Secret to multi-resistant germs

Up to 15,000 deaths occur annually due to multi-drug resistant germs such as MRSA or VRE. Thus, the mortality rate of resistant germs is four times as high as in traffic accidents. Particularly affected are Lower Saxony and North Rhine-Westphalia. This is the result of statistics from the Robert Koch Institute, "the most important disease control facility in Germany". The statistic counts cases per ten thousand inhabitants in districts and cities. According to this, "ten of them have been constantly affected for years, so they are infection hot spots."

Specifically, these are the following cities and counties: Holzminden, Saxon Switzerland-Ore Mountains, Goslar, Nienburg (Weser), Northeim, Peine, Mönchengladbach, Hameln-Pyrmont, Höxter, Duisburg. More precise data, who got infected when and where, are hardly to get. Thus, information which hospitals or institutions were particularly affected, in short supply. However, these would be needed to see if the case numbers indicate institutional issues, such as hygiene issues, or if they are perhaps specialized in the treatment of multi-drug resistant bacteria. In addition, such information is of considerable interest to the inhabitants of the regions.

Health authorities wrap themselves in silence
Specific data on which hospitals were affected in which regions were available from the Robert Koch Institute (RKI). The reason for this is the fact that they are located at the local health authorities who register the cases and then pass them on anonymously to the RKI.

A request from Zeit-Online for detailed data yielded only half of the surveyed health authorities of the ten Infection Hotspots, while the other five failed to do so.

The reasons are quite different. Among other things, reasons of data protection or lack of staff were advanced and Zeit-Online indirectly even a hindrance to the work of the authorities accused: “In the responsible department we are staffed (...) very close. It would mean that a force could not devote itself to its consulting and control tasks because the data has to be selected for you.“ In addition, the authority remained guilty of the legal basis for alleged data protection: “Information as requested by you is subject to data protection. Therefore, an information is unfortunately not possible.“ In addition, Zeit-Online was accused of harming clinics economically and threatened with recourse claims in the event of cases: “Thus, from the point of view of § 823 Civil Code, § 1004 BGB (established and practiced business enterprise) e.g. to disapprove of a negative operating report in the sense of an unauthorized act and to trigger a corresponding claim for injunctive relief, if this leads to or is to be feared to have corresponding financial disadvantages.”

In addition, a health authority argued that violations of compliance with the Infection Protection Act would result in a loss of compliance by law-abiding hospitals complying with the obligation to notify, even though the health authorities are responsible for enforcing the reporting of such cases: “In fact, against a single statement that not all hospitals report their MRSA cases, that is, if we were to appoint the reporting hospitals, those who complied with the reporting requirement would be punished. Those who do not comply with the obligation to register would be in a good light.“ Only a public health service provided a substantive argument: “It should be mentioned that (...) is provable that far predominantly in the cases reported already at admission a positive MRSA (...) Findings has been present! (...) An in-house causation is not apparent (...).“

No data on the origin of the germs
In fact, the argument raises the question of how meaningful the statistics of the RKI are. Because it gives no information about whether patients have been treated with the germs, or if they were infected with it only in the hospital. Fatal in the face of 15,000 officially reported annual deaths, a presumably significantly higher number of unreported cases, and the significant importance of resistant bacteria and the growing ineffectiveness of antibiotics for healthcare. Therefore, the pathways of resistant germs should be well understood in order to counteract their spread. In the UK, such transparency has led to a significant reduction in the incidence of MRSA infections and in France, too, the infection routes are understandable to the population. In addition to the transparency of the pathways of resistant bacteria but also the responsible use of antibiotics is important in the fight against the pathogens. So reserve antibiotics should actually be used only as an ultima ratio. Alternatives exist in naturopathy, e.g. in the form of coriander oil. This has been fatal in tests for the extremely aggressive antibiotic-resistant MRSA pathogens. In any case, the treatment should be prescribed by a specialist.

After a long tug of war, nine of the ten health authorities responded to the request from Zeit-Online. Only the Health Department Goslar has maintained its position of refusal and still refuses any information. (Sb)

Picture: Urs Mücke