Multidrug-resistant germs or multidrug-resistant pathogens (MRE) (ICD-10-GM U81.-! : Gram-negative pathogens with certain antibiotic resistances that require special therapeutic or hygienic measures) are germs or pathogens (bacteria or viruses) that are insensitive to several different antibiotics or antivirals. Bacteria of the staphylococcus group (Staphylococcus aureus) that were resistant to methicillin first appeared in the 1960s. Staphylococcus aureus has since become resistant to a number of other antibiotics. Methicillin-resistant Staphylococcus (= MRSA) has become synonymous with hospital germs, falsely leaving the impression that these pathogens only occur in hospitals. In fact, humans are often the carriers of this pathogen without knowing it and without falling ill from it. Three variants of the multidrug-resistant Staphylococcus epidermidis (S. epidermidis) have now also become known. Other important multidrug-resistant pathogens include VRE (vancomycin-resistant enterococci) and ESBL (extended spectrum beta-lactamase-producing bacteria). Under the sub-topic “Pathogenesis – Etiology”, the entire spectrum of all currently known multidrug-resistant pathogens is listed. Increasingly, the first evidence of colistin resistance is being reported and still rare but also increasing is carbapenem resistance in E. coli and Klebsiella. Complications from resistance are increasing rapidly in Europe. For the first time, there are figures on disease adjusted life years (DALY) caused by pathogens in individual countries. Essentially, 8 germs represent all sorts of infections such as sepsis, urologic infections, respiratory infections, and surgical infections:
- Acinetobacter, Enterococcus faecalis and faecium, and E. coli and Klebsiella pneumoniae (all resistant to colistin, carbapenem, third-generation cephalosporins).
- Pseudomonas aeruginosa, Staph. aureus and Streptococc. pneumoniae (resistant to meticillin, macrolides and penicillin).
Pathogen reservoir for MRSA are humans who are germ carriers (sick or clinically healthy), rarely pets (dogs, cats, horses, pigs).One in four patients carried multidrug-resistant pathogens (MRE) on their hands when admitted to a U.S. rehabilitation facility.Aside: more than half of the rats in Vienna (59.7 percent) carried multidrug-resistant staphylococci. Pathogens are transmitted aerogenically (airborne droplet infection), contact or smear infection, fecal-orally (infection in which pathogens excreted with feces (fecal) are absorbed through the mouth (oral), e.g., through contaminated drinking water and/or contaminated food), or parenterally (infections through sexual intercourse, blood bags, or contaminated injection needles), depending on the type of pathogen. Depending on the type of pathogen, entry is enteral (the pathogen enters through the intestine or bacteria as fecal matter enters the body through the mouth), i.e., it is a fecal-oral infection, parenterally (the pathogen does not enter through the intestine), i.e., it enters through the mouth. i.e., it enters the body by numerous routes: through the skin (percutaneous infection), through the mucous membranes (permucous infection), through the respiratory tract (inhalation infection), through the urinary tract (urogenital infection), or genitally (through the reproductive organs into the blood; genital infection). The incubation period for infections with methicillin-resistant Staphylococcus (= MRSA) is 4-10 days. However, endogenous infection can occur months after initial colonization. The prevalence (disease frequency) of MRSA is between 0.8 and 2.8 % throughout Germany (data from prevalence studies concern patients admitted to a facility; evidence of colonization). In Europe, 3-6% of healthy residents are colonized with enterobacteria that produce “extended spectrum” petalactamases (ESBL; extended spectrum beta-lactamase-producing bacteria).The pooled prevalence of colonization or infection with multidrug-resistant germs was 25.4% in the overall group of migrants and 33.0% in refugees or asylum seekers. Almost every tenth hospital patient in Germany brings multiresistant germs (ESBL enterobacteria) with him to the clinic. This explains why most MRSA transmissions occur in the hospital. When a patient leaves the hospital again, the general practitioner should consider whether a smear test to diagnose MRSA would be appropriate.The incidence (frequency of new cases) of multi-resistant germs is approx. 5 cases per 100,000 inhabitants per year. No immunity develops after previous colonization or infection with MRSA. Course and prognosis: Many MRSA transmissions remain unnoticed, which favors the further spread of the pathogen. If the pathogen MRSA is detected, sanitation should be started. If the two control swabs (the first is performed after 3-6 months and the second after 12 months) are negative, the patient is considered sanitized. The estimated lethality (mortality rate) in Europe is 25,000 deaths due to infections with antibiotic-resistant pathogens per year based on figures from the European Center for Disease Prevention and Control (ECDC) and the European Medicines Agency (EMA).For the U.S., the U.S. Center for Disease Control and Prevention (CDC) has estimated at least 23,000 deaths due to antibiotic-resistant germs. There is a reporting requirement for multidrug-resistant germs (public health department). The following system for presenting the significance of multidrug-resistant germs is based on the outline of a disease.
