title: Multidrug-resistant organisms in refugees: prevalences and impact on infection control in hospitals.
abstract: BACKGROUND
  The refugee crisis is a great challenge to the social and healthcare system in European countries, especially in Germany. An abundance of data has been published on the refugees' health problems (infections as well as physical diseases and psychiatric problems) and their prevention (i.e., sanitary and vaccination programs). However, data on prevalences of multidrug-resistant organisms (MDRO) in refugees are scarce, although it is known that most refugees are from or travelled through countries with high prevalences of MDRO. This paper presents current data on MDRO colonization of refugees admitted to hospitals, and the impact of screening upon admission and infection control in hospitals is discussed.
  
  
  METHODS
  Anonymous data obtained by screening upon hospital admission were reported by hospitals in the Rhine-Main region of Germany to the local public health department. Screening and microbiological analyses were performed from December 2015 to March 2016 according to standardized and validated methods.
  
  
  RESULTS
  9.8% of the refugees screened (32/325) exhibited colonization with methicillin-resistant Staphylococcus aureus (MRSA), and 23.3% of the refugees (67/290) were colonized with Gram-negative bacteria with extended spectrum beta-lactamases, and/or enterobacteria with resistance against 3 or 4 groups of antibacterials, so-called 3MRGN (multidrug-resistant Gram-negative bacteria with resistance against penicillins, cephalosporins and quinolones) and 4MRGN (with additional resistance against carbapenems). Carbapenem-resistant Gram-negative bacteria (CRGN) were detected in 2.1% (6/290) of the refugees.
  
  
  CONCLUSIONS
  The data confirms the studies published between 2014 and 2016, encompassing refugees tested in Germany, the Netherlands and Israel, with prevalences of MRSA and CRGN up to 13.5% and 5.6%. The MDRO prevalences are higher than those of "risk groups" for MRSA, such as hemodialysis patients and patients depending on outpatient home-nursing care or residing in nursing homes. Therefore, screening and special infection control in hospitals is strongly suggested when refugees are admitted to hospitals, in order to ensure best medical practice and safety for all hospital patients regardless of their country of origin.
authors: Public Health Department, Division of Infectious Diseases and Hygiene, Frankfurt am Main, Germany.
authors: Ursel
authors: U
authors: Heudorf
authors: Institute for Laboratory Medicine, Klinikum Frankfurt Höchst, Frankfurt/Main, Germany.
authors: Sabine
authors: S
authors: Albert-Braun
authors: Institute for Laboratory Medicine, Microbiology and Infection Control, Northwest Medical Centre, Frankfurt/Main, Germany.
authors: Klaus-Peter
authors: KP
authors: Hunfeld
authors: Krankenhaus Sachsenhausen, Frankfurt/Main, Germany.
authors: Franz-Ulrich
authors: FU
authors: Birne
authors: Sana Clinicum Offenbach, Offenbach, Germany.
authors: Jörg
authors: J
authors: Schulze
authors: St. Katharinen Krankenhaus, Frankfurt/Main, Germany.
authors: Klaus
authors: K
authors: Strobel
authors: Klinikum Itzehoe, Itzehoe, Germany.
authors: Knut
authors: K
authors: Petscheleit
authors: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors: Volkhard A J
authors: VA
authors: Kempf
authors: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Frankfurt/Main, Germany.
authors: Christian
authors: C
authors: Brandt
keywords: asylum seekers; carbapenem-resistant Gram-negative bacteria (CRGN); infection control; methicillin-resistant Staphylococcus aureus (MRSA); multidrug-resistant Gram-negative bacteria (MRGN); multidrug-resistant organisms (MDRO); refugees; screening