Background:  Infections caused by third generation cephalosporin-resistant Enterobacteriaceae (3GCREB) are an increasing healthcare problem. We aim to describe the  3GCREB infection incidence and compare it to prevalence upon admission.  In addition, we aim to describe infections caused by 3GCREB, which are  also carbapenem resistant (CRE).

Methods:  In 2014-2015, we performed prospective 3GCREB surveillance in  clinically relevant patient specimens (screening specimens excluded).  Infections counted as hospital-acquired (HAI) when the 3GCREB was  detected after the third day following admission, otherwise as  community-acquired infection (CAI).

Results: Of 578,420 hospitalized patients under surveillance, 3367 had a  3GCREB infection (0.58%). We observed a similar 3GCREB CAI and HAI  incidence (0.28 and 0.31 per 100 patients, respectively). The most  frequent pathogen was 3GCR E. coli, in CAI and HAI (0.15 and 0.12  per 100 patients). We observed a CRE CAI incidence of 0.006 and a HAI  incidence of 0.008 per 100 patients (0.014 per 1000 patient days).

Conclusions: Comparing the known 3GCREB admission prevalence of the  participating hospitals (9.5%) with the percentage of patients with a  3GCREB infection (0.58%), we conclude the prevalence of 3GCREB in  university hospitals to be about 16 times higher than suggested when  only patients with 3GCREB infections are considered. Moreover, we find  the HAI and CAI incidence caused by CRE in Germany to be relatively low.

Keywords: CRE; Carbapenem; Community-acquired infections; E. coli; ESBL;  Enterobacter spp.; Fluoroquinolone; Gram-negative;  Hospital-acquired infections; Klebsiella spp..

Conflict of interest statement

The  ethics committee at Charité, University Medicine Berlin, Germany,  approved this study (EA/018/14). Surveillance was performed in  accordance with the German Infection Protection Act and did not require  patient consent.(9).Not applicable.No competing interests unless stated.  MJGTV is a consultant to: Alb Fils Kliniken, Astellas Pharma, MaaT  Pharma, MSD/Merck; has served with the speakers’ bureau of: Astellas  Pharma, Basilea, Gilead Sciences, Merck/MSD, Organobalance and Pfizer;  received research funding from: 3 M, Astellas Pharma, DaVolterra, Gilead  Sciences, Merck/MSD, Morphochem, Organobalance, and Seres Therapeutics.  HS reports grants from Bundesministerium für Bildung und Forschung  (BMBF), the German Center for Infection Research (DZIF), Cubist, and  Novartis, and personal fees from Astellas-Basilea, Cubist, Durata,  Genentech, Gilead, MSD, Roche Pharma, and Tetraphase. JKMK received  research and travel grants from Novartis, bioMérieux, Bayer Vital, and  Alere and served as consultant or speaker for bioMérieux, Novartis,and  Pfizer. JZ received a speaker’s honorarium from Pfizer.Springer Nature  remains neutral with regard to jurisdictional claims in published maps  and institutional affiliations.