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Pneumologie 2010; 64(5): 291-299
DOI: 10.1055/s-0029-1243917
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Infektionsdiagnostik in der Pneumologie

Teil 2: Nachweis von bakteriellen Mikroorganismen aus dem Tracheobronchialsystem: Infektion oder Kolonisation?Diagnosis of Infections in PneumologyPart II: Detection of Bacterial Microorganisms from the Tracheobronchial System: Infection or Colonisation?A.  Strassburg1 , K.  Dalhoff2 , I.  Engelmann3 , S.  Ewig4 , F.  J.  F.  Herth5 , J.  Knobloch6 , G.  Rohde7 , H.  Sahly8 , B.  Schaaf9 , C.  Lange1
  • 1Klinische Infektiologie, Medizinische Klinik, Forschungszentrum Borstel
  • 2Medizinische Klinik III, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
  • 3Institut für Virologie, Medizinische Hochschule Hannover; aktuelle Adresse: Centre d’Immunologie de Marseille-Luminy, Université de la Méditerranée, Marseille, France
  • 4Thoraxzentrum Ruhrgebiet, Kliniken für Pneumologie und Infektiologie, EVK Herne und Augusta-Kranken-Anstalt Bochum
  • 5Thoraxklinik am Universitätsklinikum Heidelberg, Pneumologie und Beatmungsmedizin
  • 6Institut für Medizinische Mikrobiologie und Hygiene, Universitätsklinikum Schleswig-Holstein, Campus Lübeck
  • 7Medizinische Klinik III, Pneumologie, Allergologie, Schlaf- und Beatmungsmedizin, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil GmbH, Bochum
  • 8Institut für Infektionsmedizin, Universitätsklinikum Schleswig-Holstein, Campus Kiel, und IPM-Biotech, Labor Lademannbogen, Hamburg
  • 9Medizinische Klinik Nord, Pneumologie und Infektiologie, Klinikum Dortmund, Dortmund
Further Information

Publication History

eingereicht 11.1.2010

akzeptiert 12.1.2010

Publication Date:
07 May 2010 (online)

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Zusammenfassung

Untere Atemwegsinfektionen gehören weltweit zu den häufigsten Erkrankungen und Todesursachen. Im klinischen Alltag, insbesondere bei der Betreuung schwer kranker Patienten, stellt die Unterscheidung zwischen einer tracheobronchialen Kolonisation von Mikroorganismen und einer behandlungsbedürftigen Infektion eine Herausforderung dar. Während die rasche Einleitung einer antibiotischen Therapie bei schwer kranken Patienten von entscheidender prognostischer Bedeutung ist, stellt der inadäquate Gebrauch von Antibiotika eine wichtige Ursache von Resistenzbildungen dar. Im ersten Teil der Arbeit wurden Methoden zur Infektionsdiagnostik bei tiefen Atemwegserkrankungen detailliert vorgestellt. Der hier vorliegende zweite Teil der Übersicht behandelt Methoden und Kriterien zur Unterscheidung von bakterieller Kolonisation und Infektion im Rahmen von tiefen Atemwegsinfektionen durch klinisch relevante Mikroorganismen.

Abstract

Lower respiratory tract infections rank among the leading causes of morbidity and mortality worldwide. In clinical practice, especially in the care of severely ill patients, discrimination between tracheobronchial colonisation with potentially pathogenic microorganisms and infection is a common diagnostic challenge. While prompt antibiotic treatment is needed in critically ill patients with pneumonia, an inadequate use of antibiotics is the major cause for the emergence of drug-resistant microorganisms. The first part of this review provided a detailed overview of the currently available methods for the diagnosis of pulmonary infectious diseases. In the present second part of the manuscript, we focus upon methods and criteria for the differentiation between lower respiratory tract bacterial colonisation and lower respiratory tract infections, highlighting important pathogens.

Literatur

  • 1 Lopez A D, Mathers C D, Ezzati M. et al . Global and regional burden of disease and risk factors, 2001: systematic analysis of population health data.  Lancet. 2006;  367 1747-1757
    CrossrefPubMedGoogle Scholar
  • 2 Strassburg A, Rupp J, Herth F J. et al . Infection diagnostics in pneumology. Part 1. Survey and methods.  Pneumologie. 2008;  62 730-743
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Becker K, Friedrich A W, Lubritz G. et al . Prevalence of genes encoding pyrogenic toxin superantigens and exfoliative toxins among strains of Staphylococcus aureus isolated from blood and nasal specimens.  J Clin Microbiol. 2003;  41 1434-1439
    CrossrefPubMedGoogle Scholar
  • 4 von Eiff C, Friedrich A W, Peters G. et al . Prevalence of genes encoding for members of the staphylococcal leukotoxin family among clinical isolates of Staphylococcus aureus.  Diagn Microbiol Infect Dis. 2004;  49 157-162
    CrossrefPubMedGoogle Scholar
  • 5 Becker K, Friedrich A W, Peters G. et al . Systematic survey on the prevalence of genes coding for staphylococcal enterotoxins SElM, SElO, and SElN.  Mol Nutr Food Res. 2004;  48 488-495
    CrossrefPubMedGoogle Scholar
  • 6 Gold H S, Pillai S K. Antistaphylococcal agents.  Infect Dis Clin North Am. 2009;  23 99-131
    CrossrefPubMedGoogle Scholar
  • 7 Williams R E. Healthy carriage of Staphylococcus aureus: its prevalence and importance.  Bacteriol Rev. 1963;  27 56-71
    PubMedGoogle Scholar
  • 8 Kluytmans J A, Wertheim H F. Nasal carriage of Staphylococcus aureus and prevention of nosocomial infections.  Infection. 2005;  33 3-8
    PubMedGoogle Scholar
  • 9 Peacock S J, de Silva I, Lowy F D. What determines nasal carriage of Staphylococcus aureus?.  Trends Microbiol. 2001;  9 605-610
    CrossrefPubMedGoogle Scholar
  • 10 Bundesamt für Verbraucherschutz und Lebensmittelsicherheit, Paul-Ehrlich-Gesellschaft für Chemotherapie e. V. Infektiologie Freiburg . Germap 2008 – Bericht über den Antibiotikaverbrauch und die Verbreitung von Antibiotikaresistenzen in der Human- und Veterinärmedizin in Deutschland.  Antiinfectives Intelligence, Rheinbach. 2008;  1 0-149
    PubMedGoogle Scholar
  • 11 Welte T, Kohnlein T. Global and local epidemiology of community-acquired pneumonia: the experience of the CAPNETZ Network.  Semin Respir Crit Care Med. 2009;  30 127-135
    Article in Thieme ConnectPubMedGoogle Scholar
  • 12 Rothberg M B, Haessler S D, Brown R B. Complications of viral influenza.  Am J Med. 2008;  121 258-264
    CrossrefPubMedGoogle Scholar
  • 13 Struelens M J, Hawkey P M, French G L. et al . Laboratory tools and strategies for methicillin-resistant Staphylococcus aureus screening, surveillance and typing: state of the art and unmet needs.  Clin Microbiol Infect. 2009;  15 112-119
    PubMedGoogle Scholar
  • 14 Tenover F C, Sinner S W, Segal R E. et al . Characterisation of a Staphylococcus aureus strain with progressive loss of susceptibility to vancomycin and daptomycin during therapy.  Int J Antimicrob Agents. 2009;  33 564-568
    CrossrefPubMedGoogle Scholar
  • 15 Locke J B, Hilgers M, Shaw K J. Mutations in ribosomal protein L3 are associated with oxazolidinone resistance in staphylococci of clinical origin.  Antimicrob Agents Chemother. 2009;  53 5275-5278
    CrossrefPubMedGoogle Scholar
  • 16 Morgan M S. Diagnosis and treatment of Panton-Valentine leukocidin (PVL)-associated staphylococcal pneumonia.  Int J Antimicrob Agents. 2007;  30 289-296
    CrossrefPubMedGoogle Scholar
  • 17 Mesaros N, Nordmann P, Plesiat P. et al . Pseudomonas aeruginosa: resistance and therapeutic options at the turn of the new millennium.  Clin Microbiol Infect. 2007;  13 560-578
    CrossrefPubMedGoogle Scholar
  • 18 Rossolini G M, Mantengoli E. Antimicrobial resistance in Europe and its potential impact on empirical therapy.  Clin Microbiol Infect. 2008;  14 2-8
    PubMedGoogle Scholar
  • 19 Munoz-Price L S, Weinstein R A. Acinetobacter infection.  N Engl J Med. 2008;  358 1271-1281
    CrossrefPubMedGoogle Scholar
  • 20 Tsiodras S, Pittet D, Carmeli Y. et al . Clinical implications of stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole: a study of 69 patients at 2 university hospitals.  Scand J Infect Dis. 2000;  32 651-656
    CrossrefPubMedGoogle Scholar
  • 21 Soler N, Torres A, Ewig S. et al . Bronchial microbial patterns in severe exacerbations of chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation.  Am J Respir Crit Care Med. 1998;  157 1498-1505
    CrossrefPubMedGoogle Scholar
  • 22 Lode H, Allewelt M, Balk S. et al . A prediction model for bacterial etiology in acute exacerbations of COPD.  Infection. 2007;  35 143-149
    CrossrefPubMedGoogle Scholar
  • 23 Eller J, Ede A, Schaberg T. et al . Infective exacerbations of chronic bronchitis: relation between bacteriologic etiology and lung function.  Chest. 1998;  113 1542-1548
    CrossrefPubMedGoogle Scholar
  • 24 Trouillet J L, Chastre J, Vuagnat A. et al . Ventilator-associated pneumonia caused by potentially drug-resistant bacteria.  Am J Respir Crit Care Med. 1998;  157 531-539
    CrossrefPubMedGoogle Scholar
  • 25 Rello J, Torres A. Microbial causes of ventilator-associated pneumonia.  Semin Respir Infect. 1996;  11 24-31
    PubMedGoogle Scholar
  • 26 Parker C M, Kutsogiannis J, Muscedere J. et al . Ventilator-associated pneumonia caused by multidrug-resistant organisms or Pseudomonas aeruginosa: prevalence, incidence, risk factors, and outcomes.  J Crit Care. 2008;  23 18-26
    CrossrefPubMedGoogle Scholar
  • 27 Baum H von, Welte T, Marre R, Suttorp N. Community-acquired pneumonia through enterobacteriaceae and Pseudomonas aeruginosa: diagnosis, incidence and predictors.  Eur Respir J. 2009;  Epub ahead of print
    PubMedGoogle Scholar
  • 28 Fagon J Y, Chastre J, Vuagnat A. et al . Nosocomial pneumonia and mortality among patients in intensive care units.  JAMA. 1996;  275 866-869
    CrossrefPubMedGoogle Scholar
  • 29 Chen M Z, Hsueh P R, Lee L N. et al . Severe community-acquired pneumonia due to Acinetobacter baumannii.  Chest. 2001;  120 1072-1077
    CrossrefPubMedGoogle Scholar
  • 30 Govan J R, Brown A R, Jones A M. Evolving epidemiology of Pseudomonas aeruginosa and the Burkholderia cepacia complex in cystic fibrosis lung infection.  Future Microbiol. 2007;  2 153-164
    CrossrefPubMedGoogle Scholar
  • 31 Agodi A, Barchitta M, Cipresso R. et al . Pseudomonas aeruginosa carriage, colonization, and infection in ICU patients.  Intensive Care Med. 2007;  33 1155-1161
    CrossrefPubMedGoogle Scholar
  • 32 Ewig S, Torres A, El-Ebiary M. et al . Bacterial colonization patterns in mechanically ventilated patients with traumatic and medical head injury. Incidence, risk factors, and association with ventilator-associated pneumonia.  Am J Respir Crit Care Med. 1999;  159 188-198
    CrossrefPubMedGoogle Scholar
  • 33 Winer-Muram H T, Jennings S G, Wunderink R G. et al . Ventilator-associated Pseudomonas aeruginosa pneumonia: radiographic findings.  Radiology. 1995;  195 247-252
    PubMedGoogle Scholar
  • 34 Fabregas N, Ewig S, Torres A. et al . Clinical diagnosis of ventilator associated pneumonia revisited: comparative validation using immediate post-mortem lung biopsies.  Thorax. 1999;  54 867-873
    CrossrefPubMedGoogle Scholar
  • 35 Torres A, Fabregas N, Ewig S. Sampling methods for ventilator-associated pneumonia: validation using different histologic and microbiological references.  Crit Care Med. 2000;  28 2799-2804
    CrossrefPubMedGoogle Scholar
  • 36 Torres A, Ewig S. Diagnosing ventilator-associated pneumonia.  N Engl J Med. 2004;  350 433-435
    CrossrefPubMedGoogle Scholar
  • 37 Ewig S, Torres A. Flexible bronchoscopy in nosocomial pneumonia.  Clin Chest Med. 2001;  22 263-279, viii
    CrossrefPubMedGoogle Scholar
  • 38 Murphy T F, Brauer A L, Eschberger K. et al . Pseudomonas aeruginosa in chronic obstructive pulmonary disease.  Am J Respir Crit Care Med. 2008;  177 853-860
    CrossrefPubMedGoogle Scholar
  • 39 Amsden G W. Anti-inflammatory effects of macrolides – an underappreciated benefit in the treatment of community-acquired respiratory tract infections and chronic inflammatory pulmonary conditions?.  J Antimicrob Chemother. 2005;  55 10-21
    CrossrefPubMedGoogle Scholar
  • 40 Farmer III J J, Boatwaright K D, Janda J M. Enterobacteriaceae: Intoduction and identification. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, eds. Manuals of Clinical Microbiology. 9th ed. Washington D.C; ASM Press 2007: 649-669
    PubMedGoogle Scholar
  • 41 Brenner D J, Farmer III J J. Introduction to the family Enterobacteriaceae. In: Brenner DJ, Krieg NR, Staley JT, Garrity GM, eds. Bergy's manual of Systematic Bacteriology, The Proteobacteria, part B The Gammaproteobacteria. 2nd ed. New York; Springer 2005: 587-850
    PubMedGoogle Scholar
  • 42 File T M. Community-acquired pneumonia.  Lancet. 2003;  362 1991-2001
    CrossrefPubMedGoogle Scholar
  • 43 Harbarth S, Ruef C, Francioli P. et al . Nosocomial infections in Swiss university hospitals: a multi-centre survey and review of the published experience. Swiss-Noso Network.  Schweiz Med Wochenschr. 1999;  129 1521-1528
    PubMedGoogle Scholar
  • 44 Geffers C, Zuschneid I, Sohr D. et al . Microbiological isolates associated with nosocomial infections in intensive care units: data of 274 intensive care units participating in the German Nosocomial Infections Surveillance System (KISS).  Anasthesiol Intensivmed Notfallmed Schmerzther. 2004;  39 15-19
    Article in Thieme ConnectPubMedGoogle Scholar
  • 45 Gaynes R, Edwards J R. Overview of nosocomial infections caused by gram-negative bacilli.  Clin Infect Dis. 2005;  41 848-854
    CrossrefPubMedGoogle Scholar
  • 46 Kohlenberg A, Schwab F, Geffers C. et al . Time-trends for Gram-negative and multidrug-resistant Gram-positive bacteria associated with nosocomial infections in German intensive care units between 2000 and 2005.  Clin Microbiol Infect. 2008;  14 93-96
    CrossrefPubMedGoogle Scholar
  • 47 Suetens C, Morales I, Savey A. et al . European surveillance of ICU-acquired infections (HELICS-ICU): methods and main results.  J Hosp Infect. 2007;  65 (Suppl 2) 171-173
    CrossrefPubMedGoogle Scholar
  • 48 Sethi S, Murphy T F. Infection in the pathogenesis and course of chronic obstructive pulmonary disease.  N Engl J Med. 2008;  359 2355-2365
    CrossrefPubMedGoogle Scholar
  • 49 Chastre J, Fagon J Y. Ventilator-associated pneumonia.  Am J Respir Crit Care Med. 2002;  165 867-903
    CrossrefPubMedGoogle Scholar
  • 50 Wunderink R G. Clinical criteria in the diagnosis of ventilator-associated pneumonia.  Chest. 2000;  117 (4 Suppl 2) 191S-194S
    CrossrefPubMedGoogle Scholar
  • 51 Grossman R F, Fein A. Evidence-based assessment of diagnostic tests for ventilator-associated pneumonia. Executive summary.  Chest. 2000;  117 (4 Suppl 2) 177S-181S
    CrossrefPubMedGoogle Scholar
  • 52 Rello J, Paiva J A, Baraibar J. et al . International Conference for the Development of Consensus on the Diagnosis and Treatment of Ventilator-associated Pneumonia.  Chest. 2001;  120 955-970
    CrossrefPubMedGoogle Scholar
  • 53 Ramirez P, Valencia M, Torres A. Bronchoalveolar lavage to diagnose respiratory infections.  Semin Respir Crit Care Med. 2007;  28 525-533
    Article in Thieme ConnectPubMedGoogle Scholar
  • 54 Mackowiak P A, Martin R M, Jones S R. et al . Pharyngeal colonization by gram-negative bacilli in aspiration-prone persons.  Arch Intern Med. 1978;  138 1224-1227
    CrossrefPubMedGoogle Scholar
  • 55 Johanson W G, Pierce A K, Sanford J P. Changing pharyngeal bacterial flora of hospitalized patients. Emergence of gram-negative bacilli.  N Engl J Med. 1969;  281 1137-1140
    CrossrefPubMedGoogle Scholar
  • 56 LaForce F M. Hospital-acquired gram-negative rod pneumonias: an overview.  Am J Med. 1981;  70 664-669
    CrossrefPubMedGoogle Scholar
  • 57 Johanson Jr W G, Pierce A K, Sanford J P. et al . Nosocomial respiratory infections with gram-negative bacilli. The significance of colonization of the respiratory tract.  Ann Intern Med. 1972;  77 701-706
    CrossrefPubMedGoogle Scholar
  • 58 Bonten M J, Gaillard C A, de Leeuw P W. et al . Role of colonization of the upper intestinal tract in the pathogenesis of ventilator-associated pneumonia.  Clin Infect Dis. 1997;  24 309-319
    CrossrefPubMedGoogle Scholar
  • 59 Rello J, Gallego M, Mariscal D. et al . The value of routine microbial investigation in ventilator-associated pneumonia.  Am J Respir Crit Care Med. 1997;  156 196-200
    PubMedGoogle Scholar
  • 60 Wagner D, Young L S. Nontuberculous mycobacterial infections: a clinical review.  Infection. 2004;  32 257-270
    CrossrefPubMedGoogle Scholar
  • 61 Wolinsky E. Mycobacterial diseases other than tuberculosis.  Clin Infect Dis. 1992;  15 1-10
    CrossrefPubMedGoogle Scholar
  • 62 Garcia Garcia J M, Palacios Gutierrez J J, Sanchez Antuna A A. Respiratory infections caused by environmental mycobacteria.  Arch Bronconeumol. 2005;  41 206-219
    PubMedGoogle Scholar
  • 63 Daley C L, Griffith D E. Pulmonary disease caused by rapidly growing mycobacteria.  Clin Chest Med. 2002;  23 623-632, vii
    CrossrefPubMedGoogle Scholar
  • 64 Piersimoni C, Scarparo C. Pulmonary infections associated with non-tuberculous mycobacteria in immunocompetent patients.  Lancet Infect Dis. 2008;  8 323-334
    CrossrefPubMedGoogle Scholar
  • 65 Griffith D E, Aksamit T, Brown-Elliott B A. et al . An official ATS/IDSA statement: diagnosis, treatment, and prevention of nontuberculous mycobacterial diseases.  Am J Respir Crit Care Med. 2007;  175 367-416
    CrossrefPubMedGoogle Scholar
  • 66 Henry M T, Inamdar L, O'Riordain D. et al . Nontuberculous mycobacteria in non-HIV patients: epidemiology, treatment and response.  Eur Respir J. 2004;  23 741-746
    CrossrefPubMedGoogle Scholar
  • 67 Dhillon S S, Watanakunakorn C. Lady Windermere syndrome: middle lobe bronchiectasis and Mycobacterium avium complex infection due to voluntary cough suppression.  Clin Infect Dis. 2000;  30 572-575
    CrossrefPubMedGoogle Scholar
  • 68 Dailloux M, Abalain M L, Laurain C. et al . Respiratory infections associated with nontuberculous mycobacteria in non-HIV patients.  Eur Respir J. 2006;  28 1211-1215
    CrossrefPubMedGoogle Scholar
  • 69 Sexton P, Harrison A C. Susceptibility to nontuberculous mycobacterial lung disease.  Eur Respir J. 2008;  31 1322-1333
    CrossrefPubMedGoogle Scholar
  • 70 Wolinsky E. Mycobacterial diseases other than tuberculosis.  Clin Infect Dis. 1992;  15 1-10
    CrossrefPubMedGoogle Scholar
  • 71 Ellis S M. The spectrum of tuberculosis and non-tuberculous mycobacterial infection.  Eur Radiol. 2004;  14 (Suppl 3) E34-E42
    CrossrefPubMedGoogle Scholar
  • 72 Field S K, Cowie R L. Lung disease due to the more common nontuberculous mycobacteria.  Chest. 2006;  129 1653-1672
    CrossrefPubMedGoogle Scholar
  • 73 Kalsdorf B, Strassburg A, Greinert U. et al . Clinical features and diagnosis of tuberculosis.  Pneumologie. 2008;  62 284-294
    Article in Thieme ConnectPubMedGoogle Scholar
  • 74 Thomson R M, Yew W W. When and how to treat pulmonary non-tuberculous mycobacterial diseases.  Respirology. 2009;  14 12-26
    CrossrefPubMedGoogle Scholar
  • 75 Olivier K N, Weber D J, Lee J H. et al . Nontuberculous mycobacteria. II: nested-cohort study of impact on cystic fibrosis lung disease.  Am J Respir Crit Care Med. 2003;  167 835-840
    CrossrefPubMedGoogle Scholar
  • 76 Ernst A, Simoff M, Ost D. et al . Prospective risk-adjusted morbidity and mortality outcome analysis after therapeutic bronchoscopic procedures: results of a multi-institutional outcomes database.  Chest. 2008;  134 514-519
    CrossrefPubMedGoogle Scholar
  • 77 Sottile F D, Marrie T J, Prough D S. et al . Nosocomial pulmonary infection: possible etiologic significance of bacterial adhesion to endotracheal tubes.  Crit Care Med. 1986;  14 265-270
    CrossrefPubMedGoogle Scholar
  • 78 Comhaire A, Lamy M. Contamination rate of sterilized ventilators in an ICU.  Crit Care Med. 1981;  9 546-548
    CrossrefPubMedGoogle Scholar
  • 79 Levine S A, Niederman M S. The impact of tracheal intubation on host defenses and risks for nosocomial pneumonia.  Clin Chest Med. 1991;  12 523-543
    PubMedGoogle Scholar
  • 80 Noppen M, Pierard D, Meysman M. et al . Bacterial colonization of central airways after stenting.  Am J Respir Crit Care Med. 1999;  160 672-677
    PubMedGoogle Scholar
  • 81 Nouraei S A, Petrou M A, Randhawa P S. et al . Bacterial colonization of airway stents: a promoter of granulation tissue formation following laryngotracheal reconstruction.  Arch Otolaryngol Head Neck Surg. 2006;  132 1086-1090
    CrossrefPubMedGoogle Scholar
  • 82 Schmal F, Fegeler W, Terpe H J. et al . Bacteria and granulation tissue associated with Montgomery T-tubes.  Laryngoscope. 2003;  113 1394-1400
    CrossrefPubMedGoogle Scholar
  • 83 Sasaki C T, Horiuchi M, Koss N. Tracheostomy-related subglottic stenosis: bacteriologic pathogenesis.  Laryngoscope. 1979;  89 857-865
    PubMedGoogle Scholar
  • 84 van Rijen M, Bonten M, Wenzel R. et al . Mupirocin ointment for preventing Staphylococcus aureus infections in nasal carriers.  Cochrane Database Syst Rev. 2008;  4 CD006216
    PubMedGoogle Scholar

Prof. Dr. med. Dipl.-Biol. Christoph Lange

Klinische Infektiologie, Medizinische Klinik
Forschungszentrum Borstel

Parkallee 35
23845 Borstel

Email: clange@fz-borstel.de

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