title: Multicentre investigation of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in German hospitals.
abstract: Aim of this study was to determine the incidence and molecular epidemiology of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in Germany. E. coli and K. pneumoniae isolates from clinical samples which were non-susceptible to carbapenems were collected in laboratories serving 20 hospitals throughout Germany from November 2013 to April 2014. The isolates were tested for the presence of carbapenemases by PCR and phenotypic methods and typed by multilocus sequence typing. Risk factors including a previous hospitalization abroad were analysed. Carbapenemases were detected in 24 isolates from 22 patients out of 464,514 admissions. Carbapenemases included OXA-48 (n=14), KPC-2 (n=8) and NDM-1 (n=2). Except for two K. pneumoniae isolates with ST101, all OXA-48 producing strains belonged to different clones. In contrast, half of KPC-2 producing K. pneumoniae were of ST258 and both NDM-1 producing strains were of ST11. Compared to carbapenem-susceptible controls, patients with carbapenemase-producing strains differed by a significantly higher proportion of males, a higher proportion of isolates from wound samples and a more frequent previous stay abroad in univariate analysis. This multicentre study demonstrated an incidence of carbapenemase-producing E. coli and K. pneumoniae from clinical samples in Germany of 0.047 cases per 1000 admissions. OXA-48 was more frequent than KPC-2 and NDM-1 and showed a multiclonal background.
authors.affiliation: Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany. Electronic address: martin.kaase@rub.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Kaase
authors.affiliation: Institut für Laboratoriumsmedizin und Mikrobiologie, Klinikum Bayreuth GmbH, Preuschwitzer Straße 101, 95445 Bayreuth, Germany. Electronic address: sven.schimanski@klinikum-bayreuth.de.
authors.forename: Sven
authors.initials: S
authors.lastname: Schimanski
authors.affiliation: Labor Berlin-Charité Vivantes GmbH, Sylter Straße 2, 13353 Berlin, Germany. Electronic address: reinhold-andreas.schiller@charite.de.
authors.forename: Reinhold
authors.initials: R
authors.lastname: Schiller
authors.affiliation: Carl-Thiem-Klinikum Cottbus gGmbH, Thiemstraße 111, 03048 Cottbus, Germany. Electronic address: B.Beyreiss@ctk.de.
authors.forename: Bettina
authors.initials: B
authors.lastname: Beyreiß
authors.affiliation: Institut für Medizinische Mikrobiologie und Hygiene, Medizinische Fakultät "Carl Gustav Carus", Technische Universität Dresden, Fiedlerstr. 42, 01307 Dresden, Germany. Electronic address: alexander.thuermer@tu-dresden.de.
authors.forename: Alexander
authors.initials: A
authors.lastname: Thürmer
authors.affiliation: Institut für Medizinische Mikrobiologie, Universitätsklinikum Essen, Hufelandstraße 55, 45122 Essen, Germany. Electronic address: joerg.steinmann@uk-essen.de.
authors.forename: Jörg
authors.initials: J
authors.lastname: Steinmann
authors.affiliation: Universitätsklinikum Frankfurt, Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Paul-Ehrlich-Str. 40, 60596 Frankfurt am Main, Germany. Electronic address: Volkhard.Kempf@kgu.de.
authors.forename: Volkhard A
authors.initials: VA
authors.lastname: Kempf
authors.affiliation: Universitätsklinikum Freiburg, Department für Medizinische Mikrobiologie und Hygiene, Institut für Medizinische Mikrobiologie und Hygiene, Hermann-Herder-Str. 11, 79104 Freiburg, Germany. Electronic address: christina.hess@uniklinik-freiburg.de.
authors.forename: Christina
authors.initials: C
authors.lastname: Hess
authors.affiliation: LADR GmbH, Medizinisches Versorgungszentrum, Lauenburger Str. 67, 21502 Geesthacht, Germany. Electronic address: i.sobottka@ladr.de.
authors.forename: Ingo
authors.initials: I
authors.lastname: Sobottka
authors.affiliation: Labor Dr. Fenner und Kollegen, Bergstr. 14, 20095 Hamburg, Germany. Electronic address: ifenner@fennerlabor.de.
authors.forename: Ines
authors.initials: I
authors.lastname: Fenner
authors.affiliation: Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover, Germany. Electronic address: Ziesing.Stefan@mh-hannover.de.
authors.forename: Stefan
authors.initials: S
authors.lastname: Ziesing
authors.affiliation: Zentrum für Infektiologie, Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany. Electronic address: Irene.Burckhardt@med.uni-heidelberg.de.
authors.forename: Irene
authors.initials: I
authors.lastname: Burckhardt
authors.affiliation: Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum des Saarlandes Kirrbergerstr., Gebäude 43, 66421 Homburg/Saar, Germany. Electronic address: lutz.mueller@christophorus-kliniken.de.
authors.forename: Lutz
authors.initials: L
authors.lastname: von Müller
authors.affiliation: Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Goldenfelsstrasse 19-21, 50935 Köln, Germany. Electronic address: axel.hamprecht@uk-koeln.de.
authors.forename: Axel
authors.initials: A
authors.lastname: Hamprecht
authors.affiliation: Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Universitätsklinikum Magdeburg, Leipziger Str. 44, 39120 Magdeburg, Germany. Electronic address: Ina.Tammer@med.ovgu.de.
authors.forename: Ina
authors.initials: I
authors.lastname: Tammer
authors.affiliation: Institut für Medizinische Mikrobiologie, Immunologie und Hygiene, Trogerstr. 30, 81675 München, Germany. Electronic address: nina.wantia@tum.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Wantia
authors.affiliation: Institute of Medical Microbiology, University Hospital Münster, Domagkstr. 10, 48149 Münster, Germany. Electronic address: kbecker@uni-muenster.de.
authors.forename: Karsten
authors.initials: K
authors.lastname: Becker
authors.affiliation: Institut für Klinische Mikrobiologie und Hygiene, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053 Regensburg, Germany. Electronic address: Thomas.Holzmann@klinik.uni-regensburg.de.
authors.forename: Thomas
authors.initials: T
authors.lastname: Holzmann
authors.affiliation: Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany. Electronic address: Martina.Furitsch@uniklinik-ulm.de.
authors.forename: Martina
authors.initials: M
authors.lastname: Furitsch
authors.affiliation: Institut für Labordiagnostik und Hygiene, HSK, Dr. Horst Schmidt Kliniken GmbH, Ludwig-Erhard-Str. 100, 65199 Wiesbaden, Germany. Electronic address: Gabriele.Volmer@helios-kliniken.de.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Volmer
authors.affiliation: Department of Medical Microbiology, Ruhr-University Bochum, Universitätsstraße 150, 44801 Bochum, Germany. Electronic address: soeren.gatermann@rub.de.
authors.forename: Sören G
authors.initials: SG
authors.lastname: Gatermann
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001426:Bacterial Proteins / Q000032:analysis / Q000235:genetics / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D005838:Genotype; D005858:Germany / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D016133:Polymerase Chain Reaction; D015995:Prevalence; D012307:Risk Factors; D055815:Young Adult; D001618:beta-Lactamases / Q000032:analysis / Q000235:genetics / Q000378:metabolism*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: Carbapenemase; KPC; Multidrug-resistance; NDM; OXA-48