[Epidemiology of multidrug-resistant organisms in travellers: Results of a 2-year screening in a German level 1 trauma center].
BACKGROUND
Antibiotic resistance has emerged as one of the eminent public health concerns. Infections can cause prolonged illness and are related to a high mortality. Expanding tourism and global travelling is one risk factor for spreading of "superbugs" (multidrug-resistant organisms, MDRO) from endemic countries with less hygiene conditions and an overuse of antibiotics. Persons that have had contact with foreign healthcare systems are at a high risk of being contaminated with these bacteria. Returning home they can transmit them to other patients and release nosocomial infections.


METHODS
To improve the prevention of nosocomial infections at the Unfallkrankenhaus Berlin (ukb), at the beginning of 2011 the hospital hygiene commission decided to expand the existing testing for methicillin-resistant Staphylococcus aureus (MRSA) to screening of incoming patients with contact to foreign healthcare systems to identify colonization or infection with multidrug-resistant bacteria.


RESULTS
In a 24-month period 155 patients were screened for MDROs, 31 patients (20%) were found to be positive, 18 showed colonization,13 patients showed infection and a multifold colonization was found in 10 patients. A total of 26 multiresistant gram-negative resistant rod-shaped bacilli resistant to 3 of the 4 classes of antibiotics (3MRGNs) were detected, 12 cases of 4MRGNs and 9 MRSAs. The average isolation time was 39 days and the calculated costs for isolation of MDRO positive patients were approximately 205,000 €. The average case mix index of MDRO positive patients was 9.54.


CONCLUSIONS
The high percentage of patients with MDROs who had had contact with foreign healthcare systems or stayed in foreign countries shows the importance of screening to identify these persons and thus help avoid nosocomial infections of other patients as well as to protect healthcare workers. No transmissions or nosocomial infections were observed during the study period.
Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Deutschland. Julia.seifert@ukb.de.|Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland. Julia.seifert@ukb.de.
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Seifert
Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Deutschland.|Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland.
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Frank
Institut für Hygiene, Unfallkrankenhaus Berlin, Berlin, Deutschland.
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Köln
Institut für Hygiene, Unfallkrankenhaus Berlin, Berlin, Deutschland.
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Beniers
Institut für Hygiene und Umweltmedizin, Universitätsmedizin Greifswald, Greifswald, Deutschland.
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Kramer
Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Deutschland.|Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland.
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Ekkernkamp
Klinik für Unfallchirurgie und Orthopädie, Unfallkrankenhaus Berlin, Warenerstr. 7, 12683, Berlin, Deutschland.|Abteilung für Unfall- und Wiederherstellungschirurgie, Universitätsmedizin Greifswald, Greifswald, Deutschland.
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Gümbel
D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012307:Risk Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014195:Travel / Q000706:statistics & numerical data*; D055815:Young Adult
Foreign healthcare system; Gram-negative bacteria; MRSA; Nosocomial infections; Transmission