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Objective: Vancomycin-resistant (VRE) are of major concern in infection control. Although broad infection control actions to check VRE have been implemented, VRE remain part of daily infection prevention in clinical settings. Cleaning procedures in the inanimate ward environment might play a key role in controlling VRE. In order to optimize infection control management at University Hospital Frankfurt, Germany (UHF), this study evaluates the impact of HO-containing cleaning wipes compared to Glucoprotamin containing wipes on VRE prevalence in intensive care wards.Methods: Retrospective analyses were conducted of the VRE prevalence on environmental materials obtained from three intensive care units (ICU) at UHF for 17 months prior to (T1) and during the 25 months after (T2) the implementation of HO-containing cleaning wipes from January 2016 to June 2019. The bactericidal power of the two disinfectants against VRE was compared using the 4-field test according to EN 16615 (2015).Results: At T1 and T2, n=666 and n=710 environmental samples, respectively, were obtained. At T1, 24.2% (n=161/666; 95% confidence interval: 21.0–27.6) and at T2, 6.9% (n=49/710; 5.1–9.0) samples were positive for VRE. disinfectant testing did not reveal any superiority of HO over glucoprotamin. No effect on the VRE prevalence in patients’ rectal screening materials was observed.Conclusion: Though Glucoprotamin and HO were equally effective against VRE, the prevalence of VRE in ICU environment at UHF decreased after implementation of HO-containig wipes. This might be due to multiple factors, of which we consider the impact of the to be the strongest. Success of infection control strategies might depend on the compliance of the persons critically involved. Transparent information on infection control strategies is suggested to increase compliance and should therefore be considered both in daily infection control and outbreak management.

Background: Carbapenem-resistant and are of major concern in terms of infection prevention and control. This study evaluated factors that may increase the frequency of and with carbapenem resistance (CR) in patients admitted to a German University Hospital for implementation of optimized infection control management.Methods: A five-year-retrospective epidemiological cohort analysis was conducted on anamnestic risk factors for carrying and/or with CR in patients who were first tested positive for these species at University Hospital Frankfurt (UHF) between January 2013 and June 2018. Results: 364 patients were tested positive for and/or with CR, resulting in n=400 bacterial isolates in total, with being the most frequently detected species (n=146/400; 36.5%; 95% confidence interval: 31.8–41.4). In patients who were tested positive for and/or with CR, any hospital stay within the previous 12 months was the most frequently reported common factor (n=275/364; 75.5%; 70.8–79.9).Conclusion: A hospital stay within the previous 12 months, including hospitals in Germany and abroad, is a frequent characteristic of patients who tested positive for and/or with CR. Upon admission, any previous hospital stay of the given patient within the previous 12 months should be determined. Infection control strategies such as screening measures need to be adapted to these patient groups in hospital settings. In order to reflect the varying determinants in “nosocomial” cases in greater detail, the existing criteria used to characterize “nosocomial detection” of gram-negative bacteria with CR should be reviewed.

Background: Refugees have a significant risk of carrying multidrug-resistant organisms (MDRO), including multidrug-resistant gram-negative organisms (MDRGN) and methicillin-resistant (MRSA). Since the duration of MDRGN colonization has been shown to last for several months, we hypothesize that the prevalence of MDRO in refugees gradually declines during their stay in Germany to the level of MDRO prevalence in non-refugee patients. Knowledge about the dynamics of refugees’ MDRO prevalence might provide the basis for appropriate infection control measures for refugees in hospitals as well as refugees’ MDRO epidemiology in general.Material and methods: MDRO prevalence in 109 refugees admitted to the University Hospital Frankfurt, Germany, were compared to 819 adult controls and 224 pediatric patients admitted to the intensive care unit between June 2016 and May 2017.Results: 41.3% (95% confidence interval=31.9–51.1) of the refugees, 5.7% (4.2–7.6) of the adult controls and 8.9% (5.5–13.5) of the pediatric controls were positive for at least one MDRGN. The highest MDRGN prevalence was found in refugees who recently arrived (≤3 months) in Germany (72.4%; 52.8–87.3). Refugees’ MDRGN prevalence declined continuously over time, reaching the adult and pediatric controls’ MDRGN prevalence 18 months at the earliest after their arrival in Germany, i.e., 14.9% (1.8–42.8). Conclusion: This study demonstrates that refugees’ MDRGN prevalence is declining over time since their arrival in Germany. 18 months after their arrival, refugees’ and locals’ MDRGN prevalence no longer differs significantly, although the refugees’ MDRGN prevalence is still higher. A decline of MRSA prevalence was found 18 months after refugees’ arrival. However, MRSA prevalence was still 14%, and thus 8 times higher than that of controls, indicating that precautionary measures continue to be necessary to prevent MRSA transmission.

Objectives: Tuberculosis (TB) and multidrug- and extensively drug-resistant TB in particular are remaining a major global health challenge and efficient new drugs against TB are needed. This study evaluated the anti-tubercular activity of a natural stilbene and its synthetic derivatives against .Methods: Isopropylstilbene and its synthetic derivatives were analyzed for their anti-tubercular activity against ATCC 27294 as well as multidrug- and extensively drug-resistant clinical isolates by using MGIT 960 instrumentation and EpiCenter software equipped with TB eXiST module. Cytotoxic effects of drug candidates were determined by a MTT dye reduction assay using A549 adenocarcinomic human alveolar basal epithelial cells.Results: Growth of ATCC 27294 was suppressed by the natural isopropylstilbene HB64 as well as synthetic derivatives DB56 and DB55 at 25 µg/ml. Growth of clinical isolates MDR and XDR was suppressed by HB64 at 100 µg/ml as well as by synthetic derivatives DB56 and DB55 at 50 µg/ml and 25 µg/ml, respectively. No anti-tubercular activity was demonstrated for synthetic derivatives DB53, EB251, and RB57 at 100 µg/ml. Toxicity in terms of IC values of HB64, DB55 and DB56 were 7.92 µg/ml, 12.15 µg/ml and 16.01 µg/ml, respectively.Conclusions: Synthetical derivatives of stilbene might be effective candidates as anti-tubercular drugs. However, toxicity of these substances as determined by IC values might limit therapeutic success . Further investigations should address lowering the toxicity for parenteral administration by remodeling stilbene derivatives.

Background: In accordance with the German Infection Protection Act, the treatment and handling of laundry was checked by the Public Health Department in 2016 in all Frankfurt nursing homes with special focus on the staff’s clothing.Methods: On-site visits and surveys were conducted in all 44 nursing homes in Frankfurt/Main, Germany, and random microbiological examinations of 58 reprocessed and 58 already worn protective gowns were performed to determine the numbers of the colony forming units (cfu) and microbiological differentiation of the pathogen species.Results: 41 (93%) of the 44 homes tested had contracted a certified laundry service. 23 (52%) of the homes also ran a laundry of their own; in 21 of these, laundry was reprocessed and disinfected in an industrial washing machine. Regular technical or microbiological tests were carried out in 16 or 12 of the home-owned laundries, respectively. Only (70%) provided uniforms for their employees. The staff’s clothing was processed in 25 homes by the external laundry, in 9 homes by the internal laundry, and in 12 homes, the nursing staff had to do this privately at their own home.Used coats exhibited significantly higher contamination than freshly prepared ones (median: 80 vs. 2 cfu/25 cm; P 95 percentile: 256 cfu vs. 81 cfu/25 cm). Clothing prepared in private homes showed significantly higher contamination rates than those washed in the certified external laundry or in the nursing homes themselves (Median: vs. 0.5–1 cfu/25 cm).Conclusion: Considering various publications on pathogen transfers and outbreaks due to contaminated laundry in medical facilities, the treatment of laundry, in particular the uniforms, must be given more attention, also in nursing homes for the elderly. The private reprocessing of occupational clothing by the employees at home must be rejected on hygienic principles, and is furthermore prohibited by law in Germany.

Healthcare professionals (HCP) might be at increased risk of acquisition of multidrug-resistant bacteria (MDRB), i.e., methillicin-resistant (MRSA), vancomycin-resistant enterococci (VRE), and multidrug-resistant gram-negative bacteria (MDRGN) and could be an unidentified source of MDRB transmission.The aim of this study was to determine the prevalence as well as risk factors of MDRB colonization among HCP.HCP (n=107) taking part in an antibiotic stewardship program, were voluntarily recruited to perform a rectal swab and to fill in a questionnaire to identify risk factors of MDRB carriage, i.e. being physician, gender, travel abroad within the previous 12 months, vegetarianism, regular consumption of raw meat, contact to domestic animals, household members with contact to livestock, work or fellowship abroad, as well as medical treatment abroad and antibiotic therapy within the previous 12 months. Selective solid media were used to determine the colonization rate with MRSA, VRE and MDRGN. MDRGN were further characterized by molecular analysis of underlying β-lactamases. None of the participants had an intestinal colonization with MRSA or VRE. 3.7% of the participants were colonized with extended-spectrum beta-lactamase (ESBL)-producing , predominantly type. Neither additional flouroquinolone resistance nor carbapenem resistance was detected in any of these isolates. No risk factors were identified to have a significant impact of MDRB carriage among HCP.A colonization rate of 3.7% with ESBL-producing is of interest, but comparing it to previously published data with similar colonization rates in the healthy population in the same geographic area, it is probably less an occupational risk.

Background The efficacy of antibiotic prophylaxis to prevent spontaneous bacterial peritonitis (SBP) in patients colonized with multidrug-resistant organisms (MDROs) is unknown. We evaluated the effectiveness of fluoroquinolone-based SBP prophylaxis in an era and area of frequent antibiotic resistance. Methods This is a prospective observational study in patients with liver cirrhosis and an indication for fluoroquinolone-based prophylaxis of SBP. Patients were recruited and followed in a large German tertiary reference center with comprehensive microbiological and clinical monitoring performed at baseline and after 30, 60, 90, and 180 days of prophylaxis. Results Overall, 77 patients received antibiotic prophylaxis for an average of 93 days. Baseline prevalence of colonization with MDROs was high (N = 39, 50.6%). At least one de novo MDRO was detected in 27 patients (35.1%) during antibiotic prophylaxis; 33 patients (42.9%) developed secondary infections, including 14 cases (17.9%) of infections with MDROs, and 13 cases (16.9%) of de novo/recurrent SBP. Thirty patients (39.0%) died during follow-up. Significantly higher risks of SBP development during antibiotic prophylaxis were observed for patients with versus without any apparent MDROs (P =.009), vancomycin-resistant enterococci (P =.008), multidrug-resistant gram-negative bacteria (P =.016), or quinolone-resistant gram-negative bacteria (QR-GNB) (P =.015). In competing risk analysis, QR-GNB were independently associated with prophylaxis failure (hazard ratio, 3.39; P =.045) and infections with QR-GNB were independently associated with death before SBP (subdistribution hazard risk, 6.47; P =.034). Conclusions Antibiotic prophylaxis of SBP appears to be less efficient in patients with known MDROs. Regular MDRO screening seems to be useful to tailor treatment of secondary infections and re-evaluate antibiotic prophylaxis in case of selection of quinolone resistance. [ABSTRACT FROM AUTHOR]

Background: In hematology and oncology, in particular in the setting of allogeneic hematopoietic stem cell transplantation (allo‐HSCT), vancomycin‐resistant Enterococcus spp. (VRE) colonization rates are high due to previous hospital stays and preceding antibiotic treatment and colonized patients have a lower overall survival (OS). Objective: We reanalyzed our previously published cohort, to unravel which colonization timepoints before and during allo‐HSCT might be predictive for the subsequent outcome. Patients and methods: We report about 268 patients with acute myeloid leukemia receiving an allo‐HSCT between 2006 and 2016. Results: We identified 129 never‐colonized patients, 15 previously colonized patients (positive only before admission for allo‐HSCT), 41 persistently colonized patients (positive before and at admission for allo‐HSCT), and 83 newly colonized patients (positive only during allo‐HSCT). Persistently and newly colonized patients had a worse 60 months OS due to increased incidence of non‐relapse‐related mortality (NRM) than never‐colonized patients (OS: never‐colonized: 61.0% vs persistently colonized: 43.5%; P = 0.023 vs newly colonized: 45.6%; P = 0.046). In contrast, OS and NRM of never‐colonized and previously colonized patients as well as between persistently and newly colonized patients were similar. Conclusion: Patients can lose their VRE colonization status and acquisition of VRE during inpatient stay for allo‐HSCT decreases survival to a similar extend as persistent colonization. [ABSTRACT FROM AUTHOR]