1887
  1. Home
  2. Eurosurveillance
  3. Volume 20, Issue 46, 19/Nov/2015
  4. Article
Surveillance and outbreak report Open Access
Like 0
Download

Abstract

Voluntary surveillance systems in Germany suggest a recent decline in the incidence of infections (subsequent to at least 2010) with meticillin-resistant (MRSA) from various types of specimens and settings. We asked whether this decline is reflected by data from the mandatory national surveillance system for invasive MRSA infections. Our analysis is based on the population in Germany in 2010 to 2014. Cases were identified from passive reporting by microbiological laboratories of the diagnosis of MRSA from blood culture or cerebrospinal fluid. Respective clinical data were subsequently added to the notification. We calculated risk ratios (RR) between consecutive years, stratifying cases by sex, age and federal state of residence. The national incidence increased from 4.6 episodes per 100,000 persons in 2010 to 5.6 in 2012 (2011 vs 2010: RR: 1.13, 95% confidence interval (CI): 1.08–1.18; 2012 vs 2011: RR: 1.08, 95% CI: 1.04–1.13). It stagnated at 5.4 per 100,000 in 2013 (RR: 0.97, 95% CI: 0.93–1.01) before declining to 4.8 in 2014 (RR: 0.88, 95% CI: 0.84–0.91). This trend was observed in most, but not all federal states and strata of sex and age groups. Only 204 of 20,679 (1%) episodes of infection were notified as belonging to an outbreak. Our analysis corroborates previous findings that the incidence of invasive MRSA infections in Germany may be declining.

© Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Loading

Article metrics loading...

/content/10.2807/1560-7917.ES.2015.20.46.30067
2015-11-19
2018-04-26
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2015.20.46.30067
Loading
Loading full text...

Full text loading...

/deliver/fulltext/eurosurveillance/20/46/eurosurv-20-30067-3.html?itemId=/content/10.2807/1560-7917.ES.2015.20.46.30067&mimeType=html&fmt=ahah

References

  1. European Centre for Disease Prevention and Control (ECDC). Antimicrobial resistance surveillance in Europe 2013 Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2014.
  2. Layer F, Cuny C, Strommenger B, Werner G, Witte W. Aktuelle Daten und Trends zu Methicillin-resistenten Staphylococcus aureus (MRSA). [Current data and trends on methicillin-resistant Staphylococcus aureus (MRSA)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012;55(11-12):1377-86.  https://doi.org/10.1007/s00103-012-1560-x  PMID: 23114436 
  3. Robert Koch-Institut (RKI). Infektionsepidemiologisches Jahrbuch meldepflichtiger Krankheiten für 2012. Berlin: RKI; 2013. German.
  4. Eckmanns T, Richter D, Feig M. MRSA und ESBL in der ambulanten Versorgung: Entwicklung in den Jahren 2008 bis 2012 sowie soziodemografische Unterschiede. [MRSA and ESBL in outpatient: development from 2008 up to 2012 and socio demographic differences]. Berl Munch Tierarztl Wochenschr. 2014;127(9-10):399-402. PMID: 25868167 
  5. Köck R, Schaumburg F, Mellmann A, Köksal M, Jurke A, Becker K, et al. Livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) as causes of human infection and colonization in Germany. PLoS ONE. 2013;8(2):e55040.  https://doi.org/10.1371/journal.pone.0055040  PMID: 23418434 
  6. Meyer E, Schröder C, Gastmeier P, Geffers C. The reduction of nosocomial MRSA infection in Germany: an analysis of data from the Hospital Infection Surveillance System (KISS) between 2007 and 2012. Dtsch Arztebl Int. 2014;111(19):331-6. PMID: 24875457 
  7. Noll I, Schweickert B, Abu Sin M, Feig M, Claus H, Eckmanns T. Daten zur Antibiotikaresistenzlage in Deutschland. [Antimicrobial Resistance in Germany]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012;55(11-12):1370-6.  https://doi.org/10.1007/s00103-012-1559-3  PMID: 23114435 
  8. Communicable Diseases Law. 20. Juli 2000 (BGBl. I S. 1045), last changed by article 2 paragraph 36 and article 4 paragraph 21 of the law from 7. August 2013 (BGBl. I S. 3154). Amended for MRSA by the “Labormeldepflicht-Anpassungsverordnung”, 26. Mai 2009 (BGBl. I S. 1139). Bundesgesetzblatt.2000;1:1045.
  9. Schweickert B, Noll I, Feig M, Claus H, Krause G, Velasco E, et al. MRSA-surveillance in Germany: data from the Antibiotic Resistance Surveillance System (ARS) and the mandatory surveillance of MRSA in blood. Eur J Clin Microbiol Infect Dis. 2012;31(8):1855-65.  https://doi.org/10.1007/s10096-011-1511-8  PMID: 22210264 
  10. Haller S, Eckmanns T, Benzler J, Tolksdorf K, Claus H, Gilsdorf A, et al. Results from the first 12 months of the national surveillance of healthcare associated outbreaks in Germany, 2011/2012. PLoS ONE. 2014;9(5):e98100.  https://doi.org/10.1371/journal.pone.0098100  PMID: 24875674 
  11. von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. J Clin Epidemiol. 2008;61(4):344-9.  https://doi.org/10.1016/j.jclinepi.2007.11.008  PMID: 18313558 
  12. Heudorf U, Otto U, Gottschalk R. MRSA in Blutkulturen in Frankfurter Krankenhäusern 2010. [MRSA bloodstream infections in hospitals in Frankfurt/Main, Germany, 2010]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2011;54(9):1126-34.  https://doi.org/10.1007/s00103-011-1349-3  PMID: 21887627 
  13. Mielke M. Bericht über das 3. Treffen der Moderatoren der Regionalen MRE-Netzwerke am 15. und 16. Dezember 2011 am Robert Koch-Institut. [Report of the third meeting of the coordinators of the regional MRP networks in Germany on 15 and 16 December 2011 at the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012;55(11-12):1474-82.  https://doi.org/10.1007/s00103-012-1553-9  PMID: 23114447 
  14. Herrmann M, Petit C, Dawson A, Biechele J, Halfmann A, von Müller L, et al. Methicillin-resistant Staphylococcus aureus in Saarland, Germany: a statewide admission prevalence screening study. PLoS ONE. 2013;8(9):e73876.  https://doi.org/10.1371/journal.pone.0073876  PMID: 24040103 
  15. Mehraj J, Akmatov MK, Strömpl J, Gatzemeier A, Layer F, Werner G, et al. Methicillin-sensitive and methicillin-resistant Staphylococcus aureus nasal carriage in a random sample of non-hospitalized adult population in northern Germany. PLoS ONE. 2014;9(9):e107937.  https://doi.org/10.1371/journal.pone.0107937  PMID: 25251407 
  16. Gruber I, Heudorf U, Werner G, Pfeifer Y, Imirzalioglu C, Ackermann H, et al. Multidrug-resistant bacteria in geriatric clinics, nursing homes, and ambulant care--prevalence and risk factors. Int J Med Microbiol. 2013;303(8):405-9.  https://doi.org/10.1016/j.ijmm.2013.05.002  PMID: 23770266 
  17. Wyllie D, Paul J, Crook D. Waves of trouble: MRSA strain dynamics and assessment of the impact of infection control. J Antimicrob Chemother. 2011;66(12):2685-8.  https://doi.org/10.1093/jac/dkr392  PMID: 21948966 
  18. Gastmeier P, Schwab F, Behnke M, Geffers C. Wenige Blutkulturproben – wenige Infektionen? [Less blood culture samples: less infections?]. Anaesthesist. 2011;60(10):902-7.  https://doi.org/10.1007/s00101-011-1889-9  PMID: 21874374 
  19. Grundmann H, Schouls LM, Aanensen DM, Pluister GN, Tami A, Chlebowicz M, et al. The dynamic changes of dominant clones of Staphylococcus aureus causing bloodstream infections in the European region: results of a second structured survey. Euro Surveill. 2014;19(49):20987.  https://doi.org/10.2807/1560-7917.ES2014.19.49.20987  PMID: 25523972 
  20. Layer F, Strommenger B, Cuny C. Eigenschaften, Häufigkeiten und Verbreitung von MRSA in Deutschland, Update 2013/2014. Epidemiologisches Bulletin.2015;31. German.
  21. Bundesamt für Verbraucherschutz und Lebensmittelsicherheit. Paul-Ehrlich-Gesellschaft für Chemotherapie e.V., Freiburg I. GERMAP 2012 Antibiotika-Resistenz und -Verbrauch Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland. Antiinfectives Intelligence; 2014.
  22. DANMAP. Use of antimicrobial agents and occurrence of antimicrobial resistance in bacteria from food animals, food and humans in Denmark; 2014. Available from: http://www.danmap.org/~/media/projekt%20sites/danmap/danmap%20reports/danmap%202014/danmap_2014.ashx
  23. Laupland KB, Lyytikäinen O, Søgaard M, Kennedy KJ, Knudsen JD, Ostergaard C, et al. The changing epidemiology of Staphylococcus aureus bloodstream infection: a multinational population-based surveillance study. Clin Microbiol Infect. 2013;19(5):465-71.  https://doi.org/10.1111/j.1469-0691.2012.03903.x  PMID: 22616816 
  24. Public Health England (PHE). Annual Epidemiological Commentary: Mandatory MRSA, MSSA and E. coli bacteraemia and C. difficile infection data, 2013/14. London: PHE; 2014. [Accessed 22 Feb 2015]. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/330529/HCAI_mandatory_surveillance_annual_epidemiological_commentary_2013_14.pdf
  25. Kallen AJ, Mu Y, Bulens S, Reingold A, Petit S, Gershman K, et al. Health care-associated invasive MRSA infections, 2005-2008. JAMA. 2010;304(6):641-8.  https://doi.org/10.1001/jama.2010.1115  PMID: 20699455 
  26. de Kraker MEA, Wolkewitz M, Davey PG, Grundman H; on behalf of the BURDEN Study Group, et al. Clinical impact of antimicrobial resistance in European hospitals: excess mortality and length of hospital stay related to methicillin-resistant Staphylococcus aureus bloodstream infections. Antimicrob Agents Chemother. 2011;55(4):1598-605.  https://doi.org/10.1128/AAC.01157-10  PMID: 21220533 
  27. Cosgrove SE, Sakoulas G, Perencevich EN, Schwaber MJ, Karchmer AW, Carmeli Y. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis. 2003;36(1):53-9.  https://doi.org/10.1086/345476  PMID: 12491202 
  28. Tom S, Galbraith JC, Valiquette L, Jacobsson G, Collignon P, Schønheyder HC, et al. Case fatality ratio and mortality rate trends of community-onset Staphylococcus aureus bacteraemia. Clin Microbiol Infect. 2014;20(10):O630-2.  https://doi.org/10.1111/1469-0691.12564  PMID: 24461038 
Incidence of invasive meticillin-resistant Staphylococcus aureus infections in Germany, 2010 to 2014
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Jan+Walter&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Walter Jan</a>, <a href="/search?value1=Sebastian+Haller&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Haller Sebastian</a>, <a href="/search?value1=Hans-Peter+Blank&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Blank Hans-Peter</a>, <a href="/search?value1=Tim+Eckmanns&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Eckmanns Tim</a>, <a href="/search?value1=Muna+Abu+Sin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Abu Sin Muna</a>, <a href="/search?value1=Julia+Hermes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hermes Julia</a></span>. Incidence of invasive meticillin-resistant Staphylococcus aureus infections in Germany, 2010 to 2014. <a href="/content/ecdc">Euro Surveill.</a> 2015;20(46):pii=30067. <a href="https://doi.org/10.2807/1560-7917.ES.2015.20.46.30067" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2015.20.46.30067</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 20 Mar 2015;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Nov 2015 </span> </p>
/content/10.2807/1560-7917.ES.2015.20.46.30067
/content/10.2807/1560-7917.ES.2015.20.46.30067
Loading

Data & Media loading...

Comment has been disabled for this content
Submit comment
Close
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error