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In 2022, German surveillance systems observed rapidly increasing numbers of NDM-1- and NDM-1/OXA-48-producing , which may in part reflect recurring pre-pandemic trends. Among these cases, however, a presence in Ukraine before diagnosis was frequently reported. Whole genome sequencing of 200 isolates showed a high prevalence of sequence types ST147, ST307, ST395 and ST23, including clusters corresponding to clonal dissemination and suggesting onward transmission in Germany. Screening and isolation of patients from Ukraine may help avoid onward transmission.


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  1. Schranz M, Ullrich A, Rexroth U, Hamouda O, Schaade L, Diercke M, et al. Die Auswirkungen der COVID-19-Pandemie und assoziierter Public-Health-Maßnahmen auf andere meldepflichtige Infektionskrankheiten in Deutschland (MW 1/2016 – 32/2020). [The effects of the COVID-19 pandemic and associated public health measures on other notifiable infectious diseases in Germany]. Epid Bull. 2021;7:3-7. German.  https://doi.org/10.25646/8011 
  2. Reuss A, Klingeberg A, Schmidt N, Eckmanns T, Zacher B. Einfluss der COVID-19-Pandemie auf die Anzahl der gemäß IfSG meldepflichtigen Nachweise von Erregern mit Antibiotikaresistenzen und C. difficile-Infektionen. [Impact of the COVID-19 pandemic on the number of confirmations of pathogens with antibiotic resistance and C. difficile infections notifiable under the Infection Protection Act]. Epid Bull. 2021;7:8-11. German.  https://doi.org/10.25646/8026 
  3. Pfennigwerth N. Schauer J. Bericht des Nationalen Referenzzentrums für gramnegative Krankenhauserreger – Zeitraum 1. Januar 2021 bis 31. Dezember 2021. [Report of the National Reference Centre for Gram-negative hospital pathogens - period 1 January 2021 to 31 December 2021]. Epid Bull. 2022;19:3-9. German. Available from: http://edoc.rki.de/176904/9709
  4. Kondratiuk V, Jones BT, Kovalchuk V, Kovalenko I, Ganiuk V, Kondratiuk O, et al. Phenotypic and genotypic characterization of antibiotic resistance in military hospital-associated bacteria from war injuries in the Eastern Ukraine conflict between 2014 and 2020. J Hosp Infect. 2021;112:69-76.  https://doi.org/10.1016/j.jhin.2021.03.020 
  5. Dietze N, Trawinski H, Schönherr SG, Lippmann N, Ranft D, Fichtner F, et al. Infektionsmedizinische und chirurgische Herausforderungen durch Carbapenem-resistente bakterielle Erreger bei der Versorgung Kriegsverletzter aus der Ukraine. [Challenges in infection medicine and surgery caused by carbapenem-resistant bacterial pathogens in the care for war casualties from Ukraine]. Epid Bull. 2022;36:3-10. German. Available from: http://edoc.rki.de/176904/10214
  6. European Centre for Disease Prevention and Control (ECDC). Risk assessment: Emergence of hypervirulent Klebsiella pneumoniae ST23 carrying carbapenemase genes in EU/EEA countries. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/ publications-data/risk-assessment-emergence-hypervirulent-klebsiella-pneumoniae-eu-eea
  7. Lam MMC, Wyres KL, Duchêne S, Wick RR, Judd LM, Gan YH, et al. Population genomics of hypervirulent Klebsiella pneumoniae clonal-group 23 reveals early emergence and rapid global dissemination. Nat Commun. 2018;9(1):2703.  https://doi.org/10.1038/s41467-018-05114-7 
  8. Lam MMC, Wick RR, Watts SC, Cerdeira LT, Wyres KL, Holt KE. A genomic surveillance framework and genotyping tool for Klebsiella pneumoniae and its related species complex. Nat Commun. 2021;12(1):4188.  https://doi.org/10.1038/s41467-021-24448-3 
  9. Tenover FC, Arbeit RD, Goering RV, Mickelsen PA, Murray BE, Persing DH, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol. 1995;33(9):2233-9.  https://doi.org/10.1128/jcm.33.9.2233-2239.1995 
  10. European Committee on Antimicrobial Susceptibility Testing (EUCAST). Breakpoint tables for interpretation of MICs and zone diameters, Version 12.0. Växjö: EUCAST; 2022. Available from: https://www. eucast.org/clinical_breakpoints
  11. Oueslati S, Bogaerts P, Dortet L, Bernabeu S, Ben Lakhal H, Longshaw C, et al. In vitro activity of cefiderocol and comparators against carbapenem-resistant Gram-negative pathogens from France and Belgium. Antibiotics (Basel). 2022;11(10):1352.  https://doi.org/10.3390/antibiotics11101352 
  12. Isler B, Aslan AT, Akova M, Harris P, Paterson DL. Treatment strategies for OXA-48-like and NDM producing Klebsiella pneumoniae infections. Expert Rev Anti Infect Ther. 2022;20(11):1389-400.  https://doi.org/10.1080/14787210.2022.2128764 
  13. The European Committee on Antimicrobial Susceptibility Testing (EUCAST). EUCAST guidance documents. Växjö: EUCAST; 2022. Available from: https://www.eucast.org/eucastguidancedocuments
  14. Falcone M, Daikos GL, Tiseo G, Bassoulis D, Giordano C, Galfo V, et al. Efficacy of ceftazidime-avibactam plus aztreonam in patients with bloodstream infections caused by metallo-β-lactamase-producing Enterobacterales. Clin Infect Dis. 2021;72(11):1871-8.  https://doi.org/10.1093/cid/ciaa586 
  15. Shaw E, Rombauts A, Tubau F, Padullés A, Càmara J, Lozano T, et al. Clinical outcomes after combination treatment with ceftazidime/avibactam and aztreonam for NDM-1/OXA-48/CTX-M-15-producing Klebsiella pneumoniae infection. J Antimicrob Chemother. 2018;73(4):1104-6.  https://doi.org/10.1093/jac/dkx496 
  16. World Health Organization Regional Office for Europe (WHO/Europe). Antimicrobial Resistance Map. Acinetobacter spp. Aminoglycosides. Copenhagen: WHO/Europe. [Accessed:13 Dec 2022]. Available from: https://worldhealthorg.shinyapps.io/WHO-AMR-Dashboard/?_ga=2.172166563.1827800992.1668654440-1324205868.1668654440
  17. European Centre for Disease Prevention and Control (ECDC). Operational public health considerations for the prevention and control of infectious diseases in the context of Russia’s aggression towards Ukraine. Stockholm: ECDC; 2022. Available from: https://www.ecdc.europa.eu/en/publications-data/operational-public-health-considerations-prevention-and-control-infectious
  18. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). (Hygiene measures for infection or colonization with multidrug-resistant gram-negative bacilli. Commission recommendation for hospital hygiene and infection prevention (KRINKO) at the Robert Koch Institute (RKI)). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2012;55(10):1311-54.
  19. Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO). Ergänzung zu den “Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen” (2012) im Rahmen der Anpassung an die epidemiologische Situation. [Supplement to the " Hygiene measures for infection or colonization with multidrug-resistant gram-negative bacilli" (2012) as part of the adaptation to the epidemiological situation]. Epid Bull. 2014;21:183-4. German. Available from: https://www.rki.de/DE/Content/Infekt/EpidBull/Archiv/2014/Ausgaben/21_14.pdf?__blob=publicationFile
  20. Letunic I, Bork P. Interactive Tree Of Life (iTOL) v5: an online tool for phylogenetic tree display and annotation. Nucleic Acids Res. 2021;49(W1):W293-6.  https://doi.org/10.1093/nar/gkab301 

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