# Analysis of multidrug-resistant Gram-negative pathogens (MRGN) in different areas of the healthcare system and their significance in the outpatient sector

## TL;DR

This study examines the prevalence of multidrug-resistant Gram-negative pathogens in outpatients, highlighting the need for better data in outpatient healthcare settings.

## Contribution

The study provides new epidemiological data on MRGN and ESBL in outpatients from a travel medicine clinic.

## Key findings

- MRGN prevalence was 2.6% with 5 Escherichia coli and 1 Klebsiella pneumoniae cases.
- ESBL prevalence was 5.6%, with 13 ESBL Escherichia coli, 4 of which were also MRGN.
- Geographical and sector-specific data gaps were identified in the German healthcare system.

## Abstract

Given the global threat of increasing antibiotic resistance, risk factor detection of multi-resistant pathogens is particularly important. This is complicated by different definitions, using the international extended spectrum beta-lactamases (ESBL) definition and the German definition of multidrug-resistant Gram-negative pathogens (MRGN). Although the MRGN definition was primarily introduced for hospital hygiene measures, it is often used in outpatient or semi-inpatient areas. Due to the increasing numbers of outpatient treatments of the healthcare system, corresponding data is necessary for specific hygiene regulations.

This study provides MRGN and ESBL data based on a stool examination and a questionnaire evaluation in the period 07/2021–03/2022 of 231 outpatients of Saarland University Medical Center before traveling abroad.

There was a 3MRGN prevalence of 2.6% with five Escherichia coli and one Klebsiella pneumoniae and an ESBL prevalence of 5.6% with 13 ESBL Escherichia coli, four of which could also be classified as 3MRGN. These prevalences were compared with MRGN/ESBL prevalences in PubMed and Google Scholar in different areas of the German healthcare system in the period 2013–2024 at the federal state level. The selective literature search revealed geographical differences and missing prevalence data depending on the healthcare sector (outpatient/inpatient) and federal state.

Resistance data is often evaluated according to international standards, i.e. according to the ESBL definition. Outpatient MRGN prevalences are hardly known despite the increasing numbers of outpatients of the healthcare system. Due to the scarcity of outpatient data, our study from a travel medicine clinic provides interesting epidemiological data that should be considered in the context of the COVID-19 pandemic.