Prevalence of Multidrug Resistant Bacteria in Refugees: A Prospective Case Control Study in an Obstetric Cohort

Abstract

Purpose To determine the prevalence of multidrug resistant (MDR) bacteria in a cohort of pregnant refugee women.

Methods In a prospective case control study, surveillance cultures for MDR bacteria (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], MDR Gram-negative bacteria [MRGN]) were analysed between October 2015 and June 2016 from a cohort of 50 pregnant refugee women and 50 resident controls in the obstetric unit of a German tertiary referral hospital.

Results Prevalence of MRSA was noticeably higher among refugee women compared to residents (6 vs. 0%). In addition, a trend towards a higher prevalence of VRE and MDR Gram-negative bacteria in refugees was shown (1.8 vs. 0%).

Conclusions Due to the higher prevalence of MDR bacteria, surveillance cultures are justified in order to prevent nosocomial spread of MDR bacteria.

Zusammenfassung

Hintergrund Da verlässliche epidemiologische Daten zur Prävalenz von multiresistenten Keimen aus den Herkunftsländern der Flüchtlinge fehlen, müssen die Zielländer Daten erheben, um über adäquate Hygienemaßnahmen entscheiden zu können. In dieser prospektiven Fall-Kontroll-Studie haben wir das Vorkommen von multiresistenten Keimen in einer geburtshilflichen Kohorte untersucht.

Methoden In einer prospektiven Fall-Kontroll-Studie erfolgten bei 50 schwangeren Zufluchtsuchenden Abstriche vom Nasen-Rachenraum sowie Analabstriche auf MRSA, VRE und 3/4-MRGN zwischen Oktober 2015 und Juni 2016. Eine Gruppe von 50 einheimischen Schwangeren diente als Kontrollgruppe.

Ergebnisse Die Prävalenz von MRSA war in der Gruppe der Zufluchtsuchenden deutlich höher als in der Gruppe einheimischer Schwangerer (6 vs. 0%). Zusätzlich zeigte sich eine nicht signifikante Tendenz zu einem häufigeren Vorkommen von VRE und 3-MRGN (je 1.8 vs. 0%).

Fazit Wir konnten zeigen, dass auch in einem Kollektiv junger schwangerer Flüchtlinge multiresistente Keime häufiger vorkommen als in der einheimischen Bevölkerung. Dies gilt insbesondere für MRSA. Das Ergebnis rechtfertigt die Durchführung entsprechender Kontrollabstriche vor stationärer Behandlung von schwangeren Flüchtlingen.

Key words

MRSA - VRE - multidrug resistant Gram-negative bacteria - refugee medical care - hospital hygiene

Schlüsselwörter

MRSA - VRE - MRGN - Flüchtlinge - Krankenhaushygiene

• References

• 1 Hussein NR, Basharat Z, Muhammed AH. et al. Comparative evaluation of MRSA nasal colonization epidemiology in the urban and rural secondary school community of Kurdistan, Iraq. PloS One 2015; 10: e0124920
• 2 Kupferschmidt K. Infectious diseases. Refugee crisis brings new health challenges. Science 2016; 352: 391-392
• 3 Cosgrove SE, Sakoulas G, Perencevich EN. et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36: 53-59
• 4 Antimicrobial Resistance. Geneva: World Health Organization; 2014
• 5 Woerther PL, Burdet C, Chachaty E. et al. Trends in human fecal carriage of extended-spectrum β-lactamases in the community: toward the globalization of CTX-M. Clin Microbiol Rev. 2013; 26: 744-758
• 6 Faron ML, Ledeboer NA, Buchan BW. Resistance mechanisms, epidemiology, and approaches to screening for vancomycin resistant Enterococcus (VRE) in the health care setting. J Clin Microbiol 2016 pii: JCM.00211-16
• 7 Leclercq R, Derlot E, Duval J. et al. Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium. N Engl J Med 1988; 319: 157-161
• 8 Vonberg RP, Wolter A, Chaberny IF. et al. Epidemiology of multi-drug-resistant Gram-negative bacteria: Data from an university hospital over a 36-month period. Int J Hyg Environ Health 2008; 211: 251-257
• 9 Hansen S, Schwab F, Asensio A. et al. Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken?. Infection 2010; 38: 159-164
• 10 Heudorf U, Krackhardt B, Karathana M et al. Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015. Euro Surveill 2016; 21: pii = 30109
• 11 Reinheimer C, Kempf VA, Göttig S et al. Multidrug-resistant organisms detected in refugee patients admitted to a University Hospital, Germany June–December 2015. Euro Surveill 2016; 21: pii = 30110
• 12 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). Bundesgesundheitsbl 2012; 55: 1311-1354
• 13 Mellmann A, Friedrich AW, Rosenkötter N. et al. Automated DNA sequence-based early warning system for the detection of methicillin-resistant Staphylococcus aureus outbreaks. PLoS Med. 2006; 3: e33
• 14 Razum O, Karrasch L, Spallek J. Migration: A neglected dimension of inequalities in health?. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2016; 59: 259-265
• 15 Razum O, Bunte A, Gilsdorf A et al. Gesundheitsversorgung von Geflüchteten: Zu gesicherten Daten kommen. Dtsch Arztebl 2016; 113: A-130/B-111/C-111
• 16 Martinez-Capolino C, Reyes K, Johnson L. et al. Impact of active surveillance on meticillin-resistant Staphylococcus aureus transmission and hospital resource utilisation. J Hosp Infect 2010; 74: 232-237
• 17 Tacconelli E. Screening and isolation for infection control. J Hosp Infect 2009; 73: 371-377
• 18 Birgand G, Johansson A, Szilagyi E. et al. Overcoming the obstacles of implementing infection prevention and control guidelines. Clin Microbiol Infect 2015; 21: 1067-1071
• 19 Ploug T, Holm S, Gjerris M. The stigmatization dilemma in public health policy–the case of MRSA in Denmark. BMC Public Health 2015; 15: 640
• 20 Noskin GA, Rubin RJ, Schentag JJ. et al. Budget impact analysis of rapid screening for Staphylococcus aureus colonization among patients undergoing elective surgery in US hospitals. Infect Control Hosp Epidemiol 2008; 29: 16-24
• 21 Empfehlungen zur Prävention und Kontrolle von Methicillin-resistenten Staphylococcus aureus-Stämmen (MRSA) in medizinischen und pflegerischen Einrichtungen. Bundesgesundheitsbl 2014; 57: 696-732
• 22 Chipolombwe J, Török ME, Mbelle N. et al. Methicillin-resistant Staphylococcus aureus multiple sites surveillance: a systemic review of the literature. Infect Drug Resist 2016; 9: 35-42
• 23 McKinnell JA, Huang SS, Eells SJ. et al. Quantifying the impact of extranasal testing of body sites for methicillin-resistant Staphylococcus aureus colonization at the time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 2013; 34: 161-170
• 24 Mutters NT, Mersch-Sundermann A, Mutterr R. et al. Control of the spread of vancomycin-resistant enterococci in hospitals: epidemiology and clinical relevance. Dtsch Artzebl Int 2013; 110: 725-731
• 25 Tacconelli E, Cataldo MA. Vancomycin-resistant enterococci (VRE): transmission and control. Int J Antimicrob Agents 2008; 31: 99-106