{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:29:39Z","timestamp":1787934579124,"version":"build-2784847793"},"reference-count":19,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T00:00:00Z","timestamp":1631059200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100003107","name":"Bundesministerium f\u00fcr Gesundheit","doi-asserted-by":"publisher","award":["IIA5-2512FSB114"],"award-info":[{"award-number":["IIA5-2512FSB114"]}],"id":[{"id":"10.13039\/501100003107","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01EO1502"],"award-info":[{"award-number":["01EO1502"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01 ZZ 1803C"],"award-info":[{"award-number":["01 ZZ 1803C"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100012957","name":"Friedrich-Schiller-Universit\u00e4t Jena","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100012957","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Antimicrob Resist Infect Control"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Monitoring pathogens of bloodstream infections (BSI) and their antibiotic susceptibility is important to guide empiric antibiotic treatment strategies and prevention programs.<\/jats:p>\n                <jats:p>This study assessed the epidemiology of BSI and antibiotic resistance patterns at the German Federal State of Thuringia longitudinally.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>A surveillance network consisting of 26 hospitals was established to monitor BSIs from 01\/2015 to 12\/2019. All blood culture results, without restriction of age of patients, of the participating hospitals were reported by the respective microbiological laboratory. A single detection of obligate pathogens and a repeated detection of coagulase-negative staphylococci, <jats:italic>Bacillus<\/jats:italic> spp., <jats:italic>Corynebacterium<\/jats:italic> spp., <jats:italic>Micrococcus<\/jats:italic> spp. and <jats:italic>Propionibacterium<\/jats:italic> spp., within 96\u00a0h were regarded as a relevant positive blood culture. If one of the aforementioned non-obligate pathogens has been detected only once within 96\u00a0h, contamination has been assumed. Logistic regression models were applied to analyse the relationship between resistance, year of BSI and hospital size. Generalized estimating equations were used to address potential clustering.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>A total of 343,284 blood cultures (BC) of 82,527 patients were recorded. Overall, 2.8% (n\u2009=\u20099571) of all BCs were classified as contaminated. At least one relevant pathogen was identified in 13.2% (n\u2009=\u200945,346) of BCs. <jats:italic>Escherichia coli<\/jats:italic> (25.4%) was the most commonly detected pathogen, followed by <jats:italic>Staphylococcus aureus<\/jats:italic> (15.2%), <jats:italic>Staphylococcus epidermidis<\/jats:italic> (8.1%) and <jats:italic>Klebsiella pneumoniae<\/jats:italic> (4.6%). In <jats:italic>S. aureus,<\/jats:italic> we observed a decline of methicillin resistance (MRSA) from 10.4% in 2015 to 2.5% in 2019 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001). The rate of vancomycin resistance in <jats:italic>Enterococcus faecium<\/jats:italic> (VRE) has increased from 16.7% in 2015 to 26.9% in 2019 (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001), with a peak in 2018 (42.5%). In addition, we observed an increase of Cefotaxime (3GC) resistance in <jats:italic>E. coli<\/jats:italic> from 10.7% in 2015 to 14.5% in 2019 (<jats:italic>p<\/jats:italic>\u2009=\u20090.007) whereas 3GC resistance in <jats:italic>K. pneumoniae<\/jats:italic> was stable (2015: 9.9%; 2019: 7.4%, <jats:italic>p<\/jats:italic>\u2009=\u20090.35). Carbapenem resistance was less than 1% for both pathogens. These patterns were robustly observed across sensitivity analyses.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>We observed evidence for a decline in MRSA, an increase in VRE and a very low rate of carbapenem resistance in gram-negative bacteria. 3GC resistance in <jats:italic>E. coli<\/jats:italic> increased constantly over time.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13756-021-00997-6","type":"journal-article","created":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T03:30:28Z","timestamp":1631071828000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["The epidemiology of bloodstream infections and antimicrobial susceptibility patterns in Thuringia, Germany: a five-year prospective, state-wide surveillance study (AlertsNet)"],"prefix":"10.1186","volume":"10","author":[{"given":"Franziska","family":"Sch\u00f6neweck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roland P. H.","family":"Schmitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florian","family":"Ri\u00dfner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andr\u00e9","family":"Scherag","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bettina","family":"L\u00f6ffler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mathias W.","family":"Pletz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Weis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank M.","family":"Brunkhorst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2999-6131","authenticated-orcid":false,"given":"Stefan","family":"Hagel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,9,8]]},"reference":[{"key":"997_CR1","doi-asserted-by":"publisher","first-page":"492","DOI":"10.1111\/1469-0691.12144","volume":"19","author":"KB Laupland","year":"2013","unstructured":"Laupland KB. Incidence of bloodstream infection: a review of population-based studies. Clin Microbiol Infect. 2013;19:492\u2013500.","journal-title":"Clin Microbiol Infect"},{"key":"997_CR2","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1111\/1469-0691.12195","volume":"19","author":"M Goto","year":"2013","unstructured":"Goto M, Al-Hasan MN. Overall burden of bloodstream infection and nosocomial bloodstream infection in North America and Europe. Clin Microbiol Infect. 2013;19:501\u20139.","journal-title":"Clin Microbiol Infect"},{"key":"997_CR3","doi-asserted-by":"publisher","first-page":"205","DOI":"10.1186\/s12879-017-2291-2","volume":"17","author":"A Mehl","year":"2017","unstructured":"Mehl A, \u00c5svold BO, Lydersen S, Paulsen J, Sollig\u00e5rd E, Dam\u00e5s JK, et al. Burden of bloodstream infection in an area of Mid-Norway 2002\u20132013: a prospective population-based observational study. BMC Infect Dis. 2017;17:205.","journal-title":"BMC Infect Dis"},{"key":"997_CR4","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1086\/376606","volume":"37","author":"KP High","year":"2003","unstructured":"High KP. Why should the infectious diseases community focus on aging and care of the older adult? Clin Infect Dis. 2003;37:196\u2013200.","journal-title":"Clin Infect Dis"},{"key":"997_CR5","doi-asserted-by":"publisher","first-page":"S5","DOI":"10.1016\/j.ijantimicag.2015.10.004","volume":"46","author":"RPH Schmitz","year":"2015","unstructured":"Schmitz RPH, Ri\u00dfner F, Brunkhorst FM. The Thuringian registry for bloodstream infections, antibiotic resistance and the practice of blood culture sampling\u2014AlertsNet. Int J Antimicrob Agents. 2015;46:S5-9.","journal-title":"Int J Antimicrob Agents"},{"key":"997_CR6","doi-asserted-by":"publisher","first-page":"146","DOI":"10.1186\/1756-0500-2-146","volume":"2","author":"KB Laupland","year":"2009","unstructured":"Laupland KB, Sch\u00f8nheyder HC, Kennedy KJ, Lyytik\u00e4inen O, Valiquette L, Galbraith J, et al. Rationale for and protocol of a multi-national population-based bacteremia surveillance collaborative. BMC Res Notes. 2009;2:146.","journal-title":"BMC Res Notes"},{"key":"997_CR7","unstructured":"Seifert H, Abele-Horn M, F\u00e4tkenheuer G, Gl\u00fcck T, Jansen B, Kern WV, et al. MIQ 03b: Blutkulturdiagnostik - Sepsis, Endokarditis, Katheterinfektionen (Teil II) - 9783437226083 | Elsevier GmbH. Qualit\u00e4tsstandards in der mikrobiologisch-infektiologischen Diagnostik [Internet]. 2. 2007 [cited 2020 May 7]. https:\/\/shop.elsevier.de\/miq-03b-blutkulturdiagnostik-sepsis-endokarditis-katheterinfektionen-teil-ii-9783437226083.html."},{"key":"997_CR8","doi-asserted-by":"publisher","first-page":"e01129-19","DOI":"10.1128\/JCM.01129-19","volume":"57","author":"G Kahlmeter","year":"2019","unstructured":"Kahlmeter G, Giske CG, Kirn TJ, Sharp SE. Point-counterpoint: differences between the European Committee on Antimicrobial Susceptibility Testing and clinical and laboratory standards institute recommendations for reporting antimicrobial susceptibility results. J Clin Microbiol. 2019;57:e01129-19.","journal-title":"J Clin Microbiol"},{"key":"997_CR9","doi-asserted-by":"publisher","first-page":"964","DOI":"10.1016\/j.cmi.2018.03.030","volume":"24","author":"S Darg\u00e8re","year":"2018","unstructured":"Darg\u00e8re S, Cormier H, Verdon R. Contaminants in blood cultures: importance, implications, interpretation and prevention. Clin Microbiol Infect. 2018;24:964\u20139.","journal-title":"Clin Microbiol Infect"},{"key":"997_CR10","doi-asserted-by":"publisher","first-page":"2435","DOI":"10.1055\/s-2002-35463","volume":"127","author":"EJK Rosenthal","year":"2002","unstructured":"Rosenthal EJK. Epidemiologie von Septik\u00e4mie-Erregern. Dtsch Med Wochenschr. 2002;127:2435\u201340.","journal-title":"Dtsch Med Wochenschr"},{"key":"997_CR11","doi-asserted-by":"publisher","first-page":"S47","DOI":"10.1093\/ofid\/ofy270","volume":"6","author":"DJ Diekema","year":"2019","unstructured":"Diekema DJ, Pfaller MA, Shortridge D, Zervos M, Jones RN. Twenty-year trends in antimicrobial susceptibilities among staphylococcus aureus from the SENTRY antimicrobial surveillance program. Open Forum Infect Dis. 2019;6:S47-53.","journal-title":"Open Forum Infect Dis"},{"key":"997_CR12","doi-asserted-by":"crossref","unstructured":"Walter J, Noll I, Feig M, Weiss B, Claus H, Werner G, et al. Decline in the proportion of methicillin resistance among Staphylococcus aureus isolates from non-invasive samples and in outpatient settings, and changes in the co-resistance profiles: an analysis of data collected within the Antimicrobial Resistance Surveillance Network, Germany 2010 to 2015. BMC Infect Dis [Internet]. 2017 [cited 2020 Jun 19];17. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC5324250\/.","DOI":"10.1186\/s12879-017-2271-6"},{"key":"997_CR13","unstructured":"(ARS) Antibiotika-Resistenz-Surveillance in Deutschland [Internet]. https:\/\/ars.rki.de."},{"key":"997_CR14","unstructured":"European Centre for Disease Prevention and Control. Surveillance of antimicrobial resistance in Europe 2018. Stockholm: ECDC; 2019."},{"key":"997_CR15","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1186\/s13756-019-0594-3","volume":"8","author":"R Markwart","year":"2019","unstructured":"Markwart R, Willrich N, Haller S, Noll I, Koppe U, Werner G, et al. The rise in vancomycin-resistant Enterococcus faecium in Germany: data from the German Antimicrobial Resistance Surveillance (ARS). Antimicrob Resist Infect Control. 2019;8:147.","journal-title":"Antimicrob Resist Infect Control"},{"key":"997_CR16","first-page":"365","volume":"37","author":"I Klare","year":"2019","unstructured":"Klare I, Bender J, Marktwart R, Reuss A, Abu Sin M, Eckmanns T, et al. Eigenschaften, H\u00e4ufigkeit und Verbreitung von Vancomycin-resistenten Enterokokken in Deutschland\u2014Update 2017\/2018. Epid Bull. 2019;37:365\u201372.","journal-title":"Epid Bull"},{"key":"997_CR17","doi-asserted-by":"publisher","first-page":"1139","DOI":"10.1086\/342904","volume":"35","author":"AK Zaas","year":"2002","unstructured":"Zaas AK, Song X, Tucker P, Perl TM. Risk factors for development of vancomycin-resistant enterococcal bloodstream infection in patients with cancer who are colonized with vancomycin-resistant enterococci. Clin Infect Dis Oxford Acad. 2002;35:1139\u201346.","journal-title":"Clin Infect Dis Oxford Acad"},{"key":"997_CR18","doi-asserted-by":"crossref","unstructured":"Barger M, Blodget E, Pena S, Mack W, Fong T-L. VRE in cirrhotic patients. BMC Infect Dis [Internet]. 2019 [cited 2020 Jul 8];19. https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC6693083\/.","DOI":"10.1186\/s12879-019-4352-1"},{"key":"997_CR19","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1016\/S1473-3099(18)30353-0","volume":"18","author":"K-D Vihta","year":"2018","unstructured":"Vihta K-D, Stoesser N, Llewelyn MJ, Quan TP, Davies T, Fawcett NJ, et al. Trends over time in Escherichia coli bloodstream infections, urinary tract infections, and antibiotic susceptibilities in Oxfordshire, UK, 1998\u20132016: a study of electronic health records. Lancet Infect Dis. 2018;18:1138\u201349.","journal-title":"Lancet Infect Dis"}],"container-title":["Antimicrobial Resistance &amp; Infection Control"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13756-021-00997-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s13756-021-00997-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s13756-021-00997-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,9,8]],"date-time":"2021-09-08T03:36:40Z","timestamp":1631072200000},"score":1,"resource":{"primary":{"URL":"https:\/\/aricjournal.biomedcentral.com\/articles\/10.1186\/s13756-021-00997-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,8]]},"references-count":19,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["997"],"URL":"https:\/\/doi.org\/10.1186\/s13756-021-00997-6","relation":{},"ISSN":["2047-2994"],"issn-type":[{"value":"2047-2994","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,8]]},"assertion":[{"value":"17 May 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 August 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"8 September 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"AlertsNet was approved by the Ethics Committee of the State Chamber of Physicians of Thuringia (Jena; 3 February 2014). The project protocol and technical IT concept were approved by the Thuringian State Commissioner for Data Protection and Freedom of Information (Erfurt, 10 April 2015, AZ: 278-7\/2014.42).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent fur publication"}},{"value":"All authors declare that they have no potential financial or ethical conflicts of interest regarding the contents of the publication.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"132"}}