC. In the Table, the clinical course and laboratory findings of both girl and cat are summarized. Table Clinical picture and isolation of EHEC serotype O145:H– from stool samples of child and her cat* To our knowledge, this case is the first documented of an EHEC strain’s affecting both a human and a domestic cat. Both excreted EHEC for ≈3 months. Although the girl had vomiting and diarrhea, the cat was asymptomatic. Several possibilities regarding the infectious process can be noted. First, the girl might have contracted the disease from her asymptomatic pet. Although in a study on eae-positive E. coli strains, ≈6% of the investigated 62 cats tested positive, none of these cats was infected with EHEC serotype O145:H– (3); this finding indicates that in our case the cat might not have been the direct source for the girl’s infection. Moreover, foodborne transmission to the cat seems unlikely because it was exclusively fed with canned food that was heated during preparation. Second, the cat might have been infected by the girl. Although the prevalence of EHEC serotype O145:H– is relatively low, it ranks among the 6 most often isolated non–O157 EHEC strains in human infections, accounting for 5%–7% of all non–O157 EHEC strains in prevalence studies in Finland (5), Germany (6), and the United States (2,7). A similar epidemiologic pattern for EHEC serotype O145:H– is seen in cattle (2,8). Taken together, the prevalence of EHEC serotype O145:H– in cats, humans, and cattle might indicate that the girl was probably more likely the infection source for the cat than vice versa. Third, a cycle of mutual infection and reinfection between the girl and her pet cat cannot be ruled out. Although the excretion rate for EHEC changes over time and EHEC can therefore remain undetected in stool samples while still present within the patient, the child tested EHEC negative for a short period. Despite all the precautions taken, the girl may have been reinfected by the cat. This case illustrates several issues: 1) domestic animals such as cats (3), dogs (3,4), and rabbits (9) may serve as reservoirs for EHEC, irrespective of whether they are the primary or secondary source for these bacteria; 2) domestic cats as carriers may excrete EHEC for a prolonged period; 3) autovaccination may be effective for treating EHEC-infected animals; and 4) fondness for pets may be problematic: although EHEC O145:H– is among the 4 most often isolated EHEC serotypes associated with severe colitis or life-threatening hemolytic uremic syndrome (10), the girl’s parents, after weighing the infectious risks against the psychological benefits for both their daughter and her feline companion, decided not to send the cat to an animal shelter until its EHEC infection disappeared.