Christiane Cuny

Robert Koch Institut, Berlín, Berlin, Germany

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Publications (101)218.48 Total impact

  • No preview · Article · Apr 2016 · Das Gesundheitswesen
  • No preview · Article · Apr 2016 · Das Gesundheitswesen
  • [Show abstract] [Hide abstract] ABSTRACT: This study reports on the emergence of linezolid-resistant coagulase-negative staphylococci (CoNS) containing the multiresistance gene cfr in veal calves and pigs, as well as in humans exposed to these animals. CoNS (Staphylococcus auricularis, S. cohnii, S. lentus, S. kloosii, S. sciuri, S. simulans), but not S. aureus, carrying the gene cfr were detected in samples of 12 out of 52 calves at three farms which had a history of florfenicol use. Nasal swabs from 10 humans living on these farms were negative for cfr-carrying staphylococci. Nasal swabs taken from 142 calves at 16 farms in the same area that did not use florfenicol were also negative for cfr-carrying staphylococci. 14 cfr-carrying CoNS (S. kloosii, S. saprophyticus, S. simulans) were detected in three of eight conventional pig farms investigated. One of 12 humans living on these farms harboured a cfr-carrying S. cohnii. Among the nasal swabs taken from 169 veterinarians from all over Germany, four (2.3%) were positive for cfr-carrying CoNS (three S. epidermidis, one S. saprophyticus), and three (1.1%) of 263 contact persons of this group also harboured cfr-carrying CoNS (one S. epidermidis, two S. saprophyticus). In vitro conjugation of cfr by filter mating to S. aureus 8325-4 was possible for 10 of 34CoNS and the cfr gene was associated with plasmids of 38–40 kb. Moreover, a total of 363 humans of a German municipal community were investigated for nasal carriage of cfr-carrying staphylococci to get an idea whether such isolates are disseminated as nasal colonizers in non-hospitalized humans in the community, were all negative.
    No preview · Article · Apr 2016 · Veterinary Microbiology
  • [Show abstract] [Hide abstract] ABSTRACT: There are only few data on the persistence and transmission of methicillin resistant Staphylococcus aureus (MRSA) of the clonal complex (CC) 398 among veterinarians and their household members. We therefore investigated the long-term colonisation with MRSA CC398 among participants of veterinary conferences in Germany in 2008/2009 and their household members. Forty-five initially MRSA CC398 positive and 180 initially MRSA CC398 negative conference participants were included in a longitudinal study. These persons and their household members were tested for nasal colonisation in 2011, 2012 and 2014. Of 31 continuously tested and initially MRSA CC398 positive participants only 8 (26%) were colonized with MRSA CC398at all 4 time points, 4 (13%) of them consistently with the same spa type. Among initially MRSA CC398 negative participants, 13 (7%) were tested MRSA CC398 positive at least once during the follow-up period. Data for household members at least at one time point were available for 185 households. Of these 21 (11%) households had one or more household member who tested positive for MRSA CC398at least once. The odds of household members to be MRSA CC398 positive was 12 times higher (95% confidence interval 4-37) when the conference participant tested MRSA CC398 positive in 2008/2009. This association remained strong when household members working in veterinary medicine or livestock farms were excluded. In summary, these data suggest that colonisation with MRSA CC398 is partially transient and that household members of MRSA CC398 colonized persons are at an increased risk of colonisation with MRSA CC398.
    No preview · Article · Mar 2016 · Veterinary Microbiology
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    [Show abstract] [Hide abstract] ABSTRACT: Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) isolates of clonal complex 398 (CC398) are frequently found in Europe, and recent studies highlighted the importance of mobile genetic element (MGE) exchange for host adaptation of this lineage. Of note, one of the MGEs commonly found in human S. aureus isolates, the immune evasion cluster (IEC) harboring bacteriophage Saint3, is very rarely found in LA-MRSA CC398 isolates obtained from farm animals, but more frequently found in LA-MRSA CC398 that were retransmitted to humans.
    Full-text · Article · Feb 2016 · Veterinary Microbiology
  • Christiane Cuny · Wolfgang Witte
    [Show abstract] [Hide abstract] ABSTRACT: MRSA infections in equine clinics were reported from Northern America, Europe, Australia, and Japan. The majority of nosocomial infections in horses is obviously associated with particular MRSA clonal lineages. As already observed for epidemic MRSA in human hospitals more than 10 years ago, a dynamics of MRSA clonal lineages is also observed in European equine clinics: clonal lineages belonging to clonal complex (CC) 8 are on the retreat whereas MRSA attributed to CC398 become increasingly prevalent. The majority of CC398 isolates belong to a subpopulation which is particularly associated with equine hospitals as indicated by molecular typing. When emerging in equine clinics, MRSA from horses were also found as nasal colonizers of veterinary personnel. MRSA exhibiting the typing characteristics of MRSA known from equine clinics are obviously rare among MRSA from infections in humans. Although rare so far epidemic MRSA from human hospitals (HA-MRSA, e.g. ST22, ST225) have been isolated from nosocomial infections in horses and need particular attention in further surveillance.
    No preview · Article · Jan 2016 · Veterinary Microbiology
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    [Show abstract] [Hide abstract] ABSTRACT: A total of 272 methicillin-resistant Staphylococcus aureus (MRSA) from equine infections originating from 17 equine hospitals and 39 veterinary practices in Germany as well as 67 isolates from personnel working at equine clinics were subjected to molecular typing. The majority of isolates from horses was attributed to clonal complex (CC) 398 (82.7%). Within CC398, 66% of isolates belonged to a subpopulation (clade) of CC398, which is associated with equine clinics. MRSA attributed to CC8 (ST254, t009, t036, SCC. mecIV; ST8, t064, SCC. mecIV) were less frequent (16.5%). Single isolates were attributed to ST1, CC22, ST130, and ST1660. The emergence of MRSA CC22 and ST130 in horses was not reported so far. Nasal MRSA colonization was found in 19.5% of veterinary personnel with occupational exposure to horses. The typing characteristics of these isolates corresponded to isolates from equine infections. Comparing typing characteristics of equine isolates with those of a substantial number of isolates from human infections typed at the German Reference Center for Staphylococci and Enterococci (2006-2014; n=10864) yielded that the proportion of isolates exhibiting characteristics of MRSA from equine medicine is very low (<. 0.5%). As this low proportion was also found among MRSA originating from nasal screenings of human carriers not suffering from a staphylococcal infection (n=5546) transmission of MRSA from equine clinics to the community seems to be rare so far.
    Full-text · Article · Jan 2016
  • No preview · Article · Dec 2015 · pferde spiegel
  • [Show abstract] [Hide abstract] ABSTRACT: Background: Data on the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in outpatient care are scarce and those on the prevalence of multidrug-resistant Gram-negative bacteria (MRGN) are lacking completely. Therefore, the network on multidrug-resistant organisms (MDRO) in the Rhine-Main region (MRE-Netz Rhein-Main) performed a multicenter study on current prevalence data and risk factors for MDRO. Materials and methods: Characteristics of all patients were obtained according to a modified healthcare-associated infections in long-term care facilities (HALT) questionnaire and swabs from the nares/throat and anus were tested for MRSA and extended-spectrum beta-lactamase (ESBL)/MRGN. Risk factors were calculated via odds ratios. Results: Ten nursing services with 486 patients participated in this study, 269 patients agreed to having swabs of the nares/throat taken, and 132 patients had anal swabs. MRSA was detected in 3.7 %, and ESBL/MRGN in 14.4 % of the patients (6.8 % ESBL, 7.6 % MRGN, 0 % MRGN). Risk factors for MRSA were high dependency on care (stage 3 or above; OR 5.1), antibiotic use during the preceding 3 months (O R 3.7), hospital stay during the last 6 months (OR 4.3), and a positive history for MRSA (OR 18.1). Incontinence and preceding hospital stays proved to be risk factors for ESBL colonization (OR 9.5 or 6.5), whereas risk factors for MRGN colonization were a high level of care dependency (OR 7.5), urinary catheter (OR 8.3), percutaneous endoscopic gastrostomy tube and other stomata (OR 6.2), and artificial respiration (OR 5), in addition to a positive history for MRSA (OR 20) and ESBL (OR 6.7). Conclusion: Considering the high prevalence of colonization with MDRO in outpatient care, nursing services must be competent in caring for such patients: good hygiene procedures, including hand hygiene and appropriate handling in wound management, punctures and injections, with catheters, stomata, and if necessary with artificial respiration should be practiced. The guidelines of the German Commission on hospital hygiene and infection prevention should also be observed.
    No preview · Article · Dec 2015 · Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz
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    Christiane Cuny · Lothar Wieler · Wolfgang Witte
    Full-text · Article · Nov 2015
  • [Show abstract] [Hide abstract] ABSTRACT: Background: While a limited number of studies have investigated the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in medical rehabilitation institutions, almost no data on the colonization of rehabilitation patients with multiresistant gram-negative rods is available. Here we report on a large multicenter study on the prevalence of MRSA and multiresistant pathogens in rehabilitation institutions in the Rhine-Main area in 2014. Materials and Methods: Altogether, 21 rehabilitation hospitals participated. For all patients, age, gender, previous history of hospitalizations, surgery, previous colonization with multidrug-resistant organisms, use of a medical device, current antimicrobial therapy, and the current infection status were ascertained. On voluntary basis, nare and throat swabs were taken for analysis of MRSA and rectal swabs were tested for extended spectrum betalactamase-producing gram-negative bacteria (ESBL). Results: 50% of 2 440 patients had a history of hospitalization within the previous 6 months while 39% had undergone surgery during the past 30 days. Approximately a quarter of the patients had been transferred to a rehabilitation hospital directly from an acute care hospital, had been under antimicrobial therapy with the past three months, or had travelled to a foreign country within the previous year. Risk factors such as lesions of the intact skin or presence of medical devices were rarely reported (< 5%) within the exception of patients undergoing geriatric or neurologic acute care rehabilitation. 0.7% (15/2155) of the patients were colonized with MRSA, while 7.7% (110/1434) showed a positive result for ESBL. The highest prevalence rates for multiresistant organisms were encountered among patients with neurologic rehabilitation (MRSA, 1.3%, and ESBL, 10.2%) or with geriatric rehabilitation (MRSA, 9.4%, and ESBL, 22.7%). Conclusion: In the rehabilitation patient population, the prevalence rates of MRSA and ESBL were found to be in the range of rates encountered in the general population (reported rates for MRSA, 0.5%, and ESBL, 6.3%). The known risk factors for MRSA such as skin lesions, medical devices and previous history for MRSA were also confirmed among this patient population. Direct transfer from an acute care hospital, antimicrobial treatment during the past 3 months, and wounds proved significant risk factors for ESBL colonization. Patients of neurologic rehabilitation and geriatric patients showed the highest rates of risk factors and the highest prevalence rates of multidrug-resistant organisms. It appears to be of importance for rehabilitation hospitals to be geared to the needs of patients with multidrug-resistant organisms, and prevent the transmission of these pathogens by appropriate hygiene measures.
    No preview · Article · Oct 2015 · Die Rehabilitation
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    Full-text · Article · Sep 2015 · Clinical Infectious Diseases
  • [Show abstract] [Hide abstract] ABSTRACT: Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected. Copyright © 2015. Published by Elsevier GmbH.
    No preview · Article · Aug 2015 · International journal of medical microbiology: IJMM
  • [Show abstract] [Hide abstract] ABSTRACT: Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge. © 2015, European Centre for Disease Prevention and Control (ECDC). All Rights Reserved.
    No preview · Article · Jul 2015 · Eurosurveillance: bulletin europeen sur les maladies transmissibles = European communicable disease bulletin
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    [Show abstract] [Hide abstract] ABSTRACT: The immune evasion gene cluster (IEC) is typical for Staphylococcus aureus isolated from humans but is usually absent in S. aureus isolated from animals. Previous studies have shown that methicillin resistant S. aureus (MRSA) CC398 obviously lost the IEC when evolving as livestock-associated MRSA from a human-adapted, methicillin-susceptible ancestor. This study aimed to look for the presence of IEC in MRSA from pigs and horses as well as from the colonization of humans with occupational animal contact and from infections in humans. For comparison, methicillin susceptible S. aureus (MSSA) isolates from infections in humans were included.
    Full-text · Article · Mar 2015 · Veterinary Microbiology
  • [Show abstract] [Hide abstract] ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) is a major cause of bacteraemia. We aimed for a complete picture of severe MRSA infections by characterizing all MRSA isolates from bloodstream infections in the largest German federal state (North Rhine-Westphalia, 18 million inhabitants) using S. aureus protein A (spa) sequence-typing and antimicrobial susceptibility testing. MRSA isolates (n=1,952) were prospectively (2011-2013) collected and spa-typed. Among 181 different spa types, t003 (n=746 isolates; 38.2%) and t032 (n=594; 30.4%) were predominant. Analysis of the geographical occurrence of spa clonal complexes (spa-CCs) and spa types revealed divergent distribution between federal state districts for spa-CCs 003 (p<0.001; including t003, p<0.001 and t264, p<0.001), 008 (p=0.021), 011 (p=0.002), 032 (p<0.001; including t022, p=0.014 and t032, p<0.001) and spa type t2807 (p<0.001).Minimum inhibitory concentrations (MICs) of antimicrobial substances were tested using broth microdilution. Of all isolates, 96% were resistant to fluoroquinolons, 78% to erythromycin, 70% to clindamycin, 4% to gentamicin, 2% to rifampicin, 0.4% to daptomycin, 0.1% to linezolid and 0% to vancomycin, respectively. Vancomycin MICs of 2 mg/L involved 0.5% of the isolates. In conclusion, the detection of regional molecular clusters added valuable information for epidemiological case tracing and allowed for conclusions on the importance of newly emerging MRSA reservoirs, such as livestock (spa-CC011), for MRSA bacteraemia in some parts of the federal state. Susceptibility testing revealed broad resistance to substances used for oral treatment, but demonstrated that those antibiotics that are mostly applied for treatment of MRSA bacteraemia and important combination partners were highly susceptible. Copyright © 2015. Published by Elsevier Ltd.
    No preview · Article · Feb 2015 · Clinical Microbiology and Infection
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    Full-text · Article · Sep 2014 · Berliner und Münchener tierärztliche Wochenschrift
  • [Show abstract] [Hide abstract] ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) causes colonization and infection both in animals and humans. In Germany, cases of MRSA colonization among humans, w+hich affect 0.5-1.5% of the general population and 1.0-2.5% of patients at hospital admission, are still mostly associated with previous healthcare contact and defined epidemic clonal lineages. However, MRSA is also distributed in livestock production in Germany, mostly without causing infections in the animals. These MRSA predominantly belong to the clonal complex (CC) 398, but also to CC9 and CC97. Zoonotic transmission of MRSA CC398 from livestock to humans occurs predominantly in people with occupational livestock contact. Spread of MRSA CC398 to household members of these persons is also frequently observed, but dissemination in the general population is limited so far However, especially in areas with intensive livestock husbandry, about 20-38% of MRSA CC398 cases among humans cannot be epidemiologically linked to direct livestock contact, indicating other transmission pathways. MRSA CC398 currently causes about 2% of all human MRSA infections (wound infections, pneumonia, sepsis) in Germany, but up to 10% in regions characterized by a high density of livestock-farming. The burden of MRSA in companion animals was demonstrated to range between 3.6-9.4% within wound samples obtained from dogs, cats and horses, respectively. In contrast to livestock and horses, MRSA distributed in pet animals are mostly associated with MRSA clonal lineages that are also prevalent in human healthcare facilities. Overall, zoonotic exchange of MRSA between humans and animals has relevant impact on the epidemiology of MRSA in Germany.
    No preview · Article · Sep 2014 · Berliner und Münchener tierärztliche Wochenschrift
  • No preview · Article · Sep 2014 · Berliner und Münchener tierärztliche Wochenschrift
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    Carmen Dahms · Nils-Olaf Hübner · Christiane Cuny · Axel Kramer
    [Show abstract] [Hide abstract] ABSTRACT: Background Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) has a wide host range and is transmissible to humans, especially to those with close contact to colonized animals. This study presents the first data on the occurrence of MRSA in farm workers and livestock farms (pig, cattle and poultry) in the federal state of Mecklenburg-Western Pomerania in northeast Germany. 78 farm workers at pig farms, cattle farms and poultry farms were tested for MRSA via pooled nasal and pharyngeal swabs. Additionally, from each of the 34 participating farms (17 pig farms, 11 cattle farms, 6 poultry farms) five dust samples were taken from the direct surroundings of the animals. Furthermore, oropharyngeal swabs were additionally taken from 10 animals per poultry farm. Isolated MRSA strains were characterized and confirmed using PCR and spa typing. Resistance patterns were obtained using the broth microdilution assay. Results In total, 20 of 78 (25.6%; 95% CI:17.3-36.3) farm workers were positive for MRSA. All MRSA-positive workers were employed at pig farms. Six of 17 (35.3%; 95% CI:17.3-58.7) pooled dust samples from pig farms were also positive. Overall, six spa types were identified, of which t034 predominated. All strains belonged to LA-MRSA CC398 and were resistant to tetracycline. Resistance to lincosamides, macrolides, fluoroquinolones and aminoglycosides was present in some strains. Three farm workers harbored the identical spa type and antimicrobial resistance pattern found in the corresponding dust sample. Neither workers, dust samples from cattle and poultry farms, nor oropharyngeal poultry swabs tested positive for MRSA. Conclusions The present study emphasizes the importance of MRSA on pig farms and pig-farm workers in the rural region of Mecklenburg-Western Pomerania, whereas LA-MRSA could not be isolated from cattle and poultry farms.
    Preview · Article · Aug 2014 · Acta Veterinaria Scandinavica