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Figure S1. Origin of the 107 German carbapenemase-producing K. pneumoniae isolates. Regions are shown, where isolates originated from. Isolates from Saxony could not be elucidated further due to the lack of additional geographic information. Number of isolates is given by the size of the circle (see legend). Image is from: © Bundesamt für Kartographie und Geodäsie, Frankfurt am Main, Germany. Figure S2. Virulence gene content in 107 carbapenemase-producing K. pneumonaie isolates from Germany. Data are given in % of isolates showing possession of the corresponding gene cluster. The graph shows four most frequent virulence genes identified in more than one single isolate. Figure S3. Detailed view of the ML tree concerning ST258/ST512 – carbapenemase-producing K. pneumoniae isolates from Germany, 2008-2014. The image shows a subtree of Fig. 3 containing 52 isolates of ST258 (light violett) and ST512 (grey). Colour codes of the inner ring designate the corresponding carbapenemase type, the outer designates the wzi allele (see legend). Figure S4. ML tree of NGS-based analysis of German K. pneumoniae isolates and isolates from an international collection - detailed view of the cluster ST258/ST512 isolates. The image shows a subtree of Fig. 4 containing 66 isolates of ST258 and ST512. Colour codes of the inner ring correspond to the origin of strains, the middle ring to the carbapenemase KPC-2 or KPC-3, and the outer ring demonstrates the wzi allele type. (PPTX 1367 kb)

Appendix S1. List of laboratories that participate in ARS and contributed data to this analysis. Appendix S2. Geographical distribution of hospitals contributing data to the analysis. Appendix S3. Klebsiella pneumoniae isolates by year and location of hospital in Germany, 2011–2016. Appendix S4. Klebsiella pneumoniae isolates by patient and hospital characteristics in Germany 2011–2016. Appendix S5. Numbers of K. pneumoniae isolates in Germany 2011–2016 included in the analysis stratified by standards used for interpretation of antimicrobial susceptibility testing. Appendix S6. Carbapenem non-susceptibility of K. pneumoniae isolates in Germany 2011–2016 that were tested against all three carbapenems. Appendix S7. Cross-resistance of K. pneumoniae isolates non-susceptible to one carbapenem to other carbapenems restricted to isolates tested against all three carbapenems, Germany 2011–2016. Appendix S8. Sensitivity analyses to investigate the trend of carbapenem non-susceptibility over time. Appendix S9. Proportions of carbapenem non-susceptibility in K. pneumoniae isolates across substrata, Germany 2011–2016. Appendix S10. Uni- and multivariable analyses for carbapenem non-susceptibility of K. pneumoniae isolates stratified by age and sex, Germany 2011–2016. (DOCX 464 kb)

Table S2. Names and sequences of used primers for MLST and PCR amplification of virulence genes and β-lactamase genes. Table S3. Identified virulence genes in K. pneumoniae isolate no. 316/15 (ST23, OXA-48). Table S4. Identified wzi alleles from NGS data of 107 carbapenemase-producing K. pneumoniae from Germany. (DOCX 35 kb)

Am Nationalen Referenzzentrum für gramnegative Krankenhauserreger wurde im November und Dezember 2020 das gehäufte Auftreten von Isolaten des Acinetobacter baumannii-Komplex mit Carbapenemresistenz beobachtet. Der Beitrag beschreibt die in Kooperation mit dem Robert Koch-Institut durchgeführte Ausbruchsuntersuchung und die Aufklärung als Pseudoausbruch.

Additional file 3. Hospitals and university hospitals in Germany per district, 2017. Dots are randomly placed within one district. * According to the directory of hospitals, there were 1,776 general hospitals and 35 university hospitals in Germany in 2017 with a total of 479,893 general hospital beds and 45,156 university hospital beds. A total of 19,442,810 patients were treated in hospitals what accounted for 141,152*1,000 patient-days and patients stayed in hospital for a mean of 7.3 days (range: 6.9-7.9 days by federal state).

Additional file 1. Completeness of CRA (n = 2,278) and CRE (n = 12,282) notifications, Germany, 2017-2019.

Additional file 2. Most common reported bacteria in notified CRA (n = 2,278) and CRE (n = 12,282) cases, Germany, 2017-2019.

Anlässlich des Welt-Hepatitis-Tags am 28. Juli hat das Robert Koch-Institut zwei Ausgaben des Epidemiologischen Bulletins zu Hepatitis veröffentlicht, nach der Ausgabe 29 zu Hepatitis C ist am 26. Juli 2018 die Ausgabe 30 zur Situation bei Hepatitis B und D erschienen. Hepatitis B wird sexuell, durch Blut oder von der Mutter auf das Kind übertragen. Hepatitis B ist eine weltweit beim Menschen vorkommende, durch Hepatitis-B-Viren ausgelöste Leberentzündung, die vorwiegend sexuell und durch Kontakt mit kontaminiertem Blut oder anderen Körperflüssigkeiten übertragen wird. Bei Erwachsenen verläuft sie in 5 bis 10 Prozent der Fälle chronisch und kann in eine Leberzirrhose oder ein Leberzellkarzinom übergehen. Bei einer Infektion im frühen Kindesalter verlaufen circa 90 Prozent der Fälle chronisch. Vor einer Hepatitis B kann man sich mit einer effektiven Impfung schützen, die in Deutschland für alle Kinder und Jugendlichen und bestimmte Gruppen mit erhöhtem Risiko empfohlen ist. Die Impfquoten sind allerdings noch unzureichend. Das Hepatitis-D-Virus benötigt für die Infektion die Hülle des Hepatitis-B-Virus. Hepatitis D tritt somit stets zusammen mit Hepatitis B auf und führt in 70 bis 90 % der Fälle zu schweren chronischen Verläufen.

Table S2. Names and sequences of used primers for MLST and PCR amplification of virulence genes and β-lactamase genes. Table S3. Identified virulence genes in K. pneumoniae isolate no. 316/15 (ST23, OXA-48). Table S4. Identified wzi alleles from NGS data of 107 carbapenemase-producing K. pneumoniae from Germany. (DOCX 35 kb)

Appendix S1. List of laboratories that participate in ARS and contributed data to this analysis. Appendix S2. Geographical distribution of hospitals contributing data to the analysis. Appendix S3. Klebsiella pneumoniae isolates by year and location of hospital in Germany, 2011–2016. Appendix S4. Klebsiella pneumoniae isolates by patient and hospital characteristics in Germany 2011–2016. Appendix S5. Numbers of K. pneumoniae isolates in Germany 2011–2016 included in the analysis stratified by standards used for interpretation of antimicrobial susceptibility testing. Appendix S6. Carbapenem non-susceptibility of K. pneumoniae isolates in Germany 2011–2016 that were tested against all three carbapenems. Appendix S7. Cross-resistance of K. pneumoniae isolates non-susceptible to one carbapenem to other carbapenems restricted to isolates tested against all three carbapenems, Germany 2011–2016. Appendix S8. Sensitivity analyses to investigate the trend of carbapenem non-susceptibility over time. Appendix S9. Proportions of carbapenem non-susceptibility in K. pneumoniae isolates across substrata, Germany 2011–2016. Appendix S10. Uni- and multivariable analyses for carbapenem non-susceptibility of K. pneumoniae isolates stratified by age and sex, Germany 2011–2016. (DOCX 464 kb)

Figure S1. Origin of the 107 German carbapenemase-producing K. pneumoniae isolates. Regions are shown, where isolates originated from. Isolates from Saxony could not be elucidated further due to the lack of additional geographic information. Number of isolates is given by the size of the circle (see legend). Image is from: © Bundesamt für Kartographie und Geodäsie, Frankfurt am Main, Germany. Figure S2. Virulence gene content in 107 carbapenemase-producing K. pneumonaie isolates from Germany. Data are given in % of isolates showing possession of the corresponding gene cluster. The graph shows four most frequent virulence genes identified in more than one single isolate. Figure S3. Detailed view of the ML tree concerning ST258/ST512 – carbapenemase-producing K. pneumoniae isolates from Germany, 2008-2014. The image shows a subtree of Fig. 3 containing 52 isolates of ST258 (light violett) and ST512 (grey). Colour codes of the inner ring designate the corresponding carbapenemase type, the outer designates the wzi allele (see legend). Figure S4. ML tree of NGS-based analysis of German K. pneumoniae isolates and isolates from an international collection - detailed view of the cluster ST258/ST512 isolates. The image shows a subtree of Fig. 4 containing 66 isolates of ST258 and ST512. Colour codes of the inner ring correspond to the origin of strains, the middle ring to the carbapenemase KPC-2 or KPC-3, and the outer ring demonstrates the wzi allele type. (PPTX 1367 kb)