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Yetiş Ö, Ali S, Coen P, Wilson P. Is screening of patients for Pseudomonas aeruginosa groin/rectal carriage useful in identifying those at risk of bacteraemia in haematology and other high-risk clinical settings? J Hosp Infect 2024; 152:42-46. [PMID: 39032566 DOI: 10.1016/j.jhin.2024.07.005] [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: 04/15/2024] [Revised: 06/28/2024] [Accepted: 07/01/2024] [Indexed: 07/23/2024]
Abstract
BACKGROUND Pseudomonas aeruginosa is a leading cause of healthcare-associated infections in patients exposed to hospital waters. A rising incidence of P. aeruginosa bacteraemia at our tertiary teaching hospital prompted investigation. AIM Microbiological screening at patient admission to support early identification of acquisition. METHODS A 41-bed haematology ward (800-bed teaching-hospital, London) was surveyed between January 24th, 2020 and May 13th, 2020. Concurrent rectal and groin swabs were collected in duplicate upon admission weekly. Results were compared with historical shower, drain, and tap water contamination data. FINDINGS A total of 606 groin/rectal swabs were collected from 154 patients; 61 female and 93 male. Six out of 154 patients admitted (3.9%) were positive for P. aeruginosa. Two patients (1.3%; 95% confidence interval (CI): 0.16 to 4.6) were colonized at admission while four patients (2.6%; CI: 0.7 to 6.5) became colonized by 33 days (interquartile range: 13 to 54) of stay. Concurrent duplicate sampling yielded both positive and negative results in all colonized patient-cases. One patient subsequently developed P. aeruginosa bacteraemia. Shower water and corresponding drains from the four patient rooms where P. aeruginosa was acquired were heavily contaminated (>300 cfu/100 mL) with P. aeruginosa 265 days (median; range: 247-283) before patient admission. CONCLUSION Rectal/groin swab-screening at admission to hospital might be valuable for early detection of patient colonization but it is intrusive, resource-demanding, and yield may be low. In high-risk settings, enhanced environmental monitoring, decontamination of surfaces and drains, and point-of-use filter-barriers is recommended, especially if expected duration of stay exceeds 30 days.
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Affiliation(s)
- Ö Yetiş
- Faculty of Medical Sciences, Division of Infection and Immunity, University College London, London, UK; Environmental Research Laboratory, University College London Hospitals NHS Foundation Trust, London, UK.
| | - S Ali
- Faculty of Medical Sciences, Division of Infection and Immunity, University College London, London, UK; Environmental Research Laboratory, University College London Hospitals NHS Foundation Trust, London, UK
| | - P Coen
- Department of Clinical Microbiology & Virology, University College London Hospitals NHS Foundation Trust, London, UK
| | - P Wilson
- Faculty of Medical Sciences, Division of Infection and Immunity, University College London, London, UK; Department of Clinical Microbiology & Virology, University College London Hospitals NHS Foundation Trust, London, UK
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2
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Santonato D, Martinelli I, Quevedo A, Sadorin R, Novau A, Fabbro L, Cuello Mena MDLÁ, Araoz Sanchez V, Cornistein W. Investigation of an outbreak of metallo-β-lactamase producing Pseudomonas aeruginosa linked to the water distribution system in a Hematopoietic Stem Cell Transplantation Unit. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e130. [PMID: 39290623 PMCID: PMC11406561 DOI: 10.1017/ash.2024.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 06/28/2024] [Accepted: 06/30/2024] [Indexed: 09/19/2024]
Abstract
Introduction Pseudomonas aeruginosa (PA) is an opportunistic pathogen. Metallo-β-lactamase producing PA (MBL-PA) poses a problematic issue given limited available treatments. In Argentina, it accounts for less than one percent of healthcare-associated infections. Objectives To describe an outbreak of verona integron-encoded metallo-β-lactamase (VIM) Pseudomonas aeruginosa in a Hematopoietic Stem Cell Transplantation Unit (HSCTU), and the strategies implemented to control it. Materials and methods Investigation of an outbreak by MBL-PA in an HSCTU in May 2023. Active case search, environmental sampling, identification and susceptibility pattern of strains, mitigation strategies. Case: patient admitted to the HSCTU with positive sample for MBL-PA after 48 hours of admission. Mitigation strategies: biweekly rectal swabbing, contact precautions, dedicated nursing staff, waterless patient care, and disinfection of bacterial reservoirs. Results In May 2023 two cases were identified. A retrospective search determined an additional case. One (10%) of the environmental samples was positive for VIM type MBL-PA in the drain of the hand hygiene station in the nurse's office. Strains were susceptible to colistin and fosfomycin and intermediate to aztreonam. Incidence density (ID) of colonization and infection by MBL-PA in the HSCTU were .68/1,000 patient-days (pd) and 0, respectively, in the second semester of 2022. In the first semester of 2023, ID rose to 2.93/1,000 pd for colonization and .73/1,000 pd for infection.Mitigation strategies aimed at reducing exposure of immunocompromised hosts to water. No new cases have been identified since. Conclusions We report an MBL-PA outbreak probably linked to the water distribution system in an HSCTU, and mitigation strategies put in place.
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Affiliation(s)
- Daniela Santonato
- Infection Control Department, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Ivana Martinelli
- Department of Microbiology, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Alejandra Quevedo
- Department of Microbiology, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Roxana Sadorin
- Department of Microbiology, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Andrea Novau
- Infection Control Department, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Leonardo Fabbro
- Infection Control Department, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | | | - Vanessa Araoz Sanchez
- Department of Haematology and Hematopoietic Stem Cell Transplantation, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
| | - Wanda Cornistein
- Infection Control Department, Hospital Universitario Austral. Pilar, Buenos Aires, Argentina
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3
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Zhang Z, Guo Y, Zhuang M, Liu F, Xia Z, Zhang Z, Yang F, Zeng H, Wu Y, Huang J, Xu K, Li J. Gut microbiome diversity and biogeography for Chinese bumblebee Bombus pyrosoma. mSystems 2024; 9:e0045924. [PMID: 38934544 PMCID: PMC11264632 DOI: 10.1128/msystems.00459-24] [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: 03/30/2024] [Accepted: 05/30/2024] [Indexed: 06/28/2024] Open
Abstract
Gut microbiota of the bumblebee is critical as it modulates the health and fitness of the host. However, the mechanisms underlying the formation and maintenance of the diversity of bumblebee gut bacteria over a long period of evolution have yet to be elucidated. In particular, the gut bacterial diversity and community assembly processes of Bombus pyrosoma across the Chinese border remain unclear. In this study, we systematically carried out unprecedented sampling of 513 workers of the species Bombus pyrosoma across the Chinese landscape and used full-length 16S rRNA gene sequencing to examine their gut microbiota diversity and biogeography. The gut microbiota composition and community structure of Bombus pyrosoma from different geographical locations were diverse. On the whole, the gut bacteria Gilliamella and Snodgrassella are dominant in bumblebees, but opportunistic pathogens Serratia and Pseudomonas are dominant in some sampling sites such as Hb15, Gs1, Gs45, Qhs15, and Ssx35. All or part of environmental factors such as latitude, annual mean temperature, elevation, human footprint, population density, and annual precipitation can affect the alpha diversity and community structure of gut bacteria. Further analysis showed that the assembly and shift of bumblebee gut bacterial communities under geographical variation were mainly driven by the stochastic drift of the neutral process rather than by variable selection of niche differentiation. In conclusion, our unprecedented sampling uncovers bumblebee gut microbiome diversity and shifts over evolutionary time. IMPORTANCE The microbiotas associated with organisms facilitates host health and fitness, and the homeostasis status of gut microbiota also reflects the habitat security faced by the host. In addition, managing gut microbiota is important to improve bumblebee health by understanding the ecological process of the gut microbiome. Thus, we first carried out an runprecedented sampling of 513 workers of the species Bombus pyrosoma across the Chinese landscape and used full-length 16S rRNA gene sequencing to uncover their gut microbiota diversity and biogeography. Our study provides new insights into the understanding of gut microbiome diversity and shifts for Chinese Bumblebee over evolutionary time.
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Affiliation(s)
- Zhengyi Zhang
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Yulong Guo
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Mingsheng Zhuang
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Fugang Liu
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Zhongyan Xia
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Zhihao Zhang
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Fan Yang
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Huayan Zeng
- Luoping Yunling Bee Industry and Trade Co., Ltd, Yunnan, China
| | - Yueguo Wu
- Luoping Yunling Bee Industry and Trade Co., Ltd, Yunnan, China
| | - Jiaxing Huang
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
| | - Kai Xu
- Apiculture science Institute of Jilin Province, Jilin, China
| | - Jilian Li
- State Key Laboratory of Resource Insects, Institute of Apicultural Research, Chinese Academy of Agricultural Sciences, Beijing, China
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Azari R, Yousefi MH, Fallah AA, Alimohammadi A, Nikjoo N, Wagemans J, Berizi E, Hosseinzadeh S, Ghasemi M, Mousavi Khaneghah A. Controlling of foodborne pathogen biofilms on stainless steel by bacteriophages: A systematic review and meta-analysis. Biofilm 2024; 7:100170. [PMID: 38234712 PMCID: PMC10793095 DOI: 10.1016/j.bioflm.2023.100170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 11/27/2023] [Accepted: 12/10/2023] [Indexed: 01/19/2024] Open
Abstract
This study investigates the potential of using bacteriophages to control foodborne pathogen biofilms on stainless steel surfaces in the food industry. Biofilm-forming bacteria can attach to stainless steel surfaces, rendering them difficult to eradicate even after a thorough cleaning and sanitizing procedures. Bacteriophages have been proposed as a possible solution, as they can penetrate biofilms and destroy bacterial cells within, reducing the number of viable bacteria and preventing the growth and spread of biofilms. This systematic review and meta-analysis evaluates the potential of bacteriophages against different biofilm-forming foodborne bacteria, including Cronobacter sakazakii, Escherichia coli, Staphylococcus aureus, Pseudomonas fluorescens, Pseudomonas aeruginosa and Listeria monocytogenes. Bacteriophage treatment generally causes a significant average reduction of 38 % in biofilm formation of foodborne pathogens on stainless steel. Subgroup analyses revealed that phages are more efficient in long-duration treatment. Also, applying a cocktail of phages is 1.26-fold more effective than applying individual phages. Phages at concentrations exceeding 107 PFU/ml are significantly more efficacious in eradicating bacteria within a biofilm. The antibacterial phage activity decreases substantially by 3.54-fold when applied at 4 °C compared to temperatures above 25 °C. This analysis suggests that bacteriophages can be a promising solution for controlling biofilms in the food industry.
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Affiliation(s)
- Rahim Azari
- Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Hashem Yousefi
- Department of Food Hygiene and Public Health, School of Veterinary Medicine, Shiraz University, Shiraz, 71946-84471, Iran
| | - Aziz A. Fallah
- Department of Food Hygiene and Quality Control, School of Veterinary Medicine, Shahrekord University, Shahrekord, 34141, Iran
| | - Arezoo Alimohammadi
- Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nastaran Nikjoo
- Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Enayat Berizi
- Department of Food Hygiene and Quality Control, School of Nutrition and Food Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Saeid Hosseinzadeh
- Department of Food Hygiene and Public Health, School of Veterinary Medicine, Shiraz University, Shiraz, 71946-84471, Iran
| | - Mohammad Ghasemi
- Department of Pharmacology, School of Veterinary Medicine, Shahrekord University, P. O. Box 115, Shahrekord, Iran
| | - Amin Mousavi Khaneghah
- Food Health Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
- Department of Fruit and Vegetable Product Technology, Prof. Wacław Dąbrowski Institute of Agricultural and Food Biotechnology—State Research Institute, 36 Rakowiecka St., 02-532, Warsaw, Poland
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Aroca Molina KJ, Gutiérrez SJ, Benítez-Campo N, Correa A. Genomic Differences Associated with Resistance and Virulence in Pseudomonas aeruginosa Isolates from Clinical and Environmental Sites. Microorganisms 2024; 12:1116. [PMID: 38930498 PMCID: PMC11205572 DOI: 10.3390/microorganisms12061116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 04/05/2024] [Accepted: 04/13/2024] [Indexed: 06/28/2024] Open
Abstract
Pseudomonas aeruginosa is a pathogen that causes healthcare-associated infections (HAIs) worldwide. It is unclear whether P. aeruginosa isolated from the natural environment has the same pathogenicity and antimicrobial resistance potential as clinical strains. In this study, virulence- and resistance-associated genes were compared in 14 genomic sequences of clinical and environmental isolates of P. aeruginosa using the VFDB, PATRIC, and CARD databases. All isolates were found to share 62% of virulence genes related to adhesion, motility, secretion systems, and quorum sensing and 72.9% of resistance genes related to efflux pumps and membrane permeability. Our results indicate that both types of isolates possess conserved genetic information associated with virulence and resistance mechanisms regardless of the source. However, none of the environmental isolates were associated with high-risk clones (HRCs). These clones (ST235 and ST111) were found only in clinical isolates, which have an impact on human medical epidemiology due to their ability to spread and persist, indicating a correlation between the clinical environment and increased virulence. The genomic variation and antibiotic susceptibility of environmental isolates of P. aeruginosa suggest potential biotechnological applications if obtained from sources that are under surveillance and investigation to limit the emergence and spread of antibiotic resistant strains.
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Affiliation(s)
- Kelly J. Aroca Molina
- Department of Biology, Faculty of Natural and Exact Sciences, Universidad del Valle, Cali 760042, Colombia; (K.J.A.M.); (S.J.G.)
| | - Sonia Jakeline Gutiérrez
- Department of Biology, Faculty of Natural and Exact Sciences, Universidad del Valle, Cali 760042, Colombia; (K.J.A.M.); (S.J.G.)
| | - Neyla Benítez-Campo
- Department of Biology, Faculty of Natural and Exact Sciences, Universidad del Valle, Cali 760042, Colombia; (K.J.A.M.); (S.J.G.)
| | - Adriana Correa
- Department of Basic Sciences, Universidad Santiago de Cali, Cali 760035, Colombia;
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6
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Khan MAS, Islam Z, Shah ST, Rahman SR. Characterization of biofilm formation and multi-drug resistance among Pseudomonas aeruginosa isolated from hospital wastewater in Dhaka, Bangladesh. JOURNAL OF WATER AND HEALTH 2024; 22:825-834. [PMID: 38822462 DOI: 10.2166/wh.2024.294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 04/09/2024] [Indexed: 06/03/2024]
Abstract
Hospital wastewater has been identified as a hotspot for the emergence and transmission of multidrug-resistant (MDR) pathogens that present a serious threat to public health. Therefore, we investigated the current status of antibiotic resistance as well as the phenotypic and genotypic basis of biofilm formation in Pseudomonas aeruginosa from hospital wastewater in Dhaka, Bangladesh. The disc diffusion method and the crystal violet assay were performed to characterize antimicrobial resistance and biofilm formation, respectively. Biofilm and integron-associated genes were amplified by the polymerase chain reaction. Isolates exhibited varying degrees of resistance to different antibiotics, in which >80% of isolates showed sensitivity to meropenem, amikacin, and gentamicin. The results indicated that 93.82% of isolates were MDR and 71 out of 76 MDR isolates showed biofilm formation activities. We observed the high prevalence of biofilm-related genes, in which algD+pelF+pslD+ (82.7%) was found to be the prevalent biofilm genotypic pattern. Sixteen isolates (19.75%) possessed class 1 integron (int1) genes. However, statistical analysis revealed no significant association between biofilm formation and multidrug resistance (χ2 = 0.35, P = 0.55). Taken together, hospital wastewater in Dhaka city may act as a reservoir for MDR and biofilm-forming P. aeruginosa, and therefore, the adequate treatment of wastewater is recommended to reduce the occurrence of outbreaks.
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Affiliation(s)
- Md Abu Sayem Khan
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh; Md Abu Sayem Khan and Zahidul Islam contributed equally to this study
| | - Zahidul Islam
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh; Md Abu Sayem Khan and Zahidul Islam contributed equally to this study
| | - Sm Tanjil Shah
- Department of Microbiology, University of Dhaka, Dhaka 1000, Bangladesh
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7
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Hunfeld N, Salinas Gabiña I, Weinbren M. Five sustainable tips about water in the ICU: reduction of water use and decrease of the amount of antibiotics in wastewater. Intensive Care Med 2024; 50:446-448. [PMID: 38300265 DOI: 10.1007/s00134-023-07317-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 12/27/2023] [Indexed: 02/02/2024]
Affiliation(s)
- Nicole Hunfeld
- Department of Intensive Care, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Irene Salinas Gabiña
- Department of Intensive Care, University Hospital del Henares, Coslada-Madrid, Spain.
- Faculty of Health Science, University Francisco de Vitoria, Madrid, Spain.
| | - Michael Weinbren
- Department of Microbiology, New Hospital Programme, NHS England, London, UK
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Regev-Yochay G, Margalit I, Smollan G, Rapaport R, Tal I, Hanage WP, Pinas Zade N, Jaber H, Taylor BP, Che Y, Rahav G, Zimlichman E, Keller N. Sink-traps are a major source for carbapenemase-producing Enterobacteriaceae transmission. Infect Control Hosp Epidemiol 2024; 45:284-291. [PMID: 38149351 DOI: 10.1017/ice.2023.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2023]
Abstract
OBJECTIVE We studied the extent of carbapenemase-producing Enterobacteriaceae (CPE) sink contamination and transmission to patients in a nonoutbreak setting. METHODS During 2017-2019, 592 patient-room sinks were sampled in 34 departments. Patient weekly rectal swab CPE surveillance was universally performed. Repeated sink sampling was conducted in 9 departments. Isolates from patients and sinks were characterized using pulsed-field gel electrophoresis (PFGE), and pairs of high resemblance were sequenced by Oxford Nanopore and Illumina. Hybrid assembly was used to fully assemble plasmids, which are shared between paired isolates. RESULTS In total, 144 (24%) of 592 CPE-contaminated sinks were detected in 25 of 34 departments. Repeated sampling (n = 7,123) revealed that 52%-100% were contaminated at least once during the sampling period. Persistent contamination for >1 year by a dominant strain was common. During the study period, 318 patients acquired CPE. The most common species were Klebsiella pneumoniae, Escherichia coli, and Enterobacter spp. In 127 (40%) patients, a contaminated sink was the suspected source of CPE acquisition. For 20 cases with an identical sink-patient strain, temporal relation suggested sink-to-patient transmission. Hybrid assembly of specific sink-patient isolates revealed that shared plasmids were structurally identical, and SNP differences between shared pairs, along with signatures for potential recombination events, suggests recent sharing of the plasmids. CONCLUSIONS CPE-contaminated sinks are an important source of transmission to patients. Although traditionally person-to-person transmission has been considered the main route of CPE transmission, these data suggest a change in paradigm that may influence strategies of preventing CPE dissemination.
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Affiliation(s)
- Gili Regev-Yochay
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ili Margalit
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gillian Smollan
- Microbiology laboratory, Sheba Medical Center, Ramat-Gan, Israel
| | - Rotem Rapaport
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ilana Tal
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - William P Hanage
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Nani Pinas Zade
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Hanaa Jaber
- Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Bradford P Taylor
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - You Che
- Center for Communicable Disease Dynamics, Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts
| | - Galia Rahav
- Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Infectious Disease Unit, Sheba Medical Center, Ramat-Gan, Israel
| | | | - Nati Keller
- Microbiology laboratory, Sheba Medical Center, Ramat-Gan, Israel
- Ariel University, Ari'el, Samaria
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Meda M, Weinbren M. The healthcare built environment - an under-recognized and preventable source of transmission of organisms and antimicrobial resistance to patients. J Hosp Infect 2024; 144:150. [PMID: 37952607 DOI: 10.1016/j.jhin.2023.10.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Affiliation(s)
- M Meda
- Frimley Health NHS Foundation Trust, Frimley, UK
| | - M Weinbren
- New Hospital Programme, NHS England, London, UK.
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10
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Valzano F, Coda ARD, Liso A, Arena F. Multidrug-Resistant Bacteria Contaminating Plumbing Components and Sanitary Installations of Hospital Restrooms. Microorganisms 2024; 12:136. [PMID: 38257963 PMCID: PMC10818725 DOI: 10.3390/microorganisms12010136] [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: 11/20/2023] [Revised: 12/05/2023] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Antimicrobial resistance (AMR) poses several issues concerning the management of hospital-acquired infections, leading to increasing morbidity and mortality rates and higher costs of care. Multidrug-resistant (MDR) bacteria can spread in the healthcare setting by different ways. The most important are direct contact transmission occurring when an individual comes into physical contact with an infected or colonized patient (which can involve healthcare workers, patients, or visitors) and indirect contact transmission occurring when a person touches contaminated objects or surfaces in the hospital environment. Furthermore, in recent years, toilets in hospital settings have been increasingly recognised as a hidden source of MDR bacteria. Different sites in restrooms, from toilets and hoppers to drains and siphons, can become contaminated with MDR bacteria that can persist there for long time periods. Therefore, shared toilets may play an important role in the transmission of nosocomial infections since they could represent a reservoir for MDR bacteria. Such pathogens can be further disseminated by bioaerosol and/or droplets potentially produced during toilet use or flushing and be transmitted by inhalation and contact with contaminated fomites. In this review, we summarize available evidence regarding the molecular features of MDR bacteria contaminating toilets of healthcare environments, with a particular focus on plumbing components and sanitary installation. The presence of bacteria with specific molecular traits in different toilet sites should be considered when adopting effective managing and containing interventions against nosocomial infections potentially due to environmental contamination. Finally, here we provide an overview of traditional and new approaches to reduce the spreading of such infections.
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Affiliation(s)
- Felice Valzano
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122 Foggia, Italy; (F.V.); (F.A.)
| | - Anna Rita Daniela Coda
- Department of Medical and Surgical Sciences, University of Foggia, Via Napoli 20, 71122 Foggia, Italy;
| | - Arcangelo Liso
- Department of Medical and Surgical Sciences, University of Foggia, Via Napoli 20, 71122 Foggia, Italy;
| | - Fabio Arena
- Department of Clinical and Experimental Medicine, University of Foggia, Via Napoli 20, 71122 Foggia, Italy; (F.V.); (F.A.)
- IRCCS Don Carlo Gnocchi Foundation, Via di Scandicci 269, 50143 Florence, Italy
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11
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Cullom A, Spencer MS, Williams MD, Falkinham JO, Brown C, Edwards MA, Pruden A. Premise Plumbing Pipe Materials and In-Building Disinfectants Shape the Potential for Proliferation of Pathogens and Antibiotic Resistance Genes. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2023; 57:21382-21394. [PMID: 38071676 DOI: 10.1021/acs.est.3c05905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
In-building disinfectants are commonly applied to control the growth of pathogens in plumbing, particularly in facilities such as hospitals that house vulnerable populations. However, their application has not been well optimized, especially with respect to interactive effects with pipe materials and potential unintended effects, such as enrichment of antibiotic resistance genes (ARGs) across the microbial community. Here, we used triplicate convectively mixed pipe reactors consisting of three pipe materials (PVC, copper, and iron) for replicated simulation of the distal reaches of premise plumbing and evaluated the effects of incrementally increased doses of chlorine, chloramine, chlorine dioxide, and copper-silver disinfectants. We used shotgun metagenomic sequencing to characterize the resulting succession of the corresponding microbiomes over the course of 37 weeks. We found that both disinfectants and pipe material affected ARG and microbial community taxonomic composition both independently and interactively. Water quality and total bacterial numbers were not found to be predictive of pathogenic species markers. One result of particular concern was the tendency of disinfectants, especially monochloramine, to enrich ARGs. Metagenome assembly indicated that many ARGs were enriched specifically among the pathogenic species. Functional gene analysis was indicative of a response of the microbes to oxidative stress, which is known to co/cross-select for antibiotic resistance. These findings emphasize the need for a holistic evaluation of pathogen control strategies for plumbing.
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Affiliation(s)
- Abraham Cullom
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, Virginia 24061, United States
| | - Matheu Storme Spencer
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, Virginia 24061, United States
| | - Myra D Williams
- Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia 24061, United States
| | - Joseph O Falkinham
- Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia 24061, United States
| | - Connor Brown
- Department of Genetics, Bioinformatics, and Computational Biology, Virginia Tech, Blacksburg, Virginia 24061, United States
| | - Marc A Edwards
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, Virginia 24061, United States
| | - Amy Pruden
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, Virginia 24061, United States
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Katsipis G, Avgoulas DI, Geromichalos GD, Petala M, Pantazaki AA. In vitro and in silico evaluation of the serrapeptase effect on biofilm and amyloids of Pseudomonas aeruginosa. Appl Microbiol Biotechnol 2023; 107:7269-7285. [PMID: 37741938 PMCID: PMC10638192 DOI: 10.1007/s00253-023-12772-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 09/25/2023]
Abstract
Pseudomonas aeruginosa is an emerging threat for hospitalized and cystic fibrosis patients. Biofilm, a microbial community embedded in extracellular polymeric substance, fortifies bacteria against the immune system. In biofilms, the expression of functional amyloids is linked with highly aggregative, multi-resistant strains, and chronic infections. Serrapeptase (SPT), a protease possessing similar or superior anti-microbial properties with many antibiotics, presents anti-amyloid potential. However, studies on the employment of SPT against Pseudomonas biofilms and Fap amyloid, or the possible mechanisms of action are scarce. Here, SPT inhibited biofilm formation of P. aeruginosa ATCC 27853 on both plastic and glass surfaces, with an IC50 of 11.26 µg/mL and 0.27 µg/mL, respectively. The inhibitory effect of SPT on biofilm was also verified with optical microscopy of crystal violet-stained biofilms and with confocal microscopy. Additionally, SPT caused a dose-dependent decrease of bacterial viability (IC50 of 3.07 µg/mL) as demonstrated by MTT assay. Reduction of bacterial functional amyloids was also demonstrated, employing both fluorescence microscopy with thioflavin T and photometrical determination of Congo-red-positive compounds. Both viability and functional amyloids correlated significantly with biofilm inhibition. Finally, in silico molecular docking studies provided a mechanistic insight into the interaction of SPT with FapC or FapD, proving that both peptides are possible targets of SPT. These results offer new insights into the biofilm formation of P. aeruginosa and potentiate the involvement of SPT in the prevention and eradication of Pseudomonas biofilms. KEY POINTS: • Serrapeptase inhibits biofilm formation of P. aeruginosa on plastic and glass. • Biofilm inhibition correlated with reduced viability and functional amyloid levels. • In silico studies indicated that serrapeptase may target FapC and FapD peptides.
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Affiliation(s)
- Georgios Katsipis
- Laboratory of Biochemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece
| | - Dimitrios I Avgoulas
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece
- Laboratory of Chemical and Environmental Technology, Deparment of Chemistry, Aristotle University of Thessaloniki, 54 124, 54124, Thessaloniki, Greece
| | - George D Geromichalos
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece
- Department of General and Inorganic Chemistry, Faculty of Chemistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Maria Petala
- Laboratory of Environmental Engineering & Planning, Department of Civil Engineering, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece
| | - Anastasia A Pantazaki
- Laboratory of Biochemistry, Department of Chemistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
- Center for Interdisciplinary Research and Innovation, Laboratory of Neurodegenerative Diseases (LND), Thermi, 57001, Thessaloniki, Greece.
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13
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Cullom A, Spencer MS, Williams MD, Falkinham JO, Pruden A, Edwards MA. Influence of pipe materials on in-building disinfection of P. aeruginosa and A. baumannii in simulated hot water plumbing. WATER RESEARCH X 2023; 21:100189. [PMID: 38098877 PMCID: PMC10719577 DOI: 10.1016/j.wroa.2023.100189] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 04/20/2023] [Accepted: 06/12/2023] [Indexed: 12/17/2023]
Abstract
A framework is needed to account for interactive effects of plumbing materials and disinfectants on opportunistic pathogens (OPs) in building water systems. Here we evaluated free chlorine, monochloramine, chlorine dioxide, and copper-silver ionization (CSI) for controlling Pseudomonas aeruginosa and Acinetobacter baumannii as two representative OPs that colonize hot water plumbing, in tests using polyvinylchloride (PVC), copper-PVC, and iron-PVC convectively-mixed pipe reactors (CMPRs). Pipe materials vulnerable to corrosion (i.e., iron and copper) altered the pH, dissolved oxygen, and disinfectant levels in a manner that influenced growth trends of the two OPs and total bacteria. P. aeruginosa grew well in PVC CMPRs, poorly in iron-PVC CMPRs, and was best controlled by CSI disinfection, whereas A. baumannii showed the opposite trend for pipe material and was better controlled by chlorine and chlorine dioxide. Various scenarios were identified in which pipe material and disinfectant can interact to either hinder or accelerate growth of OPs, illustrating the difficulties of controlling OPs in portions of plumbing systems experiencing warm, stagnant water.
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Affiliation(s)
- Abraham Cullom
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061
| | - Mattheu Storme Spencer
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061
| | - Myra D. Williams
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Joseph O. Falkinham
- Department of Biological Sciences, Virginia Tech, Blacksburg, VA, 24061, USA
| | - Amy Pruden
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061
| | - Marc A. Edwards
- Civil and Environmental Engineering, Virginia Tech, 1145 Perry St., 418 Durham Hall, Blacksburg, VA, 24061
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14
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Kelly SA, O'Connell NH, Thompson TP, Dillon L, Wu J, Creevey C, Kiely P, Slevin B, Powell J, Gilmore BF, Dunne CP. Large-scale characterization of hospital wastewater system microbiomes and clinical isolates from infected patients: profiling of multi-drug-resistant microbial species. J Hosp Infect 2023; 141:152-166. [PMID: 37696473 DOI: 10.1016/j.jhin.2023.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) and infectious agents exhibiting antimicrobial resistance (AMR) are challenges globally. Environmental patient-facing wastewater apparatus including handwashing sinks, showers and toilets are increasingly identified as sources of infectious agents and AMR genes. AIM To provide large-scale metagenomics analysis of wastewater systems in a large teaching hospital in the Republic of Ireland experiencing multi-drug-resistant HAI outbreaks. METHODS Wastewater pipe sections (N=20) were removed immediately prior to refurbishment of a medical ward where HAIs had been endemic. These comprised toilet U-bends, and sink and shower drains. Following DNA extraction, each pipe section underwent metagenomic analysis. FINDINGS Diverse taxonomic and resistome profiles were observed, with members of phyla Proteobacteria and Actinobacteria dominating (38.23 ± 5.68% and 15.78 ± 3.53%, respectively). Genomes of five clinical isolates were analysed. These AMR bacterial isolates were from patients >48 h post-admission to the ward. Genomic analysis determined that the isolates bore a high number of antimicrobial resistance genes (ARGs). CONCLUSION Comparison of resistome profiles of isolates and wastewater metagenomes revealed high degrees of similarity, with many identical ARGs shared, suggesting probable acquisition post-admission. The highest numbers of ARGs observed were those encoding resistance to clinically significant and commonly used antibiotic classes. Average nucleotide identity analysis confirmed the presence of highly similar or identical genomes in clinical isolates and wastewater pipes. These unique large-scale analyses reinforce the need for regular cleaning and decontamination of patient-facing hospital wastewater pipes and effective infection control policies to prevent transmission of nosocomial infection and emergence of AMR within potential wastewater reservoirs.
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Affiliation(s)
- S A Kelly
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - T P Thompson
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - L Dillon
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - J Wu
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C Creevey
- School of Biological Sciences, Queen's University Belfast, Belfast, UK
| | - P Kiely
- School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - B Slevin
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland
| | - B F Gilmore
- School of Pharmacy, Queen's University Belfast, Belfast, UK
| | - C P Dunne
- School of Medicine and Centre for Interventions in Infection, Inflammation and Immunity (4i), University of Limerick, Limerick, Ireland.
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15
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Inkster T, Walker J, Weinbren M. Waterborne infections in haemato-oncology units - a narrative review. J Hosp Infect 2023:S0195-6701(23)00165-2. [PMID: 37290689 DOI: 10.1016/j.jhin.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 05/26/2023] [Accepted: 05/29/2023] [Indexed: 06/10/2023]
Abstract
Bone marrow transplant and haemato-oncology patients are at risk of healthcare associated infections due to waterborne pathogens. We undertook a narrative review of waterborne outbreaks in haemato-oncology patients from 2000-2022. Databases searched included Pubmed, DARE and CDSR and were undertaken by two authors. We analysed the organisms implicated, sources identified and infection prevention and control strategies implemented. The most commonly implicated pathogens were Pseudomonas aeruginosa, non-tuberculous mycobacteria and Legionella pneumophila. Bloodstream infection was the most common clinical presentation. The majority of incidents employed multimodal strategies to achieve control, addressing both the water source and routes of transmission. This review highlights the risk to haemato-oncology patients from waterborne pathogens and discusses future preventative strategies and the requirement for new UK guidance for haemato-oncology units.
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Affiliation(s)
- T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK.
| | - J Walker
- Walker on Water, 23 Anderson Road, Bishopdown, Salisbury, UK
| | - M Weinbren
- Department of Microbiology, Kings Mill Hospital, Sutton-in -Ashfield, UK
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16
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Ambreetha S, Singh V. Genetic and environmental determinants of surface adaptations in Pseudomonas aeruginosa. MICROBIOLOGY (READING, ENGLAND) 2023; 169. [PMID: 37276014 DOI: 10.1099/mic.0.001335] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Pseudomonas aeruginosa
is a well-studied Gram-negative opportunistic bacterium that thrives in markedly varied environments. It is a nutritionally versatile microbe that can colonize a host as well as exist in the environment. Unicellular, planktonic cells of
P. aeruginosa
can come together to perform a coordinated swarming movement or turn into a sessile, surface-adhered population called biofilm. These collective behaviours produce strikingly different outcomes. While swarming motility rapidly disseminates the bacterial population, biofilm collectively protects the population from environmental stresses such as heat, drought, toxic chemicals, grazing by predators, and attack by host immune cells and antibiotics. The ubiquitous nature of
P. aeruginosa
is likely to be supported by the timely transition between planktonic, swarming and biofilm lifestyles. The social behaviours of this bacteria viz biofilm and swarm modes are controlled by signals from quorum-sensing networks, LasI-LasR, RhlI-RhlR and PQS-MvfR, and several other sensory kinases and response regulators. A combination of environmental and genetic cues regulates the transition of the
P. aeruginosa
population to specific states. The current review is aimed at discussing key factors that promote physiologically distinct transitioning of the
P. aeruginosa
population.
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Affiliation(s)
- Sakthivel Ambreetha
- Department of Developmental Biology and Genetics, Indian Institute of Science, Bengaluru, Karnataka - 560012, India
| | - Varsha Singh
- Department of Developmental Biology and Genetics, Indian Institute of Science, Bengaluru, Karnataka - 560012, India
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17
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Freier L, Zacharias N, Gemein S, Gebel J, Engelhart S, Exner M, Mutters NT. Environmental Contamination and Persistence of Clostridioides difficile in Hospital Wastewater Systems. Appl Environ Microbiol 2023; 89:e0001423. [PMID: 37071016 PMCID: PMC10231184 DOI: 10.1128/aem.00014-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/28/2023] [Indexed: 04/19/2023] Open
Abstract
Clostridioides difficile produces an environmentally resistant dormant spore morphotype that infected patients shed to the hospital environment. C. difficile spores persist in clinical reservoirs that are not targeted by hospital routine cleaning protocols. Transmissions and infections from these reservoirs present a hazard to patient safety. This study aimed to assess the impact of patients acutely suffering from C. difficile-associated diarrhea (CDAD) on C. difficile environmental contamination to identify potential reservoirs. Twenty-three hospital rooms accommodating CDAD inpatients with corresponding soiled workrooms of 14 different wards were studied in a German maximum-care hospital. Additionally, four rooms that never accommodated CDAD patients were examined as negative controls. Stagnant water and biofilms from sinks, toilets, and washer disinfector (WD) traps as well as swabs from cleaned bedpans and high-touch surfaces (HTSs) were sampled. For detection, a culture method was used with selective medium. A latex agglutination assay and a Tox A/B enzyme-linked immunosorbent assay were performed with suspect colonies. Stagnant water and biofilms in hospital traps (29%), WDs (34%), and HTSs (37%) were found to be reservoirs for large amounts of C. difficile during the stay of CDAD inpatients that decreased but could persist 13 ± 6 days after their discharge (13%, 14%, and 9.5%, respectively). Control rooms showed none or only slight contamination restricted to WDs. A short-term cleaning strategy was implemented that reduced C. difficile in stagnant water almost entirely. IMPORTANCE Wastewater pipes are microbial ecosystems. The potential risk of infection emanating from the wastewater for individuals is often neglected, since it is perceived to remain in the pipes. However, sewage systems start with siphons and are thus naturally connected to the outside world. Wastewater pathogens do not only flow unidirectionally to wastewater treatment plants but also retrogradely, e.g., through splashing water from siphons to the hospital environment. This study focused on the pathogen C. difficile, which can cause severe and sometimes fatal diarrheas. This study shows how patients suffering from such diarrheas contaminate the hospital environment with C. difficile and that contamination persists in siphon habitats after patient discharge. This might pose a health risk for hospitalized patients afterward. Since this pathogen's spore morphotype is very environmentally resistant and difficult to disinfect, we show a cleaning measure that can almost entirely eliminate C. difficile from siphons.
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Affiliation(s)
- Lia Freier
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nicole Zacharias
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Stefanie Gemein
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
- Reference Institute for Bioanalytics, Bonn, Germany
| | - Jürgen Gebel
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Steffen Engelhart
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Martin Exner
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Nico T. Mutters
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
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18
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Chan A, Thure K, Tobey K, Shugart A, Schmedes S, Burks JA, Hardin H, Moore C, Carpenter T, Brooks S, Gable P, Moulton Meissner H, McAllister G, Lawsin A, Laufer Halpin A, Spalding Walters M, Keaton A. Containment of a Verona Integron-Encoded Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Outbreak Associated With an Acute Care Hospital Sink-Tennessee, 2018-2020. Open Forum Infect Dis 2023; 10:ofad194. [PMID: 37180588 PMCID: PMC10173543 DOI: 10.1093/ofid/ofad194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Contaminated healthcare facility wastewater plumbing is recognized as a source of carbapenemase-producing organism transmission. In August 2019, the Tennessee Department of Health (TDH) identified a patient colonized with Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). A record review revealed that 33% (4 of 12) of all reported patients in Tennessee with VIM had history of prior admission to acute care hospital (ACH) A intensive care unit (ICU) Room X, prompting further investigation. Methods A case was defined as polymerase chain reaction detection of blaVIM in a patient with prior admission to ACH A from November 2017 to November 2020. The TDH performed point prevalence surveys, discharge screening, onsite observations, and environmental testing at ACH A. The VIM-CRPA isolates underwent whole-genome sequencing (WGS). Results In a screening of 44% (n = 11) of 25 patients admitted to Room X between January and June 2020, we identified 36% (n = 4) colonized with VIM-CRPA, resulting in 8 cases associated with Room X from March 2018 to June 2020. No additional cases were identified in 2 point-prevalence surveys of the ACH A ICU. Samples from the bathroom and handwashing sink drains in Room X grew VIM-CRPA; all available case and environmental isolates were found to be ST253 harboring blaVIM-1 and to be closely related by WGS. Transmission ended after implementation of intensive water management and infection control interventions. Conclusions A single ICU room's contaminated drains were associated with 8 VIM-CRPA cases over a 2-year period. This outbreak highlights the need to include wastewater plumbing in hospital water management plans to mitigate the risk of transmission of antibiotic-resistant organisms to patients.
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Affiliation(s)
- Allison Chan
- Correspondence: Allison Chan, MPH, Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, 2525 West End Avenue, Suite 600, Nashville, TN 37203 (); Present Affiliation: Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Katie Thure
- Present Affiliation: David Geffen School of Medicine, University of California, Los Angeles, California, USA
| | - Kelley Tobey
- Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Alicia Shugart
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Sarah Schmedes
- Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA
| | - James Albert Burks
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Henrietta Hardin
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Christina Moore
- Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA
| | - Tina Carpenter
- North Knoxville Medical Center, Knoxville, Tennessee, USA
| | | | - Paige Gable
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Heather Moulton Meissner
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Gillian McAllister
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Adrian Lawsin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Alison Laufer Halpin
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Maroya Spalding Walters
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
| | - Amelia Keaton
- Present Affiliation: Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA
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19
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Fraenkel CJ, Starlander G, Tano E, Sütterlin S, Melhus Å. The First Swedish Outbreak with VIM-2-Producing Pseudomonas aeruginosa, Occurring between 2006 and 2007, Was Probably Due to Contaminated Hospital Sinks. Microorganisms 2023; 11:microorganisms11040974. [PMID: 37110397 PMCID: PMC10143745 DOI: 10.3390/microorganisms11040974] [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: 02/22/2023] [Revised: 04/05/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Multidrug-resistant Pseudomonas aeruginosa is an increasing clinical problem worldwide. The aim of this study was to describe the first outbreak of a Verona integron-borne metallo-ß-lactamase (VIM)-2-producing P. aeruginosa strain in Sweden and its expansion in the region. A cluster of multidrug-resistant P. aeruginosa appeared at two neighbouring hospitals in 2006. The isolates were characterized by PCR, pulsed-field gel electrophoresis (PFGE), and whole-genome sequencing. Patient charts, laboratory records, and hygiene routines were reviewed, and patients, staff, and the environment were screened. The investigation revealed a clonal outbreak of a VIM-2-producing P. aeruginosa strain belonging to the high-risk clonal complex 111, susceptible only to gentamicin and colistin. No direct contact between patients could be established, but most of them had stayed in certain rooms/wards weeks to months apart. Cultures from two sinks yielded growth of the same strain. The outbreak ended when control measures against the sinks were taken, but new cases occurred in a tertiary care hospital in the region. In conclusion, when facing prolonged outbreaks with this bacterium, sinks and other water sources in the hospital environment should be considered. By implementing proactive control measures to limit the bacterial load in sinks, the waterborne transmission of P. aeruginosa may be reduced.
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Affiliation(s)
- Carl-Johan Fraenkel
- Department of Infectious Diseases and Hospital Infection Control, Lund University Hospital, SE-22185 Lund, Sweden
| | - Gustaf Starlander
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, SE-75185 Uppsala, Sweden
| | - Eva Tano
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, SE-75185 Uppsala, Sweden
| | - Susanne Sütterlin
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, SE-75185 Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, SE-75185 Uppsala, Sweden
| | - Åsa Melhus
- Section of Clinical Microbiology, Department of Medical Sciences, Uppsala University, SE-75185 Uppsala, Sweden
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20
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Duarte DS, Luzardo FHM, Velasco FG, de Almeida ON, Bedon GDRZ, Nascimento GG, Andrade TBV, Salay LC. Adsorption of BSA Protein in Aqueous Medium Using Vegetable Tannin Resin from Acacia mearnsii (Mimosa) and Modified Lignocellulosic Fibers from the Bark of Eucalyptus citriodora. JOURNAL OF POLYMERS AND THE ENVIRONMENT 2023; 31:1-15. [PMID: 37361350 PMCID: PMC10019408 DOI: 10.1007/s10924-023-02790-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 06/28/2023]
Abstract
Proteins are abundant biomolecules found in human cells, as well as pathogenic bacteria and viruses. Some of them become pollutants when released into water. Adsorption is an advantageous method for separating proteins in aqueous media since proteins are already immobilized on solid surfaces. Adsorbents with surfaces rich in tannins are efficient due to their affinity for strong interactions with the various amino acids that make up proteins. This work aimed to develop an adsorbent for protein adsorption in aqueous medium using lignocellulosic materials modified from eucalyptus bark and vegetable tannins. A more efficient resin was prepared containing 10% eucalyptus bark fibers and 90% tannin mimosa by condensation with formaldehyde, and it was characterized by UV-Vis, FTIR-ATR spectroscopy and determinations of degree of swelling, bulk and bulk density and specific mass. For UV-Vis spectroscopy the percentage of condensed and hydrolysable tannins in the extracts of fibers of the dry husks of Eucalyptus Citriodora was estimated and it was also determined your soluble solids. The study of bovine serum albumin (BSA) adsorption was carried out in batch with quantification by UV-Vis spectroscopy. The most efficient prepared resin obtained 71.6 ± 2.78% removal in a solution of 260 mg L-1 of BSA working in a better pH range of the aqueous solution of BSA in its isoelectric point, ~ 5, 32 ± 0.02, under these conditions, the synthesized resin can reach a maximum BSA adsorption capacity of ~ 26.7 ± 0.29 mg g-1 in 7 min. The new synthesized resin presents good prospects for adsorption of proteins or species that in their structure have higher percentages of amino functional groups or amino acids with aliphatic, acidic and/or basic hydrophilic characteristics. Graphical Abstract
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Affiliation(s)
- Dalvani S. Duarte
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Francisco H. M. Luzardo
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Fermin G. Velasco
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Ohana N. de Almeida
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Guisela D. R. Z. Bedon
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Glauber G. Nascimento
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Thais B. V. Andrade
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
| | - Luiz C. Salay
- Department of Exact e Technological Sciences, State University of Santa Cruz – UESC, Ilhéus, Bahia Brazil
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21
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Walker J, Inkster T, Weinbren M. Aspects and problems associated with the water services to be considered in intensive care units. J Infect Prev 2023; 24:60-64. [PMID: 36815062 PMCID: PMC9940243 DOI: 10.1177/17571774231152716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 12/13/2022] [Indexed: 01/13/2023] Open
Abstract
Background Water is a product taken for granted and assumed to be a safe commodity in intensive care units (ICU). Biofilm readily becomes established in complex water services presenting a risk to vulnerable patients. Harboured within biofilms are opportunistic pathogens which can be transmitted via hand contact, splashing, aerosol and indirect contact through medical equipment. Evidence linking the role of water services in transmission of infection to patients in ICUs has increased in recent years. Aims This research based commentary set out to identify current problems with water and wastewater systems in ICU settings. Methods Databases and open source information was used to obtain data on current water and wastewater-related issues in ICU settings. This and the authors experiences have been used to describe current challenges. Findings the authors found a number of problems with water systems in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk. Discussion Hand hygiene stations are frequently misused or close enough to patients such that splashing poses a transmission risk. The wastewater system (drain) also presents a risk, from where Gram-negative antibiotic resistant organisms may be dispersed resulting in untreatable patient infections. The water and wastewater system provide a superhighway for the movement of pathogenic microorganisms and these risks need to be addressed if we are to safeguard vulnerable users in ICU.
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Affiliation(s)
| | - Teresa Inkster
- Department of Microbiology, Queen Elizabeth University Hospital Campus, Glasgow, UK
| | - Michael Weinbren
- Department of Microbiology, King’s Mill Hospital, Sutton-in-Ashfield, UK
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Huang D, Wang Y, Xiao J, Wang Y, Zhu X, Xu B, Wang M. Scavenging of reactive oxygen species effectively reduces Pseudomonas aeruginosa biofilms through disrupting policing. ENVIRONMENTAL RESEARCH 2023; 220:115182. [PMID: 36586713 DOI: 10.1016/j.envres.2022.115182] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 06/17/2023]
Abstract
Biofilm formation is likely to contribute greatly to antibiotic resistance in bacteria and therefore the efficient removal of bacterial biofilms needs addressing urgently. Here, we reported that the supplement of non-inhibitory concentration of N-acetyl-L-cysteine (NAC), a common reactive oxygen species (ROS) scavenger, can significantly reduce the biomass of mature Pseudomonas aeruginosa biofilms (corroborated by crystal violet assay and laser scanning confocal microscopy). 1 mM NAC increased the cheater (ΔlasR mutant) frequency to 89.4 ± 1.5% in the evolved PAO1 after the 15-day treatment. Scavenging of ROS by NAC induced the collapse of P. aeruginosa biofilms, but it did not alter quorum sensing-regulated genes expression (e.g., hcnC and cioAB) and hydrogen cyanide production. The replenishment of public good protease contributed to the recovery of biofilm biomass, indicating the role of disrupting policing in biofilm inhibition. Furthermore, 7 typical ROS scavengers (e.g., superoxide dismutase, catalase and peroxidase, etc.) also effectively inhibited mature P. aeruginosa biofilms. This study demonstrates that scavenging of ROS can promote the selective control of P. aeruginosa biofilms through policing disruption as a targeted biofilm control strategy in complex water environments.
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Affiliation(s)
- Dan Huang
- School of Environmental Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling, Hangzhou, 310012, China
| | - Yujie Wang
- School of Environmental Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310012, China
| | - Junwei Xiao
- School of Environmental Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310012, China
| | - Yufan Wang
- School of Environmental Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310012, China
| | - Xinyu Zhu
- Eco-Environmental Science Research and Design Institute of Zhejiang Province, Hangzhou, 310007, China
| | - Baile Xu
- Institute of Soil and Water Resources and Environmental Science, College of Environment and Resource Sciences, Zhejiang University, Hangzhou, 310058, China
| | - Meizhen Wang
- School of Environmental Science and Engineering, Zhejiang Gongshang University, Hangzhou, 310012, China; Zhejiang Provincial Key Laboratory of Solid Waste Treatment and Recycling, Hangzhou, 310012, China.
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Challenges in the Hospital Water System and Innovations to Prevent Healthcare-Associated Infections. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2023. [DOI: 10.1007/s40506-023-00261-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Rice W, Martin J, Hodgkin M, Carter J, Barrasa A, Sweeting K, Johnson R, Best E, Nahl J, Denton M, Hughes GJ. A protracted outbreak of difficult-to-treat resistant Pseudomonas aeruginosa in a haematology unit: a matched case-control study demonstrating increased risk with use of fluoroquinolone. J Hosp Infect 2023; 132:52-61. [PMID: 36563938 DOI: 10.1016/j.jhin.2022.11.013] [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: 09/09/2022] [Revised: 11/11/2022] [Accepted: 11/20/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Between September 2016 and November 2020, 17 cases of difficult-to-treat resistant Pseudomonas aeruginosa (DTR-PA) were reported in haematology patients at a tertiary referral hospital in the North of England. AIM A retrospective case-control study was conducted to investigate the association between DTR-PA infection and clinical interventions, patient movement, antimicrobial use and comorbidities. METHODS Cases were patients colonized or infected with the outbreak strain of DTR-PA who had been admitted to hospital prior to their positive specimen. Exposures were extracted from medical records, and cases were compared with controls using conditional logistic regression. Environmental and microbiological investigations were also conducted. FINDINGS Seventeen cases and 51 controls were included. The final model included age [>65 years, adjusted OR (aOR) 6.85, P=0.232], sex (aOR 0.60, P=0.688), admission under the transplant team (aOR 14.27, P=0.43) and use of ciprofloxacin (aOR 102.13, P=0.030). Investigations did not indicate case-to-case transmission or a point source, although a common environmental source was highly likely. CONCLUSION This study found that the use of fluoroquinolones is an independent risk factor for DTR-PA in haematology patients. Antimicrobial stewardship and review of fluoroquinolone prophylaxis should be considered as part of PA outbreak investigations in addition to standard infection control interventions.
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Affiliation(s)
- W Rice
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK; Field Service, United Kingdom Health Security Agency, Leeds, UK
| | - J Martin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - M Hodgkin
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Carter
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - A Barrasa
- Field Epidemiology Training Programme, United Kingdom Heath Security Agency, London, UK
| | - K Sweeting
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - R Johnson
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - E Best
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Nahl
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - M Denton
- Field Service, United Kingdom Health Security Agency, Leeds, UK; Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - G J Hughes
- Field Service, United Kingdom Health Security Agency, Leeds, UK.
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Better Outcome of Off-Label High-Dose Ceftazidime in Hemato-Oncological Patients with Infections Caused by Extensively Drug-Resistant Pseudomonas Aeruginosa. Mediterr J Hematol Infect Dis 2023; 15:e2023001. [PMID: 36660352 PMCID: PMC9833305 DOI: 10.4084/mjhid.2023.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/09/2022] [Indexed: 01/03/2023] Open
Abstract
Background P. aeruginosa sepsis in immunocompromised patients is a serious complication of cancer treatment, especially in the case of an Extensively Drug Resistant (XDR) pathogen. The aim of the study is to evaluate the efficacy of high-dose ceftazidime in the treatment of XDR P. aeruginosa infection and to compare it with the conventionally treated cohort in hemato-oncological patients. Methods We identified 27 patients with XDR P. aeruginosa infection during the 2008-2018 period, 16 patients served as a conventionally treated cohort with an antipseudomonal beta-lactam antibiotic in standard dose (cohort A), and 11 patients were treated with high-dose ceftazidime (cohort B). Most of the patients were neutropenic and under active treatment for their cancer in both cohorts. Results Mortality and related mortality were statistically significantly better for cohort B than cohort A; it was 18.2% and 9.1% for cohort B and 68.8% and 68.8% for cohort A, respectively. More patients in cohort A needed mechanical ventilation and renal replacement therapy, 75% and 50% for cohort A and 27.3% and 9.9% for cohort B, respectively. It corresponded well with the worst sequential organ failure score (SOFA) in cohort A compared to cohort B, 16 versus 7, respectively. Reversible neurotoxicity was seen only in two patients in cohort B. Conclusion Ceftazidime in high doses is a very potent antibiotic (ATB) for treating XDR P. aeruginosa infections in neutropenic cancer with acceptable toxicity.
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Pham TM, Büchler AC, Voor in ‘t holt AF, Severin JA, Bootsma MCJ, Gommers D, Kretzschmar ME, Vos MC. Routes of transmission of VIM-positive Pseudomonas aeruginosa in the adult intensive care unit-analysis of 9 years of surveillance at a university hospital using a mathematical model. Antimicrob Resist Infect Control 2022; 11:55. [PMID: 35379340 PMCID: PMC8981946 DOI: 10.1186/s13756-022-01095-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 03/15/2022] [Indexed: 12/03/2022] Open
Abstract
Background Hospital outbreaks of multidrug resistant Pseudomonas aeruginosa are often caused by Pseudomonas aeruginosa clones which produce metallo-β-lactamases, such as Verona Integron-encoded Metallo-β-lactamase (VIM). Although different sources have been identified, the exact transmission routes often remain unknown. However, quantifying the role of different transmission routes of VIM-PA is important for tailoring infection prevention and control measures. The aim of this study is to quantify the relative importance of different transmission routes by applying a mathematical transmission model using admission and discharge dates as well as surveillance culture data of patients. Methods We analyzed VIM-PA surveillance data collected between 2010 and 2018 of two intensive-care unit (ICU) wards for adult patients of the Erasmus University Medical Center Rotterdam using a mathematical transmission model. We distinguished two transmission routes: direct cross-transmission and a persistent environmental route. Based on admission, discharge dates, and surveillance cultures, we estimated the proportion of transmissions assigned to each of the routes. Results Our study shows that only 13.7% (95% CI 1.4%, 29%) of the transmissions that occurred in these two ICU wards were likely caused by cross-transmission, leaving the vast majority of transmissions (86.3%, 95% CI 71%, 98.6%) due to persistent environmental contamination. Conclusions Our results emphasize that persistent contamination of the environment may be an important driver of nosocomial transmissions of VIM-PA in ICUs. To minimize the transmission risk from the environment, potential reservoirs should be regularly and thoroughly cleaned and disinfected, or redesigned. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01095-x.
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Bakon SK, Mohamad ZA, Jamilan MA, Hashim H, Kuman MY, Shaharudin R, Ahmad N, Muhamad NA. Prevalence of antibiotics resistant pathogenic bacteria and level of antibiotic residues in the hospital effluents in Selangor: study protocol (Preprint). JMIR Res Protoc 2022; 12:e39022. [DOI: 10.2196/39022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 02/24/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023] Open
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Draft genome analysis of a multidrug-resistant Pseudomonas aeruginosa CMPL223 from hospital wastewater in Dhaka, Bangladesh. J Glob Antimicrob Resist 2022; 30:237-240. [DOI: 10.1016/j.jgar.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/24/2022] Open
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29
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Mohamad ZA, Bakon SK, Jamilan MA, Daud N, Ciric L, Ahmad N, Muhamad NA. Prevalence of antibiotic resistance in pre-and post-treatment of drinking water treatment plant (DWTPs) in Malaysia: protocol for a cross-sectional study (Preprint). JMIR Res Protoc 2022; 11:e37663. [DOI: 10.2196/37663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 08/29/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
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30
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Vardoulakis S, Espinoza Oyarce DA, Donner E. Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 803:149932. [PMID: 34525681 PMCID: PMC8390098 DOI: 10.1016/j.scitotenv.2021.149932] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/13/2021] [Accepted: 08/23/2021] [Indexed: 05/03/2023]
Abstract
BACKGROUND The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments. METHODS We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms. RESULTS Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings. CONCLUSION Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.
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Affiliation(s)
- Sotiris Vardoulakis
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia.
| | - Daniela A Espinoza Oyarce
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Canberra, ACT 2601, Australia
| | - Erica Donner
- Future Industries Institute, University of South Australia, Mawson Lakes, SA 5095, Australia
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Weinbren M, Inkster T, Lafferty F. Drains and the periphery of the water system - what do you do when the guidance is outdated? Infect Prev Pract 2022; 3:100179. [PMID: 34988421 PMCID: PMC8696270 DOI: 10.1016/j.infpip.2021.100179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022] Open
Abstract
The periphery of the water system (defined as the last 2 m of pipework from an outlet and ensuing devices including drainage), is the juncture of multiple inherent risks: the necessity to use materials with higher risk of biofilm formation, difficulty in maintaining safe water temperatures, a human interface with drainage systems, poor design, poor layout and use by staff. Add to this risk a large new healthcare facility capital build programme in England, outdated guidance and bacteria emanating from drainage systems containing highly mobile genetic elements (threatening the end of the antibiotic era), and the scene is set for the perfect storm. There is an urgent need for the re-evaluation of the periphery of the water system and drainage systems. Consequently, in this article we examine the requirement and placement of hand wash stations (HWSs), design of showers, kitchens and the dirty utility with respect to water services. Lastly, we discuss the provision of safe water to high-risk patient groups. The purpose of this article is to stimulate debate and provide infection control and design teams with support in deviating from the outdated existing guidance and to challenge conventional thinking until new advice is forthcoming.
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Affiliation(s)
- M Weinbren
- Department of Microbiology, King's Mill Hospital, Sutton-in-Ashfield, UK
| | - T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
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32
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Tümmler B. What Makes Pseudomonas aeruginosa a Pathogen? ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1386:283-301. [DOI: 10.1007/978-3-031-08491-1_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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National surveillance pilot study unveils a multicenter, clonal outbreak of VIM-2-producing Pseudomonas aeruginosa ST111 in the Netherlands between 2015 and 2017. Sci Rep 2021; 11:21015. [PMID: 34697344 PMCID: PMC8545960 DOI: 10.1038/s41598-021-00205-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/29/2021] [Indexed: 02/01/2023] Open
Abstract
Verona Integron-encoded Metallo-beta-lactamase (VIM) is the most frequently-encountered carbapenemase in the healthcare-related pathogen Pseudomonas aeruginosa. In the Netherlands, a low-endemic country for antibiotic-resistant bacteria, no national surveillance data on the prevalence of carbapenemase-producing P. aeruginosa (CPPA) was available. Therefore, in 2016, a national surveillance pilot study was initiated to investigate the occurrence, molecular epidemiology, genetic characterization, and resistomes of CPPA among P. aeruginosa isolates submitted by medical microbiology laboratories (MMLs) throughout the country. From 1221 isolates included in the study, 124 (10%) produced carbapenemase (CIM-positive); of these, the majority (95, 77%) were positive for the blaVIM gene using PCR. Sequencing was performed on 112 CIM-positive and 56 CIM-negative isolates (n = 168), and genetic clustering revealed that 75/168 (45%) isolates were highly similar. This genetic cluster, designated Group 1, comprised isolates that belonged to high-risk sequence type ST111/serotype O12, had similar resistomes, and all but two carried the blaVIM-2 allele on an identical class 1 integron. Additionally, Group 1 isolates originated from around the country (i.e. seven provinces) and from multiple MMLs. In conclusion, the Netherlands had experienced a nationwide, inter-institutional, clonal outbreak of VIM-2-producing P. aeruginosa for at least three years, which this pilot study was crucial in identifying. A structured, national surveillance program is strongly advised to monitor the spread of Group 1 CPPA, to identify emerging clones/carbapenemase genes, and to detect transmission in and especially between hospitals in order to control current and future outbreaks.
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34
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Weinbren M, Inkster T. Role of the kitchen environment. Infect Prev Pract 2021; 3:100155. [PMID: 34647009 PMCID: PMC8498711 DOI: 10.1016/j.infpip.2021.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 06/03/2021] [Indexed: 11/11/2022] Open
Affiliation(s)
- M Weinbren
- Department of Microbiology, King's Mill Hospital, Sutton-in-Ashfield, UK
| | - T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
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35
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Aranega-Bou P, Ellaby N, Ellington MJ, Moore G. Migration of Escherichia coli and Klebsiella pneumoniae Carbapenemase (KPC)-Producing Enterobacter cloacae through Wastewater Pipework and Establishment in Hospital Sink Waste Traps in a Laboratory Model System. Microorganisms 2021; 9:microorganisms9091868. [PMID: 34576763 PMCID: PMC8468231 DOI: 10.3390/microorganisms9091868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/19/2021] [Accepted: 08/20/2021] [Indexed: 11/17/2022] Open
Abstract
Sink waste traps and drains are a reservoir for multi-drug resistant Gram-negative bacteria in the hospital environment. It has been suggested that these bacteria can migrate through hospital plumbing. Hospital waste traps were installed in a laboratory model system where sinks were connected through a common wastewater pipe. Enterobacterales populations were monitored using selective culture, MALDI-TOF identification and antibiotic resistance profiling before and after a wastewater backflow event. When transfer between sinks was suspected, isolates were compared using whole-genome sequencing. Immediately after the wastewater backflow, two KPC-producing Enterobacter cloacae were recovered from a waste trap in which Carbapenemase-producing Enterobacterales (CPE) had not been detected previously. The isolates belonged to ST501 and ST31 and were genetically indistinguishable to those colonising sinks elsewhere in the system. Following inter-sink transfer, KPC-producing E. cloacae ST501 successfully integrated into the microbiome of the recipient sink and was detected in the waste trap water at least five months after the backflow event. Seven weeks and three months after the backflow, other inter-sink transfers involving Escherichia coli ST5295 and KPC-producing E. cloacae ST501 were also observed.
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Affiliation(s)
- Paz Aranega-Bou
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Manor Farm Rd, Porton Down, Salisbury SP4 0JG, UK;
- Correspondence: ; Tel.: +44-1980612630
| | - Nicholas Ellaby
- Antimicrobial Resistance and Health Care Associated Infections, National infection Service, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| | - Matthew J. Ellington
- National Infection Service Laboratories, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK;
| | - Ginny Moore
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Manor Farm Rd, Porton Down, Salisbury SP4 0JG, UK;
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Kearney A, Boyle MA, Curley GF, Humphreys H. Preventing infections caused by carbapenemase-producing bacteria in the intensive care unit - Think about the sink. J Crit Care 2021; 66:52-59. [PMID: 34438134 DOI: 10.1016/j.jcrc.2021.07.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/27/2021] [Accepted: 07/28/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Outbreaks caused by carbapenemase-producing bacteria (CPB) are challenging to manage in critical care settings and can be protracted due to inadvertent and ubiquitous ecological niches within the built unit environment, such as handwashing sinks. We discuss evidence from a narrative review on transmission pathways and interventions for critical care practitioners. METHODS A literature review was undertaken using Pubmed, CINAHL and Embase and included outbreaks of CPB, and equivalent bacteria in critical care units, between 1998 and May 2020. Intervention studies targeting elements of sinks that were employed in response to outbreaks in critical care units were included (n = 30). FINDINGS We found control measures included sink removal, use of physical barriers or design modification to protect patients from sinks, engineering controls to mitigate bacterial dispersal and administrative controls. A multi-disciplinary approach involving practitioners from critical care, infection prevention and control, engineering and other staff, should be involved in ongoing measures and in outbreak control activities. Ascertaining the optimal method to end CPB outbreaks in critical care is challenging due to the lack of prospective studies available. However, the literature suggests that sinks can and do serve as reservoirs of CPB near critically ill patients, and should be considered hazardous, especially when sub-optimally designed or used.
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Affiliation(s)
- A Kearney
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland.
| | - M A Boyle
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland
| | - G F Curley
- Department of Anaesthesia and Critical Care, the Royal College of Surgeons in Ireland, Ireland
| | - H Humphreys
- Department of Clinical Microbiology, the Royal College of Surgeons in Ireland, Ireland; Department of Microbiology, Beaumont Hospital, Dublin, Ireland
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Inkster T, Peters C, Wafer T, Holloway D, Makin T. Investigation and control of an outbreak due to a contaminated hospital water system, identified following a rare case of Cupriavidus pauculus bacteraemia. J Hosp Infect 2021; 111:53-64. [PMID: 33926650 DOI: 10.1016/j.jhin.2021.02.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Cupriavidus pauculus is rare cause of clinical infection. We describe an outbreak of C. pauculus and other Gram-negative bacteraemias in a paediatric haemato-oncology unit secondary to a contaminated water supply and drainage system. AIM To describe the investigation and control measures implemented for a waterborne infection outbreak in a new build hospital. METHODS Extensive water testing from various points within the water system was undertaken. Taps, showerheads and components including flow straighteners underwent microbiological analysis. Drains were also swabbed. Surveillance for Gram-negative infections was established on the unit. FINDINGS Water testing revealed widespread contamination of the water and drainage system. Outlets were also heavily contaminated, including flow straighteners. Drains were found to have underlying structural abnormalities. Water testing enabled us to detect high-risk components within the water system such as the expansion vessels and outlets and the results assisted with hypotheses generation. Review of commissioning data and risk assessments revealed extensive risks present within the water system prior to and after hospital opening. CONCLUSION Careful design, adequate control measures and maintenance are essential for hospital water systems in order to prevent infections due to waterborne organisms. We discuss what can be learned from this incident with a view to future prevention.
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Affiliation(s)
- T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK.
| | - C Peters
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - T Wafer
- The Water Solutions Group, Haggs Road, Harrogate, UK
| | - D Holloway
- Water Quality Services, Intertek, Stoke on Trent, UK
| | - T Makin
- Makin and Makin Consultancy, Tarporley, UK
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Nishiyama M, Praise S, Tsurumaki K, Baba H, Kanamori H, Watanabe T. Prevalence of Antibiotic-Resistant Bacteria ESKAPE among Healthy People Estimated by Monitoring of Municipal Wastewater. Antibiotics (Basel) 2021; 10:495. [PMID: 33925842 PMCID: PMC8145489 DOI: 10.3390/antibiotics10050495] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 04/12/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
There is increasing attention toward factors that potentially contribute to antibiotic resistance (AR), as well as an interest in exploring the emergence and occurrence of antibiotic resistance bacteria (ARB). We monitored six ARBs that cause hospital outbreaks in wastewater influent to highlight the presence of these ARBs in the general population. We analyzed wastewater samples from a municipal wastewater treatment plant (MWWTP) and hospital wastewater (HW) for six species of ARB: Carbapenem-resistant Enterobacteria (CARBA), extended-spectrum β-lactamase producing Enterobacteria (ESBL), multidrug-resistant Acinetobacter (MDRA), multidrug-resistant Pseudomonas aeruginosa (MDRP), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-resistant Enterococci (VRE). We registered a high percentage of ARBs in MWWTP samples (>66%) for all ARBs except for MDRP, indicating a high prevalence in the population. Percentages in HW samples were low (<78%), and no VRE was detected throughout the study. CARBA and ESBL were detected in all wastewater samples, whereas MDRA and MRSA had a high abundance. This result demonstrated the functionality of using raw wastewater at MWWTP to monitor the presence and extent of ARB in healthy populations. This kind of surveillance will contribute to strengthening the efforts toward reducing ARBs through the detection of ARBs to which the general population is exposed.
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Affiliation(s)
- Masateru Nishiyama
- Department of Food, Life and Environmental Sciences, Faculty of Agriculture, Yamagata University, Tsuruoka 9978555, Japan; (S.P.); (K.T.)
| | - Susan Praise
- Department of Food, Life and Environmental Sciences, Faculty of Agriculture, Yamagata University, Tsuruoka 9978555, Japan; (S.P.); (K.T.)
| | - Keiichi Tsurumaki
- Department of Food, Life and Environmental Sciences, Faculty of Agriculture, Yamagata University, Tsuruoka 9978555, Japan; (S.P.); (K.T.)
| | - Hiroaki Baba
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 9808574, Japan; (H.B.); (H.K.)
| | - Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai 9808574, Japan; (H.B.); (H.K.)
| | - Toru Watanabe
- Department of Food, Life and Environmental Sciences, Faculty of Agriculture, Yamagata University, Tsuruoka 9978555, Japan; (S.P.); (K.T.)
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Aranega-Bou P, Cornbill C, Verlander NQ, Moore G. A splash-reducing clinical handwash basin reduces droplet-mediated dispersal from a sink contaminated with Gram-negative bacteria in a laboratory model system. J Hosp Infect 2021; 114:171-174. [PMID: 33895165 DOI: 10.1016/j.jhin.2021.04.017] [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: 03/09/2021] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Infection prevention strategies need to be identified and evaluated to reduce the risk associated with contaminated hospital sinks. This study used settle plates to compare the dispersal of Gram-negative bacteria from a conventional, rear-draining clinical handwash basin (CHWB) and a 'splash-reducing' CHWB with and/or without impaired drainage. Two scenarios were assessed: dispersal from a contaminated basin and dispersal from a contaminated drain. The associated tap was operated for 1 min and, for all contamination scenarios, the 'splash-reducing' CHWB had significantly lower odds of spreading contamination than the conventional CHWB.
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Affiliation(s)
- P Aranega-Bou
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK.
| | - C Cornbill
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
| | - N Q Verlander
- Statistics Unit, Statistics, Modelling and Economics Department, National Infection Service, Public Health England, Colindale, UK
| | - G Moore
- Biosafety, Air and Water Microbiology Group, National Infection Service, Public Health England, Salisbury, UK
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Wu L, Wu ZC, Todosiichuk T, Korneva O. Nosocomial Infections: Pathogenicity, Resistance and Novel Antimicrobials. INNOVATIVE BIOSYSTEMS AND BIOENGINEERING 2021. [DOI: 10.20535/ibb.2021.5.2.228970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background. The fight against the spread of infectious diseases creates the problem of resistance to pathogens and the most resistant of them – the propagators of nosocomial infections – are formed in hospitals because of a number of reasons. The solution of the problem lies in different areas, but the search of new effective means for the treatment of such diseases remains relevant right today. The shortest way to do this is to find the "pain points" of the pathogens themselves, i.e. the factors of their pathogenicity and resistance to which the action of novel antiseptics should be directed.
Objective. We aimed to analyse and evaluate the main factors of pathogenicity and resistance of pathogens of nosocomial infections to determine modern approaches to the development of novel antimicrobials.
Methods. Search and systematization of new scientific data and results concerning pathogenic factors of microbial pathogens that can be used as targets for the action of drugs.
Results. Over the last 10–20 years, due to the development of new research methods in biology, it has become possible to clarify the features and additional conditions for the detection of pathogenic factors of nosocomial infections. Additional mechanisms of manifestation of resistance, adhesiveness, invasiveness, transmission of signs, secretion of toxins by pathogens are shownthat determines the general increase of their resistance to the action of currently used means. The general idea of creating antiseptics that will not increase the resistance of pathogens can now be implemented by using substances with multidirectional or indirect mechanisms of action that minimally affect the metabolism of the cell and significantly reduce its resistance and pathogenicity.
Conclusions. Factors of pathogenicity of propagators of nosocomial infections and mechanisms of their implementation can be considered as the main targets for the action of novel antiseptics that will inhibit the spread of pathogens without increasing their resistance. The promising substances for such drugs, among other things, are bacteriophages and their modifications, enzybiotics, immunobiotics, autoinducer inhibitors, quorum sensing-system inhibitors, b-lactamase inhibitors and others. Some of these substances in combination with the new generation of antibiotics significantly enhance their effectiveness and together they are able to overcome the resistance of even multidrug-resistant pathogens.
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Valentin AS, Santos SD, Goube F, Gimenes R, Decalonne M, Mereghetti L, Daniau C, van der Mee-Marquet N. A prospective multicentre surveillance study to investigate the risk associated with contaminated sinks in the intensive care unit. Clin Microbiol Infect 2021; 27:1347.e9-1347.e14. [PMID: 33640576 DOI: 10.1016/j.cmi.2021.02.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/15/2021] [Accepted: 02/16/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES The aim was to assess the incidence of sink contamination by multidrug-resistant (MDR) Pseudomonas aeruginosa and Enterobacteriaceae, risk factors for sink contamination and splashing, and their association with clinical infections in the intensive care setting. METHODS A prospective French multicentre study (1 January to 30 May 2020) including in each intensive care unit (ICU) a point-prevalence study of sink contamination, a questionnaire of risk factors for sink contamination (sink use, disinfection procedure) and splashing (visible plashes, distance and barrier between sink and bed), and a 3-month prospective infection survey. RESULTS Seventy-three ICUs participated in the study. In total, 50.9% (606/1191) of the sinks were contaminated by MDR bacteria: 41.0% (110/268) of the sinks used only for handwashing, 55.3% (510/923) of those used for waste disposal, 23.0% (62/269) of sinks daily bleached, 59.1% (126/213) of those daily exposed to quaternary ammonium compounds (QACs) and 62.0% (285/460) of those untreated; 459 sinks (38.5%) showed visible splashes and 30.5% (363/1191) were close to the bed (<2 m) with no barrier around the sink. MDR-associated bloodstream infection incidence rates ≥0.70/1000 patient days were associated with ICUs meeting three or four of these conditions, i.e. a sink contamination rate ≥51%, prevalence of sinks with visible splashes ≥14%, prevalence of sinks close to the patient's bed ≥21% and no daily bleach disinfection (6/30 (20.0%) of the ICUs with none, one or two factors vs. 14/28 (50.0%) of the ICUs with three or four factors; p 0.016). DISCUSSION Our data showed frequent and multifactorial infectious risks associated with contaminated sinks in ICUs.
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Affiliation(s)
- Anne-Sophie Valentin
- Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France
| | - Sandra Dos Santos
- Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France
| | - Florent Goube
- Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France
| | - Rémi Gimenes
- Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France
| | - Marie Decalonne
- Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France
| | - Laurent Mereghetti
- Service de Bactériologie, Virologie et Hygiène, Centre Hospitalier Universitaire, Tours, France
| | - Côme Daniau
- Unité Infections Associées aux Soins et Résistance aux Antibiotiques, Agence Santé Publique France, Saint Maurice, France
| | - Nathalie van der Mee-Marquet
- Mission Nationale SPIADI, Centre d'Appui pour la Prévention des Infections Associées aux Soins en Région Centre Val de Loire, Centre Hospitalier Universitaire, Tours, France.
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Weinbren M, Inkster T. The hospital-built environment: biofilm, biodiversity and bias. J Hosp Infect 2021; 111:50-52. [PMID: 33631235 DOI: 10.1016/j.jhin.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- M Weinbren
- Department of Microbiology, King's Mill Hospital, Sutton-in-Ashfield, UK.
| | - T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
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Halstead FD, Quick J, Niebel M, Garvey M, Cumley N, Smith R, Neal T, Roberts P, Hardy K, Shabir S, Walker JT, Hawkey P, Loman NJ. Pseudomonas aeruginosa infection in augmented care: the molecular ecology and transmission dynamics in four large UK hospitals. J Hosp Infect 2021; 111:162-168. [PMID: 33539934 DOI: 10.1016/j.jhin.2021.01.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/15/2021] [Accepted: 01/16/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is a common opportunistic pathogen and molecular typing in outbreaks has linked patient acquisition to contaminated hospital water systems. AIM To elucidate the role of P. aeruginosa transmission rates in non-outbreak augmented care settings in the UK. METHODS Over a 16-week period, all water outlets in augmented care units of four hospitals were sampled for P. aeruginosa and clinical isolates were collected. Outlet and clinical P. aeruginosa isolates underwent whole-genome sequencing (WGS), which with epidemiological data identified acquisition from water as definite (level 1), probable (level 2), possible (level 3), and no evidence (level 4). FINDINGS Outlets were positive in each hospital on all three occasions: W (16%), X (2.5%), Y (0.9%) and Z (2%); and there were 51 persistently positive outlets in total. WGS identified likely transmission (at levels 1, 2 and 3) from outlets to patients in three hospitals for P. aeruginosa positive patients: W (63%), X (54.5%) and Z (26%). According to the criteria (intimate epidemiological link and no phylogenetic distance), approximately 5% of patients in the study 'definitely' acquired their P. aeruginosa from their water outlets in the intensive care unit. This study found extensive evidence of transmission from the outlet to the patients particularly in the newest hospital (W), which had the highest rate of positive outlets. CONCLUSIONS The overall findings suggest that water outlets are the most likely source of P. aeruginosa nosocomial infections in some settings, and that widespread introduction of control measures would have a substantial impact on infections.
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Affiliation(s)
- F D Halstead
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - J Quick
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
| | - M Niebel
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M Garvey
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - N Cumley
- NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK; Department of Clinical Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Smith
- Royal Free London NHS Foundation Trust, Hampstead, London, UK
| | - T Neal
- Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - P Roberts
- Royal Liverpool University Hospital, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - K Hardy
- Public Health England, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | - S Shabir
- Public Health England, Heartlands Hospital, University Hospitals Birmingham, Birmingham, UK
| | | | - P Hawkey
- Department of Clinical Microbiology, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK.
| | - N J Loman
- Institute of Microbiology and Infection, School of Biosciences, University of Birmingham, Birmingham, UK
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Hofmaenner DA, Wendel Garcia PD, Duvnjak B, Chakrakodi B, Maier JD, Huber M, Huder J, Wolfensberger A, Schreiber PW, Schuepbach RA, Zinkernagel AS, Buehler PK, Brugger SD. Bacterial but no SARS-CoV-2 contamination after terminal disinfection of tertiary care intensive care units treating COVID-19 patients. Antimicrob Resist Infect Control 2021; 10:11. [PMID: 33436105 PMCID: PMC7802978 DOI: 10.1186/s13756-021-00885-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 01/05/2021] [Indexed: 01/08/2023] Open
Abstract
Background In intensive care units (ICUs) treating patients with Coronavirus disease 2019 (COVID-19) invasive ventilation poses a high risk for aerosol and droplet formation. Surface contamination of severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) or bacteria can result in nosocomial transmission.
Methods Two tertiary care COVID-19 intensive care units treating 53 patients for 870 patient days were sampled after terminal cleaning and preparation for regular use to treat non-COVID-19 patients. Results A total of 176 swabs were sampled of defined locations covering both ICUs. No SARS-CoV-2 ribonucleic acid (RNA) was detected. Gram-negative bacterial contamination was mainly linked to sinks and siphons. Skin flora was isolated from most swabbed areas and Enterococcus faecium was detected on two keyboards. Conclusions After basic cleaning with standard disinfection measures no remaining SARS-CoV-2 RNA was detected. Bacterial contamination was low and mainly localised in sinks and siphons.
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Affiliation(s)
- Daniel A Hofmaenner
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Pedro David Wendel Garcia
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Branko Duvnjak
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Bhavya Chakrakodi
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Julian D Maier
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Michael Huber
- Institute of Medical Virology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Jon Huder
- Institute of Medical Virology, University of Zurich, Winterthurerstrasse 190, CH-8057, Zurich, Switzerland
| | - Aline Wolfensberger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Peter W Schreiber
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Reto A Schuepbach
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Annelies S Zinkernagel
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Philipp K Buehler
- Institute of Intensive Care, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland
| | - Silvio D Brugger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Raemistrasse 100, CH-8091, Zurich, Switzerland.
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Coppola PE, Gaibani P, Sartor C, Ambretti S, Lewis RE, Sassi C, Pignatti M, Paolini S, Curti A, Castagnetti F, Ursi M, Cavo M, Stanzani M. Ceftolozane-Tazobactam Treatment of Hypervirulent Multidrug Resistant Pseudomonas aeruginosa Infections in Neutropenic Patients. Microorganisms 2020; 8:E2055. [PMID: 33371496 PMCID: PMC7767535 DOI: 10.3390/microorganisms8122055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/07/2020] [Accepted: 12/11/2020] [Indexed: 12/28/2022] Open
Abstract
The effectiveness of ceftolozane/tazobactam for the treatment of infections in neutropenic patients caused by hypervirulent multidrug-resistant (MDR) Pseudomonas aeruginosa has not been previously reported. We identified seven cases of MDR P. aeruginosa infection in neutropenic patients over a four-month period within the same hematology ward. Four cases were associated with rapid progression despite piperacillin-tazobactam or meropenem therapy, and three patients developed sepsis or extensive skin/soft tissue necrosis. In three of the four cases, patients were empirically switched from meropenem to ceftolozane/avibactam before carbapenem susceptibility test results were available, and all four patients underwent extensive surgical debridement or amputation of affected tissues and survived. Further investigation revealed a common bathroom source of MDR P. aeruginosa clonal subtypes ST175 and ST235 that harbored genes for type III secretion system expression and elaboration of ExoU or ExoS exotoxin. We conclude that ceftolozane/tazobactam plus early source control was critical for control of rapidly progressing skin and soft infection in these neutropenic patients caused by highly virulent ST175 and ST235 clones of MDR P. aeruginosa.
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Affiliation(s)
- Paolo E. Coppola
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Paolo Gaibani
- Microbiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.G.); (S.A.)
| | - Chiara Sartor
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Simone Ambretti
- Microbiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.G.); (S.A.)
| | - Russell E. Lewis
- Infectious Diseases, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Medical and Surgical Sciences (DIMEC)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy
| | - Claudia Sassi
- Radiology, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy;
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Marco Pignatti
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
- Plastic Surgery, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy
| | - Stefania Paolini
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Antonio Curti
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Fausto Castagnetti
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Margherita Ursi
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
| | - Michele Cavo
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
- Department of Diagnostic and Experimental Medicine Specialty (DIMES)- Università di Bologna, Alma Mater Studiorum, 40138 Bologna, Italy;
| | - Marta Stanzani
- Institute of Hematology “Seràgnoli”, IRCCS-Azienda Ospedaliero Policlinico Sant’Orsola-Universitaria di Bologna, 40138 Bologna, Italy; (P.E.C.); (C.S.); (S.P.); (A.C.); (F.C.); (M.U.); (M.C.)
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Hallam C, Denton A, Thirkell G. COVID-19: considerations for the safe management and disposal of human excreta. Infect Prev Pract 2020; 2:100085. [PMID: 34316567 PMCID: PMC7443054 DOI: 10.1016/j.infpip.2020.100085] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/18/2020] [Indexed: 01/12/2023] Open
Abstract
Management and disposal of human excreta is an essential element of healthcare practice. The potential for cross transmission of SARS-CoV-2 in faeces and urine has led global healthcare providers to examine different infection prevention and control practices not least the management and disposal of human excreta. There are two major systems in place to undertake this; one being the use of re-usable bedpans and urinals with reprocessing in a washer disinfectors (WD). The other is use of disposable system; either with pulp bedpans and urinals disposed of in a macerator or hygienic bags disposed of as waste. A review of the literature provided limited evidence to explore these different methods; both having pros and cons with regards to the environmental aspects as well as the infection prevention and control implications. Manual cleaning can pose associated infection risks to both staff and patients. Disinfection of re-usable bedpans may not achieve the level of disinfection required. Disposable systems offer an alternative that can overcome some of the infection prevention and control limitations of washer disinfectors. Adherence to infection prevention and control standards are paramount to the safe management and disposal of excreta.
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Affiliation(s)
- Carole Hallam
- AC Independent Nursing Consultants, Huddersfield, UK
| | - Andrea Denton
- AC Independent Nursing Consultants, Huddersfield, UK
| | - Gary Thirkell
- Infection Prevention and Control Department, The Christie NHS Foundation Trust, Manchester, UK
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Sarink MJ, Pirzadian J, van Cappellen WA, Tielens AGM, Verbon A, Severin JA, van Hellemond JJ. Acanthamoeba castellanii interferes with adequate chlorine disinfection of multidrug-resistant Pseudomonas aeruginosa. J Hosp Infect 2020; 106:490-494. [PMID: 32976863 DOI: 10.1016/j.jhin.2020.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/14/2020] [Indexed: 12/14/2022]
Abstract
Verona-Integron-encoded-Metallo-β-lactamase-positive Pseudomonas aeruginosa (VIM-PA) is a cause of hard-to-treat nosocomial infections, and can colonize hospital water networks alongside Acanthamoeba. We developed an in-vitro disinfection model to examine whether Acanthamoeba castellanii can harbour VIM-PA intracellularly, allowing VIM-PA to evade being killed by currently used hospital disinfectants. We observed that A. castellanii presence resulted in significantly increased survival of VIM-PA after exposure to chlorine for 30 s or for 2 min. This undesirable effect was not observed after disinfection by 70% alcohol or 24% acetic acid. Confocal microscopy confirmed the presence of VIM-PA within A. castellanii pseudocysts. Our data indicate that A. castellanii contributes to persistent VIM-PA colonization of water systems after chlorine treatment.
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Affiliation(s)
- M J Sarink
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J Pirzadian
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - W A van Cappellen
- Erasmus Optical Imaging Center and Department of Pathology, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A G M Tielens
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - A Verbon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - J J van Hellemond
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Wilson G, Jackson V, Boyken L, Puig-Asensio M, Marra AR, Perencevich E, Schweizer ML, Diekema D, Breheny P, Petersen C. A randomized control trial evaluating efficacy of antimicrobial impregnated hospital privacy curtains in an intensive care setting. Am J Infect Control 2020; 48:862-868. [PMID: 32139090 DOI: 10.1016/j.ajic.2019.12.024] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Revised: 12/27/2019] [Accepted: 12/27/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Acquisition of pathogens into health care settings from prior room occupants has been documented. Hospital room privacy curtains are at high risk for pathogenic bacterial contamination. Antimicrobial impregnated curtains could be effective in reducing contamination. METHODS Rooms within an intensive care unit at The University of Iowa Hospitals and Clinics were randomized to 3 arms. The 2 intervention arms: (1) halamine antimicrobial curtains (BioSmart curtain [BSC]) and (2) halamine antimicrobial curtains sprayed twice weekly with a sodium hypochlorite-based disinfecting spray (BSC-pre and BSC-post) and a third control arm (standard curtain [SC]). Samples were collected twice weekly for 3 weeks to assess pathogenic bacterial contamination. RESULTS The likelihood of remaining uncontaminated was 38% for SC, 37% for BSC, and 60% for the BSC-pre group. Time to event (contamination) analysis found no statistically significant difference between pathogenic contamination between the SC, BSC, and BSC-pre groups (P value = .1921). There was a decrease in average colony count for BSC curtains compared with control, however, this difference was not statistically significant. Hypochlorite spray was found to transiently decontaminate curtains, but effects dissipated after 72 hours. CONCLUSIONS BSC did not show a significant reduction in pathogenic contamination compared with control. Antimicrobial curtains could have a role in reducing environmental contamination in the health care setting. Future studies should be done to determine the long-term effects of using antimicrobial curtains in health care.
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Gómez-Gómez B, Volkow-Fernández P, Cornejo-Juárez P. Bloodstream Infections Caused by Waterborne Bacteria. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2020. [DOI: 10.1007/s40506-020-00234-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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de Sales RO, Migliorini LB, Puga R, Kocsis B, Severino P. A Core Genome Multilocus Sequence Typing Scheme for Pseudomonas aeruginosa. Front Microbiol 2020; 11:1049. [PMID: 32528447 PMCID: PMC7264379 DOI: 10.3389/fmicb.2020.01049] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 04/28/2020] [Indexed: 12/15/2022] Open
Abstract
Pseudomonas aeruginosa is a ubiquitous microorganism and an important opportunistic pathogen responsible for a broad spectrum of infections mainly in immunosuppressed and critically ill patients. Molecular investigations traditionally rely on pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). In this work we propose a core genome multilocus sequence typing (cgMLST) scheme for P. aeruginosa, a methodology that combines traditional MLST principles with whole genome sequencing data. All publicly available complete P. aeruginosa genomes, representing the diversity of this species, were used to establish a cgMLST scheme targeting 2,653 genes. The scheme was then tested using genomes available at contig, chromosome and scaffold levels. The proposed cgMLST scheme for P. aeruginosa typed over 99% (2,314/2,325) of the genomes available for this study considering at least 95% of the cgMLST target genes present. The absence of a certain number gene targets at the threshold considered for both the creation and validation steps due to low genome sequence quality is possibly the main reason for this result. The cgMLST scheme was compared with previously published whole genome single nucleotide polymorphism analysis for the characterization of the population structure of the epidemic clone ST235 and results were highly similar. In order to evaluate the typing resolution of the proposed scheme, collections of isolates belonging to two important STs associated with cystic fibrosis, ST146 and ST274, were typed using this scheme, and ST235 isolates associated with an outbreak were evaluated. Besides confirming the relatedness of all the isolates, earlier determined by MLST, the higher resolution of cgMLST denotes that it may be suitable for surveillance programs, overcoming possible shortcomings of classical MLST. The proposed scheme is publicly available at: https://github.com/BioinformaticsHIAEMolecularMicrobiology/cgMLST-Pseudomonas-aeruginosa.
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Affiliation(s)
- Romário Oliveira de Sales
- Hospital Israelita Albert Einstein, Albert Einstein Research and Education Institute, São Paulo, Brazil
| | - Letícia Busato Migliorini
- Hospital Israelita Albert Einstein, Albert Einstein Research and Education Institute, São Paulo, Brazil
| | - Renato Puga
- Hospital Israelita Albert Einstein, Albert Einstein Research and Education Institute, São Paulo, Brazil
| | - Bela Kocsis
- Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
| | - Patricia Severino
- Hospital Israelita Albert Einstein, Albert Einstein Research and Education Institute, São Paulo, Brazil
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