Nosokomial germs

Question

I would like to know whether patients with long-term diagnosed MRSA and 4-MRGN infections are still considered high-risk patients if no MRSA or 4MRGN has been detected over a period of 18 months with multiple examinations conducted during this time?
Provided that the clinic does not downgrade the patient for safety reasons, the question would be whether the patient can again participate in public events of the Cystic Fibrosis Association. Are there guidelines, recommendations for action, or similar advice regarding this?

Answer

Dear questioner,
this is a very valid but also complex question that cannot be answered simply or in a generalized way. In Germany, as a basic principle, the management of patients colonized with multidrug-resistant organisms (MDROs) is regulated according to the recommendations of KRINKO (the Commission for Hospital Hygiene and Infection Prevention at the Robert Koch Institute) with the aim of preventing the spread (colonization/infection) of multidrug-resistant pathogens. The tasks and responsibilities of KRINKO are legally regulated by the Infection Protection Act. Healthcare facilities are responsible for implementing KRINKO's recommendations locally, for example through detailed hygiene plans and situation-specific screening measures.
In this context, local factors, such as infrastructural conditions, as well as facility-specific or situation-specific risk assessments, must be taken into account. This can lead to procedures often not being entirely uniform. For the status 'MRE-free,' several defined 'swab series' over a period of several weeks to months are typically required, depending on the pathogen. Certain situations can, for example, lead to the assumption that an 'MRE loss' is at least more difficult to achieve and that the criteria should be applied more strictly, with longer intervals or a greater number of samples specified. Here, chronic pulmonary infection with MRE in cystic fibrosis would initially be classified in this context, although individual or situational differences also play a role (contact times, outpatient visit, rehabilitation measure, event participation, etc.).
A clear general definition of how the MRE-free status is to be assessed today in cystic fibrosis, especially in the case of culture negativity under modulator therapy (actual sample quality), in my opinion, does not yet exist. All hygiene measures are ultimately a matter of weighing benefits and risks or safety and serve infection prevention, thereby primarily protecting the general public or at-risk groups from health damage. The ultimate responsibility lies with the institutions, which are also the primary contact points. In hospitals, the infection control department and/or, for example, the management of the CF outpatient clinic is primarily responsible for the established hygiene measures.
For public events, the German Cystic Fibrosis Association (Mukoviszidose e.V.) has published a hygiene guideline (https://www.muko.info/hygienerichtlinie) in this sense, which is intended to provide guidance and also relies on the personal responsibility of the affected individuals. For events, the ultimate responsibility for a coherent hygiene concept lies with the organizer. A period of 12-24 months is discussed as the timeframe for being germ-free following a previous chronic pulmonary Pseudomonas infection in CF with adequate monitoring. I hope these remarks help you further assess the situation.
Kind regards
M. Hogardt

19.01.2026