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Multiresistente Keime aus der Klinik: Wie geht es mit dem Patienten weiter?

Infektiologie

Management of patients with multidrug-resistant bacteria after hospital discharge

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MMW - Fortschritte der Medizin Aims and scope

Wird ein Patient mit multiresistenten Keimen aus dem Krankenhaus entlassen, herrscht große Verunsicherung. Müssen sich die Angehörigen und das soziale Umfeld besonders schützen? Welche Hygienemaßnahmen sind in der Arztpraxis oder beim Hausbesuch empfehlenswert? Der nachfolgende Beitrag klärt auf.

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Literatur

  1. (KRINKO) KfKuI: Hygienemaßnahmen bei Infektionen oder Besiedlung mit multiresistenten gramnegativen Stäbchen. In: Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz. vol. 55; 2012: 1311–1354.

    Article  Google Scholar 

  2. (KRINKO) KfKuI: Hygienemaßnahmen zur Prävention der Infektion durch Enterokokken mit speziellen Antibiotikaresistenzen. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2018, 61(10):1310–1361.

    Google Scholar 

  3. (KRINKO) KfKul: Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz 2014, 57(6):695–732.

    Article  Google Scholar 

  4. Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen: Referenzdaten Erreger-Surveillance 2014-2018 https://www.nrz-hygiene.de/surveillance/kiss/stations-kiss/erreger/ (abgerufen am 10.01.2020)

  5. Becker K, Schaumburg F, Fegeler C, Friedrich AW, Kock R, Prevalence of Multiresistant Microorganisms PMMS: Staphylococcus aureus from the German general population is highly diverse. Int J Med Microbiol 2017, 307(1):21–27.

    Article  CAS  Google Scholar 

  6. Holtfreter S, Grumann D, Balau V, Barwich A, Kolata J, Goehler A, Weiss S, Holtfreter B, Bauerfeind SS, Doring P et al: Molecular Epidemiology of Staphylococcus aureus in the General Population in Northeast Germany: Results of the Study of Health in Pomerania (SHIP-TREND-0). J Clin Microbiol 2016, 54(11):27742785.

    Article  Google Scholar 

  7. Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen: Referenzdaten MRSA-KISS 2018 https://www.nrzhygiene.de/surveillance/kiss/mrsa-kiss/ (abgerufen am 10.01.2020)

  8. Robert Koch-Institut: Epidemiologisches Bulletin 05 / 2018. In.: Robert Koch-Institut; 2018.

  9. Mediavilla JR, Chen L, Mathema B, Kreiswirth BN: Global epidemiology of community-associated methicillin resistant Staphylococcus aureus (CA-MRSA). Curr Opin Microbiol 2012, 15(5):588–595.

    Article  Google Scholar 

  10. Eriksson BKG, Thollstrom UB, Nederby-Ohd J, Ortqvist A: Epidemiology and control of meticillin-resistant Staphylococcus aureus in Stockholm County, Sweden, 2000 to 2016: overview of a „search-and-contain“ strategy. Eur J Clin Microbiol Infect Dis 2019, 38(12):2221–2228.

    Article  CAS  Google Scholar 

  11. van Alen S, Ballhausen B, Peters G, Friedrich AW, Mellmann A, Kock R, Becker K: In the centre of an epidemic: Fifteen years of LA-MRSA CC398 at the University Hospital Munster. Vet Microbiol 2017, 200:19–24.

    Article  Google Scholar 

  12. Cuny C, Wieler LH, Witte W: Livestock-Associated MRSA: The Impact on Humans. Antibiotics (Basel) 2015, 4(4):521–543.

    Article  CAS  Google Scholar 

  13. Hamprecht A, Rohde AM, Behnke M, Feihl S, Gastmeier P, Gebhardt F, Kern WV, Knobloch JK, Mischnik A, Obermann B et al: Colonization with third-generation cephalosporin-resistant Enterobacteriaceae on hospital admission: prevalence and risk factors. J Antimicrob Chemother 2016, 71(10):2957–2963.

    Article  CAS  Google Scholar 

  14. Rohde AM, Wiese-Posselt M, Zweigner J, Schwab F, Mischnik A, Seifert H, Gastmeier P, Kern WV, Group D-AS: High admission prevalence of fluoroquinolone resistance in third-generation cephalosporin-resistant Enterobacteriaceae in German university hospitals. J Antimicrob Chemother 2018, 73(6):1688–1691.

    Article  CAS  Google Scholar 

  15. Woerther PL, Andremont A, Kantele A: Travel-acquired ESBLproducing Enterobacteriaceae: impact of colonization at individual and community level. J Travel Med 2017, 24(suppl_1):S29S34.

    Article  Google Scholar 

  16. Meyer E, Gastmeier P, Kola A, Schwab F: Pet animals and foreign travel are risk factors for colonisation with extended-spectrum beta-lactamase-producing Escherichia coli. Infection 2012, 40(6):685–687.

    Article  CAS  Google Scholar 

  17. Arcilla MS, van Hattem JM, Bootsma MC, van Genderen PJ, Goorhuis A, Schultsz C, Stobberingh EE, Verbrugh HA, de Jong MD, Melles DC et al: The Carriage Of Multiresistant Bacteria After Travel (COMBAT) prospective cohort study: methodology and design. BMC Public Health 2014, 14:410.

    Article  Google Scholar 

  18. Pletz MW, Wollny A, Dobermann UH, Rodel J, Neubauer S, Stein C, Brandt C, Hartung A, Mellmann A, Trommer S et al: A Nosocomial Foodborne Outbreak of a VIM Carbapenemase-Expressing Citrobacter freundii. Clin Infect Dis 2018, 67(1):58–64.

    Article  CAS  Google Scholar 

  19. Kaesbohrer A, Bakran-Lebl K, Irrgang A, Fischer J, Kampf P, Schiffmann A, Werckenthin C, Busch M, Kreienbrock L, Hille K: Diversity in prevalence and characteristics of ESBL/pAmpC producing E. coli in food in Germany. Vet Microbiol 2019, 233:52–60.

    Article  CAS  Google Scholar 

  20. Liebana E, Carattoli A, Coque TM, Hasman H, Magiorakos AP, Mevius D, Peixe L, Poirel L, Schuepbach-Regula G, Torneke K et al: Public health risks of enterobacterial isolates producing extended-spectrum beta-lactamases or AmpC beta-lactamases in food and food-producing animals: an EU perspective of epidemiology, analytical methods, risk factors, and control options. Clin Infect Dis 2013, 56(7):1030–1037.

    Article  Google Scholar 

  21. Yaw LK, Robinson JO, Ho KM: A comparison of long-term outcomes after meticillin-resistant and meticillin-sensitive Staphylococcus aureus bacteraemia: an observational cohort study. Lancet Infect Dis 2014, 14(10):967–975.

    Article  Google Scholar 

  22. Vehreschild M, Haverkamp M, Biehl LM, Lemmen S, Fatkenheuer G: Vancomycin-resistant enterococci (VRE): a reason to isolate? Infection 2019, 47(1):7–11.

    Article  Google Scholar 

  23. Morgan DJ, Wenzel RP, Bearman G: Contact Precautions for Multidrug-Resistant Organisms-Reply. JAMA 2017, 318(22):2258.

    Article  Google Scholar 

  24. Morgan DJ, Wenzel RP, Bearman G: Contact Precautions for Endemic MRSA and VRE: Time to Retire Legal Mandates. JAMA 2017, 318(4):329–330.

    Article  Google Scholar 

  25. Peterson LR: Contact Precautions for Multidrug-Resistant Organisms. JAMA 2017, 318(22):2257.

    Article  Google Scholar 

  26. Fatkenheuer G, Hirschel B, Harbarth S: Screening and isolation to control meticillin-resistant Staphylococcus aureus: sense, nonsense, and evidence. Lancet 2015, 385(9973):1146–1149.

    Article  Google Scholar 

  27. Marra AR, Edmond MB, Schweizer ML, Ryan GW, Diekema DJ: Discontinuing contact precautions for multidrug-resistant organisms: A systematic literature review and meta-analysis. Am J Infect Control 2018, 46(3):333–340.

    Article  Google Scholar 

  28. Biehl LM, Higgins P, Wille T, Peter K, Hamprecht A, Peter S, Dorfel D, Vogel W, Hafner H, Lemmen S et al: Impact of singleroom contact precautions on hospital-acquisition and transmission of multidrug-resistant Escherichia coli: a prospective multicentre cohort study in haematological and oncological wards. Clin Microbiol Infect 2019, 25(8):1013–1020.

    Article  CAS  Google Scholar 

  29. Kluytmans-van den Bergh MFQ, Bruijning-Verhagen PCJ, Vandenbroucke-Grauls C, de Brauwer E, Buiting AGM, Diederen BM, van Elzakker EPM, Friedrich AW, Hopman J, Al Naiemi N et al: Contact precautions in single-bed or multiple-bed rooms for patients with extended-spectrum beta-lactamase-producing Enterobacteriaceae in Dutch hospitals: a cluster-randomised, crossover, non-inferiority study. Lancet Infect Dis 2019, 19(10):1069–1079.

    Article  CAS  Google Scholar 

  30. Zahar JR, Garrouste-Orgeas M, Vesin A, Schwebel C, Bonadona A, Philippart F, Ara-Somohano C, Misset B, Timsit JF: Impact of contact isolation for multidrug-resistant organisms on the occurrence of medical errors and adverse events. Intensive Care Med 2013, 39(12):2153–2160.

    Article  CAS  Google Scholar 

  31. Rump B, Timen A, Verweij M, Hulscher M: Experiences of carriers of multidrug-resistant organisms: a systematic review. Clin Microbiol Infect 2019, 25(3):274–279.

    Article  CAS  Google Scholar 

  32. Huang SS, Singh R, McKinnell JA, Park S, Gombosev A, Eells SJ, Gillen DL, Kim D, Rashid S, Macias-Gil R et al: Decolonization to Reduce Postdischarge Infection Risk among MRSA Carriers. N Engl J Med 2019, 380(7):638–650.

    Article  Google Scholar 

  33. Ammerlaan HS, Kluytmans JA, Wertheim HF, Nouwen JL, Bonten MJ: Eradication of methicillin-resistant Staphylococcus aureus carriage: a systematic review. Clin Infect Dis 2009, 48(7):922–930.

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Zentralbereich für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Pauwelsstr. 30, D-52074, Aachen, Deutschland

    Steffen Höring

  2. Leiter des Zentralbereichs für Krankenhaushygiene und Infektiologie (ZfKI), Zentrum für Infektiologie (DGI), Universitätsklinikum Aachen, Deutschland

    Sebastian Lemmen

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Correspondence to Steffen Höring.

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Höring, S., Lemmen, S. Multiresistente Keime aus der Klinik: Wie geht es mit dem Patienten weiter?. MMW - Fortschritte der Medizin 162, 56–60 (2020). https://doi.org/10.1007/s15006-020-0343-9

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