Multidrug-resistant Germs: Lab Test

1st order laboratory parameters – obligatory laboratory tests.

  • Small blood count
  • Differential blood count
  • Inflammatory parameters – CRP (C-reactive protein) or ESR (erythrocyte sedimentation rate).
  • Urine status (rapid test for: pH, leukocytes, nitrite, protein, glucose, ketone, urobilinogen, bilirubin, blood), sediment, if necessary urine culture (pathogen detection and resistogram, that is, testing suitable antibiotics for sensitivity / resistance).
  • Swabs from the wound area (bacteriology: pathogen and resistance) or sampling from the following locations:
    • Both nasal vestibules; swab medially and laterally approximately 1 cm inside the nostril using a swab.
    • Swab pharynx (posterior pharyngeal wall) and (tonsils).
    • Perineum (region between the anus and the external genital organs; here: swab the perianal skin).
    • Sores, eczema
    • Urine sample
  • Wg. MRSA: Staphylococcus aureus identification:
    • Cultivation on blood-containing culture media – screening for nutrient agar with added antibiotics.
    • Differentiation from coagulase-negative staphylococci (e.g., by testing for coagulase).
    • Possibly biochemical confirmation
  • PCR (polymerase chain reaction, PCR) – direct detection of MRSA from original material.

Notifiable in the sense of the Infection Protection Act for laboratories is the direct detection of the following pathogens:

  • Staphylococcus aureus, methicillin-resistant strains (MRSA); reporting requirement for the detection from blood or cerebrospinal fluid,Note: For the finding “MRSA” must always be for the respective isolate both the species diagnosis S. aureus secured and its oxacillin or cefoxitin resistance has been proven flawlessly.
  • Enterobacteriaceae with carbapenem nonsusceptibility or when a carbapenemase determinant is detected, with the exception of isolated nonsusceptibility to imipenem in Proteus spp, Morganella spp, Providencia spp, and Serratia marcescens; mandatory reporting of infection or colonization,
  • Acinetobacter spp. with carbapenem nonsusceptibility or when a carbapenemase determinant is detected; mandatory reporting when infection or colonization occurs.

Further notes

  • General screening of all hospital patients for multi-resistant Staphylococcus aureus (MRSA) pathogens on admission did not result in better protection against nosocomial infections, according to one study.Conclusion: risk-group-based or department-based screening is more useful.