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Lefebvre A, Bertrand X, Quantin C, Vanhems P, Lucet JC, Nuemi G, Astruc K, Chavanet P, Aho-Glélé LS. Association between Pseudomonas aeruginosa positive water samples and healthcare-associated cases: nine-year study at one university hospital. J Hosp Infect 2016; 96:238-243. [PMID: 28189270 DOI: 10.1016/j.jhin.2016.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/08/2016] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To study the association between the results of water samples and Pseudomonas aeruginosa healthcare-associated cases in a French university hospital. METHODS Generalized Estimating Equations were used on complete case and imputed datasets. The spatial unit was the building and the time unit was the quarter. RESULTS For the period 2004-2013, 2932 water samples were studied; 17% were positive for P. aeruginosa. A higher incidence of P. aeruginosa cases was associated with a higher proportion of positive water samples (P=0.056 in complete case analysis and P=0.031 with the imputed dataset). The association was no longer observed when haematology and intensive care units were excluded, but was significant in analyses of data concerning intensive care units alone (P<0.001). CONCLUSION This study suggests that water outlet contamination in hospitals can lead to an increase in healthcare-associated P. aeruginosa cases in wards dealing with susceptible patients, but does not play a significant role in other wards.
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Affiliation(s)
- A Lefebvre
- Service d'épidémiologie et hygiène hospitalières, CHU Dijon, France; Laboratoire Microbiologie Environnementale et Risques Sanitaires, Dijon, France.
| | - X Bertrand
- Université Paris Diderot, Paris, France; Service d'hygiène, CHU Besançon, France
| | - C Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France; INSERM, CIC 1432, Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France; Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
| | - P Vanhems
- Service d'Hygiène Hospitalière, Epidémiologie et Prévention, groupe hospitalier Edouard Herriot, Lyon, France
| | - J-C Lucet
- Equipe d'épidémiologie et santé publique, Université Claude Bernard, Lyon, France; UHLIN, groupe hospitalier Bichat - Claude Bernard, HUPNVS, AP-HP, Paris, France
| | - G Nuemi
- Biostatistics and Bioinformatics (DIM), University Hospital, Bourgogne Franche-Comté University, Dijon, France; INSERM, CIC 1432, Dijon University Hospital, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon, France
| | - K Astruc
- Service d'épidémiologie et hygiène hospitalières, CHU Dijon, France
| | - P Chavanet
- Laboratoire Chrono-environnement, UMR CNRS 6249, Université de Franche-Comté, Besançon, France; Département de maladies infectieuses, CHU Dijon, France
| | - L S Aho-Glélé
- Service d'épidémiologie et hygiène hospitalières, CHU Dijon, France
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Lefebvre A, Laporte S, Faure S, Tiv M, Chavanet P, Belpois-Duchamp C, Astruc K, Aho-Glélé LS. Information concerning multidrug-resistant bacterial colonization or infection in the medical transfer letter. Med Mal Infect 2015; 45:286-92. [PMID: 26123765 DOI: 10.1016/j.medmal.2015.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 04/07/2015] [Accepted: 05/22/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the proportion of transfer letters that contained information relative to infection or colonization by multidrug-resistant (MDR) bacteria and factors associated with the presence of that information. PATIENTS AND METHODS Patients for whom at least one of these selected MDR bacteria (methicillin-resistant Staphylococcus aureus, extended-spectrum β-lactamase-producing Enterobacteriaceae, or MDR Pseudomonas aeruginosa) was isolated during their hospitalization and who were transferred to another health care facility between 2009 and 2012 were included. Information of the MDR bacterium and the mention of isolation precautions were evaluated in the electronic medical record. RESULTS Information (mention of MDR bacterium or isolation precaution) was present in 57% [52; 65] of records. Full information (genus and species, concept of MDR bacterium and mention of isolation precaution) was found in 20% [16; 25]. The presence of a dedicated item in the standard medical discharge letter was associated with more frequent information. Less information was retrieved with P. aeruginosa cases than with the other 2 MDR bacteria. CONCLUSION The presence of the information has improved, but it is still insufficiently reported. Measures to improve information are needed. Indeed, information on MDR bacterial colonization or infection is the first step for isolation precautions. An item could be added to all standard medical discharge letters. An item could also be added to the indicators used to assess quality and safety in healthcare facilities.
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Affiliation(s)
- A Lefebvre
- Infection control unit, Dijon University Hospital, 21800 Dijon, France.
| | - S Laporte
- Infection control unit, Dijon University Hospital, 21800 Dijon, France
| | - S Faure
- Infection control unit, Dijon University Hospital, 21800 Dijon, France
| | - M Tiv
- Infection control unit, Dijon University Hospital, 21800 Dijon, France
| | - P Chavanet
- Department of infectious diseases, Dijon University Hospital, 21800 Dijon, France
| | - C Belpois-Duchamp
- Infection control unit, Dijon University Hospital, 21800 Dijon, France
| | - K Astruc
- Infection control unit, Dijon University Hospital, 21800 Dijon, France
| | - L S Aho-Glélé
- Infection control unit, Dijon University Hospital, 21800 Dijon, France
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Mamoudou S, Lassina D, Fla K. [Pseudomonas aeruginosa infections in the service of infectious diseases at CHU YO, Burkina Faso: about two cases]. Pan Afr Med J 2015; 21:78. [PMID: 26491521 PMCID: PMC4594982 DOI: 10.11604/pamj.2015.21.78.4739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 03/12/2015] [Indexed: 11/30/2022] Open
Abstract
Nous rapportons deux cas d'infection à Pseudomonas aeruginosa : un cas de méningite et un cas d'infection urinaire. Les auteurs rappellent qu’à côté des étiologies classiques des méningites et des infections urinaires, des germes résistants comme Pseudomonas aeruginosa peuvent être responsables d'infections à localisation méningées et urinaires et dont il faut connaître pour une bonne prise en charge. Le traitement de ces infections requiert un antibiogramme au regard de la grande capacité de résistance de Pseudomonas aeruginosa en milieu hospitalier. La limitation des gestes invasifs et l'application rigoureuse des mesures de prévention des infections en milieu hospitalier contribueront à lutter efficacement contre ces infections en milieu de soins.
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Affiliation(s)
| | - Dao Lassina
- CHU Pédiatrique Charles De Gaulle, Ouagadougou, Burkina Faso
| | - Koueta Fla
- CHU Pédiatrique Charles De Gaulle, Ouagadougou, Burkina Faso
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Drozdov AL, Beleneva IA, Lepeshkin FD, Krutikova AA, Ustinovich KB, Pokrovskii OI, Parenago OO. The effect of St. John’s wort supercritical extract and hyperforin solution on biological subjects. RUSSIAN JOURNAL OF PHYSICAL CHEMISTRY B 2014. [DOI: 10.1134/s1990793113070063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Koh AY, Mikkelsen PJ, Smith RS, Coggshall KT, Kamei A, Givskov M, Lory S, Pier GB. Utility of in vivo transcription profiling for identifying Pseudomonas aeruginosa genes needed for gastrointestinal colonization and dissemination. PLoS One 2010; 5:e15131. [PMID: 21170272 PMCID: PMC3000825 DOI: 10.1371/journal.pone.0015131] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 10/25/2010] [Indexed: 12/01/2022] Open
Abstract
Microarray analysis of Pseudomonas aeruginosa mRNA transcripts expressed in vivo during animal infection has not been previously used to investigate potential virulence factors needed in this setting. We compared mRNA expression in bacterial cells recovered from the gastrointestinal (GI) tracts of P. aeruginosa-colonized mice to that of P. aeruginosa in the drinking water used to colonize the mice. Genes associated with biofilm formation and type III secretion (T3SS) had markedly increased expression in the GI tract. A non-redundant transposon library in P. aeruginosa strain PA14 was used to test mutants in genes identified as having increased transcription during in vivo colonization. All of the Tn-library mutants in biofilm-associated genes had an attenuated ability to form biofilms in vitro, but there were no significant differences in GI colonization and dissemination between these mutants and WT P. aeruginosa PA14. To evaluate T3SS factors, we tested GI colonization and neutropenia-induced dissemination of both deletional (PAO1 and PAK) and insertional (PA14) mutants in four genes in the P. aeruginosa T3SS, exoS or exoU, exoT, and popB. There were no significant differences in GI colonization among these mutant strains and their WT counterparts, whereas rates of survival following dissemination were significantly decreased in mice infected by the T3SS mutant strains. However, there was a variable, strain-dependent effect on overall survival between parental and T3SS mutants. Thus, increased transcription of genes during in vivo murine GI colonization is not predictive of an essential role for the gene product in either colonization or overall survival following induction of neutropenia.
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Affiliation(s)
- Andrew Y Koh
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas, United States of America.
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Adjidé CC, De Meyer A, Weyer M, Obin O, Lamory F, Lesueur C, Trouillet L, Biendo M, Eb F, Ganry O. [Stenotrophomonas maltophilia and Pseudomonas aeruginosa water-associated microbiologic risk assessment in Amiens' University Hospital Centre]. ACTA ACUST UNITED AC 2009; 58:e1-5. [PMID: 19892487 DOI: 10.1016/j.patbio.2009.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2009] [Accepted: 07/12/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa (Psa) and Stenotrophomonas maltophilia (Smalto) are major opportunistic waterborne pathogens causing hospital-acquired infections. This study aimed to assess the biocontamination level of cold water used in Amiens' university hospital wards, from March to June 2008. METHODS We cultivated 122 pairs of cold water first jet and taps cotton-swabs on Cetrimide agar for Psa, on Stenotrophomonas maltophilia selective medium with coloured indicator (SM2i) for Smalto, on Mueller Hinton agar used as isolation medium reference for both, 48h at 30 degrees C. Data analysed with Epi-Info 6.04dFr were compared with chi(2) test, significant at p<.05. RESULTS Psa and Smalto were isolated in 26.2 and 14.8% of water samples and in 21.3 and 10.7% of swab samples respectively. They were associated in 11.5% of water samples and 5% of swab samples. Psa was alone in 13.1% of water samples and 7.4% of swab samples whereas Smalto was found in 6.6% of water and 2.5% of swabs. Psa and Smalto were isolated from 14.8% of water samples and 8.2% of swab samples of the same tap. Finally, respectively 35.2 and 17.2% of the cold water taps were biocontaminated by Psa and Smalto. In fact, microbiologic water taps contamination risk was two-fold higher for Psa than for Smalto, p<.001, without variation between wards. CONCLUSION Sm2i and Cetrimide are suited and efficient medium respectively for Smalto and Psa isolation. Cold-water samples are sufficient for waterborne pathogens biocontamination risk appraisal. Our results urged healthcare workers on efficient water fittings microbiologic risk control to prevent healthcare associated waterborne infections, notably due to Psa and Smalto.
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Affiliation(s)
- C C Adjidé
- Unité d'hygiène et épidémiologie hospitalière, service d'épidémiologie hygiène hospitalière et santé publique, CHU d'Amiens, 1, place Victor-Pauchet, 80054 Amiens cedex 01, France.
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Donaldson AD, Razak L, Liang LJ, Fisher DA, Tambyah PA. Carbapenems and subsequent multiresistant bloodstream infection: does treatment duration matter? Int J Antimicrob Agents 2009; 34:246-51. [PMID: 19628129 DOI: 10.1016/j.ijantimicag.2009.04.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 02/26/2009] [Accepted: 04/06/2009] [Indexed: 10/20/2022]
Abstract
It has been proposed that initial empirical broad-spectrum antibiotic therapy will result in better clinical outcomes and that shorter courses will reduce the 'collateral damage' of promoting antibiotic resistance. There are few data from Intensive Care Units (ICUs) that support this latter conclusion. A prospective observational study was undertaken at the National University Hospital, Singapore, to examine the relationship between duration of carbapenem therapy and subsequent nosocomial multidrug-resistant (MDR) bloodstream infection (BSI). Over a 2-year period, 415 ICU patients receiving empirical carbapenem therapy were prospectively followed. MDR BSI occurred on 35 occasions in 31 patients, comprising 21 carbapenem-resistant Acinetobacter baumannii, 3 carbapenem-resistant Pseudomonas aeruginosa and 11 meticillin-resistant Staphylococcus aureus (MRSA). There was no difference in the duration of carbapenems for those who developed MDR BSI compared with those who did not [median duration 8 days (range 3-23 days) vs. 9 days (range 3-59 days); P=0.78]. On multivariate analysis using the Cox proportional hazard model the hazard ratio was 0.935 (P=0.070). In this cohort of critically ill patients, a shorter duration of carbapenem therapy was not shown to protect against subsequent development of MDR BSI. Strategies that depend primarily on reducing broad-spectrum antibiotic duration may be inadequate in preventing the emergence of MDR organisms.
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Affiliation(s)
- Annabelle D Donaldson
- Yong Loo Lin School of Medicine, National University of Singapore, 5 Lower Kent Ridge Road, Singapore 119074, Singapore
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Zaborina O, Kohler JE, Wang Y, Bethel C, Shevchenko O, Wu L, Turner JR, Alverdy JC. Identification of multi-drug resistant Pseudomonas aeruginosa clinical isolates that are highly disruptive to the intestinal epithelial barrier. Ann Clin Microbiol Antimicrob 2006; 5:14. [PMID: 16762075 PMCID: PMC1513249 DOI: 10.1186/1476-0711-5-14] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2006] [Accepted: 06/08/2006] [Indexed: 12/01/2022] Open
Abstract
Background Multi-drug resistant Pseudomonas aeruginosa nosocomial infections are increasingly recognized worldwide. In this study, we focused on the virulence of multi-drug resistant clinical strains P. aeruginosa against the intestinal epithelial barrier, since P. aeruginosa can cause lethal sepsis from within the intestinal tract of critically ill and immuno-compromised patients via mechanisms involving disruption of epithelial barrier function. Methods We screened consecutively isolated multi-drug resistant P. aeruginosa clinical strains for their ability to disrupt the integrity of human cultured intestinal epithelial cells (Caco-2) and correlated these finding to related virulence phenotypes such as adhesiveness, motility, biofilm formation, and cytotoxicity. Results Results demonstrated that the majority of the multi-drug resistant P. aeruginosa clinical strains were attenuated in their ability to disrupt the barrier function of cultured intestinal epithelial cells. Three distinct genotypes were found that displayed an extreme epithelial barrier-disrupting phenotype. These strains were characterized and found to harbor the exoU gene and to display high swimming motility and adhesiveness. Conclusion These data suggest that detailed phenotypic analysis of the behavior of multi-drug resistant P. aeruginosa against the intestinal epithelium has the potential to identify strains most likely to place patients at risk for lethal gut-derived sepsis. Surveillance of colonizing strains of P. aeruginosa in critically ill patients beyond antibiotic sensitivity is warranted.
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Affiliation(s)
- Olga Zaborina
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - Yingmin Wang
- Department of Pathology, University of Chicago, Chicago, USA
| | - Cindy Bethel
- Clinical Microbiology Laboratories, University of Chicago, Chicago, USA
| | | | - Licheng Wu
- Department of Surgery, University of Chicago, Chicago, USA
| | | | - John C Alverdy
- Department of Surgery, University of Chicago, Chicago, USA
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Lashéras A, Guisset O, Boulestreau H, Rogues AM, Fiore M, Szajner S, Bezian MC, Gabinski C, Gachie JP. Réservoirs et transmission de Pseudomonas aeruginosa en réanimation médicale. Med Mal Infect 2006; 36:99-104. [PMID: 16459043 DOI: 10.1016/j.medmal.2005.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Accepted: 11/21/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The authors had for aim to study reservoirs and transmission of Pseudomonas aeruginosa in an intensive care unit. DESIGN A 6-month prospective descriptive study was made on water samples, samples from hands of health care workers, and clinical samples. P. aeruginosa strains were compared by pulsed-field gel electrophoresis. RESULTS Among the 211 patients hospitalized during the study, 14 (6.6%) were infected by P. aeruginosa. Out of 494 water samples, 80 were contaminated by P. aeruginosa. The regularly disinfected water taps were more rarely contaminated than the others (P<10(-5)). Out of 140 hand samples, one showed contamination from an infected patient. CONCLUSIONS aeruginosa cross transmission was observed during this study. We should follow strict hygienic precautions such as wearing gloves and performing thorough alcoholic rub disinfection. Water taps are often contaminated and require regular disinfection.
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Affiliation(s)
- A Lashéras
- Service d'hygiène hospitalière, hôpital Pellegrin, place Amélie-Raba-Léon, 33076 Bordeaux cedex, France.
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