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Osman AH, Darkwah S, Kotey FCN, Odoom A, Hotor P, Dayie NTKD, Donkor ES. Reservoirs of Nosocomial Pathogens in Intensive Care Units: A Systematic Review. ENVIRONMENTAL HEALTH INSIGHTS 2024; 18:11786302241243239. [PMID: 38828046 PMCID: PMC11141231 DOI: 10.1177/11786302241243239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 03/14/2024] [Indexed: 06/05/2024]
Abstract
Background Nosocomial pathogens are known to exacerbate morbidity and mortality in contemporary critical healthcare. Hospital fomites, which include inanimate surfaces, have been identified as "breeding grounds" for pathogens that cause nosocomial infections. This systematic review aimed to deliver incisive insights on nosocomial pathogens in intensive care units (ICUs) and the role of fomites as potential reservoirs for their transmission. Method An extensive exploration of electronic databases, including PubMed and Scopus, from 1990 to 2023, was carried out between 25th and 29th May 2023, per standard PRISMA guidelines. Information were extracted from articles that reported on fomites in the ICU. Studies that did not quantitatively report the fomite contamination, and those that exclusively took samples from patients in the ICU were excluded from the analysis. Results About 40% of the total samples collected on fomites from all the studies yielded microbial growth, with species of Staphylococcus being the most predominant. Other prevalent microbes were Acinetobacter baumannii, Escherichia coli, Klebsiella pneumoniae, Candida spp., Enterococcus sp., and Enterobacter sp. The neonatal intensive care unit (NICU) had the highest proportion of contaminated fomites. Among known fomites, the sphygmomanometer exhibited a 100% detection rate of nosocomial pathogens. This included E. aerogenes, Staphylococcus aureus, coagulase-negative Staphylococci (CoNS), E. coli, and K. pneumoniae. Multidrug-resistant (MDR) bacteria, such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococci (VRE), extended-spectrum beta-lactamase (ESBL)-producing E. coli, and MDR Pseudomonas aeruginosa were commonly isolated on fomites in the ICUs. Conclusion Many fomites that are readily used in patient care in the ICU harbour nosocomial pathogens. The most common fomite appeared to be mobile phones, sphygmomanometers, and stethoscopes, with Staphylococcus being the most common contaminant. Consequently, the need for rigorous disinfection and sterilization protocols on fomites in the ICU cannot be overemphasized. Additionally, heightened awareness on the subject among health professionals is crucial to mitigating the risk and burden of nosocomial infections caused by drug-resistant bacteria.
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Affiliation(s)
- Abdul-Halim Osman
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Samuel Darkwah
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Fleischer C N Kotey
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Alex Odoom
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Prince Hotor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Nicholas T K D Dayie
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
| | - Eric S Donkor
- Department of Medical Microbiology, University of Ghana Medical School, Accra, Ghana
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2
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Fucini GB, Geffers C, Schwab F, Behnke M, Sunder W, Moellmann J, Gastmeier P. Sinks in patient rooms in ICUs are associated with higher rates of hospital-acquired infection: a retrospective analysis of 552 ICUs. J Hosp Infect 2023; 139:99-105. [PMID: 37308060 DOI: 10.1016/j.jhin.2023.05.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/15/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023]
Abstract
BACKGROUND Sinks in hospitals are a possible reservoir for healthcare-related pathogens. They have been identified as a source of nosocomial outbreaks in intensive care units (ICU); however, their role in non-outbreak settings remains unclear. AIM To investigate whether sinks in ICU patient rooms are associated with a higher incidence of hospital-acquired infection (HAI). METHODS This analysis used surveillance data from the ICU component of the German nosocomial infection surveillance system (KISS) from 2017 to 2020. Between September and October 2021, all participating ICUs were surveyed about the presence of sinks in their patient rooms. The ICUs were then divided into two groups: the no-sink group (NSG) and the sink group (SG). Primary and secondary outcomes were total HAIs and HAIs associated with Pseudomonas aeruginosa (HAI-PA). FINDINGS In total, 552 ICUs (NSG N=80, SG N=472) provided data about sinks, total HAIs and HAI-PA. The incidence density per 1000 patient-days of total HAIs was higher in ICUs in the SG (3.97 vs 3.2). The incidence density of HAI-PA was also higher in the SG (0.43 vs 0.34). The risk of HAIs associated with all pathogens [incidence rate ratio (IRR)=1.24, 95% confidence interval (CI) 1.03-1.50] and the risk of lower respiratory tract infections associated with P. aeruginosa (IRR=1.44, 95% CI 1.10-1.90) were higher in ICUs with sinks in patient rooms. After adjusting for confounders, sinks were found to be an independent risk factor for HAI (adjusted IRR 1.21, 95% CI 1.01-1.45). CONCLUSIONS Sinks in patient rooms are associated with a higher number of HAIs per patient-day in the ICU. This should be considered when planning new ICUs or renovating existing ones.
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Affiliation(s)
- G-B Fucini
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany.
| | - C Geffers
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - F Schwab
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - M Behnke
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
| | - W Sunder
- Institute of Construction Design, Industrial and Health Care Building, Technische Universität Carolo Wilhelmina zu Braunschweig, Braunschweig, Germany
| | - J Moellmann
- Institute of Construction Design, Industrial and Health Care Building, Technische Universität Carolo Wilhelmina zu Braunschweig, Braunschweig, Germany
| | - P Gastmeier
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Hygiene and Environmental Medicine, Berlin, Germany; National Reference Centre for Surveillance of Nosocomial Infections, Berlin, Germany
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3
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Verdial C, Serrano I, Tavares L, Gil S, Oliveira M. Mechanisms of Antibiotic and Biocide Resistance That Contribute to Pseudomonas aeruginosa Persistence in the Hospital Environment. Biomedicines 2023; 11:biomedicines11041221. [PMID: 37189839 DOI: 10.3390/biomedicines11041221] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 04/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023] Open
Abstract
Pseudomonas aeruginosa is an opportunistic bacterial pathogen responsible for multiple hospital- and community-acquired infections, both in human and veterinary medicine. P. aeruginosa persistence in clinical settings is worrisome and is a result of its remarkable flexibility and adaptability. This species exhibits several characteristics that allow it to thrive under different environmental conditions, including the ability to colonize inert materials such as medical equipment and hospital surfaces. P. aeruginosa presents several intrinsic mechanisms of defense that allow it to survive external aggressions, but it is also able to develop strategies and evolve into multiple phenotypes to persevere, which include antimicrobial-tolerant strains, persister cells, and biofilms. Currently, these emergent pathogenic strains are a worldwide problem and a major concern. Biocides are frequently used as a complementary/combination strategy to control the dissemination of P. aeruginosa-resistant strains; however, tolerance to commonly used biocides has also already been reported, representing an impediment to the effective elimination of this important pathogen from clinical settings. This review focuses on the characteristics of P. aeruginosa responsible for its persistence in hospital environments, including those associated with its antibiotic and biocide resistance ability.
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Affiliation(s)
- Cláudia Verdial
- Gato Escondido-Veterinary Clinic, Av. Bombeiros Voluntários n°22B, 2950-209 Palmela, Portugal
| | - Isa Serrano
- CIISA-Center for Interdisciplinary Research in Animal Health, Faculty of Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Luís Tavares
- CIISA-Center for Interdisciplinary Research in Animal Health, Faculty of Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Solange Gil
- CIISA-Center for Interdisciplinary Research in Animal Health, Faculty of Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
| | - Manuela Oliveira
- CIISA-Center for Interdisciplinary Research in Animal Health, Faculty of Medicine, University of Lisbon, Avenida da Universidade Técnica, 1300-477 Lisboa, Portugal
- Associate Laboratory for Animal and Veterinary Sciences (AL4AnimalS), 1300-477 Lisboa, Portugal
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4
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Liu H, Yang L, Chen Q, Song H, Bo X, Guo J, Li P, Ni M. Time Series Genomics of Pseudomonas aeruginosa Reveals the Emergence of a Hypermutator Phenotype and Within-Host Evolution in Clinical Inpatients. Microbiol Spectr 2022; 10:e0005722. [PMID: 35861512 PMCID: PMC9430856 DOI: 10.1128/spectrum.00057-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 07/06/2022] [Indexed: 11/20/2022] Open
Abstract
Pseudomonas aeruginosa, a common opportunistic pathogen, is one of the leading etiological agents of nosocomial infections. Many previous studies have reported the nosocomial transmission and epidemiology of P. aeruginosa infections. However, longitudinal studies regarding the dynamics of P. aeruginosa colonization and infection in health care settings are limited. We obtained longitudinal samples from aged patients with prolonged intensive care unit (ICU) stays (~4 to 19 months). P. aeruginosa was isolated from 71 samples obtained from seven patients and characterized by whole-genome sequencing. The P. aeruginosa isolates were assigned to 10 clonal complexes, and turnover of main clones was observed in sequential sputum samples from two patients. By comparing intraclonal genomic diversities, we identified two clones that had significantly higher numbers of single nucleotide polymorphisms and variations in homopolymeric sequences than the other clones, indicating a hypermutator phenotype. These hypermutator clones were associated with mutations T147I/G521S and P27L in the MutL protein, and their mutation rates were estimated to be 3.20 × 10-5 and 6.59 × 10-5 per year per nucleotide, respectively. We also identified 24 recurrently mutated genes that exhibited intraclonal diversity in two or more clones. Notably, one recurrent mutation, S698F in FptA, was observed in four clones. These findings suggest that convergent microevolution and adaption of P. aeruginosa occur in long-term ICU patients. IMPORTANCE Pseudomonas aeruginosa is a predominant opportunistic pathogen that causes nosocomial infections. Inappropriate empirical therapy can lead to prolonged hospital stays and increased mortality. In our study of sequential P. aeruginosa isolates from inpatients, high intrahost diversity was observed, including switching of clones and the emergence of a hypermutator phenotype. Recurrently mutated genes also suggested that convergent microevolution and adaption of P. aeruginosa occur in inpatients, and genomic diversity is associated with differences in multiple-drug-resistance profiles. Taken together, our findings highlight the importance of longitudinal surveillance of nosocomial P. aeruginosa clones.
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Affiliation(s)
- Hongjie Liu
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Lang Yang
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Qichao Chen
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Hongbin Song
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Xiaochen Bo
- Institute of Health Service and Transfusion Medicine, Beijing, China
| | - Jingyu Guo
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
- The 316th Hospital of Chinese PLA, Beijing, China
| | - Peng Li
- Chinese PLA Center for Disease Control and Prevention, Beijing, China
| | - Ming Ni
- Institute of Health Service and Transfusion Medicine, Beijing, China
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5
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Qin M, Ma X, Fan S, Wu H, Yan W, Tian X, Lu J, Lyu M, Wang S. Rapid detection of Pseudomonas aeruginosa using a DNAzyme-based sensor. Food Sci Nutr 2021; 9:3873-3884. [PMID: 34262744 PMCID: PMC8269565 DOI: 10.1002/fsn3.2367] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/15/2021] [Accepted: 05/17/2021] [Indexed: 11/22/2022] Open
Abstract
In the present study, a DNAzyme was screened in vitro through the use of a DNA library and crude extracellular mixture (CEM) of Pseudomonas aeruginosa. Following eight rounds of selection, a DNAzyme termed PAE-1 was obtained, which displayed high rates of cleavage with strong specificity. A fluorescent biosensor was designed for the detection of P. aeruginosa in combination with the DNAzyme. A detection limit as low as 1.2 cfu/ml was observed. Using proteases and filtration, it was determined that the target was a protein with a molecular weight of 10 kDa-50 kDa. The DNAzyme was combined with a polystyrene board to construct a simple indicator plate sensor which produced a color that identified the target within 10 min. The results were reliable when tap water and food samples were tested. The present study provides a novel experimental strategy for the development of sensors based on a DNAzyme to rapidly detect P. aeruginosa in the field.
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Affiliation(s)
- Mingcan Qin
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Xiaoyi Ma
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Shihui Fan
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Hangjie Wu
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Wanli Yan
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Xiaopeng Tian
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Jing Lu
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Mingsheng Lyu
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
| | - Shujun Wang
- Jiangsu Key Laboratory of Marine Bioresources and Environment/Jiangsu Key Laboratory of Marine BiotechnologyJiangsu Ocean UniversityLianyungangChina
- Co‐Innovation Center of Jiangsu Marine Bio‐industry TechnologyJiangsu Ocean UniversityLianyungangChina
- Jiangsu Marine Resources Development Research InstituteLianyungangChina
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6
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Verdial C, Carneiro C, Machado I, Tavares L, Almeida V, Oliveira M, Gil S. Controlling bacteriological contamination of environmental surfaces at the biological isolation and containment unit of a veterinary teaching hospital. Ir Vet J 2021; 74:18. [PMID: 34183065 PMCID: PMC8240409 DOI: 10.1186/s13620-021-00197-z] [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: 03/30/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Background The Biological Isolation and Containment Unit (BICU) is a subunit of the Teaching Hospital of the Faculty of Veterinary Medicine of the University of Lisbon, Portugal, for the admission of animals with confirmed infectious diseases or under clinical suspicion and waiting for a diagnosis. As a high-risk environment for the transmission of infectious agents, it is extremely important to implement programs for the surveillance of nosocomial microorganisms in these facilities. The purpose of this study was to evaluate the level of bacterial contamination of the BICU environmental surfaces and to implement corrective actions on disinfection protocols. Swab samples were collected from selected environmental surfaces in 3 different areas of the BICU (isolation, work, and preparatory rooms) to evaluate the total aerobic bacterial load and investigate the presence of 4 nosocomial microorganisms: vancomycin-resistant Enterococcus spp., methicillin-resistant Staphylococcus aureus, 3rd-generation cephalosporin-resistant Escherichia coli, and carbapenem-resistant Pseudomonas aeruginosa. Bacterial quantification was performed by using non-selective media, while specific selective media were used for the isolation of the target microorganisms. Isolates were identified based on their macro and microscopic characteristics and their biochemical profile. Subsequently, new disinfection protocols were implemented, and their effectiveness evaluated. Results The surfaces with the highest bacterial load in the isolation, preparatory, and worker’s rooms were the cages, hand-held sponge, and telephone, respectively. Regarding the 4 pathogens investigated, Enterococcus spp. were the most frequently isolated (11.3%), followed by E. coli (1.5%) and P. aeruginosa (1.5%). One of the P. aeruginosa isolates obtained was resistant to imipenem. In the end, new disinfection protocols were implemented, which proved to be effective in reducing bacterial counts by 99.99% in cages and the sponge, and by 90 to 99% on the telephone. Conclusions This study allows to conclude that the cages and the human contact surfaces were the most contaminated in the isolation rooms. Nevertheless, the new disinfection strategies seemed to be effective in reducing environmental contamination, including by some potentially nosocomial agents, although more samples must be analyzed for definitive conclusions. These results may contribute to highlight the importance of infection prevention and control measures, as fundamental tools to reduce the spread of infectious agents in the hospital environment.
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Affiliation(s)
- C Verdial
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - C Carneiro
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal.,CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - I Machado
- CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal.,Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - L Tavares
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal.,CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - V Almeida
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal.,CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - M Oliveira
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal.,CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal
| | - S Gil
- Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal. .,CIISA - Centre for Interdisciplinary Research in Animal Health, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal. .,Veterinary Teaching Hospital, Faculty of Veterinary Medicine, University of Lisbon, Av. Universidade Técnica, 1300-477, Lisbon, Portugal.
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7
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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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8
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De Giglio O, Diella G, Lopuzzo M, Triggiano F, Calia C, Pousis C, Fasano F, Caggiano G, Calabrese G, Rafaschieri V, Carpagnano F, Carlucci M, Gesualdo L, Ricci ML, Scaturro M, Rota MC, Bonadonna L, Lucentini L, Montagna MT. Impact of lockdown on the microbiological status of the hospital water network during COVID-19 pandemic. ENVIRONMENTAL RESEARCH 2020; 191:110231. [PMID: 32976823 PMCID: PMC7511218 DOI: 10.1016/j.envres.2020.110231] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 05/08/2023]
Abstract
The COVID-19 pandemic started in China in early December 2019, and quickly spread around the world. The epidemic gradually started in Italy at the end of February 2020, and by May 31, 2020, 232,664 cases and 33,340 deaths were confirmed. As a result of this pandemic, the Italian Ministerial Decree issued on March 11, 2020, enforced lockdown; therefore, many social, recreational, and cultural centers remained closed for months. In Apulia (southern Italy), all non-urgent hospital activities were suspended, and some wards were closed, with a consequent reduction in the use of the water network and the formation of stagnant water. This situation could enhance the risk of exposure of people to waterborne diseases, including legionellosis. The purpose of this study was to monitor the microbiological quality of the water network (coliforms, E. coli, Enterococci, P. aeruginosa, and Legionella) in three wards (A, B and C) of a large COVID-19 regional hospital, closed for three months due to the COVID-19 emergency. Our study revealed that all three wards' water network showed higher contamination by Legionella pneumophila sg 1 and sg 6 at T1 (after lockdown) compared to the period before the lockdown (T0). In particular, ward A at T1 showed a median value = 5600 CFU/L (range 0-91,000 CFU/L) vs T0, median value = 75 CFU/L (range 0-5000 CFU/L) (p-value = 0.014); ward B at T1 showed a median value = 200 CFU/L (range 0-4200 CFU/L) vs T0, median value = 0 CFU/L (range 0-300 CFU/L) (p-value = 0.016) and ward C at T1 showed a median value = 175 CFU/L (range 0-22,000 CFU/L) vs T0, median value = 0 CFU/L (range 0-340 CFU/L) (p-value < 0.001). In addition, a statistically significant difference was detected in ward B between the number of positive water samples at T0 vs T1 for L. pneumophila sg 1 and sg 6 (24% vs 80% p-value < 0.001) and for coliforms (0% vs 64% p-value < 0.001). Moreover, a median value of coliform load resulted 3 CFU/100 ml (range 0-14 CFU/100 ml) at T1, showing a statistically significant increase versus T0 (0 CFU/100 ml) (p-value < 0.001). Our results highlight the need to implement a water safety plan that includes staff training and a more rigorous environmental microbiological surveillance in all hospitals before occupying a closed ward for a longer than one week, according to national and international guidelines.
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Affiliation(s)
- Osvalda De Giglio
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Giusy Diella
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Marco Lopuzzo
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Francesco Triggiano
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Carla Calia
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Chrysovalentinos Pousis
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Fabrizio Fasano
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | - Giuseppina Caggiano
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
| | | | | | | | | | - Loreto Gesualdo
- Department of Emergency and Organ Transplantation-Nephrology, Dialysis and Transplantation Unit, University of Bari Aldo Moro, Bari, 70124, Italy.
| | - Maria Luisa Ricci
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy.
| | - Maria Scaturro
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy.
| | - Maria Cristina Rota
- Department of Infectious Diseases, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy.
| | - Lucia Bonadonna
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy.
| | - Luca Lucentini
- Department of Environment and Health, Istituto Superiore di Sanità, Viale Regina Elena, 299-00161, Rome, Italy.
| | - Maria Teresa Montagna
- Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis, Department of Biomedical Science and Human Oncology, University of Bari Aldo Moro, Piazza G. Cesare 11, 70124, Bari, Italy.
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Slekovec C, Robert J, Berthelot P, van der Mee-Marquet N, Rogues AM, Derouin V, Cholley P, Bertrand X, Gbaguidi-Haore H. Do contact precautions reduce the incidence of ICU-acquired Pseudomonas aeruginosa infections? The DPCPYO cluster-randomized crossover trial. Clin Infect Dis 2020; 73:e2781-e2788. [PMID: 33137174 DOI: 10.1093/cid/ciaa1663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 10/26/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Issue of contact precautions as contributory factors for reducing P. aeruginosa (Pa) infections in intensive care units (ICUs) remains questioned. We evaluated the impact of the addition of contact precautions to standard precautions for Pa-positive patients on the incidence of ICU-acquired Pa infections. METHODS In this multicenter cluster-randomized crossover trial, 10 French ICUs were randomly assigned (1:1) to sequence 0-1 (6-month control period [CP]/3-month washout period/6-month intervention period [IP]) or sequence 1-0 (6-month IP/3-month washout period/6-month CP). A surveillance screening program for Pa was implemented. Competing-risks regression models were built with death and discharge without the occurrence of ICU-acquired Pa infection (the primary outcome), as competing events. Models were adjusted for within-ICU correlation, patient- and ICU-level covariates. The Simpson diversity index (SDI) and the transmission index (TI) of Pa isolates were derived from pulsed-field gel electrophoresis typing. RESULTS Within recruited ICUs, the cumulative incidence and the incidence rate of ICU-acquired Pa infections were 3.38% (55/1625) vs 3.44% (57/1658) and 3.31 vs 3.52 per 1 000 patient-days at risk during CP and IP, respectively. Multivariable models indicated that the intervention did not significantly change the cumulative incidence (subdistribution hazard ratio 0.91, 95% confidence interval [CI] 0.49-1.67, p=0.76) and the rate (cause-specific hazard ratio 1.36, 95%CI 0.71-2.63, p=0.36) of the primary outcome. SDI and TI did not significantly differ between CP and IP. CONCLUSIONS The addition of contact precautions to standard precautions for Pa-positive patients with a surveillance screening program does not significantly reduce ICU-acquired Pa infections in non-outbreak situations.
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Affiliation(s)
- Céline Slekovec
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Jérôme Robert
- Centre d'Immunologie et des Maladies Infectieuses-Paris, Cimi-Paris, INSERM, Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière-Charles Foix, Sorbonne Université, Paris, France
| | - Philippe Berthelot
- Hygiène Hospitalière et Maladies Infectieuses, Centre Hospitalier Universitaire, Saint-Etienne, France
| | | | - Anne-Marie Rogues
- Hygiène Hospitalière, Centre Hospitalier Universitaire, INSERM U657, Université de Bordeaux, Bordeaux, France
| | - Véronique Derouin
- Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Paris Sud-Clamart, Le Kremlin-Bicêtre, France
| | - Pascal Cholley
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Xavier Bertrand
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
| | - Houssein Gbaguidi-Haore
- Infection Control Department, University Hospital of Besançon, Besançon, France
- UMR 6249 Chrono-Environnement, University of Bourgogne-Franche-Comte, Besançon, France
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