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Regev-Yochay G, Margalit I, Smollan G, Rapaport R, Tal I, Hanage WP, Pinas Zade N, Jaber H, Taylor BP, Che Y, Rahav G, Zimlichman E, Keller N. Sink-traps are a major source for carbapenemase-producing Enterobacteriaceae transmission. Infect Control Hosp Epidemiol 2024; 45:284-291. [PMID: 38149351 DOI: 10.1017/ice.2023.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE We studied the extent of carbapenemase-producing Enterobacteriaceae (CPE) sink contamination and transmission to patients in a nonoutbreak setting. METHODS During 2017-2019, 592 patient-room sinks were sampled in 34 departments. Patient weekly rectal swab CPE surveillance was universally performed. Repeated sink sampling was conducted in 9 departments. Isolates from patients and sinks were characterized using pulsed-field gel electrophoresis (PFGE), and pairs of high resemblance were sequenced by Oxford Nanopore and Illumina. Hybrid assembly was used to fully assemble plasmids, which are shared between paired isolates. RESULTS In total, 144 (24%) of 592 CPE-contaminated sinks were detected in 25 of 34 departments. Repeated sampling (n = 7,123) revealed that 52%-100% were contaminated at least once during the sampling period. Persistent contamination for >1 year by a dominant strain was common. During the study period, 318 patients acquired CPE. The most common species were Klebsiella pneumoniae, Escherichia coli, and Enterobacter spp. In 127 (40%) patients, a contaminated sink was the suspected source of CPE acquisition. For 20 cases with an identical sink-patient strain, temporal relation suggested sink-to-patient transmission. Hybrid assembly of specific sink-patient isolates revealed that shared plasmids were structurally identical, and SNP differences between shared pairs, along with signatures for potential recombination events, suggests recent sharing of the plasmids. CONCLUSIONS CPE-contaminated sinks are an important source of transmission to patients. Although traditionally person-to-person transmission has been considered the main route of CPE transmission, these data suggest a change in paradigm that may influence strategies of preventing CPE dissemination.
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Affiliation(s)
- Gili Regev-Yochay
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ili Margalit
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gillian Smollan
- Microbiology laboratory, Sheba Medical Center, Ramat-Gan, Israel
| | - Rotem Rapaport
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilana Tal
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Nani Pinas Zade
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Hanaa Jaber
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Bradford P Taylor
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - You Che
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Galia Rahav
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Nati Keller
- Microbiology laboratory, Sheba Medical Center, Ramat-Gan, Israel
- Ariel University, Ari'el, Samaria
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Boutin S, Scherrer M, Späth I, Kocer K, Heeg K, Nurjadi D. Cross-contamination of carbapenem-resistant Gram-negative bacteria between patients and the hospital environment in the first year of a newly built surgical ward. J Hosp Infect 2024; 144:118-127. [PMID: 38081456 DOI: 10.1016/j.jhin.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/06/2023] [Accepted: 11/20/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Transmission and outbreaks of carbapenem-resistant Gram-negative bacteria (CRGN) in hospitals are often associated with contamination of the wastewater environment. We performed a prospective observational study to investigate the colonization of the hospital wastewater environment during the first year of occupancy of the surgical intermediate and intensive care units of a newly constructed building at the University Hospital of Heidelberg, Germany. METHODS We performed monthly screening of the wastewater system (toilets and sinks) for 12 months, starting 1 month before opening (1st October 2020 to 30th October 2021). Admission and weekly rectal screening of patients for CRGN were also performed in parallel. Bacterial isolates were characterized by whole-genome sequencing. RESULTS Twenty-seven of 1978 (1.4%) admitted patients were colonized/infected with CRGN. A total of 29 CRGN isolates from 24 patients and 52 isolates were available for sequencing. Within the first month of occupancy, we identified seven patients colonized/infected with CRGN, while none were found in the environmental reservoirs. The first detection of CRGN isolates in the sewage system started five months after the first occupancy. Two previously non-colonized patients were colonized/infected with Pseudomonas aeruginosa strains colonizing the sewage system. The significant identity of plasmids carrying the carbapenemase gene suggests that long-term colonization of the sewage system facilitates the emergence of new carbapenem-resistant clones. CONCLUSION Cross-contamination between patients and the hospital environment is bidirectional. Our study demonstrated that contamination of the hospital wastewater environment may lead to persistent colonization and may serve as a reservoir for nosocomial acquisition of CRGN.
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Affiliation(s)
- S Boutin
- University of Lübeck and University Medical Center Schleswig-Holstein, Department of Infectious Diseases and Microbiology, Lübeck, Germany; Heidelberg University Hospital, Department of Medical Microbiology and Hygiene, Heidelberg, Germany
| | - M Scherrer
- Heidelberg University Hospital, Department of Medical Microbiology and Hygiene, Heidelberg, Germany
| | - I Späth
- Heidelberg University Hospital, Department of Medical Microbiology and Hygiene, Heidelberg, Germany
| | - K Kocer
- Heidelberg University Hospital, Department of Medical Microbiology and Hygiene, Heidelberg, Germany
| | - K Heeg
- Heidelberg University Hospital, Department of Medical Microbiology and Hygiene, Heidelberg, Germany
| | - D Nurjadi
- University of Lübeck and University Medical Center Schleswig-Holstein, Department of Infectious Diseases and Microbiology, Lübeck, Germany; Heidelberg University Hospital, Department of Medical Microbiology and Hygiene, Heidelberg, Germany; German Center for Infection Research (DZIF), Partner Site Hamburg-Lübeck-Borstel-Riems, Germany.
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3
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Martins APS, da Mata CPSM, dos Santos UR, de Araújo CA, Leite EMM, de Carvalho LD, Vidigal PG, Vieira CD, dos Santos-Key SG. Association between multidrug-resistant bacteria and outcomes in intensive care unit patients: a non-interventional study. Front Public Health 2024; 11:1297350. [PMID: 38259738 PMCID: PMC10801015 DOI: 10.3389/fpubh.2023.1297350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 12/15/2023] [Indexed: 01/24/2024] Open
Abstract
Background In intensive care units (ICUs), infections by multidrug-resistant (MDR) microorganisms should be monitored to prevent healthcare-associated infections (HAIs). Methods From 2018 to 2020, we investigated all medical records of patients admitted to the ICU of a public university hospital. All patients colonized/infected by MDR microorganisms and submitted to active surveillance cultures (ASCs) were included. Results and discussion Male patients prevailed, and 9.5% were positive for MDR bacteria. In-hospital deaths were statistically significant (p < 0.05) for older patients, patients with orotracheal tube use during previous and current hospitalization, and patients with high blood pressure, cardiac and pulmonary diseases, and chronic kidney disease. Carbapenem resistant Enterobacteriaceae was the most frequently resistance profile, followed by extended-spectrum beta-lactamase. The diagnosis or evolution of HAIs was statistically significant (p < 0.0001) for patients treated with meropenem and vancomycin, and in-hospital deaths occurred in 29.5% of patients using polypeptides while the use of macrolides reduced the odds for mortality. The BRADEN Scale demonstrated that 50% of the patients were at high risk of dying. Conclusion Patients hospitalized in the ICU, colonized or infected by MDR bacteria, using invasive medical devices, and with underlying medical conditions presented increased mortality rates. The prescription of meropenem and vancomycin should be carefully monitored once patients using these antimicrobials already have or develop an HAI.
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Affiliation(s)
- Alessandro Pacheco Silveira Martins
- Hospital Risoleta Tolentino Neves, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - César Augusto de Araújo
- Hospital Risoleta Tolentino Neves, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | | | - Pedro Guatimosim Vidigal
- Hospital Risoleta Tolentino Neves, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
- Escola de Medicina, Departmento de Patologia Clínica, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Cristina Dutra Vieira
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Simone Gonçalves dos Santos-Key
- Departamento de Microbiologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Salas-Orozco MF, Lorenzo-Leal AC, de Alba Montero I, Marín NP, Santana MAC, Bach H. Mechanism of escape from the antibacterial activity of metal-based nanoparticles in clinically relevant bacteria: A systematic review. NANOMEDICINE : NANOTECHNOLOGY, BIOLOGY, AND MEDICINE 2024; 55:102715. [PMID: 37907198 DOI: 10.1016/j.nano.2023.102715] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 08/05/2023] [Accepted: 10/05/2023] [Indexed: 11/02/2023]
Abstract
The emergency of antibiotic-resistant bacteria in severe infections is increasing, especially in nosocomial environments. The ESKAPE group is of special importance in the groups of multi-resistant bacteria due to its high capacity to generate resistance to antibiotics and bactericides. Therefore, metal-based nanomaterials are an attractive alternative to combat them because they have been demonstrated to damage biomolecules in the bacterial cells. However, there is a concern about bacteria developing resistance to NPs and their harmful effects due to environmental accumulation. Therefore, this systematic review aims to report the clinically relevant bacteria that have developed resistance to the NPs. According to the results of this systematic review, various mechanisms to counteract the antimicrobial activity of various NP types have been proposed. These mechanisms can be grouped into the following categories: production of extracellular compounds, metal efflux pumps, ROS response, genetic changes, DNA repair, adaptative morphogenesis, and changes in the plasma membrane.
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Affiliation(s)
- Marco Felipe Salas-Orozco
- Facultad de Estomatología, Doctorado en Ciencias Odontológicas, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico.
| | - Ana Cecilia Lorenzo-Leal
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Nuria Patiño Marín
- Facultad de Estomatología, Laboratorio de Investigación Clinica, Universidad Autónoma de San Luis Potosí, San Luis Potosí, Mexico
| | - Miguel Angel Casillas Santana
- Maestría en Estomatología con Opcion Terminal en Ortodoncia, Facultad de Estomatología, Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Horacio Bach
- Division of Infectious Diseases, Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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5
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Woudt SH, Schoffelen AF, Frakking FN, Reuland EA, Severin JA, den Drijver M, Haenen A, Nonneman MM, Notermans DW, Aan de Stegge DC, de Stoppelaar SF, Vandenbroucke-Grauls CM, de Greeff SC. Description of a nationwide structure for monitoring nosocomial outbreaks of (highly resistant) microorganisms in the Netherlands: characteristics of outbreaks in 2012-2021. Antimicrob Resist Infect Control 2023; 12:143. [PMID: 38066583 PMCID: PMC10709896 DOI: 10.1186/s13756-023-01350-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Before 2012, established national surveillance systems in the Netherlands were not able to provide a timely, comprehensive epidemiological view on nosocomial outbreaks. The Healthcare-associated Infections and AntiMicrobial Resistance Monitoring Group (SO-ZI/AMR) was initiated in 2012 for timely national nosocomial outbreak monitoring and risk assessment. This paper aims to describe the achievements of the SO-ZI/AMR by presenting characteristics of outbreaks reported in 2012-2021. METHODS Hospitals and, since 2015, long-term care facilities (LTCF) were requested to report outbreaks when (1) continuity of care was threatened, or (2) transmission continued despite control measures. A multi-disciplinary expert panel (re-)assessed the public health risk of outbreaks during monthly meetings, using 5 severity phases and based on data collected via standardised questionnaires. We descriptively studied the panel's consensus-based severity classification, distribution of (highly resistant) microorganisms, and duration and size of outbreaks between April 2012 and December 2021. RESULTS In total, 353 hospital outbreaks and 110 LTCF outbreaks were reported. Most outbreaks (hospitals: n = 309 (88%), LTCF: n = 103 (94%)) did not progress beyond phase 1 (no public health implications, outbreak expected to be controlled within two months), one hospital outbreak reached phase 4 (insufficient/ineffective response: possible public health threat, support offered). Highly resistant microorganisms (HRMO) were involved in 269 (76%) hospital and 103 (94%) LTCF outbreaks. Most outbreaks were caused by methicillin-resistant Staphylococcus aureus (MRSA; n = 93 (26%) in hospitals, n = 80 (72%) in LTCF), vancomycin-resistant Enterococcus faecium (VRE; n = 116 (33%) in hospitals, n = 2 (2%) in LTCF) and highly resistant Enterobacterales (n = 41 (12%) in hospitals, n = 20 (18%) in LTCF). Carbapenemase-producing gram-negative bacteria were involved in 32 (9.1%) hospital and five (4.5%) LTCF outbreaks. In hospitals, VRE outbreaks had the longest duration (median 2.3; range 0.0-22.8 months) and widest range of affected patients (median 9; range 2-483). CONCLUSIONS The SO-ZI/AMR provided national insight into the characteristics of nosocomial outbreaks over the past decade. HRMO outbreaks - mostly caused by MRSA, VRE (in hospitals) and highly resistant Enterobacterales - occurred regularly, but most of them were controlled quickly and did not develop into a public health threat. The SO-ZI/AMR has become a solid monitoring body, essential to assess risks and raise awareness of potential HRMO threats.
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Affiliation(s)
- Sjoukje Hs Woudt
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
| | - Annelot F Schoffelen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Florine Nj Frakking
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - E Ascelijn Reuland
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
- Saltro Diagnostic Center for Primary Care, Utrecht, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Marije den Drijver
- Department of Infection Control, Maasstad Hospital, Rotterdam, The Netherlands
| | - Anja Haenen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | | | - Daan W Notermans
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | | | - Sacha F de Stoppelaar
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
- Infectious diseases department, Amsterdam Academic Medical Center, Amsterdam, The Netherlands
| | - Christina Mje Vandenbroucke-Grauls
- Department of Medical Microbiology and Infection Prevention, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Sabine C de Greeff
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Pertegal V, Riquelme E, Lozano-Serra J, Cañizares P, Rodrigo MA, Sáez C, Lacasa E. Cleaning technologies integrated in duct flows for the inactivation of pathogenic microorganisms in indoor environments: A critical review of recent innovations and future challenges. JOURNAL OF ENVIRONMENTAL MANAGEMENT 2023; 345:118798. [PMID: 37591101 DOI: 10.1016/j.jenvman.2023.118798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 08/02/2023] [Accepted: 08/09/2023] [Indexed: 08/19/2023]
Abstract
Pathogenic microorganisms are a major concern in indoor environments, particularly in sensitive facilities such as hospitals, due to their potential to cause nosocomial infections. This study evaluates the concentration of airborne bacteria and fungi in the University Hospital Complex of Albacete (Spain), comparing the results with recent literature. Staphylococcus is identified as the most prevalent bacterial genus with a percentage distribution of 35%, while Aspergillus represents the dominant fungal genus at 34%. The lack of high Technology Readiness Levels (TRL 6, TRL 7) for effective indoor air purification requires research efforts to bridge this knowledge gap. A screening of disinfection technologies for pathogenic airborne microorganisms such as bacteria and fungi is conducted. The integration of filtration, irradiation or and (electro)chemical gas treatment systems in duct flows is discussed to enhance the design of the air-conditioning systems for indoor air purification. Concerns over microbial growth have led to recent studies on coating commercial fibrous air filters with antimicrobial particles (silver nanoparticles, iron oxide nanowires) and polymeric materials (polyaniline, polyvinylidene fluoride). Promising alternatives to traditional short-wave UV-C energy for disinfection include LED and Far-UVC irradiation systems. Additionally, research explores the use of TiO2 and TiO2 doped with metals (Ag, Cu, Pt) in filters with photocatalytic properties, enabling the utilization of visible or solar light. Hybrid photocatalysis, combining TiO2 with polymers, carbon nanomaterials, or MXene nanomaterials, enhances the photocatalytic process. Chemical treatment systems such as aerosolization of biocidal agents (benzalkonium chloride, hydrogen peroxide, chlorine dioxide or ozone) with their possible combination with other technologies such as adsorption, filtration or photocatalysis, are also tested for gas disinfection. However, the limited number of studies on the use of electrochemical technology poses a challenge for further investigation into gas-phase oxidant generation, without the formation of harmful by-products, to raise its TRL for effectively inactivating airborne microorganisms in indoor environments.
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Affiliation(s)
- Víctor Pertegal
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071, Albacete, Spain
| | - Eva Riquelme
- Clinical Parasitology and Microbiology Area. University Hospital Complex of Albacete, C/ Hermanos Falcó 37, 02006, Albacete, Spain
| | - Julia Lozano-Serra
- Clinical Parasitology and Microbiology Area. University Hospital Complex of Albacete, C/ Hermanos Falcó 37, 02006, Albacete, Spain
| | - Pablo Cañizares
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005, Ciudad Real, Spain
| | - Manuel A Rodrigo
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005, Ciudad Real, Spain
| | - Cristina Sáez
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005, Ciudad Real, Spain
| | - Engracia Lacasa
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071, Albacete, Spain.
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Prakki SRS, Hon PY, Lim ZQ, Thevasagayam NM, Loy SQD, De PP, Marimuthu K, Vasoo S, Ng OT. Dissemination of Pseudomonas aeruginosa blaNDM-1-Positive ST308 Clone in Singapore. Microbiol Spectr 2023; 11:e0403322. [PMID: 37042789 PMCID: PMC10269627 DOI: 10.1128/spectrum.04033-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 03/25/2023] [Indexed: 04/13/2023] Open
Abstract
Pseudomonas aeruginosa ST308 clone has been reported to carry carbapenemase genes such as blaIMP and blaVIM but has been rarely associated with blaNDM-1. A total of 199 P. aeruginosa ST308 clinical and environmental isolates obtained between April 2019 and November 2020 from a tertiary-care hospital in Singapore were characterized using whole-genome sequencing. In addition, 71 blaNDM-1-positive ST308 whole-genome sequences from two other local tertiary-care hospitals in Singapore and 83 global blaNDM-1-negative ST308 whole-genome sequences in public databases were included to assess phylogenetic relationships and perform genome analyses. Phylogenetic analysis and divergent time estimation revealed that blaNDM-1-positive P. aeruginosa ST308 was introduced into Singapore in 2005 (95 % highest posterior density: 2001 to 2008). Core genome, resistome, and analyses of all local blaNDM-1-positive ST308 isolates showed chromosomal integration of multiple antibiotic resistance genes (ARGs) [aac(3)-Id, aac(6')-Il, aadA6, aadA11, dfrB5, msr(E), floR, sul2, and qnrVC1], which was absent in global blaNDM-1-negative ST308 sequences. Most ARGs and virulence genes were conserved across isolates originating from the three different local hospitals. Close genetic relatedness of the blaNDM-1-positive ST308 clinical and environmental isolates suggests cocirculation between the hospital environment and human hosts with the hospital environment as a potential reservoir. Core genome single nucleotide polymorphism analyses revealed possible clonal transmission of blaNDM-1-positive ST308 isolates between the three hospitals over 7 years. Bloodstream isolates accounted for six of 95 (6.3%) clinical isolates. This study reports the introduction of a pathogenic blaNDM-1-positive P. aeruginosa ST308 more than a decade ago in Singapore and warrants surveillance for wider dissemination. IMPORTANCE P. aeruginosa is a Gram-negative opportunistic pathogen ubiquitously found in the environment and a major cause of nosocomial infections. While the P. aeruginosa ST308 clone has been known to bear blaIMP and blaVIM among global isolates, reports of blaNDM-1-positive P. aeruginosa ST308 are rare. The local blaNDM-1-positive P. aeruginosa ST308 isolates detected in this study appear to be unique to this region, with evidence of chromosomal acquisition of multiple ARGs compared to global blaNDM-1-negative P. aeruginosa ST308 isolates. Surveillance in Singapore and beyond for dissemination is essential to determine whether existing measures are sufficient to control the spread of this ST308 clone.
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Affiliation(s)
| | - Pei Yun Hon
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
| | - Ze Qin Lim
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Song Qi Dennis Loy
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
| | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore
| | - Shawn Vasoo
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore
- Tan Tock Seng Hospital, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Heljanko V, Johansson V, Räisänen K, Anttila VJ, Lyytikäinen O, Jalava J, Weijo I, Lehtinen JM, Lehto KM, Lipponen A, Oikarinen S, Pitkänen T, Heikinheimo A. Genomic epidemiology of nosocomial carbapenemase-producing Citrobacter freundii in sewerage systems in the Helsinki metropolitan area, Finland. Front Microbiol 2023; 14:1165751. [PMID: 37303777 PMCID: PMC10250652 DOI: 10.3389/fmicb.2023.1165751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Multi-drug resistance is emerging in Citrobacter freundii, which is the third most common carbapenemase-producing (CP) Enterobacteriaceae in humans in Finland due to recent outbreaks. The objective of this study was to determine if wastewater surveillance (WWS) could detect CP C. freundii strains causing infections in humans. Selective culturing was used to isolate CP C. freundii from the hospital environment, hospital wastewater, and untreated municipal wastewater in Helsinki, Finland, between 2019 and 2022. Species were identified using MALDI-TOF, and presumptive CP C. freundii isolates were subjected to antimicrobial susceptibility testing and further characterized by whole genome sequencing. A genomic comparison was conducted to compare isolates collected from the hospital environment, untreated municipal wastewater, and a selection of isolates from human specimens from two hospitals in the same city. We also examined the persistence of CP C. freundii in the hospital environment and the impact of our attempts to eradicate it. Overall, 27 blaKPC - 2-carrying C. freundii were detected in the hospital environment (ST18; n = 23 and ST8; n = 4), while 13 blaKPC - 2-carrying C. freundii (ST8) and five blaVIM - 1-carrying (ST421) C. freundii were identified in untreated municipal wastewater. CP C. freundii was not identified in hospital wastewater. We found three clusters (cluster distance threshold ≤ 10 allelic difference) after comparing the recovered isolates and a selection of isolates from human specimens. The first cluster consisted of ST18 isolates from the hospital environment (n = 23) and human specimens (n = 4), the second consisted of ST8 isolates from the hospital environment (n = 4), untreated municipal wastewater (n = 6), and human specimens (n = 2), and the third consisted of ST421 isolates from the untreated municipal wastewater (n = 5). Our results support previous studies suggesting that the hospital environment could act as a source of transmission of CP C. freundii in clinical settings. Furthermore, the eradication of CP Enterobacteriaceae from the hospital environment is challenging. Our findings also showed that CP C. freundii is persistent throughout the sewerage system and demonstrate the potential of WWS for detecting CP C. freundii.
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Affiliation(s)
- Viivi Heljanko
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Venla Johansson
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Kati Räisänen
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Veli-Jukka Anttila
- Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
- Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Outi Lyytikäinen
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Jari Jalava
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Irma Weijo
- Inflammation Center, Helsinki University Central Hospital, Helsinki, Finland
| | - Jaana-Marija Lehtinen
- Department of Health Security, National Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi-Maarit Lehto
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Anssi Lipponen
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Sami Oikarinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Tarja Pitkänen
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Health Security, National Institute for Health and Welfare, Kuopio, Finland
| | - Annamari Heikinheimo
- Department of Food Hygiene and Environmental Health, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Finnish Food Authority, Ruokavirasto, Seinäjoki, Finland
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Chan A, Thure K, Tobey K, Shugart A, Schmedes S, Burks JA, Hardin H, Moore C, Carpenter T, Brooks S, Gable P, Moulton Meissner H, McAllister G, Lawsin A, Laufer Halpin A, Spalding Walters M, Keaton A. Containment of a Verona Integron-Encoded Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Outbreak Associated With an Acute Care Hospital Sink-Tennessee, 2018-2020. Open Forum Infect Dis 2023; 10:ofad194. [PMID: 37180588 PMCID: PMC10173543 DOI: 10.1093/ofid/ofad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Contaminated healthcare facility wastewater plumbing is recognized as a source of carbapenemase-producing organism transmission. In August 2019, the Tennessee Department of Health (TDH) identified a patient colonized with Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). A record review revealed that 33% (4 of 12) of all reported patients in Tennessee with VIM had history of prior admission to acute care hospital (ACH) A intensive care unit (ICU) Room X, prompting further investigation. Methods A case was defined as polymerase chain reaction detection of blaVIM in a patient with prior admission to ACH A from November 2017 to November 2020. The TDH performed point prevalence surveys, discharge screening, onsite observations, and environmental testing at ACH A. The VIM-CRPA isolates underwent whole-genome sequencing (WGS). Results In a screening of 44% (n = 11) of 25 patients admitted to Room X between January and June 2020, we identified 36% (n = 4) colonized with VIM-CRPA, resulting in 8 cases associated with Room X from March 2018 to June 2020. No additional cases were identified in 2 point-prevalence surveys of the ACH A ICU. Samples from the bathroom and handwashing sink drains in Room X grew VIM-CRPA; all available case and environmental isolates were found to be ST253 harboring blaVIM-1 and to be closely related by WGS. Transmission ended after implementation of intensive water management and infection control interventions. Conclusions A single ICU room's contaminated drains were associated with 8 VIM-CRPA cases over a 2-year period. This outbreak highlights the need to include wastewater plumbing in hospital water management plans to mitigate the risk of transmission of antibiotic-resistant organisms to patients.
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Affiliation(s)
- Allison Chan
- Correspondence: Allison Chan, MPH, Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, 2525 West End Avenue, Suite 600, Nashville, TN 37203 (); Present Affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katie Thure
- Present Affiliation: David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelley Tobey
- Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Sarah Schmedes
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - James Albert Burks
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Henrietta Hardin
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Christina Moore
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Tina Carpenter
- North Knoxville Medical Center, Knoxville, Tennessee, USA
| | | | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Heather Moulton Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Amelia Keaton
- Present Affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
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Büchler AC, Shahab SN, Severin JA, Vos MC, Voor In 't Holt AF. Outbreak investigations after identifying carbapenem-resistant Pseudomonas aeruginosa: a systematic review. Antimicrob Resist Infect Control 2023; 12:28. [PMID: 37013661 PMCID: PMC10068724 DOI: 10.1186/s13756-023-01223-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 02/23/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a serious cause of healthcare-associated infections. Part of the infection prevention and control measures are outbreak investigations (OI) of patients, healthcare workers (HCW), and the environment after identifying a CRPA in order to identify carriers and environmental reservoirs, so that targeted actions can be taken to prevent further transmission. However, little is known on when and how to perform such OI. Therefore, this systematic review aims to summarize OI performed after detection of CRPA in the endemic and epidemic hospital setting. MAIN TEXT Articles related to our research question were identified through a literature research in multiple databases (Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar) until January 12, 2022 (Prospero registration number CRD42020194165). Hundred-twenty-six studies were included. In both the endemic and the epidemic setting, a median number of two out of seven predefined components of OI were identified. In the endemic setting, the most frequent component of OI was screening of the environment (28 studies, 62.2%). In the epidemic setting, screening of the environment (72 studies, 88.9%), and screening of patients during hospitalization (30 studies, 37%) were most frequently performed. Only 19 out of 126 studies (15.1%) reported screening of contact patients, and 37 studies reported screening of healthcare workers (HCW, 29.4%). CONCLUSION Due to probable underreporting of OI in the literature, the available evidence for the usefulness of the individual components of OI is scarce. This could lead to inhomogeneous performance of OI after detection of CRPA in the healthcare setting, and with this, potential under- or overscreening. While we could show evidence for the usefulness for environmental screening in order to identify the mode of transmission, evidence for HCW screening is scarce and might not lead to the identification of modes of transmission. Further studies are needed to better understand CI in different settings and, finally, develop guidance on when and how to best perform OI.
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Affiliation(s)
- Andrea C Büchler
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Selvi N Shahab
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
- Department of Clinical Microbiology, Dr. Cipto Mangunkusumo General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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11
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Peters A, Parneix P, Kiernan M, Severin JA, Gauci T, Pittet D. New frontiers in healthcare environmental hygiene: thoughts from the 2022 healthcare cleaning forum. Antimicrob Resist Infect Control 2023; 12:7. [PMID: 36750872 PMCID: PMC9902814 DOI: 10.1186/s13756-022-01185-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/11/2022] [Indexed: 02/09/2023] Open
Abstract
Healthcare environmental hygiene (HEH) has become recognized as being increasingly important for patient safety and the prevention of healthcare-associated infections. At the 2022 Healthcare Cleaning Forum at Interclean in Amsterdam, the academic lectures focused on a series of main areas of interest. These areas are indicative of some of the main trends and avenues for research in the coming years. Both industry and academia need to take steps to continue the momentum of HEH as we transition out of the acute phase of the Covid-19 pandemic. There is a need for new ways to facilitate collaboration between the academic and private sectors. The Clean Hospitals® network was presented in the context of the need for both cross-disciplinarity and evidence-based interventions in HEH. Governmental bodies have also become more involved in the field, and both the German DIN 13603 standard and the UK NHS Cleaning Standards were analyzed and compared. The challenge of environmental pathogens was explored through the example of how P. aeruginosa persists in the healthcare environment. New innovations in HEH were presented, from digitalization to tracking, and automated disinfection to antimicrobial surfaces. The need for sustainability in HEH was also explored, focusing on the burden of waste, the need for a circular economy, and trends towards increasingly local provision of goods and services. The continued focus on and expansion of these areas of HEH will result in safer patient care and contribute to better health systems.
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Affiliation(s)
- Alexandra Peters
- grid.8591.50000 0001 2322 4988Infection Control Programme and WHO Collaborating Center On Infection Prevention and Control and Antimicrobial Resistance, Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre Parneix
- grid.42399.350000 0004 0593 7118Nouvelle Aquitaine Health Care-Associated Infection Control Centre, Bordeaux University Hospital, Bordeaux, France
| | - Martin Kiernan
- grid.81800.310000 0001 2185 7124Richard Wells Research Centre, University of West London, London, UK
| | - Juliëtte A. Severin
- grid.5645.2000000040459992XDepartment of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tracey Gauci
- grid.428852.10000 0001 0449 3568Hywel Dda University Health Board, NHS Wales, Carmarthen, UK
| | - Didier Pittet
- Infection Control Programme and WHO Collaborating Center On Infection Prevention and Control and Antimicrobial Resistance, Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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12
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Pertegal V, Lacasa E, Cañizares P, Rodrigo MA, Sáez C. Understanding the influence of the bioaerosol source on the distribution of airborne bacteria in hospital indoor air. ENVIRONMENTAL RESEARCH 2023; 216:114458. [PMID: 36181895 DOI: 10.1016/j.envres.2022.114458] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 06/16/2023]
Abstract
The composition and concentration of airborne microorganisms in hospital indoor air has been reported to contain airborne bacteria and fungi concentrations ranged 101-103 CFU/m3 in inpatients facilities which mostly exceed recommendations from the World Health Organization (WHO). In this work, a deeper knowledge of the performance of airborne microorganisms would allow improving the designs of the air-conditioning installations to restrict hospital-acquired infections (HAIs). A solution containing Escherichia coli (E. coli) as a model of airborne bacteria was nebulized using the Collison nebulizer to simulate bioaerosols in various hospital areas such as patients' rooms or bathrooms. Results showed that the bioaerosol source had a significant influence on the airborne bacteria concentrations since 4.00 102, 6.84 103 and 1.39 104 CFU mL-1 were monitored during the aerosolization for 10 min of urine, saliva and urban wastewater, respectively. These results may be explained considering the quite narrow distribution profile of drop sizes around 1.10-1.29 μm obtained for urban wastewater, with much vaster distribution profiles during the aerosolization of urine or saliva. The airborne bacteria concentration may increase up to 107 CFU mL-1 for longer sampling times and higher aerosolization pressures, causing several cell damages. The cell membrane damage index (ID) can vary from 0 to 1, depending on the genomic DNA releases from bacteria. In fact, the ID of E. coli was more than two times higher (0.33 vs. 0.72) when increasing the pressure of air flow was applied from 1 to 2 bar. Finally, the ventilation air flow also affected the distribution of bioaerosols due to its direct relationship with the relative humidity of indoor air. Specifically, the airborne bacteria concentration diminished almost below 3-logs by applying more than 10 L min-1 during the aerosolization of urine due to their inactivation by an increase in their osmotic pressure.
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Affiliation(s)
- Víctor Pertegal
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario S/n, 02071, Albacete, Spain
| | - Engracia Lacasa
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario S/n, 02071, Albacete, Spain.
| | - Pablo Cañizares
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario S/n, 13005, Ciudad Real, Spain
| | - Manuel A Rodrigo
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario S/n, 13005, Ciudad Real, Spain
| | - Cristina Sáez
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario S/n, 13005, Ciudad Real, Spain.
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13
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Genomic landscape of bla GES-5- and bla GES-24-harboring Gram-negative bacteria from hospital wastewater: emergence of class 3 integron-associated bla GES-24 genes. J Glob Antimicrob Resist 2022; 31:196-206. [PMID: 36180037 DOI: 10.1016/j.jgar.2022.09.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/09/2022] [Accepted: 09/13/2022] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This study aimed to characterize Gram negative bacteria carrying blaGES carbapenemase genes detected in wastewater from a hospital with no history of detection of clinical isolates producing GES carbapenemases. METHODS Six hospital effluent samples were screened for carbapenemase-producing organisms (CPO) using CHROMagar mSuperCARBA and MacConkey agar with 1 µg/mL imipenem. Polymerase chain reaction (PCR) amplification and sequencing of carbapenemase genes, multilocus sequence typing, antimicrobial susceptibility testing, and whole-genome sequencing were performed. RESULTS Among 21 CPO isolates, 11 Klebsiella spp. and 5 Enterobacter kobei isolates carried blaGES-24, and 4 E. roggenkampii and 1 Pseudomonas aeruginosa isolates carried blaGES-5. Genomic analysis of 8 representative isolates comprising 6 blaGES-24-positive and 2 blaGES-5-positive revealed that class 3 integrons with complete or defective Tn402-like transposition modules were predominantly associated with two tandem copies of blaGES-24. Furthermore, a total of 5 new class 3 integrons, In3-18 to In3-22, were identified among 5 blaGES-24 and 1 blaGES-5 plasmids. One strain each of K. pneumoniae subsp. pneumoniae and K. quasipneumoniae subsp. similipneumoniae harboring blaGES-24 plasmids also carried a rare blaVEB-1-positive class 1 integron on a non-typeable plasmid, where these blaVEB-1 plasmids had high sequence similarity. Virulence gene profiles differed between Klebsiella spp. and Enterobacter spp.; the former harbored type III fimbriae cluster, salmochelin, and T6SS type i2 gene clusters, while the latter had curli pili operon, aerobactin, T2SS gene clusters, and T6SS type i3 gene clusters. CONCLUSION Our findings confirmed the linkage of blaGES-24 with rare Tn402-like class 3 integrons and the structural diversity of their gene cassette arrays.
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14
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Dix LML, de Goeij I, Manintveld OC, Severin JA, Verkaik NJ. Pseudomonas aeruginosa left ventricular assist device (LVAD) driveline infection acquired from the bathroom at home. Am J Infect Control 2022; 50:1392-1394. [PMID: 35569615 DOI: 10.1016/j.ajic.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 01/25/2023]
Abstract
We describe a patient with a left ventricular assist device (LVAD) infection by Pseudomonas aeruginosa acquired at home. The Pseudomonas from the driveline was similar to several surface cultures of the patient's home shower. This case illustrates the potential and importance of infection prevention measures at home.
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Affiliation(s)
- Laura M L Dix
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Inge de Goeij
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Olivier C Manintveld
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Erasmus MC Transplant Institute, Rotterdam, The Netherlands
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nelianne J Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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15
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Tanum J, Choi M, Jeong H, Park S, Sutthiwanjampa C, Park H, Hong J. Generation of zinc ion-rich surface via in situ growth of ZIF-8 particle: Microorganism immobilization onto fabric surface for prohibit hospital-acquired infection. CHEMICAL ENGINEERING JOURNAL (LAUSANNE, SWITZERLAND : 1996) 2022; 446:137054. [PMID: 35601362 PMCID: PMC9116044 DOI: 10.1016/j.cej.2022.137054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 05/01/2022] [Accepted: 05/15/2022] [Indexed: 06/15/2023]
Abstract
Viruses/bacteria outbreaks have motivated us to develop a fabric that will inhibit their transmission with high potency and long-term stability. By creating a metal-ion-rich surface onto polyester (PET) fabric, a method is found to inhibit hospital-acquired infections by immobilizing microorganisms on its surface. ZIF-8 and APTES are utilized to overcome the limitations associated with non-uniform distribution, weak biomolecule interaction, and ion leaching on surfaces. Modified surfaces employing APTES enhance ZIF-8 nucleation by generating a monolayer of self-assembled amine molecules. An in-situ growth approach is then used to produce evenly distributed ZIF-8 throughout it. In comparison with pristine fabric, this large amount of zinc obtained from the modification of the fabric has a higher affinity for interacting with membranes of microorganisms, leading to a 4.55-fold increase in coronavirus spike-glycoprotein immobilization. A series of binding ability stability tests on the surface demonstrate high efficiency of immobilization, >90%, of viruses and model proteins. The immobilization capacity of the modification fabric stayed unchanged after durability testing, demonstrating its durability and stability. It has also been found that this fabric surface modification approach has maintained air/vapor transmittance and air permeability levels comparable to pristine fabrics. These results strongly advocate this developed fabric has the potential for use as an outer layer of face masks or as a medical gown to prevent hospital-acquired infections.
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Affiliation(s)
- Junjira Tanum
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Moonhyun Choi
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Hyejoong Jeong
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | - Sohyeon Park
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03722, Republic of Korea
| | | | - Hansoo Park
- School of Integrative Engineering, Chung-Ang University, Seoul 06974, Republic of Korea
| | - Jinkee Hong
- Department of Chemical and Biomolecular Engineering, Yonsei University, Seoul 03722, Republic of Korea
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Prestel C, Moulton-Meissner H, Gable P, Stanton RA, Glowicz J, Franco L, McConnell M, Torres T, John D, Blackwell G, Yates R, Brown C, Reyes K, McAllister GA, Kunz J, Conners EE, Benedict KM, Kirby A, Mattioli M, Xu K, Gualandi N, Booth S, Novosad S, Arduino M, Halpin AL, Wells K, Walters MS. Dialysis Water Supply Faucet as Reservoir for Carbapenemase-Producing Pseudomonas aeruginosa. Emerg Infect Dis 2022; 28:2069-2073. [PMID: 36148936 PMCID: PMC9514332 DOI: 10.3201/eid2810.220731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
During June 2017-November 2019, a total 36 patients with carbapenem-resistant Pseudomonas aeruginosa harboring Verona-integron-encoded metallo-β-lactamase were identified in a city in western Texas, USA. A faucet contaminated with the organism, identified through environmental sampling, in a specialty care room was the likely source for infection in a subset of patients.
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17
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Carbapenem Combinations for Infections Caused by Carbapenemase-Producing Pseudomonas aeruginosa: Experimental In Vitro and In Vivo Analysis. Antibiotics (Basel) 2022; 11:antibiotics11091212. [PMID: 36139991 PMCID: PMC9495166 DOI: 10.3390/antibiotics11091212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/04/2022] [Accepted: 09/05/2022] [Indexed: 11/29/2022] Open
Abstract
In the context of difficult-to-treat carbapenem-resistant Pseudomonas aeruginosa infections, we evaluated imipenem, meropenem, and doripenem combinations against eleven carbapenemase-producing P. aeruginosa isolates. According to the widespread global distribution of high-risk clones and carbapenemases, four representative isolates were selected: ST175 (OXA-2/VIM-20), ST175 (VIM-2), ST235 (GES-5), and ST111 (IMP-33), for efficacy studies using a sepsis murine model. Minimum inhibitory concentration (mg/L) ranges were 64–256 for imipenem and 16–128 for meropenem and doripenem. In vitro, imipenem plus meropenem was synergistic against 72% of isolates and doripenem plus meropenem or imipenem against 55% and 45%, respectively. All combinations were synergistic against the ST175, ST235, and ST155 clones. In vivo, meropenem diminished the spleen and blood bacterial concentrations of four and three isolates, respectively, with better efficacy than imipenem or doripenem. The combinations did not show efficacy compared with the more active monotherapies, except for imipenem plus meropenem, which reduced the ST235 bacterial spleen concentration. Mortality decreased with imipenem plus meropenem or doripenem for the ST175 isolate. Results suggest that carbapenem combinations are not an alternative for severe infections by carbapenemase-producing P. aeruginosa. Meropenem monotherapy showed in vivo efficacy despite its high MIC, probably because its dosage allowed a sufficient antimicrobial exposure at the infection sites.
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18
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Adelantado Lacasa M, Portillo ME, Lobo Palanco J, Chamorro J, Ezpeleta Baquedano C. Molecular Epidemiology of Multidrug-Resistant Pseudomonas aeruginosa Acquired in a Spanish Intensive Care Unit: Using Diverse Typing Methods to Identify Clonal Types. Microorganisms 2022; 10:microorganisms10091791. [PMID: 36144393 PMCID: PMC9502743 DOI: 10.3390/microorganisms10091791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
The increasing number of infections from multidrug-resistant P. aeruginosa (MDRPA) has compromised the selection of appropriate treatment in critically ill patients. Recent investigations have shown the existence of MDRPA global clones that have been disseminated in hospitals worldwide. We aimed to describe the molecular epidemiology and genetic diversity of the MDRPA acquired by Intensive Care Units (ICU) patients in our hospital. We used phenotypic methods to define the MDRPA and molecular methods were used to illustrate the presence of carbapenemase encoding genes. To characterize the MDRPA isolates, we used MALDI-TOF biomarker peaks, O-antigen serotyping, and multi-locus sequence typing analyses. Our data show that the most widely distributed MDRPA clone in our ICU unit was the ST175 strain. These isolates were further investigated by the whole-genome sequencing technique to determine the resistome profile and phylogenetic relationships, which showed, as previously described, that the MDR profile was due to the intrinsic resistance mechanisms and not the carbapenemase encoding genes. In addition, this study suggests that the combination of environmental focus and cross-transmission are responsible for the spread of MDRPA clones within our ICU unit. Serotyping and MALDI-TOF analyses are useful tools for the early detection of the most prevalent MDRPA clones in our hospital. Using these methods, semi-directed treatments can be introduced at earlier stages and healthcare professionals can actively search for environmental foci as possible sources of outbreaks.
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Affiliation(s)
- Marta Adelantado Lacasa
- Microbiology Area, Laboratory Department, Hospital Reina Sofía, 31500 Tudela, Spain
- Instituto de Investigación Sanitaria de Navarra—IdiSNA, 31008 Pamplona, Spain
- Correspondence:
| | - Maria Eugenia Portillo
- Instituto de Investigación Sanitaria de Navarra—IdiSNA, 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | | | - Judith Chamorro
- Preventive Medicine Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
| | - Carmen Ezpeleta Baquedano
- Instituto de Investigación Sanitaria de Navarra—IdiSNA, 31008 Pamplona, Spain
- Clinical Microbiology Department, Hospital Universitario de Navarra, 31008 Pamplona, Spain
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Diorio-Toth L, Irum S, Potter RF, Wallace MA, Arslan M, Munir T, Andleeb S, Burnham CAD, Dantas G. Genomic Surveillance of Clinical Pseudomonas aeruginosa Isolates Reveals an Additive Effect of Carbapenemase Production on Carbapenem Resistance. Microbiol Spectr 2022; 10:e0076622. [PMID: 35638817 PMCID: PMC9241860 DOI: 10.1128/spectrum.00766-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/01/2022] [Indexed: 01/15/2023] Open
Abstract
Carbapenem resistance in Pseudomonas aeruginosa is increasing globally, and surveillance to define the mechanisms of such resistance in low- and middle-income countries is limited. This study establishes the genotypic mechanisms of β-lactam resistance by whole-genome sequencing (WGS) in 142 P. aeruginosa clinical isolates recovered from three hospitals in Islamabad and Rawalpindi, Pakistan between 2016 and 2017. Isolates were subjected to antimicrobial susceptibility testing (AST) by Kirby-Bauer disk diffusion, and their genomes were assembled from Illumina sequencing data. β-lactam resistance was high, with 46% of isolates resistant to piperacillin-tazobactam, 42% to cefepime, 48% to ceftolozane-tazobactam, and 65% to at least one carbapenem. Twenty-two percent of isolates were resistant to all β-lactams tested. WGS revealed that carbapenem resistance was associated with the acquisition of metallo-β-lactamases (MBLs) or extended-spectrum β-lactamases (ESBLs) in the blaGES, blaVIM, and blaNDM families, and mutations in the porin gene oprD. These resistance determinants were found in globally distributed lineages, including ST235 and ST664, as well as multiple novel STs which have been described in a separate investigation. Analysis of AST results revealed that acquisition of MBLs/ESBLs on top of porin mutations had an additive effect on imipenem resistance, suggesting that there is a selective benefit for clinical isolates to encode multiple resistance determinants to the same drugs. The strong association of these resistance determinants with phylogenetic background displays the utility of WGS for monitoring carbapenem resistance in P. aeruginosa, while the presence of these determinants throughout the phylogenetic tree shows that knowledge of the local epidemiology is crucial for guiding potential treatment of multidrug-resistant P. aeruginosa infections. IMPORTANCE Pseudomonas aeruginosa is associated with serious infections, and treatment can be challenging. Because of this, carbapenems and β-lactam/β-lactamase inhibitor combinations have become critical tools in treating multidrug-resistant (MDR) P. aeruginosa infections, but increasing resistance threatens their efficacy. Here, we used WGS to study the genotypic and phylogenomic patterns of 142 P. aeruginosa isolates from the Potohar region of Pakistan. We sequenced both MDR and antimicrobial susceptible isolates and found that while genotypic and phenotypic patterns of antibiotic resistance correlated with phylogenomic background, populations of MDR P. aeruginosa were found in all major phylogroups. We also found that isolates possessing multiple resistance mechanisms had significantly higher levels of imipenem resistance compared to the isolates with a single resistance mechanism. This study demonstrates the utility of WGS for monitoring patterns of antibiotic resistance in P. aeruginosa and potentially guiding treatment choices based on the local spread of β-lactamase genes.
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Affiliation(s)
- Luke Diorio-Toth
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sidra Irum
- Atta ur Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Robert F. Potter
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Muhammad Arslan
- Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan
| | - Tehmina Munir
- Department of Microbiology, Army Medical College, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Saadia Andleeb
- Atta ur Rahman School of Applied Biosciences, National University of Sciences and Technology, Islamabad, Pakistan
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University in St. Louis, St. Louis, Missouri, USA
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Herraiz-Carboné M, Cotillas S, Lacasa E, Vasileva M, Sainz de Baranda C, Riquelme E, Cañizares P, Sáez C. Disinfection of polymicrobial urines by electrochemical oxidation: Removal of antibiotic-resistant bacteria and genes. JOURNAL OF HAZARDOUS MATERIALS 2022; 426:128028. [PMID: 34923384 DOI: 10.1016/j.jhazmat.2021.128028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 12/05/2021] [Accepted: 12/06/2021] [Indexed: 06/14/2023]
Abstract
In this work, data obtained from the University Hospital Complex of Albacete (Spain) were selected as a case study to carry out the disinfection experiments. To do this, different configurations of electrochemical reactors were tested for the disinfection of complex urines. Results showed that 4-6 logs bacterial removal were achieved for every bacterium tested when working with a microfluidic flow-through reactor after 180 min (0.423 Ah dm-3). The MIKROZON® cell reached a total disinfection after 60 min (1.212 Ah dm-3), causing severe damages induced in the cell walls observed in SEM images. The concentration profiles of the electrogenerated disinfectants in solution could explain the differences observed. Additionally, a mean decrease in the ARGs concentration ranked as follows: blaKPC (4.18-logs) > blaTEM (3.96-logs) > ermB (3.23-logs) using the MIKROZON® cell. This electro-ozonizer could be considered as a suitable alternative to reduce the risk of antibiotic resistance spread. Hence, this study provides an insight into different electrochemical reactors for the disinfection of complex hospital urine matrices and contributes to reduce the spread of antibiotic resistance through the elimination of ARGs. A topic of great importance nowadays that needs to be further studied.
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Affiliation(s)
- Miguel Herraiz-Carboné
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071 Albacete, Spain
| | - Salvador Cotillas
- Department of Chemical Engineering and Materials, Faculty of Chemical Sciences, Complutense University of Madrid, Avenida Complutense s/n, 28040 Madrid, Spain.
| | - Engracia Lacasa
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071 Albacete, Spain.
| | - Marina Vasileva
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071 Albacete, Spain
| | - Caridad Sainz de Baranda
- Clinical Parasitology and Microbiology Area, University Hospital Complex of Albacete, C/Hermanos Falcó 37, 02006 Albacete, Spain
| | - Eva Riquelme
- Clinical Parasitology and Microbiology Area, University Hospital Complex of Albacete, C/Hermanos Falcó 37, 02006 Albacete, Spain
| | - Pablo Cañizares
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005 Ciudad Real, Spain
| | - Cristina Sáez
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005 Ciudad Real, Spain
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21
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van der Zwet W, Nijsen I, Jamin C, van Alphen L, von Wintersdorff C, Demandt A, Savelkoul P. Role of the environment in transmission of Gram-negative bacteria in two consecutive outbreaks in a haematology-oncology department. Infect Prev Pract 2022; 4:100209. [PMID: 35295671 PMCID: PMC8918851 DOI: 10.1016/j.infpip.2022.100209] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/09/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- W.C. van der Zwet
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Corresponding author.
| | - I.E.J. Nijsen
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C. Jamin
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L.B. van Alphen
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C.J.H. von Wintersdorff
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A.M.P. Demandt
- Dept. Haematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P.H.M. Savelkoul
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
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22
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Weinbren M, Inkster T, Lafferty F. Drains and the periphery of the water system - what do you do when the guidance is outdated? Infect Prev Pract 2022; 3:100179. [PMID: 34988421 PMCID: PMC8696270 DOI: 10.1016/j.infpip.2021.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
The periphery of the water system (defined as the last 2 m of pipework from an outlet and ensuing devices including drainage), is the juncture of multiple inherent risks: the necessity to use materials with higher risk of biofilm formation, difficulty in maintaining safe water temperatures, a human interface with drainage systems, poor design, poor layout and use by staff. Add to this risk a large new healthcare facility capital build programme in England, outdated guidance and bacteria emanating from drainage systems containing highly mobile genetic elements (threatening the end of the antibiotic era), and the scene is set for the perfect storm. There is an urgent need for the re-evaluation of the periphery of the water system and drainage systems. Consequently, in this article we examine the requirement and placement of hand wash stations (HWSs), design of showers, kitchens and the dirty utility with respect to water services. Lastly, we discuss the provision of safe water to high-risk patient groups. The purpose of this article is to stimulate debate and provide infection control and design teams with support in deviating from the outdated existing guidance and to challenge conventional thinking until new advice is forthcoming.
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Affiliation(s)
- M Weinbren
- Department of Microbiology, King's Mill Hospital, Sutton-in-Ashfield, UK
| | - T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
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23
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Wendel AF, Malecki M, Mattner F, Xanthopoulou K, Wille J, Seifert H, Higgins PG. OUP accepted manuscript. JAC Antimicrob Resist 2022; 4:dlac057. [PMID: 35611260 PMCID: PMC9122648 DOI: 10.1093/jacamr/dlac057] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives To describe the propensity of carbapenem-resistant Pseudomonas aeruginosa to spread within a hospital critical care setting. Methods The study was conducted in a 700-bed tertiary centre in Cologne, Germany. P. aeruginosa resistant to piperacillin, ceftazidime, cefepime, imipenem, meropenem and ciprofloxacin, isolated from clinical and screening specimens from four critical care units from 2015 to 2020 were analysed. Genotyping was carried out by WGS (Illumina and MinION). MLST, core genome MLST (cgMLST) and resistome analysis was performed and merged with epidemiological data. Results Fifty-five out of 79 non-duplicate P. aeruginosa isolates were available, of which 20 were carbapenemase producers as follows: blaVIM-1 (n = 1), blaVIM-2 (n = 17), blaVIM-4 (n = 1), and blaNDM-1/blaGES-5 (n = 1). Forty-two of 55 isolates were hospital-acquired. cgMLST revealed three clusters: Cluster 1 (n = 15, ST111, blaVIM-2, recovered between 2015 and 2020); Cluster 2 (n = 4, ST970, carbapenemase negative); and Cluster 3 (n = 2, ST357, carbapenemase negative). The blaVIM-2 gene of Cluster 1 was integrated on the chromosome in a class 1 integron (type In59). Using conventional epidemiology, we were only able to confirm two patient-to-patient transmissions and one room-to-patient transmission on three different ICUs within Cluster 1. Isolates from Cluster 2 represented an outbreak occurring in 2019. Conclusions These data give insight into the epidemiology of carbapenem-resistant P. aeruginosa. Transmission dynamics differed between carbapenemase- and non-carbapenemase-producing isolates. A continuous acquisition of clonally related ST111 VIM-2 P. aeruginosa, being the main carbapenemase-producing strain, was observed over the whole study period, as well as an overall higher genomic diversity among non-carbapenemase-producing P. aeruginosa.
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Affiliation(s)
- Andreas F. Wendel
- Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany
- Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
- Corresponding author. E-mail: ; @AndyFW; @docpolski
| | - Monika Malecki
- Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany
- Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Frauke Mattner
- Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Cologne, Germany
- Division of Hygiene and Environmental Medicine, Department of Human Medicine, Faculty of Health, Witten/Herdecke University, Witten, Germany
| | - Kyriaki Xanthopoulou
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
| | - Julia Wille
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
| | - Harald Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
| | - Paul G. Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
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24
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Probst K, Boutin S, Späth I, Scherrer M, Henny N, Sahin D, Heininger A, Heeg K, Nurjadi D. Direct-PCR from rectal swabs and environmental reservoirs: A fast and efficient alternative to detect bla OXA-48 carbapenemase genes in an Enterobacter cloacae outbreak setting. ENVIRONMENTAL RESEARCH 2022; 203:111808. [PMID: 34343553 DOI: 10.1016/j.envres.2021.111808] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 07/28/2021] [Accepted: 07/28/2021] [Indexed: 06/13/2023]
Abstract
Carbapenemase-producing bacteria are a risk factor in clinical settings worldwide. The aim of the study was to accelerate the time to results during an outbreak situation with blaOXA-48-positive Enterobacter cloacae by using a real-time multiplex quantitative PCR (qPCR) directly on rectal swab specimens and on wastewater samples to detect carbapenemase-producing bacteria. Thus, we analyzed 681 rectal swabs and 947 environmental samples during a five-month period by qPCR and compared the results to culture screening. The qPCR showed a sensitivity of 100% by testing directly from rectal swabs and was in ten cases more sensitive than the culture-based methods. Environmental screening for blaOXA-48-carbapenemase genes by qPCR revealed reservoirs of different carbapenemase genes that are potential sources of transmission and might lead to new outbreaks. The rapid identification of patients colonized with those isolates and screening of the hospital environment is essential for earlier patient treatment and eliminating potential sources of nosocomial infections.
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Affiliation(s)
- Katja Probst
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany.
| | - Sébastien Boutin
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany; Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg University Hospital, Heidelberg, Germany
| | - Isabel Späth
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Scherrer
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Nicole Henny
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Delal Sahin
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Alexandra Heininger
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany; Stabsstelle Krankenhaushygiene, Universitätsmedizin Mannheim, Mannheim, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany
| | - Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hospital Hygiene, University Hospital Heidelberg, Heidelberg, Germany
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Nurjadi D, Scherrer M, Frank U, Mutters NT, Heininger A, Späth I, Eichel VM, Jabs J, Probst K, Müller-Tidow C, Brandt J, Heeg K, Boutin S. Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains. Microbiol Spectr 2021; 9:e0138021. [PMID: 34817232 PMCID: PMC8612159 DOI: 10.1128/spectrum.01380-21] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 10/28/2021] [Indexed: 11/20/2022] Open
Abstract
The hospital environment has been reported as a source of transmission events and outbreaks of carbapenemase-producing Enterobacterales. Interconnected plumbing systems and the microbial diversity in these reservoirs pose a challenge for outbreak investigation and control. A total of 133 clinical and environmental OXA-48-producing Enterobacter cloacae isolates collected between 2015 and 2021 were characterized by whole-genome sequencing (WGS) to investigate a prolonged intermittent outbreak involving 41 patients in the hematological unit. A mock-shower experiment was performed to investigate the possible acquisition route. WGS indicated the hospital water environmental reservoir as the most likely source of the outbreak. The lack of diversity of the blaOXA-48-like harbouring plasmids was a challenge for data interpretation. The detection of blaOXA-48-like-harboring E. cloacae strains in the shower area after the mock-shower experiment provided strong evidence that showering is the most likely route of acquisition. Initially, in 20 out of 38 patient rooms, wastewater traps and drains were contaminated with OXA-48-positive E. cloacae. Continuous decontamination using 25% acetic acid three times weekly was effective in reducing the trap/drain positivity in monthly environmental screening but not in reducing new acquisitions. However, the installation of removable custom-made shower tubs did prevent new acquisitions over a subsequent 12-month observation period. In the present study, continuous decontamination was effective in reducing the bacterial burden in the nosocomial reservoirs but was not sufficient to prevent environment-to-patient transmission in the long term. Construction interventions may be necessary for successful infection prevention and control. IMPORTANCE The hospital water environment can be a reservoir for a multiward outbreak, leading to acquisitions or transmissions of multidrug-resistant organisms in a hospital setting. The majority of Gram-negative bacteria are able to build biofilms and persist in the hospital plumbing system over a long period of time. The elimination of the reservoir is essential to prevent further transmission and spread, but proposed decontamination regimens, e.g., using acetic acid, can only suppress but not fully eliminate the environmental reservoir. In this study, we demonstrated that colonization with multidrug-resistant organisms can be acquired by showering in showers with contaminated water traps and drains. A construction intervention by installing removable and autoclavable shower inserts to avoid sink contact during showering was effective in containing this outbreak and may be a viable alternative infection prevention and control measure in outbreak situations involving contaminated shower drains and water traps.
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Affiliation(s)
- Dennis Nurjadi
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Scherrer
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Frank
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Infection Prevention and Hospital Epidemiology, Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Nico T. Mutters
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Alexandra Heininger
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Department of Hospital Hygiene, University Medical Center Mannheim, Mannheim, Germany
| | - Isabel Späth
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Vanessa M. Eichel
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Jonas Jabs
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
- Institute for Hygiene and Public Health, Bonn University Hospital, Bonn, Germany
| | - Katja Probst
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Carsten Müller-Tidow
- Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Juliane Brandt
- Department of Hematology, Oncology, and Rheumatology, University Hospital Heidelberg, Heidelberg, Germany
| | - Klaus Heeg
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
| | - Sébastien Boutin
- Department of Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg University Hospital, Heidelberg, Germany
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Herraiz-Carboné M, Cotillas S, Lacasa E, Sainz de Baranda C, Riquelme E, Cañizares P, Rodrigo MA, Sáez C. A review on disinfection technologies for controlling the antibiotic resistance spread. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 797:149150. [PMID: 34303979 DOI: 10.1016/j.scitotenv.2021.149150] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 06/13/2023]
Abstract
The occurrence of antibiotic-resistant bacteria (ARB) in water bodies poses a sanitary and environmental risk. These ARB and other mobile genetic elements can be easily spread from hospital facilities, the point in which, for sure, they are more concentrated. For this reason, novel clean and efficient technologies are being developed for allowing to remove these ARB and other mobile genetic elements before their uncontrolled spread. In this paper, a review on the recent knowledge about the state of the art of the main disinfection technologies to control the antibiotic resistance spread from natural water, wastewater, and hospital wastewater (including urine matrices) is reported. These technologies involve not only conventional processes, but also the recent advances on advanced oxidation processes (AOPs), including electrochemical advanced oxidation processes (EAOPs). This review summarizes the state of the art on the applicability of these technologies and also focuses on the description of the disinfection mechanisms by each technology, highlighting the promising impact of EAOPs on the remediation of this important environmental and health problem.
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Affiliation(s)
- Miguel Herraiz-Carboné
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071 Albacete, Spain
| | - Salvador Cotillas
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071 Albacete, Spain.
| | - Engracia Lacasa
- Department of Chemical Engineering, Higher Technical School of Industrial Engineering, University of Castilla-La Mancha, Edificio Infante Don Juan Manuel, Campus Universitario s/n, 02071 Albacete, Spain.
| | - Caridad Sainz de Baranda
- Clinical Parasitology and Microbiology Area, University Hospital Complex of Albacete, C/Hermanos Falcó 37, 02006 Albacete, Spain
| | - Eva Riquelme
- Clinical Parasitology and Microbiology Area, University Hospital Complex of Albacete, C/Hermanos Falcó 37, 02006 Albacete, Spain
| | - Pablo Cañizares
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005 Ciudad Real, Spain
| | - Manuel A Rodrigo
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005 Ciudad Real, Spain
| | - Cristina Sáez
- Department of Chemical Engineering, Faculty of Chemical Sciences and Technologies, University of Castilla-La Mancha, Edificio Enrique Costa Novella, Campus Universitario s/n, 13005 Ciudad Real, Spain
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National surveillance pilot study unveils a multicenter, clonal outbreak of VIM-2-producing Pseudomonas aeruginosa ST111 in the Netherlands between 2015 and 2017. Sci Rep 2021; 11:21015. [PMID: 34697344 PMCID: PMC8545960 DOI: 10.1038/s41598-021-00205-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/29/2021] [Indexed: 02/01/2023] Open
Abstract
Verona Integron-encoded Metallo-beta-lactamase (VIM) is the most frequently-encountered carbapenemase in the healthcare-related pathogen Pseudomonas aeruginosa. In the Netherlands, a low-endemic country for antibiotic-resistant bacteria, no national surveillance data on the prevalence of carbapenemase-producing P. aeruginosa (CPPA) was available. Therefore, in 2016, a national surveillance pilot study was initiated to investigate the occurrence, molecular epidemiology, genetic characterization, and resistomes of CPPA among P. aeruginosa isolates submitted by medical microbiology laboratories (MMLs) throughout the country. From 1221 isolates included in the study, 124 (10%) produced carbapenemase (CIM-positive); of these, the majority (95, 77%) were positive for the blaVIM gene using PCR. Sequencing was performed on 112 CIM-positive and 56 CIM-negative isolates (n = 168), and genetic clustering revealed that 75/168 (45%) isolates were highly similar. This genetic cluster, designated Group 1, comprised isolates that belonged to high-risk sequence type ST111/serotype O12, had similar resistomes, and all but two carried the blaVIM-2 allele on an identical class 1 integron. Additionally, Group 1 isolates originated from around the country (i.e. seven provinces) and from multiple MMLs. In conclusion, the Netherlands had experienced a nationwide, inter-institutional, clonal outbreak of VIM-2-producing P. aeruginosa for at least three years, which this pilot study was crucial in identifying. A structured, national surveillance program is strongly advised to monitor the spread of Group 1 CPPA, to identify emerging clones/carbapenemase genes, and to detect transmission in and especially between hospitals in order to control current and future outbreaks.
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Soria-Segarra C, Delgado-Valverde M, Serrano-García ML, López-Hernández I, Navarro-Marí JM, Gutiérrez-Fernández J. [Infections in patients colonized with carbapenem-resistant Gram-negative bacteria in a medium Spanish city]. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2021; 34:450-458. [PMID: 34098663 PMCID: PMC8638834 DOI: 10.37201/req/021.2021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/12/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Because there are few studies on the clinical implications of colonization by carbapenem-resistant gram-negative bacteria (CRB) this was analyzed in rectal smears (RS) and pharyngeals (PS) and its ability to predict infection/colonization. METHODS A cross-sectional, retrospective study from adult inpatients between January 2016 and December 2019 was conducted. The isolates were characterized by MicroScan and spectrometry of masses applying EUCAST 2018 cutoff points. The detection of carbapenemases was performed by PCR and Sanger sequencing; sequencies was assigned by MLST. The genetic relationship between the clinical isolates was made by pulsed field electrophoresis using the enzymes Xbal, Spel or Apal. RESULTS A total of 308 (86.03%) RS and 50 (13.97%) positive PS were detected, the RS had a 85% sensibility, 100% specificity, 100% positive predictive value and 97% negative predictive value. In RS, the following were isolated: 44% (n=135) Acinetobacter baumannii, 26% (n =80) Enterobacterales (20 KPC, 29 OXA-48, 22 VIM, 2 IMP, 7 NDM), 17% (n=53) Pseudomonas aeruginosa and 13% (n=40) Stenotrophomonas maltophilia. In the PS were isolated 44% (n=22) S. maltophilia, 40% (n = 20) A. baumannii, 8% (n=4) P. aeruginosa and 8% (n=4) Enterobacterales (3 VIM, 1 OXA). From the patients with simultaneous RS and PS, 41 (40.6%) had positivity in both smears, 45 (44.6%) only in RS and 15 (14.9%) only in PS. Colonization preceded infection in 81.3% (n=13) of the isolates; association between infection and colonization was found (p<0.001; χ2); and the episodes where the information was found all the isolates from the clinical samples and from the smears were similar. CONCLUSIONS The probability of predicting infection through the CRB colonized in different clinical samples is feasible. The RS has a major sensibility to detect colonization.
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Affiliation(s)
| | | | | | | | | | - J Gutiérrez-Fernández
- José Gutiérrez-Fernández. Laboratorio de Microbiología. Hospital Universitario Virgen de las Nieves. Avenida de las Fuerzas Armadas, 2, E-18014, Granada, Spain.
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Aranega-Bou P, Ellaby N, Ellington MJ, Moore G. Migration of Escherichia coli and Klebsiella pneumoniae Carbapenemase (KPC)-Producing Enterobacter cloacae through Wastewater Pipework and Establishment in Hospital Sink Waste Traps in a Laboratory Model System. Microorganisms 2021; 9:microorganisms9091868. [PMID: 34576763 PMCID: PMC8468231 DOI: 10.3390/microorganisms9091868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Sink waste traps and drains are a reservoir for multi-drug resistant Gram-negative bacteria in the hospital environment. It has been suggested that these bacteria can migrate through hospital plumbing. Hospital waste traps were installed in a laboratory model system where sinks were connected through a common wastewater pipe. Enterobacterales populations were monitored using selective culture, MALDI-TOF identification and antibiotic resistance profiling before and after a wastewater backflow event. When transfer between sinks was suspected, isolates were compared using whole-genome sequencing. Immediately after the wastewater backflow, two KPC-producing Enterobacter cloacae were recovered from a waste trap in which Carbapenemase-producing Enterobacterales (CPE) had not been detected previously. The isolates belonged to ST501 and ST31 and were genetically indistinguishable to those colonising sinks elsewhere in the system. Following inter-sink transfer, KPC-producing E. cloacae ST501 successfully integrated into the microbiome of the recipient sink and was detected in the waste trap water at least five months after the backflow event. Seven weeks and three months after the backflow, other inter-sink transfers involving Escherichia coli ST5295 and KPC-producing E. cloacae ST501 were also observed.
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Affiliation(s)
- Paz Aranega-Bou
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Manor Farm Rd, Porton Down, Salisbury SP4 0JG, UK;
- Correspondence: ; Tel.: +44-1980612630
| | - Nicholas Ellaby
- Antimicrobial Resistance and Health Care Associated Infections, National infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| | - Matthew J. Ellington
- National Infection Service Laboratories, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| | - Ginny Moore
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Manor Farm Rd, Porton Down, Salisbury SP4 0JG, UK;
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Coolen JPM, Jamin C, Savelkoul PHM, Rossen JWA, Wertheim HFL, Matamoros SP, van Alphen LB, On Behalf Of Sig Bioinformatics In Medical Microbiology Nl Consortium. Centre-specific bacterial pathogen typing affects infection-control decision making. Microb Genom 2021; 7. [PMID: 34356004 PMCID: PMC8549354 DOI: 10.1099/mgen.0.000612] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Whole-genome sequencing is becoming the de facto standard for bacterial outbreak surveillance and infection prevention. This is accompanied by a variety of bioinformatic tools and needs bioinformatics expertise for implementation. However, little is known about the concordance of reported outbreaks when using different bioinformatic workflows. In this multi-centre proficiency testing among 13 major Dutch healthcare-affiliated centres, bacterial whole-genome outbreak analysis was assessed. Centres who participated obtained two randomized bacterial datasets of Illumina sequences, a Klebsiella pneumoniae and a Vancomycin-resistant Enterococcus faecium, and were asked to apply their bioinformatic workflows. Centres reported back on antimicrobial resistance, multi-locus sequence typing (MLST), and outbreak clusters. The reported clusters were analysed using a method to compare landscapes of phylogenetic trees and calculating Kendall–Colijn distances. Furthermore, fasta files were analysed by state-of-the-art single nucleotide polymorphism (SNP) analysis to mitigate the differences introduced by each centre and determine standardized SNP cut-offs. Thirteen centres participated in this study. The reported outbreak clusters revealed discrepancies between centres, even when almost identical bioinformatic workflows were used. Due to stringent filtering, some centres failed to detect extended-spectrum beta-lactamase genes and MLST loci. Applying a standardized method to determine outbreak clusters on the reported de novo assemblies, did not result in uniformity of outbreak-cluster composition among centres.
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Affiliation(s)
- Jordy P M Coolen
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Casper Jamin
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Paul H M Savelkoul
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands.,Department of Medical Microbiology & Infection Control, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - John W A Rossen
- Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Pathology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Heiman F L Wertheim
- Department of Medical Microbiology and Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Sébastien P Matamoros
- Department of Medical Microbiology & Infection Control, Amsterdam University Medical Centers, location VUmc, Amsterdam, The Netherlands
| | - Lieke B van Alphen
- Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Center+, Maastricht, The Netherlands
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Neidhöfer C, Buechler C, Neidhöfer G, Bierbaum G, Hannet I, Hoerauf A, Parčina M. Global Distribution Patterns of Carbapenemase-Encoding Bacteria in a New Light: Clues on a Role for Ethnicity. Front Cell Infect Microbiol 2021; 11:659753. [PMID: 34268132 PMCID: PMC8276097 DOI: 10.3389/fcimb.2021.659753] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/31/2021] [Indexed: 11/13/2022] Open
Abstract
Antibiotic resistance represents a major global concern. The rapid spread of opportunistically pathogenic carbapenemase-encoding bacteria (CEB) requires clinicians, researchers, and policy-makers to swiftly find solutions to reduce transmission rates and the associated health burden. Epidemiological data is key to planning control measures. Our study aims to contribute by providing an analysis of 397 unique CEB isolates detected in a tertiary hospital in Germany. We propose new findings on demographic variables to support preventive sanitary precautions in routine clinical practice. Data on detected CEB was combined with patient's demographic and clinical information for each isolate. Multiple regression techniques were applied to estimate the predictive quality of observed differences. Our findings confirm the role of age and gender in CEB colonization patterns and indicate a role for ethnicity and domicile. Also, carbapenemase-encoding A. baumannii was most frequently introduced to the hospital, while the risk of colonization with VIM-encoding P. aeruginosa rose with the length of hospital stay. P. aeruginosa remains an important complication of prolonged hospital stays. The strong link to hospital-wastewater may have implications for hospital-built environments. A. baumannii can be efficiently controlled from spreading at hospital admission. OXA-encoding CEB being harder to detect in routine screening, targeted preventive measures, such as culture media selective for carbapenem-resistant bacteria, would be opportune for patients from selected regions. The CEB differences linked to ethnicity found in our study may further be supporting the tailoring of diagnostic approaches, as well as health policies upon confirmation by other studies and a better understanding of their global distribution.
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Affiliation(s)
- Claudio Neidhöfer
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Christian Buechler
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Guido Neidhöfer
- ZEW-Leibniz Centre for European Economic Research, Mannheim, Germany
| | - Gabriele Bierbaum
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | | | - Achim Hoerauf
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
| | - Marijo Parčina
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany
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SCHIAVANO GIUDITTAFIORELLA, BALDELLI GIULIA, CEPPETELLI VERONICA, BRANDI GIORGIO, AMAGLIANI GIULIA. Assessment of hygienic conditions of recreational facility restrooms: an integrated approach. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E48-E53. [PMID: 34322616 PMCID: PMC8283657 DOI: 10.15167/2421-4248/jpmh2021.62.1.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 01/15/2021] [Indexed: 11/20/2022]
Abstract
Introduction Microbiological quality of recreational environments included restrooms, is generally assessed by water and surface monitoring. In this study, an environmental monitoring, conducted in spring, of swimming pool restrooms of a recreation center located in the Marche region has been carried out. Seven water samples and seven surface swabs were collected. Moreover, six air samples have been included. The aim of this study was to evaluate if air microbiological monitoring, along with molecular detection in real-time PCR, could give additional useful information about the hygienic conditions of the facility. Methods Heterotrophic Plate Count (HPC) both at 22°C (psychrophilic) and 37°C (mesophilic) was determined by separate cultures in all samples. The presence of Legionella pneumophila and Pseudomonas aeruginosa was evaluated by both culture and real-time PCR. Results The analysis of shower water recorded a HPC load of mesophilic bacteria (37°C) more than 10-fold higher in men restroom, respect to women’s one (> 100 vs < 10 CFU/ml), while in air samples was between < 100 and > 500. Concerning pathogen presence, both species Legionella pneumophila and Pseudomonas aeruginosa were detected only in men restroom, but in different sample types by using different methods (culture and real-time PCR). Conclusions Air sampling may offer the advantage of giving more representative data about microbial presence in restrooms, including bacterial species transmitted through aerosol, like Legionella. Moreover, the concurrent use of molecular and microbiological detection in an integrated approach could offer the advantage of greater sensitivity.
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Affiliation(s)
- GIUDITTA FIORELLA SCHIAVANO
- Department of Humanities, University of Urbino Carlo Bo, Urbino (PU), Italy
- Correspondence: Giuditta Fiorella Schiavano, University of Urbino Carlo Bo, Department of Humanities, via Bramante 17, 61029 Urbino (PU), Italy - Tel. +39 0722 303546 - E-mail:
| | - GIULIA BALDELLI
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino (PU), Italy
| | | | - GIORGIO BRANDI
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino (PU), Italy
| | - GIULIA AMAGLIANI
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, Urbino (PU), Italy
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Zhao Y, Zhang J, Wang S, Yu L, Yu H, Wang Y, Feng L. Efficacy of 75% alcohol in pretreatment of the Andersen sampler in trapping maximum airborne microbes. AEROBIOLOGIA 2021; 37:171-178. [PMID: 33424104 PMCID: PMC7781652 DOI: 10.1007/s10453-020-09668-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 10/20/2020] [Indexed: 06/12/2023]
Abstract
The present study was conducted to evaluate the effects of the pretreatment methods and sampling time on the sampling of airborne bacteria in hospitals. Methods for the pretreatment of Andersen samplers, namely, non-sterilized, 75% ethanol and autoclaving sampled for 5 min, 10 min and 15 min in the general ward and class 1000 clean operating department, respectively, were studied. Statistical analysis was used to compare the differences in sampling results of airborne bacteria under different pretreatment methods, sampling time and environmental conditions. In the first test, the sampling results of the airborne bacteria obtained by pretreatment of the sampler with 75% ethanol and without pre-treatment were not very different, and the sampling results showed a certain declining trend with the extension of the sampling time. In the second test, the pretreatment effect of autoclaving was significantly better than that of 75% ethanol, and the sampling time had no effect on the sampling results. After removing the influencing factors of the environment, the results were consistent with the results of the second test. It was observed that the Andersen samplers should not be pretreated with 75% ethanol before airborne microbes sampling. The pretreatment should be carried out by autoclaving, and the sampling time has little effect on the sampling results.
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Affiliation(s)
- Yan Zhao
- Department of Environment and Health, Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, China
| | - Jingwei Zhang
- Department of Environment and Health, Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, China
| | - Shumei Wang
- Department of Pathogen Microbiology, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Lingqi Yu
- Department of Pathogen Microbiology, Tianjin Centers for Disease Control and Prevention, Tianjin, China
| | - Hao Yu
- Department of Environment and Health, Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, China
| | - Yuwen Wang
- Department of Environment and Health, Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, China
| | - Lihong Feng
- Department of Environment and Health, Tianjin Centers for Disease Control and Prevention, 6 Huayue Road, Hedong District, Tianjin, China
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Comparative evaluation of four hydrogen peroxide-based systems to decontaminate N95 respirators. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY 2021; 1:e21. [PMID: 36168470 PMCID: PMC9495415 DOI: 10.1017/ash.2021.183] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/09/2021] [Accepted: 07/15/2021] [Indexed: 11/13/2022]
Abstract
Objective: Protocols designed to facilitate N95 filtering facepiece respirator (FFR) decontamination by commercial sterilization devices do not recommend that operators verify the device’s performance against pathogens deposited on FFRs. Here, we compared the treatment efficacy of 4 hydrogen peroxide-based systems that were authorized for N95 decontamination during the COVID-19 pandemic. Methods: Suspensions prepared from S. aureus ATCC 29213 and 44300, B. subtilis ATCC 6633, a vancomycin-resistant E. faecium isolate (VRE), E. coli ATCC 25922, and P. aeruginosa ATCC 27853 colonies were inoculated onto nine 1-cm2 areas on a 3M 1805, 1860, 1860S, 1870+, 8210, 8110S, or 9105S FFR. Contaminated respirators were treated according to protocols recommended by the STERRAD 100NX, Bioquell Z-2, Sterizone VP4, or Clēan Works Mini systems. Decontamination efficacy was determined by comparing colony counts cultured from excised segments of treated and untreated FFR. Results: All devices achieved a 6-log reduction in bacterial burden and met FDA sterilization criteria. The Bioquell Z-2 device demonstrated 100% efficacy against both gram-positive and gram-negative organisms with all FFRs tested. Colonies of S. aureus ATCC 29213 and 44300 and VRE were cultivable from up to 9 (100%) of 9 STERRAD 100NX– and Sterizone VP4–treated segments. Viable B. subtilis ATCC 6633 organisms were recovered from 76.0% of STERRAD 100NX–treated FFR segments. Conclusions: Variability in decontamination efficacy was noted across devices and FFR types. gram-positive organisms were more difficult to completely eliminate than were gram-negative organisms. Prior to initiating FFR decontamination practices, institutions should verify the effectiveness of their devices and the safety of treated FFR.
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Carbapenemase-producing Enterobacterales in hospital drains in Southern Ontario, Canada. J Hosp Infect 2020; 106:820-827. [PMID: 32916210 DOI: 10.1016/j.jhin.2020.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/03/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hospital drains may be an important reservoir for carbapenemase-producing Enterobacterales (CPE). AIM To determine prevalence of CPE in hospital drains exposed to inpatients with CPE, relatedness of drain and patient CPE, and risk factors for drain contamination. METHODS Sink and shower drains in patient rooms and communal shower rooms exposed to 310 inpatients with CPE colonization/infection were cultured at 10 hospitals. Using short- and long-read whole-genome sequencing, inpatient and corresponding drain CPE were compared. Risk factors for drain contamination were assessed using multi-level modelling. FINDINGS Of 1209 exposed patient room and communal shower room drains, 53 (4%) yielded 62 CPE isolates in seven (70%) hospitals. Of 49 CPE isolates in patient room drains, four (8%) were linked to prior room occupants. Linked drain/room occupant pairs included Citrobacter freundii ST18 isolates separated by eight single nucleotide variants (SNVs), related blaKPC-containing IncN3-type plasmids (different species), related blaKPC-3-containing IncN-type plasmids (different species), and related blaOXA-48-containing IncL/M-type plasmids (different species). In one hospital, drain isolates from eight rooms on two units were Enterobacter hormaechei separated by 0-6 SNVs. Shower drains were more likely to be CPE-contaminated than hand hygiene (odds ratio: 3.45; 95% confidence interval: 1.66-7.16) or patient-use (13.0; 4.29-39.1) sink drains. Hand hygiene sink drains were more likely to be CPE-contaminated than patient-use sink drains (3.75; 1.17-12.0). CONCLUSION Drain contamination was uncommon but widely dispersed. Drain CPE unrelated to patient exposure suggests contamination by undetected colonized patients or retrograde (drain-to-drain) contamination. Drain types had different contamination risks.
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PÉrez-VÁzquez M, Sola-Campoy PJ, Zurita ÁM, Ávila A, GÓmez-Bertomeu F, SolÍs S, LÓpez-Urrutia L, GÓnzalez-BarberÁ EM, Cercenado E, Bautista V, Lara N, Aracil B, Oliver A, Campos J, Oteo-Iglesias J. Carbapenemase-producing Pseudomonas aeruginosa in Spain: interregional dissemination of the high-risk clones ST175 and ST244 carrying bla VIM-2, bla VIM-1, bla IMP-8, bla VIM-20 and bla KPC-2. Int J Antimicrob Agents 2020; 56:106026. [PMID: 32450200 DOI: 10.1016/j.ijantimicag.2020.106026] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/13/2020] [Accepted: 05/14/2020] [Indexed: 12/14/2022]
Abstract
Carbapenemase-producing (CP) Pseudomonas aeruginosa is rare compared with mutation-driven carbapenem-resistance, but this situation may be changing. A collection of CP P. aeruginosa isolates was characterized in this study. In 2016, 232 unduplicated carbapenem-resistant P. aeruginosa isolates, of which 71 (30.6%) carried carbapenemase genes, were submitted to the Spanish antibiotic reference laboratory and were further analysed by whole-genome sequencing (WGS). Of the 71 CP P. aeruginosa, 39 (54.9%) carried blaVIM-2, 14 (19.7%) blaVIM-1, 8 (11.3%) blaIMP-8, 6 (8.5%) blaVIM-20, 2 (2.8%) blaVIM-2 plus blaKPC-2, one (1.4%) blaIMP-13 and one (1.4%) blaVIM-1 plus blaIMP-18. Four sequence types (ST175, ST244, ST815 and ST155) encompassed 83.1% of the 71 CP P. aeruginosa; ST175 was detected in hospitals from seven provinces. Using core genome multilocus sequence typing (cgMLST), four clusters were detected: Cluster 1 included nine ST815/VIM-2 isolates; Cluster 2 included five ST175/VIM-2 isolates; Cluster 3 included seven ST244 isolates (five VIM-2 and two VIM-2 plus KPC-2); and Cluster 4 included 11 ST175 isolates (seven VIM-2 and four IMP-8). The average number of acquired resistance genes was significantly higher in the blaVIM-1-carying isolates (7.1 ± 0.94) than in the blaVIM-2-carrying isolates (4.5 ± 0.20). CP P. aeruginosa isolates are spreading in Spain, mainly due to the dissemination of high-risk clones such as ST175 and ST244 producing VIM and IMP carbapenemases. Emergence of CP P. aeruginosa is a cause of clinical and epidemiological concern.
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Affiliation(s)
- María PÉrez-VÁzquez
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Pedro J Sola-Campoy
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Ángela María Zurita
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | - Alicia Ávila
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain
| | | | - Sonia SolÍs
- Microbiology Department, Hospital Universitario de Guadalajara, Spain
| | - Luis LÓpez-Urrutia
- Microbiology Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Emilia Cercenado
- Microbiology Department, Hospital Gregorio Marañón, Madrid, Spain
| | - Verónica Bautista
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Noelia Lara
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Belén Aracil
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio Oliver
- Microbiology Department-Research Institute Biomedical Islas Baleares (IdISBa), Hospital Son Espases, Palma de Mallorca, Spain
| | - José Campos
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain
| | - Jesús Oteo-Iglesias
- Reference and Research Laboratory for Antibiotic Resistance and Health Care Infections, National Centre for Microbiology, Institute of Health Carlos III, Majadahonda, Madrid, Spain; Spanish Network for Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain.
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Weinbren MJ. Dissemination of antibiotic resistance and other healthcare waterborne pathogens. The price of poor design, construction, usage and maintenance of modern water/sanitation services. J Hosp Infect 2020; 105:S0195-6701(20)30133-X. [PMID: 32243955 DOI: 10.1016/j.jhin.2020.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 03/26/2020] [Indexed: 12/28/2022]
Abstract
Classical waterborne pathogens (cholera/typhoid) drove the development of safe water and sanitation during the industrial revolution. Whilst effective against these organisms, other bacteria exploited the potential to form biofilm in the narrow pipes of buildings. 1976 saw the discovery of legionella. Despite evidence dating back to 1967 (including paediatric deaths in Manchester in 1995 from splashes from a sink contaminating parenteral nutrition) it required the deaths of four neonates and the might of the Press in 2011 for the UK medical services to accept waterborne transmission of other Opportunistic Plumbing Premise Pathogens (OPPP). Human nature, a healthcare construction industry largely devoid of interest in water safety, and failures in recognising transmission are major forces hindering progress in preventing infection/deaths from waterborne infections. The advent of highly resistant Gram-negative bacteria is highlighting further deficiencies in modern drainage systems. These bacteria are not thought to have special adaptations promoting their dispersal but purely attract our attention to the well-trodden routes used by sensitive organisms, which go undetected. The O'Neill report warns of the bleak future without effective antibiotics. This paper examines the evidence as to why modern water services/sanitation continue to present a risk to patient safety (and the general public) and also suggests their designs may be flawed if they are to stem the modern equivalent of cholera, the dissemination of antibiotic resistance.
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Affiliation(s)
- M J Weinbren
- King's Mill hospital, Mansfield Road, Sutton-in Ashfield, Nottinghamshire NG17 4JL.
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Anforderungen der Hygiene an abwasserführende Systeme in medizinischen Einrichtungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:484-501. [DOI: 10.1007/s00103-020-03118-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Maynard E. An overview of a seminar on patient infections and drinking water management within healthcare buildings in the UK. Perspect Public Health 2020; 140:79. [DOI: 10.1177/1757913919899581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Chia PY, Sengupta S, Kukreja A, S L Ponnampalavanar S, Ng OT, Marimuthu K. The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms. Antimicrob Resist Infect Control 2020; 9:29. [PMID: 32046775 PMCID: PMC7014667 DOI: 10.1186/s13756-020-0685-1] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 01/23/2020] [Indexed: 12/12/2022] Open
Abstract
Infections by multidrug-resistant (MDR) Gram-negative organisms (GN) are associated with a high mortality rate and present an increasing challenge to the healthcare system worldwide. In recent years, increasing evidence supports the association between the healthcare environment and transmission of MDRGN to patients and healthcare workers. To better understand the role of the environment in transmission and acquisition of MDRGN, we conducted a utilitarian review based on literature published from 2014 until 2019.
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Affiliation(s)
- Po Ying Chia
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Sharmila Sengupta
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore
| | | | | | - Oon Tek Ng
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore.,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore.,Lee Kong Chian School of Medicine, Nanyang Technological University, Nanyang, Singapore
| | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Jln Tan Tock Seng, Singapore. .,Department of Infectious Diseases, Tan Tock Seng Hospital, Block H, CHI Level 3, 18, Jalan Tan Tock Seng, 308442, Singapore. .,Yong Loo Lin School of Medicine, National University of Singapore, Kent Ridge Rd, Singapore.
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Henderson J, Ciesielczuk H, Nelson S, Wilks M, Cummins M. A point prevalence study to determine the inpatient rate of carbapenemase-producing organisms at a large London NHS Trust. J Hosp Infect 2020; 104:12-19. [DOI: 10.1016/j.jhin.2019.10.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 10/14/2019] [Indexed: 10/25/2022]
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Schäfer E, Malecki M, Tellez-Castillo CJ, Pfennigwerth N, Marlinghaus L, Higgins PG, Mattner F, Wendel AF. Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany. Antimicrob Resist Infect Control 2019; 8:208. [PMID: 31893042 PMCID: PMC6937969 DOI: 10.1186/s13756-019-0665-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 12/17/2019] [Indexed: 12/15/2022] Open
Abstract
Background Pseudomonas aeruginosa is a common pathogen causing hospital-acquired infections. Carbapenem resistance in P. aeruginosa is either mediated via a combination of efflux pumps, AmpC overexpression, and porin loss, or through an acquired carbapenemase. Carbapenemase-producing P. aeruginosa (CPPA) strains are known to cause outbreaks and harbour a reservoir of mobile antibiotic resistance genes, however, few molecular surveillance data is available. The aim of this study was to analyse the prevalence and epidemiology of CPPA in three German medical centres from 2015 to 2017. Methods Identification and susceptibility testing were performed with VITEK 2 system. P. aeruginosa non-susceptible to piperacillin, ceftazidime, cefepime, imipenem, meropenem and ciprofloxacin (4MRGN according to the German classification guideline) isolated from 2015 to 2017 were analysed. A two-step algorithm to detect carbapenemases was performed: phenotypic tests (EDTA- and cloxacillin-combined disk tests) followed by PCR, Sanger sequencing, and eventually whole genome sequencing. CPPA isolates were further genotyped by RAPD and PFGE. In-hospital transmission was investigated using conventional epidemiology. Results Sixty two P. aeruginosa isolates were available for further analysis, of which 21 were CPPA as follows: blaVIM-1 (n = 2), blaVIM-2 (n = 17), blaNDM-1/blaGES-5 (n = 1) and the newly described blaIMP-82 (n = 1). CPPA were mostly hospital-acquired (71.4%) and isolated on intensive care units (66.7%). All (except one) were from the tertiary care centre. PFGE typing revealed one large cluster of VIM-2-producing CPPA containing 13 isolates. However, using conventional epidemiology, we were only able to confirm three patient-to-patient transmissions, and one room-to-patient transmission, on several intensive care units. Conclusions These data give insight into the epidemiology of CPPA in three centres in Germany over a period of 3 years. Carbapenemases are a relevant resistance mechanism in 4MRGN-P. aeruginosa, illustrated by genetically related VIM-2-producing strains that seem to be endemic in this region. Our data suggest that infection control measures should especially focus on controlling transmission on the ICU and support the need for a local molecular surveillance system.
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Affiliation(s)
- Elena Schäfer
- 1Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany
| | - Monika Malecki
- 1Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany
| | - Carlos J Tellez-Castillo
- Department of Clinical Microbiology, MVZ synlab Leverkusen GmbH, Site Köln-Merheim, Cologne, Germany
| | - Niels Pfennigwerth
- 3Department of Medical Microbiology, National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Ruhr-University Bochum, Bochum, Germany
| | - Lennart Marlinghaus
- 3Department of Medical Microbiology, National Reference Centre for Multidrug-resistant Gram-negative Bacteria, Ruhr-University Bochum, Bochum, Germany
| | - Paul G Higgins
- 4Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, and German Centre for Infection Research, Partner site Bonn-Cologne, Cologne, Germany
| | - Frauke Mattner
- 1Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany
| | - Andreas F Wendel
- 1Institute of Hygiene, Cologne Merheim Medical Centre, University Hospital of Witten/Herdecke, Ostmerheimer Strasse 200, 51109 Cologne, Germany
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Moloney EM, Deasy EC, Swan JS, Brennan GI, O'Donnell MJ, Coleman DC. Whole-genome sequencing identifies highly related Pseudomonas aeruginosa strains in multiple washbasin U-bends at several locations in one hospital: evidence for trafficking of potential pathogens via wastewater pipes. J Hosp Infect 2019; 104:484-491. [PMID: 31738988 DOI: 10.1016/j.jhin.2019.11.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hand washbasin U-bends have increasingly been associated with nosocomial outbreaks by Gram-negative bacteria, including Pseudomonas aeruginosa which is virtually ubiquitous in U-bends. Wastewater networks servicing U-bends are potential highways for trafficking pathogenic bacteria. AIM To use P. aeruginosa to investigate trafficking of bacteria between hospital washbasin U-bends. METHODS Twenty-five washbasin U-bends in five locations in Dublin Dental University Hospital (DDUH) were investigated for trafficking of P. aeruginosa: 10 in Clinic 2 (C2), 10 in the Accident & Emergency Department (A&E) and five in three other locations. In addition, washbasin tap samples (N=80) and mains and tap water samples (N=72) were cultured for P. aeruginosa. Selected P. aeruginosa isolates recovered over 29 months underwent whole-genome sequencing, and relatedness was interpreted using whole-genome multi-locus sequence typing and pairwise single nucleotide polymorphism (SNP) analysis. FINDINGS P. aeruginosa was recovered from all U-bends but not from taps or water. Eighty-three U-bend isolates yielded 10 sequence types (STs), with ST560 and ST179 from A&E, C2 and two other locations predominating (70%). ST560 was also recovered from a common downstream pipe. Isolates within ST560 and ST179 were highly related regardless of source. ST560 was divided into Cluster I (N=25) and Cluster II (N=2) with average allelic differences and SNPs of three and zero, and two and five, respectively. The 31 ST179 isolates exhibited an average allelic difference and SNPs of three and 12, respectively. CONCLUSION Highly related P. aeruginosa strains were identified in multiple U-bends in several DDUH locations, indicating trafficking via the wastewater network.
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Affiliation(s)
- E M Moloney
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - E C Deasy
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - J S Swan
- Facilities Department, Dublin Dental University Hospital, Dublin, Ireland
| | - G I Brennan
- National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland
| | - M J O'Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland
| | - D C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College, Dublin, Ireland.
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Smismans A, Ho E, Daniels D, Ombelet S, Mellaerts B, Obbels D, Valgaeren H, Goovaerts A, Huybrechts E, Montag I, Frans J. New environmental reservoir of CPE in hospitals. THE LANCET. INFECTIOUS DISEASES 2019; 19:580-581. [DOI: 10.1016/s1473-3099(19)30230-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/17/2019] [Indexed: 12/17/2022]
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Affiliation(s)
- Evan S Snitkin
- Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor
- Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor
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