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Unit 37: Healthcare-associated Infections, Surveillance of Antibiotic Resistance and Consumption

Tim Eckmanns
Sebastian Haller, Julia Hermes

The unit is responsible for obtaining epidemiological data on antibiotic resistance and antibiotic consumption as well as on nosocomial infections and corresponding outbreaks from reports and additional surveillance systems. Furthermore, local, regional and national outbreaks of resistant pathogens are investigated by the unit and measures are derived. These data are used to formulate, adapt and evaluate prevention strategies and to develop recommendations for diagnostics and patient care.

The unit also hosts the scientific secretariat and supports the work of the Commission on Anti-Infectives, Resistance and Therapy (Commission ART).


Surveillance and research

Within the framework of surveillance, the IfSG data of the following pathogens or diseases are analysed, evaluated and published:

  • severe courses of C. difficile infections,
  • Acinetobacter and Enterobacterales with evidence of a carbapenemase determinant or with reduced sensitivity to carbapenems except cases of natural resistance (infections and colonisations),
  • Methicillin-resistant Staphylococcus aureus (MRSA) in blood and CSF,
  • Adenoviruses

Reports on the cumulative occurrence of nosocomial infections also with pathogens that are not reportable (nosocomial outbreaks) are monitored and evaluated in communication with the state health authorities and reference or consultant laboratories. We support outbreak investigations and clarify regional, national and international outbreaks.

The unit is significantly involved in the (further) development of case definitions, transmission and evaluation criteria for reportable multi-resistant pathogens, projects and recommendations in the field of antibiotic resistance and nosocomial infections in Germany and internationally.

Surveillance of antibiotic resistance and antibiotic consumption is ensured in particular via the Antibiotic Resistance Surveillance (ARS) and the Antibiotic Consumption Surveillance (AVS). These databases are used to provide antibiotic resistance and antibiotic consumption statistics for participants in the surveillance systems and to generate reference data for the professional public as well as to serve international surveillance systems such as the European Antimicrobial Resistance Surveillance Network (EARS-Net) and the Global Antimicrobial Resistance and Use Surveillance System (GLASS). Via ARVIA "Antibiotic Resistance and Use - Integrated Analysis", data on antibiotic resistance and use from the surveillance systems ARS and AVS are evaluated in relation to each other at hospital level and the results are made available to the participating hospitals. Moreover, the project SAMBA establishes surveillance of antibiotic consumption in the outpatient sector. Via integrated genomic surveillance, i.e. by combining epidemiological and genome data of infectious agents, we are deepening the investigation of spread patterns and improving the detection of outbreaks of antibiotic-resistant pathogens. Through its activities, the unit contributes decisively to the implementation of the German Antibiotic Resistance Strategy (DART2020 und 2030).

The unit is WHO Collaborating Centre for Antimicrobial Resistance, Consumption and Health Care-Associated Infections and has been leading the WHO AMR Surveillance and Quality Assessment Collaborating Centres Network since 2019. The unit works on projects with the WHO Hub for Pandemic and Epidemic Intelligence and supports the working group on antimicrobial resistance of the German Epidemic Preparedness Team (SEEG).

We work in various low- and middle-income countries in the field of antibiotic resistance surveillance and nosocomial infections (see International Projects).

Research tasks also include areas of disease burden analysis, development of improved methods for outbreak detection (early warning), genetic and digital surveillance and artificial intelligence, as well as the investigation of the relationship between climate and antibiotic resistance. The results are regularly published in specialist articles (see Projects and Publications).

§35a SGB V Reserve antibiotics

Within the framework of § 35a SGB V Fair Health Insurance Competition Act on the exemption of reserve antibiotics from the benefit assessment by the Federal Joint Committee (G-BA), the Robert Koch Institute (RKI), together with the Federal Institute for Drugs and Medical Devices (BfArM), has compiled a non-exhaustive list of multi-resistant bacterial pathogens (MRE) (pathogen list) and developed criteria for the classification of a newly authorised antibiotic as a reserve antibiotic (criteria list).

Aspects of restrictive use in the sense of antibiotic stewardship measures are considered after the reserve status has been assigned by the G-BA by specifying requirements for quality-assured use (§ 35a, Para. 1c, Sentence 9). BfArM and RKI are included in this procedure in a separate statement. Within this framework, the G-BA decided that clinics using new antibiotics that have been granted reserve status should participate in the surveillance systems AVS (Antibiotics Consumption Surveillance) and ARS (Antibiotics Resistance Surveillance) or ARVIA (Antibiotics Resistance and Consumption - Integrated Analysis).



HiGHmed: Use Case Infection Control: Development of an automated early warning system for the algorithmic detection of pathogen clusters in hospitals.

Integrated genomic surveillance: Information on the genetic relationship of pathogens from different patients can help to detect and combat outbreaks of infection. With this aim, the molecular genetic information of isolates and the corresponding reports according to IfSG are evaluated in an integrated manner in a joint project with the national reference laboratories for multidrug-resistant gram-negative bacteria as well as for staphylococci and enterococci.

Long Term Care Surveillance (LTCSurv): Preparation of an S3 guideline on perioperative antibiotic prophylaxis guideline on perioperative antibiotic prophylaxis (upgrade of the existing S1 guideline) under the leadership of the German Society for Hygiene and Microbiology (DGHM) and with participation of surgical societies.


ANDEMIA: African Network for improved Diagnostics, Epidemiology and Management of Common Infectious Agents: Support of the German-African health research network to combat common diseases across countries through improved surveillance, diagnostics and outbreak management. Cooperation with partner institutes in Côte d'Ivoire, Burkina Faso, Democratic Republic of the Congo and South Africa.

ARGOS: Antimicrobial Resistance Global Surveillance (within the framework of the Global Health Protection Programme GHPP)

Burden Health Care Worker (BHCW): A European-African collaboration to assess whether health care workers are sufficiently protected from occupational transmission of SARS-CoV-2 and, if necessary, to demonstrably improve protection.

NiCaDe 2: Nigerian Centre for Disease Control: Collaboration with the Nigerian Centre for Disease Control. Capacity development for infectious disease preparedness and response in Nigeria. Sub-project 3 (NiCaDe-AMR): Supporting the national implementation of an expanded AMR surveillance and "Diagnostic Stewardship" strategy.

PAcCI: Strengthening Public Health Capacity in Côte d'Ivoire at local and national level in partnership with the Centre Hôspitalier et Universitaire de Bouaké (CHUB) and the Helmholtz Institute for One Health (HIOH) in particular 1) genomic surveillance and outbreak investigations of pathogens with epidemic potential, 2) surveillance of antimicrobial resistant bacteria, 3) capacity building for infection prevention and control and 4) integration of disease surveillance into national health policies. The overall goal is to further strengthen national capacities for infectious disease surveillance and prevention and to spread this knowledge throughout the West African region.

Namibia-RKI Twinning Project (TwiNit 2.0): Interdisciplinary specialist support from different RKI units in an interdepartmental collaboration supports the establishment of a Namibia Institute of Public Health (NIPH) by strengthening core public health functions. Unit 37 is responsible for the area of antimicrobial resistance and infection prevention and control.

WASP: Interdepartmental consortium project with partner countries in the Western Balkan region (Albania, Bosnia and Herzegovina, Kosovo, Montenegro, Northern Macedonia, Serbia), in which unit 37 leads the work package on clinical management and prevention and control of antimicrobial resistance together with Charité Berlin.

Completed projects

ARDIG: Antibiotic Resistance Dynamics: the influence of geographic origin and management systems on resistance gene flows within humans, animals and the environment (within the framework of EJP One Health)

Containment Scout Initiative: Project in cooperation with the Federal Office of Administration to provide staff support to the regional health offices or state offices during the COVID-19 pandemic in Germany.

DELSI: Exploring digital epidemiology with secondary data and the ethical, legal and social implications of such methods (programme and special volume in Life Sciences, Society and Policy).

EuSCAPE 2019: European Survey of carbapenem-resistant and/or Colistin-resistant Enterobacteriacea (in hospitals) (in cooperation with ECDC). Coordination of the participating German laboratories together with the National Reference Laboratory for multidrug-resistant gram-negative bacteria, Bochum.

NoDARS: Northern Dimension Antibiotic Resistance Study

NOVA: Novel approaches for design and evaluation of cost-effective surveillance across the food chain (within the framework of EJP One Health)

RAI: Rational use of antibiotics through information and communication (within the framework of InfectControl 2020): Development of information materials for general practitioners and patients on the acquisition of multidrug-resistant pathogens during travel and implementation of a cohort study with travellers to investigate the acquisition and duration of colonisation with multidrug-resistant pathogens during long-distance travel.

REDARES: Reduction of antibiotic resistance through guideline-based treatment of patients with uncomplicated urinary tract infections in outpatient care.

ReDIG: Resistance Data Informed Guidelines. Network to promote the use of AMR surveillance data in the development of treatment guidelines (with participation of NDPHS partners).

SARHA: Antibiotic resistance of E. coli in community-acquired uncomplicated urinary tract infection (in German). A prospective cohort study of 2015/2016 (SARHA study) compared with antibiotic resistance surveillance (ARS) data.

National and international cooperation partners

Date: 23.02.2024


  • Wulff A, Baier C, Ballout S et al.; Infection Control Study Group (for RKI Zacher B, Eckmanns T) (2021): Transformation of microbiology data into a standardised data representation using OpenEHR.
    Sci. Rep. 11 (1): 10556. Epub May 18. doi: 10.1038/s41598-021-89796-y. more

  • Willrich N, Stern D, Böttcher S, Biegala W, Albrecht S, Oh DY, Abu Sin M, Mielke M, Rexroth U, Eckmanns T, Hamouda O, Seifried J (2021): Erfassung der SARS-CoV-2-Testzahlen in Deutschland.
    Epid Bull (24): 3-10. doi: 10.25646/8586 (online vorab 10. Juni 2021). more

  • von Laer A, N'Guessan MA, Touré FS, Nowak K, Groeschner K, Ignatius R, Friesen J, Tomczyk S, Leendertz FH, Eckmanns T, Akoua-Koffi C (2021): Implementation of automated blood culture with quality assurance in a resource-limited setting.
    Front. Med. (Lausanne) 8: 627513. Epub May 21. doi: 10.3389/fmed.2021.627513. more

  • Suwono B, Eckmanns T, Kaspar H, Merle R, Zacher B, Kollas C, Weiser AA, Noll I, Feig M, Tenhagen BA (2021): Cluster analysis of resistance combinations in Escherichia coli from different human and animal populations in Germany 2014–2017.
    PLoS One 16 (1): e0244413. Epub Jan 20. doi: 10.1371/journal.pone.0244413. more

  • Seifried J, Böttcher S, Oh DY, Michel J, Nitsche A, Jenny MA, Wieler LH, Antão E-M, Jung-Sendzik T, Dürrwald R, Diercke M, Haas W, Abu Sin M, Eckmanns T, Hamouda O, Mielke M (2021): Was ist bei Antigentests zur Eigenanwendung (Selbsttests) zum Nachweis von SARS-CoV-2 zu beachten?
    Epid Bull (8): 3–9. doi: 10.25646/8040 (online vorab 22. Februar 2021). more

  • Seifried J, Hoffmann A, Reda S, Böttcher S, Abu Sin M, Hofmann A, Noll I, von Laer A, Reuß A, Oh DY, Albrecht S, Stern D, Willrich N, Staat D, Zacher B, Schneider M, Feig M, Nitsche A, Rieck T, Rexroth U, Eckmanns T, Hamouda O (2021): Erfassung der Labortestungen auf SARS-CoV-2 in Deutschland. [Recording of SARS-CoV-2 laboratory tests in Germany.]
    Bundesgesundheitsbl 64 (4): 403–411. Epub Apr 15. doi: 10.1007/s00103-021-03307-y. more

  • Schweickert B, Klingeberg A, Haller S, Richter D, Schmidt N, Abu Sin M, Eckmanns T (2021): COVID-19-Ausbrüche in deutschen Alten- und Pflegeheimen.
    Epid Bull (18): 3–29. doi: 10.25646/8174 (online vorab 6. April 2021). more

  • Schubert G, Achi V, Ahuka S, Belarbi E, Bourhaima O, Eckmanns T, Johnstone S, Kabore F, Kra O, Mendes A, Ouedraogo AS, Poda A, Some AS, Tomczyk S, Couacy-Hymann E, Kayembe JM, Meda N, Muyembe Tamfum JJ, Ouangraoua S, Page N, Venter M, Leendertz FH, Akoua-Koffi C; ANDEMIA consortium (for RKI Abu Sin M, Gröschner K, Köhler S, Niendorf S, Nowak K, Pitzinger P, Sachse A, Vietor AC) (2021): The African Network for Improved Diagnostics, Epidemiology and Management of Common Infectious Agents.
    BMC Infect. Dis. 21 (1): 539. Epub Jun 7. doi: 10.1186/s12879-021-06238-w. more

  • Said D, Willrich N, Ayobami O, Noll I, Eckmanns T, Markwart R (2021): The epidemiology of carbapenem resistance in Acinetobacter baumannii complex in Germany (2014–2018): an analysis of data from the national Antimicrobial Resistance Surveillance system.
    Antimicrob. Resist. Infect. Control 10 (1): 45. Epub Mar 1. doi: 10.1186/s13756-021-00909-8. more

  • Rommel A, von der Lippe E, Plaß D, Ziese T, Diercke M, an der Heiden M, Haller S, Wengler A, on behalf of the BURDEN 2020 Study Group (2021): The COVID-19 disease burden in Germany in 2020 – years of life lost to death and disease over the course of the pandemic.
    Dtsch. Arztebl. Int. 118 (9): 145–151. doi: 10.3238/arztebl.m2021.014. more

  • Reuß A, Klingeberg A, Schmidt N, Eckmanns T, Zacher B (2021): Einfluss der COVID-19-Pandemie auf die Anzahl der gemäß IfSG meldepflichtigen Nachweise von Erregern mit Antibiotikaresistenzen und C. difficile-Infektionen.
    Epid Bull (7): 8–11. doi: 10.25646/8026. more

  • Reichert F, Schulz M, Mertens E, Lachmann R, Aebischer A (2021): Reemergence of scabies driven by adolescents and young adults, Germany, 2009–2018.
    Emerg. Infect. Dis. 27 (6): 1693–1696. Epub May 6. doi: 10.3201/eid2706.203681. more

  • Meinen A, Reuß A, Willrich N, Feig M, Noll I, Eckmanns T, Al-Nawas B, Markwart R (2021): Antimicrobial resistance and the spectrum of pathogens in dental and oral-maxillofacial infections in hospitals and dental practices in Germany.
    Front. Microbiol. 12: 676108. Epub Jun 2. doi: 10.3389/fmicb.2021.676108. more

  • Markwart R, Willrich N, Eckmanns T, Werner G, Ayobami O (2021): Low proportion of linezolid and daptomycin resistance among bloodborne vancomycin-resistant Enterococcus faecium and methicillin-resistant Staphylococcus aureus infections in Europe.
    Front. Microbiol. 12: 664199. Epub May 31. doi: 10.3389/fmicb.2021.664199. more

  • Markus I, Steffen G, Lachmann R, Marquis A, Schneider T, Tomczyk S, Koppe U, Rohde AM, Schink SB, Seifried J, Domaszewska T, Rexroth U, An der Heiden M (2021): COVID-19: cross-border contact tracing in Germany, February to April 2020.
    Euro Surveill. 26 (10): 2001236. doi: 10.2807/1560-7917.ES.2021.26.10.2001236. more

  • Seifried J, Böttcher S, Oh DY, Michel J, Nitsche A, Jenny MA, Wieler LH, Antão E-M, Jung-Sendzik T, Dürrwald R, Diercke M, Haas W, Abu Sin M, Eckmanns T, Hamouda O, Mielke M (2021): Was ist bei Antigentests zur Eigenanwendung (Selbsttests) zum Nachweis von SARS-CoV-2 zu beachten?
    Epid Bull (8): 3–9. doi: 10.25646/8040 (online vorab 22. Februar 2021). more

  • Halm A, Grote U, an der Heiden M, Hamouda O, Schaade L, Rexroth U; RKI-Lagezentrums-Gruppe (2021): Das Lagemanagement des Robert Koch-Instituts während der COVID-19-Pandemie und der Austausch zwischen Bund und Ländern.
    Bundesgesundheitsbl 64 (4): 418–425. doi: 10.1007/s00103-021-03294-0. more

  • Grote U, Arvand M, Brinkwirth S, Brunke M, Buchholz U, Eckmanns T, von Kleist M, Niebank M, Ruehe B, Schulze K, Stoliaroff-Pépin A, Thanheiser M, Schaade L, Said D, Haas W (2021): Maßnahmen zur Bewältigung der COVID-19-Pandemie in Deutschland: nichtpharmakologische und pharmakologische Ansätze.
    Bundesgesundheitsbl 64 (4): 435–445. doi: 10.1007/s00103-021-03306-z. more

  • Fleischmann C, Reichert F, Cassini A, Horner R, Harder T, Markwart R, Tröndle M, Savova Y, Kissoon N, Schlattmann P, Reinhart K, Allegranzi B, Eckmanns T (2021): Global incidence and mortality of neonatal sepsis: a systematic review and meta-analysis.
    Arch. Dis. Child. 106 (8): 745-752. Epub Jan 22. doi: 10.1136/archdischild-2020-320217. more

  • Domaszewska T, Karo B, Preuß U, Kollan C, Reuß A, Blank HP, Brodhun B, Hauer B, Altmann D, Fiebig L, Haas W, Perumal N (2021): Vollständigkeit der Tuberkulose-Meldungen in Deutschland in den Jahren 2013–2017: Ergebnisse einer Inventurstudie.
    Epid Bull (11): 8–10. doi: 10.25646/8041. more

  • Buchholz U, Abu Sin M, Stoliaroff-Pépin A, Michel J, Nitsche A, Schaade L, Haas W, Bosse I (2021): Spektrum diagnostischer Proben zum Nachweis von SARS-CoV-2, Selbstabnahme durch Patient*innen und möglicher Einsatz von Antigen-Tests.
    Epid Bull (17): 15–26. doi: 10.25646/8309 (online vorab 19. April 2021). more

  • Brandl M, Hoffmann A, Willrich N, Reuß A, Reichert F, Walter J, Eckmanns T, Haller S (2021): Bugs that can resist antibiotics but not men: gender-specific differences in notified infections and colonisations in Germany, 2010–2019.
    Microorganisms 9 (5): 894. Epub Apr 22. doi: 10.3390/microorganisms9050894. more

  • Alpers K, Haller S, Buchholz U; RKI Feldteam (2021): Untersuchung von SARS-CoV-2-Ausbrüchen in Deutschland durch Feldteams des Robert Koch-Instituts, Februar–Oktober 2020.
    Bundesgesundheitsbl 64 (4): 446–453. Epub Mar 17. doi: 10.1007/s00103-021-03296-y. more

  • Achi CR, Ayobami O et al. (2021): Operationalising One Health in Nigeria: reflections from a high-level expert panel discussion commemorating the 2020 World Antibiotics Awareness Week.
    Front. Public Health 9: 673504. Epub May 31. doi: 10.3389/fpubh.2021.673504. more