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No evidence of carbapenemase-producing Enterobacteriaceae in stool samples of 1,544 asylum seekers arriving in Rhineland-Palatinate, Germany, April 2016 to March, 2017
- Lutz Ehlkes1,2,3 , Yvonne Pfeifer4 , Guido Werner4 , Ralf Ignatius5,6 , Manfred Vogt1 , Tim Eckmanns7 , Philipp Zanger1,8,9,10 , Jan Walter7,10
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View Affiliations Hide AffiliationsAffiliations: 1 Federal State Agency for Consumer & Health Protection Rhineland-Palatinate, Koblenz, Germany 2 Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany 3 European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden 4 Robert Koch Institute, Nosocomial Pathogens and Antibiotic Resistance, Wernigerode, Germany 5 MVZ Labor 28, Berlin, Germany 6 Institute of Microbiology, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany 7 Robert Koch Institute, Nosocomial Infections and Surveillance of Antibiotic Resistance, Berlin, Germany 8 Heidelberg Institute of Global Health, Unit of Epidemiology and Biostatistics, University Hospitals, Heidelberg, Germany 9 Department of Infectious Diseases, Medical Microbiology and Hygiene, University Hospitals, Heidelberg, Germany 10 These two authors have contributed equally to this manuscript and share last authorshipPhilipp Zangerphilipp.zanger uni-heidelberg.de
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Citation style for this article: Ehlkes Lutz, Pfeifer Yvonne, Werner Guido, Ignatius Ralf, Vogt Manfred, Eckmanns Tim, Zanger Philipp, Walter Jan. No evidence of carbapenemase-producing Enterobacteriaceae in stool samples of 1,544 asylum seekers arriving in Rhineland-Palatinate, Germany, April 2016 to March, 2017. Euro Surveill. 2019;24(8):pii=1800030. https://doi.org/10.2807/1560-7917.ES.2019.24.8.1800030 Received: 19 Jan 2018; Accepted: 30 Aug 2018
Abstract
Introduction: Since 2015, increased migration from Asia and Africa to Europe has raised public health concerns about potential importation of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE), specifically those producing carbapenemases (C-PE), into European hospitals.
Aims: To inform infection control practices about ESBL-PE prevalence in asylum seekers and to investigate whether C-PE prevalence exceeds that in the German population.
Methods: Cross-sectional study from April 2016–March 2017. Routinely collected stool samples from asylum seekers were tested for antibiotic resistant Enterobacteriaceae. Country/region of origin and demographic characteristics were explored as risk factors for faecal colonisation.
Results: Of 1,544 individuals, 294 tested positive for ESBL-PE colonisation (19.0%; 95% confidence intervals (CI): 17.0–21.0). Asylum seekers originating from Afghanistan/Pakistan/Iran had a prevalence of 29.3% (95% CI: 25.6–33.2), from Syria 20.4% (95% CI: 16.1–25.2) and from Eritrea/Somalia 11.9% (95% CI: 8.7–15.7). CTX-M-15 (79%) and CTX-M-27 (10%) were the most common ESBL determinants. Highest ESBL-PE prevalences were observed in boys under 10 years and women aged 20–39 years (interaction: p = 0.03). No individuals tested positive for C-PE. Faecal C-PE colonisation prevalence in asylum seekers was not statistically significantly different from prevalence reported in German communities.
Conclusion: In absence of other risk factors, being a newly arrived asylum seeker from a region with increased faecal ESBL-PE colonisation prevalence is not an indicator for C-PE colonisation and thus not a reason for pre-emptive screening and isolation upon hospital admission.
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