Die DGHM prämiert Veröffentlichungen, die sich durch eine große Anwendungsrelevanz auszeichnen. Für diese Auszeichnung können Publikationen vorgschlagen werden, an denen ein DGHM-Mitglied als Erst- oder LetztautorIn beteiligt ist und die in den vorangegangenen 3 Monaten hochrangig publiziert wurden.

Aktuelles Highlight der Infektionsprävention und Klin. Mikrobiologie

Corynebacterium diphtheriae Outbreak in Migrant Populations in Europe

Andreas Hoefer¹, Helena Seth-Smith², Federica Palma^{3 4}, Stefanie Schindler⁵, Luca Freschi¹, Alexandra Dangel⁶, Anja Berger⁷, Joshua D’Aeth⁸, Rebecca Cordery⁹, Enrique Delgado-Rodriguez¹, Eva Gruner¹⁰, Domenica Flury¹¹, Vladimira Hinic², Julian Kofler¹², Reto Lienhard¹³, Rob Mariman¹⁴, Oliver Nolte^{2 15}, Adrian Schibli¹⁶, Julie Toubiana^{4 17 18}, Marianna Traugott¹⁹, Stephanie Jacquinet²⁰, Alexander Indra⁵, Norman K Fry^{8 9}, Daniel Palm¹, Andreas Sing^{7 21}, Sylvain Brisse^{3 4 17}, Adrian Egli²; 2022 European Diphtheria Consortium

New Engl J Med 2025; 392(23):2334-2345

Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/40466062/

Abstract:
Background: A surge of cases of Corynebacterium diphtheriae infection was observed in reception centers for migrants in Europe beginning in the summer of 2022. Most of the cases were cutaneous, although some respiratory cases as well as one death were reported. A pan-European consortium was created to assess the clinical, epidemiologic, and microbiologic features of this outbreak.

Methods: We assessed cases of toxigenic C. diphtheriae infection that were reported in 10 European countries from January through November 2022. Data regarding countries of origin and transit routes were obtained from interviews with the patients. Whole-genome sequencing and antimicrobial-susceptibility testing were performed on bacterial isolates that were obtained from the patients. The phylogenetic relationships of the isolates and their antimicrobial-resistance genes were evaluated.

Results: A total of 363 toxigenic C. diphtheriae isolates were identified among 362 patients during the study period. Clinical data were available for 346 patients (95.6%): 268 (77.5%) had cutaneous diphtheria, 53 (15.3%) had respiratory diphtheria (11 [3.2%] had a pseudomembrane), and 9 (2.6%) had both respiratory and cutaneous symptoms. Four major genetic clusters were identified, which indicated the multiclonal nature of the outbreak. The ermX gene (which codes for erythromycin resistance) and the pbp2m and blaOXA-2 genes (which code for beta-lactam resistance) were detected in a subgroup of isolates. Isolates that carried ermX were resistant to erythromycin, and isolates that carried pbp2m were resistant to penicillin but were susceptible to amoxicillin. On the basis of the genomic variation within the four genetic clusters, their most recent common ancestors were estimated to have existed between 2017 and 2020.

Conclusions: The distribution of each genetic cluster of C. diphtheriae isolates across multiple countries in Europe showed repeated cross-border spread. The large number of C. diphtheriae infections among migrants is a cause for concern, particularly given that antimicrobial-resistance phenotypes threaten the efficacy of first-line treatments. (Funded by the Bavarian State Ministry of Health, Care, and Prevention and others.).

Kommentar:
Dies ist die molekularepidemiologische Darstellung des größten Diphtherie-Ausbruchs in Europa seit ca. 70 Jahren. Das Konsiliarlabor hatte hierzu im Sommer 2022 verschiedene europ. Referenzlaboratorien kontaktiert und die Gründung eines Laborkonsortiums zur Bearbeitung dieses Ausbruchs mitinitiiert. Weitere Publikationen mit Beteiligung oder Federführung des KL für Diphtherie aus diesem Ausbruch umfassen:

Badenschier F, Berger A, Dangel A, Sprenger A, Hobmaier B, Sievers C, Prins H, Dörre A, Wagner-Wiening C, Külper-Schiek W, Wichmann O, Sing A. Outbreak of imported diphtheria with Corynebacterium diphtheriae among migrants arriving in Germany, 2022. Euro Surveill. 2022 Nov;27(46):2200849

Sing A, Badenschier F, Dangel A, Sprenger A, Hobmaier B, Külper-Schiek W, Prins H, Martin-Sanchez M, Wagner-Wiening C, Berger A. Clustering of Diphtheria Cases in Refugees That Arrived in Germany in 2022. Dtsch Arztebl Int. 2023 Aug 21;120(33-34):557-558

Zink A, Hofer J, Schneider C, Kessler F, Klenze H, Klauwer D, Maleki K, Müller A, Goretzki S, Wang S, Kobbe R, Ramirez AV, Bode S, Janda A, Fressle R, Remppis J, Henneke P, Rieg S, Berger A, Sing A, Hufnagel M, Spielberger BD. Management and outcome of cutaneous diphtheria in adolescent refugees in Germany, June 2022 – October 2023. Infection. 2025 Feb;53(1):329-337

sowie die Fortschreibung 2023-2025 des aktuellen Ausbruchsgeschehens mit einem der Hauptcluster- Sequenztypen ST-574 von C. diphtheriae zunächst in das Obdachlosen-Milieu in bestimmten Regionen (v.a. Frankfurt), in die autochthone Bevölkerung (mit dem ersten resp. Diphtherie-Ausbruch in Deutschland seit ca. 40 Jahren) und in das europäische Ausland (Publikationen alle aus März-Juli 2025):

Haller J, Berger A, Dangel A, Bengs K, Friedrichs I, Kleine C, Schmidt D, Goetzens M, Goetsch U, Hogardt M, Sing A. Diphtheria Outbreak among Persons Experiencing Homelessness, 2023, Linked to 2022 Diphtheria Outbreak, Frankfurt am Main, Germany. Emerg Infect Dis. 2025 Mar;31(3):547-554

Berger A, Zasada AA, Dangel A, Piekarska K, Paradowska-Stankiewicz I, Bengs K, Noll C, Sing A. A case of fatal respiratory diphtheria imported from Poland to Germany: possible link to an undetected imported diphtheria cluster in Poland? Infection. 2025 Apr 2. doi: 10.1007/s15010-025-02522-y

Berger A, Dangel A, Bengs K, Schlotmann S, Thomaßen P, Maday C, Rubach C, Abdelgawad I, Namaschk G, Schneider L, Perriat D, Badenschier F, Rau C, Muscat M, Sing A. Autochthonous outbreak of respiratory diphtheria caused by Corynebacterium diphtheriae, Germany, September 2024. Euro Surveill. 2025 Jul 10;30(27):2500116.

Kontakt:
Dr. Anja Berger
Bayerisches Landesamt für Gesundheit und Lebensmittelsicherheit (LGL),
WHO Collaborating Centre for Diphtheria,
EU Reference Laboratory for Public Health on Diphtheria and Pertussis
(EURL-PH-DIPE), Konsiliarlabor für Diphtherie, Veterinärstraße 2, 85764
Oberschleißheim
Tel.: ++49-(0)9131-6808-5239
anja.berger@lgl.bayern.de

Autor:inneninformationen:

Collaborators
2022 European Diphtheria Consortium:

Georgie Adair, Kristian Alfsnes, Luis Alves de Sousa, Sabrina Bacci, Edgar Badell, Katja Bengs, Marion Blaschitz, Jordi Borrell Pique, Michelle Bressan, Vera Bruderer, Ana Paula Finatto Canabarro, Chiara Crestani, Maria Del Grosso, José Delgado-Blas, Xavier Didelot, Günter Dollenmaier, Seyi Eletu, Giulia Errico, Laure Fonteneau, Silvia Funke, Astrid Füszl, Florian Heger, Mélanie Hennart, Laura Herrera Leon, Bernhard Hobmaier, Frank Imkamp, Géraldine Jost, Stefan P Kuster, Nadia Liassine, Kathrin Lippert, David Litt, Stefano Mancini, Francesco Maraglino, Glady Martinetti, Helena Martini, Josefa Masa-Calles, Monica Monaco, Shennae O’Boyle, Anna Teresa Palamara, Sonja Pleininger, Sigrid Pranghofer, Srinithi Purushothaman, Martin Rethoret-Pasty, Tim Roloff, Tobias Schmid, Salome N Seiffert, Andrea Siddu, Annika Sprenger, Dimphey van Meijeren, Sophie Vaux

Affiliations
¹ European Center for Disease Prevention and Control, Solna, Sweden.
² Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland.
³ Biological Resource Center, Institut Pasteur, Université Paris Cité, Paris.
⁴ Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Université Paris Cité, Paris.
⁵ Institute for Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, Vienna.
⁶ Next-Generation Sequencing Core Unit, Public Health Microbiology, Bavarian Health and Food Safety Authority, Oberschleißheim, Germany.
⁷ National Consiliary Laboratory on Diphtheria, Bavarian Health and Food Safety Authority, World Health Organization Collaborating Center for Diphtheria, European Reference Laboratory for Diphtheria and Pertussis, Oberschleißheim, Germany.
⁸ Vaccine Preventable Bacteria Section, Respiratory and Vaccine Preventable Bacteria Reference Unit, Specialised Microbiology and Laboratories Directorate, U.K. Health Security Agency, London.
⁹ Immunisation and Vaccine Preventable Diseases Division, U.K. Health Security Agency, London.
¹⁰ Medica, Zurich, Switzerland.
¹¹ Kantonsspital St. Gallen, St. Gallen, Switzerland.
¹² Department for Dermatology and Venereology, Hospital Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria.
¹³ ADMED Microbiologie, La Chaux-de-Fonds, Switzerland.
¹⁴ Rijksinstituut voor Volksgezondheid en Milieu, Bilthoven, the Netherlands.
¹⁵ Center for Laboratory Medicine, St. Gallen, Switzerland.
¹⁶ Division of Infectious Diseases and Infection Prevention, Stadtspital Zürich, Zurich, Switzerland.
¹⁷ National Reference Center for Corynebacteria of the Diphtheriae Complex, European Reference Laboratory for Diphtheria and Pertussis, Institut Pasteur, Paris.
¹⁸ Department of General Pediatrics and Pediatric Infectious Diseases, Université Paris Cité, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris.
¹⁹ Department for Infectious Diseases and Tropical Medicine, Klinik Favoriten, Vienna.
²⁰ Sciensano, Brussels.
²¹ Ludwig-Maximilians-Universität, Munich, Germany.

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Mirco Sandfort^1,*, Jörg B Hans^2,*, Martin A Fischer^3,*, Felix Reichert¹, Martina Cremanns², Jessica Eisfeld² , Yvonne Pfeifer³, Annika Heck¹ , Tim Eckmanns¹ , Guido Werner³ , Sören Gatermann² , Sebastian Haller^1,**, Niels Pfennigwerth^2,**Eurosurveillance, 2022, Volume 27, Issue 50
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The acquisition of transferable extrachromosomal fec operon is associated with a cefiderocol MIC increase in EnterobacteralesKaan Kocer¹, Sébastien Boutin¹²³, Klaus Heeg¹, Dennis Nurjadi¹³Journal of Antimicrobial Chemotherapy, 2022 Nov 28;77(12):3487-3495
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Isabell Wagenhäuser¹ ……..Oliver Kurzai²², Ulrich Vogel³, Manuel Krone²³
Clinical Microbiology and Infection, 2022
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/36028089/

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Link zum vollständigen Artikel: link.springer.com/article/10.1007/s10875-022-01293-7

Extensively Drug-Resistant Klebsiella pneumoniae Counteracts Fitness and Virulence Costs That Accompanied Ceftazidime-Avibactam Resistance Acquisition
Elias Eger¹, Michael Schwabe¹, Lukas Schulig², Nils-Olaf Hübner³, Jürgen A Bohnert⁴, Uwe T Bornscheuer⁵, Stefan E Heiden¹, Justus U Müller¹, Fazal Adnan⁶, Karsten Becker⁴, Carlos L Correa-Martinez⁷, Sebastian Guenther⁸, Evgeny A Idelevich^4,9, Daniel Baecker², Katharina Schaufler^1,10Microbiology Spectrum, 2022, 18.04.22
Link zum voständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/35435751/

A strict mask policy for hospital staff effectively prevents from nosocomial influenza infections and mortality: monocentric data from five consecutive influenza seasons
Ambrosch, Andreas*¹, Luber, Doris¹, Klawonn, Frank^2,3, Kabesch, Michael^4,5J Hospital Infection 2021 Dec 18;121:82-90. doi: 10.1016/j.jhin.2021.12.010
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/34929232/

Molecular Surveillance of Carbapenem-Resistant Gram-Negative Bacteria in Liver Transplant
Candidates
Tilman G. Schultze, Philip G. Ferstl, David Villinger, Michael Hogardt, Wolf O. Bechstein, Stephan Göttig, Thomas A. Wichelhaus, Stefan Zeuzem, Jonel Trebicka, Oliver Waidmann, Martin-Walter Welker* and Volkhard A. J. Kempf*
Front. Microbiol., 22 November 2021
Link zum vollständigen Artikel: https://www.frontiersin.org/articles/10.3389/fmicb.2021.791574/full

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains
Dennis Nurjadi¹, Martin Scherrer¹, Uwe Frank^{1 2 3}, Nico T Mutters^{1 3}, Alexandra Heininger^{1 4}, Isabel Späth¹, Vanessa M Eichel¹, Jonas Jabs^{1 3}, Katja Probst¹, Carsten Müller-Tidow⁵, Juliane Brandt⁵, Klaus Heeg¹, Sébastien Boutin¹
Microbiol Spectr 2021 Dec 22;9(3):e0138021
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/34817232/

Development and Validation of a Tool for the Prediction of Vancomycin–Resistant Enterococci Colonization Persistence –the PREVENT Score

Christian Boeing¹, Carlos L Correa-Martinez¹ , Franziska Schuler², Alexander Mellmann¹, André Karch³, Stefanie Kampmeier^1ccccMicrobiology Spectrum, 2021, 9 (2): e00356-21
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/34523992/

Surveillance for Colonization, Transmission, and Infection with Methicillin-Susceptible Staphylococcus aureus in a Neonatal Intensive Care Unit
Dennis Nurjadi¹, Vanessa M Eichel¹, Patrik Tabatabai², Sabrina Klein¹, Katharina Last^{1 3 ,} Nico T Mutters^{1 4}, Johannes Pöschl², Philipp Zanger^{1 5}, Klaus Heeg¹, Sébastien Boutin¹JAMA Network Open. 2021 Sep 1;4(9):e2124938
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/34515783/

Performance of Three SARS-CoV-2 Immunoassays, Three Rapid Lateral Flow Tests, and a Novel Bead-Based Affinity Surrogate Test for the Detection of SARS-CoV-2 Antibodies in Human Serum
Manuel Krone, Julia Gütling, Johannes Wagener, Thiên-Trí Lâm, Christoph Schoen, Ulrich Vogel, August Stich, Florian Wedekink, Jörg Wischhusen, Thomas Kerkau, Niklas Beyersdorf, Silvana Klingler, Simone Backes, Lars Dölken, Georg Gasteiger, Oliver Kurzai, Alexandra Schubert-Unkmeir
Journal of Clinical Microbiology 2021, 59(8): e00319-21
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/33962959/

Global Distribution Patterns of Carbapenemase-Encoding Bacteria in a New Light: Clues on a Role for Ethnicity
Claudio Neidhöfer¹, Christian Buechler¹, Guido Neidhöfer², Gabriele Bierbaum¹, Irene Hannet³, Achim Hoerauf¹, Marijo Parčina¹Frontiers in Cellular and Infection Microbiology, 2021, Volume 11, p. 532-550, doi: 10.3389/fcimb.2021.659753
Link zum vollständigen Abstract: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8276097/

Clinical performance evaluation of SARS-CoV-2 rapid antigen testing in point of care usage in comparison to RT-qPCR
Isabell Wagenhäuser, Kerstin Knies, Vera Rauschenberger, Michael Eisenmann, Miriam McDonogh, Nils Petri, Oliver Andres, Sven Flemming, Micha Gawlik, Michael Papsdorf, Regina Taurines, Hartmut Böhm, Johannes Forster, Dirk Weismann, Benedikt Weißbrich, Lars Dölken, Johannes Liese, Oliver Kurzai, Ulrich Vogel, Manuel Krone
EBioMedicine 2021, 69: 103455
Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/34186490/

Pet husbandry as a risk factor for colonization or infection with MDR organisms: a systematic meta-analysis
Carolin Hackmann¹ , Petra Gastmeier¹, Stefan Schwarz² , Antina Lübke-Becker², Peter Bischoff¹, Rasmus Leistner¹,³
J Antimicrob Chemother. 2021 May 12;76(6):1392-1405.doi: 10.1093/jac/dkab058.Link zum vollständigen Artikel: https://pubmed.ncbi.nlm.nih.gov/33864082/

Prevalence of SARS-CoV-2 IgG antibodies in a large prospective cohort study of elite football players in Germany (May-June 2020): implications for a testing protocol in asymptomatic individuals and estimation of the rate of undetected cases
Dietrich Mack^1*, Barbara Christine Gärtner^2*, Annika Rössler³, Janine Kimpel³, Katrin Donde¹, Oliver Harzer¹, Werner Krutsch⁴, Dorothee von Laer³, Tim Meyer⁵(*are joint first authors)
Clinical Microbiology and Infection 202. Mar;27(3):473.e1-473.e4.
Link zum vollständigen Artikel: pubmed.ncbi.nlm.nih.gov/33285279/

“A Klebsiella pneumoniae ST307 outbreak clone from Germany demonstrates features of extensive drug resistance, hypermucoviscosity, and enhanced iron acquisition”
Stefan E. Heiden*, Nils-Olaf Hübner*, Jürgen A. Bohnert, Claus-Dieter Heidecke, Axel Kramer, Veronika Balau, Wolfgang Gierer, Stephan Schaefer, Tim Eckmanns, Sören Gatermann, Elias Eger, Sebastian Guenther, Karsten Becker & Katharina Schaufler#
Genome Medicine, 2020, 12:113
Link zum vollständigen Artikel: pubmed.ncbi.nlm.nih.gov/33298160/

DGHMEINE STARKE GEMEINSCHAFT

Aktuelles Highlight der Infektionsprävention und Klin. Mikrobiologie

Corynebacterium diphtheriae Outbreak in Migrant Populations in Europe

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