Test, test, test for COVID-19 antibodies: the importance of sensitivity, specificity and predictive powers.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody tests of varying specificity and sensitivity are now available. For informing individuals whether they have had coronavirus disease 2019 (COVID-19), they need to be very accurate. For measuring population prevalence of past infection, the numbers of false positives and negatives need to be roughly equal. With a series of worked examples for a notional population of 100,000 people, we show that even test systems with a high specificity can yield a large number of false positive results, especially where the population prevalence is low. For example, at a true population prevalence of 5%, using a test with 99% sensitivity and specificity, 16% of positive results will be false and thus 950 people will be incorrectly informed they have had the infection. Further confirmatory testing may be needed. Giving false reassurance on which personal or societal decisions might be based could be harmful for individuals, undermine public confidence and foster further outbreaks.

Genotypic Characterization of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Isolates of Clonal Complex 398 in Pigsty Visitors: Transient Carriage or Persistence?

Livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) of clonal complex (CC) 398 has become a rising issue for public health. While it is known that >80% of pig farmers are colonized with LA-MRSA, only a few studies have assessed the situation for humans with occasional livestock contact. Recently it was shown that over 75% of scientific fieldworkers visiting pigsties were temporarily carrying LA-MRSA. To find out whether they were transiently or permanently colonized, we used whole-genome sequencing (WGS) data to analyze the relatedness of isolates from these recurrently LA-MRSA-positive fieldworkers and from corresponding pigsties. Sequences were analyzed using in silico typing (spa and core genomic multilocus sequence typing [cgMLST]), and the BEAST software package was used to examine phylogeny. In total, 81 samples from three fieldworkers on eight different pigsties over a period of 2.5 years were sequenced. All isolates belonged to spa type t011, t034, or t2011, with different types found in the same fieldworker at different time points. Analysis of cgMLST revealed nine genotypic clusters, mostly correlating with the pigsty on which they were sampled. Fieldworker isolates clustered with the samples from farms that were visited on the same day. BEAST analysis corroborated the cgMLST-based clustering and suggests an origin of the lineage about 22 years ago. We conclude that nasal LA-MRSA colonization among humans with occasional livestock contact is common but most likely only temporary. Furthermore, we showed that the Western German LA-MRSA CC398 originated in the late 1990s and diversified into farm-specific genotypes, which stay relatively consistent over time.

Searching for the source of Ebola: the elusive factors driving its spillover into humans during the West African outbreak of 2013-2016.

The natural ecology of Ebola virus infection remains enigmatic. No clear reservoir species has been confirmed but there is evidence of infection in a wide spectrum of mammals, including humans, non-human primates, domestic and wild ungulates and a variety of bat species, both frugivorous and insectivorous. Humans and most other species examined appear to be spillover hosts and suffer disease. Bats are the exception and are tolerant to infection in some laboratory studies. Some surveys show a low prevalence of antibodies against Zaire Ebola virus (ZEBOV) strains in bats during human outbreaks and inter-epidemic periods, and this order of mammals is considered to be the likely reservoir for the virus. Other putative sources include insects but this hypothesis is unproven in the field or laboratory. Moreover, some potential sources, such as aquatic species, have yet to be investigated. There are a number of environmental, human behavioural and ecological risk factors proposed with respect to spillover and spread. In the West African outbreak, which was unprecedented in scale and geographic spread, the source of the spillover remains unproven, although an association exists between the proposed index case and a colony of insectivorous bats. In all but a few Ebola virus disease events, spillover has only been superficially investigated and this was also the case in the West African epidemic. The authors suggest that, to address risks at the human-animal-environmental interface, using a One Health approach, more effort is needed to investigate spillover factors at the time of a ZEBOV epidemic, in addition to conducting inter-epidemic surveys in peridomestic environments. The true prevalence of ZEBOV infection in any species of bats remains unknown. Large-scale, expensive, non-randomised surveys, with low sampling numbers per species, are unlikely to provide evidence for Ebola virus reservoirs or to improve our epidemiological understanding.

L'écologie naturelle de l'infection par le virus Ebola demeure énigmatique. Si aucune espèce réservoir au sens strict n'a été clairement identifiée, le virus peut infecter un large spectre d'espèces de mammifères, parmi lesquelles l'être humain, des primates non humains, des ongulés domestiques et sauvages ainsi que de très nombreuses espèces de chauves-souris tant frugivores qu'insectivores. Les humains et la plupart des espèces animales étudiées semblent être des hôtes incidents chez qui la maladie se développe. Les chauves-souris constituent l'exception, certaines études de laboratoire ayant prouvé qu'elles sont tolérantes à l'infection. Des enquêtes ayant montré la présence d'anticorps dirigés contre les souches Zaïre du virus Ebola (Ebola-Zaïre) chez les chauves-souris, à un taux faible de prévalence, pendant les périodes d'activité des foyers chez l'homme ou dans les intervalles inter-épidémiques, cet ordre de mammifères est considéré comme un réservoir possible du virus. Les insectes constituent aussi des sources présumées mais cette hypothèse n'est pas encore démontrée sur le terrain ni même au laboratoire. D'autres sources potentielles doivent encore être étudiées, par exemple parmi les espèces aquatiques. Un certain nombre de facteurs de risque environnementaux, anthropiques et écologiques ont été proposés pour expliquer la transmission entre espèces et la propagation du virus. En ce qui concerne le foyer survenu en Afrique de l'Ouest, sans précédent par son ampleur et par son étendue géographique, la source de la transmission demeure inconnue bien qu'une corrélation ait été observée entre le cas index présumé et la présence d'une colonie de chauves-souris insectivores. Dans pratiquement tous les événements dus au virus Ebola (et l'épidémie en Afrique de l'Ouest ne fait pas exception), l'origine de la transmission n'a guère fait l'objet d'investigations approfondies. Pour que les risques à l'interface humains­ animaux­environnement puissent être traités selon la méthode Une seule santé, les auteurs estiment indispensable d'élucider au préalable les facteurs de transmission qui ont pu intervenir lors des épidémies dues au virus Ebola-Zaïre, en plus des enquêtes à effectuer entre deux épidémies et dans un environnement péridomestique. Nous ignorons encore quelle est la prévalence réelle de l'infection par le virus EbolaZaïre chez les chauves-souris, toutes espèces confondues. Il est peu probable que des enquêtes à grande échelle, onéreuses et basées sur des échantillons non aléatoires constitués d'un faible nombre d'individus par espèce parviennent à identifier les réservoirs du virus Ebola ou à améliorer nos connaissances sur son épidémiologie.

La ecología natural de la infección por el virus del Ebola sigue siendo enigmática. No hay especie en la que esté probada una clara función de reservorio, aunque existen datos demostrativos de infección en muy diversos mamíferos, como el ser humano, primates no humanos, ungulados domésticos y silvestres y varias especies de murciélago, tanto frugívoras como insectívoras. El ser humano y la mayoría de las especies estudiadas parecen ser hospedadores no preferentes y padecer la enfermedad, con la única excepción de los murciélagos, que a tenor de ciertos estudios de laboratorio son tolerantes a la infección. En estos animales, algunas investigaciones realizadas sobre el terreno muestran una baja prevalencia de anticuerpos contra cepas de la especie Zaire del virus durante los brotes de infección en el hombre y en los periodos interepidémicos, y se considera probable que este orden de mamíferos sea el reservorio del virus. Se presume que otra fuente podrían ser los insectos, pero ni los datos de laboratorio ni los obtenidos sobre el terreno avalan por ahora tal hipótesis. Además, aún hay otras posibles fuentes por estudiar, como ciertas especies acuáticas. Con respecto a la extensión secundaria y la propagación del virus se han apuntado una serie de posibles factores de riesgo de índole ambiental o ecológica o ligados al comportamiento humano. En el caso del brote habido en África Occidental, que revistió una escala y un alcance geográfico sin precedentes, no se ha demostrado aún cuál fue la fuente de la extensión secundaria, aunque existe una relación entre el caso índice propuesto y una colonia de murciélagos insectívoros. En casi todos los episodios de enfermedad por el virus del Ebola la extensión secundaria se ha investigado solo de forma superficial, como también fue el caso de la epidemia de África Occidental. Los autores sugieren que, para abordar los riesgos existentes en la interfaz del ser humano, los animales y el medio ambiente en clave de Una sola salud, es preciso investigar más a fondo los factores que inducen la extensión secundaria durante una epidemia del virus Zaire del Ebola, además de efectuar estudios del medio peridoméstico en las fases interepidémicas. En ninguna especie de murciélago se conoce aún la verdadera prevalencia de la infección por el virus Zaire. Es poco probable que la realización de onerosos estudios no aleatorizados a gran escala, con la obtención de un pequeño número de muestras por especie, depare indicios sólidos en cuanto a los reservorios del virus del Ebola o nos sirva para entender mejor su epidemiología.

Low-level antimicrobial resistance of Enterobacteriaceae isolated from the nares of pig-exposed persons.

Extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) have recently emerged in livestock and humans. Therefore, this study assessed the carriage of Enterobacteriaceae in the anterior nares and associated antimicrobial resistance in pig-exposed persons. Nasal swabs were enriched in non-selective broth and then plated on MacConkey and ESBL-selective agars. Species was confirmed by matrix-assisted laser-desorption ionization-time-of-flight mass spectrometry (MALDI-ToF MS). Antimicrobial susceptibility testing was performed according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines. Of 114 pig-exposed persons tested, Enterobacteriaceae were detected in the nares of 76 (66·7%) participants. The predominant species were Proteus mirabilis (n = 17, 14·9%), Pantoea agglomerans (n = 13, 11·4%), Morganella morganii (n = 9, 7·9%), Citrobacter koseri (n = 9, 7·9%), Klebsiella pneumoniae, Escherichia coli and Proteus vulgaris (each n = 8, 7·0%). ESBL-E were not detected. Of all isolates tested, 3·4% were resistant against ciprofloxacin, 2·3% against gentamicin, 23·9% against trimethoprim-sulfamethoxazole and 44·3% against tigecycline. Despite the high prevalence of ESBL-E in livestock, pig-exposed persons did not carry ESBL-E in their nares. This finding is important, because colonization of the nasal reservoir might cause endogenous infections or facilitate transmission of ESBL-E in the general population.

Vertebrate reservoirs and secondary epidemiological cycles of vector-borne diseases.

Vector-borne diseases of importance to human and domestic animal health are listed and the increasing emergence of syndromes, new epidemiological cycles and distributions are highlighted. These diseases involve a multitude of vectors and hosts, frequently for the same pathogen, and involve natural enzootic cycles, wild reservoirs and secondary epidemiological cycles, sometimes affecting humans and domestic animals. On occasions the main reservoir is in the domestic environment. Drivers for secondary cycles are mainly related to human impacts and activities and therefore, for purposes of prevention and control, the focus needs to be on the socioecology of the diseases. Technical and therapeutical solutions exist, and for control there needs to be a clear understanding of the main vertebrate hosts or reservoirs and the main vectors. The targets of interventions are usually the vector and/or secondary epidemiological cycles and, in the case of humans and domestic animals, the spillover or incidental hosts are treated. More attention needs to be given to the importance of the political economy in relation to vector-borne diseases, as many key drivers arise from globalisation, climate change and changes in structural ecologies. Attention to reducing the risk of emergence of new infection cycles through better management of the human-animal-environment interface is urgently needed.

Systematic literature analysis and review of targeted preventive measures to limit healthcare-associated infections by meticillin-resistant Staphylococcus aureus.

Meticillin-resistant Staphylococcus aureus (MRSA) is a major cause of healthcare-associated infections in Europe. Many examples have demonstrated that the spread of MRSA within healthcare settings can be reduced by targeted infection control measures. The aim of this systematic literature analysis and review was to summarise the evidence for the use of bacterial cultures for active surveillance the benefit of rapid screening tests, as well as the use of decolonisation therapies and different types of isolation measures. We included 83 studies published between 2000 and 2012. Although the studies reported good evidence supporting the role of active surveillance followed by decolonisation therapy, the effectiveness of single-room isolation was mostly shown in non-controlled studies, which should inspire further research regarding this issue. Overall, this review highlighted that when planning the implementation of preventive interventions, there is a need to consider the prevalence of MRSA, the incidence of infections, the competing effect of standard control measures (e.g. hand hygiene) and the likelihood of transmission in the respective settings of implementation.

A review of bovine tuberculosis at the wildlife-livestock-human interface in sub-Saharan Africa.

Infection of wild animals by bovine tuberculosis (bTB) is raising concern worldwide. This article reviews the current epidemiological situation, risk of emergence and control options at the wildlife­livestock­human interface in sub-Saharan Africa. In livestock, bTB has been confirmed in the majority of countries from all parts of the continent. Wildlife infection is confirmed in seven countries from southern and eastern Africa, apparently spreading in the southern Africa region. Mycobacterium bovis has been isolated from 17 wild mammal species, although only four are suspected to play a role as maintenance host. Zoonotic risks are a concern, but no direct spillover from wildlife to humans has been documented, and no case of bTB spillback from wildlife to livestock has been confirmed. In this paper we assess the main risk factors of bTB spillover at the wildlife­livestock­human interface and suggest several research themes which could improve the control of the disease in the African context.

From theory to practice: molecular strain typing for the clinical and public health setting.

The persistence and transmission of infectious disease is one of the most enduring and daunting concerns in healthcare. Over the years, epidemiological analysis especially of bacterial etiological agents has undergone a remarkable evolutionary metamorphosis. While initially relying on purely phenotypic characterisation, advances in molecular biology have found translational application in a number of approaches to strain typing which commonly centre either on 'epityping' (molecular epidemiology) to characterise outbreaks, perform surveillance, and trace evolutionary pathways, or 'pathotyping' to compare strains based on the presence or absence of specific virulence or resistance genes. A perspective overview of strain typing is presented here considering the issues surrounding analyses which are employed in the localised clinical setting as well as at a more regional/national public health level. The discussion especially considers the shortcomings inherent in epidemiological analysis: less than full isolate characterisation by the typing method and limitations imposed by the available data, context, and time constraints of the epidemiological investigation (i.e. the available epidemiological window). However, the promises outweigh the pitfalls as one considers the potential for advances in genomic characterisation and information technology to provide an unprecedented aggregate of epidemiological information and analysis.

Reduction of the nosocomial meticillin-resistant Staphylococcus aureus incidence density by a region-wide search and follow-strategy in forty German hospitals of the EUREGIO, 2009 to 2011.

Meticillin-resistant Staphylococcus aureus (MRSA) disseminates between hospitals serving one patient catchment area. Successful prevention and control requires concerted efforts and regional surveillance. Forty hospitals located in the German EUREGIO have established a network for combating MRSA. In 2007 they agreed upon a synchronised strategy for screening of risk patients and a standard for transmissionbased precautions (search and follow). The same year, the hospitals started synchronised MRSA prevention and annually reporting MRSA-data to the public health authorities. The median rate of screening cultures per 100 patients admitted increased from 4.38 in 2007 to 34.4 in 2011 (p<0.0001). Between 2007 and 2011, the overall incidence density of MRSA (0.87 MRSA cases/1,000 patient days vs 1.54; p<0.0001) increased significantly. In contrast, both the incidence density of nosocomial MRSA cases (0.13 nosocomial MRSA cases/1,000 patient days in 2009 vs 0.08 in 2011; p=0.0084) and the MRSA-days-associated nosocomial MRSA rate (5.51 nosocomial MRSA cases/1,000 MRSA days in 2009 vs 3.80 in 2011; p=0.0437) decreased significantly after the second year of the project. We documented adherence to the regional screening strategy resulting in improved detection of MRSA carriers at admission. Subsequently, after two years the nosocomial MRSA-incidence density was reduced. Regional surveillance data, annually provided as benchmarking to the regional hospitals and public health authorities, indicated successful prevention.

Methicillin-resistant Staphylococcus aureus (MRSA): burden of disease and control challenges in Europe.

Methicillin-resistant Staphylococcus aureus (MRSA) isa major cause of healthcare- and community-associated infections worldwide. Within the healthcare setting alone, MRSA infections are estimated to affect more than 150,000 patients annually in the European Union (EU), resulting in attributable extra in-hospital costs of EUR 380 million for EU healthcare systems. Pan-European surveillance data on bloodstream infections show marked variability among EU Member States in the proportion of S. aureus that are methicillin-resistant, ranging from less than 1% to more than 50%. In the past five years, the MRSA bacteraemia rates have decreased significantly in 10 EU countries with higher endemic rates of MRSA infections. In addition to healthcare-associated infections, new MRSA strains have recently emerged as community and livestock-associated human pathogens in most EU Member States. The prevention and control of MRSA have therefore been identified as public health priorities in the EU. In this review, we describe the current burden of MRSA infections in healthcare and community settings across Europe and outline the main threats caused by recent changes in the epidemiology of MRSA. Thereby, we aim at identifying unmet needs of surveillance, prevention and control of MRSA in Europe.

Disease risks associated with the translocation of wildlife.

Translocation is defined as the human-managed movement of living organisms from one area for free release in another. Throughout the world, increasing numbers of animals are translocated every year. Most of these movements involve native mammals, birds and fish, and are made by private and national wildlife agencies to augment existing populations, usually for sporting purposes. The translocation of endangered species, often to reintroduce them into a part of the historical range from which they have been extirpated, has also become an important conservation technique. The main growth in reintroduction projects over the last decade has involved smaller animals, including amphibians, insects and reptiles. The success of potentially expensive, high-profile wildlife translocation projects depends to a large extent on the care with which wildlife biologists and their veterinary advisers evaluate the suitability of the animals and chosen release site, and on the ability of the translocated animals to colonise the area. The veterinary aspects of reintroduction projects are of extreme importance. There are instances of inadequate disease risk assessment resulting in expensive failures and, worse still, the introduction of destructive pathogens into naïve resident wildlife populations. In this paper, some of the disease risks attending wildlife translocation are described. Risk assessment, involving the examination of founder and recipient populations and their habitats, is now a pre-requisite of managed movements of animals.

[Multidrug-resistant bacteria in animals and humans]. / Multiresistente Erreger bei Tier und Mensch.

BACKGROUND: The increasing burden of antimicrobial-resistant bacteria causes morbidity and mortality, especially among patients affected by healthcare-associated infections. Limited treatment options challenge clinicians in both human and veterinary medicine. OBJECTIVES: To summarize current evidence for the occurrence of antimicrobial-resistant bacteria and their zoonotic transmission between humans and animals with a focus on data from Germany. MATERIALS AND METHODS: Review of scientific literature and publications from German national public health institutions. RESULTS AND CONCLUSIONS: Methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum ß­lactamase (ESBL) producing Enterobacteriaceae are frequently transmitted between animals and humans. The rates of asymptomatic carriage are increased among persons with livestock contact compared with the general population. The occurrence of carbapenemase-producing Enterobacteriaceae has been documented on German pig and chicken farms, but investigations into their prevalence and zoonotic importance are pending. Colistin is frequently used in veterinary medicine to treat diarrhoea and causes selection pressure for colistin-resistant Gram-negative bacteria harbouring mcr genes. Vancomycin-resistant enterococci (VRE), oxazolidinone-resistant Gram-positive bacteria and multiresistant staphylococci are further antimicrobial-resistant microorganisms, which might have a zoonotic potential. Besides human healthcare and livestock, the problem of antimicrobial-resistant bacteria also affects companion animals (e. g. dogs, cats and horses), wildlife and the environment, which underlines the need to prevent antimicrobial resistance in a One Health approach.

A metronidazole metabolite in human urine and its risk.

Metronidazole is a drug used for the treatment of trichomonal vaginitis, amebiasis, giardiasis, and certain anaerobic bacterial infections in humans. Acetamide and N-(2-hydroxyethyl)oxamic acid are metabolites of metronidazole in the rat, and we find small amounts of both metabolites in the urine of human patients taking the drug. Although acetamide is carcinogenic for rats, we do not believe that our finding further defines metronidazole's risk for humans. That risk can only be estimated from surveillance of people previously exposed to the drug.

Prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among pigs on German farms and import of livestock-related MRSA into hospitals.

The aim of this study was to evaluate the prevalence and molecular characteristics of methicillin-resistant Staphylococcus aureus (MRSA) among pigs and estimate the impact of this animal reservoir on human healthcare. Nasal swabs were derived from 1,600 pigs at 40 German farms. The MRSA were characterized using S. aureus protein A (spa) typing, multilocus sequence typing (MLST) and detection of toxin genes. In a retrospective case control study, we compared risk factors for the carriage of MRSA between patients carrying spa types found among regional pigs and patients with other MRSA molecular types. Pigs carrying MRSA were identified on 70% of the farms (spa types t011, t034, t108, t1451 and t2510, all associated with MLST sequence type ST398). Contact to pigs and cattle were independent risk factors for the carriage of these spa types in patients at hospital admission. Our results indicate that livestock represents a relevant reservoir for the import of MRSA into regional German hospitals.

Single-nucleotide polymorphism in the SCCmec-orfX junction distinguishes between livestock-associated MRSA CC398 and human epidemic MRSA strains.

A number of real-time PCR assays for direct detection of methicillinresistant (MRSA) in clinical specimens are targeting staphylococcal cassette chromosome mec (SCCmec) right extremity sequences and the S. aureus chromosomal orfX gene sequences located to the right of the SCCmec integration site. When testing 184 MRSA strains of human and animal origin from geographically distinct locations, we identified several characteristic single-nucleotide polymorphisms (SNPs) within the SCCmec-orfX junction of livestock-associated (LA) MRSA CC398 which serve as suitable strain markers for screening purposes. Within an assay time of 60 minutes and an additional 10 minutes for the melting curve analysis, all MRSA CC398 isolates were correctly identified by their characteristic T(m) value in the commercial LightCycler MRSA Advanced test. Studies to confirm the diagnostic accuracy of the SNP-based strain identification assay with a larger collection of clinical and LA-MRSA strains are ongoing.

Acquisition and colonization dynamics of antimicrobial-resistant bacteria during international travel: a prospective cohort study.

OBJECTIVES: Travellers may be colonized with antimicrobial-resistant bacteria on return, but little is known about colonization during travel. Our objectives were to assess the acquisition and colonization dynamics during the stay abroad for a broad range of antimicrobial-resistant bacteria and resistance phenotypes and to identify risk factors for faecal carriage of antimicrobial-resistant bacteria. METHODS: German and Dutch participants (n = 132) of this prospective cohort study (2016-2018) completed a questionnaire on risk factors and provided daily stool samples before, during, and after travel. Samples were screened for extended-spectrum ß-lactamase producing Enterobacterales (ESBL-E), carbapenem-resistant (CarbR-GN), and non-intrinsically colistin-resistant Gram-negative rods (ColR-GN), vancomycin-resistant Enterococcus faecium/faecalis (VRE), and Clostridioides difficile. RESULTS: Colonization rates reached a plateau within a week after departure fluctuating around 48.5% (63/130) and 58.4% (45/77, ESBL-E), 10.4% (11/106) and 23.4% (18/77, ColR-GN), or 3.0% (4/132) and 6.8% (8/118, CarbR-GN). Colonization rates after the travel were 46.2% (61/132, ESBL-E), 9.0% (12/132, ColR-GN), and 3.4% (5/132, CarbR-GN). Travellers carried mcr-1- (15/132; 11.4%) or blaNDM-positive (4/132; 3.0%) Enterobacterales. A vegetarian diet was associated with a lower risk for the acquisition of ESBL-E (OR = 0.4, p 0.04) and ColR-GN (OR = 0.1, p 0.01) during travel in a multivariable model. Similarly, travellers visiting friends and relatives had a lower risk for the acquisition of ESBL-E (OR = 0.3, p 0.009) and CarbR-GN (OR = 0.3, p 0.01). VRE and C. difficile were not detected. CONCLUSION: The number of travellers with a temporary colonization during the journey exceeded the number of travellers still colonized after return.

Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers' perspective.

Background: Cross-border healthcare may promote the spread of multidrug-resistant microorganisms (MDRO) and is challenging due to heterogeneous antimicrobial resistance (AMR) prevention measures (APM). The aim of this article is to compare healthcare workers (HCW) from Germany (DE) and The Netherlands (NL) on how they perceive and experience AMR and APM, which is important for safe patient exchange and effective cross-border APM cooperation. Methods: A survey was conducted amongst HCW (n = 574) in hospitals in DE (n = 305) and NL (n = 269), using an online self-administered survey between June 2017 and July 2018. Mann-Whitney U tests were used to analyse differences between answers of German and Dutch physicians (n = 177) and German and Dutch nurses (n = 397) on 5-point Likert Items and Scales. Results: Similarities between DE and NL were a high awareness about the AMR problem and the perception that the possibility to cope with AMR is limited (30% respondents perceive their contribution to limit AMR as insufficient). Especially Dutch nurses scored significantly lower than German nurses on their contribution to limit AMR (means 2.6 vs. 3.1, p ≤ 0.001). German HCW were more optimistic about their potential role in coping with AMR (p ≤ 0.001), and scored higher on feeling sufficiently equipped to perform APM (p ≤ 0.003), although the mean scores did not differ much between German and Dutch respondents. Conclusions: Although both German and Dutch HCW are aware of the AMR problem, they should be more empowered to contribute to limiting AMR through APM (i.e. screening diagnostics, infection diagnosis, treatment and infection control) in their daily working routines. The observed differences reflect differences in local, national and cross-border structures, and differences in needs of HCW, that need to be considered for safe patient exchange and effective cross-border APM.

Correction to: Cross-border comparison of antimicrobial resistance (AMR) and AMR prevention measures: the healthcare workers' perspective.

[This corrects the article DOI: 10.1186/s13756-019-0577-4.].