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Royer G, Virieux-Petit M, Aujoulat F, Hersent C, Baranovsky S, Hammer-Dedet F, Masnou A, Marchandin H, Corne P, Jumas-Bilak E, Romano-Bertrand S. Residual risk of Pseudomonas aeruginosa waterborne contamination in an intensive care unit despite the presence of filters at all water points-of-use. J Hosp Infect 2024; 149:155-164. [PMID: 38705477 DOI: 10.1016/j.jhin.2024.04.012] [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: 02/25/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/07/2024]
Abstract
OBJECTIVE To assess the residual risk of waterborne contamination by Pseudomonas aeruginosa from a water network colonized by a single genotype [sequence type (ST) 299] despite the presence of antimicrobial filters in a medical intensive care unit (ICU). METHODS During the first 19-month period since the ICU opened, contamination of the water network was assessed monthly by collecting water upstream of the filters. Downstream water was also sampled to assess the efficiency of the filters. P. aeruginosa isolates from patients were collected and compared with the waterborne ST299 P. aeruginosa by multiplex-rep polymerase chain reaction (PCR), pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. Cross-transmission events by other genotypes of P. aeruginosa were also assessed. RESULTS Overall, 1.3% of 449 samples of filtered water were positive for P. aeruginosa in inoculum, varying between 1 and 104 colony-forming units/100 mL according to the tap. All P. aeruginosa hydric isolates belonged to ST299 and displayed fewer than two single nucleotide polymorphisms (SNPs). Among 278 clinical isolates from 122 patients, 10 isolates in five patients showed identical profiles to the hydric ST299 clone on both multiplex-rep PCR and PFGE, and differed by an average of fewer than five SNPs, confirming the water network reservoir as the source of contamination by P. aeruginosa for 4.09% of patients. Cross-transmission events by other genotypes of P. aeruginosa were responsible for the contamination of 1.75% of patients. DISCUSSION/CONCLUSION Antimicrobial filters are not sufficient to protect patients from waterborne pathogens when the water network is highly contaminated. A microbiological survey of filtered water may be needed in units hosting patients at risk of P. aeruginosa infections, even when all water points-of-use are fitted with filters.
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Affiliation(s)
- G Royer
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France; Département de prévention, diagnostic et traitement des infections, Hôpital Henri Mondor, AP-HP, Créteil, France
| | - M Virieux-Petit
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France; Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - F Aujoulat
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - C Hersent
- Service de Prévention des Infections et de la Résistance, CHU Montpellier, France
| | - S Baranovsky
- Service de Prévention des Infections et de la Résistance, CHU Montpellier, France
| | - F Hammer-Dedet
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - A Masnou
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France
| | - H Marchandin
- Hydrosciences Montpellier, Univ Montpellier, IRD, CNRS, Montpellier, France; Service de Microbiologie et Hygiène hospitalière, CHU Nîmes, Nîmes, France
| | - P Corne
- Département de Médecine Intensive et Réanimation, CHU Montpellier, Montpellier, France
| | - E Jumas-Bilak
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France
| | - S Romano-Bertrand
- Hydrosciences Montpellier, IRD, CNRS, Univ Montpellier, Service de Prévention des Infections et de la Résistance, CHU Montpellier, Montpellier, France.
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Epidemiology, Evolution of Antimicrobial Profile and Genomic Fingerprints of Pseudomonas aeruginosa before and during COVID-19: Transition from Resistance to Susceptibility. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122049. [PMID: 36556414 PMCID: PMC9783587 DOI: 10.3390/life12122049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 11/24/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND The purpose of the study was to describe the epidemiological implication of Pseudomonas aeruginosa between 2017-2022 in a tertiary hospital from Romania, including the molecular fingerprinting of similar phenotypic strains (multidrug-resistant isolates), which would have an important health impact. The study also describes the resistance profile of P. aeruginosa before and during COVID-19, which might bring new information regarding the management of antibiotic treatments. MATERIALS AND METHODS Information regarding wards, specimen types, species, and antibiotic resistance profile of 1994 strains of Pseudomonas spp. Isolated over a period of 6 years in Mures Clinical County Hospital, Romania, was collected from the WHONET database. From 50 multidrug-resistant isolates, molecular fingerprinting was performed by Enterobacterial Repetitive Intergenic Consensus Polymerase Chain Reaction (ERIC-PCR) to prove the potential clonal distribution. RESULTS A number of 1994 Pseudomonas spp. were isolated between 2017-2022, from which P. aeruginosa was the most frequent species, 97.39% (n = 1942). P. aeruginosa was most frequently isolated in 2017 (n = 538), with the dermatology department as the main source, mainly from pus secretion. A drop in the harvesting rate was noted in 2020 due to COVID-19 restrictions. Regarding the resistance profile, there are a few modifications. The susceptibility of P. aeruginosa to carbapenems, piperacillin-tazobactam, and amikacin suffered alterations before and during COVID-19. The molecular fingerprinting showed three P. aeruginosa clusters, including strains with 80-99% similarity.
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Petitjean M, Juarez P, Meunier A, Daguindau E, Puja H, Bertrand X, Valot B, Hocquet D. The rise and the fall of a Pseudomonas aeruginosa endemic lineage in a hospital. Microb Genom 2021; 7. [PMID: 34473016 PMCID: PMC8715434 DOI: 10.1099/mgen.0.000629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The biological features that allow a pathogen to survive in the hospital environment are mostly unknown. The extinction of bacterial epidemics in hospitals is mostly attributed to changes in medical practice, including infection control, but the role of bacterial adaptation has never been documented. We analysed a collection of Pseudomonas aeruginosa isolates belonging to the Besançon Epidemic Strain (BES), responsible for a 12year nosocomial outbreak, using a genotype-to-phenotype approach. Bayesian analysis estimated the emergence of the clone in the hospital 5 years before its opening, during the creation of its water distribution network made of copper. BES survived better than the reference strains PAO1 and PA14 in a copper solution due to a genomic island containing 13 metal-resistance genes and was specifically able to proliferate in the ubiquitous amoeba Vermamoeba vermiformis. Mutations affecting amino-acid metabolism, antibiotic resistance, lipopolysaccharide biosynthesis, and regulation were enriched during the spread of BES. Seven distinct regulatory mutations attenuated the overexpression of the genes encoding the efflux pump MexAB-OprM over time. The fitness of BES decreased over time in correlation with its genome size. Overall, the resistance to inhibitors and predators presumably aided the proliferation and propagation of BES in the plumbing system of the hospital. The pathogen further spread among patients via multiple routes of contamination. The decreased prevalence of patients infected by BES mirrored the parallel and convergent genomic evolution and reduction that affected bacterial fitness. Along with infection control measures, this may have participated in the extinction of BES in the hospital setting.
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Affiliation(s)
- Marie Petitjean
- Hygiène Hospitalière, Centre Hospitalier Universitaire, 25030 Besançon, France.,UMR CNRS 6249, Université de Bourgogne Franche-Comté, 25030 Besançon, France
| | - Paulo Juarez
- UMR CNRS 6249, Université de Bourgogne Franche-Comté, 25030 Besançon, France
| | - Alexandre Meunier
- Hygiène Hospitalière, Centre Hospitalier Universitaire, 25030 Besançon, France
| | - Etienne Daguindau
- UMR INSERM 1098, Université de Bourgogne Franche-Comté, 25030 Besançon, France
| | - Hélène Puja
- UMR CNRS 6249, Université de Bourgogne Franche-Comté, 25030 Besançon, France
| | - Xavier Bertrand
- Hygiène Hospitalière, Centre Hospitalier Universitaire, 25030 Besançon, France.,UMR CNRS 6249, Université de Bourgogne Franche-Comté, 25030 Besançon, France
| | - Benoit Valot
- UMR CNRS 6249, Université de Bourgogne Franche-Comté, 25030 Besançon, France.,Bioinformatique et Big Data au Service de la Santé, UFR Science de la Santé, Université de Bourgogne Franche-Comté, 25030 Besançon, France
| | - Didier Hocquet
- Hygiène Hospitalière, Centre Hospitalier Universitaire, 25030 Besançon, France.,UMR CNRS 6249, Université de Bourgogne Franche-Comté, 25030 Besançon, France.,Bioinformatique et Big Data au Service de la Santé, UFR Science de la Santé, Université de Bourgogne Franche-Comté, 25030 Besançon, France.,Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, 25030 Besançon, France
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Paul G, Meißner A, Neuneier J, Neuschmelting V, Grau S, Yagdiran A, Scheyerer MJ, Malin JJ, Suárez I, Lehmann C, Exner M, Wiesmüller GA, Higgins PG, Seifert H, Fätkenheuer G, Zweigner J, Jung N. Outbreak of Pseudomonas aeruginosa infections after CT-guided spinal injections. J Hosp Infect 2021; 116:1-9. [PMID: 34298033 DOI: 10.1016/j.jhin.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 07/06/2021] [Accepted: 07/07/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Meningitis and spinal infections with Gram-negative bacteria after local injections for treatment of chronic back pain are rare. This study investigated an outbreak of Pseudomonas aeruginosa infections following computed tomography (CT)-guided spinal injections (SI). METHODS A case was defined as a spinal infection or meningitis with P. aeruginosa after SI between 10th January and 1st March 2019 in the same outpatient clinic. Patients without microbiological evidence of P. aeruginosa but with a favourable response to antimicrobial therapy active against P. aeruginosa were defined as probable cases. FINDINGS Twenty-eight of 297 patients receiving CT-guided SI during the study period developed meningitis or spinal infections. Medical records were available for 19 patients. In 15 patients, there was microbiological evidence of P. aeruginosa, and four patients were defined as probable cases. Two of 19 patients developed meningitis, while the remaining 17 patients developed spinal infections. The median time from SI to hospital admission was 8 days (interquartile range 2-23 days). Patients mainly presented with back pain (N=18; 95%), and rarely developed fever (N=3; 16%). Most patients required surgery (N=16; 84%). Seven patients (37%) relapsed and one patient died. Although the source of infection was not identified microbiologically, documented failures in asepsis when performing SI probably contributed to these infections. CONCLUSIONS SI is generally considered safe, but non-adherence to asepsis can lead to deleterious effects. Spinal infections caused by P. aeruginosa are difficult to treat and have a high relapse rate.
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Affiliation(s)
- G Paul
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; Department of Gastroenterology, Hepatology, Pneumology and Infectious Diseases, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany.
| | - A Meißner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J Neuneier
- Department of Neurology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - V Neuschmelting
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - S Grau
- Centre for Neurosurgery, Department of General Neurosurgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - A Yagdiran
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - M J Scheyerer
- Department of Orthopaedics and Trauma Surgery, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - J J Malin
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - I Suárez
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - C Lehmann
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - M Exner
- Institute of Hygiene and Public Health, Bonn University, Bonn, Germany
| | - G A Wiesmüller
- Abteilung Infektions- and Umwelthygiene, Gesundheitsamt der Stadt Köln, Germany
| | - P G Higgins
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - H Seifert
- Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - G Fätkenheuer
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Cologne-Bonn, Cologne, Germany
| | - J Zweigner
- Department of Hospital Hygiene and Infection Control, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - N Jung
- Department I of Internal Medicine, Division of Infectious Diseases, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
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Causes, Factors, and Control Measures of Opportunistic Premise Plumbing Pathogens—A Critical Review. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11104474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This review critically analyses the chemical and physical parameters that influence the occurrence of opportunistic pathogens in the drinking water distribution system, specifically in premise plumbing. A comprehensive literature review reveals significant impacts of water age, disinfectant residual (type and concentration), temperature, pH, and pipe materials. Evidence suggests that there is substantial interplay between these parameters; however, the dynamics of such relationships is yet to be elucidated. There is a correlation between premise plumbing system characteristics, including those featuring water and energy conservation measures, and increased water quality issues and public health concerns. Other interconnected issues exacerbated by high water age, such as disinfectant decay and reduced corrosion control efficiency, deserve closer attention. Some common features and trends in the occurrence of opportunistic pathogens have been identified through a thorough analysis of the available literature. It is proposed that the efforts to reduce or eliminate their incidence might best focus on these common features.
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Martak D, Meunier A, Sauget M, Cholley P, Thouverez M, Bertrand X, Valot B, Hocquet D. Comparison of pulsed-field gel electrophoresis and whole-genome-sequencing-based typing confirms the accuracy of pulsed-field gel electrophoresis for the investigation of local Pseudomonas aeruginosa outbreaks. J Hosp Infect 2020; 105:643-647. [DOI: 10.1016/j.jhin.2020.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/08/2020] [Indexed: 12/17/2022]
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Jeanvoine A, Meunier A, Puja H, Bertrand X, Valot B, Hocquet D. Contamination of a hospital plumbing system by persister cells of a copper-tolerant high-risk clone of Pseudomonas aeruginosa. WATER RESEARCH 2019; 157:579-586. [PMID: 30999256 DOI: 10.1016/j.watres.2019.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/30/2019] [Accepted: 04/06/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is an important opportunistic pathogen that thrives best in the distal elements of plumbing and waste-water systems. Although nosocomial outbreaks of PA have been associated with water sources, the role of the plumbing system of healthcare premises as a reservoir for this pathogen is still unclear. MATERIALS AND METHODS We collected water samples from 12 technical areas, distant from any medical activity, in a teaching hospital in France once a week for 11 weeks. We used a method that resuscitates persister cells because of the nutrient-poor conditions and the presence of inhibitors (e.g. chlorine and copper ions). Briefly, water was sampled in sterile bottles containing 100 μM of the copper-ion chelating agent diethyldithiocarbamate (DDTC). A portion of the samples was immediately filtered through 0.45-μm membranes, deposited on R2A agar plates, and incubated seven days at 22 °C (following European recommendations). The remaining water was incubated 14 days at 22 °C and then filtered and cultured on R2A, blood-, or cetrimide-containing agar plates. PA isolates were identified by MS MALDI-TOF, genotyped by PFGE and WGS, and tested for survival in a 150 μg/L copper (II) sulphate solution. RESULTS Although the 12 water sampling points always tested negative with the recommended method, 67% were positive at least once for PA with the adapted method (i.e. with DDTC). The 14 PA persister isolates found throughout the plumbing system were clonal and belong to the high-risk clone ST308. Their genome harbours a 37-kb genomic island (GI-7) containing 13 genes linked to copper resistance. ST308 survived better in the copper solution than comparators that did not harbour GI-7 (P. aeruginosa strains PAO1, PA14, and ST235). The deletion of GI-7 in ST308 abrogated its tolerance to copper. The GI-7 nucleotide sequence shares 98% and 72% identity with sequences from the environmental species Pseudomonas putida and the phytopathogenic species Pseudomonas syringae, respectively. CONCLUSION We report the contamination of the plumbing system of a healthcare premises by persister cells of the high-risk clone P. aeruginosa ST308. New recommendations for the monitoring of water contamination should consider persister cells. The genomic island GI-7, which confers tolerance to copper, probably originates from Pseudomonas species found in copper-contaminated soils and plants. Agricultural practices may have an unexpected consequence, allowing copper-tolerant pathogens to survive in the hospital environment and contaminate fragile patients.
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Affiliation(s)
- Audrey Jeanvoine
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Alexandre Meunier
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France
| | - Hélène Puja
- UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Xavier Bertrand
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Benoît Valot
- UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Didier Hocquet
- Laboratoire d'Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France; UMR CNRS 6249, Chrono-environnement, Université de Bourgogne Franche-Comté, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Régional Universitaire, Besançon, France.
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Slekovec C, Robert J, van der Mee-Marquet N, Berthelot P, Rogues AM, Derouin V, Cholley P, Thouverez M, Hocquet D, Bertrand X. Molecular epidemiology of Pseudomonas aeruginosa isolated from infected ICU patients: a French multicenter 2012-2013 study. Eur J Clin Microbiol Infect Dis 2019; 38:921-926. [PMID: 30826996 DOI: 10.1007/s10096-019-03519-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
Although Pseudomonas aeruginosa has a non-clonal epidemic population structure, recent studies have provided evidence of the existence of epidemic high-risk clones. The aim of this study was to assess the molecular epidemiology of P. aeruginosa isolates responsible for infections in French ICUs, regardless of resistance patterns. For a 1-year period, all non-duplicate P. aeruginosa isolated from bacteremia and pulmonary infections in ten adult ICUs of six French university hospitals were characterized by antimicrobial susceptibility testing and genotyping (MLST and PFGE). We identified β-lactamases with an extended spectrum phenotypically and by sequencing. The 104 isolates tested were distributed in 46 STs, of which 7 epidemic high-risk (EHR) clones over-represented: ST111, ST175, ST235, ST244, ST253, ST308, and ST395. Multidrug-resistant (MDR) isolates mostly clustered in these EHR clones, which frequently spread within hospitals. Only one ST233 isolate produced the carbapenemase VIM-2. PFGE analysis suggests frequent intra-hospital cross-transmission involving EHR clones. For ST395 and ST308, we also observed the progression from wild-type to MDR resistance pattern within the same PFGE pattern. Molecular epidemiology of P. aeruginosa in French ICUs is characterized by high clonal diversity notably among antimicrobial susceptible isolates and the over-representation of EHR clones, particularly within MDR isolates, even though multidrug resistance is not a constant inherent trait of EHR clones.
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Affiliation(s)
- Céline Slekovec
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France.,UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Jérôme Robert
- Centre d'immunologie et des maladies infectieuses-Paris, Cimi-Paris, INSERM, Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Sorbonne Université, F-75013, Paris, France
| | | | - Philippe Berthelot
- Hygiène hospitalière et maladies infectieuses, Centre Hospitalier Universitaire, Saint-Etienne, France
| | - Anne-Marie Rogues
- Hygiène hospitalière, Centre Hospitalier Universitaire, INSERM U657, Université de Bordeaux, Bordeaux, France
| | - Véronique Derouin
- Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Paris Sud- Clamart, Le Kremlin-Bicêtre, France
| | - Pascal Cholley
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France.,UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Michelle Thouverez
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France.,UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France
| | - Didier Hocquet
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France.,UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.,Centre d'immunologie et des maladies infectieuses-Paris, Cimi-Paris, INSERM, Laboratoire de Bactériologie-Hygiène, AP-HP, Hôpitaux Universitaires Pitié-Salpêtrière - Charles Foix, Sorbonne Université, F-75013, Paris, France
| | - Xavier Bertrand
- Hygiène Hospitalière, Centre Hospitalier Régional Universitaire, Besançon, France. .,UMR 6249 Chrono-environnement, Université de Bourgogne-Franche-Comté, Besançon, France.
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9
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Goli HR, Nahaei MR, Rezaee MA, Hasani A, Kafil HS, Aghazadeh M, Nikbakht M, Khalili Y. Role of MexAB-OprM and MexXY-OprM efflux pumps and class 1 integrons in resistance to antibiotics in burn and Intensive Care Unit isolates of Pseudomonas aeruginosa. J Infect Public Health 2017; 11:364-372. [PMID: 28993173 DOI: 10.1016/j.jiph.2017.09.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 07/19/2017] [Accepted: 09/09/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The overexpression of efflux pumps and existence of class 1 integrons are the most important mechanisms that contribute to antimicrobial resistance in Pseudomonas aeruginosa especially in burn and Intensive Care Units (ICUs). The present study evaluated the role of MexAB-OprM and MexXY-OprM efflux pumps and class 1 integrons in resistance to antibiotics in burn and ICU isolates of P. aeruginosa. METHODS Fifteen burn and forty-two ICU isolates were obtained from four hospitals in Northwest Iran. The isolates were identified and evaluated by the disk diffusion and agar dilution methods for determining antibiotic resistances. The presence of class 1 integrons and associated resistance gene cassettes were detected by PCR and sequencing of the products. The expression levels of efflux pumps were evaluated by phenotypic and genotypic (Quantitative Real-time PCR) methods. The isolates were genotyped by Random Amplified Polymorphic DNA Typing (RAPD-PCR). RESULTS All burn isolates were integron positive and Multi-drug resistant (MDR), while 78.5% and 69% of ICU isolates were found as MDR and integron positive, respectively. The aadB gene was the most prevalent gene cassette (63.6%) followed by aacA4 (47.7%). Thirty-nine (68.4%) and 43 (75.4%) isolates exhibited an overexpression of MexAB-OprM and MexXY-OprM. Among burn isolates, 80% and 86.6% of them were mexB and mexY overexpressed, while 64.2% and 71.4% of ICU isolates exhibited mexB and mexY overexpression, correspondingly. The isolates were genotyped as 24 different RAPD profiles and were grouped into 15 clusters. CONCLUSIONS The data suggested that class 1 integron had a more significant role than efflux pumps in resistance to beta-lactams and aminoglycosides in burn and ICUs except for gentamicin in burn isolates. Based on our data, it is possible that efflux pumps were not the main cause of high-level resistance to antibiotics.
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Affiliation(s)
- Hamid R Goli
- Department of Medical Microbiology, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Islamic Republic of Iran; Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Mohammad R Nahaei
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Mohammad A Rezaee
- Infectious and Tropical Diseases Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Alka Hasani
- Infectious and Tropical Diseases Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Hossein S Kafil
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Mohammad Aghazadeh
- Drug Applied Research Center, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran.
| | - Mojtaba Nikbakht
- Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
| | - Younes Khalili
- Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Islamic Republic of Iran
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Petitjean M, Martak D, Silvant A, Bertrand X, Valot B, Hocquet D. Genomic characterization of a local epidemic Pseudomonas aeruginosa reveals specific features of the widespread clone ST395. Microb Genom 2017; 3:e000129. [PMID: 29177088 PMCID: PMC5695207 DOI: 10.1099/mgen.0.000129] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/23/2017] [Indexed: 12/21/2022] Open
Abstract
Pseudomonas aeruginosa is a ubiquitous opportunistic pathogen with several clones being frequently associated with outbreaks in hospital settings. ST395 is among these so-called ‘international’ clones. We aimed here to define the biological features that could have helped the implantation and spread of the clone ST395 in hospital settings. The complete genome of a multidrug resistant index isolate (DHS01) of a large hospital outbreak was analysed. We identified DHS01-specific genetic elements, among which were identified those shared with a panel of six independent ST395 isolates responsible for outbreaks in other hospitals. DHS01 has the fifth largest chromosome of the species (7.1 Mbp), with most of its 1555 accessory genes borne by either genomic islands (GIs, n=48) or integrative and conjugative elements (ICEs, n=5). DHS01 is multidrug resistant mostly due to chromosomal mutations. It displayed signatures of adaptation to chronic infection in part due to the loss of a 131 kbp chromosomal fragment. Four GIs were specific to the clone ST395 and contained genes involved in metabolism (GI-4), in virulence (GI-6) and in resistance to copper (GI-7). GI-7 harboured an array of six copper transporters and was shared with non-pathogenic Pseudomonas sp. retrieved from copper-contaminated environments. Copper resistance was confirmed phenotypically in all other ST395 isolates and possibly accounted for the spreading capability of the clone in hospital outbreaks, where water networks have been incriminated. This suggests that genes transferred from copper-polluted environments may have favoured the implantation and spread of the international clone P. aeruginosa ST395 in hospital settings.
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Affiliation(s)
- Marie Petitjean
- 1Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France.,2UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Daniel Martak
- 1Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France.,2UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Alicia Silvant
- 1Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
| | - Xavier Bertrand
- 1Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France.,2UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Benoit Valot
- 2UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France
| | - Didier Hocquet
- 2UMR CNRS 6249 Chrono-Environnement, Université de Bourgogne Franche-Comté, Besançon, France.,3Centre de Ressources Biologiques - Filière Microbiologique, Centre Hospitalier Universitaire de Besançon, 3 Boulevard Fleming, Besançon, France.,1Hygiène Hospitalière, Centre Hospitalier Régional Universitaire de Besançon, Besançon, France
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11
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Cholley P, Stojanov M, Hocquet D, Thouverez M, Bertrand X, Blanc DS. Comparison of double-locus sequence typing (DLST) and multilocus sequence typing (MLST) for the investigation of Pseudomonas aeruginosa populations. Diagn Microbiol Infect Dis 2015; 82:274-7. [DOI: 10.1016/j.diagmicrobio.2015.03.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/17/2015] [Accepted: 03/10/2015] [Indexed: 11/17/2022]
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12
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Falkinham JO, Hilborn ED, Arduino MJ, Pruden A, Edwards MA. Epidemiology and Ecology of Opportunistic Premise Plumbing Pathogens: Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa. ENVIRONMENTAL HEALTH PERSPECTIVES 2015; 123:749-58. [PMID: 25793551 PMCID: PMC4529011 DOI: 10.1289/ehp.1408692] [Citation(s) in RCA: 167] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 03/17/2015] [Indexed: 05/11/2023]
Abstract
BACKGROUND Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa are opportunistic premise plumbing pathogens (OPPPs) that persist and grow in household plumbing, habitats they share with humans. Infections caused by these OPPPs involve individuals with preexisting risk factors and frequently require hospitalization. OBJECTIVES The objectives of this report are to alert professionals of the impact of OPPPs, the fact that 30% of the population may be exposed to OPPPs, and the need to develop means to reduce OPPP exposure. We herein present a review of the epidemiology and ecology of these three bacterial OPPPs, specifically to identify common and unique features. METHODS A Water Research Foundation-sponsored workshop gathered experts from across the United States to review the characteristics of OPPPs, identify problems, and develop a list of research priorities to address critical knowledge gaps with respect to increasing OPPP-associated disease. DISCUSSION OPPPs share the common characteristics of disinfectant resistance and growth in biofilms in water distribution systems or premise plumbing. Thus, they share a number of habitats with humans (e.g., showers) that can lead to exposure and infection. The frequency of OPPP-infected individuals is rising and will likely continue to rise as the number of at-risk individuals is increasing. Improved reporting of OPPP disease and increased understanding of the genetic, physiologic, and structural characteristics governing the persistence and growth of OPPPs in drinking water distribution systems and premise plumbing is needed. CONCLUSIONS Because broadly effective community-level engineering interventions for the control of OPPPs have yet to be identified, and because the number of at-risk individuals will continue to rise, it is likely that OPPP-related infections will continue to increase. However, it is possible that individuals can take measures (e.g., raise hot water heater temperatures and filter water) to reduce home exposures.
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Affiliation(s)
- Joseph O Falkinham
- Department of Biological Sciences, Virginia Tech, Blacksburg, Virginia, USA
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13
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Sartory DP, Pauly D, Garrec N, Bonadonna L, Semproni M, Schell C, Reimann A, Firth SJ, Thom C, Hartemann P, Exner M, Baldauf H, Lee S, Lee JV. Evaluation of an MPN test for the rapid enumeration of Pseudomonas aeruginosa in hospital waters. JOURNAL OF WATER AND HEALTH 2015; 13:427-436. [PMID: 26042975 DOI: 10.2166/wh.2014.187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
In this study, the performance of a new most probable number (MPN) test (Pseudalert(®)/Quanti-Tray(®)) for the enumeration of Pseudomonas aeruginosa from hospital waters was compared with both international and national membrane filtration-based culture methods for P. aeruginosa: ISO 16266:2006 and UK The Microbiology of Drinking Water - Part 8 (MoDW Part 8), which both use Pseudomonas CN agar. The comparison based on the calculation of mean relative differences between the two methods was conducted according to ISO 17994:2014. Using both routine hospital water samples (80 from six laboratories) and artificially contaminated samples (192 from five laboratories), paired counts from each sample and the enumeration method were analysed. For routine samples, there were insufficient data for a conclusive assessment, but the data do indicate at least equivalent performance of Pseudalert(®)/Quanti-Tray(®). For the artificially contaminated samples, the data revealed higher counts of P. aeruginosa being recorded by Pseudalert(®)/Quanti-Tray(®). The Pseudalert(®)/Quanti-Tray(®) method does not require confirmation testing for atypical strains of P. aeruginosa, saving up to 6 days of additional analysis, and has the added advantage of providing confirmed counts within 24-28 hours incubation compared to 40-48 hours or longer for the ISO 16266 and MoDW Part 8 methods.
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Affiliation(s)
- David P Sartory
- SWM Consulting, 7 Sunnybank, Little Ness, Shrewsbury SY4 2LQ, UK E-mail:
| | - Danièle Pauly
- Département Environnement et Santé Publique - INSERM EA 7298 INGRES - Faculté de Médecine, Lorraine University Medical School, Vandoeuvre les Nancy, France
| | - Nathalie Garrec
- Centre Scientifique et Technique du Bâtiment, 11 rue Henri Picherit, BP 82341-44323, Nantes Cedex 3, France
| | - Lucia Bonadonna
- Istituto Superiore di Sanità, Reparto di Microbiologia e Virologia Ambientale e Wellness Dipartimento di Ambiente e Connessa Prevenzione Primaria, Viale Regina Elena 299, Rome 00161, Italy
| | - Maurizio Semproni
- Istituto Superiore di Sanità, Reparto di Microbiologia e Virologia Ambientale e Wellness Dipartimento di Ambiente e Connessa Prevenzione Primaria, Viale Regina Elena 299, Rome 00161, Italy
| | - Christiane Schell
- Hygiene-Institut des Ruhrgebiets, Institut für Umwelthygiene und Toxikologie, Rotthauser Str. 21, Gelsenkirchen 45879, Germany
| | - Annika Reimann
- Hygiene-Institut des Ruhrgebiets, Institut für Umwelthygiene und Toxikologie, Rotthauser Str. 21, Gelsenkirchen 45879, Germany
| | - Susan J Firth
- ALcontrol Laboratories, 7 & 8 Aspen Court, Bessemer Way, Rotherham S60 1FB, UK
| | | | - Philippe Hartemann
- Département Environnement et Santé Publique - INSERM EA 7298 INGRES - Faculté de Médecine, Lorraine University Medical School, Vandoeuvre les Nancy, France
| | - Martin Exner
- Universitätsklinikum Bonn, Institut für Hygiene und Öffentliche Gesundheit, Sigmund-Freud-Straße 25, Bonn 53105, Germany
| | | | - Susanne Lee
- Leegionella Ltd, Edgemoor Cottage, Rockford, Ringwood BH24 3NA, UK
| | - John V Lee
- Leegionella Ltd, Edgemoor Cottage, Rockford, Ringwood BH24 3NA, UK
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Comparative Genomic Analysis of Two Multidrug-Resistant Clinical Isolates of ST395 Epidemic Strain of Pseudomonas aeruginosa Obtained 12 Years Apart. GENOME ANNOUNCEMENTS 2014; 2:2/3/e00515-14. [PMID: 24874685 PMCID: PMC4038890 DOI: 10.1128/genomea.00515-14] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pseudomonas aeruginosa can cause large and prolonged outbreaks in hospitals. We have sequenced and annotated the genomes of two multidrug-resistant P. aeruginosa isolates from the same strain obtained 12 years apart from different patients. Genomic analysis provided insight on the genes acquired and lost by P. aeruginosa during its spread.
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15
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A systematic review and meta-analyses show that carbapenem use and medical devices are the leading risk factors for carbapenem-resistant Pseudomonas aeruginosa. Antimicrob Agents Chemother 2014; 58:2626-37. [PMID: 24550343 DOI: 10.1128/aac.01758-13] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A systematic review and meta-analyses were performed to identify the risk factors associated with carbapenem-resistant Pseudomonas aeruginosa and to identify sources and reservoirs for the pathogen. A systematic search of PubMed and Embase databases from 1 January 1987 until 27 January 2012 identified 1,662 articles, 53 of which were included in a systematic review and 38 in a random-effects meta-analysis study. The use of carbapenem, use of fluoroquinolones, use of vancomycin, use of other antibiotics, having medical devices, intensive care unit (ICU) admission, having underlying diseases, patient characteristics, and length of hospital stay were significant risk factors in multivariate analyses. The meta-analyses showed that carbapenem use (odds ratio [OR] = 7.09; 95% confidence interval [CI] = 5.43 to 9.25) and medical devices (OR = 5.11; 95% CI = 3.55 to 7.37) generated the highest pooled estimates. Cumulative meta-analyses showed that the pooled estimate of carbapenem use was stable and that the pooled estimate of the risk factor "having medical devices" increased with time. We conclude that our results highlight the importance of antibiotic stewardship and the thoughtful use of medical devices in helping prevent outbreaks of carbapenem-resistant P. aeruginosa.
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16
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Tacconelli E, Cataldo M, Dancer S, De Angelis G, Falcone M, Frank U, Kahlmeter G, Pan A, Petrosillo N, Rodríguez-Baño J, Singh N, Venditti M, Yokoe D, Cookson B. ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. Clin Microbiol Infect 2014; 20 Suppl 1:1-55. [DOI: 10.1111/1469-0691.12427] [Citation(s) in RCA: 527] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Revised: 09/29/2013] [Accepted: 10/06/2013] [Indexed: 01/04/2023]
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17
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Knoester M, de Boer MGJ, Maarleveld JJ, Claas ECJ, Bernards AT, de Jonge E, van Dissel JT, Veldkamp KE. An integrated approach to control a prolonged outbreak of multidrug-resistant Pseudomonas aeruginosa in an intensive care unit. Clin Microbiol Infect 2013; 20:O207-15. [PMID: 24707852 DOI: 10.1111/1469-0691.12372] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 08/22/2013] [Accepted: 08/22/2013] [Indexed: 01/05/2023]
Abstract
In this paper we aim to provide insight into the complexity of outbreak management in an intensive care unit (ICU) setting. In October 2010 four patients on the ICU of our tertiary care centre were colonized or infected with a multidrug-resistant strain of Pseudomonas aeruginosa (MDR-PA). An outbreak investigation was carried out and infection control measures were taken in an attempt to identify a potential source and stop transmission. The outbreak investigation included descriptive epidemiology, comprising retrospective case finding by reviewing the laboratory information system back to 2004 and prospective case finding by patient screening for MDR-PA. Furthermore, microbiological analysis, environmental screening and a case-control study were carried out. Infection control measures consisted of re-education of healthcare personnel on basic hygiene measures, auditing of hygiene procedures used in daily practice by infection control practitioners, and stepwise up-regulation of isolation measures. From February 2009 to January 2012, 44 patients on our ICU were found to be MDR-PA positive. MDR-PA isolates of the 44 patients showed two distinct AFLP patterns, with homology within each of the AFLP clusters of more than 93%. The VIM metallo-β-lactamase gene was detected in 20 of 21 tested isolates. A descriptive epidemiology investigation identified the rooms with the highest numbers of MDR-PA positive patients. The case-control study showed three factors to be independently associated with MDR-PA positivity: admission to ICU subunit 1 (OR, 6.1; 95% CI, 1.7, 22), surgery prior to or during admission (OR, 5.7; 95% CI, 1.6, 20) and being warmed-up with the warm-air blanket (OR, 3.6; 95% CI, 1.2, 11). After three environmental screening rounds, with sampling of sinks, furniture and devices in the ICU, without revealing a clear common source, a fourth environmental investigation included culturing of faucet aerators. Two faucets were found to be positive for MDR-PA and were replaced. The occurrence of new cases decreased with the strengthening of infection control measures and declined further with the removal of the common source. With this integrated approach a prolonged outbreak of P. aeruginosa was controlled. Contaminated faucet aerators on the ICU probably served as a persisting source, while interpatient transmission by medical staff was a likely way of spread. Seven months after the last case (January 2012) and 3 months after cessation of extended isolation measures (May 2012), single cases started to occur on the ICU, with a total of seven patients in the past year. No common source has yet been found.
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Affiliation(s)
- M Knoester
- Department of Medical Microbiology, Leiden University Medical Centre, Leiden, the Netherlands
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18
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Loveday HP, Wilson JA, Kerr K, Pitchers R, Walker JT, Browne J. Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review. J Hosp Infect 2013; 86:7-15. [PMID: 24289866 DOI: 10.1016/j.jhin.2013.09.010] [Citation(s) in RCA: 100] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Accepted: 09/18/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Pseudomonas aeruginosa is an opportunistic pathogen with a particular propensity to cause disease in the immunocompromised. Water systems have been reported to contribute to P. aeruginosa transmission in healthcare settings. AIM To systematically assess the evidence that healthcare water systems are associated with P. aeruginosa infection; to review aspects of design that can increase their potential to act as a reservoir; and to compare the efficacy of strategies for eradicating contamination and preventing infection. METHODS A rapid review methodology with a three-step search strategy was used to identify published studies. Scientific advisors were used to identify unpublished studies. FINDINGS Twenty-five relevant studies were included. There was plausible evidence of transmission of P. aeruginosa from water systems to patients and vice versa, although no direct evidence to explain the exact mode of transfer. Two studies provided plausible evidence for effective interventions: point-of-use filters and increasing chlorine disinfection. Non-touch taps and aspects of water system design were identified as probable risk factors for P. aeruginosa biofilm formation and subsequent transmission to patients. Poor hand hygiene or compliance with contact precautions were identified as potential contributory factors; plausible evidence to confirm this was not available. CONCLUSIONS Water systems can act as a source of P. aeruginosa infection in healthcare settings, although the route of transmission is unclear. Contamination appears to be confined to the distal ends of a water system and can persist for prolonged periods. Further studies are required to establish effective methods of preventing transmission and eradicating P. aeruginosa from plumbing systems.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Centre, University of West London, London, UK
| | - J A Wilson
- Institute of Practice, Interdisciplinary Research & Enterprise, University of West London, London, UK.
| | - K Kerr
- Department of Medical Microbiology, Harrogate and District NHS Foundation Trust, Hull York Medical School, York, UK
| | | | - J T Walker
- Biosafety Unit, Health Protection Agency, Porton Down, UK
| | - J Browne
- Richard Wells Research Centre, University of West London, London, UK
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19
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Muscarella LF. Other Possible Causes of a Well-Publicized Outbreak of <i>Pseudomonas aeruginosa</i> Following Arthroscopy in Texas. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/aid.2013.32021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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20
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A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition. BMC Infect Dis 2011; 11:272. [PMID: 21995287 PMCID: PMC3203071 DOI: 10.1186/1471-2334-11-272] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Accepted: 10/13/2011] [Indexed: 11/16/2022] Open
Abstract
Background Studies of recent hospital outbreaks caused by multiresistant P.aeruginosa (MRPA) have often failed to identify a specific environmental reservoir. We describe an outbreak due to a single clone of multiresistant (MR) Pseudomonas aeruginosa (PA) and evaluate the effectiveness of the surveillance procedures and control measures applied. Methods Patients with MRPA isolates were prospectively identified (January 2006-May 2008). A combined surveillance procedure (environmental survey, and active surveillance program in intensive care units [ICUs]) and an infection control strategy (closure of ICU and urology wards for decontamination, strict compliance with cross-transmission prevention protocols, and a program restricting the use of carbapenems in the ICUs) was designed and implemented. Results Three hundred and ninety patients were identified. ICU patients were the most numerous group (22%) followed by urology patients (18%). Environmental surveillance found that 3/19 (16%) non-ICU environmental samples and 4/63 (6%) ICU samples were positive for the MRPA clonal strain. In addition, active surveillance found that 19% of patients were fecal carriers of MRPA. Significant changes in the trends of incidence rates were noted after intervention 1 (reinforcement of cleaning procedures): -1.16 cases/1,000 patient-days (95%CI -1.86 to -0.46; p = 0.003) and intervention 2 (extensive decontamination): -1.36 cases/1,000 patient-days (95%CI -1.88 to -0.84; p < 0.001) in urology wards. In addition, restricted use of carbapenems was initiated in ICUs (January 2007), and their administration decreased from 190-170 DDD/1,000 patient-days (October-December 2006) to 40-60 DDD/1,000 patient-days (January-April 2007), with a reduction from 3.1 cases/1,000 patient-days in December 2006 to 2.0 cases/1,000 patient-days in May 2007. The level of initial carbapenem use rose again during 2008, and the incidence of MRPA increased progressively once more. Conclusions In the setting of sustained MRPA outbreaks, epidemiological findings suggest that patients may be a reservoir for further environmental contamination and cross-transmission. Although our control program was not successful in ending the outbreak, we think that our experience provides useful guidance for future approaches to this problem.
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Boyer A, Doussau A, Thiébault R, Venier AG, Tran V, Boulestreau H, Bébéar C, Vargas F, Hilbert G, Gruson D, Rogues AM. Pseudomonas aeruginosa acquisition on an intensive care unit: relationship between antibiotic selective pressure and patients' environment. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2011; 15:R55. [PMID: 21306623 PMCID: PMC3221986 DOI: 10.1186/cc10026] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 12/13/2010] [Accepted: 02/09/2011] [Indexed: 11/10/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the relationship among Pseudomonas aeruginosa acquisition on the intensive care unit (ICU), environmental contamination and antibiotic selective pressure against P. aeruginosa. METHODS An open, prospective cohort study was carried out in a 16-bed medical ICU where P. aeruginosa was endemic. Over a six-month period, all patients without P. aeruginosa on admission and with a length of stay >72 h were included. Throat, nasal, rectal, sputum and urine samples were taken on admission and at weekly intervals and screened for P. aeruginosa. All antibiotic treatments were recorded daily. Environmental analysis included weekly tap water specimen culture and the presence of other patients colonized with P. aeruginosa. RESULTS A total of 126 patients were included, comprising 1,345 patient-days. Antibiotics were given to 106 patients (antibiotic selective pressure for P. aeruginosa in 39). P. aeruginosa was acquired by 20 patients (16%) and was isolated from 164/536 environmental samples (31%). Two conditions were independently associated with P. aeruginosa acquisition by multivariate analysis: (i) patients receiving ≥3 days of antibiotic selective pressure together with at least one colonized patient on the same ward on the previous day (odds ratio (OR) = 10.3 ((% confidence interval (CI): 1.8 to 57.4); P = 0.01); and (ii) presence of an invasive device (OR = 7.7 (95% CI: 2.3 to 25.7); P = 0.001). CONCLUSIONS Specific interaction between both patient colonization pressure and selective antibiotic pressure is the most relevant factor for P. aeruginosa acquisition on an ICU. This suggests that combined efforts are needed against both factors to decrease colonization with P. aeruginosa.
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Affiliation(s)
- Alexandre Boyer
- Service de Réanimation Médicale, Hôpital Pellegrin-Tripode, place Amélie Raba Léon, 33076 Bordeaux Cedex, France.
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Cholley P, Hocquet D, Alauzet C, Cravoisy-Popovic A, Talon D, Aissa N, Plésiat P, Bertrand X. Hospital outbreak of Pseudomonas aeruginosa producing extended-spectrum oxacillinase OXA-19. J Med Microbiol 2010; 59:866-869. [PMID: 20299501 DOI: 10.1099/jmm.0.019364-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Pascal Cholley
- UMR 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Didier Hocquet
- Centre National de Référence-Résistance chez P. aeruginosa, Centre Hospitalier Universitaire Besançon, Besançon, France.,Service de Bactériologie, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Corentine Alauzet
- Service de Bactériologie, Centre Hospitalier Universitaire Nancy, Nancy, France
| | | | - Daniel Talon
- Centre National de Référence-Résistance chez P. aeruginosa, Centre Hospitalier Universitaire Besançon, Besançon, France.,UMR 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Nejla Aissa
- Service de Bactériologie, Centre Hospitalier Universitaire Nancy, Nancy, France
| | - Patrick Plésiat
- Centre National de Référence-Résistance chez P. aeruginosa, Centre Hospitalier Universitaire Besançon, Besançon, France.,Service de Bactériologie, Centre Hospitalier Universitaire Besançon, Besançon, France
| | - Xavier Bertrand
- Centre National de Référence-Résistance chez P. aeruginosa, Centre Hospitalier Universitaire Besançon, Besançon, France.,UMR 6249 Chrono-Environnement, Université de Franche-Comté, Besançon, France.,Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire Besançon, Besançon, France
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23
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Vettoretti L, Floret N, Hocquet D, Dehecq B, Plésiat P, Talon D, Bertrand X. Emergence of extensive-drug-resistant Pseudomonas aeruginosa in a French university hospital. Eur J Clin Microbiol Infect Dis 2009; 28:1217-22. [PMID: 19504273 DOI: 10.1007/s10096-009-0767-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 05/23/2009] [Indexed: 12/01/2022]
Abstract
The aim of this study was to describe the molecular epidemiology and the mechanisms of resistance to beta-lactams of emerging extensive-drug-resistant Pseudomonas aeruginosa (XDRPA) in a tertiary-care university hospital over a three-year period. Analysis included antimicrobial susceptibility profiling and pulsed-field gel electrophoresis (PFGE). Resistance mechanisms to beta-lactams were identified: production of naturally occurring and acquired beta-lactamases, overproduction of MexAB-OprM and MexXY efflux systems and loss of porin OprD were assessed. Eighteen patients were colonised or infected with XDRPA which remained susceptible to colistin and, to a lesser extent, to rifampicin. beta-lactam resistance was, in most cases, due to the overproduction of AmpC, overproduction of the MexXY efflux system and loss of porin OprD. One isolate produced the class D extended-spectrum oxacillinase (OXA-ESBL) Oxa-28, but none produced metallo-beta-lactamase (MBL) or class A extended-spectrum beta-lactamase (ESBL). The XDRPA clustered in eight PFGE patterns and both the acquisition and loss of resistance determinants was observed within a single clone during its spread. The emergence of XDRPA isolates in our university hospital has been characterised by genotypic heterogeneity, variation of mechanisms of resistance to beta-lactams in a single clone and the predominance of chromosomally encoded resistance mechanisms.
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Affiliation(s)
- L Vettoretti
- Service de Bactériologie, Centre Hospitalier Universitaire Besançon, Besançon, France
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24
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Nosocomial outbreak of a non-cefepime-susceptible ceftazidime-susceptible Pseudomonas aeruginosa strain overexpressing MexXY-OprM and producing an integron-borne PSE-1 betta-lactamase. J Clin Microbiol 2009; 47:2381-7. [PMID: 19494059 DOI: 10.1128/jcm.00094-09] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Cefepime (FEP) and ceftazidime (CAZ) are broad-spectrum cephalosporins that display similar MICs for wild-type Pseudomonas aeruginosa strains. Recently, P. aeruginosa isolates showing a discordance in susceptibility to CAZ and FEP have been noted at the Hospital de Bellvitge in Barcelona, Spain, and a clustering was suspected. During the study period (March to December 2007), 51 patients, particularly those in an intensive care units (ICUs) (n = 29 [57%]), infected or colonized with at least one P. aeruginosa non-FEP-susceptible and CAZ-susceptible (Fep(ns) Caz(s)) phenotype strain were detected. Twenty-three (45%) patients were infected, and the respiratory tract was the most frequent site of infection. Changes in the consumption of antimicrobials in the ICUs were observed over time: a progressive reduction in the levels of consumption of carbapenems (247 defined daily doses [DDD]/1,000 patient days to 66 DDD/1,000 patient days; P = 0.008), after restriction of its use in 2006, and an expected increase in the rate of piperacillin-tazobactam use (42 DDD/1,000 patient days in 2004 to 200 DDD/1,000 patient days in 2007; P < 0.001). Throughout the whole study period, only a single clone of a P. aeruginosa Fep(ns) Caz(s) phenotype strain was identified by pulsed-field gel electrophoresis analysis to be associated with the hyperexpression of MexXY-OprM and the production of an integron-borne PSE-1 ss-lactamase. In conclusion, we identified an epidemic P. aeruginosa clone of an Fep(ns) Caz(s) phenotype strain involving 51 patients, in particular, ICU patients. The combination of the overexpression of an efflux pump and PSE-1 ss-lactamase production is associated with the multidrug-resistant phenotype. The dominant use of a single class of antibiotics could have provided the selective pressure required for the emergence and spread of this P. aeruginosa strain.
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Floret N, Bertrand X, Thouverez M, Talon D. Infections nosocomiales à Pseudomonas aeruginosa : origine exogène ou endogène de la bactérie responsable ? ACTA ACUST UNITED AC 2009; 57:9-12. [DOI: 10.1016/j.patbio.2008.07.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2008] [Accepted: 07/03/2008] [Indexed: 11/30/2022]
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Ribeiro J, Mendes RE, Domingos R, França E, Silbert S, Jones RN, Sader HS. Microbiological and epidemiological characterization of imipenem-resistant Pseudomonas aeruginosa strains from a Brazilian tertiary hospital: report from the SENTRY Antimicrobial Surveillance Program. J Chemother 2007; 18:461-7. [PMID: 17127220 DOI: 10.1179/joc.2006.18.5.461] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES To evaluate the antimicrobial susceptibility profile, the genetic similarity, and the mechanisms of carbapenem resistance among imipenem-resistant Pseudomonas aeruginosa isolates collected from a Brazilian tertiary teaching hospital. METHODS Seventy-eight consecutive samples of P. aeruginosa were evaluated during 2000 and 2001. The antimicrobial susceptibility was evaluated by reference broth microdilution methods and the imipenem-resistant isolates were screened for metallo-beta-lactamase (MbetaL) production throughout disc approximation test and MbetaL Etest strips and isolates with positive screen test result were submitted to PCR assays using primers blaIMP-1, bla VIM-1, blaVIM-2 e blaSPM-1. The genetic similarity of MbetaL-producing strains was evaluated by automated ribotyping for epidemiological typing purpose. RESULTS Resistance rates were high to the majority of antimicrobial agents tested except polymyxin B, which inhibited all samples at the Clinical and Laboratory Standards Institute breakpoint (< or = 2 microg/ml). Twenty-nine (37.2%) isolates were resistant to imipenem and these isolates showed great genomic variability. MbetaL production was demonstrated in two imipenem-resistant isolates, which were detected using blaSPM-1 and blaIMP-2-specific primers. Sequence analysis revealed the presence of blaSPM-1 and a novel blaIMP-type gene, blaIMP-16. CONCLUSION The results of this study showed high resistance rates to the majority of antimicrobial agents among P. aeruginosa samples. High imipenem resistance rates were probably due to continuous selection of resistant mutants. The production of MbetaL did not represent a frequent mechanism of carbapenem resistance in this medical center; but a novel MbetaL was identified. Continued antimicrobial surveillance and infection control measures should be emphasized to minimize the emergence and dissemination of antimicrobial resistance.
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Affiliation(s)
- J Ribeiro
- Infection Control Committee, Hospital de Base do Distrito Federal, Brasília, DF, Brazil.
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Falagas ME, Kopterides P. Risk factors for the isolation of multi-drug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa: a systematic review of the literature. J Hosp Infect 2006; 64:7-15. [PMID: 16822583 DOI: 10.1016/j.jhin.2006.04.015] [Citation(s) in RCA: 192] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Accepted: 04/18/2006] [Indexed: 02/06/2023]
Abstract
An understanding of the epidemiology of multi-drug-resistant (MDR) Acinetobacter baumannii and Pseudomonas aeruginosa infections is necessary in order to develop strategies to curtail their spread. For this purpose, the evidence linking the isolation of MDR A. baumannii and P. aeruginosa with specific risk factors was evaluated. PubMed was searched for the 20-year period from September 1985 to September 2005, and eligible studies were considered to be those that: (1) linked the isolation of A. baumannii and P. aeruginosa with specific risk factors; (2) described the characteristics of the affected patients in detail; and (3) provided data on the antibiotic resistance profile of the isolated micro-organisms. Fifty-five studies were found referring to A. baumannii (28 with case-control methodology and 27 outbreak investigations without case-control methodology), and 42 studies were found referring to P. aeruginosa (25 with case-control methodology and 17 outbreak investigations without case-control methodology). Although heterogeneous study designs and investigated risk factors limited this analysis, it was concluded that acquisition and spread of these micro-organisms appear to be related to a large number of variables. Among the most important were deficiencies in the implementation of infection control guidelines and the use of broad-spectrum antibiotics. Use of carbapenems and third-generation cephalosporins appear to be related to the development of an MDR phenotype by A. baumannii, while carbapenems and fluoroquinolones are implicated in MDR P. aeruginosa. The diversity of risk factors associated with the development of MDR A. baumannii and P. aeruginosa suggests that a separate outbreak investigation should be performed in each hospital setting. The development of innovative control strategies is needed in order to limit the spread of these pathogens.
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Affiliation(s)
- M E Falagas
- Alfa Institute of Biomedical Sciences, Athens, Greece.
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Berthelot P, Grattard F, Mallaval FO, Ros A, Lucht F, Pozzetto B. [Epidemiology of nosocomial infections due to Pseudomonas aeruginosa, Burkholderia cepacia and Stenotrophomonas maltophilia]. ACTA ACUST UNITED AC 2005; 53:341-8. [PMID: 16004946 DOI: 10.1016/j.patbio.2004.09.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2004] [Accepted: 09/14/2004] [Indexed: 12/23/2022]
Abstract
Non-fermentative Gram negative rods are opportunistic pathogens responsible for nosocomial infections. Using phenotypic markers (serotypes for Pseudomonas aeruginosa and antibiotic susceptibility) allows a preliminary screening of epidemiologically-related strains. However, genotypic markers are necessary to better characterize nosocomial strains for the investigation of outbreaks or cross-transmissions in the hospital setting. Infections due to P. aeruginosa, Burkholderia. cepacia or Stenotrophomonas. maltophilia are usually hospital-acquired and responsible for a high mortality rate as illustrated by the lethality of nosocomial pneumonia due to P. aeruginosa. The severity of these infections is due to the virulence factors of the bacteria and to their occurrence in debilitated patients in whom invasives devices are used. The hospital environment can act as a reservoir with a rate of exogeneous transmission of these bacteria as high as 50% in some studies. To better prevent nosocomial infections related to Gram negative non fermentative rods, the control of the aqueous hospital environment, the strict application of hand disinfection and the investigation of potential cross-transmission in the hospital setting are needed.
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Affiliation(s)
- P Berthelot
- Unité d'hygiène interhospitalière, service des maladies infectieuses, CHU de Saint-Etienne, 42055 Saint-Etienne, France.
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Kampf G, Kramer A. Epidemiologic background of hand hygiene and evaluation of the most important agents for scrubs and rubs. Clin Microbiol Rev 2004; 17:863-93, table of contents. [PMID: 15489352 PMCID: PMC523567 DOI: 10.1128/cmr.17.4.863-893.2004] [Citation(s) in RCA: 416] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The etiology of nosocomial infections, the frequency of contaminated hands with the different nosocomial pathogens, and the role of health care workers' hands during outbreaks suggest that a hand hygiene preparation should at least have activity against bacteria, yeasts, and coated viruses. The importance of efficacy in choosing the right hand hygiene product is reflected in the new Centers for Disease Control and Prevention guideline on hand hygiene (J. M. Boyce and D. Pittet, Morb. Mortal. Wkly. Rep. 51:1-45, 2002). The best antimicrobial efficacy can be achieved with ethanol (60 to 85%), isopropanol (60 to 80%), and n-propanol (60 to 80%). The activity is broad and immediate. Ethanol at high concentrations (e.g., 95%) is the most effective treatment against naked viruses, whereas n-propanol seems to be more effective against the resident bacterial flora. The combination of alcohols may have a synergistic effect. The antimicrobial efficacy of chlorhexidine (2 to 4%) and triclosan (1 to 2%) is both lower and slower. Additionally, both agents have a risk of bacterial resistance, which is higher for chlorhexidine than triclosan. Their activity is often supported by the mechanical removal of pathogens during hand washing. Taking the antimicrobial efficacy and the mechanical removal together, they are still less effective than the alcohols. Plain soap and water has the lowest efficacy of all. In the new Centers for Disease Control and Prevention guideline, promotion of alcohol-based hand rubs containing various emollients instead of irritating soaps and detergents is one strategy to reduce skin damage, dryness, and irritation. Irritant contact dermatitis is highest with preparations containing 4% chlorhexidine gluconate, less frequent with nonantimicrobial soaps and preparations containing lower concentrations of chlorhexidine gluconate, and lowest with well-formulated alcohol-based hand rubs containing emollients and other skin conditioners. Too few published data from comparative trials are available to reliably rank triclosan. Personnel should be reminded that it is neither necessary nor recommended to routinely wash hands after each application of an alcohol-based hand rub. Long-lasting improvement of compliance with hand hygiene protocols can be successful if an effective and accessible alcohol-based hand rub with a proven dermal tolerance and an excellent user acceptability is supplied, accompanied by education of health care workers and promotion of the use of the product.
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Affiliation(s)
- Günter Kampf
- Bode Chemie GmbH & Co., Scientific Affairs, Melanchthonstrasse 27, 22525 Hamburg, Germany.
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Bertrand X, Blasco G, Belle E, Boillot A, Capellier G, Talon D. [Pseudomonas aeruginosa epidemiology in intensive care units: importance of cross-transmission]. ANNALES FRANCAISES D'ANESTHESIE ET DE REANIMATION 2003; 22:505-9. [PMID: 12893373 DOI: 10.1016/s0750-7658(03)00136-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To update the local epidemiological data of Pseudomonas aeruginosa in intensive care units (ICU) by assessing the colonisation incidence rate and the level of cross-transmission. METHODS Study carried out in both adult ICUs of the university-hospital of Besançon during a 2 years period. Clinical and surveillance specimens were screened for P. aeruginosa. Pulsed-field-gel-electrophoresis was used as genotyping method to evaluate the rate of cross-transmission. RESULTS During the study, 314 patients were positive for P. aeruginosa (incidence rate of 19.1 patients per 100 admitted patients). One hundred sixty-six of these patients were detected with a clinical specimen and 148 with a screening specimen. Seventy-seven patients were colonised upon admission in the intensive care unit and 237, negative on admission, became positive during their stay. Of the ICU-acquired cases, the mean length of stay before P. aeruginosa colonisation was acquired was 15.7 days. Genotyping revealed that 53.5% of P. aeruginosa colonisation was acquired via cross-transmission (respectively 48.1% in the medical ICU and 59.2% in the surgical ICU); the other cases probably originated from endogenous sources. CONCLUSION The incidences of P. aeruginosa colonisation upon admission and during hospitalisation are consistent with other french and european studies. Although we probably over-estimated the rate of cross-transmission, our results demonstrate that cross-transmission may be a major cause of P. aeruginosa dissemination in ICUs.
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Affiliation(s)
- X Bertrand
- Service d'hygiène hospitalière et d'épidémiologie moléculaire, centre hospitalier universitaire Jean-Minjoz, boulevard Fleming, 25030 Besançon, France
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Hocquet D, Bertrand X, Köhler T, Talon D, Plésiat P. Genetic and phenotypic variations of a resistant Pseudomonas aeruginosa epidemic clone. Antimicrob Agents Chemother 2003; 47:1887-94. [PMID: 12760863 PMCID: PMC155826 DOI: 10.1128/aac.47.6.1887-1894.2003] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
From May 1997 to December 2001, a serotype O:6 multidrug-resistant strain of Pseudomonas aeruginosa colonized or infected 201 patients in the University Hospital of Besançon (France). The susceptibility profile of this epidemic clone to fluoroquinolones and aminoglycosides was relatively stable during the outbreak but showed important isolate-to-isolate variations (up to 64-fold) in the MICs of beta-lactams. Analysis of 18 genotypically related isolates selected on a quarterly basis demonstrated alterations in the two DNA topoisomerases II and IV (Thr83-->Ile in GyrA and Ser87-->Leu in ParC) and production of an ANT(2")-I enzyme. Although constitutively overproduced in these bacteria, the MexXY efflux system did not appear to contribute significantly to aminoglycoside resistance. beta-Lactam resistance was associated with derepression of intrinsic AmpC beta-lactamase (with isolate-to-isolate variations of up to 58-fold) and sporadic deficiency in a 46-kDa protein identified as the carbapenem-selective porin OprD. Of the 18 isolates, 14 were also found to overproduce the efflux system MexAB-OprM as a result of alteration of the repressor protein MexR (His107-->Pro). However, complementation experiments with the cloned mexR gene demonstrated that MexAB-OprM contributed only marginally to beta-lactam and fluoroquinolone resistance. Of the four isolates exhibiting wild-type MexAB-OprM expression despite the MexR alteration, two appeared to harbor secondary mutations in the mexA-mexR intergenic region and one harbored secondary mutations in the putative ribosome binding site located upstream of the mexAB oprM operon. In conclusion, this study shows that many mechanisms were involved in the multiresistance phenotype of this highly epidemic strain of P. aeruginosa. Our results also demonstrate that the clone sporadically underwent substantial genetic and phenotypic variations during the course of the outbreak, perhaps in relation to local or individual selective drug pressures.
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Affiliation(s)
- Didier Hocquet
- Laboratoire de Bactériologie, Hôpital Jean Minjoz, Besançon, France
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Kim PW, Roghmann MC, Perencevich EN, Harris AD. Rates of hand disinfection associated with glove use, patient isolation, and changes between exposure to various body sites. Am J Infect Control 2003; 31:97-103. [PMID: 12665743 DOI: 10.1067/mic.2003.32] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Handwashing is the most effective and economic intervention shown to reduce nosocomial infection rates. However, studies have consistently documented low hand disinfection compliance. Literature regarding the roles that concomitant glove use and isolation precautions play in health care worker compliance with hand disinfection is limited. It is unclear whether workers change gloves and disinfect hands adequately between exposures to different body sites/secretions while caring for a patient. METHODS This was an observational study in which hand disinfection compliance and glove use among workers was evaluated in 2 intensive care units at a tertiary care hospital. RESULTS Five hundred eighty-nine opportunities for hand disinfection were recorded in 40 hours of observation. Overall compliance was 22.1%. We found a statistically significant, positive association between glove use and subsequent hand disinfection (relative risk [RR], 3.9 [95% CI, 2.5-6.0]; P <.0001). Isolation precautions did not significantly increase disinfection compliance. Only 4.8% (3/63) of workers appropriately complied with disinfection when hands were exposed to multiple body sites/secretions while caring for a patient. CONCLUSIONS Glove use increases compliance with hand disinfection. Isolation precautions do not increase compliance. Workers do not appropriately comply with disinfection guidelines when attending to multiple body sites/secretions on the same patient. Compliance with hand disinfection remains low.
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Affiliation(s)
- Peter W Kim
- Department of Epidemiology and Preventive Medicine, University of Maryland School of Medicine, USA
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Gruteke P, Goessens W, Van Gils J, Peerbooms P, Lemmens-Den Toom N, Van Santen-Verheuvel M, Van Belkum A, Verbrugh H. Patterns of resistance associated with integrons, the extended-spectrum beta-lactamase SHV-5 gene, and a multidrug efflux pump of Klebsiella pneumoniae causing a nosocomial outbreak. J Clin Microbiol 2003; 41:1161-6. [PMID: 12624046 PMCID: PMC150252 DOI: 10.1128/jcm.41.3.1161-1166.2003] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Multiresistant Klebsiella pneumoniae caused a nosocomial outbreak. Resistance patterns of the presumed outbreak isolates varied among and within patients. In order to control the outbreak, screening for extended-spectrum beta-lactamase (ESBL)-producing K. pneumoniae was commenced. A number of susceptible K. pneumoniae strains were stored to serve as controls in genetic strain typing. Typing by pulsed-field gel electrophoresis proved the clonality of the strains in the recognized outbreak patients. Typing of the control strains by pulsed-field gel electrophoresis showed that at least one patient had been missed by the ESBL screening procedure. Further genetic typing confirmed the presence of the SHV-5 ESBL gene in all but one of the outbreak strains. Variable presence of integrons that carried the aminoglycoside resistance genes aadB and aadA2 was found. A gyrA mutation in codon 83 was present in all outbreak strains tested, despite considerable differences in ciprofloxacin MICs. The MICs of ciprofloxacin and the chemically unrelated drug cefoxitin were correlated (r = 0.86, P < 0.01) and were compatible with the overexpression of an efflux pump in a subset of the outbreak strains. We conclude that outbreak strains that express an ESBL gene only at a low level may pass unnoticed in a screening procedure, when the laboratory is unaware of variable ESBL expression. In this particular outbreak, screening for strains for which ciprofloxacin MICs were > or =0.25 micro g/ml would in retrospect have been the most sensitive method for detection of the K. pneumoniae outbreak strain.
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Affiliation(s)
- Paul Gruteke
- Municipal Public Health Laboratory, Amsterdam. Zuiderzee Hospital, Lelystad, The Netherlands.
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Bertrand X, Thouverez M, Patry C, Balvay P, Talon D. Pseudomonas aeruginosa: antibiotic susceptibility and genotypic characterization of strains isolated in the intensive care unit. Clin Microbiol Infect 2001. [DOI: 10.1046/j.1469-0691.2001.00348.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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