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Snell LB, Prossomariti D, Alcolea-Medina A, Sasson M, Dibbens M, Al-Yaakoubi N, Humayun G, Charalampous T, Alder C, Ward D, Maldonado-Barrueco A, Abadioru O, Batra R, Nebbia G, Otter JA, Edgeworth JD, Goldenberg SD. The drainome: longitudinal metagenomic characterisation of wastewater from hospital ward sinks to characterize the microbiome and resistome and assess the effects of decontamination interventions. J Hosp Infect 2024:S0195-6701(24)00225-1. [PMID: 38969209 DOI: 10.1016/j.jhin.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/28/2024] [Accepted: 06/02/2024] [Indexed: 07/07/2024]
Abstract
BACKGROUND Hospital drains and water interfaces are implicated in nosocomial transmission of pathogens. Metagenomics can assess the microbial composition and presence of antimicrobial resistance genes in drains ('the drainome') but studies applying these methods longitudinally and to assess infection control interventions are lacking. AIM Apply long-read metagenomics coupled with microbiological measurements to investigate the drainome and assess the effects of a peracetic acid-containing decontamination product. METHODS 12-week study in three phases: a baseline phase, an intervention phase of enhanced decontamination with peracetic acid, and a post-intervention phase. Five hospital sink drains on an intensive care unit were sampled twice weekly. Each sample had 1) measurement of total viable count (TVC), 2) metagenomic analyses including i) taxonomic classification of bacteria and fungi ii) antibiotic resistance gene detection iii) plasmid identification, and 3) immunochromatographic detection of antimicrobial residues. FINDINGS Overall TVCs remain unchanged in the intervention phase (+386 CFU/mL, SE 705, p=0.59). There was a small but significant increase in the microbial diversity in the intervention phase (-0.07 in Simpson's index, SE 0.03, p=0.007), which was not sustained post-intervention (-0.05, SE 0.03, p=0.08). The intervention was associated with increased relative abundance of the Pseudomonas genus (18.3% to 40.5% [+22.2%], SE 5.7%, p<0.001). Extended spectrum beta-lactamases were found in all samples, with NDM-carbapenemase found in 3 drains in 6 samples. Antimicrobial residues were detected in a large proportion of samples (31/115, 27%), suggesting use of sinks for non-handwashing activities. CONCLUSIONS Metagenomics and other measurements can measure the composition of the drainome and assess the effectiveness of decontamination interventions.
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Affiliation(s)
- Luke B Snell
- Department of Infectious Diseases, King's College, London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | | | - Adela Alcolea-Medina
- Department of Infectious Diseases, King's College, London, UK; Infection Sciences, Synnovis Analytics LLP, London, UK
| | - Mingaile Sasson
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Michael Dibbens
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Noor Al-Yaakoubi
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gul Humayun
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Christopher Alder
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Daniel Ward
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | | | - Obaro Abadioru
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Rahul Batra
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Gaia Nebbia
- Department of Infectious Diseases, King's College, London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan A Otter
- Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Jonathan D Edgeworth
- Department of Infectious Diseases, King's College, London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Simon D Goldenberg
- Department of Infectious Diseases, King's College, London, UK; Directorate of Infection, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Bourdin T, Benoit MÈ, Prévost M, Charron D, Quach C, Déziel E, Constant P, Bédard E. Disinfection of sink drains to reduce a source of three opportunistic pathogens, during Serratia marcescens clusters in a neonatal intensive care unit. PLoS One 2024; 19:e0304378. [PMID: 38865328 PMCID: PMC11168660 DOI: 10.1371/journal.pone.0304378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVE Evaluate the effects of five disinfection methods on bacterial concentrations in hospital sink drains, focusing on three opportunistic pathogens (OPs): Serratia marcescens, Pseudomonas aeruginosa and Stenotrophomonas maltophilia. DESIGN Over two years, three sampling campaigns were conducted in a neonatal intensive care unit (NICU). Samples from 19 sink drains were taken at three time points: before, during, and after disinfection. Bacterial concentration was measured using culture-based and flow cytometry methods. High-throughput short sequence typing was performed to identify the three OPs and assess S. marcescens persistence after disinfection at the genotypic level. SETTING This study was conducted in a pediatric hospitals NICU in Montréal, Canada, which is divided in an intensive and intermediate care side, with individual rooms equipped with a sink. INTERVENTIONS Five treatments were compared: self-disinfecting drains, chlorine disinfection, boiling water disinfection, hot tap water flushing, and steam disinfection. RESULTS This study highlights significant differences in the effectiveness of disinfection methods. Chlorine treatment proved ineffective in reducing bacterial concentration, including the three OPs. In contrast, all other drain interventions resulted in an immediate reduction in culturable bacteria (4-8 log) and intact cells (2-3 log). Thermal methods, particularly boiling water and steam treatments, exhibited superior effectiveness in reducing bacterial loads, including OPs. However, in drains with well-established bacterial biofilms, clonal strains of S. marcescens recolonized the drains after heat treatments. CONCLUSIONS Our study supports thermal disinfection (>80°C) for pathogen reduction in drains but highlights the need for additional trials and the implementation of specific measures to limit biofilm formation.
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Affiliation(s)
| | | | | | | | - Caroline Quach
- CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Eric Déziel
- INRS-Armand-Frappier Santé Biotechnologie, Laval, QC, Canada
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Varghese MM, Torres-Teran MM, Greentree DH, Cadnum JL, Donskey CJ. What is the optimal frequency of sink drain decontamination with a foam disinfectant? Infect Control Hosp Epidemiol 2024:1-3. [PMID: 38659124 DOI: 10.1017/ice.2024.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
| | | | | | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Curtis J Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
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Antibiotic-resistant organisms establish reservoirs in new hospital built environments and are related to patient blood infection isolates. COMMUNICATIONS MEDICINE 2022; 2:62. [PMID: 35664456 PMCID: PMC9160058 DOI: 10.1038/s43856-022-00124-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 05/06/2022] [Indexed: 02/03/2023] Open
Abstract
Background Healthcare-associated infections due to antibiotic-resistant organisms pose an acute and rising threat to critically ill and immunocompromised patients. To evaluate reservoirs of antibiotic-resistant organisms as a source of transmission to patients, we interrogated isolates from environmental surfaces, patient feces, and patient blood infections from an established and a newly built intensive care unit. Methods We used selective culture to recover 829 antibiotic-resistant organisms from 1594 environmental and 72 patient fecal samples, in addition to 81 isolates from blood cultures. We conducted antibiotic susceptibility testing and short- and long-read whole genome sequencing on recovered isolates. Results Antibiotic-resistant organism burden is highest in sink drains compared to other surfaces. Pseudomonas aeruginosa is the most frequently cultured organism from surfaces in both intensive care units. From whole genome sequencing, different lineages of P. aeruginosa dominate in each unit; one P. aeruginosa lineage of ST1894 is found in multiple sink drains in the new intensive care unit and 3.7% of blood isolates analyzed, suggesting movement of this clone between the environment and patients. Conclusions These results highlight antibiotic-resistant organism reservoirs in hospital built environments as an important target for infection prevention in hospitalized patients. Patients in hospitals often have a suppressed immune system, putting them at increased risk of infection by bacteria that are resistant to antibiotics, some of which may come from sources in the hospital environment. We sampled multiple different surfaces in an established and a newly built intensive care unit and collected patient infection samples. We tested bacteria in these samples for their resistance to antibiotics and sequenced the genetic code of the bacteria to identify relationships between environmental and patient infections. We found the most antibiotic resistant organisms in hospital sink drains. Our sequencing data revealed strains of a certain kind of bacteria could form reservoirs and survive in sink drains and also cause patient infections. These results highlight the importance of removing these antibiotic resistant organism reservoirs to prevent infections. Sukhum, Newcomer et al. evaluate reservoirs of antibiotic-resistant organisms within the built environment and patient samples from an established and a newly-built intensive care unit. The authors demonstrate colonization of sink drains and other sites and show relatedness between environmental reservoirs and patient infections.
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