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Hornuss D, Göpel S, Walker SV, Tobys D, Häcker G, Seifert H, Higgins PG, Xanthopoulou K, Gladstone BP, Cattaneo C, Mischnik A, Rohde AM, Imirzalioglu C, Trauth J, Fritzenwanker M, Falgenhauer J, Gastmeier P, Behnke M, Kramme E, Käding N, Rupp J, Peter S, Schmauder K, Eisenbeis S, Kern WV, Tacconelli E, Rieg S. Epidemiological trends and susceptibility patterns of bloodstream infections caused by Enterococcus spp. in six German university hospitals: a prospectively evaluated multicentre cohort study from 2016 to 2020 of the R-Net study group. Infection 2024:10.1007/s15010-024-02249-2. [PMID: 38684586 DOI: 10.1007/s15010-024-02249-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 03/25/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE To analyse recent epidemiological trends of bloodstream infections (BSI) caused by Enterococcus spp. In adult patients admitted to tertiary care centres in Germany. METHODS Epidemiological data from the multicentre R-NET study was analysed. Patients presenting with E. faecium or E. faecalis in blood cultures in six German tertiary care university hospitals between October 2016 and June 2020 were prospectively evaluated. In vancomycin-resistant enterococci (VRE), the presence of vanA/vanB was confirmed via molecular methods. RESULTS In the 4-year study period, 3001 patients with BSI due to Enterococcus spp. were identified. E. faecium was detected in 1830 patients (61%) and E. faecalis in 1229 patients (41%). Most BSI occurred in (sub-) specialties of internal medicine. The pooled incidence density of enterococcal BSI increased significantly (4.0-4.5 cases per 10,000 patient days), which was primarily driven by VRE BSI (0.5 to 1.0 cases per 10,000 patient days). In 2020, the proportion of VRE BSI was > 12% in all study sites (range, 12.8-32.2%). Molecular detection of resistance in 363 VRE isolates showed a predominance of the vanB gene (77.1%). CONCLUSION This large multicentre study highlights an increase of BSI due to E. faecium, which was primarily driven by VRE. The high rates of hospital- and ICU-acquired VRE BSI point towards an important role of prior antibiotic exposure and invasive procedures as risk factors. Due to limited treatment options and high mortality rates of VRE BSI, the increasing incidence of VRE BSI is of major concern.
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Affiliation(s)
- Daniel Hornuss
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany.
- DZIF German Centre for Infection Research, Brunswick, Germany.
| | - Siri Göpel
- DZIF German Centre for Infection Research, Brunswick, Germany
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Sarah V Walker
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute Für Clinical Microbiology and Hospital Hygiene, RKH Regionale Kliniken Holding Und Services GmbH, Ludwigsburg, Germany
| | - David Tobys
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Georg Häcker
- Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Harald Seifert
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Institute of Translational Research, CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Paul G Higgins
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kyriaki Xanthopoulou
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Beryl Primrose Gladstone
- DZIF German Centre for Infection Research, Brunswick, Germany
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Chiara Cattaneo
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany
- DZIF German Centre for Infection Research, Brunswick, Germany
- Department of Neonatology and Pediatric Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, University Children's Hospital, Hamburg, Germany
| | - Alexander Mischnik
- DZIF German Centre for Infection Research, Brunswick, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538, Lübeck, Germany
| | - Anna M Rohde
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Can Imirzalioglu
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Janina Trauth
- DZIF German Centre for Infection Research, Brunswick, Germany
- Department of Internal Medicine (Infectious Diseases), Uniklinikum Giessen, Justus Liebig University Giessen, Giessen, Germany
| | - Moritz Fritzenwanker
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Jane Falgenhauer
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Petra Gastmeier
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Michael Behnke
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Evelyn Kramme
- DZIF German Centre for Infection Research, Brunswick, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538, Lübeck, Germany
| | - Nadja Käding
- DZIF German Centre for Infection Research, Brunswick, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538, Lübeck, Germany
| | - Jan Rupp
- DZIF German Centre for Infection Research, Brunswick, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538, Lübeck, Germany
| | - Silke Peter
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Kristina Schmauder
- DZIF German Centre for Infection Research, Brunswick, Germany
- Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Simone Eisenbeis
- DZIF German Centre for Infection Research, Brunswick, Germany
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany
| | - Evelina Tacconelli
- DZIF German Centre for Infection Research, Brunswick, Germany
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
- Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Center - University of Freiburg, University of Freiburg, 79106, Freiburg, Germany
- DZIF German Centre for Infection Research, Brunswick, Germany
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Mathé P, Göpel S, Hornuss D, Tobys D, Käding N, Eisenbeis S, Kohlmorgen B, Trauth J, Gölz H, Walker SV, Mischnik A, Peter S, Hölzl F, Rohde AM, Behnke M, Fritzenwanker M, Häcker G, Steffens B, Vehreschild M, Kramme E, Falgenhauer J, Peyerl-Hoffmann G, Seifert H, Rupp J, Gastmeier P, Imirzalioglu C, Tacconelli E, Kern W, Rieg S. Increasing numbers and complexity of Staphylococcus aureus bloodstream infection-14 years of prospective evaluation at a German tertiary care centre with multi-centre validation of findings. Clin Microbiol Infect 2023; 29:1197.e9-1197.e15. [PMID: 37277092 DOI: 10.1016/j.cmi.2023.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/16/2023] [Accepted: 05/25/2023] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Staphylococcus aureus bloodstream infection (SAB) is a common and severe infection. This study aims to describe temporal trends in numbers, epidemiological characteristics, clinical manifestations, and outcomes of SAB. METHODS We performed a post-hoc analysis of three prospective SAB cohorts at the University Medical Centre Freiburg between 2006 and 2019. We validated our findings in a large German multi-centre cohort of five tertiary care centres (R-Net consortium, 2017-2019). Time-dependent trends were estimated using Poisson or beta regression models. RESULTS We included 1797 patients in the mono-centric and 2336 patients in the multi-centric analysis. Overall, we observed an increasing number of SAB cases over 14 years (6.4%/year and 1000 patient days, 95% CI: 5.1% to 7.7%), paralleled by an increase in the proportion of community-acquired SAB (4.9%/year [95% CI: 2.1% to 7.8%]) and a decrease in the rate of methicillin-resistant-SAB (-8.5%/year [95% CI: -11.2% to -5.6%]). All of these findings were confirmed in the multi-centre validation cohort (6.2% cases per 1000 patient cases/year [95% CI: -0.6% to 12.6%], community-acquired-SAB 8.7% [95% CI: -1.2% to 19.6%], methicillin-resistant S. aureus-SAB -18.6% [95% CI: -30.6 to -5.8%]). Moreover, we found an increasing proportion of patients with multiple risk factors for complicated/difficult-to-treat SAB (8.5%/year, 95% CI: 3.6% to 13.5%, p < 0.001), alongside an overall higher level of comorbidities (Charlson comorbidity score 0.23 points/year, 95% CI: 0.09 to 0.37, p 0.005). At the same time, the rate of deep-seated foci such as osteomyelitis or deep-seated abscesses significantly increased (6.7%, 95% CI: 3.9% to 9.6%, p < 0.001). A reduction of in-hospital mortality by 0.6% per year (95% CI: 0.08% to 1%) was observed in the subgroup of patients with infectious diseases consultations. DISCUSSION We found an increasing number of SAB combined with a significant increase in comorbidities and complicating factors in tertiary care centres. The resulting challenges in securing adequate SAB management in the face of high patient turnover will become an important task for physicians.
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Affiliation(s)
- Philipp Mathé
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Siri Göpel
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Daniel Hornuss
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - David Tobys
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nadja Käding
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Simone Eisenbeis
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Britta Kohlmorgen
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Janina Trauth
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Internal Medicine (Infectious Diseases), Uniklinikum Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Hanna Gölz
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Sarah V Walker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany; Institute for Clinical Microbiology and Hospital Hygiene, Klinikum Ludwigsburg, Ludwigsburg, Germany
| | - Alexander Mischnik
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Silke Peter
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Florian Hölzl
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Anna M Rohde
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Michael Behnke
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Moritz Fritzenwanker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Georg Häcker
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Benedict Steffens
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Maria Vehreschild
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Frankfurt, Germany
| | - Evelyn Kramme
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Jane Falgenhauer
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Gabriele Peyerl-Hoffmann
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Harald Seifert
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Medical Microbiology, Immunology, and Hygiene, Medical Faculty and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan Rupp
- DZIF German Centre for Infection Research, Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Petra Gastmeier
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Can Imirzalioglu
- DZIF German Centre for Infection Research, Braunschweig, Germany; Institute of Medical Microbiology, Justus-Liebig-University of Giessen, Giessen, Germany
| | - Evelina Tacconelli
- DZIF German Centre for Infection Research, Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany; Division of Infectious Diseases, Department of Diagnostic and Public Health, University of Verona, Policlinico GB Rossi, Verona, Italy
| | - Winfried Kern
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany; DZIF German Centre for Infection Research, Braunschweig, Germany.
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Yagdiran A, Paul G, Meyer-Schwickerath C, Scheder-Bieschin J, Tobys D, Kernich N, Eysel P, Jung N. Clinical features and outcome of vertebral osteomyelitis after spinal injection: is it worth the price? Infection 2023; 51:599-607. [PMID: 37071309 DOI: 10.1007/s15010-023-02024-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 03/14/2023] [Indexed: 04/19/2023]
Abstract
PURPOSE Spinal injections are increasingly used for back pain treatment. Vertebral osteomyelitis (VO) after spinal injection (SIVO) is rare, but patient characteristics and outcome have not been well characterized. The aim of this study was to assess patient characteristics of SIVO in comparison to patients with native vertebral osteomyelitis (NVO) and to determine predictors for 1-year survival. METHODS This is a single-center cohort study from a tertiary referral hospital. This is a retrospective analysis of Patients with VO who were prospectively enrolled into a spine registry from 2008 to 2019. Student's t-test, Kruskal-Wallis test or Chi-square test were applied for group comparisons. Survival analysis was performed using a log-rank test and a multivariable Cox regression model. RESULTS 283 VO patients were enrolled in the study, of whom 44 (15.5%) had SIVO and 239 (84.5%) NVO. Patients with SIVO were significantly younger, had a lower Charlson comorbidity index and a shorter hospital stay compared to NVO. They also showed a higher rate of psoas abscesses and spinal empyema (38.6% [SIVO] vs. 20.9% [NVO]). Staphylococcus aureus (27%) and coagulase-negative staphylococci (CNS) (25%) were equally often detected in SIVO while S. aureus was more frequently than CNS in NVO (38.1% vs. 7.9%).Patients with SIVO (P = 0.04) had a higher 1-year survival rate (Fig. 1). After multivariate analysis, ASA score was associated with a lower 1-year survival in VO. CONCLUSION The results from this study emphasize unique clinical features of SIVO, which warrant that SIVO should be estimated as a separate entity of VO.
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Affiliation(s)
- Ayla Yagdiran
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Gregor Paul
- Department of Internal Medicine III - Gastroenterology and Infectious Diseases, University Hospital of Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany.
| | | | - Justus Scheder-Bieschin
- Department of Interdisciplinary Acute, Emergency and Intensive Care Medicine (DIANI), Klinikum Stuttgart, Stuttgart, Germany
| | - David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine, University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Nikolaus Kernich
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Peer Eysel
- Department of Orthopedics and Trauma Surgery, University Hospital of Cologne, Cologne, Germany
| | - Norma Jung
- Division of Infectious Diseases, Department I of Internal Medicine, University of Cologne, Cologne, Germany
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Both A, Huang J, Hentschke M, Tobys D, Christner M, Klatte TO, Seifert H, Aepfelbacher M, Rohde H. Genomics of Invasive Cutibacterium acnes Isolates from Deep-Seated Infections. Microbiol Spectr 2023; 11:e0474022. [PMID: 36976006 PMCID: PMC10100948 DOI: 10.1128/spectrum.04740-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
Cutibacterium acnes, formerly known as Propionibacterium acnes, is a commensal of the human pilosebaceous unit but also causes deep-seated infection, especially in the context of orthopedic and neurosurgical foreign materials. Interestingly, little is known about the role of specific pathogenicity factors for infection establishment. Here, 86 infection-associated and 103 commensalism-associated isolates of C. acnes were collected from three independent microbiology laboratories. We sequenced the whole genomes of the isolates for genotyping and a genome-wide association study (GWAS). We found that C. acnes subsp. acnes IA1 was the most significant phylotype among the infection isolates (48.3% of all infection isolates; odds ratio [OR] = 1.98 for infection). Among the commensal isolates, C. acnes subsp. acnes IB was the most significant phylotype (40.8% of all commensal isolates; OR = 0.5 for infection). Interestingly, C. acnes subsp. elongatum (III) was rare overall and did not occur at all in infection. The open reading frame-based GWAS (ORF-GWAS) did not show any loci with a strong signal for infection association (no P values of ≤0.05 after adjustment for multiple testing; no logarithmic OR [logOR] of ≥|2|). We concluded that all subspecies and phylotypes of C. acnes, possibly with the exception of C. acnes subsp. elongatum, are able to cause deep-seated infection given favorable conditions, most importantly related to inserted foreign material. Genetic content appears to have a small effect on the likelihood of infection establishment, and functional studies are needed to understand the individual factors contributing to deep-seated infections caused by C. acnes. IMPORTANCE Opportunistic infections emerging from human skin microbiota are of ever-increasing importance. Cutibacterium acnes, being abundant on the human skin, may cause deep-seated infections (e.g., device-associated infections). Differentiation between invasive (i.e., clinically significant) C. acnes isolates and sole contaminants is often difficult. Identification of genetic markers associated with invasiveness not only would strengthen our knowledge related to pathogenesis but also could open ways to selectively categorize invasive and contaminating isolates in the clinical microbiology lab. We show that in contrast to other opportunistic pathogens (e.g., Staphylococcus epidermidis), invasiveness is apparently a broadly distributed ability across almost all C. acnes subspecies and phylotypes. Thus, our work strongly supports an approach in which clinical significance is judged from clinical context rather than by detecting specific genetic traits.
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Affiliation(s)
- Anna Both
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jiabin Huang
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | - David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Martin Christner
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Till Orla Klatte
- Department for Trauma Surgery and Orthopedics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Center for Infection Research (DZIF), Partner Site Bonn-Cologne, Cologne, Germany
| | - Martin Aepfelbacher
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Holger Rohde
- Institute for Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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5
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Rohde AM, Walker S, Behnke M, Eisenbeis S, Falgenhauer L, Falgenhauer JC, Häcker G, Hölzl F, Imirzalioglu C, Käding N, Kern WV, Kola A, Kramme E, Mischnik A, Peter S, Rieg S, Rupp J, Schneider C, Schwab F, Seifert H, Tacconelli E, Tobys D, Trauth J, Weber A, Xanthopoulou K, Zweigner J, Higgins PG, Gastmeier P. Vancomycin-resistant Enterococcus faecium: admission prevalence, sequence types and risk factors-a cross-sectional study in seven German university hospitals from 2014 to 2018. Clin Microbiol Infect 2022; 29:515-522. [PMID: 36481293 DOI: 10.1016/j.cmi.2022.11.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/11/2022] [Accepted: 11/27/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Assessment of vancomycin-resistant Enterococcus faecium (VREfm) prevalence upon hospital admission and analysis of risk factors for colonization. METHODS From 2014 to 2018, patients were recruited within 72 hours of admission to seven participating German university hospitals, screened for VREfm and questioned for potential risk factors (prior multidrug-resistant organism detection, current/prior antibiotic consumption, prior hospital, rehabilitation or long-term care facility stay, international travel, animal contact and proton pump inhibitor [PPI]/antacid therapy). Genotype analysis was done using cgMLST typing. Multivariable analysis was performed. RESULTS In 5 years, 265 of 17,349 included patients were colonized with VREfm (a prevalence of 1.5%). Risk factors for VREfm colonization were age (adjusted OR [aOR], 1.02; 95% CI, 1.01-1.03), previous (aOR, 2.71; 95% CI, 1.87-3.92) or current (aOR, 2.91; 95% CI, 2.60-3.24) antibiotic treatment, prior multidrug-resistant organism detection (aOR, 2.83; 95% CI, 2.21-3.63), prior stay in a long-term care facility (aOR, 2.19; 95% CI, 1.62-2.97), prior stay in a hospital (aOR, 2.91; 95% CI, 2.05-4.13) and prior consumption of PPI/antacids (aOR, 1.29; 95% CI, 1.18-1.41). Overall, the VREfm admission prevalence increased by 33% each year and 2% each year of life. 250 of 265 isolates were genotyped and 141 (53.2%) of the VREfm were the emerging ST117. Multivariable analysis showed that ST117 and non-ST117 VREfm colonized patients differed with respect to admission year and prior multidrug-resistant organism detection. DISCUSSION Age, healthcare contacts and antibiotic and PPI/antacid consumption increase the individual risk of VREfm colonization. The VREfm admission prevalence increase in Germany is mainly driven by the emergence of ST117.
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Affiliation(s)
- Anna M Rohde
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Sarah Walker
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Michael Behnke
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Simone Eisenbeis
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - Linda Falgenhauer
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Hygiene and Environmental Medicine, Justus Liebig University, Giessen, Germany
| | - Jane C Falgenhauer
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Medical Microbiology, Justus Liebig University, Giessen, Germany
| | - Georg Häcker
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Florian Hölzl
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany; Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Can Imirzalioglu
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Medical Microbiology, Justus Liebig University, Giessen, Germany
| | - Nadja Käding
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Freiburg, Germany
| | - Axel Kola
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Evelyn Kramme
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Alexander Mischnik
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Siegbert Rieg
- Division of Infectious Diseases, Department of Medicine II, University Medical Centre and Faculty of Medicine, Albert-Ludwigs-University, Freiburg, Freiburg, Germany
| | - Jan Rupp
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Infectious Diseases and Microbiology, University Hospital Schleswig-Holstein/Campus, Lübeck, Germany
| | - Christian Schneider
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Frank Schwab
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Division of Infectious Diseases, Department of Internal Medicine 1, University Hospital Tübingen, Tübingen, Germany
| | - David Tobys
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Janina Trauth
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Internal Medicine (Infectiology), Uniklinikum, Giessen, Germany
| | - Anna Weber
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kyriaki Xanthopoulou
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Janine Zweigner
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Department of Hospital Hygiene and Infection Control, University Hospital Cologne, Cologne, Germany
| | - Paul G Higgins
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Petra Gastmeier
- German Centre for Infection Research (DZIF), Braunschweig, Germany; Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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6
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Xanthopoulou K, Imirzalioglu C, Walker SV, Behnke M, Dinkelacker AG, Eisenbeis S, Gastmeier P, Gölz H, Käding N, Kern WV, Kola A, Kramme E, Lucassen K, Mischnik A, Peter S, Rohde AM, Rupp J, Tacconelli E, Tobys D, Vehreschild MJGT, Wille J, Seifert H, Higgins PG. Surveillance and Genomic Analysis of Third-Generation Cephalosporin-Resistant and Carbapenem-Resistant Klebsiella pneumoniae Complex in Germany. Antibiotics (Basel) 2022; 11:antibiotics11101286. [PMID: 36289942 PMCID: PMC9598256 DOI: 10.3390/antibiotics11101286] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/31/2022] [Accepted: 09/05/2022] [Indexed: 11/21/2022] Open
Abstract
To analyse the epidemiology and population structure of third-generation cephalosporin-resistant (3GCR) and carbapenem-resistant (CR) Klebsiella pneumoniae complex isolates, patients were screened for rectal colonisation with 3GCR/CR K. pneumoniae complex on admission to six German university hospitals (2016–2019). Also collected were 3GCR/CR and susceptible K. pneumoniae isolates from patients with bloodstream infections (2016–2018). Whole-genome sequencing was performed followed by multilocus sequencing typing (MLST), core-genome MLST, and resistome and virulome analysis. The admission prevalence of 3GCR K. pneumoniae complex isolates during the 4-year study period was 0.8%, and 1.0 bloodstream infection per 1000 patient admissions was caused by K. pneumoniae complex (3GCR prevalence, 15.1%). A total of seven K. pneumoniae complex bloodstream isolates were CR (0.8%). The majority of colonising and bloodstream 3GCR isolates were identified as K. pneumoniae, 96.7% and 98.8%, respectively; the remainder were K. variicola and K. quasipneumoniae. cgMLST showed a polyclonal population of colonising and bloodstream isolates, which was also reflected by MLST and virulome analysis. CTX-M-15 was the most prevalent extended-spectrum beta-lactamase, and 29.7% of the colonising and 48.8% of the bloodstream isolates were high-risk clones. The present study provides an insight into the polyclonal 3GCR K. pneumoniae population in German hospitals.
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Affiliation(s)
- Kyriaki Xanthopoulou
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
- Correspondence: ; Tel.: +49-221-478-32231
| | - Can Imirzalioglu
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Medical Microbiology, Justus Liebig University Giessen, 35392 Giessen, Germany
| | - Sarah V. Walker
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Michael Behnke
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany
- National Reference Centre for the Surveillance of Nosocomial Infections, 12203 Berlin, Germany
| | - Ariane G. Dinkelacker
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, 72074 Tübingen, Germany
| | - Simone Eisenbeis
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, 72076 Tübingen, Germany
| | - Petra Gastmeier
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany
- National Reference Centre for the Surveillance of Nosocomial Infections, 12203 Berlin, Germany
| | - Hanna Gölz
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, 79104 Freiburg, Germany
| | - Nadja Käding
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Winfried V. Kern
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Centre, University of Freiburg, 79106 Freiburg, Germany
| | - Axel Kola
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany
- National Reference Centre for the Surveillance of Nosocomial Infections, 12203 Berlin, Germany
| | - Evelyn Kramme
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Kai Lucassen
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Alexander Mischnik
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
- Division of Infectious Diseases, Department of Medicine II, Faculty of Medicine, Medical Centre, University of Freiburg, 79106 Freiburg, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, 72074 Tübingen, Germany
| | - Anna M. Rohde
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute of Hygiene and Environmental Medicine, Charité–Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, 12203 Berlin, Germany
| | - Jan Rupp
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Department of Infectious Diseases and Microbiology, University of Lübeck and University Hospital Schleswig-Holstein, Campus Lübeck, 23538 Lübeck, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Division of Infectious Diseases, Department of Internal Medicine I, University Hospital Tübingen, 72076 Tübingen, Germany
| | - David Tobys
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Maria J. G. T. Vehreschild
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Department I of Internal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, 50937 Cologne, Germany
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, 60590 Frankfurt am Main, Germany
| | - Julia Wille
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
| | - Paul G. Higgins
- German Centre for Infection Research (DZIF), 38124 Braunschweig, Germany
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, 50935 Cologne, Germany
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Abdrabou AMM, Bischoff M, Mellmann A, von Müller L, Margardt L, Gärtner BC, Berger FK, Haase G, Häfner H, Hoffmann R, Simon V, Stappmanns H, Hischebeth GT, Büchler C, Rößler S, Hochauf-Stange K, Pfeffer K, MacKenzie C, Kunz C, Alsalameh R, Dziobaka J, le Chapot VS, Sanabria E, Hogardt M, Komp J, Imirzalioglu C, Schmiedel J, Pararas M, Sommer F, Groß U, Bohne W, Kekulé AS, Dagwadordsch U, Löffler B, Rödel J, Walker SV, Tobys D, Weikert-Asbeck S, Hauswaldt S, Kaasch AJ, Zautner AE, Joß N, Siegel E, Kehr K, Schaumburg F, Schoeler S, Hamprecht A, Hellkamp J, Hagemann JB, Kubis J, Hering S, Warnke P. Implementation of a Clostridioides difficile sentinel surveillance system in Germany: First insights for 2019–2021. Anaerobe 2022; 77:102548. [DOI: 10.1016/j.anaerobe.2022.102548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/01/2022]
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8
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Tobys D, Johannis W, Juebner M, Drinhaus H. A New Kind of Barrel Chest: Alcoholic Fermentation due to Candida albicans in a Pleural Effusion. Am J Med 2021; 134:e482-e483. [PMID: 33864766 DOI: 10.1016/j.amjmed.2021.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 11/15/2022]
Affiliation(s)
- David Tobys
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany; German Centre for Infection Research (DZIF), partner site Bonn-Cologne, Germany
| | - Wibke Johannis
- Institute for Clinical Chemistry, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Martin Juebner
- Institute of Legal Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany
| | - Hendrik Drinhaus
- Department of Anaesthesiology and Intensive Care Medicine, Faculty of Medicine and University Hospital of Cologne, University of Cologne, Germany.
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9
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Xanthopoulou K, Peter S, Tobys D, Behnke M, Dinkelacker AG, Eisenbeis S, Falgenhauer J, Falgenhauer L, Fritzenwanker M, Gölz H, Häcker G, Higgins PG, Imirzalioglu C, Käding N, Kern WV, Kramme E, Kola A, Mischnik A, Rieg S, Rohde AM, Rupp J, Tacconelli E, Vehreschild MJGT, Walker SV, Gastmeier P, Seifert H. Vancomycin-resistant Enterococcus faecium colonizing patients on hospital admission in Germany: prevalence and molecular epidemiology. J Antimicrob Chemother 2021; 75:2743-2751. [PMID: 32699884 DOI: 10.1093/jac/dkaa271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 05/12/2020] [Accepted: 05/20/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To analyse the rectal carriage rate and the molecular epidemiology of vancomycin-resistant Enterococcus faecium (VREfm) recovered from patients upon hospital admission. METHODS Adult patients were screened at six German university hospitals from five different federal states upon hospital admission for rectal colonization with VREfm between 2014 and 2018. Molecular characterization of VREfm was performed by WGS followed by MLST and core-genome MLST analysis. RESULTS Of 16350 patients recruited, 263 were colonized with VREfm, with increasing prevalence rates during the 5 year study period (from 0.8% to 2.6%). In total, 78.5% of the VREfm were vanB positive and 20.2% vanA positive, while 1.2% harboured both vanA and vanB. The predominant ST was ST117 (56.7%) followed by ST80 (15%), ST203 (10.9%), ST78 (5.7%) and ST17 (3.2%). ST117/vanB VREfm isolates formed a large cluster of 96 closely related isolates extending across all six study centres and four smaller clusters comprising 13, 5, 4 and 3 isolates each. In contrast, among the other STs inter-regional clonal relatedness was rarely observed. CONCLUSIONS To our knowledge, this is the largest admission prevalence and molecular epidemiology study of VREfm. These data provide insight into the epidemiology of VREfm at six German university hospitals and demonstrate the remarkable inter-regional clonal expansion of the ST117/vanB VREfm clone.
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Affiliation(s)
- Kyriaki Xanthopoulou
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Silke Peter
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - David Tobys
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Michael Behnke
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Ariane G Dinkelacker
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute of Medical Microbiology and Hygiene, University of Tübingen, Tübingen, Germany
| | - Simone Eisenbeis
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Division of Infectious Disease, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
| | - Jane Falgenhauer
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Linda Falgenhauer
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute of Hygiene and Environmental Medicine, Justus Liebig University Giessen, Giessen, Germany
| | - Moritz Fritzenwanker
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Hannah Gölz
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Georg Häcker
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology and Hygiene, University Medical Centre Freiburg, Freiburg, Germany
| | - Paul G Higgins
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Can Imirzalioglu
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute of Medical Microbiology, Justus Liebig University Giessen, Giessen, Germany
| | - Nadja Käding
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Winfried V Kern
- Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Centre and Faculty of Medicine, Freiburg, Germany
| | - Evelyn Kramme
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Axel Kola
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Alexander Mischnik
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Siegbert Rieg
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Division of Infectious Diseases, Department of Medicine II, University of Freiburg Medical Centre and Faculty of Medicine, Freiburg, Germany
| | - Anna M Rohde
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Jan Rupp
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Department of Infectious Diseases and Microbiology, University of Lübeck, Lübeck, Germany
| | - Evelina Tacconelli
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Division of Infectious Disease, Department of Internal Medicine I, Tübingen University Hospital, Tübingen, Germany
| | - Maria J G T Vehreschild
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,University of Cologne, Department I of Internal Medicine, Cologne, Germany.,Department of Internal Medicine, Infectious Diseases, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sarah V Walker
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
| | - Petra Gastmeier
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité-University Hospital, Berlin, Germany
| | - Harald Seifert
- German Centre for Infection Research (DZIF), Braunschweig, Germany.,Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany
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10
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Tobys D, Kowalski LM, Cziudaj E, Müller S, Zentis P, Pach E, Zigrino P, Blaeske T, Höning S. Inhibition of clathrin-mediated endocytosis by knockdown of AP-2 leads to alterations in the plasma membrane proteome. Traffic 2020; 22:6-22. [PMID: 33225555 DOI: 10.1111/tra.12770] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 11/19/2020] [Accepted: 11/19/2020] [Indexed: 01/05/2023]
Abstract
In eukaryotic cells, clathrin-mediated endocytosis (CME) is a central pathway for the internalization of proteins from the cell surface, thereby contributing to the maintenance of the plasma membrane protein composition. A key component for the formation of endocytic clathrin-coated vesicles (CCVs) is AP-2, as it sequesters cargo membrane proteins, recruits a multitude of other endocytic factors and initiates clathrin polymerization. Here, we inhibited CME by depletion of AP-2 and explored the consequences for the plasma membrane proteome. Quantitative analysis revealed accumulation of major constituents of the endosomal-lysosomal system reflecting a block in retrieval by compensatory CME. The noticeable enrichment of integrins and blockage of their turnover resulted in severely impaired cell migration. Rare proteins such as the anti-cancer drug target CA9 and tumor markers (CD73, CD164, CD302) were significantly enriched. The AP-2 knockdown attenuated the global endocytic capacity, but clathrin-independent entry pathways were still operating, as indicated by persistent internalization of specific membrane-spanning and GPI-anchored receptors (PVR, IGF1R, CD55, TNAP). We hypothesize that blocking AP-2 function and thus inhibiting CME may be a novel approach to identify new druggable targets, or to increase their residence time at the plasma membrane, thereby increasing the probability for efficient therapeutic intervention.
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Affiliation(s)
- David Tobys
- Institute for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Lisa Maria Kowalski
- Institute for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Eva Cziudaj
- Institute for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
| | - Stefan Müller
- Center for Molecular Medicine Cologne (CMMC), University of Cologne, Cologne, Germany
| | - Peter Zentis
- CECAD Cluster of Excellence, University of Cologne, Cologne, Germany
| | - Elke Pach
- Department of Dermatology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Paola Zigrino
- Department of Dermatology, Medical Faculty, University of Cologne, Cologne, Germany
| | - Tobias Blaeske
- Department of Plant Physiology and Biochemistry, University of Constance, Constance, Germany
| | - Stefan Höning
- Institute for Biochemistry, Medical Faculty, University of Cologne, Cologne, Germany
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11
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Classen A, Jakob C, Stecher M, Tobys D, Piepenbrock E, Holtick U, Scheid C, Cornely O, Janne Vehreschild J. 224. Epidemiology of Bloodstream infections in a Cohort of Allogeneic Hematopoietic Stem Cell Transplant Patients from 2009 to 2018. Open Forum Infect Dis 2019. [PMCID: PMC6809814 DOI: 10.1093/ofid/ofz360.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Due to severe immunosuppression, patients undergoing allogeneic hematopoietic stem cell transplantation (aSCT) are at increased risk of infection and especially bloodstream infections (BSI) remain a major cause of death. Knowledge of the specific epidemiology of pathogens and resistances is of utmost importance to optimize antimicrobial treatment strategies. Methods Based on the Cologne Cohort of Neutropenic Patients (CoCoNut) database, we conducted a retrospective analysis of blood cultures collected within 100 days following transplantation of patients undergoing aSCT between January 2009 and December 2018 at the University Hospital of Cologne, Germany. Contamination of coagulase-negative Staphylococci (CoNS) isolates (single positive isolate within 5 days) was considered within the analysis. Results In total, 843 aSCT patients were available for analysis (484/843 [57%] male). The median age was 53 (interquartile range [IQR] 43–62) years, predominant underlying diseases were acute myeloid leukemia (47%, 397/843), lymphoma (14%, 117/843), and acute lymphoblastic leukemia (11%, 89/843). Median inpatient stay was 39 (IQR 34–50) days, while 67/843 (8%) patients died. Antibacterial prophylaxis was administered in 289/843 (34%) and antifungal prophylaxis in 738/843 (88%) patients. BSI was diagnosed in 233/843 (28%) patients. In total, 5,489 pairs of blood cultures were taken (median 4 per patient, IQR 2–8), while a pathogen could only be detected in 922/5,489 (17%). Most frequent pathogens were CoNS (259/922, 28%), Enterococcus spp. (219/922, 24%), E. coli (132/922, 14%), Klebsiella spp. (44/922, 5%), P. aeruginosa (39/922, 4%), S. aureus (37/922, 4%), and Candida spp. (42/922, 5%). Polymicrobial infection was detected in 58/922 (6%) cases. Within Enterococci isolates, 24/219 (11%) were VRE. None of the Klebsiella, but 9/132 (7%) of E. coli isolates were ESBL positive. In 4/37 (11%) cases S. aureus isolates were MRSA. Conclusion Patients in the early phase after aSCT are at high risk of BSI with a predominantly gram-positive spectrum. Empirical antimicrobial treatment must consider pathogen epidemiology and resistance patterns while waiting for blood culture results. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Annika Classen
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Carolin Jakob
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Melanie Stecher
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Department I for Internal Medicine, Cologne, Nordrhein-Westfalen, Germany
| | - David Tobys
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Ellen Piepenbrock
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Udo Holtick
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Christof Scheid
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Oliver Cornely
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Jörg Janne Vehreschild
- University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
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