Geographical differences of carbapenem non-susceptible Enterobacterales and Acinetobacter spp. in Germany from 2017 to 2019

Anja von Laer; Tim Eckmanns; Benedikt Zacher; Niels Pfennigwerth; Sören G Gatermann; Felix Reichert; Michaela Diercke; Gyde Steffen; Doris Altmann; Annicka Reuss

doi:10.1186/s13756-021-01045-z

Geographical differences of carbapenem non-susceptible Enterobacterales and Acinetobacter spp. in Germany from 2017 to 2019

Antimicrob Resist Infect Control. 2022 Feb 4;11(1):25. doi: 10.1186/s13756-021-01045-z.

Authors

Anja von Laer^{1

2

3}, Tim Eckmanns⁴, Benedikt Zacher⁴, Niels Pfennigwerth⁵, Sören G Gatermann⁵, Felix Reichert^{4

6

7}, Michaela Diercke⁴, Gyde Steffen^{4

6

7}, Doris Altmann⁴, Annicka Reuss⁴

Affiliations

¹ Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany. LaerA@rki.de.
² Postgraduate Training for Applied Epidemiology, Robert Koch-Institute, Berlin, Germany. LaerA@rki.de.
³ European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden. LaerA@rki.de.
⁴ Department of Infectious Disease Epidemiology, Robert Koch-Institute, Berlin, Germany.
⁵ German National Reference Centre for Multidrug-Resistant Gram-Negative Bacteria, Department of Medical Microbiology, Ruhr-University Bochum, Bochum, Germany.
⁶ Postgraduate Training for Applied Epidemiology, Robert Koch-Institute, Berlin, Germany.
⁷ European Programme for Intervention Epidemiology Training, European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden.

Abstract

Background: Since May 2016, infection and colonisation with carbapenem non-susceptible Acinetobacter spp. (CRA) and Enterobacterales (CRE) have to be notified to health authorities in Germany. The aim of our study was to assess the epidemiology of CRA and CRE from 2017 to 2019 in Germany, to identify risk groups and to determine geographical differences of CRA and CRE notifications.

Methods: Cases were notified from laboratories to local public health authorities and forwarded to state and national level. Non-susceptibility was defined as intermediate or resistant to ertapenem, imipenem, or meropenem excluding intrinsic bacterial resistance or the detection of a carbapenemase gene. We analysed CRA and CRE notifications from 2017, 2018 and 2019 per 100,000 inhabitants (notification incidence), regarding their demographic, clinical and laboratory information. The effect of regional hospital-density on CRA and CRE notification incidence was estimated using negative binomial regression.

Results: From 2017 to 2019, 2278 CRA and 12,282 CRE cases were notified in Germany. CRA and CRE cases did not differ regarding demographic and clinical information, e.g. proportion infected. The notification incidence of CRA declined slightly from 0.95 in 2017 to 0.86 in 2019, whereas CRE increased from 4.23 in 2017 to 5.72 in 2019. The highest CRA and CRE notification incidences were found in the age groups above 70 years. Infants below 1 year showed a high CRE notification incidence, too. Notification incidences varied between 0.10 and 2.86 for CRA and between 1.49 and 9.99 for CRE by federal state. The notification incidence of CRA and CRE cases increased with each additional hospital per district.

Conclusion: The notification incidence of CRA and CRE varied geographically and was correlated with the number of hospitals.The results support the assumption that hospitals are the main driver for higher CRE and CRA incidence. Preventive strategies and early control measures should target older age groups and newborns and areas with a high incidence.

Keywords: Acinetobacter; Antibiotic Resistance; Carbapenems; Enterobacterales; Epidemiology; Germany; Public Health.

MeSH terms

Acinetobacter* / genetics
Aged
Anti-Bacterial Agents / pharmacology
Anti-Bacterial Agents / therapeutic use
Carbapenems* / pharmacology
Humans
Infant
Infant, Newborn
Meropenem
Microbial Sensitivity Tests

Substances

Anti-Bacterial Agents
Carbapenems
Meropenem