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Assaad C, Chaibi K, Jaureguy F, Plésiat P, Carbonnelle E, Cohen Y, Zahar JR, Pilmis B. Risk factors for Pseudomonas aeruginosa VIM colonization or infection in the ICU: Case-control study. Am J Infect Control 2024:S0196-6553(24)00574-1. [PMID: 38925502 DOI: 10.1016/j.ajic.2024.06.013] [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: 03/25/2024] [Revised: 06/19/2024] [Accepted: 06/19/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Carbapenem-resistant strains of Pseudomonas aeruginosa (CRPA) have become a major health care concern in many countries, against which anti-infective strategies are limited and which require adequate infection control interventions. Knowing the different modes of transmission of CRPA in intensive care units (ICUs) would be helpful to adapt the means of prevention. METHODS The aim of this retrospective case-control study was conducted between January 1, 2017 and February 28, 2022 to identify the risk factors for the acquisition of CRPA in ICUs. RESULTS During the study period, 147 patients were included (49 cases and 98 controls). Among the 49 patients, 31 (63%) acquired CRPA in clusters and 18 (37%) sporadically. A univariate analysis showed that 4 variables were associated with CRPA acquisition, including (1) prior antibiotic prescriptions, (2) admission to rooms 203 and 207, (3) severity of illness at admission, and (4) use of mechanical ventilation. Multivariate analysis identified 3 factors of CRPA acquisition, including admission to room 203 (odds ratio [OR] = 29.5 [3.52-247.09]), previous antibiotic therapy (OR = 3.44 [1.02-11.76]), and severity of condition at admission (OR = 1.02 [1-1.04]). CONCLUSIONS Our study suggests the role of a contaminated environment in the acquisition of CRPA in the ICU, along with antibiotic use.
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Affiliation(s)
- Charbel Assaad
- Unité de Prévention du Risque Infectieux, Département de Microbiologie Clinique, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, Bobigny, France
| | - Khalil Chaibi
- Service de Réanimation Médico Chirurgicale, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, Bobigny, France
| | - Françoise Jaureguy
- Unité de Prévention du Risque Infectieux, Département de Microbiologie Clinique, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, Bobigny, France
| | - Patrick Plésiat
- Université de Franche-Comté, UMR CNRS 6249 Chrono-Environnement, Besançon, France; Laboratoire Associé du Centre National de Référence de la Résistance aux Antibiotiques, Centre Hospitalier Universitaire de Besançon, Besançon, France
| | - Etienne Carbonnelle
- Unité de Prévention du Risque Infectieux, Département de Microbiologie Clinique, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, Bobigny, France
| | - Yves Cohen
- Service de Réanimation Médico Chirurgicale, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, Bobigny, France
| | - Jean-Ralph Zahar
- Service de Réanimation Médico Chirurgicale, Groupe Hospitalier Paris Seine Saint-Denis, Université Paris 13, Bobigny, France.
| | - Benoit Pilmis
- Service de Microbiologie et Plateforme de Dosage des Anti-infection, Équipe Mobile de Microbiologie Clinique, Hôpitaux Saint-Joseph & Marie Lannelongue, Paris, France; Université Paris-Saclay, INRAE, AgroParisTech, UMR 1319, Micalis Institute, Jouy-en-Josas, France
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Volling C, Mataseje L, Graña-Miraglia L, Hu X, Anceva-Sami S, Coleman BL, Downing M, Hota S, Jamal AJ, Johnstone J, Katz K, Leis JA, Li A, Mahesh V, Melano R, Muller M, Nayani S, Patel S, Paterson A, Pejkovska M, Ricciuto D, Sultana A, Vikulova T, Zhong Z, McGeer A, Guttman DS, Mulvey MR. Epidemiology of healthcare-associated Pseudomonas aeruginosa in intensive care units: are sink drains to blame? J Hosp Infect 2024; 148:77-86. [PMID: 38554807 DOI: 10.1016/j.jhin.2024.03.009] [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: 11/16/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infection (PA-HAI) in the intensive care unit (ICU). AIM To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink-to-patient PA transmission. METHODS This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial-resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained ≥48 h after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen. FINDINGS Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU-days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks. CONCLUSION Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAIs were associated with sink-to-patient transmission. Sinks may be an under-recognized reservoir for HAIs.
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Affiliation(s)
- C Volling
- Department of Microbiology, Sinai Health, Toronto, Canada.
| | - L Mataseje
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | - L Graña-Miraglia
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | - X Hu
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | - S Anceva-Sami
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - B L Coleman
- Department of Microbiology, Sinai Health, Toronto, Canada
| | | | - S Hota
- Department of Medicine, University Health Network, Toronto, Canada
| | - A J Jamal
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - J Johnstone
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - K Katz
- Department of Medicine, North York General Hospital, Toronto, Canada
| | - J A Leis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - A Li
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - V Mahesh
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - R Melano
- Pan American Health Organization, Washington, USA
| | - M Muller
- Department of Medicine, Unity Health Toronto, Toronto, Canada
| | - S Nayani
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - S Patel
- Public Health Ontario Laboratory, Toronto, Canada
| | - A Paterson
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - M Pejkovska
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - D Ricciuto
- Department of Medicine, Lakeridge Health, Oshawa, Canada
| | - A Sultana
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - T Vikulova
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - Z Zhong
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - A McGeer
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - D S Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada; Centre for the Analysis of Genome Evolution and Function, Department of Cell and Systems Biology, University of Toronto, Toronto, Canada
| | - M R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
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Couchoud C, Bertrand X, Bourgeon M, Piton G, Valot B, Hocquet D. Genome-based typing reveals rare events of patient contamination with Pseudomonas aeruginosa from other patients and sink traps in a medical intensive care unit. J Hosp Infect 2023; 134:63-70. [PMID: 36738994 DOI: 10.1016/j.jhin.2023.01.010] [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: 10/18/2022] [Revised: 01/03/2023] [Accepted: 01/18/2023] [Indexed: 02/05/2023]
Abstract
AIM We used genome-based typing data with the aim of identifying the routes of acquisition of Pseudomonas aeruginosa by patients hospitalized in a medical intensive care unit (MICU) over a long period in a non-epidemic context. METHODS This monocentric prospective study took place over 10 months in 2019 in a 15-bed MICU that applies standard precautions of hygiene. Lockable sink traps installed at all water points of use were bleach disinfected twice a week. We sampled all sink traps weekly to collect 404 P. aeruginosa environmental isolates and collected all P. aeruginosa isolates (N = 115) colonizing or infecting patients (N = 65). All isolates had their phenotypic resistance profile determined and their genome sequenced, from which we identified resistance determinants and assessed the population structure of the collection at the nucleotide level to identify events of P. aeruginosa transmission. FINDINGS All sink traps were positive for P. aeruginosa, each sink trap being colonized for several months by one or more clones. The combination of genomic and spatiotemporal data identified one potential event of P. aeruginosa transmission from a sink trap to a patient (1/65, 1.5%) and six events of patient cross-transmission, leading to the contamination of five patients (5/65, 7.7%). All transmitted isolates were fully susceptible to β-lactams and aminoglycosides. CONCLUSIONS Genome-based typing revealed the contamination of patients by P. aeruginosa originating from sink traps to be infrequent (1.5%) in an MICU with sink trap-bleaching measures, and that only 7.7% of the patients acquired P. aeruginosa originating from another patient.
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Affiliation(s)
- C Couchoud
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France
| | - X Bertrand
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France
| | - M Bourgeon
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France
| | - G Piton
- Service de Médecine Intensive Réanimation, Centre Hospitalier Universitaire, Besançon, France; EA3920, Université de Franche-Comté, Besançon, France
| | - B Valot
- Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France; Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France
| | - D Hocquet
- Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; Chrono-environnement UMR6249, CNRS Université de Franche-Comté, F-25000, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France; Bioinformatique et Big Data Au Service de La Santé, UFR Santé, Université de Bourgogne Franche-Comté, Besançon, France.
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Causes, Factors, and Control Measures of Opportunistic Premise Plumbing Pathogens—A Critical Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review critically analyses the chemical and physical parameters that influence the occurrence of opportunistic pathogens in the drinking water distribution system, specifically in premise plumbing. A comprehensive literature review reveals significant impacts of water age, disinfectant residual (type and concentration), temperature, pH, and pipe materials. Evidence suggests that there is substantial interplay between these parameters; however, the dynamics of such relationships is yet to be elucidated. There is a correlation between premise plumbing system characteristics, including those featuring water and energy conservation measures, and increased water quality issues and public health concerns. Other interconnected issues exacerbated by high water age, such as disinfectant decay and reduced corrosion control efficiency, deserve closer attention. Some common features and trends in the occurrence of opportunistic pathogens have been identified through a thorough analysis of the available literature. It is proposed that the efforts to reduce or eliminate their incidence might best focus on these common features.
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Volling C, Ahangari N, Bartoszko JJ, Coleman BL, Garcia-Jeldes F, Jamal AJ, Johnstone J, Kandel C, Kohler P, Maltezou HC, Maze Dit Mieusement L, McKenzie N, Mertz D, Monod A, Saeed S, Shea B, Stuart RL, Thomas S, Uleryk E, McGeer A. Are Sink Drainage Systems a Reservoir for Hospital-Acquired Gammaproteobacteria Colonization and Infection? A Systematic Review. Open Forum Infect Dis 2020; 8:ofaa590. [PMID: 33553469 PMCID: PMC7856333 DOI: 10.1093/ofid/ofaa590] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/04/2020] [Indexed: 01/23/2023] Open
Abstract
Increasing rates of antimicrobial-resistant organisms have focused attention on sink drainage systems as reservoirs for hospital-acquired Gammaproteobacteria colonization and infection. We aimed to assess the quality of evidence for transmission from this reservoir. We searched 8 databases and identified 52 studies implicating sink drainage systems in acute care hospitals as a reservoir for Gammaproteobacterial colonization/infection. We used a causality tool to summarize the quality of evidence. Included studies provided evidence of co-occurrence of contaminated sink drainage systems and colonization/infection, temporal sequencing compatible with sink drainage reservoirs, some steps in potential causal pathways, and relatedness between bacteria from sink drainage systems and patients. Some studies provided convincing evidence of reduced risk of organism acquisition following interventions. No single study provided convincing evidence across all causality domains, and the attributable fraction of infections related to sink drainage systems remains unknown. These results may help to guide conduct and reporting in future studies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Adam Monod
- Sinai Health System, Toronto, Ontario, Canada
| | | | | | | | - Sera Thomas
- Sinai Health System, Toronto, Ontario, Canada
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Exogenous acquisition of Pseudomonas aeruginosa in intensive care units: a prospective multi-centre study (DYNAPYO study). J Hosp Infect 2020; 104:40-45. [DOI: 10.1016/j.jhin.2019.08.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022]
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Jeanvoine A, Meunier A, Puja H, Bertrand X, Valot B, Hocquet D. Contamination of a hospital plumbing system by persister cells of a copper-tolerant high-risk clone of Pseudomonas aeruginosa. WATER RESEARCH 2019; 157:579-586. [PMID: 30999256 DOI: 10.1016/j.watres.2019.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/30/2019] [Accepted: 04/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is an important opportunistic pathogen that thrives best in the distal elements of plumbing and waste-water systems. Although nosocomial outbreaks of PA have been associated with water sources, the role of the plumbing system of healthcare premises as a reservoir for this pathogen is still unclear. MATERIALS AND METHODS We collected water samples from 12 technical areas, distant from any medical activity, in a teaching hospital in France once a week for 11 weeks. We used a method that resuscitates persister cells because of the nutrient-poor conditions and the presence of inhibitors (e.g. chlorine and copper ions). Briefly, water was sampled in sterile bottles containing 100 μM of the copper-ion chelating agent diethyldithiocarbamate (DDTC). A portion of the samples was immediately filtered through 0.45-μm membranes, deposited on R2A agar plates, and incubated seven days at 22 °C (following European recommendations). The remaining water was incubated 14 days at 22 °C and then filtered and cultured on R2A, blood-, or cetrimide-containing agar plates. PA isolates were identified by MS MALDI-TOF, genotyped by PFGE and WGS, and tested for survival in a 150 μg/L copper (II) sulphate solution. RESULTS Although the 12 water sampling points always tested negative with the recommended method, 67% were positive at least once for PA with the adapted method (i.e. with DDTC). The 14 PA persister isolates found throughout the plumbing system were clonal and belong to the high-risk clone ST308. Their genome harbours a 37-kb genomic island (GI-7) containing 13 genes linked to copper resistance. ST308 survived better in the copper solution than comparators that did not harbour GI-7 (P. aeruginosa strains PAO1, PA14, and ST235). The deletion of GI-7 in ST308 abrogated its tolerance to copper. The GI-7 nucleotide sequence shares 98% and 72% identity with sequences from the environmental species Pseudomonas putida and the phytopathogenic species Pseudomonas syringae, respectively. CONCLUSION We report the contamination of the plumbing system of a healthcare premises by persister cells of the high-risk clone P. aeruginosa ST308. New recommendations for the monitoring of water contamination should consider persister cells. The genomic island GI-7, which confers tolerance to copper, probably originates from Pseudomonas species found in copper-contaminated soils and plants. Agricultural practices may have an unexpected consequence, allowing copper-tolerant pathogens to survive in the hospital environment and contaminate fragile patients.
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Affiliation(s)
- Audrey Jeanvoine
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Alexandre Meunier
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France
| | - Hélène Puja
- UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Xavier Bertrand
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Benoît Valot
- UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Didier Hocquet
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Régional Universitaire, Besançon, France.
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Keskinkan O, Balci B. Removal of Bisphenol-A from Aqueous Solutions by Pseudomonas aeruginosa in Batch Reactors: Effect of Carbon Source, Temperature and Concentrations. INTERNATIONAL JOURNAL OF CHEMICAL REACTOR ENGINEERING 2018. [DOI: 10.1515/ijcre-2017-0125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThis study was carried out to investigate the potential ofPseudomonas aeruginosafor the removal of bisphenol-A (BPA) from synthetic wastewater. To achieve this, BPA removal capability ofP. aeruginosawith respect to BPA concentration, and temperature were examined in batch reactors. Experiments were conducted in the presence/absence of glucose, as a carbon source. The first set of experiments consisted of evaluating the kinetic of removal of BPA at different concentrations (5, 10, 20, and 30 mg BPA/L) without glucose. In the second set of experiments, three different glucose concentrations (0.5, 1.0, and 2.0 glucose/L) with BPA concentrations were tested. After settlement of theP. aeruginosabiomass in the shakers, supernatants and control groups were filtered and analyzed for BPA using high performance liquid chromatography. In the biotic study, BPA removal rates were between 63 % and 100 %. All concentrations of BPA under 20 mg/L were completely degraded at 25 and 35 ºC at first step. However, 30 mgBPA/L was decreased to 8.56 mg/L byP. aeruginosaat first step at 25 ºC. At the second step, all concentrations of BPA were completely degraded by the cells at the presence of glucose. Hence, it can be summarized that bisphenol A can be used byP. aeruginosaas an external carbon source in the wastewater environments.
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Tran-Dinh A, Neulier C, Amara M, Nebot N, Troché G, Breton N, Zuber B, Cavelot S, Pangon B, Bedos JP, Merrer J, Grimaldi D. Impact of intensive care unit relocation and role of tap water on an outbreak of Pseudomonas aeruginosa expressing OprD-mediated resistance to imipenem. J Hosp Infect 2018; 100:e105-e114. [PMID: 29857026 DOI: 10.1016/j.jhin.2018.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 05/23/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem (PA-OprD). AIM The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before and after an incidental relocation of the ICU. The role of tap water as a route of contamination for colonization/infection of patients with PA-OprD was assessed as a secondary aim. METHODS A single-centre, observational, before/after comparison study was conducted from October 2013 to October 2015. The ICU was relocated at the end of October 2014. All P. aeruginosa-positive samples isolated from patients hospitalized ≥48 h in the ICU were included. Tap water specimens were collected every three months in the ICU. PA-OprD strains isolated from patients and tap water were genotyped using pulse-field gel electrophoresis. FINDINGS A total of 139 clinical specimens of P. aeruginosa and 19 tap water samples were analysed. The proportion of PA-OprD strains decreased significantly from 31% to 7.7% after the relocation of the ICU (P = 0.004). All PA-OprD clinical specimens had a distinct genotype. Surprisingly, tap water was colonized with a single PA-OprD strain during both periods, but this single clone has never been isolated from clinical specimens. CONCLUSION Relocation of the ICU was associated with a marked decrease in P. aeruginosa strains resistant to imipenem. The polyclonal character of PA-OprD strains isolated from patients and the absence of tap-water-to-patient contamination highlight the complexity of the environmental impact on the endogenous colonization/infection with P. aeruginosa.
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Affiliation(s)
- A Tran-Dinh
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France; Département d'anesthésie et de réanimation chirurgicale, 75018, Centre Hospitalier de Bichat, Paris, France.
| | - C Neulier
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - M Amara
- Service de Biologie, Unité de microbiologie, 78157, Centre Hospitalier De Versailles, Le Chesnay, France
| | - N Nebot
- Service de pharmacie, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - G Troché
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - N Breton
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - B Zuber
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - S Cavelot
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - B Pangon
- Service de Biologie, Unité de microbiologie, 78157, Centre Hospitalier De Versailles, Le Chesnay, France
| | - J P Bedos
- Service de réanimation, 78150, Centre Hospitalier De Versailles, Le Chesnay, France
| | - J Merrer
- Service de Prévention du Risque Infectieux, Centre Hospitalier de Versailles, Le Chesnay, France
| | - D Grimaldi
- Département de réanimation, CUB-Erasme, Université Libre de Bruxelles (ULB), Bruxelles, Belgium
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Transcriptional Responses of Pseudomonas aeruginosa to Potable Water and Freshwater. Appl Environ Microbiol 2018; 84:AEM.02350-17. [PMID: 29305509 DOI: 10.1128/aem.02350-17] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/01/2018] [Indexed: 02/03/2023] Open
Abstract
Many Pseudomonas aeruginosa infections are derived from residential, recreational, or surface water sources; thus, these environments represent an important preinfection niche. To better understand P. aeruginosa biology in these environments, we quantified transcriptional changes by microarray after exposure to diluted LB, diluted R2B, potable tap water, and freshwater from a eutrophic pond. Quantitative reverse transcription-PCR (qRT-PCR) confirmed the conservation of these responses in other water sources, and competition experiments were used to test the importance of three implicated metabolic pathways. The global transcriptional responses in potable water and freshwater showed strong induction of genes involved in metabolism of the head groups and acyl tails of phospholipids, as well as nucleotide metabolism, with commensurate decreased transcript expression of genes encoding their synthetic pathways. These data suggest that phospholipids and nucleotides are part of the nutritional milieu of these two environments. A unique response in municipal-delivered potable water was to the metals in the piping system, particularly copper. To identify potential nutrient sources used by P. aeruginosa in these environments, we used competition assays between the wild-type and deletion mutant strains in three pathways induced under these conditions. For phospholipid head-group metabolism, ethanolamine utilization (eutB) was important for competition in potable water, while choline oxidation (betBA) was important for competition in freshwater. Nucleotide utilization, particularly pyrimidine metabolism (dht), showed a trend toward importance in freshwater but was not statistically significant. These findings provide new insights into the P. aeruginosa response to potable water and freshwater and led to the identification of potentially important nutrient sources in these environments.IMPORTANCE Much of our knowledge about Pseudomonas aeruginosa comes from the infection niche, and much less is known about its lifestyle in the environment. P. aeruginosa is an adaptable bacterium capable of growing in many environments but is particularly common in potable water systems and freshwater. We used the transcriptional responses of P. aeruginosa to these environments to identify important nutrient sources specific to either of these two environments. Additionally, these environments could provide experimental situations to understand gene function for the large number of transcripts with unknown functions induced under these conditions.
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Deasy EC, Moloney EM, Boyle MA, Swan JS, Geoghegan DA, Brennan GI, Fleming TE, O'Donnell MJ, Coleman DC. Minimizing microbial contamination risk simultaneously from multiple hospital washbasins by automated cleaning and disinfection of U-bends with electrochemically activated solutions. J Hosp Infect 2018; 100:e98-e104. [PMID: 29410281 DOI: 10.1016/j.jhin.2018.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 01/12/2018] [Indexed: 10/18/2022]
Abstract
BACKGROUND Outbreaks of infection associated with microbial biofilm in hospital hand washbasin U-bends are being reported increasingly. In a previous study, the efficacy of a prototype automated U-bend decontamination method was demonstrated for a single non-hospital pattern washbasin. It used two electrochemically activated solutions (ECA) generated from brine: catholyte with detergent properties and anolyte with disinfectant properties. AIM To develop and test a large-scale automated ECA treatment system to decontaminate 10 hospital pattern washbasin U-bends simultaneously in a busy hospital clinic. METHODS A programmable system was developed whereby the washbasin drain outlets, U-bends and proximal wastewater pipework automatically underwent 10-min treatments with catholyte followed by anolyte, three times weekly, over five months. Six untreated washbasins served as controls. Quantitative bacterial counts from U-bends were determined on Columbia blood agar, Reasoner's 2A agar and Pseudomonas aeruginosa selective agar following treatment and 24 h later. FINDINGS The average bacterial densities in colony-forming units/swab from treated U-bends showed a >3 log reduction compared with controls, and reductions were highly significant (P<0.0001) on all media. There was no significant increase in average bacterial counts from treated U-bends 24 h later on all media (P>0.1). P. aeruginosa was the most prevalent organism recovered throughout the study. Internal examination of untreated U-bends using electron microscopy showed dense biofilm extending to the washbasin drain outlet junction, whereas treated U-bends were free from biofilm. CONCLUSION Simultaneous automated treatment of multiple hospital washbasin U-bends with ECA consistently minimizes microbial contamination and thus the associated risk of infection.
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Affiliation(s)
- E C Deasy
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - E M Moloney
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - M A Boyle
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - J S Swan
- Facilities Department, Dublin Dental University Hospital, Dublin, Ireland
| | - D A Geoghegan
- Facilities Department, Dublin Dental University Hospital, Dublin, Ireland
| | - G I Brennan
- National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland
| | - T E Fleming
- National MRSA Reference Laboratory, St. James's Hospital, Dublin, Ireland
| | - M J O'Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland
| | - D C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Dublin, Ireland.
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12
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Parcell BJ, Oravcova K, Pinheiro M, Holden MTG, Phillips G, Turton JF, Gillespie SH. Pseudomonas aeruginosa intensive care unit outbreak: winnowing of transmissions with molecular and genomic typing. J Hosp Infect 2017; 98:282-288. [PMID: 29229490 PMCID: PMC5840502 DOI: 10.1016/j.jhin.2017.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 12/03/2017] [Indexed: 12/29/2022]
Abstract
Background Pseudomonas aeruginosa healthcare outbreaks can be time consuming and difficult to investigate. Guidance does not specify which typing technique is most practical for decision-making. Aim To explore the usefulness of whole-genome sequencing (WGS) in the investigation of a P. aeruginosa outbreak, describing how it compares with pulsed-field gel electrophoresis (PFGE) and variable number tandem repeat (VNTR) analysis. Methods Six patient isolates and six environmental samples from an intensive care unit (ICU) positive for P. aeruginosa over two years underwent VNTR, PFGE and WGS. Findings VNTR and PFGE were required to fully determine the potential source of infection and rule out others. WGS results unambiguously distinguished linked isolates, giving greater assurance of the transmission route between wash-hand basin water and two patients, supporting the control measures employed. Conclusion WGS provided detailed information without the need for further typing. When allied to epidemiological information, WGS can be used to understand outbreak situations rapidly and with certainty. Implementation of WGS in real-time would be a major advance in day-to-day practice. It could become a standard of care as it becomes more widespread due to its reproducibility and lower costs.
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Affiliation(s)
- B J Parcell
- Ninewells Hospital & Medical School, Dundee, UK.
| | - K Oravcova
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M Pinheiro
- School of Medicine, University of St Andrews, St Andrews, UK
| | - M T G Holden
- School of Medicine, University of St Andrews, St Andrews, UK
| | - G Phillips
- Ninewells Hospital & Medical School, Dundee, UK
| | - J F Turton
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, UK
| | - S H Gillespie
- School of Medicine, University of St Andrews, St Andrews, UK
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13
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Lalancette C, Charron D, Laferrière C, Dolcé P, Déziel E, Prévost M, Bédard E. Hospital Drains as Reservoirs of Pseudomonas aeruginosa: Multiple-Locus Variable-Number of Tandem Repeats Analysis Genotypes Recovered from Faucets, Sink Surfaces and Patients. Pathogens 2017; 6:pathogens6030036. [PMID: 28792484 PMCID: PMC5617993 DOI: 10.3390/pathogens6030036] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/03/2017] [Accepted: 08/04/2017] [Indexed: 12/16/2022] Open
Abstract
Identifying environmental sources of Pseudomonas aeruginosa (Pa) related to hospital-acquired infections represents a key challenge for public health. Biofilms in water systems offer protection and favorable growth conditions, and are prime reservoirs of microorganisms. A comparative genotyping survey assessing the relationship between Pa strains recovered in hospital sink biofilm and isolated in clinical specimens was conducted. Environmental strains from drain, faucet and sink-surface biofilm were recovered by a culture method after an incubation time ranging from 48 to 240 h. The genotyping of 38 environmental and 32 clinical isolates was performed using a multiple-locus variable-number of tandem repeats analysis (MLVA). More than one-third of Pa isolates were only cultivable following ≥48 h of incubation, and were predominantly from faucet and sink-surface biofilms. In total, 41/70 strains were grouped within eight genotypes (A to H). Genotype B grouped a clinical and an environmental strain isolated in the same ward, 5 months apart, suggesting this genotype could thrive in both contexts. Genotype E grouped environmental isolates that were highly prevalent throughout the hospital and that required a longer incubation time. The results from the multi-hospital follow-up study support the drain as an important reservoir of Pa dissemination to faucets, sink surfaces and patients. Optimizing the recovery of environmental strains will strengthen epidemiological investigations, facilitate pathway identification, and assist in identifying and controlling the reservoirs potentially associated to hospital-acquired infections.
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Affiliation(s)
| | - Dominique Charron
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada.
| | - Céline Laferrière
- Department of microbiology, infectious diseases and immunology, Université de Montréal, Montréal, QC H3T 1J4, Canada.
| | - Patrick Dolcé
- Department of Medical Microbiology and Infectious Diseases, Centre Hospitalier Régional de Rimouski, Rimouski, QC G5L 5T1, Canada.
| | - Eric Déziel
- INRS-Institut Armand-Frappier, Laval, QC H7V 1B7, Canada.
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada.
| | - Emilie Bédard
- INRS-Institut Armand-Frappier, Laval, QC H7V 1B7, Canada.
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC H3T 1J4, Canada.
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14
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Varin A, Valot B, Cholley P, Morel C, Thouverez M, Hocquet D, Bertrand X. High prevalence and moderate diversity of Pseudomonas aeruginosa in the U-bends of high-risk units in hospital. Int J Hyg Environ Health 2017; 220:880-885. [PMID: 28456381 DOI: 10.1016/j.ijheh.2017.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 03/02/2017] [Accepted: 04/09/2017] [Indexed: 11/15/2022]
Abstract
The presence of P. aeruginosa in water supply is clearly identified as a risk factor for P. aeruginosa infection in critical care units, even if routes of transmission are often unclear and remain a matter of debate. We determined here the frequency of U-bends contaminated with P. aeruginosa in high-risk units and described the population structure of this opportunistic pathogen in a non-outbreak situation. Eighty-seven U-bends from sinks of rooms in five wards were sampled 3 times and P. aeruginosa was detected in 121 of the 261 (46.4%) U-bend samples. We genotyped 123 P. aeruginosa isolates with pulsed-field gel electrophoresis and multilocus sequence typing and found 41 pulsotypes distributed in 21 Sequence Types (STs). Seven major ST (ST111, CC235, CC253, ST520, ST539, ST1216, and ST1725) were overrepresented in the collection, including the high-risk clones ST111, CC253, and CC235. The distribution of the 21 STs in the cladogram of the species was uneven with most major STs clustering into 2 clades. The major STs were found in different units and buildings and could be represented by a high diversity of pulsotypes. Altogether, this suggests a long term presence of P. aeruginosa in the hospital water network, possibly contaminated by the distribution water or by plumbing fittings before putting into service. Analysis of resistance rates showed that the deficiency of porin OprD was very frequent in U-bends isolates that may benefit from this resistance mechanism in hospital water fittings. In conclusion, our study demonstrates that U-bends of high-risk units are very frequently contaminated with P. aeruginosa with a moderate genomic diversity and with an over-representation of adapted clones.
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Affiliation(s)
- Amélie Varin
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France
| | - Benoît Valot
- UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Pascal Cholley
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Camille Morel
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Michelle Thouverez
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Didier Hocquet
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Régional Universitaire, Besançon, France
| | - Xavier Bertrand
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.
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15
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Swan JS, Deasy EC, Boyle MA, Russell RJ, O'Donnell MJ, Coleman DC. Elimination of biofilm and microbial contamination reservoirs in hospital washbasin U-bends by automated cleaning and disinfection with electrochemically activated solutions. J Hosp Infect 2016; 94:169-74. [PMID: 27485396 DOI: 10.1016/j.jhin.2016.07.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 07/11/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Washbasin U-bends are reservoirs of microbial contamination in healthcare environments. U-Bends are constantly full of water and harbour microbial biofilm. AIM To develop an effective automated cleaning and disinfection system for U-bends using two solutions generated by electrochemical activation of brine including the disinfectant anolyte (predominantly hypochlorous acid) and catholyte (predominantly sodium hydroxide) with detergent properties. METHODS Initially three washbasin U-bends were manually filled with catholyte followed by anolyte for 5min each once weekly for five weeks. A programmable system was then developed with one washbasin that automated this process. This U-bend had three cycles of 5min catholyte followed by 5min anolyte treatment per week for three months. Quantitative bacterial counts from treated and control U-bends were determined on blood agar (CBA), R2A, PAS, and PA agars following automated treatment and on CBA and R2A following manual treatment. FINDINGS The average bacterial density from untreated U-bends throughout the study was >1×10(5) cfu/swab on all media with Pseudomonas aeruginosa accounting for ∼50% of counts. Manual U-bend electrochemically activated (ECA) solution treatment reduced counts significantly (<100cfu/swab) (P<0.01 for CBA; P<0.005 for R2A). Similarly, counts from the automated ECA-treatment U-bend were significantly reduced with average counts for 35 cycles on CBA, R2A, PAS, and PA of 2.1±4.5 (P<0.0001), 13.1±30.1 (P<0.05), 0.7±2.8 (P<0.001), and 0 (P<0.05) cfu/swab, respectively. P. aeruginosa was eliminated from all treated U-bends. CONCLUSION Automated ECA treatment of washbasin U-bends consistently minimizes microbial contamination.
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Affiliation(s)
- J S Swan
- Facilities Department, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland
| | - E C Deasy
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland
| | - M A Boyle
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland
| | - R J Russell
- Department of Microbiology, University of Dublin, Trinity College Dublin, Dublin 2, Ireland
| | - M J O'Donnell
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland
| | - D C Coleman
- Microbiology Research Unit, Division of Oral Biosciences, Dublin Dental University Hospital, University of Dublin, Trinity College Dublin, Lincoln Place, Dublin 2, Ireland.
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16
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Bédard E, Prévost M, Déziel E. Pseudomonas aeruginosa in premise plumbing of large buildings. Microbiologyopen 2016; 5:937-956. [PMID: 27353357 PMCID: PMC5221438 DOI: 10.1002/mbo3.391] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 06/01/2016] [Accepted: 06/06/2016] [Indexed: 12/27/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic bacterial pathogen that is widely occurring in the environment and is recognized for its capacity to form or join biofilms. The present review consolidates current knowledge on P. aeruginosa ecology and its implication in healthcare facilities premise plumbing. The adaptability of P. aeruginosa and its capacity to integrate the biofilm from the faucet and the drain highlight the role premise plumbing devices can play in promoting growth and persistence. A meta‐analysis of P. aeruginosa prevalence in faucets (manual and electronic) and drains reveals the large variation in device positivity reported and suggest the high variability in the sampling approach and context as the main reason for this variation. The effects of the operating conditions that prevail within water distribution systems (disinfection, temperature, and hydraulic regime) on the persistence of P. aeruginosa are summarized. As a result from the review, recommendations for proactive control measures of water contamination by P. aeruginosa are presented. A better understanding of the ecology of P. aeruginosa and key influencing factors in premise plumbing are essential to identify culprit areas and implement effective control measures.
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Affiliation(s)
- Emilie Bédard
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC, Canada.,INRS-Institut Armand-Frappier, Laval, QC, Canada
| | - Michèle Prévost
- Department of Civil Engineering, Polytechnique Montréal, Montréal, QC, Canada
| | - Eric Déziel
- INRS-Institut Armand-Frappier, Laval, QC, Canada
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17
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Zhou Z, Hu B, Gao X, Bao R, Chen M, Li H. Sources of sporadic Pseudomonas aeruginosa colonizations/infections in surgical ICUs: Association with contaminated sink trap. J Infect Chemother 2016; 22:450-5. [PMID: 27184934 DOI: 10.1016/j.jiac.2016.03.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/01/2016] [Accepted: 03/31/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many studies have reported the hospital outbreaks of Pseudomonas aeruginosa due to cross-contamination between patients and water fittings, but the importance of water fittings as sources of sporadic P. aeruginosa colonizations/infections remains ambiguous. AIM To investigate the sources of sporadic P. aeruginosa colonizations/infections in a clinical intensive surveillance, and further analysis the potential of sink trap for P. aeruginosa transmission in intensive care units (ICUs). METHODS Patients monitoring and targeted environmental screening for P. aeruginosa was performed prospectively over a 27-week period, in absence of recognized outbreak, in two surgical intensive care units (SICUs). All isolates were genotyped by Pulsed field gel electrophoresis analysis. FINDINGS 18.9% (46/244) of water fitting samples harbored P. aeruginosa, and active screening samples from 9.2% (55/595) of hospitalized patients carried with P. aeruginosa. According to genotype results, approximately 50% of P. areuginosa colonizations/infections of patients were of exogenous origin. 64.7% (11/17) of exogenous sourced cases were associated with contaminated sink traps. There was a significant correlation between the incidence of exogenous colonization/infection and the prevalence of P. areuginosa in water fitting in SICU-2 (rs = 0.972; p = 0.014). Furthermore, P. areuginosa from sink trap possessed a higher level of resistance to multi-antibiotics as opposed to cross-transmission from other patients. CONCLUSION Water fitting especially sink trap act as an important role in sporadic P. aeruginosa transmission in SICU patients. This report highlights the necessity of identification of potential environmental reservoirs, such as sinks, for control of infections of environmentally hardy multi-resistant P. areuginosa.
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Affiliation(s)
- ZhaoYan Zhou
- Clinical Microbiology Laboratory, Department of Respiratory Disease, Zhongshan Hospital of Fudan University, Shanghai, China
| | - BiJie Hu
- Department of Infection Control, Zhongshan Hospital of Fudan University, Shanghai, China.
| | - XiaoDong Gao
- Department of Infection Control, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Rong Bao
- Clinical Microbiology Laboratory, Department of Respiratory Disease, Zhongshan Hospital of Fudan University, Shanghai, China
| | - Min Chen
- Laboratory of Microbiology, Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - HuaYin Li
- Clinical Microbiology Laboratory, Department of Respiratory Disease, Zhongshan Hospital of Fudan University, Shanghai, China
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18
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Impact of electronic faucets and water quality on the occurrence of Pseudomonas aeruginosa in water: a multi-hospital study. Infect Control Hosp Epidemiol 2015; 36:311-9. [PMID: 25695173 DOI: 10.1017/ice.2014.46] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare Pseudomonas aeruginosa prevalence in electronic and manual faucets and assess the influence of connecting pipes and water quality. SETTING Faucets in 4 healthcare centers in Quebec, Canada. METHODS Water samples from 105 electronic, 90 manual, and 14 foot-operated faucets were analyzed for P. aeruginosa by culture and enzymatic detection, and swab samples from drains and aerators were analyzed by culture. Copper and residual chlorine concentrations, temperature, and flow rate were measured. P. aeruginosa concentrations were analyzed in 4 consecutive volumes of cold water and a laboratory study was conducted on copper pipes and flexible hoses. RESULTS P. aeruginosa contamination was found in drains more frequently (51%) than in aerators (1%) or water (culture: 4%, enzyme detection: 16%). Prevalence in water samples was comparable between manual (14%) and 2 types of electronic faucets (16%) while higher for foot-operated faucets (29%). However, type 2 electronic faucets were more often contaminated (31%) than type 1 (14%), suggesting that faucet architecture and mitigated volume (30 mL vs 10 mL) influence P. aeruginosa growth. Concentrations were 100 times higher in the first 250 mL than after flushing. Flexible hoses were more favorable to P. aeruginosa growth than copper and a temperature of 40°C led to higher counts. CONCLUSIONS The types of faucets and connecting pipes, flow rate, and water quality are important parameters influencing the prevalence and the concentrations of P. aeruginosa in faucets. High concentrations of P. aeruginosa in the first 250 mL suggest increased risk of exposure when using the first flush.
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19
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Cholley P, Stojanov M, Hocquet D, Thouverez M, Bertrand X, Blanc DS. Comparison of double-locus sequence typing (DLST) and multilocus sequence typing (MLST) for the investigation of Pseudomonas aeruginosa populations. Diagn Microbiol Infect Dis 2015; 82:274-7. [DOI: 10.1016/j.diagmicrobio.2015.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 03/10/2015] [Indexed: 11/17/2022]
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20
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Falkinham JO, Hilborn ED, Arduino MJ, Pruden A, Edwards MA. Epidemiology and Ecology of Opportunistic Premise Plumbing Pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:749-58. [PMID: 25793551 PMCID: PMC4529011 DOI: 10.1289/ehp.1408692] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 03/17/2015] [Indexed: 05/11/2023]
Abstract
BACKGROUND Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa are opportunistic premise plumbing pathogens (OPPPs) that persist and grow in household plumbing, habitats they share with humans. Infections caused by these OPPPs involve individuals with preexisting risk factors and frequently require hospitalization. OBJECTIVES The objectives of this report are to alert professionals of the impact of OPPPs, the fact that 30% of the population may be exposed to OPPPs, and the need to develop means to reduce OPPP exposure. We herein present a review of the epidemiology and ecology of these three bacterial OPPPs, specifically to identify common and unique features. METHODS A Water Research Foundation-sponsored workshop gathered experts from across the United States to review the characteristics of OPPPs, identify problems, and develop a list of research priorities to address critical knowledge gaps with respect to increasing OPPP-associated disease. DISCUSSION OPPPs share the common characteristics of disinfectant resistance and growth in biofilms in water distribution systems or premise plumbing. Thus, they share a number of habitats with humans (e.g., showers) that can lead to exposure and infection. The frequency of OPPP-infected individuals is rising and will likely continue to rise as the number of at-risk individuals is increasing. Improved reporting of OPPP disease and increased understanding of the genetic, physiologic, and structural characteristics governing the persistence and growth of OPPPs in drinking water distribution systems and premise plumbing is needed. CONCLUSIONS Because broadly effective community-level engineering interventions for the control of OPPPs have yet to be identified, and because the number of at-risk individuals will continue to rise, it is likely that OPPP-related infections will continue to increase. However, it is possible that individuals can take measures (e.g., raise hot water heater temperatures and filter water) to reduce home exposures.
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Affiliation(s)
- Joseph O Falkinham
- Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia, USA
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21
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Sartory DP, Pauly D, Garrec N, Bonadonna L, Semproni M, Schell C, Reimann A, Firth SJ, Thom C, Hartemann P, Exner M, Baldauf H, Lee S, Lee JV. Evaluation of an MPN test for the rapid enumeration of Pseudomonas aeruginosa in hospital waters. JOURNAL OF WATER AND HEALTH 2015; 13:427-436. [PMID: 26042975 DOI: 10.2166/wh.2014.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this study, the performance of a new most probable number (MPN) test (Pseudalert(®)/Quanti-Tray(®)) for the enumeration of Pseudomonas aeruginosa from hospital waters was compared with both international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water - Part 8 (MoDW Part 8), which both use Pseudomonas CN agar. The comparison based on the calculation of mean relative differences between the two methods was conducted according to ISO 17994:2014. Using both routine hospital water samples (80 from six laboratories) and artificially contaminated samples (192 from five laboratories), paired counts from each sample and the enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert(®)/Quanti-Tray(®). For the artificially contaminated samples, the data revealed higher counts of P. aeruginosa being recorded by Pseudalert(®)/Quanti-Tray(®). The Pseudalert(®)/Quanti-Tray(®) method does not require confirmation testing for atypical strains of P. aeruginosa, saving up to 6 days of additional analysis, and has the added advantage of providing confirmed counts within 24-28 hours incubation compared to 40-48 hours or longer for the ISO 16266 and MoDW Part 8 methods.
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Affiliation(s)
- David P Sartory
- SWM Consulting, 7 Sunnybank, Little Ness, Shrewsbury SY4 2LQ, UK E-mail:
| | - Danièle Pauly
- Département Environnement et Santé Publique - INSERM EA 7298 INGRES - Faculté de Médecine, Lorraine University Medical School, Vandoeuvre les Nancy, France
| | - Nathalie Garrec
- Centre Scientifique et Technique du Bâtiment, 11 rue Henri Picherit, BP 82341-44323, Nantes Cedex 3, France
| | - Lucia Bonadonna
- Istituto Superiore di Sanità, Reparto di Microbiologia e Virologia Ambientale e Wellness Dipartimento di Ambiente e Connessa Prevenzione Primaria, Viale Regina Elena 299, Rome 00161, Italy
| | - Maurizio Semproni
- Istituto Superiore di Sanità, Reparto di Microbiologia e Virologia Ambientale e Wellness Dipartimento di Ambiente e Connessa Prevenzione Primaria, Viale Regina Elena 299, Rome 00161, Italy
| | - Christiane Schell
- Hygiene-Institut des Ruhrgebiets, Institut für Umwelthygiene und Toxikologie, Rotthauser Str. 21, Gelsenkirchen 45879, Germany
| | - Annika Reimann
- Hygiene-Institut des Ruhrgebiets, Institut für Umwelthygiene und Toxikologie, Rotthauser Str. 21, Gelsenkirchen 45879, Germany
| | - Susan J Firth
- ALcontrol Laboratories, 7 & 8 Aspen Court, Bessemer Way, Rotherham S60 1FB, UK
| | | | - Philippe Hartemann
- Département Environnement et Santé Publique - INSERM EA 7298 INGRES - Faculté de Médecine, Lorraine University Medical School, Vandoeuvre les Nancy, France
| | - Martin Exner
- Universitätsklinikum Bonn, Institut für Hygiene und Öffentliche Gesundheit, Sigmund-Freud-Straße 25, Bonn 53105, Germany
| | | | - Susanne Lee
- Leegionella Ltd, Edgemoor Cottage, Rockford, Ringwood BH24 3NA, UK
| | - John V Lee
- Leegionella Ltd, Edgemoor Cottage, Rockford, Ringwood BH24 3NA, UK
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Behzat B. Decolorization of Reactive Black 39 and Acid Red 360 by Pseudomonas aeruginosa. WATER SCIENCE AND TECHNOLOGY : A JOURNAL OF THE INTERNATIONAL ASSOCIATION ON WATER POLLUTION RESEARCH 2015; 72:1266-1273. [PMID: 26465295 DOI: 10.2166/wst.2015.342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this work is to evaluate decolorization of Reactive Black 39 (RB39) and Acid Red 360 (AR360) by Pseudomonas aeruginosa, which was isolated from a non-dye-contaminated activated sludge biomass. In the present study, the effect of various physicochemical parameters, initial dye concentration, temperature, pH, inoculum size and yeast extract concentration as an organic source on decolorization were investigated. P. aeruginosa was able to decolorize 20 mg/L RB39 completely within 144 hours in the presence of 0.5 g/L yeast extract at 25°C. Decolorization efficiencies for AR360 were found to be higher than RB39 under the same conditions. Optimal temperature to decolorize RB39 and AR360 was found to be 30 and 25°C, respectively. The activation energy (Ea) values for decolorization of RB39 and AR360 were found to be 61.89 kJ/mol and 81.18 kJ/mol, respectively. Experience showed that the pH and inoculum size had a considerable effect on decolorization of RB39 and AR360 by P. aeruginosa.
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Affiliation(s)
- Balci Behzat
- Department of Environmental Engineering, Cukurova University, 01136, Balcali, Saricam, Adana, Turkey E-mail:
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Venier AG, Leroyer C, Slekovec C, Talon D, Bertrand X, Parer S, Alfandari S, Guerin JM, Megarbane B, Lawrence C, Clair B, Lepape A, Perraud M, Cassier P, Trivier D, Boyer A, Dubois V, Asselineau J, Rogues AM, Thiébaut R. Risk factors for Pseudomonas aeruginosa acquisition in intensive care units: a prospective multicentre study. J Hosp Infect 2014; 88:103-8. [PMID: 25155240 DOI: 10.1016/j.jhin.2014.06.018] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Accepted: 06/28/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a major nosocomial pathogen in intensive care units (ICUs); however, endogenous versus exogenous origin of contamination remains unclear. AIM To identify individual and environmental ICU risk factors for P. aeruginosa acquisition. METHODS A five-month prospective multicentric study was performed in ten French ICUs. Adult patients hospitalized in ICU for ≥ 24 h were included and screened for P. aeruginosa colonization on admission, weekly and before discharge. P. aeruginosa acquisition was defined by a subsequent colonization or infection if screening swabs on admission were negative. Water samples were obtained weekly on water taps of the ICUs. Data on patient characteristics, invasive devices exposure, antimicrobial therapy, P. aeruginosa water and patient colonization pressures, and ICU characteristics were collected. Hazard ratios (HRs) were estimated using multivariate Cox model. FINDINGS Among the 1314 patients without P. aeruginosa on admission, 201 (15%) acquired P. aeruginosa during their ICU stay. Individual characteristics significantly associated with P. aeruginosa acquisition were history of previous P. aeruginosa infection or colonization, cumulative duration of mechanical ventilation and cumulative days of antibiotics not active against P. aeruginosa. Environmental risk factors for P. aeruginosa acquisition were cumulative daily ward 'nine equivalents of nursing manpower use score' (NEMS) [hazard ratio (HR): 1.47 for ≥ 30 points; 95% confidence interval (CI): 1.06-2.03] and contaminated tap water in patient's room (HR: 1.76; CI: 1.09-2.84). CONCLUSION Individual risk factors and environmental factors for which intervention is possible were identified for P. aeruginosa acquisition.
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Affiliation(s)
- A-G Venier
- CHU, CCLIN Sud-Ouest, Bordeaux, France; INSERM U657, Université de Bordeaux, Bordeaux, France.
| | - C Leroyer
- CHU, Hygiène hospitalière, Bordeaux, France
| | - C Slekovec
- CHU, Hygiène hospitalière, Besançon, France
| | - D Talon
- CHU, Hygiène hospitalière, Besançon, France
| | - X Bertrand
- CHU, Hygiène hospitalière, Besançon, France
| | - S Parer
- CHU, Hygiène hospitalière, Montpellier, France
| | - S Alfandari
- CH DRon, Réanimation et maladies infectieuses, Tourcoing, France
| | - J-M Guerin
- CHU Lariboisière, AP-HP, Hygiène hospitalière, Paris, France
| | - B Megarbane
- CHU Lariboisière, AP-HP, Réanimation médicale, Paris, France
| | - C Lawrence
- CHU Poincaré, AP-HP, Hygiène hospitalière, Garches, France
| | - B Clair
- CHU Poincaré, AP-HP, Réanimation médicale, Garches, France
| | - A Lepape
- CHU Lyon Sud, Réanimation médicale, Lyon, France
| | - M Perraud
- CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France
| | - P Cassier
- CHU Lyon Hôpital E. Herriot, Laboratoire d'hygiène, Lyon, France
| | - D Trivier
- CH Lens, Hygiène hospitalière, Lens, France
| | - A Boyer
- CHU, Réanimation médicale, Bordeaux, France
| | - V Dubois
- CHU, Laboratoire de bactériologie, Bordeaux, France; UMR 5234 CNRS, Université de Bordeaux, Bordeaux, France
| | - J Asselineau
- CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France
| | - A-M Rogues
- INSERM U657, Université de Bordeaux, Bordeaux, France; CHU, Hygiène hospitalière, Bordeaux, France
| | - R Thiébaut
- CHU, Unité de soutien méthodologique à la recherche clinique et épidémiologique, Bordeaux, France; INSERM, U897 Epidemiologie et Biostatistique, Bordeaux, France; Univ Bordeaux, ISPED, Bordeaux, France
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Georges H, Alfandari S, Gois J, Thellier D, Leroy O. Doit-on utiliser la décontamination cutanée par la chlorhexidine en réanimation ? MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0853-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Loveday HP, Wilson JA, Kerr K, Pitchers R, Walker JT, Browne J. Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review. J Hosp Infect 2013; 86:7-15. [PMID: 24289866 DOI: 10.1016/j.jhin.2013.09.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is an opportunistic pathogen with a particular propensity to cause disease in the immunocompromised. Water systems have been reported to contribute to P. aeruginosa transmission in healthcare settings. AIM To systematically assess the evidence that healthcare water systems are associated with P. aeruginosa infection; to review aspects of design that can increase their potential to act as a reservoir; and to compare the efficacy of strategies for eradicating contamination and preventing infection. METHODS A rapid review methodology with a three-step search strategy was used to identify published studies. Scientific advisors were used to identify unpublished studies. FINDINGS Twenty-five relevant studies were included. There was plausible evidence of transmission of P. aeruginosa from water systems to patients and vice versa, although no direct evidence to explain the exact mode of transfer. Two studies provided plausible evidence for effective interventions: point-of-use filters and increasing chlorine disinfection. Non-touch taps and aspects of water system design were identified as probable risk factors for P. aeruginosa biofilm formation and subsequent transmission to patients. Poor hand hygiene or compliance with contact precautions were identified as potential contributory factors; plausible evidence to confirm this was not available. CONCLUSIONS Water systems can act as a source of P. aeruginosa infection in healthcare settings, although the route of transmission is unclear. Contamination appears to be confined to the distal ends of a water system and can persist for prolonged periods. Further studies are required to establish effective methods of preventing transmission and eradicating P. aeruginosa from plumbing systems.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, University of West London, London, UK
| | - J A Wilson
- Institute of Practice, Interdisciplinary Research & Enterprise, University of West London, London, UK.
| | - K Kerr
- Department of Medical Microbiology, Harrogate and District NHS Foundation Trust, Hull York Medical School, York, UK
| | | | - J T Walker
- Biosafety Unit, Health Protection Agency, Porton Down, UK
| | - J Browne
- Richard Wells Research Centre, University of West London, London, UK
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Balm MND, Salmon S, Jureen R, Teo C, Mahdi R, Seetoh T, Teo JTW, Lin RTP, Fisher DA. Bad design, bad practices, bad bugs: frustrations in controlling an outbreak of Elizabethkingia meningoseptica in intensive care units. J Hosp Infect 2013; 85:134-40. [PMID: 23958153 DOI: 10.1016/j.jhin.2013.05.012] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 05/23/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Elizabethkingia meningoseptica is a nosocomial-adapted Gram-negative bacillus intrinsically resistant to antibiotics commonly used in the intensive care setting. An outbreak investigation commenced when five patients developed E. meningoseptica infection in two intensive care units (ICUs). METHODS Analysis of laboratory data, case reviews, ICU workflows and extensive environmental sampling were undertaken. Molecular typing was performed using repetitive element palindromic polymerase chain reaction. Follow-up studies after interventions included environmental monitoring and a survey of staff compliance with interventions. FINDINGS Laboratory data revealed increasing incidence of E. meningoseptica colonization or infection in ICU patients compared with preceding years. E. meningoseptica was cultured from 44% (35/79) of taps, but not from other sources. Hand hygiene sinks were used for disposal of patient secretions and rinsing re-usable patient care items. Sinks misused in this way were contaminated more often than sinks that were not misused (odds ratio 4.38, 95% confidence interval 1.68-11.39; P = 0.004). Molecular typing revealed that patient isolates had identical patterns to several isolates from hand hygiene taps. An urgent education programme was instituted to change these practices. Taps were cleaned systematically and aerators were changed. A temporary reduction in case numbers was achieved. Recolonization of taps was demonstrated on follow-up environmental screening, and cases recurred after two months. A survey revealed that 77.3% (163/213) of nursing staff still misused sinks due to time constraints or other problems adhering to the interventions. CONCLUSION Introduction of non-sanctioned practices due to suboptimal unit design may have unintentional consequences for ICU patients. Room design and staff workflows must be optimized for patient safety as lapses in procedure can inadvertently put patients at risk.
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Affiliation(s)
- M N D Balm
- Infection Control Team, National University Hospital, Singapore; Microbiology, Department of Laboratory Medicine, National University Hospital, Singapore
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Reboux G, Rocchi S, Millon L, Talon D, Bertrand X. [Fungal and bacterial contamination of 30 general practitioners' consultation room in Franche-Comté (eastern France)]. J Mycol Med 2013; 23:149-54. [PMID: 23856447 DOI: 10.1016/j.mycmed.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Revised: 04/25/2013] [Accepted: 05/14/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the level of microbial contamination of general pratice environment. METHODS Ten points, including air, water and surfaces were sampled in general practitioner's consultation room of 30 general practices in Franche-Comté region (eastern France). For each sample, a global microbial count was assessed as well as the presence of potential pathogen microorganisms: Aspergillus fumigatus, Staphylococcus aureus, Pseudomonas aeruginosa, and Enterobacteriaceae. RESULTS We note that 66.3% of the samples (n=202) were on the target level (<51 ufc/25 cm (2), <101 ufc/m(3), <100 ufc/mL in total bacteria, without pathogenic species and without A. fumigatus respectively on surfaces, air and water, without isolation of coliforme bacteria or P. aeruginosa for 100mL of water). A. fumigatus, S. aureus, P. aeruginosa and Enterobacteriaceae were recovered in 8.0%, 2.1%, 0.7%, 0% respectively. However, 66.7% of air sampling were positive to A. fumigatus with 2 to 12 cfu/m(3). CONCLUSION This study shows a low level of bacterial contamination of general practitioner's consultation room. A. fumigatus frequency in air samples seems equivalent to that found in housing without air treatment.
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Affiliation(s)
- G Reboux
- Service de parasitologie-mycologie, CHU de Besançon, 3 boulevard Fleming, Besançon cedex, France.
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Abstract
The problem of Pseudomonas as a nosocomial pathogen is not new, with some authors dating its onset to the start of the antimicrobial era, although other factors, such as the growth of intensive or augmented care, have a part to play. This paper outlines the historical and environmental issues that may be associated with a potential increase in the incidence of this difficult-to-treat pathogen.
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Affiliation(s)
- Michael Kelsey
- Department of Microbiology, Whittington Hospital, London N19 5NF, UK
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Goudot A, Pourceau G, Meyer A, Gehin T, Vidal S, Vasseur JJ, Morvan F, Souteyrand E, Chevolot Y. Quantitative analysis (Kd and IC50) of glycoconjugates interactions with a bacterial lectin on a carbohydrate microarray with DNA Direct Immobilization (DDI). Biosens Bioelectron 2013; 40:153-60. [DOI: 10.1016/j.bios.2012.07.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 06/22/2012] [Accepted: 07/07/2012] [Indexed: 01/14/2023]
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Philippart F, Max A, Couzigou C, Misset B. Reanimación y prevención de las infecciones nosocomiales. EMC - ANESTESIA-REANIMACIÓN 2013. [PMCID: PMC7147915 DOI: 10.1016/s1280-4703(12)63970-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Los servicios de reanimación deben organizar de forma minuciosa la prevención de infecciones en sus enfermos, ya que éstos suelen estar inmunodeprimidos, están sometidos a múltiples procedimientos invasivos realizados por un personal sanitario variado, a menudo en situaciones de urgencia y a cualquier hora del día o de la noche. Las principales infecciones que hay que tratar de prevenir son las neumonías bacterianas adquiridas asociadas a ventilación mecánica (NAVM), las infecciones relacionadas con catéteres intravasculares y las infecciones urinarias asociadas al sondeo vesical. La incidencia de estas infecciones ha disminuido en la mayoría de los servicios que realizan un control cifrado, sobre todo gracias a la implantación de programas de mejora de la calidad. Las técnicas de prevención son múltiples y deben aplicarse simultáneamente. Incluyen medidas globales, como las modalidades de prevención de la transmisión cruzada (higiene de las manos, sobre todo) o de uso de antibióticos, concebidas para reducir la presión de selección de bacterias resistentes a éstos, así como medidas específicas relativas a la colocación y uso de cada uno de los dispositivos invasivos. Numerosas técnicas han demostrado su eficacia en estudios de buen nivel metodológico (higiene de las manos, apósitos para catéteres, etc.), mientras que otras siguen siendo objeto de controversias, por lo que las recomendaciones nacionales e internacionales se actualizan regularmente de acuerdo con los nuevos datos científicos. Estas medidas, implantadas de manera razonada en el marco de programas de mejora de la calidad, permiten obtener tasas muy bajas de infecciones relacionadas con el uso de catéteres vasculares y resultados menos satisfactorios con las NAVM, que justifican la necesidad de proseguir la investigación en este campo.
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Affiliation(s)
- F. Philippart
- Service de réanimation, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
- Université Paris Descartes, 12, rue de l’École-de-Médecine, 75270 Paris cedex 06, France
- Unité cytokines et inflammation, Institut Pasteur, 25-28, rue du Docteur-Roux, 75015 Paris, France
| | - A. Max
- Service de réanimation, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - C. Couzigou
- Unité d’hygiène, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
| | - B. Misset
- Université Paris Descartes, 12, rue de l’École-de-Médecine, 75270 Paris cedex 06, France
- Chef du service de réanimation, Groupe hospitalier Paris Saint-Joseph, 185, rue Raymond-Losserand, 75014 Paris, France
- Auteur correspondant.
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Rianimazione e prevenzione delle infezioni nosocomiali. EMC - ANESTESIA-RIANIMAZIONE 2013. [PMCID: PMC7148748 DOI: 10.1016/s1283-0771(12)63945-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
I servizi di rianimazione devono organizzare la prevenzione delle infezioni nei loro pazienti in modo minuzioso, in quanto i pazienti sono spesso immunodepressi e subiscono gesti invasivi molteplici, realizzati da personale differente, spesso in situazioni di urgenza e a qualsiasi ora del giorno o della notte. Le principali infezioni che bisogna tentare di prevenire sono le polmoniti batteriche acquisite sotto ventilazione meccanica (PAVM), le infezioni su cateteri intravascolari e le infezioni urinarie su catetere vescicale. L’incidenza di queste infezioni è diminuita nella maggior parte dei servizi che ne effettuano un monitoraggio su base numerica, in particolare nel quadro di programmi di miglioramento della qualità. Le tecniche di prevenzione sono molteplici e devono essere applicate simultaneamente. Esse riguardano delle misure globali, come le modalità di prevenzione della trasmissione crociata (igiene delle mani, in particolare) o di utilizzo degli antibiotici nella prospettiva di ridurre la pressione di selezione di batteri resistenti agli antibiotici, così come delle misure specifiche relative al posizionamento e all’utilizzo di ciascuno dei dispositivi invasivi. Numerose tecniche si sono dimostrate efficaci in studi di buon livello metodologico (igiene delle mani, medicazioni dei cateteri, ecc.) mentre altre sono ancora oggetto di controversie, portando a raccomandazioni nazionali e internazionali regolarmente aggiornate in funzione dei nuovi dati scientifici. Queste misure, implementate in modo ragionato nel quadro di programmi di miglioramento della qualità, consentono di ottenere dei tassi molto bassi per quanto riguarda le infezioni dei cateteri vascolari e dei risultati meno buoni per le PAVM, illustrando la necessità di proseguire la ricerca in questo settore.
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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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Boyer A, Doussau A, Thiébault R, Venier AG, Tran V, Boulestreau H, Bébéar C, Vargas F, Hilbert G, Gruson D, Rogues AM. Pseudomonas aeruginosa acquisition on an intensive care unit: relationship between antibiotic selective pressure and patients' environment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R55. [PMID: 21306623 PMCID: PMC3221986 DOI: 10.1186/cc10026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 12/13/2010] [Accepted: 02/09/2011] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship among Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa. METHODS An open, prospective cohort study was carried out in a 16-bed medical ICU where P. aeruginosa was endemic. Over a six-month period, all patients without P. aeruginosa on admission and with a length of stay >72 h were included. Throat, nasal, rectal, sputum and urine samples were taken on admission and at weekly intervals and screened for P. aeruginosa. All antibiotic treatments were recorded daily. Environmental analysis included weekly tap water specimen culture and the presence of other patients colonized with P. aeruginosa. RESULTS A total of 126 patients were included, comprising 1,345 patient-days. Antibiotics were given to 106 patients (antibiotic selective pressure for P. aeruginosa in 39). P. aeruginosa was acquired by 20 patients (16%) and was isolated from 164/536 environmental samples (31%). Two conditions were independently associated with P. aeruginosa acquisition by multivariate analysis: (i) patients receiving ≥3 days of antibiotic selective pressure together with at least one colonized patient on the same ward on the previous day (odds ratio (OR) = 10.3 ((% confidence interval (CI): 1.8 to 57.4); P = 0.01); and (ii) presence of an invasive device (OR = 7.7 (95% CI: 2.3 to 25.7); P = 0.001). CONCLUSIONS Specific interaction between both patient colonization pressure and selective antibiotic pressure is the most relevant factor for P. aeruginosa acquisition on an ICU. This suggests that combined efforts are needed against both factors to decrease colonization with P. aeruginosa.
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Affiliation(s)
- Alexandre Boyer
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, place Amélie Raba Léon, 33076 Bordeaux Cedex, France.
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Nseir S, Blazejewski C, Lubret R, Wallet F, Courcol R, Durocher A. Risk of acquiring multidrug-resistant Gram-negative bacilli from prior room occupants in the intensive care unit. Clin Microbiol Infect 2010; 17:1201-8. [PMID: 21054665 DOI: 10.1111/j.1469-0691.2010.03420.x] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The objective of this prospective cohort study was to determine whether admission to an intensive care unit (ICU) room previously occupied by a patient with multidrug-resistant (MDR) Gram-negative bacilli (GNB) increases the risk of acquiring these bacteria by subsequent patients. All patients hospitalized for >48 h were eligible. Patients with MDR GNB at ICU admission were excluded. The MDR GNB were defined as MDR Pseudomonas aeruginosa, Acinetobacter baumannii and extended spectrum β-lactamase (ESBL) -producing GNB. All patients were hospitalized in single rooms. Cleaning of ICU rooms between two patients was performed using quaternary ammonium disinfectant. Risk factors for MDR P. aeruginosa, A. baumannii and ESBL-producing GNB were determined using univariate and multivariate analysis. Five hundred and eleven consecutive patients were included; ICU-acquired MDR P. aeruginosa was diagnosed in 82 (16%) patients, A. baumannii in 57 (11%) patients, and ESBL-producing GNB in 50 (9%) patients. Independent risk factors for ICU-acquired MDR P. aeruginosa were prior occupant with MDR P. aeruginosa (OR 2.3, 95% CI 1.2-4.3, p 0.012), surgery (OR 1.9, 95% CI 1.1-3.6, p 0.024), and prior piperacillin/tazobactam use (OR 1.2, 95% CI 1.1-1.3, p 0.040). Independent risk factors for ICU-acquired A. baumannii were prior occupant with A. baumannii (OR 4.2, 95% CI 2-8.8, p <0.001), and mechanical ventilation (OR 9.3, 95% CI 1.1-83, p 0.045). Independent risk factors for ICU-acquired ESBL-producing GNB were tracheostomy (OR 2.6, 95% CI 1.1-6.5, p 0.049), and sedation (OR 6.6, 95% CI 1.1-40, p 0.041). We conclude that admission to an ICU room previously occupied by a patient with MDR P. aeruginosa or A. baumannii is an independent risk factor for acquisition of these bacteria by subsequent room occupants. This relationship was not identified for ESBL-producing GNB.
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Affiliation(s)
- S Nseir
- Intensive Care Unit, Calmette Hospital, University Hospital of Lille, Lille, France.
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Inglis T, Benson K, O'Reilly L, Bradbury R, Hodge M, Speers D, Heath C. Emergence of multi-resistant Pseudomonas aeruginosa in a Western Australian hospital. J Hosp Infect 2010; 76:60-5. [DOI: 10.1016/j.jhin.2010.01.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 01/26/2010] [Indexed: 11/27/2022]
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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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Kerr KG, Snelling AM. Pseudomonas aeruginosa: a formidable and ever-present adversary. J Hosp Infect 2009; 73:338-44. [PMID: 19699552 DOI: 10.1016/j.jhin.2009.04.020] [Citation(s) in RCA: 323] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 04/13/2009] [Indexed: 11/27/2022]
Abstract
Pseudomonas aeruginosa is a versatile pathogen associated with a broad spectrum of infections in humans. In healthcare settings the bacterium is an important cause of infection in vulnerable individuals including those with burns or neutropenia or receiving intensive care. In these groups morbidity and mortality attributable to P. aeruginosa infection can be high. Management of infections is difficult as P. aeruginosa is inherently resistant to many antimicrobials. Furthermore, treatment is being rendered increasingly problematic due to the emergence and spread of resistance to the few agents that remain as therapeutic options. A notable recent development is the acquisition of carbapenemases by some strains of P. aeruginosa. Given these challenges, it would seem reasonable to identify strategies that would prevent acquisition of the bacterium by hospitalised patients. Environmental reservoirs of P. aeruginosa are readily identifiable, and there are numerous reports of outbreaks that have been attributed to an environmental source; however, the role of such sources in sporadic pseudomonal infection is less well understood. Nevertheless there is emerging evidence from prospective studies to suggest that environmental sources, especially water, may have significance in the epidemiology of sporadic P. aeruginosa infections in hospital settings, including intensive care units. A better understanding of the role of environmental reservoirs in pseudomonal infection will permit the development of new strategies and refinement of existing approaches to interrupt transmission from these sources to patients.
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Affiliation(s)
- K G Kerr
- Department of Microbiology, Harrogate District Hospital, Lancaster Park Road, Harrogate, North Yorkshire HG2 7SX, UK.
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Trautmann M, Halder S, Lepper PM, Exner M. Reservoire von Pseudomonas aeruginosa auf der Intensivstation. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009; 52:339-44. [DOI: 10.1007/s00103-009-0796-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Floret N, Bertrand X, Thouverez M, Talon D. Infections nosocomiales à Pseudomonas aeruginosa : origine exogène ou endogène de la bactérie responsable ? ACTA ACUST UNITED AC 2009; 57:9-12. [DOI: 10.1016/j.patbio.2008.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 07/03/2008] [Indexed: 11/30/2022]
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Antonelli M, Azoulay E, Bonten M, Chastre J, Citerio G, Conti G, De Backer D, Lemaire F, Gerlach H, Groeneveld J, Hedenstierna G, Macrae D, Mancebo J, Maggiore SM, Mebazaa A, Metnitz P, Pugin J, Wernerman J, Zhang H. Year in review in Intensive Care Medicine, 2008: I. Brain injury and neurology, renal failure and endocrinology, metabolism and nutrition, sepsis, infections and pneumonia. Intensive Care Med 2008; 35:30-44. [PMID: 19066847 PMCID: PMC7094904 DOI: 10.1007/s00134-008-1371-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Accepted: 12/01/2008] [Indexed: 12/16/2022]
Affiliation(s)
- Massimo Antonelli
- Department of Intensive Care and Anesthesiology, Policlinico Universitario A. Gemelli, Università Cattolica del Sacro Cuore, Largo A. Gemelli, 8, 00168, Rome, Italy.
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