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Jochims F, Lippmann N, Simon JC. [Cutaneous diphtheria]. Dermatologie (Heidelb) 2024; 75:343. [PMID: 38277020 DOI: 10.1007/s00105-024-05296-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Affiliation(s)
- F Jochims
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Deutschland.
| | - Norman Lippmann
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
| | - Jan Christoph Simon
- Klinik und Poliklinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum Leipzig, Leipzig, Deutschland
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2
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Jochims F, Lippmann N, Simon JC. [Painful ulcers in a young male refugee]. Dermatologie (Heidelb) 2024; 75:340-342. [PMID: 38172280 DOI: 10.1007/s00105-023-05285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Affiliation(s)
- F Jochims
- , Philipp-Rosenthal-Str. 23, 04103, Leipzig, Deutschland.
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Wahl A, Fischer MA, Klaper K, Müller A, Borgmann S, Friesen J, Hunfeld KP, Ilmberger A, Kolbe-Busch S, Kresken M, Lippmann N, Lübbert C, Marschner M, Neumann B, Pfennigwerth N, Probst-Kepper M, Rödel J, Schulze MH, Zautner AE, Werner G, Pfeifer Y. Presence of hypervirulence-associated determinants in Klebsiella pneumoniae from hospitalised patients in Germany. Int J Med Microbiol 2024; 314:151601. [PMID: 38359735 DOI: 10.1016/j.ijmm.2024.151601] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/15/2023] [Accepted: 01/15/2024] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Klebsiella (K.) pneumoniae is a ubiquitous Gram-negative bacterium and a common coloniser of animals and humans. Today, K. pneumoniae is one of the most persistent nosocomial pathogens worldwide and poses a severe threat/burden to public health by causing urinary tract infections, pneumonia and bloodstream infections. Infections mainly affect immunocompromised individuals and hospitalised patients. In recent years, a new type of K. pneumoniae has emerged associated with community-acquired infections such as pyogenic liver abscess in otherwise healthy individuals and is therefore termed hypervirulent K. pneumoniae (hvKp). The aim of this study was the characterisation of K. pneumoniae isolates with properties of hypervirulence from Germany. METHODS A set of 62 potentially hypervirulent K. pneumoniae isolates from human patients was compiled. Inclusion criteria were the presence of at least one determinant that has been previously associated with hypervirulence: (I) clinical manifestation, (II) a positive string test as a marker for hypermucoviscosity, and (III) presence of virulence associated genes rmpA and/or rmpA2 and/or magA. Phenotypic characterisation of the isolates included antimicrobial resistance testing by broth microdilution. Whole genome sequencing (WGS) was performed using Illumina® MiSeq/NextSeq to investigate the genetic repertoire such as multi-locus sequence types (ST), capsule types (K), further virulence associated genes and resistance genes of the collected isolates. For selected isolates long-read sequencing was applied and plasmid sequences with resistance and virulence determinants were compared. RESULTS WGS analyses confirmed presence of several signature genes for hvKp. Among them, the most prevalent were the siderophore loci iuc and ybt and the capsule regulator genes rmpA and rmpA2. The most dominant ST among the hvKp isolates were ST395 capsule type K2 and ST395 capsule type K5; both have been described previously and were confirmed by our data as multidrug-resistant (MDR) isolates. ST23 capsule type K1 was the second most abundant ST in this study; this ST has been described as commonly associated with hypervirulence. In general, resistance to beta-lactams caused by the production of extended-spectrum beta-lactamases (ESBL) and carbapenemases was observed frequently in our isolates, confirming the threatening rise of MDR-hvKp strains. CONCLUSIONS Our study results show that K. pneumoniae strains that carry several determinants of hypervirulence are present for many years in Germany. The detection of carbapenemase genes and hypervirulence associated genes on the same plasmid is highly problematic and requires intensified screening and molecular surveillance. However, the non-uniform definition of hvKp complicates their detection. Testing for hypermucoviscosity alone is not specific enough to identify hvKp. Thus, we suggest that the classification of hvKp should be applied to isolates that not only fulfil phenotypical criteria (severe clinical manifestations, hypermucoviscosity) but also (I) the presence of at least two virulence loci e.g. iuc and ybt, and (II) the presence of rmpA and/or rmpA2.
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Affiliation(s)
- Anika Wahl
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Martin A Fischer
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Kathleen Klaper
- Robert Koch Institute, Department of Sexually transmitted bacterial Pathogens (STI) and HIV, Berlin, Germany
| | - Annelie Müller
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Stefan Borgmann
- Klinikum Ingolstadt, Department of Infectious Diseases and Infection Control, Ingolstadt, Germany
| | | | - Klaus-Peter Hunfeld
- Institute for Laboratory Medicine, Microbiology & Infection Control, Northwest Medical Centre, Medical Faculty, Goethe University, Frankfurt am Main, Germany
| | | | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig University Medical Center, Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany
| | - Michael Kresken
- Paul-Ehrlich-Gesellschaft für Infektionstherapie e. V., Cologne, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Christoph Lübbert
- Interdisciplinary Center for Infectious Diseases, Leipzig University Medical Center, Leipzig, Germany; Division of Infectious Diseases and Tropical Medicine, Department of Medicine I, Leipzig University Medical Center, Leipzig, Germany
| | | | - Bernd Neumann
- Institute of Clinical Microbiology, Infectious Diseases and Infection Control, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Niels Pfennigwerth
- German National Reference Centre for Multidrug-Resistant Gram-Negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | | | - Jürgen Rödel
- Institute of Medical Microbiology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Marco H Schulze
- Department for Infection Control and Infectious Diseases, University Medical Center Goettingen, Goettingen, Germany
| | - Andreas E Zautner
- Institute of Medical Microbiology and Hospital Hygiene, Faculty of Medicine, Otto-von-Guericke-University, Magdeburg, Germany; Center for Health and Medical Prevention (CHaMP), Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Guido Werner
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany
| | - Yvonne Pfeifer
- Robert Koch Institute, Division of Infectious Diseases, Department of Nosocomial Pathogens and Antibiotic Resistances, Wernigerode, Germany.
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Mehdorn M, Kolbe-Busch S, Lippmann N, Moulla Y, Scheuermann U, Jansen-Winkeln B, Chaberny IF, Gockel I, Kassahun WT. Rectal colonization is predictive for surgical site infections with multidrug-resistant bacteria in abdominal surgery. Langenbecks Arch Surg 2023; 408:230. [PMID: 37301803 PMCID: PMC10257639 DOI: 10.1007/s00423-023-02961-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 05/26/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Superficial surgical site infections (SSI) are a common complication after abdominal surgery. Additionally, multidrug-resistant organisms (MDRO) have shown an increasing spread in recent years with a growing importance for health care. As there is varying evidence on the importance of MDRO in different surgical fields and countries as causative agents of SSI, we report our findings of MDRO-caused SSI. METHODS We assembled an institutional wound register spanning the years 2015-2018 including all patients with abdominal surgery and SSI only, including demographics, procedure-related data, microbiological data from screenings, and body fluid samples. The cohort was examined for the frequency of different MDRO in screenings, body fluids, and wound swabs and assessed for risk factors for MDRO-positive SSI. RESULTS A total of 138 out of 494 patients in the register were positive for MDRO, and of those, 61 had an MDRO isolated from their wound, mainly multidrug-resistant Enterobacterales (58.1%) followed by vancomycin-resistant Enterococcus spp. (19.7%). As 73.2% of all MDRO-carrying patients had positive rectal swabs, rectal colonization could be identified as the main risk factor for an SSI caused by a MDRO with an odds ratio (OR) of 4.407 (95% CI 1.782-10.896, p = 0.001). Secondly, a postoperative ICU stay was also associated with an MDRO-positive SSI (OR 3.73; 95% CI 1.397-9.982; p = 0.009). CONCLUSION The rectal colonization status with MDRO should be taken into account in abdominal surgery regarding SSI prevention strategies. Trial registration Retrospectively registered in the German register for clinical trials (DRKS) 19th December 2019, registration number DRKS00019058.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Susanne Kolbe-Busch
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Yusef Moulla
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
- Department of General, Visceral and Oncological Surgery, Klinikum St. Georg, Leipzig, Germany
| | - Iris F Chaberny
- Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, University Hospital of Leipzig, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Woubet Tefera Kassahun
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Doerr N, Dietze N, Lippmann N, Rodloff AC. Extended-spectrum beta-lactamases found in Escherichia coli isolates obtained from blood cultures and corresponding stool specimen. Sci Rep 2023; 13:8940. [PMID: 37268680 DOI: 10.1038/s41598-023-36240-y] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 05/31/2023] [Indexed: 06/04/2023] Open
Abstract
With extended-spectrum β-lactamases (ESBLs) and CTX-M enzymes being on the rise, antimicrobial treatment of enterobacterial infections is becoming more and more challenging. Our study aimed at a molecular characterization of phenotypically ESBL-positive E. coli strains obtained from blood cultures of patients of the University Hospital of Leipzig (UKL), Germany. The presence of CMY-2, CTX-M-14 and CTX-M-15 was investigated using Streck ARM-D Kit (Streck, USA). Real-time amplifications were performed by QIAGEN Rotor-Gene Q MDx Thermocycler (QIAGEN, Thermo Fisher Scientific, USA). Antibiograms as well as epidemiological data were evaluated. Among 117 cases, 74.4% of the isolates showed a resistance to ciprofloxacin, piperacillin and ceftazidime or cefotaxime while being susceptible to imipenem/meropenem. The proportion of ciprofloxacin resistance was significantly higher than the proportion of ciprofloxacin susceptibility. At least one of the investigated genes was detected in 93.1% of the blood culture E. coli isolates: CTX-M-15 (66.7%), CTX-M-14 (25.6%) or the plasmid-mediated ampC gene CMY-2 (3.4%). 2.6% were tested positive for two resistance genes. 94 of the corresponding stool specimens tested positive for ESBL producing E. coli (94/112, 83.9%). 79 (79/94, 84%) E. coli strains found in the stool samples matched with the respective patient's blood culture isolate phenotypically (MALDI-TOF, antibiogram). The distribution of resistance genes was in accordance with recent studies in Germany as well as worldwide. This study provides indications of an endogenous focus of infection and emphasize the importance of screening programs for high-risk patients.
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Affiliation(s)
- Nina Doerr
- Institute Medical Microbiology and Virology, Microbiology Department, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany.
| | - Nadine Dietze
- Institute Medical Microbiology and Virology, Microbiology Department, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany
| | - Norman Lippmann
- Institute Medical Microbiology and Virology, Microbiology Department, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany
| | - Arne C Rodloff
- Institute Medical Microbiology and Virology, Microbiology Department, Leipzig University, Johannisallee 30, 04103, Leipzig, Germany
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Wendt S, Hegelmaier A, Lippmann N, Lübbert C. Botulismus. Z Gastroenterol 2022. [DOI: 10.1055/a-1801-3662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cao I, Lippmann N, Thome UH. The Value of Perinatal Factors, Blood Biomarkers and Microbiological Colonization Screening in Predicting Neonatal Sepsis. J Clin Med 2022; 11:jcm11195837. [PMID: 36233706 PMCID: PMC9571877 DOI: 10.3390/jcm11195837] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 09/22/2022] [Accepted: 09/28/2022] [Indexed: 11/09/2022] Open
Abstract
Background: Neonatal sepsis is one of the most important causes of elevated morbidity and mortality rates in neonatal intensive care units worldwide. While the clinical manifestations of neonatal sepsis tend to be nonspecific, its rapid development and life-threatening potential call for reliable markers for early detection. Methods: We conducted a retrospective single-center study including all neonates suspected of having developed neonatal sepsis from 2013 to 2016. Perinatal and clinical characteristics as well as microbiological and laboratory findings were evaluated. Neonatal sepsis was defined as either culture-proven sepsis (positive blood culture) or clinical sepsis (at least one symptom and elevated C-reactive protein (CRP) concentrations within 72 h with negative blood culture). We further differentiated between early-onset (EOS) and late-onset (LOS) sepsis. Results: Microbiological colonization screening by throat and rectal swabs frequently did not detect the organism that subsequently caused the sepsis. Depending on the age of the newborn with sepsis (EOS or LOS), associations between different anamnestic and clinical factors (prenatal or postnatal ones) were found. In particular, the central−peripheral temperature difference showed a strong association with LOS. Laboratory results useful for the early detection of neonatal sepsis included interleukin-6 (IL-6) and CRP concentrations. Conclusions: Elevated IL-6 >100 ng/L was a strong marker for neonatal sepsis. When choosing the antibiotics for treatment, data from microbiological colonization screening should be considered but not solely relied on. Some indicators of infection also depended on postnatal age.
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Affiliation(s)
- Isabel Cao
- Divison of Neonatology, Center for Pediatric Research, University Hospital for Children, Liebigstraße 20a, 04103 Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University of Leipzig, 04103 Leipzig, Germany
| | - Ulrich H. Thome
- Divison of Neonatology, Center for Pediatric Research, University Hospital for Children, Liebigstraße 20a, 04103 Leipzig, Germany
- Correspondence:
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Oberhuber-Kurth LM, Angeli R, Lippmann N, Notov D, Osterhoff G, Frank K, Langer S, Kohler L. Pathogens and Shift of Resistance in Early Infections after Operative Fracture Fixation. Surg Infect (Larchmt) 2022; 23:583-589. [PMID: 35917386 DOI: 10.1089/sur.2022.033] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Surgical site infections (SSIs) remain a challenge for the healthcare system. During the last 30 years, the literature has shown an increase of gram-negative bacterial strains in multiple infectious sites and that cephalosporins have replaced penicillin as the gold standard in peri-operative antibiotic prophylaxis. This study aims to examine the recent bacterial spectrum in orthopedic early SSIs and to compare it with a historical cohort. Patients and Methods: Patients in a level 1 trauma center with an SSI within six weeks after open fixation of a fracture were analyzed in two adjacent periods from 2007 to 2012 (data pool 1; DP1) and 2013 to 2017 (data pool 2; DP2), retrospectively. The detected microbiologic pathogens and the associated resistograms from both time periods were compared. Results: Six hundred eighty-one smear tests and respective pathogens from the wounds of 463 patients (mean age, 62.6 ± 20 years) with SSIs were analyzed. The following pathogens were found most frequent: Staphylococcus epidermidis (DP1, 20.6%; DP2, 26.3%), Staphylococcus aureus (DP1, 27.1%; DP2, 16.5%), Enterococcus faecalis (DP1, 13.7%; DP2, 11.1%), Bacillus sp. (DP1, 3.0%; DP2, 5.3%), Escherichia coli (DP1, 5.1%; DP2, 4.1%), Pseudomonas aeruginosa (DP1, 3.7%; DP2, 2.5%). In DP2, there were lower primary early infection rates with Staphylococcus aureus than in DP1 (p = 0.002). In DP2, Staphylococcus epidermidis showed an oxacillin resistance in 90.6% and an increased resistance (79.8%; p = 0.069) to several classes of antibiotic agents compared to DP1. Conclusions: No bacterial shift toward gram-negative species was observed in this investigation. However, Staphylococcus epidermidis showed an increased antibiotic resistance in the more recent patient cohort. The incidence of SSIs with Staphylococcus aureus decreased substantially.
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Affiliation(s)
| | - Rico Angeli
- Department of Anaesthesiology and Critical Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Dmitry Notov
- Department of Orthopaedics, Trauma, and Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Georg Osterhoff
- Department of Orthopaedics, Trauma, and Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Konstantin Frank
- Division of Hand, Plastic, and Aesthetic Surgery, Munich University Hospital, LMU, Munich, Germany
| | - Stefan Langer
- Department of Orthopaedics, Trauma, and Plastic Surgery, Leipzig University Hospital, Leipzig, Germany
| | - Lukas Kohler
- Division of Hand, Plastic, and Aesthetic Surgery, Munich University Hospital, LMU, Munich, Germany
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Wendt S, Lippmann N, Lübbert C. Diagnosis at a Glance: Tapeworm Infestation. Dtsch Arztebl Int 2022; 119:513. [PMID: 36345590 PMCID: PMC9669320 DOI: 10.3238/arztebl.m2022.0148] [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] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- Sebastian Wendt
- *Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig Bereich Infektiologie und Tropenmedizin, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig Bereich Mikrobiologie, Institut für Medizinische Mikrobiologie und Virologie, Universitätsklinikum Leipzig
| | - Norman Lippmann
- **Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig Bereich Mikrobiologie, Institut für Medizinische Mikrobiologie und Virologie, Universitätsklinikum Leipzig
| | - Christoph Lübbert
- ***, Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig Bereich Infektiologie und Tropenmedizin, Klinik und Poliklinik für Onkologie, Gastroenterologie, Hepatologie, Pneumologie und Infektiologie, Universitätsklinikum Leipzig,
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Neumann B, Lippmann N, Wendt S, Karlas T, Lübbert C, Werner G, Pfeifer Y, Schuster CF. Recurrent bacteremia with a hypermucoviscous Escherichia coli isolated from a patient with perihilar cholangiocarcinoma: insights from a comprehensive genome-based analysis. Ann Clin Microbiol Antimicrob 2022; 21:28. [PMID: 35751078 PMCID: PMC9233328 DOI: 10.1186/s12941-022-00521-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/13/2022] [Indexed: 02/07/2023] Open
Abstract
Background Escherichia coli (E. coli) is a common human pathogen, responsible for a broad spectrum of infections. Sites of infection can vary, but the hepato-biliary system is of particular concern due to the infection-associated formation of gallstones and the spread of pathogens from the bile ducts into the bloodstream. Case presentation The presented case is striking, as the detected isolate showed a positive string test. This hypermucoviscous phenotype is atypical for E. coli and a particular feature of hypervirulent Klebsiella pneumoniae (K. pneumoniae) variants. Objectives To provide new insights into the genomic background of an E. coli strain with an unusual hypermucoviscous phenotype using hybrid short- and long-read sequencing approaches. Results Complete hybrid assemblies of the E. coli genome and plasmids were done and used for genome based typing. Isolate 537–20 was assigned to the multilocus sequence type ST88 and serotype O8:H4. The strain showed a close relationship to avian pathogenic strains. Analysis of the chromosome and plasmids revealed the presence of several virulence factors, such as the Conserved Virulence Plasmidic (CVP) region on plasmid 537-20_1, including several iron acquisition genes (sitABCD, iroABCDEN, iucABCD, hbd) and the iutA gene encoding the receptor of the siderophore aerobactin. The hypermucoviscous phenotype could be caused by encapsulation of putative K. pneumoniae origin. Conclusions Hybrid sequencing enabled detailed genomic characterization of the hypermucoviscous E. coli strain, revealing virulence factors that have their putative origin in K. pneumoniae. Supplementary Information The online version contains supplementary material available at 10.1186/s12941-022-00521-7.
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Affiliation(s)
- Bernd Neumann
- Division Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, 38855, Wernigerode, Germany. .,Institute for Hospital Hygiene, Medical Microbiology and Clinical Infectiology, Paracelsus Medical University, Nuremberg General Hospital, 90419, Nuremberg, Germany.
| | - Norman Lippmann
- Interdisciplinary Centre for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany
| | - Sebastian Wendt
- Interdisciplinary Centre for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, 04103, Leipzig, Germany
| | - Thomas Karlas
- Division of Gastroenterology, Department of Medicine II, Leipzig University Medical Center, 04103, Leipzig, Germany
| | - Christoph Lübbert
- Interdisciplinary Centre for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, 04103, Leipzig, Germany
| | - Guido Werner
- Division Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, 38855, Wernigerode, Germany
| | - Yvonne Pfeifer
- Division Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, 38855, Wernigerode, Germany
| | - Christopher F Schuster
- Division Nosocomial Pathogens and Antibiotic Resistance, Department of Infectious Diseases, Robert Koch Institute, Wernigerode Branch, 38855, Wernigerode, Germany. .,Current Address: Center for Pandemic Vaccines and Therapeutics (ZEPAI), Paul-Ehrlich-Institute, 63225, Langen, Germany.
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Schulz S, Ziganshyna S, Lippmann N, Glass S, Eulenburg V, Habermann N, Schwarz UT, Voigt A, Heilmann C, Rüffer T, Werdehausen R. The Meta-Substituted Isomer of TMPyP Enables More Effective Photodynamic Bacterial Inactivation than Para-TMPyP In Vitro. Microorganisms 2022; 10:microorganisms10050858. [PMID: 35630304 PMCID: PMC9143678 DOI: 10.3390/microorganisms10050858] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 01/27/2023] Open
Abstract
Porphyrinoid-based photodynamic inactivation (PDI) provides a promising approach to treating multidrug-resistant infections. However, available agents for PDI still have optimization potential with regard to effectiveness, toxicology, chemical stability, and solubility. The currently available photosensitizer TMPyP is provided with a para substitution pattern (para-TMPyP) of the pyridinium groups and has been demonstrated to be effective for PDI of multidrug-resistant bacteria. To further improve its properties, we synthetized a structural variant of TMPyP with an isomeric substitution pattern in a meta configuration (meta-TMPyP), confirmed the correct structure by crystallographic analysis and performed a characterization with NMR-, UV/Vis-, and IR spectroscopy, photostability, and singlet oxygen generation assay. Meta-TMPyP had a hypochromic shift in absorbance (4 nm) with a 55% higher extinction coefficient and slightly improved photostability (+6.9%) compared to para-TMPyP. Despite these superior molecular properties, singlet oxygen generation was increased by only 5.4%. In contrast, PDI, based on meta-TMPyP, reduced the density of extended spectrum β-lactamase-producing and fluoroquinolone-resistant Escherichia coli by several orders of magnitude, whereby a sterilizing effect was observed after 48 min of illumination, while para-TMPyP was less effective (p < 0.01). These findings demonstrate that structural modification with meta substitution increases antibacterial properties of TMPyP in PDI.
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Affiliation(s)
- Sebastian Schulz
- Department of Anesthesiology and Intensive Care, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (S.S.); (S.Z.); (V.E.)
| | - Svitlana Ziganshyna
- Department of Anesthesiology and Intensive Care, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (S.S.); (S.Z.); (V.E.)
| | - Norman Lippmann
- Institute of Medical Microbiology and Virology, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany;
| | - Sarah Glass
- Leibniz Institute of Surface Engineering (IOM), 04318 Leipzig, Germany;
| | - Volker Eulenburg
- Department of Anesthesiology and Intensive Care, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (S.S.); (S.Z.); (V.E.)
| | - Natalia Habermann
- Institute of Physics, Chemnitz University of Technology, 09111 Chemnitz, Germany; (N.H.); (U.T.S.)
| | - Ulrich T. Schwarz
- Institute of Physics, Chemnitz University of Technology, 09111 Chemnitz, Germany; (N.H.); (U.T.S.)
| | - Alexander Voigt
- Institute of Chemistry, Faculty of Natural Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany; (A.V.); (C.H.)
| | - Claudia Heilmann
- Institute of Chemistry, Faculty of Natural Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany; (A.V.); (C.H.)
| | - Tobias Rüffer
- Institute of Chemistry, Faculty of Natural Sciences, Chemnitz University of Technology, 09111 Chemnitz, Germany; (A.V.); (C.H.)
- Correspondence: (T.R.); (R.W.)
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care, Medical Faculty, University of Leipzig, 04103 Leipzig, Germany; (S.S.); (S.Z.); (V.E.)
- Correspondence: (T.R.); (R.W.)
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Sasse M, Lippmann N, Lübbert C. Nichttyphoidale Salmonellen. Dtsch Med Wochenschr 2022. [DOI: 10.1055/a-1714-2160] [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] [Indexed: 10/19/2022]
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Mehdorn M, Kassahun WT, Lippmann N, Scheuermann U, Groos L, Buchloh D, Jansen-Winkeln B, Gockel I. Surgical Revision Promotes Presence of Enterococcus spp. in Abdominal Superficial Surgical Site Infections. J Gastrointest Surg 2022; 26:444-452. [PMID: 34661870 DOI: 10.1007/s11605-021-05170-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Superficial surgical site infections (SSSIs) are a major reason for morbidity after abdominal surgery. Microbiologic isolates of SSSIs vary widely geographically. Therefore, knowledge about the specific bacterial profile is of paramount importance to prevent SSSI. METHODS We performed a subgroup analysis of the microbiological isolates from patients with SSSI after abdominal surgery that were included in our institutional wound register. We aimed at identifying predominant strains as well as risk factors that would predispose for SSSI with certain bacteria. RESULTS A total of 494 patients were eligible for analysis. Of those 313 had received wound swaps, with 268 patients yielding a bacterial isolate. Enterobacterales (31.7%) and Enterococcus spp. (29.5%) were found as main bacteria in SSSI, with 62.3% of the wounds being polymicrobial. As risk factors for changes in bacterial isolates, we identified operative revision (OR 3.032; 95%CI 1.734-5.303) in multivariate analysis. Enterococcus spp. showed a significant increase in patients after revision surgery (p<0.001). Antibiotic therapy was neither influential on bacterial changes nor on the presence of Enterococcus spp. in SSSI. CONCLUSION Our study accentuates the high frequency of Enterococcus spp. in SSSI after abdominal surgery, while identifying surgical revision as major risk factor. The results urge vigilance in the treatment of patients with surgical revisions to include Enterococcus spp. in the prevention and treatment strategies.
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Affiliation(s)
- Matthias Mehdorn
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Woubet Tefera Kassahun
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, University Hospital of Leipzig, Leipzig, Germany
| | - Uwe Scheuermann
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Linda Groos
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dorina Buchloh
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Boris Jansen-Winkeln
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Ines Gockel
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
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Reinhardt F, Lippmann N, Lübbert C. Listeriose. Dtsch Med Wochenschr 2022. [DOI: 10.1055/a-1710-0959] [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] [Indexed: 10/19/2022]
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15
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Viehweger A, Blumenscheit C, Lippmann N, Wyres KL, Brandt C, Hans JB, Hölzer M, Irber L, Gatermann S, Lübbert C, Pletz MW, Holt KE, König B. Context-aware genomic surveillance reveals hidden transmission of a carbapenemase-producing Klebsiella pneumoniae. Microb Genom 2021; 7:000741. [PMID: 34913861 PMCID: PMC8767333 DOI: 10.1099/mgen.0.000741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Genomic surveillance can inform effective public health responses to pathogen outbreaks. However, integration of non-local data is rarely done. We investigate two large hospital outbreaks of a carbapenemase-carrying Klebsiella pneumoniae strain in Germany and show the value of contextual data. By screening about 10 000 genomes, over 400 000 metagenomes and two culture collections using in silico and in vitro methods, we identify a total of 415 closely related genomes reported in 28 studies. We identify the relationship between the two outbreaks through time-dated phylogeny, including their respective origin. One of the outbreaks presents extensive hidden transmission, with descendant isolates only identified in other studies. We then leverage the genome collection from this meta-analysis to identify genes under positive selection. We thereby identify an inner membrane transporter (ynjC) with a putative role in colistin resistance. Contextual data from other sources can thus enhance local genomic surveillance at multiple levels and should be integrated by default when available.
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Affiliation(s)
- Adrian Viehweger
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
- *Correspondence: Adrian Viehweger,
| | | | - Norman Lippmann
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
| | - Kelly L. Wyres
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
| | - Christian Brandt
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Jörg B. Hans
- National Reference Center for multidrug-resistant Gram-negative bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Martin Hölzer
- Methodology and Research Infrastructure, MF1 Bioinformatics, Robert Koch Institute, Berlin, Germany
| | - Luiz Irber
- Department of Population Health and Reproduction, University of California, Davis, Davis, California, USA
| | - Sören Gatermann
- National Reference Center for multidrug-resistant Gram-negative bacteria, Department for Medical Microbiology, Ruhr-University Bochum, Bochum, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, University Hospital Leipzig, Leipzig, Germany
| | - Mathias W. Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany
| | - Kathryn E. Holt
- Department of Infectious Diseases, Central Clinical School, Monash University, Melbourne, Australia
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Brigitte König
- Institute of Medical Microbiology and Virology, University Hospital Leipzig, Leipzig, Germany
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Schönherr SG, Ranft D, Lippmann N, Lübbert C. Changes in antibiotic consumption, AMR and Clostridioides difficile infections in a large tertiary-care center following the implementation of institution-specific guidelines for antimicrobial therapy: A nine-year interrupted time series study. PLoS One 2021; 16:e0258690. [PMID: 34648594 PMCID: PMC8516227 DOI: 10.1371/journal.pone.0258690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/01/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Institution-specific guidelines (ISGs) within the framework of antimicrobial stewardship programs offer locally tailored decision support taking into account local pathogen and resistance epidemiology as well as national and international guidelines. OBJECTIVES To assess the impact of ISGs for antimicrobial therapy on antibiotic consumption and subsequent changes in resistance rates and Clostridioides difficile infections (CDIs). METHODS The study was conducted at the Leipzig University Hospital, a 1,451-bed tertiary-care medical center, and covered the years 2012 to 2020. Since 2014, ISGs were provided to optimize empirical therapies, appropriate diagnostics, and antimicrobial prophylaxis. We used interrupted time series analysis (ITSA) and simple linear regression to analyze changes in antimicrobial consumption, resistance and CDIs. RESULTS Over the study period, 1,672,200 defined daily doses (DDD) of antibiotics were dispensed, and 85,645 bacterial isolates as well as 2,576 positive C. difficile cultures were collected. Total antimicrobial consumption decreased by 14% from 2012 to 2020, without clear impact of the deployment of ISGs. However, implementation of ISGs was associated with significant decreases in the use of substances that were rarely recommended (e.g., fluoroquinolones). Over the whole study period, we observed declining resistance rates to most antibiotic classes of up to 25% in Enterobacterales, staphylococci, and Pseudomonas aeruginosa. Switching from ceftriaxone to cefotaxime was associated with reduced resistance to third-generation cephalosporins. The number of CDI cases fell by 65%, from 501 in 2012 to 174 in 2020. CONCLUSIONS Well-implemented ISGs can have a significant, immediate, and lasting impact on the prescription behavior. ISGs might thereby contribute to reduce resistance rates and CDI incidences in the hospital setting.
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Affiliation(s)
- Sebastian G. Schönherr
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
| | - Donald Ranft
- Hospital Pharmacy, Leipzig University Hospital, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Virology, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases (ZINF), Leipzig University Hospital, Leipzig, Germany
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
- * E-mail:
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17
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Glass S, Kühnert M, Lippmann N, Zimmer J, Werdehausen R, Abel B, Eulenburg V, Schulze A. Photosensitizer-loaded hydrogels for photodynamic inactivation of multirestistant bacteria in wounds. RSC Adv 2021; 11:7600-7609. [PMID: 35423227 PMCID: PMC8694937 DOI: 10.1039/d0ra09786a] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 11/18/2020] [Accepted: 02/10/2021] [Indexed: 01/10/2023] Open
Abstract
Photodynamic treatment is a promising tool for the therapy of multidrug-resistant bacteria. In this study, we highlight photosensitizer-loaded hydrogels as an application system for infected wounds. The poly(ethylene glycol) diacrylate-based and electron beam-polymerized hydrogels were mechanically stable and transparent. They were loaded with two photoactive, porphyrin-based drugs - tetrakis(1 methylpyridinium-4-yl)porphyrin p-toluenesulfonate (TMPyP) and tetrahydroporphyrin - p toluenesulfonate (THPTS). The hydrogels released a sufficient amount of the photosensitizers (up to 300 μmol l-1), relevant for efficiency. The antimicrobial effectivity of loaded hydrogels was investigated in a tissue-like system as well as in a liquid system against a multiresistant Escherichia coli. In both systems, light induced eradication was possible. In contrast, hydrogels alone showed only minor antimicrobial activity. Furthermore, the loaded hydrogels were successfully tested against seven multidrug-resistant bacterial strains, namely Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumonia, Acinetobacter baumannii, Pseudomonas aeruginosa, Escherichia coli and Achromobacter xylosoxidans. The eradication of these pathogens, except A. xylosoxidans, was successfully demonstrated. In general, TMPyP-loaded hydrogels were more effective than THPTS-loaded ones. Nevertheless, both photosensitizers displayed effectivity against all investigated bacteria strains. Taken together, our data demonstrate that photosensitizer-loaded hydrogels are a promising new tool to improve the treatment of wounds infected with problematic bacterial pathogens.
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Affiliation(s)
- Sarah Glass
- Leibniz Institute of Surface Engineering (IOM) Permoserstraße 15 D-04318 Leipzig Germany
| | - Mathias Kühnert
- Leibniz Institute of Surface Engineering (IOM) Permoserstraße 15 D-04318 Leipzig Germany
| | - Norman Lippmann
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital Leipzig Liebigstraße 21 D-04103 Leipzig Germany
| | - Joanne Zimmer
- Leibniz Institute of Surface Engineering (IOM) Permoserstraße 15 D-04318 Leipzig Germany
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig Liebigstraße 20 D-04103 Leipzig Germany
| | - Bernd Abel
- Leibniz Institute of Surface Engineering (IOM) Permoserstraße 15 D-04318 Leipzig Germany
| | - Volker Eulenburg
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Leipzig Liebigstraße 20 D-04103 Leipzig Germany
| | - Agnes Schulze
- Leibniz Institute of Surface Engineering (IOM) Permoserstraße 15 D-04318 Leipzig Germany
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18
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Tessema B, Lippmann N, Willenberg A, Knüpfer M, Sack U, König B. The Diagnostic Performance of Interleukin-6 and C-Reactive Protein for Early Identification of Neonatal Sepsis. Diagnostics (Basel) 2020; 10:diagnostics10110978. [PMID: 33233806 PMCID: PMC7699903 DOI: 10.3390/diagnostics10110978] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 11/16/2022] Open
Abstract
Interleukin-6 (IL-6) and C-reactive protein (CRP) are being used for diagnosis of sepsis. However, studies have reported varying cut-off levels and diagnostic performance. This study aims to investigate the optimal cut-off levels and performance of IL-6 and CRP for the diagnosis of neonatal sepsis. The study was conducted at the University Hospital of Leipzig, Germany from November 2012 to June 2020. A total of 899 neonates: 104 culture proven sepsis, 160 clinical sepsis, and 625 controls were included. Blood culture was performed using BacT/ALERT 3D system. IL-6 and CRP were analyzed by electrochemiluminescent immunoassay and immunoturbidimetric assay, respectively. Data were analyzed using SPSS 20 statistical software. Among neonates with proven sepsis, the optimal cut-off value of IL-6 was 313.5 pg/mL. The optimal cut-off values for CRP in 5 days serial measurements (CRP1, CRP2, CRP3, CRP4, and CRP5) were 2.15 mg/L, 8.01 mg/L, 6.80 mg/L, 5.25 mg/L, and 3.72 mg/L, respectively. IL-6 showed 73.1% sensitivity, 80.2% specificity, 37.6% PPV, and 94.8% NPV. The highest performance of CRP was observed in the second day with 89.4% sensitivity, 97.3% specificity, 94.5% PPV, and 98.3% NPV. The combination of IL-6 and CRP showed increase in sensitivity with decrease in specificity. In conclusion, this study defines the optimal cut-off values for IL-6 and CRP. The combination of IL-6 and CRP demonstrated increased sensitivity. The CRP 2 at cut-off 8.01 mg/L showed the highest diagnostic performance for identification of culture negative clinical sepsis cases. We recommend the combination of IL-6 (≥313.5 pg/mL) and CRP1 (≥2.15 mg/L) or IL-6 (≥313.5 pg/mL) and CRP2 (≥8.01 mg/L) for early and accurate diagnosis of neonatal sepsis. The recommendation is based on increased sensitivity, that is, to minimize the risk of any missing cases of sepsis. The CRP2 alone at cut-off 8.01 mg/L might be used to identify clinical sepsis cases among culture negative sepsis suspected neonates in hospital settings.
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Affiliation(s)
- Belay Tessema
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany; (N.L.); (B.K.)
- Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany;
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, 196 Gondar, Ethiopia
- Correspondence: ; Tel.: +251-919306918
| | - Norman Lippmann
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany; (N.L.); (B.K.)
| | - Anja Willenberg
- Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany;
| | - Matthias Knüpfer
- Department of Neonatology, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany;
| | - Ulrich Sack
- Institute of Clinical Immunology, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany;
| | - Brigitte König
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, Faculty of Medicine, University of Leipzig, 04103 Leipzig, Germany; (N.L.); (B.K.)
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19
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Wendt S, Ranft D, Rodloff AC, Lippmann N, Lübbert C. Switching From Ceftriaxone to Cefotaxime Significantly Contributes to Reducing the Burden of Clostridioides difficile infections. Open Forum Infect Dis 2020; 7:ofaa312. [PMID: 33005693 PMCID: PMC7518363 DOI: 10.1093/ofid/ofaa312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 07/15/2020] [Indexed: 02/06/2023] Open
Abstract
We analyzed Clostridioides difficile infection (CDI) rates and various antimicrobials' application densities from 2013 to 2019 at Leipzig University Hospital, Germany, by using multivariate linear regression. Ceftriaxone application was the only independent predictor of CDI incidence. Thus, antibiotics' specific pharmacokinetic and pharmacodynamic properties such as biliary excretion of ceftriaxone in its active form should be considered when determining their potential to cause CDI.
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Affiliation(s)
- Sebastian Wendt
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Donald Ranft
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Hospital Pharmacy, Leipzig University Hospital, Leipzig, Germany
| | - Arne C Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Leipzig, Germany
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
- Department of Infectious Diseases/Tropical Medicine, Nephrology and Rheumatology, Hospital St. Georg, Leipzig, Germany
- Correspondence: Christoph Lübbert, MD, PhD, DTM&H, Division of Infectious Diseases and Tropical Medicine, Department of Medicine II, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany ()
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20
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Schönfeld A, Ascherl R, Petzold-Quinque S, Lippmann N, Rodloff AC, Kiess W. Relocating a pediatric hospital: Does antimicrobial resistance change? BMC Res Notes 2020; 13:242. [PMID: 32404147 PMCID: PMC7218827 DOI: 10.1186/s13104-020-05065-7] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Accepted: 04/07/2020] [Indexed: 11/24/2022] Open
Abstract
Objective Analyze the changes in antimicrobial drug resistance patterns due to hospital relocation. To this end, we conducted a retrospective analysis of microbiological results, especially minimum inhibitory concentrations (MIC) of all isolates from blood, urine and bronchial secretions, in our pediatric university hospital before and after moving to a new building. Results While the number of tests done did not change, the fraction of those positive increased, more MICs were determined and certain microbes (A. baumannii, E. faecalis, Klebsiella spp. and P. mirabilis) were detected more frequently. Most changes in MICs occurred in E. faecium (increases in 8 antimicrobials, decreases only in linezolid and gentamicin). For imipenem and aminopenicillins the MICs commonly rose after relocation, the opposite is true for gentamicin and trimethoprim/sulfamethoxazole. The other factors that alter by moving a hospital such as changes in medical personnel or case severity cannot be corrected for, but using MICs we are able to provide insights into changes down to the individual antimicrobial drug and even small changes usually undetectable to the common categorical reporting of resistance.
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Affiliation(s)
- Annika Schönfeld
- Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Rudolf Ascherl
- Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany.
| | - Stefanie Petzold-Quinque
- Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
| | - Norman Lippmann
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital Leipzig, Liebigstraße 21, 04103, Leipzig, Germany
| | - Arne C Rodloff
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University Hospital Leipzig, Liebigstraße 21, 04103, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, University Hospital Leipzig, Liebigstraße 20a, 04103, Leipzig, Germany
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21
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Ziganshyna S, Guttenberger A, Lippmann N, Schulz S, Bercker S, Kahnt A, Rüffer T, Voigt A, Gerlach K, Werdehausen R. Tetrahydroporphyrin-tetratosylate (THPTS)-based photodynamic inactivation of critical multidrug-resistant bacteria in vitro. Int J Antimicrob Agents 2020; 55:105976. [PMID: 32325201 DOI: 10.1016/j.ijantimicag.2020.105976] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 11/18/2019] [Revised: 03/15/2020] [Accepted: 04/03/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Photodynamic inactivation (PDI) is a promising approach to treat multidrug-resistant infections. However, effectiveness of PDI is limited, particularly in Gram-negative bacteria. The use of photosensitizer (PS) 3,3',3'',3'''-(7,8,17,18-tetrahydro-21H,23H-porphyrine-5,10,15,20-tetrayl)tetrakis[1-methyl-pyridinium]tetratosylate (THPTS) and laser light has led to very promising results. This study focuses on the effects of THPTS in various critical multidrug-resistant bacterial strains and explores the possibility of light-emitting diode (LED)-based activation as a clinically more feasible alternative to laser light. METHODS THPTS was further chemically characterized and in vitro testing of PDI of different multidrug-resistant bacterial strains was performed under various experimental conditions, including varying drug concentration, incubation time, light source (laser and LED) and light intensity, by determination of viable bacteria after treatment. The effect of hyaluronic acid as an adjuvant for medical applications was also evaluated. RESULTS Bacterial density of all investigated bacterial strains was reduced by several orders of magnitude, irrespective of multidrug-resistance or hyaluronic acid addition. The effect was less intense in Gram-negative strains (disinfection), and more pronounced in Gram-positive strains (sterilization), even at reduced THPTS concentrations or decreased light treatment intensity. Controls without THPTS or without light treatment did not indicate reduced bacterial density. CONCLUSIONS PDI with THPTS and laser light was effective in all investigated bacterial strains. Gram-negative strains were less, but sufficiently, susceptible to PDI. Adding hyaluronic acid did not reduce the antibacterial treatment effect. LED-based PDI is equally effective when illumination duration is increased to compensate for reduced light intensity.
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Affiliation(s)
- Svitlana Ziganshyna
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Anna Guttenberger
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Norman Lippmann
- Institute of Medical Microbiology and Epidemiology of Infectious Diseases, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Sebastian Schulz
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Sven Bercker
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Faculty, Leipzig, Germany
| | - Axel Kahnt
- Leibniz Institute of Surface Engineering (IOM), Leipzig, Germany
| | - Tobias Rüffer
- Institute of Chemistry, Faculty of Natural Sciences, Technical University of Chemnitz, Chemnitz, Germany
| | - Alexander Voigt
- Institute of Chemistry, Faculty of Natural Sciences, Technical University of Chemnitz, Chemnitz, Germany
| | - Khrystyna Gerlach
- Institute of Chemistry, Faculty of Natural Sciences, Technical University of Chemnitz, Chemnitz, Germany
| | - Robert Werdehausen
- Department of Anesthesiology and Intensive Care, University of Leipzig, Medical Faculty, Leipzig, Germany.
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22
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Trawinski H, Wendt S, Lippmann N, Heinitz S, von Braun A, Lübbert C. [Typhoid and paratyphoid fever]. Z Gastroenterol 2020; 58:160-170. [PMID: 32050286 DOI: 10.1055/a-1063-1945] [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] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Typhoid fever and paratyphoid fever are systemic infectious diseases of global significance caused by Salmonella enterica subspecies enterica Serovar Typhi (short name: Salmonella Typhi) or Serovar Paratyphi (short name: Salmonella Paratyphi). The course of these fecal-orally transmitted diseases is mainly characterized by a high fever. Left untreated, the course of typhoid fever can be severe and lethal. The infection is almost always acquired outside of Europe (mainly in India) and is notifiable in Germany, Austria and Switzerland. Paratyphoid is an attenuated disease of typhoid fever caused by Salmonella Paratyphi. Available vaccines only protect against Salmonella Typhi. Antibiotic resistance reflects the situation in endemic countries and shows a worrying increase of multi-drug resistant isolates. Currently, third-generation cephalosporins such as ceftriaxone are recommended as first-line therapy; if sensitive to quinolones, fluoroquinolones such as ciprofloxacin may continue to be administered. Crucial preventive measures for travelers to endemic regions include consistent water and food hygiene as well as vaccination, whereby only protection rates of 50-70 % are achieved by currently available vaccines. In the light of increasing multi-drug resistance, a more effective conjugate vaccine against Salmonella Typhi with cross-reactivity against Salmonella Paratyphi is needed more than ever.
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Affiliation(s)
- Henning Trawinski
- Bereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Hepatologie, Infektiologie, Pneumologie, Universitätsklinikum Leipzig.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig
| | - Sebastian Wendt
- Bereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Hepatologie, Infektiologie, Pneumologie, Universitätsklinikum Leipzig.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig.,Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig
| | - Norman Lippmann
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig
| | - Sascha Heinitz
- Bereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Hepatologie, Infektiologie, Pneumologie, Universitätsklinikum Leipzig.,Klinik und Poliklinik für Endokrinologie, Nephrologie, Rheumatologie, Universitätsklinikum Leipzig.,Helmholtz-Institut für Metabolismus-, Adipositas- und Gefäßforschung München an der Universität Leipzig und dem Universitätsklinikum Leipzig
| | - Amrei von Braun
- Bereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Hepatologie, Infektiologie, Pneumologie, Universitätsklinikum Leipzig.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig
| | - Christoph Lübbert
- Bereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie, Hepatologie, Infektiologie, Pneumologie, Universitätsklinikum Leipzig.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig
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Hagel S, Gantner J, Spreckelsen C, Fischer C, Ammon D, Saleh K, Phan-Vogtmann LA, Heidel A, Müller S, Helhorn A, Kruse H, Thomas E, Rißner F, Haferkamp S, Vorwerk J, Deffge S, Juzek-Küpper MF, Lippmann N, Lübbert C, Trawinski H, Wendt S, Wendt T, Dürschmid A, Konik M, Moritz S, Tiller D, Röhrig R, Schulte-Coerne J, Fortmann J, Jonas S, Witzke O, Rath PM, Pletz MW, Scherag A. Hospital-wide ELectronic medical record evaluated computerised decision support system to improve outcomes of Patients with staphylococcal bloodstream infection (HELP): study protocol for a multicentre stepped-wedge cluster randomised trial. BMJ Open 2020; 10:e033391. [PMID: 32047014 PMCID: PMC7044885 DOI: 10.1136/bmjopen-2019-033391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Staphylococci are the most commonly identified pathogens in bloodstream infections. Identification of Staphylococcus aureus in blood culture (SAB) requires a prompt and adequate clinical management. The detection of coagulase-negative staphylococci (CoNS), however, corresponds to contamination in about 75% of the cases. Nevertheless, antibiotic therapy is often initiated, which contributes to the risk of drug-related side effects. We developed a computerised clinical decision support system (HELP-CDSS) that assists physicians with an appropriate management of patients with Staphylococcus bacteraemia. The CDSS is evaluated using data of the Data Integration Centers (DIC) established at each clinic. DICs transform heterogeneous primary clinical data into an interoperable format, and the HELP-CDSS displays information according to current best evidence in bacteraemia treatment. The overall aim of the HELP-CDSS is a safe but more efficient allocation of infectious diseases specialists and an improved adherence to established guidelines in the treatment of SAB. METHODS AND ANALYSIS The study is conducted at five German university hospitals and is designed as a stepped-wedge cluster randomised trial. Over the duration of 18 months, 135 wards will change from a control period to the intervention period in a randomised stepwise sequence. The coprimary outcomes are hospital mortality for all patients to establish safety, the 90-day disease reoccurrence-free survival for patients with SAB and the cumulative vancomycin use for patients with CoNS bacteraemia. We will use a closed, hierarchical testing procedure and generalised linear mixed modelling to test for non-inferiority of the CDSS regarding hospital mortality and 90-day disease reoccurrence-free survival and for superiority of the HELP-CDSS regarding cumulative vancomycin use. ETHICS AND DISSEMINATION The study is approved by the ethics committee of Jena University Hospital and will start at each centre after local approval. Results will be published in a peer-reviewed journal and presented at scientific conferences. TRIAL REGISTRATION NUMBER DRKS00014320.
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Affiliation(s)
- Stefan Hagel
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Thüringen, Germany
| | - Julia Gantner
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
| | - Cord Spreckelsen
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
| | - Claudia Fischer
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
| | - Danny Ammon
- IT Department, Data Integration Center, Jena University Hospital, Jena, Thüringen, Germany
| | - Kutaiba Saleh
- IT Department, Data Integration Center, Jena University Hospital, Jena, Thüringen, Germany
| | - Lo An Phan-Vogtmann
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
| | - Andrew Heidel
- IT Department, Data Integration Center, Jena University Hospital, Jena, Thüringen, Germany
| | - Susanne Müller
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
| | - Alexander Helhorn
- IT Department, Data Integration Center, Jena University Hospital, Jena, Thüringen, Germany
| | - Henner Kruse
- IT Department, Data Integration Center, Jena University Hospital, Jena, Thüringen, Germany
| | - Eric Thomas
- IT Department, Data Integration Center, Jena University Hospital, Jena, Thüringen, Germany
| | - Florian Rißner
- Center for Clinical Studies, Jena University Hospital, Jena, Thüringen, Germany
| | - Silke Haferkamp
- IT Department, Data Integration Center, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Jens Vorwerk
- IT Department, Data Integration Center, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Saskia Deffge
- Department of Intensive and Intermediate Care, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Marc Fabian Juzek-Küpper
- Medical Faculty, Division of Infection Control and Infectious Diseases, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Norman Lippmann
- Institute of Medical Microbiology and Epidemiology on Infectious Diseases, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Christoph Lübbert
- Department of Gastroenterology and Rheumatology, Division of Infectious Diseases and Tropical Medicine, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Henning Trawinski
- Department of Gastroenterology and Rheumatology, Division of Infectious Diseases and Tropical Medicine, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Sebastian Wendt
- Department of Gastroenterology and Rheumatology, Division of Infectious Diseases and Tropical Medicine, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Thomas Wendt
- IT Department, Data Integration Center, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Andreas Dürschmid
- IT Department, Data Integration Center, University Hospital Leipzig, Leipzig, Sachsen, Germany
| | - Margarethe Konik
- Department of Nephrology, Clinic for Infectiology, University of Duisburg-Essen, Essen, Nordrhein-Westfalen, Germany
| | - Stefan Moritz
- Section of Clinical Infectious Diseases, University Hospital Halle, Halle, Sachsen-Anhalt, Germany
| | - Daniel Tiller
- IT Department, Data Integration Center, University Hospital Halle, Halle, Sachsen-Anhalt, Germany
| | - Rainer Röhrig
- Institute of Medical Informatics, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Jonas Schulte-Coerne
- Department of Informatics, Technical University of Munich, Munchen, Bayern, Germany
| | - Jonas Fortmann
- Institute of Medical Informatics, University Hospital Aachen, Aachen, Nordrhein-Westfalen, Germany
| | - Stephan Jonas
- Department of Informatics, Technical University of Munich, Munchen, Bayern, Germany
| | - Oliver Witzke
- Institute for Infectious Diseases, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Peter-Michael Rath
- Institute for Medical Microbiology, University Hospital Essen, Essen, Nordrhein-Westfalen, Germany
| | - Mathias W Pletz
- Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Thüringen, Germany
| | - André Scherag
- Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Thüringen, Germany
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24
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Wendt S, Böhm P, Daniel J, Lippmann N, Lübbert C. How are travellers colonized with antimicrobial-resistant bacteria? J Travel Med 2020; 27:5562943. [PMID: 31502644 DOI: 10.1093/jtm/taz068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 08/06/2019] [Revised: 08/21/2019] [Accepted: 09/06/2019] [Indexed: 01/30/2023]
Affiliation(s)
- Sebastian Wendt
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany.,Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany.,Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Paul Böhm
- Institute for Environmental Research, Department of Ecosystem Analysis, RWTH Aachen University, Aachen, Germany
| | - Jonas Daniel
- Institute for Environmental Research, Department of Ecosystem Analysis, RWTH Aachen University, Aachen, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany.,Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Leipzig University Hospital, Leipzig, Germany.,Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
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25
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Eisner R, Lippmann N, Josten C, Rodloff AC, Behrendt D. Development of the Bacterial Spectrum and Antimicrobial Resistance in Surgical Site Infections of Trauma Patients. Surg Infect (Larchmt) 2020; 21:684-693. [PMID: 31944899 DOI: 10.1089/sur.2019.158] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background: While ubiquitously multi-resistant bacteria are on the rise, peri-operative antimicrobial prophylaxis in trauma and near-to-bone surgical procedures has only been changed slightly during the last 25 years. Recent clinical studies concerning the bacterial spectrum and efficacy of antimicrobial treatment in infected trauma surgical patients are rare. The aim of the study was analysis of the contemporary bacterial spectrum and its antimicrobial resistance including the assessment of the appropriateness of peri-operative antimicrobial prophylaxis with cefuroxime. Methods: Patients of a level-I academic trauma center who underwent open or arthroscopic surgery because of a recent trauma necessitating the use of bone-near metal implants were included in the study. All patients in whom a surgical site infection (SSI) had developed during six weeks post-operatively necessitating surgical debridement and had positive microbiologic culture results from an intra-operative surgical site swab were analyzed, retrospectively. In particular, age, gender, date and duration of surgical interventions, and patient's related risk factors were collected, and infecting agents and their minimum inhibitory concentration values for 34 selected antimicrobial agents were evaluated. An SSI occurring later than 6 weeks post-operatively and patients with chronic and septic wounds were excluded. Statistical analysis was performed with SPSS® (IBM, Armonk, NY). Results: There were 438 pathogens cultured in specimens from 303 enrolled patients (female = 140, male = 163). The most frequent pathogens were Staphylococcus aureus (27.1%), S. epidermidis (20.6%), Enterococcus faecalis (13.6%), Escherichia coli (5.1%), and Pseudomonas aeruginosa (3.7%) accounting for 303 isolates. Of those, 89 (29.4%) were multi-resistant. Of the S. epidermidis isolates, 79.8% (n = 71) were resistant against Oxacillin and thus against most beta-lactam antibiotic agents. Altogether, only 44.1% of the infecting organisms were susceptible to cefuroxime, the antimicrobial agent most often being used for prophylactic purposes. Conclusion: Standardized antimicrobial prophylaxis with cephalosporins has to be reconsidered critically. Multi-resistant species such as S. epidermidis are an increasing challenge in trauma operations.
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Affiliation(s)
- Rico Eisner
- Department of Anaesthesiology and Critical Care Medicine, Trauma Surgery and Plastic Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Trauma Surgery and Plastic Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Christoph Josten
- Department of Orthopedics, Trauma Surgery and Plastic Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Arne C Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Trauma Surgery and Plastic Surgery, Universitätsklinikum Leipzig, Leipzig, Germany
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26
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Meurs L, Lempp FS, Lippmann N, Trawinski H, Rodloff AC, Eckardt M, Klingeberg A, Eckmanns T, Walter J, Lübbert C. Intestinal colonization with extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE) during long distance travel: A cohort study in a German travel clinic (2016-2017). Travel Med Infect Dis 2019; 33:101521. [PMID: 31770602 DOI: 10.1016/j.tmaid.2019.101521] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/22/2019] [Revised: 11/14/2019] [Accepted: 11/18/2019] [Indexed: 02/05/2023]
Abstract
BACKGROUND Intercontinental travel contributes to the spread of extended-spectrum beta-lactamase producing Enterobacterales (ESBL-PE). We assessed risk factors for intestinal ESBL-PE colonization in people travelling to low and middle income countries in the tropics and subtropics to better understand how travel affects ESBL-PE spread. METHOD This prospective cohort study in travellers attending a travel clinic in Leipzig, Germany was conducted in 2016-2017. Information on risk factors related to travel, symptoms, antibiotic use, health care usage, accommodation, destination, diet and hygiene was collected by questionnaire after travel. Stools were phenotypically tested for ESBL-PE before and after travel. Risk factors for ESBL-PE colonization were identified using logistic regression. RESULTS Of the 230 travellers that were ESBL-PE negative before travelling, 23% (n = 53) travellers returned positive. Multivariable analyses showed that age, type of accommodation and travelling to Asia were associated with ESBL-PE colonization. CONCLUSIONS Given that a considerable amount of travellers returned with ESBL-PE, we recommend raising awareness in returning high-risk travellers, e.g. those returning from high-risk areas. They should be aware that they may carry antimicrobial-resistant bacteria after travel, and how they can prevent its spread. The role of the type of accommodation as a factor favouring intestinal colonization with ESBL-PE requires further investigation.
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Affiliation(s)
- Lynn Meurs
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control, Gustav III:s Boulevard 40, 16973, Solna, Sweden; Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany.
| | - Felix S Lempp
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Germany
| | - Norman Lippmann
- Interdisciplinary Centre for Infectious Diseases, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Germany
| | - Henning Trawinski
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Germany
| | - Arne C Rodloff
- Interdisciplinary Centre for Infectious Diseases, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Germany
| | | | | | - Tim Eckmanns
- Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Jan Walter
- Robert Koch Institute, Seestraße 10, 13353, Berlin, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Germany; Interdisciplinary Centre for Infectious Diseases, Leipzig University Hospital, Liebigstraße 20, 04103, Leipzig, Germany
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27
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Karlas T, Reinhardt F, Blank V, Lippmann N, Seehofer D, Lübbert C. Frequency and clinical presentation of alveolar and cystic echinococcosis in a tertiary medical center in Germany 2004-2018: lessons from a low-prevalence area. Z Gastroenterol 2019; 57:1281-1290. [PMID: 31739373 DOI: 10.1055/a-1013-4405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
INTRODUCTION The prevalence of alveolar echinococcosis (AE) and cystic echinococcosis (CE) in Germany is increasing. The number of cases in northern and eastern regions is low, so there is little experience with regard to diagnosis and therapy. OBJECTIVES The objective of this paper was to evaluate the management of suspected and/or diagnosed echinococcosis at a university center in a low-prevalence region. METHODS All the patients at the Leipzig University Hospital between 2004 and 2018 who had been serologically examined for echinococci were included in a retrospective cohort study. Clinical course, imaging, histology, therapeutic characteristics, relevant comorbidities and risk factors for AE and CE were evaluated. A time-staggered prevalence estimation, as well as sensitivity and specificity calculations for the serological tests, were performed. RESULTS A total of 382 patients were enrolled, with 11 AE and 7 CE cases identified. The mean prevalence rate of AE in this cohort was 2.9 % and that of CE was 1.8 %. Among the patients, 56 % had known risk factors for AE and CE. The serological tests showed a sensitivity of 86 % and a specificity of 91 %. Two patients with false-negative serology were diagnosed by biopsy. All CE and 5 AE patients (45 %) were operated on. Six AE patients received long-term treatment with albendazole. CONCLUSIONS AE and CE are rare diseases in the greater Leipzig region; however, case numbers are on the rise. Due to favorable factors such as the escalation of migration, a further increase is expected. Diagnosis and therapy are challenging and should be supported by specialists (experienced infectiologists, imaging experts and skilled hepatobiliary surgeons) who should be integrated in a German network.
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Affiliation(s)
- Thomas Karlas
- Leipzig University Hospital, Department of Gastroenterology, Hepatology, Infectious Diseases, Pneumology, Germany
| | - Fabian Reinhardt
- Leipzig University Hospital, Division of Infectious Diseases and Tropical Medicine, Germany
| | - Valentin Blank
- Leipzig University Hospital, Department of Gastroenterology, Hepatology, Infectious Diseases, Pneumology, Germany.,University of Leipzig, Faculty of Medicine, Integrated Research and Treatment Center Adiposity Diseases Leipzig, Germany
| | - Norman Lippmann
- Leipzig University Hospital, Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Germany.,Leipzig University Hospital, Interdisciplinary Center for Infectious Diseases, Germany
| | - Daniel Seehofer
- Leipzig University Hospital, Division of Hepatobiliar and Transplant Surgery, Germany
| | - Christoph Lübbert
- Leipzig University Hospital, Department of Gastroenterology, Hepatology, Infectious Diseases, Pneumology, Germany.,Leipzig University Hospital, Division of Infectious Diseases and Tropical Medicine, Germany.,Leipzig University Hospital, Interdisciplinary Center for Infectious Diseases, Germany
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Abstract
Was ist neu?
Epidemiologie Clostridium-difficile-Infektionen (CDI) gehen auch in Deutschland mit unverändert hoher Krankheitslast und einem Anstieg der Zahl schwerer bzw. letaler Verläufe einher. Der Anteil ambulant erworbener CDI steigt weltweit weiter an und umfasst selten auch Patienten mit einer Reisediarrhö. Es gibt eine gute Evidenz dafür, dass nosokomiale Fälle durch Implementierung von Antibiotic-Stewardship- (ABS-) Programmen stark verringert werden können.
Diagnostik Nur Patienten mit unklarer, neu aufgetretener Diarrhö sollten getestet werden. Die mikrobiologische Untersuchung auf toxigene C.-difficile-Stämme sollte mehrstufig erfolgen, d. h. mittels Glutamatdehydrogenase- (GDH-) Test plus Toxinnachweis oder Nukleinsäureamplifikationstests (NAAT), oder NAAT plus Toxinnachweis. Von einem alleinigen Toxinnachweis mittels Enzymimmunoassay (EIA) oder einem alleinigen Einsatz von NAAT wird abgeraten.
Neue Therapieleitlinien Nach den 2017/18 aktualisierten US-amerikanischen Leitlinien gilt oral verabreichtes Vancomycin inzwischen als Mittel der ersten Wahl. Fidaxomicin ist ähnlich wirksam wie Vancomycin, sein Vorteil besteht jedoch in der geringeren Rate an Rezidiven.
Weitere Behandlungsoptionen und Impfung Es konnte gezeigt werden, dass die zusätzliche Gabe des monoklonalen Antikörpers Bezlotoxumab die Rezidivrate signifikant senkt. Neue Antibiotika, die die Darmmikrobiota besser schützen, werden derzeit in klinischen Studien getestet. Für die Therapie multipel rezidivierender CDI bestehen gesicherte Behandlungserfolge von ≥ 90 % durch den fäkalen Mikrobiomtransfer (FMT). Da der FMT in Deutschland zurzeit lediglich den Status eines individuellen Heilversuchs hat, ist eine evidenzbasierte generelle Empfehlung für die klinische Praxis nicht möglich. Wahrscheinlich wird sich die Applikation kryokonservierter FMT-Kapseln längerfristig durchsetzen. Es ist zu erwarten, dass Toxoid-Impfstoffe CDI wirksam verhindern können; allerdings wurde bislang noch keine Zulassungsstudie abgeschlossen.
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Affiliation(s)
- Christoph Lübbert
- Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig
| | - Norman Lippmann
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig
| | - Amrei von Braun
- Fachbereich Infektions- und Tropenmedizin, Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Department für Innere Medizin, Neurologie und Dermatologie, Universitätsklinikum Leipzig
- Interdisziplinäres Zentrum für Infektionsmedizin, Universitätsklinikum Leipzig
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Kaiser T, Finstermeier K, Häntzsch M, Faucheux S, Kaase M, Eckmanns T, Bercker S, Kaisers UX, Lippmann N, Rodloff AC, Thiery J, Lübbert C. Stalking a lethal superbug by whole-genome sequencing and phylogenetics: Influence on unraveling a major hospital outbreak of carbapenem-resistant Klebsiella pneumoniae. Am J Infect Control 2018; 46:54-59. [PMID: 28935481 DOI: 10.1016/j.ajic.2017.07.022] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 07/24/2017] [Accepted: 07/24/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND From July 2010-April 2013, Leipzig University Hospital experienced the largest outbreak of a Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing Klebsiella pneumoniae (KPC-2-Kp) strain observed in Germany to date. After termination of the outbreak, we aimed to reconstruct transmission pathways by phylogenetics based on whole-genome sequencing (WGS). METHODS One hundred seventeen KPC-2-Kp isolates from 89 outbreak patients, 5 environmental KPC-2-Kp isolates, and 24 K pneumoniae strains not linked to the outbreak underwent WGS. Phylogenetic analysis was performed blinded to clinical data and based on the genomic reads. RESULTS A patient from Greece was confirmed as the source of the outbreak. Transmission pathways for 11 out of 89 patients (12.4%) were plausibly explained by descriptive epidemiology, applying strict definitions. Five of these and an additional 15 (ie, 20 out of 89 patients [22.5%]) were confirmed by phylogenetics. The rate of phylogenetically confirmed transmissions increased significantly from 8 out of 66 (12.1% for the time period before) to 12 out of 23 patients (52.2% for the time period after; P <.001) after implementation of systematic screening for KPC-2-Kp (33,623 screening investigations within 11 months). Using descriptive epidemiology, systematic screening showed no significant effect (7 out of 66 [10.6%] vs 4 out of 23 [17.4%] patients; P = .465). The phylogenetic analysis supported the assumption that a contaminated positioning pillow served as a reservoir for the persistence of KPC-2-Kp. CONCLUSIONS Effective phylogenetic identification of transmissions requires systematic microbiologic screening. Extensive screening and phylogenetic analysis based on WGS should be started as soon as possible in a bacterial outbreak situation.
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Lippmann N, Wendt S, Lübbert C. 44-jährige Afrikareisende mit „regenwurmartiger“ Struktur im Stuhl. Dtsch Med Wochenschr 2018; 143:13-14. [DOI: 10.1055/s-0043-122587] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Norman Lippmann
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, AöR
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
| | - Sebastian Wendt
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, AöR
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
| | - Christoph Lübbert
- Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
- Klinik und Poliklinik für Gastroenterologie und Rheumatologie, Fachbereich Infektions- und Tropenmedizin, Universitätsklinikum Leipzig, AöR
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Wendt S, Lippmann N, Fahnert J, Rodloff AC, Lübbert C. Brucella related myocarditis. Int J Infect Dis 2017; 66:126-127. [PMID: 29146514 DOI: 10.1016/j.ijid.2017.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/05/2017] [Indexed: 10/18/2022] Open
Affiliation(s)
- Sebastian Wendt
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany.
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany
| | - Jeanette Fahnert
- Department of Diagnostic and Interventional Radiology, Leipzig University Hospital, Liebigstraße 20, D-04103 Leipzig, Germany
| | - Arne C Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany; Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany
| | - Christoph Lübbert
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, Liebigstraße 21, D-04103 Leipzig, Germany; Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstraße 20, D-04103 Leipzig, Germany
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Lippmann N, Petzold-Quinque S, Siekmeyer M, Kieß W, Wolf L. A Fulminant Case of Haemophilus influenzae Serotype F Meningitis in an Immunocompetent 3-Year-Old Boy. J PEDIAT INF DIS-GER 2017. [DOI: 10.1055/s-0037-1606341] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AbstractOf all encapsulated Haemophilus influenzae (Hi), serotype b (Hib) is considered as the potentially most virulent one for children. After vaccination was introduced in the 1990s, the incidence of this serotype has dropped dramatically. Other encapsulated forms such as Hi serotype a, c, d, e, f (Hia-Hif) are diagnosed rarely and mostly affect vulnerable patient groups. As serotyping is not performed routinely, the number of unreported cases is estimated to be even higher. Whereas several cases of Hif disease in children with favorable outcome were published, a 3-year-old boy diagnosed with this serotype died at our hospital despite initial antimicrobial therapy.
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Affiliation(s)
- Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Stefanie Petzold-Quinque
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Manuela Siekmeyer
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
| | - Wieland Kieß
- Department of Women and Child Health, Hospital for Children and Adolescents, Center for Pediatric Research, University Hospital Leipzig, Leipzig, Germany
| | - Luise Wolf
- Department of Women and Child Health, Hospital for Children and Adolescents, University Hospital Leipzig, Leipzig, Germany
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Abstract
Background Botulism is a rare, life-threatening, time-critical neuroparalytic disease that is frequently a subject of differential diagnostic considerations. But there is much uncertainty regarding diagnosis and therapy. Rapid diagnosis, early antitoxin dose, consistent food hygiene and the sensitization of the population can help to reduce incidence, morbidity and mortality. Methods This overview is based on an epidemiological data inquiry (RKI, ECDC, CDC, WHO) and a selective literature research (pubmed till March 2017). Additionally, the German botulism guideline (2012) and own diagnostical experiences were taken into account. Results The incidence of botulinum toxin intoxication induced by ubiquitous spore-forming Clostridium botulinum (main representative) is < 0.01/100 000 EU citizens. Foodborne botulism is a pure intoxication syndrome (most common form) due to improperly prepared or incorrectly stored food. Wound and infant botulism are kinds of "toxico-infections". A "bulbar" neuroparalysis is a main symptom progressing to a flaccid tetraparesis up to respiratory paralysis. Infant botulism is presented non-specific and is treated only symptomatically; but a special human-derived antitoxin is available at international pharmacies. In case of suspected foodborne or wound botulism antitoxin must be administered as soon as possible, which may also be effective 24 hours after symptoms onset. There is no evidence for adjuvant treatment except of intensive care unit (ICU) therapy. Conclusion Despite typical symptomatology botulism is often diagnosed too late. Early antitoxin administration and ICU therapy are crucial for survival. A consultant laboratory should be contacted for advice.
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Affiliation(s)
- Sebastian Wendt
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, AöR.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
| | - Ines Eder
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, AöR.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
| | - Roman Wölfel
- Kompetenzbereich Bakterien und Toxine, Institut für Mikrobiologie der Bundeswehr, München
| | - Peggy Braun
- Institut für Lebensmittelhygiene, Veterinärmedizinische Fakultät, Universität Leipzig.,Zentrum für Veterinary Public Health, Veterinärmedizinische Fakultät, Universität Leipzig
| | - Norman Lippmann
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, AöR.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
| | - Arne Rodloff
- Institut für Medizinische Mikrobiologie und Infektionsepidemiologie, Universitätsklinikum Leipzig, AöR.,Interdisziplinäres Zentrum für Infektionsmedizin (ZINF), Universitätsklinikum Leipzig, AöR
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Lübbert C, Baars C, Dayakar A, Lippmann N, Rodloff AC, Kinzig M, Sörgel F. Environmental pollution with antimicrobial agents from bulk drug manufacturing industries in Hyderabad, South India, is associated with dissemination of extended-spectrum beta-lactamase and carbapenemase-producing pathogens. Infection 2017. [PMID: 28444620 DOI: 10.1007/s15010‐017‐1007‐2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE High antibiotic and antifungal concentrations in wastewater from anti-infective drug production may exert selection pressure for multidrug-resistant (MDR) pathogens. We investigated the environmental presence of active pharmaceutical ingredients and their association with MDR Gram-negative bacteria in Hyderabad, South India, a major production area for the global bulk drug market. METHODS From Nov 19 to 28, 2016, water samples were collected from the direct environment of bulk drug manufacturing facilities, the vicinity of two sewage treatment plants, the Musi River, and habitats in Hyderabad and nearby villages. Samples were analyzed for 25 anti-infective pharmaceuticals with liquid chromatography-tandem mass spectrometry and for MDR Gram-negative bacteria using chromogenic culture media. In addition, specimens were screened with PCR for bla VIM, bla KPC, bla NDM, bla IMP-1, and bla OXA-48 resistance genes. RESULTS All environmental specimens from 28 different sampling sites were contaminated with antimicrobials. High concentrations of moxifloxacin, voriconazole, and fluconazole (up to 694.1, 2500, and 236,950 µg/L, respectively) as well as increased concentrations of eight other antibiotics were found in sewers in the Patancheru-Bollaram industrial area. Corresponding microbiological analyses revealed an extensive presence of extended-spectrum beta-lactamase and carbapenemase-producing Enterobacteriaceae and non-fermenters (carrying mainly bla OXA-48, bla NDM, and bla KPC) in more than 95% of the samples. CONCLUSIONS Insufficient wastewater management by bulk drug manufacturing facilities leads to unprecedented contamination of water resources with antimicrobial pharmaceuticals, which seems to be associated with the selection and dissemination of carbapenemase-producing pathogens. The development and global spread of antimicrobial resistance present a major challenge for pharmaceutical producers and regulatory agencies.
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Affiliation(s)
- Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany.
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany.
| | - Christian Baars
- Ressort Investigation, North German Broadcasting Corporation (NDR), Hugh-Greene-Weg 1, 22529, Hamburg, Germany
| | - Anil Dayakar
- NGO Gamana, Gayatri Millennium Enclave Plot 1, Arunodaya Colony, Madhapur, Hyderabad, 500033, India
| | - Norman Lippmann
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, 04103, Leipzig, Germany
| | - Arne C Rodloff
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, 04103, Leipzig, Germany
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, 04103, Leipzig, Germany
| | - Martina Kinzig
- IBMP-Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Str. 19, 90562, Nürnberg-Heroldsberg, Germany
| | - Fritz Sörgel
- IBMP-Institute for Biomedical and Pharmaceutical Research, Paul-Ehrlich-Str. 19, 90562, Nürnberg-Heroldsberg, Germany
- Institute of Pharmacology, University of Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Germany
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Reuken PA, Torres D, Baier M, Löffler B, Lübbert C, Lippmann N, Stallmach A, Bruns T. Correction: Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis. PLoS One 2017; 12:e0172373. [PMID: 28192501 PMCID: PMC5305072 DOI: 10.1371/journal.pone.0172373] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Reuken PA, Torres D, Baier M, Löffler B, Lübbert C, Lippmann N, Stallmach A, Bruns T. Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis. PLoS One 2017; 12:e0169900. [PMID: 28076388 PMCID: PMC5226732 DOI: 10.1371/journal.pone.0169900] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 12/23/2016] [Indexed: 12/27/2022] Open
Abstract
Background Acute cholangitis (AC) requires the immediate initiation of antibiotic therapy in addition to treatment for biliary obstruction. Against a background of an increasing prevalence of multi-drug resistant (MDR) bacteria, the risk factors for the failure of empiric therapy must be defined. Methods Using a pathogen-based approach, 1764 isolates from positive bile duct cultures were retrospectively analyzed to characterize the respective pathogen spectra in two German tertiary centers. Using a patient-based approach, the clinical and laboratory data for 83 patients with AC were assessed to identify risk factors for AC with pathogens resistant to the applied empiric therapy. Results Bile cultures were predominantly polymicrobial, and empiric antibiotic therapies did not cover the full biliary pathogen spectrum in 78% of cases. MDR bacteria were isolated from the bile of 24/83 (29%) patients. The univariate risk factors for biliary MDR bacteria were male sex, nosocomial AC, prior antibiotic exposure and prior biliary stenting, of which biliary stenting was the only independent risk factor according to multivariate analysis (OR = 3.8; 95% CI 1.3–11.0, P = 0.013). Although there were no significant differences in survival or hospital stay in AC patients with and without detected biliary MDR pathogens, the former more often had a concomitant bloodstream infection (58% vs. 24%; P = 0.019), including those involving MDR pathogens or fungi (21% vs. 2%; P = 0.007). Conclusion Patients with biliary stents who develop AC should receive empiric therapy covering enterococci and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. These patients are at an increased risk for bloodstream infections by MDR pathogens or fungi.
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Affiliation(s)
- Philipp A. Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
- * E-mail:
| | - Dorian Torres
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Michael Baier
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany
| | - Bettina Löffler
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
- The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Tony Bruns
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
- The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
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Reuken PA, Torres D, Baier M, Löffler B, Lübbert C, Lippmann N, Stallmach A, Bruns T. Risk Factors for Multi-Drug Resistant Pathogens and Failure of Empiric First-Line Therapy in Acute Cholangitis. PLoS One 2017. [PMID: 28076388 DOI: 10.137/journal.pone.0169900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Acute cholangitis (AC) requires the immediate initiation of antibiotic therapy in addition to treatment for biliary obstruction. Against a background of an increasing prevalence of multi-drug resistant (MDR) bacteria, the risk factors for the failure of empiric therapy must be defined. METHODS Using a pathogen-based approach, 1764 isolates from positive bile duct cultures were retrospectively analyzed to characterize the respective pathogen spectra in two German tertiary centers. Using a patient-based approach, the clinical and laboratory data for 83 patients with AC were assessed to identify risk factors for AC with pathogens resistant to the applied empiric therapy. RESULTS Bile cultures were predominantly polymicrobial, and empiric antibiotic therapies did not cover the full biliary pathogen spectrum in 78% of cases. MDR bacteria were isolated from the bile of 24/83 (29%) patients. The univariate risk factors for biliary MDR bacteria were male sex, nosocomial AC, prior antibiotic exposure and prior biliary stenting, of which biliary stenting was the only independent risk factor according to multivariate analysis (OR = 3.8; 95% CI 1.3-11.0, P = 0.013). Although there were no significant differences in survival or hospital stay in AC patients with and without detected biliary MDR pathogens, the former more often had a concomitant bloodstream infection (58% vs. 24%; P = 0.019), including those involving MDR pathogens or fungi (21% vs. 2%; P = 0.007). CONCLUSION Patients with biliary stents who develop AC should receive empiric therapy covering enterococci and extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. These patients are at an increased risk for bloodstream infections by MDR pathogens or fungi.
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Affiliation(s)
- Philipp A Reuken
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Dorian Torres
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany
| | - Michael Baier
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany
| | - Bettina Löffler
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Institute of Medical Microbiology, Jena University Hospital, Jena, Germany
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany
| | - Andreas Stallmach
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.,The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
| | - Tony Bruns
- Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.,The Integrated Research and Treatment Center for Sepsis Control and Care (CSCC), Jena University Hospital, Jena, Germany
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Lübbert C, Wendt K, Feisthammel J, Moter A, Lippmann N, Busch T, Mössner J, Hoffmeister A, Rodloff AC. Epidemiology and Resistance Patterns of Bacterial and Fungal Colonization of Biliary Plastic Stents: A Prospective Cohort Study. PLoS One 2016; 11:e0155479. [PMID: 27171497 PMCID: PMC4865241 DOI: 10.1371/journal.pone.0155479] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [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: 03/10/2016] [Accepted: 04/29/2016] [Indexed: 12/17/2022] Open
Abstract
Background Plastic stents used for the treatment of biliary obstruction will become occluded over time due to microbial colonization and formation of biofilms. Treatment of stent-associated cholangitis is often not effective because of inappropriate use of antimicrobial agents or antimicrobial resistance. We aimed to assess the current bacterial and fungal etiology of stent-associated biofilms, with particular emphasis on antimicrobial resistance. Methods Patients with biliary strictures requiring endoscopic stent placement were prospectively enrolled. After the retrieval of stents, biofilms were disrupted by sonication, microorganisms were cultured, and isolates were identified by matrix-associated laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry and/or biochemical typing. Finally, minimum inhibitory concentrations (MICs) were determined for various antimicrobial agents. Selected stents were further analyzed by fluorescence in situ hybridization (FISH). Results Among 120 patients (62.5% males, median age 64 years) with biliary strictures (35% malignant, 65% benign), 113 double pigtail polyurethane and 100 straight polyethylene stents were analyzed after a median indwelling time of 63 days (range, 1–1274 days). The stent occlusion rate was 11.5% and 13%, respectively, being associated with a significantly increased risk of cholangitis (38.5% vs. 9.1%, P<0.001). Ninety-five different bacterial and 13 fungal species were detected; polymicrobial colonization predominated (95.8% vs. 4.2%, P<0.001). Enterococci (79.3%), Enterobacteriaceae (73.7%), and Candida spp. (55.9%) were the leading pathogens. Candida species were more frequent in patients previously receiving prolonged antibiotic therapy (63% vs. 46.7%, P = 0.023). Vancomycin-resistant enterococci accounted for 13.7%, extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae with co-resistance to ciprofloxacin accounted for 13.9%, and azole-resistant Candida spp. accounted for 32.9% of the respective isolates. Conclusions Enterococci and Candida species play an important role in the microbial colonization of biliary stents. Therefore, empirical antimicrobial treatment of stent-associated cholangitis should be guided toward enterococci, Enterobacteriaceae, streptococci, anaerobes, and Candida. To determine causative pathogens, an accurate microbiological analysis of the extracted stent(s) may be helpful.
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Affiliation(s)
- Christoph Lübbert
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.,Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany.,Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, D-04103 Leipzig, Germany
| | - Karolin Wendt
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany
| | - Jürgen Feisthammel
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany
| | - Annette Moter
- Biofilm Center, German Heart Institute (Deutsches Herzzentrum Berlin, DHZB), Hindenburgdamm 30, D-12203 Berlin, Germany
| | - Norman Lippmann
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, D-04103 Leipzig, Germany.,Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, D-04103 Leipzig, Germany
| | - Thilo Busch
- Department of Anaesthesiology and Intensive Care Medicine, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany
| | - Joachim Mössner
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany
| | - Albrecht Hoffmeister
- Interdisciplinary Endoscopy Unit, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr. 20, D-04103 Leipzig, Germany
| | - Arne C Rodloff
- Interdisciplinary Center for Infectious Diseases, Leipzig University Hospital, D-04103 Leipzig, Germany.,Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Liebigstr. 21, D-04103 Leipzig, Germany
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Fehrenbach MK, Bernhard M, Siekmeyer M, Lippmann N, Kiess W, Nestler U, Meixensberger J, Preuss M. VP-shunt dysfunction caused by malaria CNS infection. Childs Nerv Syst 2016; 32:759-60. [PMID: 26394787 DOI: 10.1007/s00381-015-2912-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Accepted: 09/14/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Malaria is a widespread mosquito-borne infectious disease with over 300 million cases and roughly 900 thousand deaths in 2013. Cerebral involvement of malaria causes 50 % of all infection-associated deaths, especially in children below the age of 5 years. Hydrocephalus is a medical condition with abnormal accumulation of cerebrospinal fluid in physiological cavities and ventricles. Standard treatment is the implantation of a cerebrospinal fluid shunt device. A common problem associated with shunt treatment especially in pediatric patients is infection and consecutive shunt dysfunction caused by bacteriae or high protein levels clogging the valve. In these cases, Staphylococcus aureus and Staphylococcus epidermidis are predominantly found in CSF cultures. CASE PRESENTATION We present a case of a 2-year old boy from Saudi Arabia with a ventriculoperitoneal (VP)-shunt-dependent congenital hydrocephalus who suffered from cerebral malaria and developed consecutive shunt failure. CONCLUSION To the best of our knowledge, shunt failure caused by malaria CNS infection with Plasmodium falciparum has not yet been reported in the literature and should be considered as a rare cause of VP-shunt failure in patients with atypical VP-shunt infections living in or traveling from endemic areas.
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Affiliation(s)
- Michael Karl Fehrenbach
- Department of Neurosurgery, University Clinic of Leipzig, Liebigstr. 18, 04103, Leipzig, Sachsen, Germany.
| | - Matthias Bernhard
- Department of Pediatrics Hospital for Children and Adolescents, University Clinic of Leipzig, Leipzig, Germany
| | - Manuela Siekmeyer
- Department of Pediatrics Hospital for Children and Adolescents, University Clinic of Leipzig, Leipzig, Germany
| | - Norman Lippmann
- Institute of Medical Microbiology, University Clinic of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Department of Pediatrics Hospital for Children and Adolescents, University Clinic of Leipzig, Leipzig, Germany
| | - Ulf Nestler
- Department of Neurosurgery, University Clinic of Leipzig, Liebigstr. 18, 04103, Leipzig, Sachsen, Germany
| | - Jürgen Meixensberger
- Department of Neurosurgery, University Clinic of Leipzig, Liebigstr. 18, 04103, Leipzig, Sachsen, Germany
| | - Matthias Preuss
- Department of Neurosurgery, University Clinic of Leipzig, Liebigstr. 18, 04103, Leipzig, Sachsen, Germany
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Lippmann N, Lübbert C, Kaiser T, Kaisers UX, Rodloff AC. Clinical epidemiology of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis 2014; 14:271-2. [PMID: 24670625 DOI: 10.1016/s1473-3099(14)70705-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany
| | - Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Liebigstr 20, D-04103 Leipzig, Germany.
| | - Thorsten Kaiser
- Institute for Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Leipzig University Hospital, Leipzig, Germany
| | - Udo X Kaisers
- Department of Anaesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Arne C Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany
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Weis S, John E, Lippmann N, Mössner J, Lübbert C. Erratum: Clostridium-difficile-Infektionen (CDI) im Wandel der Zeit – ein Thema nur für den Internisten? Zentralbl Chir 2014. [DOI: 10.1055/s-0034-1368432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- S. Weis
- Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Gastroenterologie und Rheumatologie, Universität Leipzig, Leipzig, Deutschland
| | - E. John
- Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland
| | - N. Lippmann
- Institut für Medizinische Mikrobiologie, Universität Leipzig, Leipzig, Deutschland
| | - J. Mössner
- Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Gastroenterologie und Rheumatologie, Universität Leipzig, Leipzig, Deutschland
| | - C. Lübbert
- Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Gastroenterologie und Rheumatologie, Universität Leipzig, Leipzig, Deutschland
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Lübbert C, Lippmann N, Busch T, Kaisers UX, Ducomble T, Eckmanns T, Rodloff AC. Long-term carriage of Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae after a large single-center outbreak in Germany. Am J Infect Control 2014; 42:376-80. [PMID: 24679563 DOI: 10.1016/j.ajic.2013.12.001] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [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: 10/02/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND The natural progress of intestinal colonization with Klebsiella pneumoniae carbapenemase-2-producing K pneumoniae (KPC-2-KP) is almost unknown. METHODS After a large, single-center outbreak of KPC-2-KP, we analyzed carrier prevalence through retrospective and prospective investigation of intestinal KPC-2-KP carriage 1 month, 3 months, 6 months, 1 year, and 2 years after acquisition, defined as the earliest date of KPC-2-KP detection. Rectal swabs or stool samples were collected at baseline and at each visit and submitted for both culture and KPC-specific polymerase chain reaction. Resolution of intestinal KPC-2-KP carriage was defined as a minimum of 3 consecutive negative polymerase chain reaction test results separated by at least 48 hours. RESULTS In patients available for long-term evaluation 26 out of 84 patients (31%) tested negative for KPC-2-KP after 1 month, 14 out of 34 (41%) after 3 months, 17 out of 26 (65%) after 6 months, 14 out of 19 (74%) after 1 year, and 5 out of 6 (83%) after 2 years. Decolonization of KPC-2-KP was hampered in patients with prolonged or repeated hospitalization (P = .044-.140, depending on the time interval). Two patients retested positive for KPC-2-KP after they had previously shown 3 consecutive negative tests. The longest positive KPC-2-KP carrier status so far was observed after nearly 40 months (1,191 days). CONCLUSIONS The majority of patients experienced spontaneous decolonization within 6 months after acquisition, mainly after discharge from the hospital. However, long-term carriage of >3 years is possible. Appropriate infection control measures must be taken when these patients are readmitted to health care facilities. A series of at least 4 consecutive negative rectal swabs or stool samples separated by sufficient time intervals appears necessary before the declaration of successful KPC-2-KP decolonization is made.
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Affiliation(s)
- Christoph Lübbert
- Division of Infectious Diseases and Tropical Medicine, Department of Gastroenterology and Rheumatology, Leipzig University Hospital, Leipzig, Germany.
| | - Norman Lippmann
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany
| | - Thilo Busch
- Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Udo X Kaisers
- Department of Anesthesiology and Intensive Care Medicine, Leipzig University Hospital, Leipzig, Germany
| | - Tanja Ducomble
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Tim Eckmanns
- Department for Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - Arne C Rodloff
- Institute for Medical Microbiology and Epidemiology of Infectious Diseases, Leipzig University Hospital, Leipzig, Germany; Hospital Hygiene Staff Unit, Leipzig University Hospital, Leipzig, Germany
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Weis S, John E, Lippmann N, Mössner J, Lübbert C. [Clostridium difficile infection (CDI) in the course of time - an issue only for the internist?]. Zentralbl Chir 2013; 139:460-8. [PMID: 24132675 DOI: 10.1055/s-0032-1328623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Toxigenic strains of Clostridium (C.) difficile are the most prevalent pathogens of antibiotic associated intestinal disease and nosocomial diarrhoea. During the last 10 years, incidences of C. difficile infection (CDI) have increased worldwide. MATERIALS AND METHODS With clinical and microbiological original data for 2002-2012 from the University Hospitals Leipzig and Halle (Saale), Germany, the authors illustrate the current situation regarding CDI in the states of Saxony and Saxony-Anhalt and exemplify the latest developments in terms of incidence, prevalence of resistance, diagnosis and treatment strategies regarding CDI with an emphasis on surgical options. RESULTS Following the general trend, at the University Hospitals of Leipzig and Halle (Saale) there was also an increase in incidence of CDI, especially of severe clinical courses. In primary and secondary care facilities, prevention of CDI is based on hygiene management and restricted usage of antibiotics, preferably as "Antibiotic Stewardship" programmes. In 2012, the new macrocyclic antibiotic Fidaxomicin was approved in the European Union for the treatment of CDI. The therapeutic armamentarium, previously based on metronidazole or vancomycin, has now been enriched by a substance that presumably will reduce the rate of recurrence of CDI. Moreover, early data from case series and controlled trials suggest that the re-establishment of eubiosis in the colon of patients with recurrent CDI by stool transplantation from healthy donors is an alternative to antibiotics. Standard surgical intervention for refractory CDI is subtotal colectomy with terminal ileostomy. In patients with adequate life expectancy and without organ dysfunction, a colon-saving surgical technique should be considered. CONCLUSION Taking antibiotics for most remains the main risk factor for suffering from symptomatic CDI. With the introduction of Fidaxomicin there is hope for an improvement in the conservative treatment of CDI. Stool transplants from healthy donors are now considered to be better than giving antibiotics for severe CDI, but this treatment has not found broad acceptance yet. In cases with a lack of early treatment success, the surgeon must be consulted. Here, the evidence for preferably colon-saving surgical procedures is so far unfortunately low.
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Affiliation(s)
- S Weis
- Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Gastroenterologie und Rheumatologie, Universität Leipzig, Leipzig, Deutschland
| | - E John
- Chirurgie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale, Deutschland
| | - N Lippmann
- Institut für Medizinische Mikrobiologie, Universität Leipzig, Leipzig, Deutschland
| | - J Mössner
- Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Gastroenterologie und Rheumatologie, Universität Leipzig, Leipzig, Deutschland
| | - C Lübbert
- Department für Innere Medizin, Neurologie und Dermatologie, Klinik für Gastroenterologie und Rheumatologie, Universität Leipzig, Leipzig, Deutschland
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