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Stoesser N, George R, Aiken Z, Phan HTT, Lipworth S, Quan TP, Mathers AJ, De Maio N, Seale AC, Eyre DW, Vaughan A, Swann J, Peto TEA, Crook DW, Cawthorne J, Dodgson A, Walker AS. Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of bla KPC-carbapenemase-producing Enterobacterales in a hospital setting. JAC Antimicrob Resist 2024; 6:dlae140. [PMID: 39234218 PMCID: PMC11369815 DOI: 10.1093/jacamr/dlae140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2024] [Accepted: 08/13/2024] [Indexed: 09/06/2024] Open
Abstract
Background Healthcare-associated wastewater and asymptomatic patient reservoirs colonized by carbapenemase-producing Enterobacterales (CPE) contribute to nosocomial CPE dissemination, but the characteristics and dynamics of this remain unclear. Methods We systematically sampled wastewater sites (n = 4488 samples; 349 sites) and patients (n = 1247) across six wards over 6-12 months to understand blaKPC-associated CPE (KPC-E) diversity within these reservoirs and transmission in a healthcare setting. Up to five KPC-E-positive isolates per sample were sequenced (Illumina). Recombination-adjusted phylogenies were used to define genetically related strains; assembly and mapping-based approaches were used to characterize antimicrobial resistance genes, insertion sequences (ISs) and Tn4401 types/target site sequences. The accessory genome was evaluated in some of the largest clusters, and those crossing reservoirs. Results Wastewater site KPC-E-positivity was substantial [101/349 sites (28.9%); 228/5601 (4.1%) patients cultured]. Thirteen KPC-E species and 109 strains were identified using genomics, and 24% of wastewater and 26% of patient KPC-E-positive samples harboured one or more strains. Most diversity was explained by the individual niche, suggesting localized factors are important in selection and spread. Tn4401 + flanking target site sequence diversity was greater in wastewater sites (P < 0.001), which might favour Tn4401-associated transposition/evolution. Shower/bath- and sluice/mop-associated sites were more likely to be KPC-E-positive (adjusted OR = 2.69; 95% CI: 1.44-5.01; P = 0.0019; and adjusted OR = 2.60; 95% CI: 1.04-6.52; P = 0.0410, respectively). Different strains had different blaKPC dissemination dynamics. Conclusions We identified substantial and diverse KPC-E colonization of wastewater sites and patients in this hospital setting. Reservoir and niche-specific factors (e.g. microbial interactions, selection pressures), and different strains and mobile genetic elements likely affect transmission dynamics. This should be considered in surveillance and control strategies.
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Affiliation(s)
- N Stoesser
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Nuffield Department of Medicine, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - R George
- Department of Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - Z Aiken
- Department of Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - H T T Phan
- Academic Unit of Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - S Lipworth
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - T P Quan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Nuffield Department of Medicine, Oxford, UK
| | - A J Mathers
- Department of Pathology, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - N De Maio
- Goldman Group, EMBL-European Bioinformatics Institute, Cambridge, UK
| | - A C Seale
- Warwick Medical School - Health Sciences, University of Warwick, Coventry, UK
| | - D W Eyre
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Nuffield Department of Medicine, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - A Vaughan
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - J Swann
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - T E A Peto
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - D W Crook
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Nuffield Department of Medicine, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
| | - J Cawthorne
- Department of Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - A Dodgson
- Department of Microbiology, Manchester University NHS Foundation Trust, Manchester, UK
| | - A S Walker
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at University of Oxford in partnership with Public Health England, Nuffield Department of Medicine, Oxford, UK
- NIHR Oxford Biomedical Research Centre, Oxford University Hospitals NHS Foundation Trust, John Radcliffe Hospital, Oxford, UK
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2
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Norville P, Otter JA. The requirement to move towards standardization of wastewater sampling. J Hosp Infect 2024; 149:88-89. [PMID: 38685412 DOI: 10.1016/j.jhin.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024]
Affiliation(s)
- P Norville
- School of Pharmacy, Cardiff University, Cardiff, UK.
| | - J A Otter
- Directorate of Infection, Guy's and St. Thomas' NHS Foundation Trust, St Thomas' Hospital, London, UK; National Institute for Healthcare Research Health Protection Research Unit in HCAI and AMR, Imperial College London and Public Health England, Hammersmith Hospital, London, UK
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3
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Durand C, Jolivet S, Le Neindre K, Couturier J, Lazare C, Montagne T, Nou G, Leplay C, Barbut F. Contamination of hospital drains and toilets by carbapenemase-producing Enterobacterales: a prevalence study apart from any outbreak context. J Hosp Infect 2024; 147:221-223. [PMID: 38316258 DOI: 10.1016/j.jhin.2024.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/22/2023] [Accepted: 01/03/2024] [Indexed: 02/07/2024]
Affiliation(s)
- C Durand
- Unité de prévention du risque infectieux, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - S Jolivet
- Unité de prévention du risque infectieux, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - K Le Neindre
- 3PHM, UMR 1139, INSERM, Université de Paris, Faculté de Pharmacie Paris, Paris, France; Service de Microbiologie de l'Environnement, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - J Couturier
- 3PHM, UMR 1139, INSERM, Université de Paris, Faculté de Pharmacie Paris, Paris, France; Service de Microbiologie de l'Environnement, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Lazare
- Service de Microbiologie de l'Environnement, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - T Montagne
- Service de Microbiologie de l'Environnement, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - G Nou
- Unité de prévention du risque infectieux, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - C Leplay
- Pharmacie à Usage Intérieur, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - F Barbut
- Unité de prévention du risque infectieux, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France; 3PHM, UMR 1139, INSERM, Université de Paris, Faculté de Pharmacie Paris, Paris, France; Service de Microbiologie de l'Environnement, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
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4
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Regad M, Lizon J, Alauzet C, Roth-Guepin G, Bonmati C, Pagliuca S, Lozniewski A, Florentin A. Outbreak of carbapenemase-producing Citrobacter farmeri in an intensive care haematology department linked to a persistent wastewater reservoir in one hospital room, France, 2019 to 2022. Euro Surveill 2024; 29:2300386. [PMID: 38577805 PMCID: PMC11004594 DOI: 10.2807/1560-7917.es.2024.29.14.2300386] [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: 07/17/2023] [Accepted: 01/18/2024] [Indexed: 04/06/2024] Open
Abstract
In 2019-2022, a prolonged outbreak of oxacillinase (OXA)-48-producing Citrobacter farmeri due to a persistent environmental contamination, occurred in our haematology intensive care unit. In April 2019, we isolated OXA-48-producing C. farmeri from rectal samples of two patients in weekly screenings. The cases had stayed in the same hospital room but 4 months apart. We screened five patients who had stayed in this room between the two cases and identified a third case. Over the following 3 years, five other cases were detected, the last case in September 2022. In total, eight cases were detected: seven colonised with the bacterium and one infected with a lethal outcome. All cases stayed in the same hospital room. We detected OXA-48-producing C. farmeri from a shower, washbasin drains and wastewater drainage of the bathroom of the hospital room. Molecular typing confirmed that all C. farmeri isolates from the environment and the cases were indistinguishable. Despite bundle measures to control the outbreak, the bacterium persisted in the system, which resulted in transmission to new patients. A design defect in the placement of wastewater drains contributed to the persistence and proliferation of the bacterium. The room was closed after the last case and the bathroom rebuilt.
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Affiliation(s)
- Marie Regad
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Département territorial d'hygiène et de prévention du risque infectieux, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Département d'Hygiène, des Risques Environnementaux et Associés aux Soins (DHREAS), Faculté de Médecine, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Institut national de la santé et de la recherche médicale (Inserm), Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes (INSPIIRE), Nancy, France
| | - Julie Lizon
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Département territorial d'hygiène et de prévention du risque infectieux, Vandœuvre-lès-Nancy, France
| | - Corentine Alauzet
- CHRU-Nancy, Laboratoire de microbiologie, Vandœuvre-lès-Nancy, France
| | | | | | - Simona Pagliuca
- CHRU-Nancy, Service d'hématologie, Vandœuvre-lès-Nancy, France
| | - Alain Lozniewski
- CHRU-Nancy, Laboratoire de microbiologie, Vandœuvre-lès-Nancy, France
- CHRU-Nancy, Laboratoire de microbiologie environnementale, Vandœuvre-lès-Nancy, France
| | - Arnaud Florentin
- Centre Hospitalier Régional Universitaire (CHRU)-Nancy, Département territorial d'hygiène et de prévention du risque infectieux, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Département d'Hygiène, des Risques Environnementaux et Associés aux Soins (DHREAS), Faculté de Médecine, Vandœuvre-lès-Nancy, France
- Université de Lorraine, Institut national de la santé et de la recherche médicale (Inserm), Interdisciplinarité en Santé Publique Interventions et Instruments de mesure complexes (INSPIIRE), Nancy, France
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5
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Benbow A, Clarke M, Yates C, Montgomery R, Staniforth K, Boswell T, Prescott K, Mahida N. Hospital-wide healthcare-associated carbapenemase-producing Enterobacterales outbreak: risks of electric floor scrubbers in catering facilities and kitchens. J Hosp Infect 2024; 146:59-65. [PMID: 38341149 DOI: 10.1016/j.jhin.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/16/2024] [Accepted: 01/19/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) are associated with poor clinical outcomes and can spread rapidly in healthcare settings. Environmental reservoirs are increasingly recognized as playing an important part in some nosocomial outbreaks. AIM To describe the investigation and control of a CPE outbreak, lasting several years, across two separate hospital sites within one organization. METHODS Investigation of multiple ward-level CPE cross-transmissions with a number of sporadic cases. Environmental sampling of ward environments, catering facilities and electric floor scrubbers was undertaken. FINDINGS Eleven patients over a 19-month period were identified as carrying healthcare-associated New Delhi metallo-beta-lactamase (NDM)-producing Enterobacter cloacae, and a further patient carried NDM Escherichia coli. E. cloacae isolates were indistinguishable on pulsed-field gel electrophoresis typing, supporting acquisition with a single point source. Environmental sampling found contamination of the electric floor scrubbers used for cleaning the hospital catering facilities and in the associated toilets. Standard outbreak response measures achieved control of ward outbreaks. Sporadic cases and hospital-wide cross-transmission were controlled after interventions on the central food-handling unit and by decommissioning affected floor scrubbers. Electric floor scrubbers were found to have the potential to disperse Gram-negative bacteria into the surrounding environment under experimental conditions. CONCLUSION This outbreak report demonstrates that catering facilities and kitchens can be involved in widespread healthcare outbreaks of enteric organisms. This is also the first report of the potential role of electric floor scrubbers in causing significant environmental contamination with CPE which may indicate a role in nosocomial transmission.
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Affiliation(s)
- A Benbow
- Department of Medical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK.
| | - M Clarke
- Infection Prevention and Control Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - C Yates
- Infection Prevention and Control Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - R Montgomery
- Infection Prevention and Control Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Staniforth
- HCAI, Fungal, AMR, AMU and Sepsis Division, United Kingdom Health Security Agency, UK
| | - T Boswell
- Department of Medical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - K Prescott
- Department of Medical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - N Mahida
- Department of Medical Microbiology, Nottingham University Hospitals NHS Trust, Nottingham, UK
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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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7
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Hamerlinck H, Aerssens A, Boelens J, Dehaene A, McMahon M, Messiaen AS, Vandendriessche S, Velghe A, Leroux-Roels I, Verhasselt B. Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting. Antimicrob Resist Infect Control 2023; 12:58. [PMID: 37337245 DOI: 10.1186/s13756-023-01261-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Accumulating evidence shows a role of the hospital wastewater system in the spread of multidrug-resistant organisms, such as carbapenemase producing Enterobacterales (CPE). Several sequential outbreaks of CPE on the geriatric ward of the Ghent University hospital have led to an outbreak investigation. Focusing on OXA-48 producing Citrobacter freundii, the most prevalent species, we aimed to track clonal relatedness using whole genome sequencing (WGS). By exploring transmission routes we wanted to improve understanding and (re)introduce targeted preventive measures. METHODS Environmental screening (toilet water, sink and shower drains) was performed between 2017 and 2021. A retrospective selection was made of 53 Citrobacter freundii screening isolates (30 patients and 23 environmental samples). DNA from frozen bacterial isolates was extracted and prepped for shotgun WGS. Core genome multilocus sequence typing was performed with an in-house developed scheme using 3,004 loci. RESULTS The CPE positivity rate of environmental screening samples was 19.0% (73/385). Highest percentages were found in the shower drain samples (38.2%) and the toilet water samples (25.0%). Sink drain samples showed least CPE positivity (3.3%). The WGS data revealed long-term co-existence of three patient sample derived C. freundii clusters. The biggest cluster (ST22) connects 12 patients and 8 environmental isolates taken between 2018 and 2021 spread across the ward. In an overlapping period, another cluster (ST170) links eight patients and four toilet water isolates connected to the same room. The third C. freundii cluster (ST421) connects two patients hospitalised in the same room but over a period of one and a half year. Additional sampling in 2022 revealed clonal isolates linked to the two largest clusters (ST22, ST170) in the wastewater collection pipes connecting the rooms. CONCLUSIONS Our findings suggest long-term circulation and transmission of carbapenemase producing C. freundii clones in hospital sanitary installations despite surveillance, daily cleaning and intermittent disinfection protocols. We propose a role for the wastewater drainage system in the spread within and between rooms and for the sanitary installations in the indirect transmission via bioaerosol plumes. To tackle this problem, a multidisciplinary approach is necessary including careful design and maintenance of the plumbing system.
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Affiliation(s)
- Hannelore Hamerlinck
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
| | - Annelies Aerssens
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Jerina Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Andrea Dehaene
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Michael McMahon
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | | | | | - Anja Velghe
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Isabel Leroux-Roels
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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Neidhöfer C, Sib E, Neuenhoff M, Schwengers O, Dummin T, Buechler C, Klein N, Balks J, Axtmann K, Schwab K, Holderried TAW, Feldmann G, Brossart P, Engelhart S, Mutters NT, Bierbaum G, Parčina M. Hospital sanitary facilities on wards with high antibiotic exposure play an important role in maintaining a reservoir of resistant pathogens, even over many years. Antimicrob Resist Infect Control 2023; 12:33. [PMID: 37061726 PMCID: PMC10105422 DOI: 10.1186/s13756-023-01236-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 03/29/2023] [Indexed: 04/17/2023] Open
Abstract
BACKGROUND Hospitals with their high antimicrobial selection pressure represent the presumably most important reservoir of multidrug-resistant human pathogens. Antibiotics administered in the course of treatment are excreted and discharged into the wastewater system. Not only in patients, but also in the sewers, antimicrobial substances exert selection pressure on existing bacteria and promote the emergence and dissemination of multidrug-resistant clones. In previous studies, two main clusters were identified in all sections of the hospital wastewater network that was investigated, one K. pneumoniae ST147 cluster encoding NDM- and OXA-48 carbapenemases and one VIM-encoding P. aeruginosa ST823 cluster. In the current study, we investigated if NDM- and OXA-48-encoding K. pneumoniae and VIM-encoding P. aeruginosa isolates recovered between 2014 and 2021 from oncological patients belonged to those same clusters. METHODS The 32 isolates were re-cultured, whole-genome sequenced, phenotypically tested for their antimicrobial susceptibility, and analyzed for clonality and resistance genes in silico. RESULTS Among these strains, 25 belonged to the two clusters that had been predominant in the wastewater, while two others belonged to a sequence-type less prominently detected in the drains of the patient rooms. CONCLUSION Patients constantly exposed to antibiotics can, in interaction with their persistently antibiotic-exposed sanitary facilities, form a niche that might be supportive for the emergence, the development, the dissemination, and the maintenance of certain nosocomial pathogen populations in the hospital, due to antibiotic-induced selection pressure. Technical and infection control solutions might help preventing transmission of microorganisms from the wastewater system to the patient and vice versa, particularly concerning the shower and toilet drainage. However, a major driving force might also be antibiotic induced selection pressure and parallel antimicrobial stewardship efforts could be essential.
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Affiliation(s)
- Claudio Neidhöfer
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany.
| | - Esther Sib
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Marcel Neuenhoff
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
- Bioinformatics and Systems Biology, Justus Liebig University Giessen, Giessen, Germany
| | - Oliver Schwengers
- Bioinformatics and Systems Biology, Justus Liebig University Giessen, Giessen, Germany
| | - Tobias Dummin
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Christian Buechler
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Niklas Klein
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
- Department of Microbiology and Hospital Hygiene, Bundeswehr Central Hospital Koblenz, Koblenz, Germany
| | - Julian Balks
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Katharina Axtmann
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Katjana Schwab
- Department of Oncology, Hematology, and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Tobias A W Holderried
- Department of Oncology, Hematology, and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Georg Feldmann
- Department of Oncology, Hematology, and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Peter Brossart
- Department of Oncology, Hematology, and Rheumatology, University Hospital Bonn, Bonn, Germany
| | - Steffen Engelhart
- 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
| | - Gabriele Bierbaum
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
| | - Marijo Parčina
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Venusberg Campus 1, 53127, Bonn, Germany
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9
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Okada N, Takahashi M, Yano Y, Sato M, Abe A, Ishizawa K, Azuma M. Hospital outbreak of extended-spectrum beta-lactamase-producing Escherichia coli potentially caused by toilet and bath chair use. Infect Prev Pract 2022; 4:100239. [PMID: 36052314 PMCID: PMC9424950 DOI: 10.1016/j.infpip.2022.100239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 08/02/2022] [Indexed: 11/21/2022] Open
Affiliation(s)
- Naoto Okada
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan.,Department of Infection Control and Prevention, Tokushima University Hospital, Tokushima, Japan
| | - Mari Takahashi
- Department of Infection Control and Prevention, Tokushima University Hospital, Tokushima, Japan
| | - Yumiko Yano
- Department of Infection Control and Prevention, Tokushima University Hospital, Tokushima, Japan
| | - Masami Sato
- Department of Infection Control and Prevention, Tokushima University Hospital, Tokushima, Japan
| | - Akane Abe
- Department of Infection Control and Prevention, Tokushima University Hospital, Tokushima, Japan
| | - Keisuke Ishizawa
- Department of Pharmacy, Tokushima University Hospital, Tokushima, Japan.,Department of Clinical Pharmacology and Therapeutics, Tokushima University Graduate School of Biomedical Sciences, Tokushima, Japan.,Clinical Research Center for Developmental Therapeutics, Tokushima University Hospital, 2-50-1 Kuramoto, Tokushima, 770-8503 Japan
| | - Momoyo Azuma
- Department of Infection Control and Prevention, Tokushima University Hospital, Tokushima, Japan
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Raun-Petersen C, Toft A, Nordestgaard MM, Holm A, Overballe-Petersen S, Hammerum AM, Hasman H, Justesen US. Investigation of an Enterobacter hormaechei OXA-436 carbapenemase outbreak: when everything goes down the drain. Infect Prev Pract 2022; 4:100228. [PMID: 35860606 PMCID: PMC9289634 DOI: 10.1016/j.infpip.2022.100228] [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: 03/31/2022] [Accepted: 06/22/2022] [Indexed: 11/27/2022] Open
Abstract
Over a time period of 18 months an Enterobacter hormaechei sequence type (ST) 90, harboring a blaOXA-436 carbapenemase gene, was isolated from seven patients at Odense University Hospital, Denmark. The patients were all from the same department, but there was no apparent direct epidemiological link. Whole genome sequencing (WGS) was performed on all clinical isolates as well as on a number of environmental samples including two E. hormaechei ST90 isolates carrying the blaOXA-436 gene, which were isolated in samples from two shower drains at the department. These drains were suspected to be the source of the outbreak.
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Affiliation(s)
| | - Annette Toft
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
| | | | - Anette Holm
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
| | | | - Anette M Hammerum
- Statens Serum Institut, Department of Microbiology and Infection Control, Copenhagen, Denmark
| | - Henrik Hasman
- Statens Serum Institut, Department of Microbiology and Infection Control, Copenhagen, Denmark
| | - Ulrik Stenz Justesen
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
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Andrews V, Hasman H, Midttun M, Feldthaus MB, Porsbo LJ, Holzknecht BJ, Scheutz F, Hess CE, Olesen B. A hospital outbreak of an NDM-producing ST167 Escherichia coli with a possible link to a toilet. J Hosp Infect 2021; 117:186-187. [PMID: 34481891 DOI: 10.1016/j.jhin.2021.08.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/26/2022]
Affiliation(s)
- V Andrews
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark.
| | - H Hasman
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - M Midttun
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - M B Feldthaus
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
| | - L J Porsbo
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - B J Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - F Scheutz
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - C E Hess
- Department of Nephrology and Endocrinology, Copenhagen University Hospital - North Zealand Hospital, Hillerød, Denmark
| | - B Olesen
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
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12
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Tompkins K, van Duin D. Treatment for carbapenem-resistant Enterobacterales infections: recent advances and future directions. Eur J Clin Microbiol Infect Dis 2021; 40:2053-2068. [PMID: 34169446 DOI: 10.1007/s10096-021-04296-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022]
Abstract
Carbapenem-resistant Enterobacterales (CRE) are a growing threat to human health worldwide. CRE often carry multiple resistance genes that limit treatment options and require longer durations of therapy, are more costly to treat, and necessitate therapies with increased toxicities when compared with carbapenem-susceptible strains. Here, we provide an overview of the mechanisms of resistance in CRE, the epidemiology of CRE infections worldwide, and available treatment options for CRE. We review recentlyapproved agents for the treatment of CRE, including ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol, and novel aminoglycosides and tetracyclines. We also discuss recent advances in phage therapy and antibiotics that are currently in development targeted to CRE. The potential for the development of resistance to these therapies remains high, and enhanced antimicrobial stewardship is imperative both to reduce the spread of CRE worldwide and to ensure continued access to efficacious treatment options.
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Affiliation(s)
- Kathleen Tompkins
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
| | - David van Duin
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
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