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Jo JL, Lee JY, Kim JY, Lim YJ, Kim EO, Jung J, Kim SH. Positive rate for carbapenem-resistant Enterobacterales in hospital water environment: a single-centre study in South Korea. J Hosp Infect 2024; 149:203-205. [PMID: 38599496 DOI: 10.1016/j.jhin.2024.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/12/2024]
Affiliation(s)
- J L Jo
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea
| | - J Y Lee
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea
| | - J Y Kim
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea
| | - Y-J Lim
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea
| | - E O Kim
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea
| | - J Jung
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea; Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea.
| | - S-H Kim
- Office for Infection Control, Asan Medical Centre, Seoul, South Korea; Department of Infectious Diseases, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, South Korea
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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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Manageiro V, Cano M, Furtado C, Iglesias C, Reis L, Vieira P, Teixeira A, Martins C, Veloso I, Machado J, Paiva JA, Caniça M. Genomic and epidemiological insight of an outbreak of carbapenemase-producing Enterobacterales in a Portuguese hospital with the emergence of the new KPC-124. J Infect Public Health 2024; 17:386-395. [PMID: 38246112 DOI: 10.1016/j.jiph.2023.12.014] [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: 11/06/2023] [Revised: 12/11/2023] [Accepted: 12/17/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) is an increasing problem in healthcare settings. This study aimed to identify the source of a CPE outbreak that occurred in 2022, in a tertiary hospital in the North of Portugal, to identify exposed patients, and to assess the risk of becoming CPE-positive following hospital admission. METHODS A multi-disciplinary investigation was conducted including descriptive, analytical, and molecular epidemiology, environmental screening, and assessment of infection control measures. Clinical and environmental isolates were analyzed using whole-genome sequencing and phylogenetic analysis. Additionally, a prospective observational cohort study was conducted to further investigate the risk factors associated with the emergence of new cases in cohorts of CPE-negative admitted patients. RESULTS We observed the presence of multispecies KPC-, IMP-, and/or NDM-producing isolates. Genetically indistinguishable clinical and environmental isolates were found on the same room/ward. The ST45 KPC-3-producing Klebsiella pneumoniae clone was the responsible for the outbreak. During patients' treatment, we detected the emergence of resistance to ceftazidime-avibactam, associated with mutations in the blaKPC-3 gene (blaKPC-46, blaKPC-66 and blaKPC-124, the last variant never previously reported), suggesting a vertical evolutionary trajectory. Patients aged ≥ 75 years, hygiene/feeding-care dependent, and/or subjected to secretion aspiration were risk factors for CPE colonization after hospital admission. Additionally, cases with previous admission to the emergency department suggest that CPE dissemination may occur not only during hospitalization but also in the emergency department. CONCLUSION Overall, the study highlights that selection pressure with antibiotics, like ceftazidime-avibactam, is a contributing factor to the emergence of new β-lactamase variants and antibiotic resistance. It also shows that the hospital environment can be a significant source of CPE transmission, and that routine use of infection control measures and real-time molecular epidemiology investigations are essential to ensure the long-term termination of CPE outbreaks and prevent future resurgences.
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Affiliation(s)
- Vera Manageiro
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; ECDC fellowship Programme, Public Health Microbiology path (EUPHEM), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Manuela Cano
- Department of Environmental Health, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Cristina Furtado
- Reference and Surveillance Unit, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Carmen Iglesias
- Clinical Pathology Service, Hospital de Braga, Braga, Portugal
| | - Lígia Reis
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Patrícia Vieira
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal
| | - Aida Teixeira
- Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance (UL-PPCIRA), Hospital de Braga, Braga, Portugal
| | - Cláudia Martins
- Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance (UL-PPCIRA), Hospital de Braga, Braga, Portugal
| | - Isabel Veloso
- Local Unit of the Program for Prevention and Control of Infection and Antimicrobial Resistance (UL-PPCIRA), Hospital de Braga, Braga, Portugal
| | - Jorge Machado
- Coordination of the Department of Infectious Diseases, National Institute of Health, Lisbon, Portugal
| | - José Artur Paiva
- Intensive Care Medicine Service, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal; Medicine Department, Faculty of Medicine, University of Porto, Porto, Portugal; Infections and Antimicrobial Resistance Prevention Programme, Directorate General of Health, Portugal
| | - Manuela Caniça
- National Reference Laboratory of Antibiotic Resistance and Healthcare Associated Infections, Department of Infectious Diseases, National Institute of Health Dr. Ricardo Jorge, Lisbon, Portugal; Centre for the Studies of Animal Science, Institute of Agrarian and Agri-Food Sciences and Technologies, University of Porto, Porto, Portugal; AL4AnimalS, Associate Laboratory for Animal and Veterinary Sciences, Portugal.
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Mascellino MT, Biswas S, Oliva A. Editorial: Enterobacteriaceae antimicrobial agents and resistance: relationship with the therapeutic approach, volume II. Front Cell Infect Microbiol 2024; 14:1356413. [PMID: 38304194 PMCID: PMC10830809 DOI: 10.3389/fcimb.2024.1356413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 01/08/2024] [Indexed: 02/03/2024] Open
Affiliation(s)
| | - Silpak Biswas
- Department of Microbiology, School of Tropical Medicine, Kolkata, India
| | - Alessandra Oliva
- Department of Public Health and Infectious Disease, Sapienza University, Rome, Italy
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SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Hadjadj L, Cassir N, Saïdani N, Hoffman C, Brouqui P, Astoul P, Rolain JM, Baron SA. Outbreak of carbapenem-resistant enterobacteria in a thoracic-oncology unit through clonal and plasmid-mediated transmission of the bla OXA-48 gene in Southern France. Front Cell Infect Microbiol 2022; 12:1048516. [PMID: 36569199 PMCID: PMC9768218 DOI: 10.3389/fcimb.2022.1048516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Carbapenemase-producing Enterobacteriaceae (CPE) represent an increasing threat to public health, especially in hospitals. Objectives To investigate an outbreak of CPE in a thoracic-oncology unit by using whole genome sequencing (WGS) and to describe the control measures taken to limit the epidemic, including fecal microbiota transplantation (FMT). Methods A retrospective study between December 2016 and October 2017 was performed to investigate an outbreak of CPE in a thoracic-oncology unit at the North Hospital in Marseille, France. The isolates were identified, and antimicrobial susceptibility tests were performed. All CPE were sequenced using MiSeq and/or MinIon technologies. Nucleotide variations between plasmids and similarity within the same species were investigated. The origin of this outbreak, its spread, and the decolonization of patients in the ward were also studied. Results Four Citrobacter freundii, one Enterobacter cloacae and four E. hormaechei OXA-48 carbapenemase producers were isolated in eight patients hospitalized the same year in a thoracic-oncology ward. The bla OXA-48 gene was present in a Tn1999.2 transposon located in IncL/M plasmids, with single nucleotide variants (SNV) ranging from 0 to 5. All C. freundii strains belonged to the same ST22 and had more than 99.6% similarity between them. Two strains of E. hormaechei ST1007 were almost identical at 99.98%, while the others belonged to a different ST (ST98, ST114, ST133). No single source was identified. FMT resulted in decolonization in 4/6 patients. Conclusions WGS demonstrated the dissemination of the bla OXA-48 gene by both clonal (C. freundii ST22 and E. hormaechei ST1007) and plasmid spread (pOXA-48 IncL/M). The origin of this outbreak appeared to be both external and internal to the ward. This evidence of cross-infection supports the urgent need for the implementation of infection control measures to prevent CPE dissemination.
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Affiliation(s)
- Linda Hadjadj
- Aix Marseille Univ, Institut de recherche pour le développement (IRD), Assistance Publique-Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infection (MEPHI), Faculté de Médecine et de Pharmacie, Marseille, France,Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Nadim Cassir
- Aix Marseille Univ, Institut de recherche pour le développement (IRD), Assistance Publique-Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infection (MEPHI), Faculté de Médecine et de Pharmacie, Marseille, France,Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Nadia Saïdani
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France,Service de Maladies infectieuses et tropicales, Centre Hospitalier de Quimper, Quimper, France
| | - Clémence Hoffman
- Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Philippe Brouqui
- Aix Marseille Univ, Institut de recherche pour le développement (IRD), Assistance Publique-Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infection (MEPHI), Faculté de Médecine et de Pharmacie, Marseille, France,Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Philippe Astoul
- Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, North University Hospital, Marseille, France,Aix-Marseille University, Marseille, France
| | - Jean-Marc Rolain
- Aix Marseille Univ, Institut de recherche pour le développement (IRD), Assistance Publique-Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infection (MEPHI), Faculté de Médecine et de Pharmacie, Marseille, France,Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France
| | - Sophie Alexandra Baron
- Aix Marseille Univ, Institut de recherche pour le développement (IRD), Assistance Publique-Hôpitaux de Marseille (APHM), Microbes, Evolution, Phylogénie et Infection (MEPHI), Faculté de Médecine et de Pharmacie, Marseille, France,Institut hospitalo-universitaire (IHU) Méditerranée Infection, Marseille, France,*Correspondence: Sophie Alexandra Baron,
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Yeh TK, Lin HJ, Liu PY, Wang JH, Hsueh PR. Antibiotic resistance in Enterobacter hormaechei. Int J Antimicrob Agents 2022; 60:106650. [DOI: 10.1016/j.ijantimicag.2022.106650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/25/2022] [Accepted: 07/31/2022] [Indexed: 11/28/2022]
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blaKPC-2-Encoding IncP-6 Plasmids in Citrobacter freundii and Klebsiella variicola Strains from Hospital Sewage in Japan. Appl Environ Microbiol 2022; 88:e0001922. [PMID: 35380451 DOI: 10.1128/aem.00019-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Klebsiella pneumoniae carbapenemase (KPC) producers are an emerging threat to global health, and the hospital water environment is considered an important reservoir of these life-threatening bacteria. We characterized plasmids of KPC-2-producing Citrobacter freundii and Klebsiella variicola isolates recovered from hospital sewage in Japan. Antimicrobial susceptibility testing, whole-genome sequencing analysis, bacterial conjugation, and transformation experiments were performed for both KPC-2 producers. The blaKPC-2 gene was located on the Tn3 transposon-related region from an IncP-6 replicon plasmid that could not be transferred via conjugation. Compared to the blaKPC-2-encoding plasmid of the C. freundii isolate, alignment analysis of plasmids with blaKPC-2 showed that the blaKPC-2-encoding plasmid of the K. variicola isolate was a novel IncP-6/IncF-like hybrid plasmid containing a 75,218-bp insertion sequence composed of IncF-like plasmid conjugative transfer proteins. Carbapenem-resistant transformants harboring blaKPC-2 were obtained for both isolates. However, no IncF-like insertion region was found in the K. variicola donor plasmid of the transformant, suggesting that this IncF-like region is not readily functional for plasmid conjugative transfer and is maintained depending on the host cells. The findings on the KPC-2 producers and novel genetic content emphasize the key role of hospital sewage as a potential reservoir of pathogens and its linked dissemination of blaKPC-2 through the hospital water environment. Our results indicate that continuous monitoring for environmental emergence of antimicrobial-resistant bacteria might be needed to control the spread of these infectious bacteria. Moreover, it will help elucidate both the evolution and transmission pathways of these bacteria harboring antimicrobial resistance. IMPORTANCE Antimicrobial resistance is a significant problem for global health, and the hospital environment has been recognized as a reservoir of antimicrobial resistance. Here, we provide insight into the genomic features of blaKPC-2-harboring isolates of Citrobacter freundii and Klebsiella variicola obtained from hospital sewage in Japan. The findings of carbapenem-resistant bacteria containing this novel genetic context emphasize that hospital sewage could act as a potential reservoir of pathogens and cause the subsequent spread of blaKPC-2 via horizontal gene transfer in the hospital water environment. This indicates that serial monitoring for environmental bacteria possessing antimicrobial resistance may help us control the spread of infection and also lead to elucidating the evolution and transmission pathways of these bacteria.
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van der Zwet W, Nijsen I, Jamin C, van Alphen L, von Wintersdorff C, Demandt A, Savelkoul P. Role of the environment in transmission of Gram-negative bacteria in two consecutive outbreaks in a haematology-oncology department. Infect Prev Pract 2022; 4:100209. [PMID: 35295671 PMCID: PMC8918851 DOI: 10.1016/j.infpip.2022.100209] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 02/09/2022] [Indexed: 12/18/2022] Open
Affiliation(s)
- W.C. van der Zwet
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Corresponding author.
| | - I.E.J. Nijsen
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C. Jamin
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - L.B. van Alphen
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - C.J.H. von Wintersdorff
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - A.M.P. Demandt
- Dept. Haematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - P.H.M. Savelkoul
- Dept. Medical Microbiology, Maastricht University Medical Center, Maastricht, the Netherlands
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β-lactam Resistance in Pseudomonas aeruginosa: Current Status, Future Prospects. Pathogens 2021; 10:pathogens10121638. [PMID: 34959593 PMCID: PMC8706265 DOI: 10.3390/pathogens10121638] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/06/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022] Open
Abstract
Pseudomonas aeruginosa is a major opportunistic pathogen, causing a wide range of acute and chronic infections. β-lactam antibiotics including penicillins, carbapenems, monobactams, and cephalosporins play a key role in the treatment of P. aeruginosa infections. However, a significant number of isolates of these bacteria are resistant to β-lactams, complicating treatment of infections and leading to worse outcomes for patients. In this review, we summarize studies demonstrating the health and economic impacts associated with β-lactam-resistant P. aeruginosa. We then describe how β-lactams bind to and inhibit P. aeruginosa penicillin-binding proteins that are required for synthesis and remodelling of peptidoglycan. Resistance to β-lactams is multifactorial and can involve changes to a key target protein, penicillin-binding protein 3, that is essential for cell division; reduced uptake or increased efflux of β-lactams; degradation of β-lactam antibiotics by increased expression or altered substrate specificity of an AmpC β-lactamase, or by the acquisition of β-lactamases through horizontal gene transfer; and changes to biofilm formation and metabolism. The current understanding of these mechanisms is discussed. Lastly, important knowledge gaps are identified, and possible strategies for enhancing the effectiveness of β-lactam antibiotics in treating P. aeruginosa infections are considered.
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Standard versus combined chemical, mechanical, and heat decontamination of hospital drains harboring carbapenemase-producing organisms (CPOs): A randomized controlled trial. Infect Control Hosp Epidemiol 2021; 42:1275-1278. [PMID: 33551004 DOI: 10.1017/ice.2020.1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We sought to determine whether combined chemical, mechanical, and heat cleaning was superior to standard cleaning for the decontamination of 32 sink and shower drains harboring carbapenemase-producing organisms (CPOs). Of 16 intervention drains, 10 (63%) were decontaminated until day 7 versus 1 (5%) of 16 comparator drains (P = .002). Intensive cleaning may be useful if administered repeatedly in drain-associated CPO outbreaks.
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