title: Dramatic increase in vancomycin-resistant enterococci in Germany.
abstract: OBJECTIVE
  Among European countries, Germany has one of the highest proportions of vancomycin-resistant Enterococcus faecium bloodstream infections. The aim of this study was to investigate the development of vancomycin-resistant enterococci (VRE) in German hospitals and to consider the regional distribution of VRE in Germany.
  
  
  METHODS
  Data from three components of the German national nosocomial surveillance system (KISS) from the period 2007-12 were used for analysis: ICU-KISS data on nosocomial primary bloodstream infections and urinary tract infections from intensive care units (ICUs); OP-KISS data on surgical site infections from surgical departments; and Pathogen-KISS data concentrating on VRE cases (infections and colonizations) in ICUs. Trends over time were calculated and a map according to German federal states was prepared.
  
  
  RESULTS
  Data from up to 645 ICUs and 681 surgical departments for 2 year periods from 2007 to 2012 were analysed. The proportion of VRE increased significantly for surgical site infections (526%; P < 0.01) and bloodstream infections (265%; P < 0.01) and non-significantly for urinary tract infections (278%; P = 0.07). A large subgroup of ICUs also reported VRE cases in the same period, with a significant increase of 282%. The mapping of federal states showed large variation in VRE proportions and incidence rates in a belt of states with significantly higher VRE proportions from west (North Rhine-Westphalia) to east (Saxony).
  
  
  CONCLUSIONS
  The high overall VRE proportion in Germany is mainly due to the situation in four states. There is an urgent need to analyse the epidemiology of VRE in detail to develop appropriate infection control strategies.
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany German National Reference Centre for Surveillance of Nosocomial Infections (NRZ), Hindenburgdamm 27, 12203 Berlin, Germany petra.gastmeier@charite.de.
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany German National Reference Centre for Surveillance of Nosocomial Infections (NRZ), Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Christin
authors.initials: C
authors.lastname: Schröder
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany German National Reference Centre for Surveillance of Nosocomial Infections (NRZ), Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnke
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany German National Reference Centre for Surveillance of Nosocomial Infections (NRZ), Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Meyer
authors.affiliation: Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203 Berlin, Germany German National Reference Centre for Surveillance of Nosocomial Infections (NRZ), Hindenburgdamm 27, 12203 Berlin, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Geffers
mesh_terms: D003428:Cross Infection / Q000453:epidemiology*; D066264:Datasets as Topic; D005060:Europe / Q000453:epidemiology; D005843:Geography; D005858:Germany / Q000453:epidemiology; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology*; D006757:Hospital Units; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D011159:Population Surveillance; D065507:Vancomycin-Resistant Enterococci
keywords: epidemiology; multiresistant; surveillance