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Yashar M, Basarir KE, Tanriverdi ES, Celep S, Sirekbasan L, Rakici E, Ejder N, Musellim E, Cicek AC, Yilmaz M. Stenotrophomonas maltophilia outbreak originating from a pull-out faucet in a pediatric intensive care unit in Turkey: Insights from clinical records and molecular typing. Am J Infect Control 2024; 52:605-610. [PMID: 38043636 DOI: 10.1016/j.ajic.2023.11.018] [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: 08/29/2023] [Revised: 11/21/2023] [Accepted: 11/25/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Nosocomial Stenotrophomonas maltophilia-related cases are rising and pose a threat to immunocompromised patients. Twelve patients from our pediatric intensive care unit (PICU) presented with S maltophilia-associated bloodstream infection. METHODS This outbreak investigation includes 12 patients from PICU between the ages of 2 months and 4 years (mean 16 months, 7 male). To identify the origin, samples from all possible sources throughout the hospital were collected and ran through DNA isolation and Pulse Field Gel Electrophoresis. RESULTS 120 samples were collected during the outbreak. 31 samples (26%) were positive for S maltophilia. 30 S maltophilia isolates were analyzed, 10 different genotypes were identified. Clustering isolates were grouped into 3 different clusters (tolerance and optimization 1.0, cutoff 90%). The largest cluster was genotype 1, which included 19 isolates, those belong to patients' samples and a sample from a pull-out faucet inside the PICU. The Pull-out faucet was the origin of the bloodstream infection. DISCUSSION Pull-out faucets allow biofilm production, due its structure. Pulse Field Gel Electrophoresis identifies the transmission dynamics of the outbreak, with its high discriminatory power. CONCLUSIONS Water sources should be monitored on a regular basis. Pull-out faucets enable bacterial overgrowth; therefore, we recommend water surveillance during outbreak investigations.
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Affiliation(s)
- Meltem Yashar
- Department of School of Medicine, Istanbul Medipol University, School of Medicine, Istanbul, Turkey.
| | - Kerem E Basarir
- Department of International School of Medicine, Istanbul Medipol University, International School of Medicine, Istanbul, Turkey
| | - Elif S Tanriverdi
- Department of Clinical Microbiology, Malatya Training and Research Hospital, Clinical Microbiology Laboratory, Malatya, Turkey
| | - Selcuk Celep
- Istanbul Medipol Mega Hospital, Department of Clinical Microbiology, Istanbul, Turkey
| | - Leyla Sirekbasan
- Istanbul Medipol Mega Hospital, Department of Clinical Microbiology, Istanbul, Turkey
| | - Erva Rakici
- Department of Clinical Microbiology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Nebahat Ejder
- Department of Clinical Microbiology, Recep Tayyip Erdogan University, Faculty of Medicine, Rize, Turkey
| | - Eda Musellim
- Department of Infection control Unit, Istanbul Medipol Mega Hospital, Infection Control Unit, Istanbul, Turkey
| | - Aysegul C Cicek
- Istanbul Medipol University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
| | - Mesut Yilmaz
- Istanbul Medipol University, School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Istanbul, Turkey
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Lee YL, Hsueh PR. Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis. Curr Opin Infect Dis 2023; 36:481-494. [PMID: 37548375 DOI: 10.1097/qco.0000000000000953] [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: 08/08/2023]
Abstract
PURPOSE OF REVIEW This systematic review aimed to explore the recent trends in the epidemiology, risk factors, and antimicrobial susceptibility of two emerging opportunistic pathogens, Stenotrophomonas maltophilia and Elizabethkingia anophelis . RECENT FINDINGS Since 2020, numerous outbreaks of S. maltophilia and E. anophelis have been reported worldwide. Most of these outbreaks have been associated with healthcare facilities, although one outbreak caused by E. anophelis in France was considered a community-associated infection. In terms of antimicrobial susceptibility, trimethoprim/sulfamethoxazole (TMP-SMZ), levofloxacin, and minocycline have exhibited good efficacy against S. maltophilia . Additionally, cefiderocol and a combination of aztreonam and avibactam have shown promising results in in vitro susceptibility testing. For E. anophelis , there is currently no consensus on the optimal treatment. Although some studies have reported good efficacy with rifampin, TMP-SMZ, piperacillin/tazobactam, and cefoperazone/sulbactam, minocycline had the most favourable in vitro susceptibility rates. Cefiderocol may serve as an alternative due to its low minimum inhibitory concentration (MIC) against E. anophelis . The role of vancomycin in treatment is still uncertain, although several successful cases with vancomycin treatment, even with high MIC values, have been reported. SUMMARY Immunocompromised patients are particularly vulnerable to infections caused by S. maltophilia and E. anophelis , but the optimal treatment strategy remains inconclusive. Further research is necessary to determine the most effective use of conventional and novel antimicrobial agents in combatting these multidrug-resistant pathogens.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Chung Shan Medical University Hospital
- School of Medicine, Chung Shan Medical University
- PhD Program in Medical Biotechnology, National Chung-Hsing University
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital
- School of Medicine
- PhD Program for Aging, School of Medicine, China Medical University, Taichung
- Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
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Auld DB, Has P, Mermel LA. Seasonality of healthcare-associated Stenotrophomonas maltophilia. Infect Control Hosp Epidemiol 2023; 44:1500-1501. [PMID: 36416200 PMCID: PMC10507498 DOI: 10.1017/ice.2022.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 10/26/2022] [Accepted: 10/27/2022] [Indexed: 11/24/2022]
Abstract
From April 1, 2016, through March 31, 2022, growth of Stenotrophomonas maltophilia from clinical specimens at our academic medical center was significantly more likely during July-September than during other calendar quarters.
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Affiliation(s)
- Dianne B. Auld
- Department of Epidemiology and Infection Control, Lifespan Hospital System, Providence, Rhode Island
| | - Phinnara Has
- Biostatistics, Epidemiology and Research Design, Lifespan Hospital System, Providence, Rhode Island
| | - Leonard A. Mermel
- Department of Epidemiology and Infection Control, Lifespan Hospital System, Providence, Rhode Island
- Division of Infectious Diseases, Department of Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island
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Karampatakis T, Tsergouli K, Roilides E. Infection control measures against multidrug-resistant Gram-negative bacteria in children and neonates. Future Microbiol 2023; 18:751-765. [PMID: 37584552 DOI: 10.2217/fmb-2023-0072] [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] [Indexed: 08/17/2023] Open
Abstract
The increase in infections caused by multidrug-resistant (MDR) Gram-negative bacteria in neonatal and pediatric intensive care units over recent years is alarming. MDR Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii have constituted the main causes of the MDR Gram-negative bacteria problem. The implementation of infection control measures such as hand hygiene, cohorting of patients, contact precautions, active surveillance and environmental cleaning could diminish their spread. Recently, water safety has been identified as a major component of infection control policies. The aim of the current review is to highlight the effectiveness of these infection control measures in managing outbreaks caused by MDR Gram-negative bacteria in neonatal and pediatric intensive care units and highlight future perspectives on the topic.
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Affiliation(s)
| | - Katerina Tsergouli
- Microbiology Department, Agios Pavlos General Hospital, Thessaloniki, 551 34, Greece
| | - Emmanuel Roilides
- Infectious Disease Unit, 3rd Department of Pediatrics, School of Health Sciences, Hippokration General Hospital, Thessaloniki, 546 42, Greece
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van der Wielen PWJJ, Dignum M, Donocik A, Prest EI. Influence of Temperature on Growth of Four Different Opportunistic Pathogens in Drinking Water Biofilms. Microorganisms 2023; 11:1574. [PMID: 37375076 DOI: 10.3390/microorganisms11061574] [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: 05/04/2023] [Revised: 06/08/2023] [Accepted: 06/10/2023] [Indexed: 06/29/2023] Open
Abstract
High drinking water temperatures occur due to climate change and could enhance the growth of opportunistic pathogens in drinking water systems. We investigated the influence of drinking water temperatures on the growth of Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Mycobacterium kansasii and Aspergillus fumigatus in drinking water biofilms with an autochthonous microflora. Our results reveal that the growth of P. aeruginosa and S. maltophilia in the biofilm already occurred at 15.0 °C, whereas M. kansasii and A. fumigatus were able to grow when temperatures were above 20.0 °C and 25.0 °C, respectively. Moreover, the maximum growth yield of P. aeruginosa, M. kansasii and A. fumigatus increased with increasing temperatures up to 30 °C, whereas an effect of temperature on the yield of S. maltophilia could not be established. In contrast, the maximum ATP concentration of the biofilm decreased with increasing temperatures. We conclude from these results that high drinking water temperatures caused by, e.g., climate change can result in high numbers of P. aeruginosa, M. kansasii and A. fumigatus in drinking water systems, which poses a possible risk to public health. Consequently, it is recommended for countries with a more moderate climate to use or maintain a drinking water maximum standard temperature of 25 °C.
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Affiliation(s)
- Paul W J J van der Wielen
- KWR Water Research Institute, 3433 PE Nieuwegein, The Netherlands
- Laboratory of Microbiology, Wageningen University & Research, 6708 WE Wageningen, The Netherlands
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Miura K, Tanaka M, Date M, Ito M, Mizuno N, Mizuno K. Comparison of bacterial profiles in human milk from mothers of term and preterm infants. Int Breastfeed J 2023; 18:29. [PMID: 37291566 DOI: 10.1186/s13006-023-00563-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/14/2023] [Indexed: 06/10/2023] Open
Abstract
BACKGROUND Reducing the disposal of donated human milk (HM) is important for efficient management of human milk banks (HMBs). The presence of bacteria growth is the main factor that contributes to the disposal of donated HM. The bacterial profile in HM is suspected to differ between term and preterm mothers, with HM from preterm mothers containing more bacteria. Thus, elucidation of the causes of bacterial growth in preterm and term HM may help to reduce the disposal of donated preterm HM. This study compared the bacterial profiles of HM between mothers of term infants and mothers of preterm infants. METHODS This pilot study was conducted in the first Japanese HMB, which was initiated in 2017. This study analyzed 214 human milk samples (term: 75, preterm: 139) donated by 47 registered donors (term: 31, preterm: 16) from January to November 2021. Bacterial culture results in term and preterm HM were retrospectively reviewed in May 2022. Differences in total bacterial count and bacterial species count per batch were analyzed using the Mann-Whitney U test. Bacterial loads were analyzed using the Chi-square test or Fisher's exact test. RESULTS The disposal rate did not significantly differ between term and preterm groups (p = 0.77), but the total amount of disposal was greater in the preterm group (p < 0.01). Coagulase-negative Staphylococci, Staphylococcus aureus, and Pseudomonas fluorescens were frequently found in both types of HM. Serratia liquefaciens (p < 0.001) and two other bacteria were present in term HM; a total of five types of bacteria, including Enterococcus faecalis and Enterobacter aerogenes (p < 0.001) were present in preterm HM. The median (interquartile range) total bacterial counts were 3,930 (435-23,365) colony-forming units (CFU)/mL for term HM and 26,700 (4,050-334,650) CFU/mL for preterm HM (p < 0.001). CONCLUSIONS This study revealed that HM from preterm mothers had a higher total bacterial count and different types of bacteria than HM from term mothers. Additionally, preterm infants can receive nosocomial-infection-causing bacteria in the NICU through their mother's milk. Enhanced hygiene instructions for preterm mothers may reduce the disposal of valuable preterm human milk, along with the risk of HM pathogen transmission to infants in NICUs.
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Affiliation(s)
- Kumiko Miura
- The Nippon Foundation Human Milk Bank, Nihonbashi-koamicho Square Building 1F, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo, 103-0016, Japan
- Faculty of Medicine, Oita University, 1-1 Idaigaoka, Hasama-machi, Yufu-shi, Oita, 879-5593, Japan
| | - Miori Tanaka
- The Nippon Foundation Human Milk Bank, Nihonbashi-koamicho Square Building 1F, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo, 103-0016, Japan
| | - Midori Date
- The Nippon Foundation Human Milk Bank, Nihonbashi-koamicho Square Building 1F, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo, 103-0016, Japan
| | - Mizuho Ito
- The Nippon Foundation Human Milk Bank, Nihonbashi-koamicho Square Building 1F, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo, 103-0016, Japan
| | - Noriko Mizuno
- Japan Human Milk Bank Association, 4-4 Nihonbashi-Hisamatsucho, Chuo-ku, Tokyo, 103-8480, Japan
| | - Katsumi Mizuno
- The Nippon Foundation Human Milk Bank, Nihonbashi-koamicho Square Building 1F, 17-10 Nihonbashi-koamicho, Chuo-ku, Tokyo, 103-0016, Japan.
- Japan Human Milk Bank Association, 4-4 Nihonbashi-Hisamatsucho, Chuo-ku, Tokyo, 103-8480, Japan.
- Department of Pediatrics, Showa University of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, 142-8666, Japan.
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Biswal M, Gupta P, Singh C, Vig S, Saini PS. Bacterial diversity of hospital water tanks and the efficacy of hydrogen peroxide based cleaning: Experience in a tertiary care center in India. Am J Infect Control 2023; 51:18-22. [PMID: 35605751 DOI: 10.1016/j.ajic.2022.05.011] [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: 01/26/2022] [Revised: 05/13/2022] [Accepted: 05/13/2022] [Indexed: 02/05/2023]
Abstract
BACKGROUND Hospital water is often an overlooked yet preventable source of hospital-acquired infections. CDC recommends annual cleaning of water reservoirs in health care settings. In our tertiary care hospital, periodic disinfection and microbiological surveillance of all the water tanks in hospital premises is carried out. The aim of this paper is to report the diversity of bacterial flora noted and the role of cleaning method adopted in our hospital. METHODS This retrospective study was carried out from July 2015 to September 2020. Tanks were cleaned using hydrogen peroxide based method and swabs were collected, pre- and post-cleaning. Any growth noted was identified using MALDI-TOF MS. RESULTS A total of 398 swabs were collected during this period. In pre-cleaning samples, 144 (72%) showed growth of 219 microorganisms. Gram-negative organisms (53.7%, 116/216) were more frequently isolated than Gram-positive organisms (46.3%, 100/216). Although the overwhelming majority is generally regarded as non-pathogenic, a few pathogenic bacteria were also recovered. No bacteria were isolated in any of the post-cleaning samples. CONCLUSIONS Diverse bacteria colonize water tanks over time, some of which are known to cause infections. Hydrogen peroxide is a simple and highly efficacious method of water tank disinfection. More such studies are required with other disinfectants to generate evidence with the ultimate aim of increasing safety of water supplied in hospitals.
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Affiliation(s)
- Manisha Biswal
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Parakriti Gupta
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Charu Singh
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Shashi Vig
- Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - P S Saini
- Department of Engineering, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mojica MF, Humphries R, Lipuma JJ, Mathers AJ, Rao GG, Shelburne SA, Fouts DE, Van Duin D, Bonomo RA. Clinical challenges treating Stenotrophomonas maltophilia infections: an update. JAC Antimicrob Resist 2022; 4:dlac040. [PMID: 35529051 PMCID: PMC9071536 DOI: 10.1093/jacamr/dlac040] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2023] Open
Abstract
Stenotrophomonas maltophilia is a non-fermenting, Gram-negative bacillus that has emerged as an opportunistic nosocomial pathogen. Its intrinsic multidrug resistance makes treating infections caused by S. maltophilia a great clinical challenge. Clinical management is further complicated by its molecular heterogeneity that is reflected in the uneven distribution of antibiotic resistance and virulence determinants among different strains, the shortcomings of available antimicrobial susceptibility tests and the lack of standardized breakpoints for the handful of antibiotics with in vitro activity against this microorganism. Herein, we provide an update on the most recent literature concerning these issues, emphasizing the impact they have on clinical management of S. maltophilia infections.
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Affiliation(s)
- Maria F. Mojica
- Department of Molecular Biology and Microbiology, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Case Western Reserve University-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Grupo de Resistencia Antimicrobiana y Epidemiología Hospitalaria, Universidad El Bosque, Bogotá, Colombia
| | - Romney Humphries
- Department of Pathology, Immunology and Microbiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - John J. Lipuma
- University of Michigan Medical School, Pediatric Infectious Disease, Ann Arbor, MI, USA
| | - Amy J. Mathers
- Division of Infectious Disease and International Health, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
- Clinical Microbiology Laboratory, Department of Pathology, University of Virginia Health System, Charlottesville, VA, USA
| | - Gauri G. Rao
- Division of Pharmacotherapy and Experimental Therapeutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel A. Shelburne
- Department of Infectious Diseases Infection Control and Employee Health, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Department of Genomic Medicine, University of Texas MD Anderson Cancer Center, Houston, TX, USA
- Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center McGovern Medical School, Houston, TX, USA
| | - Derrick E. Fouts
- Genomic Medicine, The J. Craig Venter Institute, Rockville, MD, USA
| | - David Van Duin
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert A. Bonomo
- Case Western Reserve University-Cleveland VA Medical Center for Antimicrobial Resistance and Epidemiology (Case VA CARES), Cleveland, OH, USA
- Research Service, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
- Senior Clinician Scientist Investigator, Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
- Medical Service and Geriatric Research, Education, and Clinical Center (GRECC), Veterans Affairs Northeast Ohio Healthcare System, Cleveland, OH, USA
- Departments of Medicine, Biochemistry, Pharmacology, Molecular Biology and Microbiology, and Proteomics and Bioinformatics, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Kanaujia R, Bandyopadhyay A, Biswal M, Sahni N, Kaur K, Vig S, Sharma V, Angrup A, Yaddanapudi LN, Ray P. Colonization of the central venous catheter by Stenotrophomonas maltophilia in an ICU setting: An impending outbreak managed in time. Am J Infect Control 2022; 50:663-667. [PMID: 34736990 DOI: 10.1016/j.ajic.2021.10.026] [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: 10/05/2021] [Revised: 10/25/2021] [Accepted: 10/25/2021] [Indexed: 11/15/2022]
Abstract
BACKGROUND Stenotrophomonas maltophiliacauses opportunistic infections in immunocompromised and patients in intensive care units (ICUs). An outbreak of S. maltophilia in ICU is described which highlights the importance of the risk of infection from contaminated medical devices and suction fluids in ventilated patients. METHODS The investigation of the outbreak was carried out. Environmental sampling was done. This was followed by MALDI-TOF MS typing and recA gene-based-phylogeny. RESULTS In February, S. maltophilia was reported from the central line blood of six patients from ICU within a span of two weeks. The peripheral line blood cultures were sterile in all patients. Relevant environmental sampling of the high-touch surface and fluids revealed S. maltophilia strains in normal saline used for suction and in the inspiratory circuit of two patients. The isolated strains from patients and environment (inspiratory fluid) showed a minimum of 95.41% recA gene sequence identity between each other. Strict cleaning and disinfection procedures were followed. Continuous surveillance was done and no further case of S. maltophilia was detected. Timely diagnosis and removal of central line prevented development of central-line associated blood stream infection. CONCLUSION This outbreak report illustrates that environmental sources like suction fluid and normal saline could be the source of S. maltophilia in ICU patients.
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Affiliation(s)
| | | | - Manisha Biswal
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Neeru Sahni
- Department of Anaesthesia and Intensive Care, PGIMER, Chandigarh, India
| | - Kulbeer Kaur
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Shashi Vig
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Vikas Sharma
- Department of Medical Microbiology, PGIMER, Chandigarh, India
| | - Archana Angrup
- Department of Medical Microbiology, PGIMER, Chandigarh, India.
| | | | - Pallab Ray
- Department of Medical Microbiology, PGIMER, Chandigarh, India
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Stenotrophomonas maltophilia as a Cause of Meningitis in an Infant. Indian J Pediatr 2021; 88:726. [PMID: 34018128 DOI: 10.1007/s12098-021-03800-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
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Abstract
Although many aspects of infection prevention and control (IPC) mirror institutional efforts, optimization of IPC practices in the neonatal intensive care unit requires careful consideration of its unique population and environment, addressed here for key IPC domains. In addition, innovative mitigation efforts to address challenges specific to limited resource settings are discussed.
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Lin Q, Zou H, Chen X, Wu M, Ma D, Yu H, Niu S, Huang S. Avibactam potentiated the activity of both ceftazidime and aztreonam against S. maltophilia clinical isolates in vitro. BMC Microbiol 2021; 21:60. [PMID: 33618662 PMCID: PMC7901100 DOI: 10.1186/s12866-021-02108-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
Background Treatment options for Stenotrophomonas maltophilia (S. maltophilia) infections were limited. We assessed the efficacy of ceftazidime (CAZ), ceftazidime-avibactam (CAZ-AVI), aztreonam (ATM), and aztreonam-avibactam (ATM-AVI) against a selection of 76 S. maltophilia out of the 1179 strains isolated from the First Affiliated Hospital of Chongqing Medical University during 2011–2018. Methods We investigated the antimicrobial resistance profiles of the 1179 S. maltophilia clinical isolates from the first affiliated hospital of Chongqing Medical University during 2011–2018, a collection of 76 isolates were selected for further study of microbiological characterization. Minimum inhibitory concentrations (MICs) of CAZ, CAZ-AVI, ATM and ATM-AVI were determined via the broth microdilution method. We deemed that CAZ-AVI or ATM-AVI was more active in vitro than CAZ or ATM alone when CAZ-AVI or ATM-AVI led to a category change from “Resistant” or “Intermediate” with CAZ or ATM alone to “Susceptible” with CAZ-AVI or ATM-AVI, or if the MIC of CAZ-AVI or ATM-AVI was at least 4-fold lower than the MIC of CAZ or ATM alone. Results For the 76 clinical isolates included in the study, MICs of CAZ, ATM, CAZ-AVI and ATM-AVI ranged from 0.03–64, 1–1024, 0.016–64, and 0.06–64 μg/mL, respectively. In combined therapy, AVI was active at restoring the activity of 48.48% (16/33) and 89.71% (61/68) of S. maltophilia to CAZ and ATM, respectively. Furthermore, CAZ-AVI showed better results in terms of the proportion of susceptible isolates (77.63% vs. 56.58%, P < 0.001), and MIC50 (2 μg/mL vs. 8 μg/mL, P < 0.05) when compared to CAZ. According to our definition, CAZ-AVI was more active in vitro than CAZ alone for 81.58% (62/76) of the isolates. Similarly, ATM-AVI also showed better results in terms of the proportion of susceptible isolates (90.79% vs.10.53%, P < 0.001) and MIC50 (2 μg/mL vs. 64 μg/mL, P < 0.001) when compared to ATM. According to our definition, ATM-AVI was also more active in vitro than ATM alone for 94.74% (72/76) of the isolates. Conclusions AVI potentiated the activity of both CAZ and ATM against S. maltophilia clinical isolates in vitro. We demonstrated that CAZ-AVI and ATM-AVI are both useful therapeutic options to treat infections caused by S. maltophilia.
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Affiliation(s)
- Qiuxia Lin
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, 400016, China
| | - Hua Zou
- Department of Clinical Laboratory Medicine, Chongqing Health Center for Women And Children, 120 Longshan Road, Yubei District, Chongqing, 400016, China
| | - Xian Chen
- Department of Clinical Laboratory, The Affiliated Hospital of Qingdao University, No. 59, Haier Road, Laoshan District, Qingdao, 266061, China
| | - Menglu Wu
- Department of Clinical Laboratory, Qingdao Women's and Children's Hospital, No.6, Tongfu Road, Shibei District, Qingdao, 266061, China
| | - Deyu Ma
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, 400016, China
| | - Hanbing Yu
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, 400016, China
| | - Siqiang Niu
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, 400016, China.
| | - Shifeng Huang
- Department of Clinical Laboratory Medicine, The First Affiliated Hospital of Chongqing Medical University, No. 1 Friendship Road, Yuzhong District, Chongqing, 400016, China.
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Behera B. Stenotrophomonas maltophilia, an emerging pathogen in newborns: Three case reports and a review of the literature. World J Clin Infect Dis 2021; 11:11-18. [DOI: 10.5495/wjcid.v11.i1.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/05/2020] [Accepted: 12/02/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stenotrophomonas maltophilia (S. maltophilia) is a rare cause of neonatal sepsis with significant morbidity and mortality and has extensive resistance to several antibiotics leaving few options for antimicrobial therapy. Only a few cases have been reported in neonates from developing countries. We report three cases of critically ill, extramural babies with neonatal S. maltophilia sepsis. All three babies recovered and were discharged.
CASE SUMMARY All three cases were term extramural babies, who were critically ill at the time of presentation at our neonatal intensive care unit. They had features of multiorgan dysfunction at admission. Blood culture was positive for S. maltophilia in two babies and one had a positive tracheal aspirate culture. The babies were treated according to the antibiogram available. They recovered and were subsequently discharged.
CONCLUSION Although various authors have reported S. maltophilia in pediatric and adult populations, only a few cases have been reported in the newborn period and this infection is even rarer in developing countries. Although S. maltophilia infection has a grave outcome, our three babies were successfully treated and subsequently discharged.
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Affiliation(s)
- Bijaylaxmi Behera
- Department of Pediatrics & Neonatology, Chaitanya Hospital, Chandigarh 160044, India
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14
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Proctor CR, Rhoads WJ, Keane T, Salehi M, Hamilton K, Pieper KJ, Cwiertny DM, Prévost M, Whelton AJ. Considerations for large building water quality after extended stagnation. AWWA WATER SCIENCE 2020; 2:e1186. [PMID: 32838226 DOI: 10.31219/osf.io/qvj3b] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 05/25/2023]
Abstract
The unprecedented number of building closures related to the coronavirus disease (COVID-19) pandemic is concerning because water stagnation will occur in many buildings that do not have water management plans in place. Stagnant water can have chemical and microbiological contaminants that pose potential health risks to occupants. Health officials, building owners, utilities, and other entities are rapidly developing guidance to address this issue, but the scope, applicability, and details included in the guidance vary widely. To provide a primer of large building water system preventative and remedial strategies, peer-reviewed, government, industry, and nonprofit literature relevant to water stagnation and decontamination practices for plumbing was synthesized. Preventative practices to help avoid the need for recommissioning (e.g., routine flushing) and specific actions, challenges, and limitations associated with recommissioning were identified and characterized. Considerations for worker and occupant safety were also indicated. The intended audience of this work includes organizations developing guidance.
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Affiliation(s)
- Caitlin R Proctor
- Division of Environmental and Ecological Engineering, Lyles School of Civil Engineering, Weldon School of Biomedical Engineering, School of Materials Engineering Purdue University West Lafayette Indiana
| | - William J Rhoads
- Department of Civil and Environmental Engineering Virginia Tech Blacksburg Virginia
| | - Tim Keane
- Legionella Risk Management, Inc. Chalfont Pennsylvania
| | - Maryam Salehi
- Department of Civil Engineering University of Memphis Memphis Tennessee
| | - Kerry Hamilton
- School of Sustainable Engineering and the Built Environment Arizona State University Tempe Arizona
| | - Kelsey J Pieper
- Department of Civil and Environmental Engineering Northeastern University Boston Massachusetts
| | - David M Cwiertny
- Department of Civil and Environmental Engineering, Seamans Center for the Engineering Arts and Sciences University of Iowa Iowa City Iowa
- Center for Health Effects of Environmental Contamination University of Iowa Iowa City Iowa
- Public Policy Center University of Iowa Iowa City Iowa
| | - Michele Prévost
- Civil, Geological and Mining Engineering Polytechnique Montreal Montréal Québec Canada
| | - Andrew J Whelton
- Lyles School of Civil Engineering, Division of Environmental and Ecological Engineering Purdue University West Lafayette Indiana
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Proctor CR, Rhoads WJ, Keane T, Salehi M, Hamilton K, Pieper KJ, Cwiertny DM, Prévost M, Whelton AJ. Considerations for Large Building Water Quality after Extended Stagnation. ACTA ACUST UNITED AC 2020; 2:e1186. [PMID: 32838226 PMCID: PMC7323006 DOI: 10.1002/aws2.1186] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 01/04/2023]
Abstract
The unprecedented number of building closures related to the coronavirus disease (COVID‐19) pandemic is concerning because water stagnation will occur in many buildings that do not have water management plans in place. Stagnant water can have chemical and microbiological contaminants that pose potential health risks to occupants. Health officials, building owners, utilities, and other entities are rapidly developing guidance to address this issue, but the scope, applicability, and details included in the guidance vary widely. To provide a primer of large building water system preventative and remedial strategies, peer‐reviewed, government, industry, and nonprofit literature relevant to water stagnation and decontamination practices for plumbing was synthesized. Preventative practices to help avoid the need for recommissioning (e.g., routine flushing) and specific actions, challenges, and limitations associated with recommissioning were identified and characterized. Considerations for worker and occupant safety were also indicated. The intended audience of this work includes organizations developing guidance.
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Affiliation(s)
- Caitlin R Proctor
- Division of Environmental and Ecological Engineering, Lyles School of Civil Engineering, Weldon School of Biomedical Engineering, School of Materials Engineering Purdue University West Lafayette IN
| | - William J Rhoads
- Department of Civil and Environmental Engineering Virginia Tech Blacksburg VA
| | - Tim Keane
- Consulting Engineer, Legionella Risk Management, Inc PA
| | - Maryam Salehi
- Department of Civil Engineering University of Memphis Memphis TN
| | - Kerry Hamilton
- School of Sustainable Engineering and the Built Environment Arizona State University Tempe AZ
| | - Kelsey J Pieper
- Department of Civil and Environmental Engineering Northeastern University Boston MA
| | - David M Cwiertny
- Department of Civil & Environmental Engineering, 4105 Seamans Center for the Engineering Arts and Sciences University of Iowa Iowa City IA.,Center for Health Effects of Environmental Contamination, 251 North Capitol Street, Chemistry Building - Room W195 University of Iowa Iowa City IA.,Public Policy Center, 310 South Grand Ave, 209 South Quadrangle University of Iowa Iowa City IA
| | - Michele Prévost
- Professor and Principal Chairholder, NSERC Industrial Chair on Drinking Water, Civil, Geological and Mining Engineering, Polytechnique Montreal CP Québec Canada
| | - Andrew J Whelton
- Purdue University, Lyles School of Civil Engineering, Division of Environmental and Ecological Engineering West Lafayette IN
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Faucet aerators as a reservoir for Carbapenem-resistant Acinetobacter baumannii: a healthcare-associated infection outbreak in a neurosurgical intensive care unit. Antimicrob Resist Infect Control 2019; 8:205. [PMID: 31893039 PMCID: PMC6938019 DOI: 10.1186/s13756-019-0635-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 10/24/2019] [Indexed: 01/22/2023] Open
Abstract
Background On January 7, 2019, we observed an outbreak of healthcare-associated infection (HAI) caused by Carbapenem-resistant Acinetobacter baumannii (CRAB) in the neurosurgical intensive care unit (NSICU). A follow-up epidemiological investigation was conducted, and an emergency response was initiated. We aimed to study the clonal transmission of CRAB and its possible source. Methods A matched case-control (1:2) study was performed to identify the possible predisposing factors. A multifaceted intervention was implemented to control the outbreak. We collected environmental samples from patients' rooms and living area of the staff. CRAB isolates were tested for genetic relatedness by Pulsed-Field Gel Electrophoresis (PFGE). Results Environmental sampling showed that a faucet aerator was contaminated with A. baumannii. Molecular typing revealed the only outbreak strain, which was isolated from tracheal aspirate cultures of the first case of community-acquired infection and 3 cases of HAI. In environmental samples, the outbreak strain was found only in the faucet aerator of the dining room. This CRAB outbreak was discovered in time, and further progress of this outbreak was prevented through a pre-set emergency response procedure. Conclusions The faucet aerator acted as a reservoir for bacteria in the outbreak, and contamination of the faucet aerator might have occurred from splashes originating from handwashing by the healthcare workers (HCWs). In high-risk areas, such as NSICU, the faucet aerators should not be used during an outbreak or they should be regularly cleaned and disinfected. The start-up criteria for the emergency response played a key role in controlling the CRAB outbreak, and its settings should be discussed more widely.
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Sah R, Siwakoti S, Baral R, Rajbhandari RS, Khanal B. Stenotrophomonas maltophilia causing blood stream infection in neonates and infants: a cause for concern. Trop Doct 2017; 48:227-229. [PMID: 29161992 DOI: 10.1177/0049475517743360] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Stenotrophomonas maltophilia ( S. maltophilia) is an important Gram-negative, non-fermentative, multidrug resistant (MDR) nosocomial organism. We evaluated the isolation of S. maltophilia from the seven blood culture specimens received from the Paediatric Emergency Department (PED) of BP Koirala Institute of Health Sciences (BPKIHS) over the duration of two weeks. The suspicion of a possible outbreak was raised and the hospital infection control team investigated the source and found the hand of one healthcare provider harbouring a similar organism. All six steps of hand hygiene were subsequently strictly enforced after which the same bacteria were no longer isolated. Infection control measures should be rigorously adopted for the control of such nosocomial bacteria.
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Affiliation(s)
- Rinku Sah
- 1 Senior resident, Department of microbiology, 58594 BP Koirala Institute of Health Sciences , Dharan, Nepal
| | - Shraddha Siwakoti
- 2 Assistant professor, Department of microbiology, 58594 BP Koirala Institute of Health Sciences , Dharan, Nepal
| | - Ratna Baral
- 3 Associate professor, Department of microbiology, 58594 BP Koirala Institute of Health Sciences , Dharan, Nepal
| | - Rupa S Rajbhandari
- 4 Professor, Department of microbiology, 58594 BP Koirala Institute of Health Sciences , Dharan, Nepal
| | - Basuda Khanal
- 5 Professor and Head, Department of microbiology, 58594 BP Koirala Institute of Health Sciences , Dharan, Nepal
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18
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A systematic review of nosocomial waterborne infections in neonates and mothers. Int J Hyg Environ Health 2017; 220:1199-1206. [DOI: 10.1016/j.ijheh.2017.07.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/31/2017] [Accepted: 07/31/2017] [Indexed: 11/24/2022]
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19
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Hopman J, Tostmann A, Wertheim H, Bos M, Kolwijck E, Akkermans R, Sturm P, Voss A, Pickkers P, Vd Hoeven H. Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'water-free' patient care. Antimicrob Resist Infect Control 2017; 6:59. [PMID: 28616203 PMCID: PMC5466749 DOI: 10.1186/s13756-017-0213-0] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 05/30/2017] [Indexed: 11/10/2022] Open
Abstract
Background Sinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates. Methods We conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18 years and older admitted to our ICUs for at least 48 h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of ‘water-free’ patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a ‘negative control’. In addition, colonization rates were calculated for first positive culture results from cultures taken ≥3, ≥5, ≥7, ≥10 and ≥14 days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests. Results In the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67–0.99; P = 0.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (≥2 days), to a 1.6-fold (≥5 days; P = 0.002), 2.5-fold (for ≥10 days; P < 0.001) to a 3.6-fold (≥14 days; P < 0.001) reduction. Conclusions Removal of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay. Electronic supplementary material The online version of this article (doi:10.1186/s13756-017-0213-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joost Hopman
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Heiman Wertheim
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Maria Bos
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Eva Kolwijck
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands
| | - Reinier Akkermans
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Patrick Sturm
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands.,Department of Medical Microbiology, Laurentius hospital, Roermond, The Netherlands
| | - Andreas Voss
- Department of Medical Microbiology, Radboud university medical center, Geert Grooteplein 10, Postbus 9101, 6500 HB Nijmegen, The Netherlands.,Department of Medical Microbiology and Infectious Diseases, Canisius-Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Peter Pickkers
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
| | - Hans Vd Hoeven
- Department of Intensive Care, Radboud university medical center, Nijmegen, The Netherlands
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20
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Pseudo-outbreaks of Stenotrophomonas maltophilia on an intensive care unit in England. J Hosp Infect 2016; 92:392-6. [DOI: 10.1016/j.jhin.2015.12.014] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/23/2015] [Indexed: 11/21/2022]
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21
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Sacchetti R, De Luca G, Guberti E, Zanetti F. Quality of Drinking Water Treated at Point of Use in Residential Healthcare Facilities for the Elderly. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:11163-77. [PMID: 26371025 PMCID: PMC4586667 DOI: 10.3390/ijerph120911163] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 08/24/2015] [Accepted: 08/25/2015] [Indexed: 02/05/2023]
Abstract
Municipal tap water is increasingly treated at the point of use (POU) to improve the acceptability and palatability of its taste. The aim of this study was to assess the bacteriologic and nutritional characteristics of tap water treated at the point of use in residential healthcare facilities for the elderly. Two types of POU devices were used: microfiltered water dispensers (MWDs) and reverse-osmosis water dispensers (ROWDs). All samples of water entering the devices and leaving them were tested for the bacteriological parameters set by Italian regulations for drinking water and for opportunistic pathogens associated with various infections in healthcare settings; in addition, the degree of mineralization of the water was assessed. The results revealed widespread bacterial contamination in the POU treatment devices, particularly from potentially pathogenic species. As expected, the use of ROWDs led to a decrease in the saline content of the water. In conclusion, the use of POU treatment in healthcare facilities for the elderly can be considered advisable only if the devices are constantly and carefully maintained.
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Affiliation(s)
- Rossella Sacchetti
- Department of Education Sciences, Hygiene, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy.
| | - Giovanna De Luca
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy.
| | - Emilia Guberti
- Department of Public Health, UO Food Hygiene and Nutrition, Local Health Unit of Bologna, Via Altura 5, 40100 Bologna, Italy.
| | - Franca Zanetti
- Department of Biomedical and Neuromotor Sciences, Unit of Hygiene, Public Health and Medical Statistics, University of Bologna, Via San Giacomo 12, 40126 Bologna, Italy.
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Minogue E, Tuite NL, Smith CJ, Reddington K, Barry T. A rapid culture independent methodology to quantitatively detect and identify common human bacterial pathogens associated with contaminated high purity water. BMC Biotechnol 2015; 15:6. [PMID: 25888294 PMCID: PMC4342816 DOI: 10.1186/s12896-015-0124-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/06/2015] [Indexed: 02/06/2023] Open
Abstract
Background Water and High Purity Water (HPW) distribution systems can be contaminated with human pathogenic microorganisms. This biocontamination may pose a risk to human health as HPW is commonly used in the industrial, pharmaceutical and clinical sectors. Currently, routine microbiological testing of HPW is performed using slow and labour intensive traditional microbiological based techniques. There is a need to develop a rapid culture independent methodology to quantitatively detect and identify biocontamination associated with HPW. Results A novel internally controlled 5-plex real-time PCR Nucleic Acid Diagnostics assay (NAD), was designed and optimised in accordance with Minimum Information for Publication of Quantitative Real-Time PCR Experiments guidelines, to rapidly detect, identify and quantify the human pathogenic bacteria Stenotrophomonas maltophilia, Burkholderia species, Pseudomonas aeruginosa and Serratia marcescens which are commonly associated with the biocontamination of water and water distribution systems. The specificity of the 5-plex assay was tested against genomic DNA isolated from a panel of 95 microorganisms with no cross reactivity observed. The analytical sensitivities of the S. maltophilia, B. cepacia, P. aeruginosa and the S. marcescens assays are 8.5, 5.7, 3.2 and 7.4 genome equivalents respectively. Subsequently, an analysis of HPW supplied by a Millipore Elix 35 water purification unit performed using standard microbiological methods revealed high levels of naturally occurring microbiological contamination. Five litre water samples from this HPW delivery system were also filtered and genomic DNA was purified directly from these filters. These DNA samples were then tested using the developed multiplex real-time PCR NAD assay and despite the high background microbiological contamination observed, both S. maltophilia and Burkholderia species were quantitatively detected and identified. At both sampling points the levels of both S. maltophilia and Burkholderia species present was above the threshold of 10 cfu/100 ml recommended by both EU and US guidelines. Conclusions The novel culture independent methodology described in this study allows for rapid (<5 h), quantitative detection and identification of these four human pathogens from biocontaminated water and HPW distribution systems. We propose that the described NAD assay and associated methodology could be applied to routine testing of water and HPW distribution systems to assure microbiological safety and high water quality standards. Electronic supplementary material The online version of this article (doi:10.1186/s12896-015-0124-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elizabeth Minogue
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Nina L Tuite
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Cindy J Smith
- Marine Microbial Ecology Laboratory, Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Kate Reddington
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
| | - Thomas Barry
- Nucleic Acid Diagnostics Research Laboratory (NADRL), Microbiology, School of Natural Sciences, National University of Ireland Galway, Galway, Ireland.
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Ferranti G, Marchesi I, Favale M, Borella P, Bargellini A. Aetiology, source and prevention of waterborne healthcare-associated infections: a review. J Med Microbiol 2014; 63:1247-1259. [DOI: 10.1099/jmm.0.075713-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the settings and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot-water distribution systems were the primary source of legionnaires’ disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.
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Affiliation(s)
- Greta Ferranti
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Marchesi
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcella Favale
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Borella
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Bargellini
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Chawla K, Vishwanath S, Munim FC. Nonfermenting Gram-negative Bacilli other than Pseudomonas aeruginosa and Acinetobacter Spp. Causing Respiratory Tract Infections in a Tertiary Care Center. J Glob Infect Dis 2014; 5:144-8. [PMID: 24672175 PMCID: PMC3958983 DOI: 10.4103/0974-777x.121996] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Nonfermenting gram-negative bacilli have emerged as important healthcare-associated pathogens. It is important to correctly identify all clinically significant nonfermenting gram-negative bacilli considering the intrinsic multidrug resistance exhibited by these bacteria. Materials and Methods: A retrospective study was undertaken to identify the various nonfermenting gram-negative bacilli other than Pseudomonas aeruginosa and Acinetobacter spp. isolated from respiratory samples (n = 9363), to understand their clinical relevance and to analyze their antibiotic susceptibility pattern. Results: Nonfermenting gram-negative bacilli were isolated from 830 (16.4%) samples showing significant growth. Thirty-three (4%) isolates constituted nonfermenting gram-negative bacilli other than P. aeruginosa and Acinetobacter spp. Stenotrophomonas maltophilia (15, 45.5%) was the most common isolate followed by Burkholderia cepacia (4, 12.1%), Sphingomonas paucimobilis (3, 9.1%), and Achromobacter xylosoxidans (3, 9.1%). On the basis of clinicomicrobiological correlation, pathogenicity was observed in 69.7% (n = 23) isolates. Timely and correct treatment resulted in clinical improvement in 87.9% cases. Conclusion: Any nonfermenting gram-negative bacilli isolated from respiratory tract infection should not be ignored as mere contaminant, but correlated clinically for its pathogenic potential and identified using standard methods so as to institute appropriate and timely antibiotic coverage.
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Affiliation(s)
- Kiran Chawla
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal University, Karnataka, India
| | - Shashidhar Vishwanath
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal University, Karnataka, India
| | - Frenil C Munim
- Department of Microbiology, Kasturba Medical College, Manipal, Manipal University, Karnataka, India
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25
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Guyot A, Turton J, Garner D. Outbreak of Stenotrophomonas maltophilia on an intensive care unit. J Hosp Infect 2013; 85:303-7. [DOI: 10.1016/j.jhin.2013.09.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 09/19/2013] [Indexed: 10/26/2022]
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Abstract
PURPOSE OF REVIEW The aim is to discuss the epidemiology of infections that arise from contaminated water in healthcare settings, including Legionnaires' disease, other Gram-negative pathogens, nontuberculous mycobacteria, and fungi. RECENT FINDINGS Legionella can colonize a hospital water system and infect patients despite use of preventive disinfectants. Evidence-based measures are available for secondary prevention. Vulnerable patients can develop healthcare-associated infections with waterborne organisms that are transmitted by colonization of plumbing systems, including sinks and their fixtures. Room humidifiers and decorative fountains have been implicated in serious outbreaks, and pose unwarranted risks in healthcare settings. SUMMARY Design of hospital plumbing must be purposeful and thoughtful to avoid the features that foster growth and dissemination of Legionella and other pathogens. Exposure of patients who have central venous catheters and other invasive devices to tap water poses a risk for infection with waterborne pathogens. Healthcare facilities must conduct aggressive clinical surveillance for Legionnaires' disease and other waterborne infections in order to detect and remediate an outbreak promptly. Hand hygiene is the most important measure to prevent transmission of other Gram-negative waterborne pathogens in the healthcare setting.
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Williams MM, Armbruster CR, Arduino MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. BIOFOULING 2013; 29:147-62. [PMID: 23327332 PMCID: PMC9326810 DOI: 10.1080/08927014.2012.757308] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Several bacterial species that are natural inhabitants of potable water distribution system biofilms are opportunistic pathogens important to sensitive patients in healthcare facilities. Waterborne healthcare-associated infections (HAI) may occur during the many uses of potable water in the healthcare environment. Prevention of infection is made more challenging by lack of data on infection rate and gaps in understanding of the ecology, virulence, and infectious dose of these opportunistic pathogens. Some healthcare facilities have been successful in reducing infections by following current water safety guidelines. This review describes several infections, and remediation steps that have been implemented to reduce waterborne HAIs.
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Affiliation(s)
- Margaret M Williams
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Nontuberculous mycobacteria, fungi, and opportunistic pathogens in unchlorinated drinking water in The Netherlands. Appl Environ Microbiol 2012; 79:825-34. [PMID: 23160134 DOI: 10.1128/aem.02748-12] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The multiplication of opportunistic pathogens in drinking water supplies might pose a threat to public health. In this study, distributed unchlorinated drinking water from eight treatment plants in the Netherlands was sampled and analyzed for fungi, nontuberculous mycobacteria (NTM), and several opportunistic pathogens by using selective quantitative PCR methods. Fungi and NTM were detected in all drinking water samples, whereas Legionella pneumophila, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, and Aspergillus fumigatus were sporadically observed. Mycobacterium avium complex and Acanthamoeba spp. were not detected. Season had no influence on the occurrence of these organisms, except for NTM and S. maltophilia, which were present in higher numbers in the summer. Opportunistic pathogens were more often observed in premise plumbing water samples than in samples from the distribution system. The lowest number of these organisms was observed in the finished water at the plant. Thus, fungi, NTM, and some of the studied opportunistic pathogens can multiply in the distribution and premise plumbing systems. Assimilable organic carbon (AOC) and/or total organic carbon (TOC) had no clear effects on fungal and NTM numbers or on P. aeruginosa- and S. maltophilia-positive samples. However, L. pneumophila was detected more often in water with AOC concentrations above 10 μg C liter(-1) than in water with AOC levels below 5 μg C liter(-1). Finally, samples that contained L. pneumophila, P. aeruginosa, or S. maltophilia were more frequently positive for a second opportunistic pathogen, which shows that certain drinking water types and/or sampling locations promote the growth of multiple opportunistic pathogens.
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Abstract
Stenotrophomonas maltophilia is an emerging multidrug-resistant global opportunistic pathogen. The increasing incidence of nosocomial and community-acquired S. maltophilia infections is of particular concern for immunocompromised individuals, as this bacterial pathogen is associated with a significant fatality/case ratio. S. maltophilia is an environmental bacterium found in aqueous habitats, including plant rhizospheres, animals, foods, and water sources. Infections of S. maltophilia can occur in a range of organs and tissues; the organism is commonly found in respiratory tract infections. This review summarizes the current literature and presents S. maltophilia as an organism with various molecular mechanisms used for colonization and infection. S. maltophilia can be recovered from polymicrobial infections, most notably from the respiratory tract of cystic fibrosis patients, as a cocolonizer with Pseudomonas aeruginosa. Recent evidence of cell-cell communication between these pathogens has implications for the development of novel pharmacological therapies. Animal models of S. maltophilia infection have provided useful information about the type of host immune response induced by this opportunistic pathogen. Current and emerging treatments for patients infected with S. maltophilia are discussed.
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Affiliation(s)
- Joanna S Brooke
- Department of Biological Sciences, DePaul University, Chicago, Illinois, USA.
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Viswanathan R, Singh AK, Ghosh C, Basu S. Stenotrophomonas maltophilia causing early onset neonatal sepsis. Indian Pediatr 2011; 48:397-9. [PMID: 21654005 DOI: 10.1007/s13312-011-0063-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Stenotrophomonas maltophilia, a multi drug resistant non fermenting Gram negative bacillus is an increasingly common nosocomial pathogen, especially in intensive care units. Comparatively few cases of infection have been reported in neonatal population. We present two cases of early onset neonatal sepsis due to S.maltophilia and a brief review of documented isolation in neonates.
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Affiliation(s)
- R Viswanathan
- Department of Neonatology, Institute of Post Graduate Medical Education and Research, Kolkata, West Bengal, India.
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Gordon NC, Wareham DW. Antimicrobial activity of the green tea polyphenol (-)-epigallocatechin-3-gallate (EGCG) against clinical isolates of Stenotrophomonas maltophilia. Int J Antimicrob Agents 2010; 36:129-31. [PMID: 20472404 DOI: 10.1016/j.ijantimicag.2010.03.025] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 03/17/2010] [Indexed: 12/25/2022]
Abstract
Stenotrophomonas maltophilia is increasingly recognised as an important nosocomial pathogen. Treatment options are limited due to intrinsic resistance to many antibiotics as well as concerns over toxicity of the mainstay of treatment, co-trimoxazole. Epigallocatechin-3-gallate (EGCG), the major catechin found in green tea, has been shown to have antimicrobial effects against a number of bacterial pathogens. We evaluated the in vitro activity of this compound against 40 clinical isolates of S. maltophilia. MIC(50/90) values (minimal inhibitory concentrations for 50% and 90% of the organisms, respectively) were 256 mg/L when determined by agar dilution and 512 mg/L by broth microdilution. MBC(50/90) values (minimal bactericidal concentrations for 50% and 90% of the organisms, respectively) were 512 mg/L. In time-kill assays, the bactericidal activity of EGCG was analysed by viable colony counts as well as a colorimetric assay for bacterial reduction of XTT. EGCG was slowly bactericidal at 4x MIC, with a 2.5 log reduction in viable bacteria at 24h. EGCG has promising in vitro antimicrobial activity against S. maltophilia. Although the mechanism of action is not yet clear, further studies to evaluate its clinical potential and role in combination with other antimicrobial agents are warranted.
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Affiliation(s)
- Nicola C Gordon
- Division of Infection, Barts & The London NHS Trust, London, UK
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[Requirements for hygiene in the medical care of immunocompromised patients. Recommendations from the Committee for Hospital Hygiene and Infection Prevention at the Robert Koch Institute (RKI)]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2010; 53:357-88. [PMID: 20300719 PMCID: PMC7095954 DOI: 10.1007/s00103-010-1028-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Adjidé CC, De Meyer A, Weyer M, Obin O, Lamory F, Lesueur C, Trouillet L, Biendo M, Eb F, Ganry O. [Stenotrophomonas maltophilia and Pseudomonas aeruginosa water-associated microbiologic risk assessment in Amiens' University Hospital Centre]. ACTA ACUST UNITED AC 2009; 58:e1-5. [PMID: 19892487 DOI: 10.1016/j.patbio.2009.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/12/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (Psa) and Stenotrophomonas maltophilia (Smalto) are major opportunistic waterborne pathogens causing hospital-acquired infections. This study aimed to assess the biocontamination level of cold water used in Amiens' university hospital wards, from March to June 2008. METHODS We cultivated 122 pairs of cold water first jet and taps cotton-swabs on Cetrimide agar for Psa, on Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) for Smalto, on Mueller Hinton agar used as isolation medium reference for both, 48h at 30 degrees C. Data analysed with Epi-Info 6.04dFr were compared with chi(2) test, significant at p<.05. RESULTS Psa and Smalto were isolated in 26.2 and 14.8% of water samples and in 21.3 and 10.7% of swab samples respectively. They were associated in 11.5% of water samples and 5% of swab samples. Psa was alone in 13.1% of water samples and 7.4% of swab samples whereas Smalto was found in 6.6% of water and 2.5% of swabs. Psa and Smalto were isolated from 14.8% of water samples and 8.2% of swab samples of the same tap. Finally, respectively 35.2 and 17.2% of the cold water taps were biocontaminated by Psa and Smalto. In fact, microbiologic water taps contamination risk was two-fold higher for Psa than for Smalto, p<.001, without variation between wards. CONCLUSION Sm2i and Cetrimide are suited and efficient medium respectively for Smalto and Psa isolation. Cold-water samples are sufficient for waterborne pathogens biocontamination risk appraisal. Our results urged healthcare workers on efficient water fittings microbiologic risk control to prevent healthcare associated waterborne infections, notably due to Psa and Smalto.
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Affiliation(s)
- C C Adjidé
- Unité d'hygiène et épidémiologie hospitalière, service d'épidémiologie hygiène hospitalière et santé publique, CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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[A sensitive, specific and predictive isolation medium developed for Stenotrophomonas maltophilia study in healthcare settings]. ACTA ACUST UNITED AC 2009; 58:11-7. [PMID: 19892479 DOI: 10.1016/j.patbio.2009.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2009] [Accepted: 07/12/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Stenotrophomonas maltophilia (Smalto) is a prominent nosocomial pathogen, commonly isolated in the hospital environment. Multiple Smalto nosocomial outbreaks have been linked to contaminated water sources. This study aimed to develop a medium able to ease healthcare environment Smalto isolation. METHODS Financed, from March 2007 to June 2008, by a university hospital of Amiens' clinical research program, this study allowed Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) development. SM2i is constituted of Mueller Hinton agar (MH), maltose, DL-methionine, bromothymol blue. The mixture sterilized is refreshed at 50 degrees C, its pH adjusted to 7.1, and render selective by addition of vancomycin, imipenem and amphotericin B. Then, SM2i agar is sunk into 90 cm diameter Petri dish dated and stored at 4 degrees C for 4 weeks. SM2i is developed using Pasteur Institute culture type collection (CIP) strains of Smalto, Burkholderia cepacia, Pseudomonas aeruginosa (Psa) and a Smalto strain of our hygiene laboratory collection. It was validate on Psa imipenem-resistant and Enterococcus faecium vancomycin-resistant strains, then, tested on cold water first jet and faucet cotton-swabs samples. SM2i tests were made in comparison with the MH agar, MH agar plus four paper disks loaded 10 microg of imipenem and Cetrimed agar. Its sensitivity, specificity, positive (PPV) and negative (NPV) predictive values, accuracy, likehood-ratio (LR) and Youden index have been determined. RESULTS SM2i agar is better in culturing Smalto test-strains. On SM2i, Smalto colonies are smooth, round, greeny, olive or lime green, have a green olive centre with a peripheral lighter or a dark green centre with an olive green suburb surrounded by a blue halo. SM2i is a selective, specific, predictive, accurate medium to search for Smalto in healthcare environment. In 122 pairs of cold water first jet and taps cotton-swabs samples, Smalto was isolated from 14.8% of water samples, 10.7% of cotton-swabs samples. It was isolated alone in 6.6% of water samples and 2.5% of swab samples. Thus, smalto has biocontaminated 17.2% of cold water taps. Compared to MH agar, SM2i sensitivity, specificity, PPV, NPV, accuracy, LR were 100, 100, 100, 100, 100% and infinity, and 87.5, 100, 100, 98.1, 98.4% and infinity for water and cotton-swabs samples respectively. CONCLUSION SM2i is a selective, specific, predictive medium which can allow easily isolating and identifying accurately Smalto in environmental samples. Its evaluation on clinical samples is on going.
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Falagas ME, Kastoris AC, Vouloumanou EK, Dimopoulos G. Community-acquired Stenotrophomonas maltophilia infections: a systematic review. Eur J Clin Microbiol Infect Dis 2009; 28:719-30. [DOI: 10.1007/s10096-009-0709-5] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 01/20/2009] [Indexed: 10/21/2022]
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Cervia JS, Ortolano GA, Canonica FP. Hospital tap water as a source of stenotrophomonas maltophilia infection. Clin Infect Dis 2008; 46:1485-7. [PMID: 18419467 DOI: 10.1086/587180] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
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Souza Dias MB, Habert AB, Borrasca V, Stempliuk V, Ciolli A, Araújo MRE, Costa SF, Levin AS. Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution. Infect Control Hosp Epidemiol 2008; 29:125-30. [PMID: 18179367 DOI: 10.1086/526440] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVE To describe the management of patients with long-term central venous catheters (CVCs) during an outbreak of infection due to Pseudomonas putida and Stenotrophomonas maltophilia associated with contaminated heparin catheter-lock solution. DESIGN Descriptive study. SETTING Private, 250-bed tertiary-care hospital. METHODS In March 2003, we identified 2 febrile cancer patients with P. putida bacteremia. Over 2 days, 7 cases of bacteremia were identified; lots of syringes prefilled with heparin catheter-lock solution, supplied by a compounding pharmacy, were recalled and samples were cultured. More cases of bacteremia appeared during the following days, and any patient who had had a catheter lock infused with the suspect solution was asked to provide blood samples for culture, even if the patient was asymptomatic. Isolates that were recovered from culture were typed by pulsed-field gel electrophoresis. Antimicrobial salvage treatment of long-term CVCs was attempted. RESULTS A total of 154 patients had had their catheter lock infused with solution from the lots that were suspected of being contaminated. Only 48 of these patients had CVCs. By day 7 of the outbreak, 18 of these patients had become symptomatic. Twenty-six of the remaining 30 asymptomatic patients then also provided blood samples for culture, 10 of whom developed fever shortly after samples were collected. Thirty-two patients were identified who had P. putida bacteremia; 9 also had infection due to S. maltophilia. Samples from 1 of the 3 lots of prefilled syringes in use at the time of the outbreak also grew P. putida on culture. Molecular typing identified 3 different clones of P. putida from patients and heparin catheter-lock solution, and 1 clone of S. maltophilia. A total of 27 patients received antimicrobial therapy regimens, some of which included decontamination of the catheter lock with anti-infective lock solution. Of 27 patients, 19 (70%) retained their long-term CVC during the 6-month follow-up period. CONCLUSIONS To our knowledge, this is one of the largest prospective experiences in the management of bloodstream infection associated with long-term CVCs. The infections were caused by gram-negative bacilli and were managed without catheter removal, with a high response rate. We emphasize the risks of using intravenous formulations of medications supplied by compounding pharmacies that produce large quantities of drugs.
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Affiliation(s)
- M Beatriz Souza Dias
- Infection Control Department, Hospital Sírio Libanês, University of São Paulo, Brazil
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008. [PMID: 18041117 PMCID: PMC7080031 DOI: 10.1007/s00103-007-0337-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1265-303. [PMID: 18041117 PMCID: PMC7080031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
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Berthelot P, Grattard F, Mallaval FO, Ros A, Lucht F, Pozzetto B. [Epidemiology of nosocomial infections due to Pseudomonas aeruginosa, Burkholderia cepacia and Stenotrophomonas maltophilia]. ACTA ACUST UNITED AC 2005; 53:341-8. [PMID: 16004946 DOI: 10.1016/j.patbio.2004.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 09/14/2004] [Indexed: 12/23/2022]
Abstract
Non-fermentative Gram negative rods are opportunistic pathogens responsible for nosocomial infections. Using phenotypic markers (serotypes for Pseudomonas aeruginosa and antibiotic susceptibility) allows a preliminary screening of epidemiologically-related strains. However, genotypic markers are necessary to better characterize nosocomial strains for the investigation of outbreaks or cross-transmissions in the hospital setting. Infections due to P. aeruginosa, Burkholderia. cepacia or Stenotrophomonas. maltophilia are usually hospital-acquired and responsible for a high mortality rate as illustrated by the lethality of nosocomial pneumonia due to P. aeruginosa. The severity of these infections is due to the virulence factors of the bacteria and to their occurrence in debilitated patients in whom invasives devices are used. The hospital environment can act as a reservoir with a rate of exogeneous transmission of these bacteria as high as 50% in some studies. To better prevent nosocomial infections related to Gram negative non fermentative rods, the control of the aqueous hospital environment, the strict application of hand disinfection and the investigation of potential cross-transmission in the hospital setting are needed.
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Affiliation(s)
- P Berthelot
- Unité d'hygiène interhospitalière, service des maladies infectieuses, CHU de Saint-Etienne, 42055 Saint-Etienne, France.
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Ortolano GA, McAlister MB, Angelbeck JA, Schaffer J, Russell RL, Maynard E, Wenz B. Hospital water point-of-use filtration: a complementary strategy to reduce the risk of nosocomial infection. Am J Infect Control 2005; 33:S1-19. [PMID: 15940112 DOI: 10.1016/j.ajic.2005.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cholera, hepatitis and typhoid are well-recognized water-borne illnesses that take the lives of many every year in areas of uncontrollable flood, but far less attention is afforded to the allegedly safe potable water in affluent nations and the presumed healthful quality of water in communities and hospitals. Recent literature, however, points to increasing awareness of serious clinical sequelae particularly experienced by immunocompromised patients at high risk for disease and death from exposure to water-borne microbes in hospitals. This review reflects the literature indicting hospital water as an important source for nosocomial infections, examines patient populations at greatest risk, uncovers examples of failures in remedial water treatment methods and the reasons for them, and introduces point-of-use water filtration as a practical alternative or complementary component of an infection control strategy that may reduce the risk of nosocomial infections.
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Gulcan H, Kuzucu C, Durmaz R. Nosocomial Stenotrophomonas maltophilia cross-infection: three cases in newborns. Am J Infect Control 2004; 32:365-8. [PMID: 15454897 DOI: 10.1016/j.ajic.2004.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Increased nosocomial Stenotrophomonas maltophilia infection rates in newborns, especially in recent years, are a significant cause for concern. These cases are the second case group in the literature to have been identified as nosocomial cross-infection with S. maltophilia in neonates. OBJECTIVE To investigate the clinical, microbiological, and epidemiologic features of the outbreak caused by S. maltophilia in the neonatal intensive care unit within a period of 7 days. METHODS Three cases with nosocomial S. maltophilia infection considered to be the result of cross-transmission were prospectively analyzed. Arbitrarily primed polymerase chain reaction (AP-PCR) performed with M13 primer and pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion with XbaI were used to determine clonal relationship among the isolates. Results S. maltophilia was isolated from the blood cultures of all 3 patients. Molecular typing confirmed that the 3 cases were epidemiologically linked. CONCLUSIONS Opportunistic pathogens such as S. maltophilia can lead to major problems in neonates. Molecular typing is helpful to improve effective control programs for preventing the spread of the infection.
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Affiliation(s)
- Hande Gulcan
- Department of Pediatrics, Inonu University Faculty of Medicine, Malatya, Turkey.
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Hanrahan KS, Lofgren M. Evidence-based practice: examining the risk of toys in the microenvironment of infants in the neonatal intensive care unit. Adv Neonatal Care 2004; 4:184-201, quiz 202-5. [PMID: 15368211 DOI: 10.1016/j.adnc.2004.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Toys placed in the bed or microenvironment of infants in the neonatal intensive care unit (NICU) demonstrate high rates of colonization (92%). As with other fomites, toys may be one potential source of nosocomial infection (NI). This project critically evaluated the practice of placing toys in the microenvironment of critically ill infants by using the Iowa Model of Evidence-Based Practice to Promote Quality Care. With the model as a guide for decision making, the existing evidence was explored using a systematic review of the literature, case studies, scientific principles, theory, and expert opinion. A comprehensive review of the literature did not clearly identify a causal relationship between toys in the NICU microenvironment and NI. Levels of evidence suggesting an association between toys and NI were determined to be moderately strong and consistent. A plausible relationship between the practice of placing toys in the beds of NICU patients and risk for infection was found. These findings prompted a pilot practice change, eliminating toys in the NICU, to test the potential impact of this intervention. Pre- and postintervention infection rates were compared. NI rates decreased from 4.6 to 1.99 per 1,000 patient days over a 6-month evaluation period. Although this decrease was not statistically significant, it was the lowest rate recorded in 5 years. Ongoing evaluation of NI rates is in progress. Individual NICUs must determine if the evidence warrants a practice change in their setting.
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Affiliation(s)
- Kirsten Sueppel Hanrahan
- Department of Pediatrics, Division of Neonatology, University of Iowa Health Care, Iowa City, IA 52242, USA.
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Döring G, Hoiby N. Early intervention and prevention of lung disease in cystic fibrosis: a European consensus. J Cyst Fibros 2004; 3:67-91. [PMID: 15463891 DOI: 10.1016/j.jcf.2004.03.008] [Citation(s) in RCA: 193] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2004] [Accepted: 03/24/2004] [Indexed: 10/26/2022]
Abstract
In patients with cystic fibrosis (CF), early intervention and prevention of lung disease is of paramount importance. Principles to achieve this aim include early diagnosis of CF, regular monitoring of the clinical status, various hygienic measures to prevent infection and cross-infection, early use of antibiotic courses in patients with recurrent or continuous bacterial colonisation and appropriate use of chest physiotherapy.
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Affiliation(s)
- Gerd Döring
- Institute of General and Environmental Hygiene, Eberhard, Karls-University of Tübingen, Wilhelmstrasse 31, D-72074 Tübingen, Germany.
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Lanotte P, Cantagrel S, Mereghetti L, Marchand S, Van der Mee N, Besnier JM, Laugier J, Quentin R. Spread of Stenotrophomonas maltophilia colonization in a pediatric intensive care unit detected by monitoring tracheal bacterial carriage and molecular typing. Clin Microbiol Infect 2004; 9:1142-7. [PMID: 14616735 DOI: 10.1046/j.1469-0691.2003.00785.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In our pediatric intensive care unit in Tours (France), intubated and ventilated inpatients are systematically monitored for tracheal bacterial colonization twice a week. This led us to detect five patients colonized with Stenotrophomonas maltophilia over a 4-month period. Molecular typing of the isolates using random amplified polymorphism DNA (RAPD) and pulsed-field gel electrophoresis (PFGE) confirmed that four of the five isolates were genetically related. The strict isolation of carriers and improvements in hygiene measures stopped the spread. This systematic strategy prevented pulmonary nosocomial infections or allowed their early detection. Moreover, it has made it possible to assess the efficiency of care practices continuously.
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Affiliation(s)
- P Lanotte
- Département de Microbiologie Médicale et Moléculaire, EA 3250, Faculté de Médecine de Tours, Hôpital Bretonneau et Clocheville, CHU de Tours, 2, boulevard Tonnellé, F-37044 Tours.
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Apisarnthanarak A, Mayfield JL, Garison T, McLendon PM, DiPersio JF, Fraser VJ, Polish LB. Risk factors for Stenotrophomonas maltophilia bacteremia in oncology patients: a case-control study. Infect Control Hosp Epidemiol 2003; 24:269-74. [PMID: 12725356 DOI: 10.1086/502197] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To characterize risk factors for Stenotrophomonas maltophilia bloodstream infection in oncology patients. DESIGN A 3:1 case-control study. SETTING Stem Cell Transplant and Leukemic Center at Barnes-Jewish Hospital (St. Louis), a 1,442-bed, tertiary-care teaching hospital with a 26-bed transplantation ward. METHOD From, June 1999 to April 2001, 13 patients with S. maltophilia bacteremia were compared with 39 control-patients who were on the transplantation unit on the same day as the case-patients' positive blood cultures. Information collected included patient demographics, medical history, history of transplantation, transplantation type, graft versus host disease, neutropenia, antibiotic use, chemotherapy, mucositis, diarrhea, the presence of central venous catheter(s), cultures, and concomitant infections. RESULTS Significant risk factors for S. maltophilia bacteremia included severe mucositis (7 [53.8%] of 13 vs 8 [20.5%] of 39; P = .034), diarrhea (7 [53.8%] of 13 vs 8 [20%] of 39; P = .034), and the use of metronidazole (9 [69.2%] of 13 vs 8 [20.5%] of 39; P = .002). In addition, the number of antibiotics used (median, 9 vs 5; P < .001), duration of mucositis (median, 29 vs 15 days; P = .032), and length of hospital stay (median, 34 vs 22 days; P = .017) were significantly different between case- and control-patients. Nine S. maltophilia isolates tested by pulsed-field gel electrophoresis were found to be distinctly different. CONCLUSION Interventions to ameliorate the severity of mucositis, reduce antibiotic pressure, prevent diarrhea, and promote meticulous central venous catheter care may help prevent S. maltophilia bloodstream infection in oncology patients. The role of gastrointestinal tract colonization as a potential source of S. maltophilia bacteremia in oncology patients deserves further investigation.
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Affiliation(s)
- Anucha Apisarnthanarak
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri 63110, USA
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del Toro MD, Rodríguez-Bano J, Herrero M, Rivero A, García-Ordoñez MA, Corzo J, Pérez-Cano R. Clinical epidemiology of Stenotrophomonas maltophilia colonization and infection: a multicenter study. Medicine (Baltimore) 2002; 81:228-39. [PMID: 11997719 DOI: 10.1097/00005792-200205000-00006] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
- Maria Dolores del Toro
- Sección de Enfermedades Infecciosas, Hospital Universitario Virgen Macarena, Sevilla, Spain
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Sakhnini E, Weissmann A, Oren I. Fulminant Stenotrophomonas maltophilia soft tissue infection in immunocompromised patients: an outbreak transmitted via tap water. Am J Med Sci 2002; 323:269-72. [PMID: 12018671 DOI: 10.1097/00000441-200205000-00008] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Soft tissue infection caused by Stenotrophomonas maltophilia is uncommon, but nosocomial infections had been reported. We describe herein 2 young female patients, with severe neutropenia, on broad spectrum antimicrobial agents for neutropenic fever, with Hickman-type central venous catheter, who developed mucocutaneous and soft tissue infections with rapidly progressive and devastating course. Cultures from the skin of both patients and from blood of one of them grew S. maltophilia. Both patients died and post mortem examination of the patient with S. maltophilia bacteremia revealed extensive soft tissue necrosis and a vegetation on the mitral valve that grew S. maltophilia. The infection occurred in both patients at the same time and in the same ward. Epidemiological study was done, and surveillance cultures grew the organism from the faucets from the room of 1 patient and also from some of the neighboring rooms in our ward but not from any other ward nor in the water reservoir of the building.
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Affiliation(s)
- E Sakhnini
- Department of Medicine A, Rambam Medical Center and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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Rogues AM, Maugein J, Allery A, Fleureau C, Boulestreau H, Surcin S, Bebear C, Janvier G, Gachie JP. Electronic ventilator temperature sensors as a potential source of respiratory tract colonization with Stenotrophomonas maltophilia. J Hosp Infect 2001; 49:289-92. [PMID: 11740879 DOI: 10.1053/jhin.2001.1099] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Stenotrophomonas maltophilia (S. maltophilia) is an important cause of nosocomial infection among ventilated and immunocompromised patients, and among patients receiving broad-spectrum antimicrobials. We report a cluster of patients in a surgical intensive care unit who were colonized or infected with S. maltophilia. An epidemiological investigation was initiated after surveillance data revealed that eight patients were culture-positive from sputum for S. maltophilia in the preceding month. Review of respiratory care procedures revealed that when mechanical ventilators were serviced between patients, the electronic temperature probes used with servo-controlled humidifiers were wiped with inadequate disinfection. We collected cultures of case-patient room surfaces, sinks and ventilator equipment. S. maltophilia was recovered from room surfaces, ventilator expiratory circuits and a temperature sensor which had been kept in ambient air after disinfection. Patients and environmental isolates were examined by RAPD-PCR. Three clinical isolates and one environmental isolate had the same profile, which suggests cross-contamination or common source exposure. The outbreak was controlled by adequate disinfection of the temperature sensors. No single epidemic strain was identified but several observations support the conclusion that the temperature probes contributed to the outbreak.
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Affiliation(s)
- A M Rogues
- Service d'Hygiène Hospitalière, Hôpital du Haut Lévêque, Groupe Hospitalier Sud, CHU de Bordeaux, France
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Abstract
Bone marrow transplant recipients are at increased risk of a variety of infections from endogenous and exogenous sources. Various practices, including the use of prophylactic agents and a controlled environment are often employed in the name of infection control. Comparable data are lacking because of non-unified definitions of infection and endpoints. Antibiotic-resistant bacteria and fungi are being isolated more frequently as a result of selective pressure.
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Affiliation(s)
- S Kusne
- Division of Infectious Diseases, Thomas E. Starzl Transplantation Institute, Pittsburgh, Pennsylvania 15213, USA.
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