Multidrug-Resistant Bacteria in Refugee Children and Pregnant Women Admitted to a General Hospital in North Rhine-Westphalia, Germany

Introduction

In 2015, more than 300,000 children and an unknown number of pregnant women arrived in Germany after fleeing from their home countries. The most frequent countries of origin were Syria (36%), Afghanistan (10%), Iraq (10%), Albania and Kosovo [www.soziales.bremen.de/sixcms/media.php/13/statistik-anlage-teil-4-aktuelle-zahlen-zu-asyl_Dez%202015.pdf]. It is currently unknown to what extent refugee children and pregnant women who arrive in Germany are carriers of multidrug-resistant bacteria (MDRB), especially methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant gram-negative (MRGN) Enterobacteriaceae, although many of them originate from or pass through countries with high prevalence rates of MDRB colonisation [van der Bij et al., J Antimicrob Chemother 2012; 67: 2090–2100; Vento et al., BMC Infect Dis 2013; 13: 325].

After arrival in Germany, refugees are given initial shelter in large camps called “Erstaufnahmeeinrichtung” (EAE). Good personal and public hygiene is difficult to maintain under these conditions. When being admitted to in-patient care these patients may constitute a high-risk group for MDRB colonisation according to recent guidelines issued by the German commission on hospital hygiene and infection prevention (Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO)), the Robert-Koch Institute and the German Society of Paediatric Infectious Diseases [Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention (KRINKO) beim Robert Koch-Institut (RKI), Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2012; 55: 1311–1354 and 2014; 57: 696–732; Pfeil et al., Monatsschr Kinderheilkd 2015; 163: 1269–1286; www.rki.de/DE/Content/Gesundheitsmonitoring/Gesundheitsberichterstattung/GesundAZ/Content/A/Asylsuchende/Inhalt/MRE-Screening_Asylsuchende.pdf?__blob=publicationFile].

The aim of this study was to determine MDRB colonisation rates both for MRSA and MRGN Enterobacteriaceae in refugee children and pregnant women admitted to our hospital. These data could inform public health policy committees how to adjust current hygiene recommendations to the rapidly changing refugee situation in Germany and beyond.