title: Prevalence of multidrug-resistant organisms in refugee patients, medical tourists and domestic patients admitted to a German university hospital.
abstract: Patients with contact to healthcare-system in high-prevalence countries (HPC) and refugee patients in hospital settings (REF) have previously been identified to be at risk of carrying multidrug-resistant organisms (MDRO). Comparative studies addressing the epidemiology of MDRO in patients transferred from hospitals abroad (ABROAD) and REF are lacking but are necessary to introduce refined infection control measures.
  
  
  
  From December 2015 to June 2016, 117 REF, 84 ABROAD and 495 patients admitted to intensive care unit, with no refugee history or pre-treatment abroad (ICU), at University Hospital Frankfurt, Germany (UHF) were screened for MDRO on day of admittance. Data within these groups were compared and set in an epidemiological context.
  
  
  
  52.1% (95% confidence interval = 42.7-61.5) of REF and 41.6% (31.0-52.9) of ABROAD, were positive for at least one MDRGN, respectively. In contrast, 7.9% (5.6-10.6) of ICU were positive for MDRGN. Thereof, 0.9% (0.0-4.7) of REF, 15.5% (8.5-25.0) of ABROAD and 0% (0.0-0.7) of ICU were positive for at least one MDRGN with carbapenem resistance (CR). In total, 19 MDRGN with CR were detected in ABROAD, with the most frequent species with CR being A. baumannii with 42.1% (20.3-66.5). Regarding MRSA, 10.3% (5.4-17.2) of REF, 5.9% (1.9-13.3) of ABROAD and a significantly lower proportion 1.4% (0.6-2.9) of ICU, respectively, were tested positive.
  
  
  
  Both REF and ABROAD pose a relevant hospital hygiene risk. High prevalence of MDRGN with CR in ABROAD was observed. Concise screening and infection control guidelines are needed in patient cohorts with increased risk for MDRO carriage.
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Reinheimer
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany. volkhard.kempf@kgu.de.
authors.forename: Volkhard A J
authors.initials: VA
authors.lastname: Kempf
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
authors.forename: Katalin
authors.initials: K
authors.lastname: Jozsa
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wichelhaus
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Hogardt
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
authors.forename: Fiona
authors.initials: F
authors.lastname: O'Rourke
authors.affiliation: Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Straße 40, 60596, Frankfurt am Main, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Brandt
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D015780:Carbapenems / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D006920:Hygiene; D017053:Infection Control; D007362:Intensive Care Units / Q000706:statistics & numerical data; D008297:Male; D057193:Medical Tourism / Q000706:statistics & numerical data*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D015995:Prevalence; D012036:Refugees / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015780:Carbapenems
keywords: Hospital hygiene; Infection control; Medical tourists; Multidrug-resistant organisms; Refugees