http://edoc.rki.de/176904/43 Sun, 10 May 2026 06:35:00 GMT 2026-05-10T06:35:00Z http://edoc.rki.de/176904/13737 Nosokomialer Ausbruch von Ralstonia mannitolilytica-Infektionen Robert Koch-Institut Thu, 07 May 2026 00:00:00 GMT http://edoc.rki.de/176904/13737 2026-05-07T00:00:00Z http://edoc.rki.de/176904/13736 Global, regional, and national incidence and mortality burden of non-COVID-19 lower respiratory infections and aetiologies, 1990–2021: a systematic analysis from the Global Burden of Disease Study 2021 GBD 2021 Lower Respiratory Infections and Antimicrobial Resistance Collaborators; Bender, Rose Grace; Sirota, Sarah Brooke; Swetschinski, Lucien R.; Villanueva Dominguez, Regina-Mae; Novotney, Amanda; Wool, Eve E.; Ikuta, Kevin S.; Vongpradith, Avina; Best Rogowski, Emma Lynn; Doxey, Matthew; Troeger, Christopher E.; Albertson, Samuel B.; Ma, Jianing; He, Jiawei; Maass, Kelsey Lynn; Simões, Eric A. F.; Abdoun, Meriem; Abdul Aziz, Jeza Muhamad; Abdulah, Deldar Morad; Abu Rumeileh, Samir; Abualruz, Hasan; Aburuz, Salahdein; Adepoju, Abiola Victor; Adha, Rishan; Adikusuma, Wirawan; Adra, Saryia; Afraz, Ali; Aghamiri, Shahin; Agodi, Antonella; Ahmadzade, Amir Mahmoud; Ahmed, Haroon; Ahmed, Ayman; Akinosoglou, Karolina; AL-Ahdal, Tareq Mohammed Ali; Al-amer, Rasmieh Mustafa; Albashtawy, Mohammed; AlBataineh, Mohammad T.; Alemi, Hediyeh; Al-Gheethi, Adel Ali Saeed; Ali, Abid; Shujait Ali, Syed Shujait; Alqahtani, Jaber S.; AlQudah, Mohammad; Al-Tawfiq, Jaffar A.; Al-Worafi, Yaser Mohammed; Alzoubi, Karem H.; Amani, Reza; Amegbor, Prince M.; Ameyaw, Edward Kwabena; Amuasi, John H.; Anil, Abhishek; Anyanwu, Philip Emeka; Arafat, Mosab; Areda, Damelash; Arefnezhad, Reza; Atalell, Kendalem Asmare; Ayele, Firayad; Azzam, Ahmed Y.; Babamohamadi, Hassan; Babin, François-Xavier; Bahurupi, Yogesh; Baker, Stephen; Banik, Biswajit; Barchitta, Martina; Barqawi, Hiba Jawdat; Basharat, Zarrin; Baskaran, Pritish; Batra, Kavita; Batra, Ravi; Bayileyegn, Nebiyou Simegnew; Beloukas, Apostolos; Berkley, James A.; Beyene, Kebede A.; Bhargava, Ashish; Bhattacharjee, Priyadarshini; Bielicki, Julia A.; Bilalaga, Mariah Malak; Bitra, Veera R.; Brown, Colin Stewart; Burkart, Katrin; Bustanji, Yasser; Carr, Sinclair; Chahine, Yaacoub; Chattu, Vijay Kumar; Chichagi, Fatemeh; Chopra, Hitesh; Chukwu, Isaac Sunday; Chung, Eunice; Dadana, Sriharsha; Dai, Xiaochen; Dandona, Lalit; Dandona, Rakhi; Darban, Isaac; Dash, Nihar Ranjan; Dashti, Mohsen; Dashtkoohi, Mohadese; Dekker, Denise Myriam; Delgado-Enciso, Ivan; Devanbu, Vinoth Gnana Chellaiyan; Dhama, Kuldeep; Diao, Nancy; Do, Thao Huynh Phuong; Dokova, Klara Georgieva; Dolecek, Christiane; Dziedzic, Arkadiusz Marian; Eckmanns, Tim; Ed-Dra, Abdelaziz; Efendi, Ferry; Eftekharimehrabad, Aziz; Eyre, David William; Fahim, Ayesha; Feizkhah, Alireza; Felton, Timothy William; Ferreira, Nuno; Flor, Luisa S.; Gaihre, Santosh; Gebregergis, Miglas W.; Gebrehiwot, Mesfin; Geffers, Christine; Gerema, Urge; Ghaffari, Kazem; Goldust, Mohamad; Goleij, Pouya; Guan, Shi-Yang; Gudeta, Mesay Dechasa; Guo, Cui; Gupta, Veer Bala; Gupta, Ishita; Habibzadeh, Farrokh; Hadi, Najah R.; Haeuser, Emily; Hailu, Wase Benti; Hajibeygi, Ramtin; Haj-Mirzaian, Arvin; Haller, Sebastian; Hamiduzzaman, Mohammad; Hanifi, Nasrin; Hansel, Jan; Hasnain, Md Saquib; Haubold, Johannes; Hoan, Nguyen Quoc; Huynh, Hong-Han; Iregbu, Kenneth Chukwuemeka; Islam, Md Rabiul; Jafarzadeh, Abdollah; Jairoun, Ammar Abdulrahman; Jalil, Mahsa; Jomehzadeh, Nabi; Joshua, Charity Ehimwenma; Kabir, Awal; Kamal, Zul; Kanmodi, Kehinde Kazeem; Kantar, Rami S.; Karimi Behnagh, Arman; Kaur, Navjot; Kaur, Harkiran; Khamesipour, Faham; Khan, M. Nuruzzaman; Khan suheb, Mahammed Ziauddin; Khanal, Vishnu; Khatab, Khaled; Khatib, Mahalaqua Nazli; Kim, Grace; Kim, Kwanghyun; Kitila, Aiggan Tamene Tamene; Komaki, Somayeh; Krishan, Kewal; Krumkamp, Ralf; Kuddus, Abdul; Kurniasari, Maria Dyah; Lahariya, Chandrakant; Latifinaibin, Kaveh; Le, Nhi Huu Hanh; Le, Thao Thi Thu; Le, Trang Diep Thanh; Lee, Seung Won; Le Pape, Alain; Lerango, Temesgen L.; Li, Ming-Chieh; Mahboobipour, Amir Ali; Malhotra, Kashish; Mallhi, Tauqeer Hussain; Manoharan, Anand; Martinez-Guerra, Bernardo Alfonso; Mathioudakis, Alexander G.; Mattiello, Rita; May, Jürgen; McManigal, Barney; McPhail, Steven M.; Meto, Tesfahun Mekene; Mendez-Lopez, Max Alberto Mendez; Meo, Sultan Ayoub; Merati, Mohsen; Mestrovic, Tomislav; Mhlanga, Laurette; Minh, Le Huu Nhat; Misganaw, Awoke; Mishra, Vinaytosh; Misra, Arup Kumar; Mohamed, Nouh Saad; Mohammadi, Esmaeil; Mohammed, Mesud; Mohammed, Mustapha; Mokdad, Ali H.; Monasta, Lorenzo; Moore, Catrin E.; Motappa, Rohith; Mougin, Vincent; Mousavi, Parsa; Mulita, Francesk; Mulu, Atsedemariam Andualem; Naghavi, Pirouz; Naik, Ganesh R.; Nainu, Firzan; Nair, Tapas Sadasivan; Nargus, Shumaila; Negaresh, Mohammad; Nguyen, Hau Thi Hien; Nguyen, Dang H.; Nguyen, Van Thanh; Nikolouzakis, Taxiarchis Konstantinos; Noman, Efaq Ali; Nri-Ezedi, Chisom Adaobi; Odetokun, Ismail A.; Okwute, Patrick Godwin; Olana, Matifan Dereje; Olanipekun, Titilope O; Olasupo, Omotola O.; Olivas-Martinez, Antonio; Ordak, Michal; Ortiz-Brizuela, Edgar; Ouyahia, Amel; Padubidri, Jagadish Rao; Pak, Anton; Pandey, Anamika; Pantazopoulos, Ioannis; Parija, Pragyan Paramita; Parikh, Romil R.; Park, Seoyeon; Parthasarathi, Ashwaghosha; Pashaei, Ava; Peprah, Prince; Pham, Hoang Tran; Poddighe, Dimitri; Pollard, Andrew; Ponce-De-Leon, Alfredo; Prakash, Peralam Yegneswaran; Prates, Elton Junio Sady; Quan, Nguyen Khoi; Raee, Pourya; Rahim, Fakher; Rahman, Mosiur; Rahmati, Masoud; Ramasamy, Shakthi Kumaran; Ranjan, Shubham; Rao, Indu Ramachandra; Rashid, Ahmed Mustafa; Rattanavong, Sayaphet; Ravikumar, Nakul; Reddy, Murali Mohan Rama Krishna; Redwan, Elrashdy Moustafa Mohamed; Reiner Jr., Robert C.; Reyes, Luis Felipe; Roberts, Tamalee; Rodrigues, Mónica; Rosenthal, Victor Daniel; Roy, Priyanka; Runghien, Tilleye; Saeed, Umar; Saghazadeh, Amene; Sharif-Askari, Narjes Saheb; Sharif-Askari, Fatemeh Saheb; Sahoo, Soumya Swaroop; Sahu, Monalisha; Sakshaug, Joseph W.; Salami, Afeez Abolarinwa; Saleh, Mohamed A.; Salehi omran, Hossein; Sallam, Malik; Samadzadeh, Sara; Samodra, Yoseph Leonardo; Sanjeev, Rama Krishna; Sarasmita, Made Ary; Saravanan, Aswini; Sartorius, Benn; Saulam, Jennifer; Schumacher, Austin E.; Seyedi, Seyed Arsalan; Shafie, Mahan; Shahid, Samiah; Sham, Sunder; Shamim, Muhammad Aaqib; Shamshirgaran, Mohammad Ali; Shastry, Rajesh P.; Sherchan, Samendra P.; Shiferaw, Desalegn; Shittu, Aminu; Siddig, Emmanuel Edwar; Sinto, Robert; Sood, Aayushi; Sorensen, Reed J. D.; Stergachis, Andy; Stoeva, Temenuga Zhekova; Swain, Chandan Kumar; Szarpak, Lukasz; Tamuzi, Jacques Lukenze; Temsah, Mohamad-Hani; Tessema, Melkamu B Tessema; Thangaraju, Pugazhenthan; Tran, Nghia Minh; Tran, Ngoc-Ha; Tumurkhuu, Munkhtuya; Ty, Sree Sudha; Udoakang, Aniefiok John; Ulhaq, Inam; Umar, Tungki Pratama; Umer, Abdurezak Adem; Vahabi, Seyed Mohammad; Vaithinathan, Asokan Govindaraj; Van den Eynde, Jef; Walson, Judd L.; Waqas, Muhammad; Xing, Yuhan; Yadav, Mukesh Kumar; Yahya, Galal; Yon, Dong Keon; Zahedi Bialvaei, Abed; Zakham, Fathiah; Zeleke, Abyalew Mamuye; Zhai, Chunxia; Zhang, Zhaofeng; Zhang, Haijun; Zielińska, Magdalena; Zheng, Peng; Aravkin, Aleksandr Y.; Vos, Theo; Hay, Simon I.; Mosser, Jonathan F.; Lim, Stephen S.; Naghavi, Mohsen; Murray, Christopher J. L.; Kyu, Hmwe Hmwe Background: Lower respiratory infections (LRIs) are a major global contributor to morbidity and mortality. In 2020–21, non-pharmaceutical interventions associated with the COVID-19 pandemic reduced not only the transmission of SARS-CoV-2, but also the transmission of other LRI pathogens. Tracking LRI incidence and mortality, as well as the pathogens responsible, can guide health-system responses and funding priorities to reduce future burden. We present estimates from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 of the burden of non-COVID-19 LRIs and corresponding aetiologies from 1990 to 2021, inclusive of pandemic effects on the incidence and mortality of select respiratory viruses, globally, regionally, and for 204 countries and territories. Methods: We estimated mortality, incidence, and aetiology attribution for LRI, defined by the GBD as pneumonia or bronchiolitis, not inclusive of COVID-19. We analysed 26 259 site-years of mortality data using the Cause of Death Ensemble model to estimate LRI mortality rates. We analysed all available age-specific and sex-specific data sources, including published literature identified by a systematic review, as well as household surveys, hospital admissions, health insurance claims, and LRI mortality estimates, to generate internally consistent estimates of incidence and prevalence using DisMod-MR 2.1. For aetiology estimation, we analysed multiple causes of death, vital registration, hospital discharge, microbial laboratory, and literature data using a network analysis model to produce the proportion of LRI deaths and episodes attributable to the following pathogens: Acinetobacter baumannii, Chlamydia spp, Enterobacter spp, Escherichia coli, fungi, group B streptococcus, Haemophilus influenzae, influenza viruses, Klebsiella pneumoniae, Legionella spp, Mycoplasma spp, polymicrobial infections, Pseudomonas aeruginosa, respiratory syncytial virus (RSV), Staphylococcus aureus, Streptococcus pneumoniae, and other viruses (ie, the aggregate of all viruses studied except influenza and RSV), as well as a residual category of other bacterial pathogens. Findings: Globally, in 2021, we estimated 344 million (95% uncertainty interval [UI] 325–364) incident episodes of LRI, or 4350 episodes (4120–4610) per 100 000 population, and 2·18 million deaths (1·98–2·36), or 27·7 deaths (25·1–29·9) per 100 000. 502 000 deaths (406 000–611 000) were in children younger than 5 years, among which 254 000 deaths (197 000–320 000) occurred in countries with a low Socio-demographic Index. Of the 18 modelled pathogen categories in 2021, S pneumoniae was responsible for the highest proportions of LRI episodes and deaths, with an estimated 97·9 million (92·1–104·0) episodes and 505 000 deaths (454 000–555 000) globally. The pathogens responsible for the second and third highest episode counts globally were other viral aetiologies (46·4 million [43·6–49·3] episodes) and Mycoplasma spp (25·3 million [23·5–27·2]), while those responsible for the second and third highest death counts were S aureus (424 000 [380 000–459 000]) and K pneumoniae (176 000 [158 000–194 000]). From 1990 to 2019, the global all-age non-COVID-19 LRI mortality rate declined by 41·7% (35·9–46·9), from 56·5 deaths (51·3–61·9) to 32·9 deaths (29·9–35·4) per 100 000. From 2019 to 2021, during the COVID-19 pandemic and implementation of associated non-pharmaceutical interventions, we estimated a 16·0% (13·1–18·6) decline in the global all-age non-COVID-19 LRI mortality rate, largely accounted for by a 71·8% (63·8–78·9) decline in the number of influenza deaths and a 66·7% (56·6–75·3) decline in the number of RSV deaths. Interpretation: Substantial progress has been made in reducing LRI mortality, but the burden remains high, especially in low-income and middle-income countries. During the COVID-19 pandemic, with its associated non-pharmaceutical interventions, global incident LRI cases and mortality attributable to influenza and RSV declined substantially. Expanding access to health-care services and vaccines, including S pneumoniae, H influenzae type B, and novel RSV vaccines, along with new low-cost interventions against S aureus, could mitigate the LRI burden and prevent transmission of LRI-causing pathogens. Funding: Bill & Melinda Gates Foundation, Wellcome Trust, and Department of Health and Social Care (UK). Mon, 15 Apr 2024 00:00:00 GMT http://edoc.rki.de/176904/13736 2024-04-15T00:00:00Z http://edoc.rki.de/176904/13734 Pregnancy Complications in Women With Pregestational and Gestational Diabetes Mellitus Reitzle, Lukas; Heidemann, Christin; Baumert, Jens; Kaltheuner, Matthias; Adamczewski, Heinke; Icks, Andrea; Scheidt-Nave, Christa Background: Diabetes mellitus (DM) is a major risk factor for complications of pregnancy. Based on information for all inpatient births in Germany, we assessed the risks for selected pregnancy complications in women with pregestational diabetes mellitus (preDM) or gestational diabetes mellitus (GDM). Method: The underlying data comprised all singleton births contained in the inpatient perinatal medicine quality assurance statistics for the years 2013–2019. The frequencies of premature birth, elevated birth weight (large for gestational age, LGA), cesarean section, transfer of the newborn to the perinatal unit, and stillbirth were stratified by maternal age and diabetes status (preDM, GDM, no DM). Poisson regression was used to calculate the relative risks (RR) with 95% confidence intervals (95% CI) for the whole period and for each individual year in women with preDM or GDM relative to women without DM. Results: Among the 4 991 275 singleton births included, GDM was documented in 283 210 (5.7%) and preDM in 46 605 (0.93%) cases. GDM was associated with higher RR for premature birth (1.13 [1.12; 1.15]), LGA (1.57 [1.55; 1.58]), cesarean section (1.26 [1.25; 1.27]), and transfer of the newborn (1.54 [1.52; 1.55]). These associations were even stronger in women with preDM: premature birth (2.13 [2.08; 2.18]), LGA (2.72 [2.67; 2.77]), cesarean section (1.62 [1.60; 1.64]), transfer of the newborn (2.61 [2.56; 2.66]). PreDM increased the risk of stillbirth (RR: 2.34 [2.11; 2.59]); GDM was associated with a lower risk (RR: 0.67 [0.62; 0.72]). For women with preDM, the risk of pregnancy complications increased over the study period. Conclusion: GDM and preDM are still associated with elevated risks of pregnancy complications. In the case of preDM, the risks may be attributable to the fact that the hyperglycemia is more severe and is already present before conception. Continuous monitoring should include risk factors in pregnant women and care-relevant aspects. Wed, 22 Nov 2023 00:00:00 GMT http://edoc.rki.de/176904/13734 2023-11-22T00:00:00Z http://edoc.rki.de/176904/13733 Prolonged carriage of OXA-244-carbapenemase-producing Escherichia coli complicates epidemiological investigations Reichert, Felix; Brinkwirth, Simon; Pfennigwerth, Niels; Haller, Sebastian; Fritsch, Lena Sophie; Eckmanns, Tim; Werner, Guido; Gatermann, Sören; Hans, Jörg B. The rapid increase of OXA-244-producing Escherichia coli, predominantly driven by genetically clustered isolates of sequence type (ST)38, has been observed in at least nine European countries, including Germany. However, the reasons for the spread of OXA-244-producing E. coli remain unclear. Here, we aim to evaluate the possibility of prolonged carriage. We identified a total of six different patients with repeated detection of OXA-244-producing E. coli isolates, which were subjected to both short and long-read whole-genome sequencing (WGS). Besides allelic differences using core genome multilocus sequence typing (cgMLST) analyses, we obtained numbers of single-nucleotide polymorphisms (SNPs) to calculate individual base-pair substitution (BPS) rates. To assess possible re-exposure and risk factors for prolonged carriage, case interviews were conducted. The time between detections ranged from eleven months to more than three years. Initial isolates originated in three+ out of six cases from clinical samples, whereas remaining samples were from screening, mostly in the inpatient setting. As expected, cgMLST analyses showed low numbers of allelic differences between isolates of each case ranging from 1 to 4, whereas numbers of SNPs were between 2 and 99 (mean = 36), thus clearly highlighting the discrepancy between these different bacterial typing approaches. For five out of six cases, observed BPS rates suggest that patients can be colonized with OXA-244-producing E. coli, including ST38 cluster isolates, for extensively long times. Thus, we may have previously missed the epidemiological link between cases because exposure to OXA-244-producing E. coli could have occurred in a time frame, which has not been evaluated in previous investigations. Our results may help to guide future epidemiological investigations as well as to support the interpretation of genetic diversity of OXA-244-producing E. coli, particularly among ST38 cluster isolates. Tue, 19 Dec 2023 00:00:00 GMT http://edoc.rki.de/176904/13733 2023-12-19T00:00:00Z