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EMPF (Equine Multinodular Equine Fibrosis) is a newly recognized disease in horses and has been first described in 2007. It is associated with gamma herpes virus infection, especially EHV-5. Most of the cases described in the literature show a poor prognosis despite specific and intensive supportive therapy and often the diagnosis is made post mortem. The current report describes four cases of EMPF diagnosed in Germany. The horses were first presented for unspecific symptoms like recurrent fever, cough, loss of condition but developed in the further course of the disease typical findings of EMPF: severe nodular interstitial pattern on lung X-rays, pulmonary finding associated with numerous comet tail artefacts, nodules or consolidation at sonographical examination as well as the presence of EHV-5 assessed by PCR on nasal swabs, tracheal wash (TW) or BAL samples. Lung biopsy was only realised in one case because of the risks of this procedure and confirmed the suspicion of EMPF. Because of deterioration of clinical and diagnostic imaging findings with conventional treatment including acyclovir, several antibiotics and later prednisolone, these four horses were treated as the last option before euthanasia with tulathromycin i.v., a macrolide antibiotic, because of the immunomodulatory effect of that group of drugs described in human medicine. They all presented after several weeks of therapy a positive outcome, are still alive to date (or died for another reason) and those ridden before the disease returned to sport. Macrolide antibiotics are well known in human and veterinary medicine for their antimicrobial effect but also for their anti-inflammatory and immunomodulatory effects. Several studies in human medicine show that their use in interstitial pulmonary disease clearly improves the survival rate of the patients. The positive results obtained on these cases with tulathromycin might be a new option as a potential treatment for EMPF in horses. [ABSTRACT FROM AUTHOR]

Purpose: There is a growing body of evidence suggesting the decisive involvement of the human microbiome in cancer development. The consumption of antibiotics may fundamentally change the microbiome and thereby create a precancerous environment promoting cancer development and growth. However, clinical data on the association between the consumption of antibiotics and cancer incidence have remained inconclusive. In this study, we quantified the association between the intake of different antibiotics and various cancer entities among outpatients from Germany. Methods: This retrospective case–control study based on the IQVIA Disease Analyzer database included 111,828 cancer patients and 111,828 non-cancer controls who were matched to cancer cases using propensity scores. Patients were categorized as non-users, low-consumption (up to 50th percentile), and high-consumption (above 50th percentile) users of antibiotics overall and for each antibiotic class. Multivariable logistic conditional regression models were used to study the association between antibiotic intake within 5 years prior to the index date (first cancer diagnosis for cases or randomly selected date for controls) and cancer incidence. Results: The probability of cancer was significantly higher among patients with a history of antibiotic intake than in matched controls. Patients using penicillin or cephalosporins displayed a higher incidence of cancer, while the intake of tetracyclines and macrolides actually reduced the risk of cancer development slightly. A complex picture was observed in our cancer site-stratified analyses. Most notably, the consumption of penicillin was significantly and positively associated with cancer development in the respiratory organs only (low consumption OR: 1.33, 95% CI 1.20–1.47; high consumption OR 1.42, 95% CI 1.22–1.64) and cephalosporin consumption was significantly associated with respiratory organ cancer (low consumption OR: 1.32, 95% CI 1.17–1.48, high consumption OR: 1.47, 95% CI 1.29–1.66), breast cancer (high consumption OR: 1.40, 95% CI 1.25–1.56), and lymphoid and hematopoietic tissue cancer (high consumption OR: 1.50, 95% CI 1.35–1.66). Conclusion: Our data strongly support the hypothesis that the intake of antibiotics is positively associated with the risk of cancer development. [ABSTRACT FROM AUTHOR]

The pathogenesis of heart failure (HF) is multifactorial, and is characterized by structural, cellular, and molecular remodeling processes. Inflammatory signaling pathways may play a particularly understudied role in HF. Recent data suggest a possible impact of antibiotic use on HF risk. Therefore, the aim of this retrospective case-control study was to investigate the association between antibiotic use and the incidence of HF. Data from the Disease Analyzer (IQVIA) database for patients diagnosed with HF and matched non-HF controls from 983 general practices in Germany between 2000 and 2019 were analyzed. A multivariable conditional logistic regression model was performed. Regression models were calculated for all patients, as well as for data stratified for sex and four age groups. A total of 81,094 patients with HF and 81,094 patients without HF were included in the analyses. In the regression analysis, low, but not high, total antibiotic use was significantly associated with a slightly lower HF risk compared with non-antibiotic users (OR: 0.87; 95% CI: 0.85–0.90). A significantly lower HF incidence was observed for sulfonamides and trimethoprim (OR: 0.87, 95% CI: 0.81–0.93) and for macrolides (OR: 0.87, 95% CI: 0.84–0.91). High use of cephalosporins, however, was associated with an increased HF risk (OR: 1.16; 95% CI: 1.11–1.22). In conclusion, this study from a large real-world cohort from Germany provides evidence that the use of different antibiotics may be associated with HF risk in a dose-dependent manner, possibly due to involved inflammatory processes. Overall, this study should provide a basis for future research to offer new therapeutic strategies for HF patients to improve their limited prognosis. [ABSTRACT FROM AUTHOR]

Background: Rectal sexually transmitted infections (STI) are common in men having sex with men (MSM). Mycoplasma genitalium is increasingly being reported in this localization, but due to frequent lack of symptoms at this site, clinical significance is still unclear. Rectal prevalence of Mycoplasma hominis and Ureaplasma species is not well studied so far. We aimed to investigate the prevalence and antibiotic sensitivity of rectal Mollicutes in our HIV-cohort. Methods: In 227 MSM presenting for annual STI-screening, 317 anorectal swabs were collected from January 2017 to December 2018. PCR was performed for detection of Chlamydia trachomatis, Neisseria gonorrhoeae, M. genitalium and also culture for M. hominis and Ureaplasma spec. Results: Prevalence for M. genitalium, M. hominis, Ureaplasma spec., C. trachomatis and N. gonorrhoeae was 8.2%, 7.3%, 12.0%, 5.1% and 1.9%, respectively. Patients were asymptomatic with few exceptions. Seroprevalence of syphilis in 227 MSM was 41.9%. In 20 strains of M. genitalium, resistance-associated mutations to macrolides and quinolones were found in 60% and 30%, respectively; in five strains (25%) to both. M. hominis and Ureaplasma spec. frequently occurred combined, mostly in significant quantity consistent with infection. M. hominis and Ureaplasma spec. regularly showed sensitivity to tetracycline. Conclusion: At screening, rectal colonization with Mollicutes was common in our patients, but rarely caused symptoms. Due to rising antibiotic resistance of M. genitalium against quinolones, therapeutic options are increasingly limited. Treatment should be guided by antibiotic resistance testing including quinolones. In persisting anorectal symptoms, M. hominis and Ureaplasma spec. should also be taken into account. [ABSTRACT FROM AUTHOR]

Environmental context: Antibiotic residues released to the environment could influence the selection of antibiotic-resistant bacteria and hence their spread within the aquatic environment. We report a multi-method approach for determining 47 antibiotics in wastewater, surface water, drinking water and groundwater. The method provides a rapid screening of water samples for common antibiotics that have the potential to alter natural bacterial populations. A simple and rapid liquid chromatography-electrospray ionisation-tandem mass spectrometry (LC-ESI-MS/MS) method for the determination of 47 different antibiotics in water samples was developed. A straightforward sample preparation of aqueous samples could be established using a simple dilution step with a mixture of water and acetonitrile (+ 0.8 g L−1 ethylenediaminetetraacetic acid (EDTA)), subsequent filtration through a hydrophilised polytetrafluoroethylene (H-PTFE) syringe filter and a subsequent direct injection. The multi-analyte method presented includes substances from eleven classes of antibiotics (penicillins, cephalosporins, carbapenems, macrolide antibiotics, lincosamides, fluoroquinolones, tetracyclines, sulfonamides, glycopeptid antibiotics, oxazolidinones and nitroimidazoles). The method is characterised by a typical dynamic range from 0.01 µg L−1 to a maximum of 5 µg L−1, with good linearity regression coefficients (r 2 > 0.99) and suitable recovery rates (generally from 65 ± 13 % to 117 ± 5 %) in spiked drinking water, surface water, groundwater and simulated treated wastewater. Suitable limits of quantification between 3.3 ng L−1 and 190 ng L−1 could be obtained, which are sufficient to determine low levels of antibiotic residues in the aquatic environment. The efficiency of the developed method was tested by analysing the residual concentrations of antibiotics in a small creek in Germany ('Swistbach'). Sulfamethoxazole in combination with trimethoprim could be detected frequently, with calculated detection frequencies of 94–100 % and 29–47 %, as well as macrolide antibiotics (azithromycin (50–60 %), clarithromycin (82–94 %), clindamycin (88–100 %) and erythromycin (41–53 %). The determined concentrations were in a range between 0.01 µg L−1 and 0.43 µg L−1 downstream of the municipal wastewater treatment plants, whereas no antibiotics could be detected upstream. Environmental context. Antibiotic residues released to the environment could influence the selection of antibiotic-resistant bacteria and hence their spread within the aquatic environment. We report a multi-method approach for determining 47 antibiotics in wastewater, surface water, drinking water and groundwater. The method provides a rapid screening of water samples for common antibiotics that have the potential to alter natural bacterial populations. [ABSTRACT FROM AUTHOR]

The use of antibiotics and especially the use of reserve antibiotics must be further reduced in the future. Of the antibiotic groups in focus, three are approved for the treatment of diseased chickens in Germany. Colistinsulfate (Polymyxin) is by far the most significant, followed by Tylosintartrate (Macrolide) and by Enrofloxacin (Fluoroquinolone) which accounted only for about 1% of the total amount of drugs used in reserve antibiotics over the years. The political attempt to completely ban certain reserve antibiotics for veterinary medicine, contrary to various scientific opinions, was launched by some EU political stakeholders but was rejected by the EU parliament in September 2021 with a two third majority. We took this process as an opportunity to create an up-to-date assessment of reserve antibiotics prescribed in German broiler production. In doing so, we were able to show that in 660 Escherichia coli (E. coli) isolates during one year (August 2020 to July 2021), which were isolated from broilers in the DAKK's accredited laboratory LVL GmbH by using the microdilution method, no resistances against colistinsulphate occurred. The resistance gene mcr1 has also been detected in preliminary tests in some E. coli strains. However, it does not appear to be activated, since there is full efficacy in treatment with colistin. Furthermore, Tylosin antibiotics as available macrolides, and fluoroquinolones, which have been added to the list of reserve antimicrobials, are indispensable for some indications. When prescribed these drugs show excellent efficacy, good tolerance at any age and no incompatibilities with the feed coccidiostats programs. In order to protect health and welfare of poultry and other animal species, we must continue the responsible, however restrictive use of reserve antibiotics in animals, in combination with the support of modern laboratory diagnostics. [ABSTRACT FROM AUTHOR]

Highlights • 40% of MRSA clones circulating in the community in 2012–2016 were PVL+ with an increasing trend. • Molecular epidemiology revealed a high proportion of imported CA-MRSA clones in the Rhine-Neckar Region. • Local circulating and imported MRSA clones have distinct antimicrobial susceptibility patterns. • This emphasises the importance of travel exposure in the choice of empirical antibiotic treatment. ABSTRACT Methicillin-resistant Staphylococcus aureus (MRSA) remains a major challenge for patient care. Community-associated (CA)-MRSA often have a fitness and virulence advantage compared with their nosocomial counterparts. Increased mobility, travel activities and migration accelerate the intercontinental spread of virulent CA-MRSA strains. Outpatient clinics are the most important route of entry for CA-MRSA into hospitals. However, systematic data on CA-MRSA in Germany are limited. In this study, community-onset (CO)-MRSA skin and soft-tissue infection (SSTI) isolates in the Rhine-Neckar Region from 2012–2016 were characterised to gain an insight into their molecular epidemiology and to monitor potential introduction of virulent and dominant MRSA strains into our hospital. A total of 2475 patients with S. aureus SSTI were identified in the outpatient departments of our hospital, of which 94 (3.8%) were MRSA. In addition, 40.4% of the CO-MRSA harboured the virulence factor Panton–Valentine leukocidin (PVL). ST8-t008-MRSA-IVa/c (23.7%; 9/39) and ST80-t044-MRSA-IVc (15.8%; 6/38) were the predominant PVL-positive MRSA. Molecular typing and epidemiological data revealed that 42.6% (40/94) of strains could be traced back to a local origin and 44.7% (42/94) were endemic outside of Europe. Resistance to quinolones, clindamycin and macrolides was common, whilst resistance to trimethoprim/sulfamethoxazole, tetracycline, mupirocin, chlorhexidine and fusidic acid was low. No resistance to rifampicin, fosfomycin or linezolid was observed. This study provides insight into the clonal composition of CO-MRSA in the Rhine-Neckar Region. The increase of PVL-positive MRSA and the introduction of imported strains may affect the local MRSA landscape in the near future and should be monitored closely. [ABSTRACT FROM AUTHOR]

Continuous nationwide surveillance of invasive pneumococcal disease (IPD) was conducted in Germany. A total of 22,208 isolates from invasive pneumococcal disease were collected between July 1, 1992 and June 30, 2013. The present study was conducted to analyze changes in antimicrobial susceptibility and pneumococcal vaccine coverage after the introduction of pneumococcal conjugate vaccination in Germany. Most of the isolates originated from adults ≥16 years (82.5%), while 17.5% were obtained from children <16 years. Penicillin resistance was observed in 7.2% of meningitis cases both among children and adults during the entire study period. In the post-PCV13 period, the resistance rate was 11.3% in children and 10.0% in adults, which is higher than in the pre-PCV7 and post-PCV7 periods. In the non-meningitis group, an overall penicillin nonsusceptibility rate (intermediate resistance and resistance) of 0.5% was detected both among children and adults. Nonsusceptibility rates among children were 6.3% (pre-PCV7), 7.6% (post-PCV7) and 9.0% (post-PCV13). The corresponding nonsusceptibility rates among adults were 4.4%, 6.0% and 7.9%, respectively. Concerning cefotaxime, in meningitis cases 0.8% of all isolates were intermediate and 0.5% resistant among children, while among adults, 0.9% were intermediate and 0.2% resistant. In non meningitis cases, cefotaxime nonsusceptibility rates were 0.5% in children and 0.3% in adults. Macrolide nonsusceptibility rates were lower in the post-PCV13 period (children 8.2%; adults 8.8%) than in the post-PCV7 period (children 17.3%; adults 13.0%) and the pre-PCV7 period (children 24.8%; adults 13.3%). In the pre-PCV7 period, macrolide resistance was mainly caused by M-phenotype clones carrying the mefA gene. In the post-PCV7/13 period, ermB (MLSb-phenotype) was the dominant resistance marker. Overall nonsusceptibility rates were 5.5% for clindamycin (intermediate 0.3%, resistant 5.2%), 0.7% for levofloxacin (intermediate 0.4%, resistant 0.3%), 8.5% for tetracycline (intermediate 0.6%, resistant 7.9%) and 11.0% for trimethoprim-sulfamethoxazole (SXT) (intermediate 5.7%, resistant 5.3%). In summary, childhood pneumococcal conjugate vaccination has had a strong effect on the pneumococcal population in Germany, both among vaccinated children as well as among non-vaccinated children and adults. Serotypes included in the pneumococcal conjugate vaccines have strongly diminished, while some non-vaccine serotypes have gained importance, particularly with respect to antibiotic resistance. However, concerning antibiotic non-susceptibility the most outstanding change over the years is the decline in macrolide resistance, especially among children. [ABSTRACT FROM AUTHOR]

The aim of the study was to comprehensively describe antibiotic use among children and young adolescents in Germany. Outpatient prescriptions of systemic antibiotics to children (<15 years) were analysed using data from four German statutory health insurances for the years 2004 to 2006. Annual prevalence of antibiotic prescriptions was determined using the average number of insured children during the respective year as reference population. Annual antibiotic prescription rates were calculated per 1,000 person years. Both figures were stratified by age (0-4, 5-9 and 10-14 years) and sex. Frequent indications for prescribing were analysed. Annual prevalence of antibiotic prescriptions rose from 35.68 % [95 % confidence intervals (CI), 35.62-35.75] in 2004 to 37.79 % [95 % CI, 37.72-37.86] in 2006. Prescription rates slightly increased by 6.01 % from 668.54 [95 % CI, 667.34-669.72] antibiotic prescriptions per 1,000 person years in 2004 to 708.71 [95 % CI, 707.47-709.95] in 2006. In 2006, prescriptions of broad-spectrum penicillins (25.09 %), second-generation cephalosporins (18.11 %) and narrow-spectrum penicillins (16.45 %) were most frequent. The most common indication for antibiotic prescribing was tonsillitis followed by bronchitis, otitis media, acute upper respiratory infections and scarlet fever. Conclusion: In contrast to other northern European countries, paediatric prescription rates are high in Germany. This and the frequent prescribing of broad spectrum agents for the treatment of mostly viral self-limiting conditions indicate limited adherence to evidence-based practice guidelines in antibiotic prescribing in the German outpatient setting. [ABSTRACT FROM AUTHOR]

The prevalence and proliferation of antibiotic resistant bacteria is profoundly important to human health, but the extent to which aquatic environments contribute toward the dissemination of antibiotic resistant genes (ARGs) is poorly understood. The prevalence of 24 ARGs active against eight antibiotic classes (β-lactams, aminoglycosides, glycopeptides, chloramphenicols, tetracycline, macrolides, trimethoprim, and sulfonamides) was evaluated in surface water samples collected from Germany and Australia with culture independent methods. The ARGs most frequently detected both in Germany and Australia were sulI, sulII (77-100%), and dfrA1 (43-55%) which code for resistance to sulfonamide and trimethoprim. Macrolides resistance gene ermB was relatively more prevalent in the surface water from Germany (68%) than Australia (18%). In contrast, the chloramphenicol resistance gene catII was more frequently detected in Australia (64%) than Germany (9%). Similarly, β-lactams resistance gene ampC was more prevalent in the samples from Australia (36%) than Germany (19%). This study highlights wide distribution of ARGs for sulfonamide, trimethoprim, macroline, β-lactams and chloramphenicol in the aquatic ecosystems. Aquatic ecosystems can therefore be reservoirs of ARGs genes which could potentially be transferred from commensal microorganisms to human pathogens. [ABSTRACT FROM AUTHOR]

Group A streptococcus (GAS) is considered to be a major pathogen of bacterial tonsillopharyngitis in children. Although GAS is generally susceptible to penicillin, macrolides are often used as the second-line treatment. Over the last several decades, the rising macrolide resistance of GAS has been detected in several countries. With the current study, we aimed to determine the development of macrolide resistance at our paediatric centre. From March 2006 to May 2009, 350 GAS isolates were tested for susceptibility to erythromycin, azithromycin, clindamycin, penicillin and cefotaxime. Macrolide-resistant isolates were screened for the presence of genes related to macrolide resistance ( mefA, ermB, ermTR, prtF1). In comparison to a prior study at our hospital, the erythromycin resistance rate decreased significantly from 13.6 to 2.6%. This effect may be attributable to a more restrictive use of macrolides in children in our region. [ABSTRACT FROM AUTHOR]

Purpose: Bartonella henselae, the cause of cat-scratch disease in humans, may lead to characteristic vision-threatening ocular findings, which importantly indicate diagnosis. Methods: This is an observational case report of a 6-year-old boy who presented with bilateral stellate maculopathy and lymphadenopathy. Results: After serologic verification of B. henselae infection, systemic azithromycin therapy initiated the full recovery of visual acuity and bilateral complete resolution of stellate exudates during the following months. Conclusion: Stellate maculopathy should always include the differential diagnosis of B. henselae infection. In this rare case of bilateral stellate maculopathy, we observed full recovery of function following systemic macrolide therapy. [ABSTRACT FROM AUTHOR]

Abstract: In this study, macrolide-resistant Streptococcus pneumoniae and Streptococcus pyogenes isolates from Germany were carefully characterised by susceptibility testing, phenotyping, polymerase chain reaction (PCR) and sequencing of macrolides resistance genes, and multilocus sequence typing (MLST). Of 2045 S. pneumoniae and 352 S. pyogenes isolates, 437 (21.4%) and 29 (8.2%), respectively, were found to be macrolide-resistant. Amongst the S. pneumoniae isolates, the most prevalent resistance marker was mef(A) (57.7%) followed by erm(B) (27.0%) and mef(E) (11.2%). Of note, the dual resistance mechanism mef(E)+ erm(B) was found in a relatively high proportion (4.1%) of pneumococcal isolates. Amongst the S. pyogenes isolates, 31.0% carried mef(A), 34.5% erm(B) and 13.8% erm(A). Dissemination of a single clone [mef(A)-positive England14-9] has significantly contributed to the emergence of macrolide resistance amongst pneumococci in Germany. [Copyright &y& Elsevier]

Clin Microbiol Infect 2010; 16: 1649-1655 Antimicrobial resistance in genital mycoplasmas is increasing and shows global variation. We determined the susceptibilities of 469 mycoplamas, comprising 290 Mycoplasma hominis and 179 ureaplasma isolates collected during 1983 and 1989-2004, to eleven antibacterials by agar dilution. Additionally, we analyzed the results of routine E-testing during 2005-2008. Doxycycline was the most active tetracycline with (MIC90 of 1 and 8 mg/L for ureaplasmas and M. hominis, respectively. Significantly more M. hominis isolates (approximately 10-13%) than ureaplasmas (approximately 1-3%) were resistant to tetracyclines. Ofloxacin was effective against both species (>95% susceptibility). Ciprofloxacin was moderately active against M. hominis and less active against ureaplasmas (70.3% and 35.2% susceptibility, respectively). Clarithromycin and josamycin were the most potent macrolides (MIC90 of 0.5 mg/L) against ureaplasmas. Erythromycin had the lowest activity (MIC90 of 8 mg/L) against ureaplasmas like clindamycin which was the most potent agent against M. hominis. Cross-resistance was found between tetracyclines (53-93%), macrolides and erythromycin (70-100%), and between erythromycin and ciprofloxacin (43-55%). M. hominis became more resistant to tetracyclines and fluoroquinolones between 1989 and 2004, although there was little change during 2005-2008. Ureaplasmas became more resistant to cipfloxacin during 1997 - 2004 and showed high resistance rates to erythromycin during 1989 - 2008. Doxycycline is still the drug of first-choice for the treatment of ureaplasmal infections and may be used for co-infection with M. hominis. [ABSTRACT FROM AUTHOR]

Clin Microbiol Infect 2010; 16: 613–616 In a total of 167 respiratory tract specimens from adult outpatients with confirmed Mycoplasma pneumoniae pneumonia, sampled between 2003 and 2008, and a further 99 isolates obtained from patients between 1991 and 2009 in Germany, M. pneumoniae was tested for macrolide resistance. Using PCR, real-time PCR and sequencing of the 23S rRNA gene, 1.2% of M. pneumoniae in the respiratory tract samples and 3.0% of the isolates were found to be resistant. The results indicate a limited but not negligible importance of macrolide-resistant M. pneumoniae in the population investigated, which requires the monitoring of macrolide susceptibility of isolates or the testing of respiratory samples by molecular methods. [ABSTRACT FROM AUTHOR]

Background: Macrolide resistant Streptococcus pneumoniae has been on a gradual increase in Germany for over a decade. The current study was undertaken against the background of the recent observation of declining macrolide resistance rates especially among German children. Nationwide surveillance of invasive pneumococcal disease has been conducted in Germany since 1992. A population- and laboratory-based approach was used to collect data on invasive pneumococcal disease, and isolates sent to the National Reference Center for Streptococci by diagnostic microbiological laboratories from 1992 to 2008 were included in this study. Results: From 1992 to 2008, data on macrolide susceptibility were available for 11,807 invasive isolates. 8,834 isolates (74.8%) were from adults (≥ 16 years), and 2,973 isolates (25.2%) from children (< 16 years). The overall nonsusceptibility rate of all isolates was 16.2% (intermediate, 0.2%; resistant, 16.0%). Higher resistance rates were observed among children (intermediate, 0.2%; resistant, 23.8%) than among adults (intermediate, 0.3%; resistant 13.4%). Maximum nonsusceptibility rates during the period under study were observed in 2005 (children: intermediate, 0.3%; resistant, 32.3%; adults: intermediate, 0.0%; resistant, 18.6%), while nonsusceptibility rates in 2008 were considerably lower, especially for children (children: intermediate, 0.0%; resistant, 15.2%; adults: intermediate, 0.1%; resistant, 12.9%). The rate of resistance was higher among the vaccine serotypes (7-valent, 36.6%; 10-valent, 28.2%; 13-valent, 24.3%) than among the non vaccine serotypes (non 7-valent, 6.5%; non 10-valent, 7.4%; non 13-valent, 6.3%). Serotype 14 (69.6% nonsusceptibility) proved to be the most resistant serotype. Conclusions: There has been a considerable and statistically significant decrease in macrolide nonsusceptibility in Germany since 2005, especially among children. [ABSTRACT FROM AUTHOR]

The behaviour of residues of antibiotic drugs during bank filtration was studied at a field site in Berlin, Germany, where bank-filtered water is used for the production of drinking water. The neighbouring surface water used for bank filtration is under the influence of treated municipal wastewater. Seven out of 19 investigated antimicrobial residues were found in the surface water with median concentrations between 7 and 151ngL−1. Out of the seven analytes detected in the surface water only three (anhydroerythromycin, clindamycin and sulfamethoxazole) were found with median concentrations above their limits of quantitation in bank filtrate with a travel time of one month or less. With the exception of sulfamethoxazole, none of the 19 analytes were present in bank filtrate with a residence time larger than one month or in the water-supply well itself. Sulfamethoxazole found with a median concentration of 151ngL−1 in the surface water was the most persistent of all antimicrobial residues. Nevertheless, it was also removed by more than 98% and only found with a median concentration of 2ngL−1 in the water-supply well. The degradation of clindamycin and sulfamethoxazole appear to be redox-dependent. Clindamycin was eliminated more efficiently under oxic infiltration conditions while sulfamethoxazole was eliminated more rapidly under anoxic infiltration conditions. A slight preference for an improved degradation under oxic (clarithromycin and roxithromycin) or anoxic (anhydroerythromycin) conditions was also observed for the macrolide antibiotics. Nevertheless, all macrolides were readily removable by bank filtration both under oxic and anoxic conditions. [Copyright &y& Elsevier]

Background: The aim of the study was to determine the prevalence of antimicrobial resistance among clinical isolates of Streptococcus pneumoniae during the winter of 1999-2000 in Germany. Methods: Pneumococcal isolates were prospectively collected by 14 different clinical microbiology laboratories. Minimal inhibitory concentrations of penicillin G, erythromycin A, clarithromycin, roxithromycin, azithromycin, clindamycin, levofloxacin and telithromycin were determined by the broth microdilution method. Results: Among 328 strains 4.6% were nonsusceptible to penicillin G (intermediate and resistant strains) and 9.5% were resistant to erythromycin A. Analysis of erythromycin-resistant strains for the underlying resistance determinants revealed that 12 (38.7%) belonged to the erm(B) and 19 (61.3%) to the mef(E) type of resistance. Among the macrolide-resistant strains, serotypes 19F (n = 9) and 14 (n = 8) were the predominant types. Conclusions: Macrolide resistance in Germany is of growing concern and mainly due to the high prevalence of pneumococci expressing the mef(E) type of resistance [ABSTRACT FROM AUTHOR]

The article focuses on the evidence of a rapid decrease in prevalence of Helicobacter pylori infection in children of a high risk group living in Germany. The World Health Organization (WHO) estimates that about 50% of the world's population carries Helicobacter pylori in the gastric mucosa. H.pylori acquisition occurs mainly in early childhood. The article concludes that the data suggest that H.pylori prevalence might have decreased in recent years in populations known to be high risk groups for this infection, at least in developed countries. One reason for this might be the increased use of antibiotics, specifically penicillin and macrolides.