, Volume 43, Issue 2, pp 163–168 | Cite as

Prevalence of carbapenem-resistant organisms and other Gram-negative MDRO in German ICUs: first results from the national nosocomial infection surveillance system (KISS)

  • F. Maechler
  • L. A. Peña Diaz
  • C. Schröder
  • C. Geffers
  • M. Behnke
  • P. Gastmeier
Original Paper



Standardized prevalence and incidence data on carbapenem-resistant organisms (CRO) and, as a relevant subgroup, carbapenem-resistant Enterobacteriaceae (CRE) are scarce. CRO-surveillance within the German nosocomial infection surveillance system (KISS) aims to provide epidemiological surveillance data on CRO colonizations and infections.


CRO-surveillance is part of a KISS-module for the surveillance of multidrug-resistant organisms (MDRO). MDRO-KISS methods require surveillance of all patients admitted to the ward and standardized documentation of imported and ICU-acquired cases. Data on all MDRO-carriers including colonization and infection with MDRO are collected. All presented data were routine data collected from January 1st 2013 until December 1st 2013 in accordance with the German Protection against Infection Act (IfSG).


341 ICUs submitted data on MDRO during the first year. In total, 5,171 cases of multidrug-resistant Gram-negative bacteria (MRGN) were identified. 848 were CRO (16 %). 325 CRO-cases were acquired within the ICU (38 %), and 373 CRO-patients had an infection (44 %). CRO-prevalence was 0.29 per 100 patients. Acquisition rate of MRGN was 1.32 per 1,000 patient days. This rate is more than doubled the acquisition rates of other MDRO under surveillance within MDRO-KISS (0.57 MRSA, 0.49 VRE). CRO-acquisition rate was 0.3 per 1,000 patient days. Incidence density of MRGN infections bacteria was 0.58 per 1,000 patient days (CRO 0.15/1,000 patient days).


To date, CRO are common in German ICUs and the relatively large proportions of ICU-acquired CRO and infections emphasize their potential to cause outbreaks. High MRGN infection rates and high ESBL prevalence data from clinical studies suggest a lack of MRGN identification in asymptomatic carriers.


Carbapenem-resistant Enterobacteriaceae Prevalence KISS Gram-negative Multidrug-resistant ICU 



We thank all nurses and physicians in the participating hospitals who provided their MDRO data to KISS. Data have been generated as part of the routine work of the nosocomial infection surveillance system (NRZ KISS).

Conflict of interest

The authors declare that they have no conflicts of interest.


  1. 1.
    Antimicrobial resistance: global report on surveillance 2014. World Health Organization; 2014Google Scholar
  2. 2.
    Maragakis LL. Recognition and prevention of multidrug-resistant Gram-negative bacteria in the intensive care unit. Crit Care Med. 2010;38:S345–51. doi: 10.1097/CCM.0b013e3181e6cbc5.
  3. 3.
    Tabah A, Koulenti D, Laupland K, Misset B, Valles J, Bruzzi de Carvalho, F et al. Characteristics and determinants of outcome of hospital-acquired bloodstream infections in intensive care units: the EUROBACT International Cohort Study. Intensive Care Med. 2012;38:1930–45. doi: 10.1007/s00134-012-2695-9.
  4. 4.
    Lubbert C, Becker-Rux D, Rodloff AC, Laudi S, Busch T, Bartels M, et al. Colonization of liver transplant recipients with KPC-producing Klebsiella pneumoniae is associated with high infection rates and excess mortality: a case-control analysis. Infection. 2014;42:309–16. doi: 10.1007/s15010-013-0547-3.CrossRefPubMedGoogle Scholar
  5. 5.
    Gastmeier P, Sohr D, Schwab F, Behnke M, Zuschneid I, Brandt C, et al. Ten years of KISS: the most important requirements for success. J Hosp Infect. 2008;70:11–6. doi: 10.1016/s0195-6701(08)60005-5.CrossRefPubMedGoogle Scholar
  6. 6.
    DIN 58940-4, 4 (2004).Google Scholar
  7. 7.
    KRINKO. Kommission für Krankenhaushygiene und Infektionsprävention: hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. Bundesgesundheitsbl. 2012;55:1311–54.CrossRefGoogle Scholar
  8. 8.
    Infektionsschutzgesetz vom 20. Juli 2000 (BGBl. I S. 1045), das durch Artikel 5 Absatz 2 des Gesetzes vom 20. April 2013 (BGBl. I S. 868) geändert worden ist, Artikel 5 Absatz 2 (2000).Google Scholar
  9. 9.
    Meyer E, Schroder 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. Deutsches Arzteblatt int. 2014;111:331–6. doi: 10.3238/arztebl.2014.0331.Google Scholar
  10. 10.
    Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009;9:228–36. doi: 10.1016/s1473-3099(09)70054-4.CrossRefPubMedGoogle Scholar
  11. 11.
    Marquez P, Terashita D, Dassey D, Mascola L. Population-based incidence of carbapenem-resistant Klebsiella pneumoniae along the continuum of care, Los Angeles County. Infect Control Hosp Epidemiol. 2013;34:144–50. doi: 10.1086/669087.CrossRefPubMedGoogle Scholar
  12. 12.
    Meyer E, Gastmeier P, Deja M, Schwab F. Antibiotic consumption and resistance: data from Europe and Germany. Int J Med Microbiol. 2013;303:388–95. doi: 10.1016/j.ijmm.2013.04.004.CrossRefPubMedGoogle Scholar
  13. 13.
    Biehl LM, Schmidt-Hieber M, Liss B, Cornely OA, Vehreschild MJ. Colonization and infection with extended spectrum beta-lactamase producing Enterobacteriaceae in high-risk patients—review of the literature from a clinical perspective. Crit Rev Microbiol. 2014;. doi: 10.3109/1040841X.2013.875515.PubMedGoogle Scholar
  14. 14.
    Liss B, Vehreschild J, Cornely O, Hallek M, Fätkenheuer G, Wisplinghoff H, et al. Intestinal colonisation and blood stream infections due to vancomycin-resistant enterococci (VRE) and extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBLE) in patients with haematological and oncological malignancies. Infection. 2012;40:613–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Reddy P, Malczynski M, Obias A, Reiner S, Jin N, Huang J, et al. Screening for extended-spectrum β-lactamase-producing Enterobacteriaceae among high-risk patients and rates of subsequent bacteremia. Clin Infect Dis. 2007;45:846–52.CrossRefPubMedGoogle Scholar
  16. 16.
    Ehrhard I, Karaalp AK, Hackel T, Holl G, Rodewald N, Reif U, et al. Prevalence of carbapenemase-producing bacteria in hospitals in Saxony, Germany. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2014;57:406–13. doi: 10.1007/s00103-013-1914-z.CrossRefPubMedGoogle Scholar
  17. 17.
    Heudorf U, Gustav C, Mischler D, Schulze J. Healthcare associated infections (HAI), antibiotic use and prevalence of multidrug-resistant bacteria (MDRO) in residents of long-term care facilities: the Frankfurt HALT plus MDRO project 2012. Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz. 2014;57:414–22. doi: 10.1007/s00103-013-1927-7.CrossRefPubMedGoogle Scholar
  18. 18.
    Lippmann N, Lubbert C, Kaiser T, Kaisers UX, Rodloff AC. Clinical epidemiology of Klebsiella pneumoniae carbapenemases. Lancet Infect Dis. 2014;14:271–2. doi: 10.1016/S1473-3099(14)70705-4.CrossRefPubMedGoogle Scholar
  19. 19.
    Souli M, Galani I, Giamarellou H. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro surveillance. 2008;13:19045.PubMedGoogle Scholar
  20. 20.
    Hombach M, Mouttet B, Bloemberg GV. Consequences of revised CLSI and EUCAST guidelines for antibiotic susceptibility patterns of ESBL- and AmpC beta-lactamase-producing clinical Enterobacteriaceae isolates. J Antimicrobiol Chemother. 2013;68:2092–8. doi: 10.1093/jac/dkt136.CrossRefGoogle Scholar
  21. 21.
    ARS. RKI: Antibiotika Resistenz Surveillance. 2014; Accessed 31.07.2014.
  22. 22.
    Kaase M, Anders A, Pfennigwerth N, Gatermann S. Report of the national reference laboratory for multidrug-resistant gramnegative bacteria on carbapenemases in Germany in 2013. ECCMID; Barcelona 2014.Google Scholar
  23. 23.
    Maechler F, Schwab F, Geffers C, Gropmann A, Gastmeier P. Infection control policies and ICU-acquired ESBL-cases in Germany: a cross-sectional questionnaire survey of 224 ICUs. ECCMID; Barcelona 2014.Google Scholar
  24. 24.
    Krankenhausstatistik-Grunddaten [database on the Internet]. Statistisches Bundesamt, Zweigstelle Bonn. 2014; Accessed: 27.06.2014.
  25. 25.
    Zuschneid I, Rucker G, Schoop R, Beyersmann J, Schumacher M, Geffers C, et al. Representativeness of the surveillance data in the intensive care unit component of the German nosocomial infections surveillance system. Infect Control Hosp Epidemiol. 2010;31:934–8. doi: 10.1086/655462.CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • F. Maechler
    • 1
  • L. A. Peña Diaz
    • 1
  • C. Schröder
    • 1
  • C. Geffers
    • 1
  • M. Behnke
    • 1
  • P. Gastmeier
    • 1
  1. 1.Institut für Hygiene und Umweltmedizin, Charité BerlinBerlinGermany

Personalised recommendations