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Carbapenems are important therapeutic agents for treating infections caused by multidrug-resistant Gram-negative bacteria. Mandatory reporting of carbapenem-resistant Gram-negative bacteria (CR-GN) can allow for a better understanding of the changing CR-GN burden and can help facilitate intervention. In November 2011, identification of CR-GN with acquired carbapenem resistance became notifiable in Hesse, Germany. Hesse is one of the 16 German federal states, with a population of 6.1 million. We report on CR-GN notified between 1 January and 8 April 2013, when reporting requirements were changed. During this period, 549 CR-GN were isolated from 525 patients. Of these, 67.0% (368/549) were . The remaining 181 CR-GN comprised 59 (32.6%) , 53 (29.3%) , 28 (15.5%) spp., 20 (11.5%) , and 21 (11.6%) other CR-GN. Seventy-three (13.3%) CR-GN were reported to harbour a carbapenemase. Fourteen different carbapenemase types were reported, with the most frequent being OXA-23 (n=18), OXA-48 (n= 16), VIM-2 (n=12), VIM-1 (n=11), and NDM (n=5). Our results suggest the widespread presence of CR-GN, a high diversity of identified carbapenemases, autochthonous transmissions, and regional differences in incidence for the different species and carbapenemases, even in the absence of major outbreaks of infection.

Background: In Germany, listeriosis surveillance is based on mandatory laboratory notification of Listeria monocytogenes. Local public health departments (LPHDs) forward the received reports anonymously to state public health departments (SPHDs) which send them to the national public health centre. For the 28th reporting week (RW) 2003, LPHDs reported four cases of listeriosis to the SPHD of Hesse, cumulating to 19 listeriosis cases in 2003 compared to four cases in RW 1 - 28, 2002., Methods: To investigate this cluster, we asked LPHDs in Hesse and Lower Saxony, where a comparable increase in cases was observed, to collect food histories for the four weeks preceding illness for cases reported from 25. - 29. RW 2003. We performed laboratory-based active case detection by contacting laboratories accepting clinical specimens from Hesse, and evaluated reporting completeness at the state level for the period 1.1.2002 - 31.8.2003., Results: Food histories of the eight cases interviewed did not permit to incriminate any particular food item. Of the 49 listeriosis cases identified through either LPHDs or active case detection, 29 (59 %) were reported, forwarded to the SPHD and identified through active case detection and four (8 %) were reported and forwarded, but not identified through active case detection. Four cases (8 %) were reported to three LPHDs, but not forwarded to the SPHD. These were identified through active case detection. Further twelve cases (24 %) were exclusively identified through active case detection., Conclusions: This assessment of reporting completeness suggests that the number of laboratory confirmed listeriosis cases exceeds the number registered at state level by at least 48 %. Completeness might be improved by electronic, automated reporting.