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Baudet A, Lizon J, Florentin A, Mortier É. Initial waterline contamination by Pseudomonas aeruginosa in newly installed dental chairs. Microbiol Spectr 2024; 12:e0396223. [PMID: 38652098 PMCID: PMC11237434 DOI: 10.1128/spectrum.03962-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/08/2024] [Indexed: 04/25/2024] Open
Abstract
Water contamination in dental unit waterlines (DUWLs) is a potential source of healthcare-associated infection during dental care. The aim of this study was to evaluate the microbiological quality of DUWLs water from newly installed dental chairs in a French University Hospital. The microbiological quality of water from 24 new DUWLs initially disinfected by ICX Renew-prior to use of the dental units for patient treatment-was assessed for total culturable aerobic bacteria at 22°C and 36°C, Legionella sp., Pseudomonas aeruginosa, and total coliforms. Among the 24 samples analyzed, 21 were compliant with the water quality levels: 19 had no bacteria, and 2 contained only 4 and 1 CFU/mL for total culturable aerobic bacteria at 22°C and 36°C, respectively. Three samples were non-compliant due to contamination by P. aeruginosa (4, 2, and 2 CFU/100 mL). Controlling and preventing the microbiological contamination of DUWLs, especially by pathogenic bacteria, at the time of the installation of the new dental chairs are crucial to prevent healthcare-associated infection in dentistry. IMPORTANCE Dental unit waterlines (DUWLs) of new dental chairs may be contaminated before their first clinical use, so an initial shock disinfection is crucial at the time of their installation. The microbiological analyses are crucial to control the water quality of DUWLs before their first clinical use because their disinfection does not guarantee the elimination of all bacteria.
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Affiliation(s)
- Alexandre Baudet
- Faculté d’odontologie, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service d’odontologie, Nancy, France
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
| | - Julie Lizon
- Département territorial d’hygiène et prévention du risque infectieux (DTPRI), CHRU-Nancy, Nancy, France
| | - Arnaud Florentin
- Université de Lorraine, Inserm, INSPIIRE, Nancy, France
- Département territorial d’hygiène et prévention du risque infectieux (DTPRI), CHRU-Nancy, Nancy, France
- Département d’hygiène, des risques environnementaux et associés aux soins (DHREAS), Faculté de Médecine, Université de Lorraine, Nancy, France
| | - Éric Mortier
- Faculté d’odontologie, Université de Lorraine, Nancy, France
- CHRU-Nancy, Service d’odontologie, Nancy, France
- CNRS, IJL, Université de Lorraine, Nancy, France
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Scales ME, Gallagher MC, Haessler S, Lindsey K, Maryanski M, Mathew M, Moore F, Hogan K, Gilmore M, Peters S, Smith K. Achromobacter cluster related to COVID-19 supply chain issues. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2024; 4:e67. [PMID: 38698950 PMCID: PMC11062781 DOI: 10.1017/ash.2024.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 04/04/2024] [Accepted: 04/08/2024] [Indexed: 05/05/2024]
Abstract
Isolation of an unusual organism, Achromobacter xylosoxidans, from 2 cardiac surgical patients on the same day prompted an investigation to search for cases and cause. An extensive review demonstrated a pseudo-outbreak related to practices to conserve laboratory saline due to short supply resulting from supply chain shortage from the coronavirus disease 2019 pandemic.
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Affiliation(s)
- Mary Ellen Scales
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA, USA
- Independent Infection Prevention Consultant, Windsor, CT, USA
| | - Megan C. Gallagher
- Department of Medicine, University of Massachusetts Chan Medical School—Baystate, Springfield, MA, USA
- Division of Infectious Disease, Baystate Medical Center, Springfield, MA, USA
| | - Sarah Haessler
- Department of Medicine, University of Massachusetts Chan Medical School—Baystate, Springfield, MA, USA
- Division of Infectious Disease, Baystate Medical Center, Springfield, MA, USA
| | - Kristy Lindsey
- Department of Microbiology, Baystate Health, Holyoke, MA, USA
| | - Michele Maryanski
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA, USA
| | - Manju Mathew
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA, USA
| | - Franklin Moore
- Department of Microbiology, Baystate Health, Holyoke, MA, USA
- Department of Pathology, University of Massachusetts Chan Medical School—Baystate, Springfield, MA, USA
| | - Karen Hogan
- Division of Infectious Disease, Baystate Medical Center, Springfield, MA, USA
| | - Morgan Gilmore
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA, USA
| | - Stacey Peters
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA, USA
| | - Kristin Smith
- Division of Healthcare Quality, Baystate Medical Center, Springfield, MA, USA
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Sorlin P, Brivet E, Jean-Pierre V, Aujoulat F, Besse A, Dupont C, Chiron R, Jumas-Bilak E, Menetrey Q, Marchandin H. Prevalence and variability of siderophore production in the Achromobacter genus. Microbiol Spectr 2024; 12:e0295323. [PMID: 38315029 PMCID: PMC10913535 DOI: 10.1128/spectrum.02953-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 12/08/2023] [Indexed: 02/07/2024] Open
Abstract
Achromobacter spp. are opportunistic pathogens of environmental origin increasingly isolated in patients with underlying conditions like cystic fibrosis (CF). Despite recent advances, their virulence factors remain incompletely studied, and siderophore production has not yet been investigated in this genus. The aim of this study was to evaluate the production of siderophores in a large collection of Achromobacter spp. and evaluate the variability according to the origin of the strain and species. A total of 163 strains were studied, including 128 clinical strains (CF and non-CF patients) and 35 strains of environmental origin. Siderophores were quantified by the liquid chrome azurol-sulphonate assay. Species were identified by nrdA gene-based phylogeny. Strains were assigned to 20 species, with Achromobacter xylosoxidans being the most represented (51.5% of strains). Siderophore production was observed in 72.4% of the strains, with amounts ranging from 10.1% to 90% siderophore units. A significantly higher prevalence of siderophore-producing strains and greater production of siderophores were observed for clinical strains compared with strains of environmental origin. Highly variable observations were made according to species: A. xylosoxidans presented unique characteristics (one of the highest prevalence of producing strains and highest amounts produced, particularly by CF strains). Siderophores are important factors for bacterial growth commonly produced by members of the Achromobacter genus. The significance of the observations made during this study must be further investigated. Indeed, the differences observed according to species and the origin of strains suggest that siderophores may represent important determinants of the pathophysiology of Achromobacter spp. infections and also contribute to the particular epidemiological success of A. xylosoxidans in human infections. IMPORTANCE Achromobacter spp. are recognized as emerging opportunistic pathogens in humans with various underlying diseases, including cystic fibrosis (CF). Although their pathophysiological traits are increasingly studied, their virulence factors remain incompletely described. Particularly, siderophores that represent important factors of bacterial growth have not yet been studied in this genus. A population-based study was performed to explore the ability of members of the Achromobacter genus to produce siderophores, both overall and in relevant subgroups (Achromobacter species; strain origin, either clinical-from CF or non-CF patients-or environmental). This study provides original data showing that siderophore production is a common trait of Achromobacter strains, particularly observed among clinical strains. The major species, Achromobacter xylosoxidans, encompassed both one of the highest prevalence of siderophore-producing strains and strains producing the largest amounts of siderophores, particularly observed for CF strains. These observations may represent additional advantages accounting for the epidemiological success of this species.
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Affiliation(s)
- P. Sorlin
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - E. Brivet
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - V. Jean-Pierre
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
- Service de Microbiologie et d’Hygiène hospitalière, CHU de Nîmes, Nîmes, France
| | - F. Aujoulat
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - A. Besse
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
| | - C. Dupont
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
- Laboratoire de Bactériologie, CHU de Montpellier, Montpellier, France
| | - R. Chiron
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
- Centre de Ressources et de Compétences de la Mucoviscidose, CHU de Montpellier, Montpellier, France
| | - E. Jumas-Bilak
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
- Laboratoire d’Écologie Microbienne Hospitalière, CHU de Montpellier, Montpellier, France
| | - Q. Menetrey
- INFINITE—Institute for Translational Research in Inflammation, Université de Lille, INSERM U1286, CHU Lille, Lille, France
| | - H. Marchandin
- HydroSciences Montpellier, Université de Montpellier, CNRS, IRD, Montpellier, France
- Service de Microbiologie et d’Hygiène hospitalière, CHU de Nîmes, Nîmes, France
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Papa-Ezdra R, Outeda M, Cordeiro NF, Araújo L, Gadea P, Garcia-Fulgueiras V, Seija V, Bado I, Vignoli R. Outbreak of Pseudomonas aeruginosa High-Risk Clone ST309 Serotype O11 Featuring blaPER-1 and qnrVC6. Antibiotics (Basel) 2024; 13:159. [PMID: 38391545 PMCID: PMC10885872 DOI: 10.3390/antibiotics13020159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 02/24/2024] Open
Abstract
Pseudomonas aeruginosa is a leading cause of hospital-acquired infections worldwide. Biofilm production, antibiotic resistance, and a wide range of virulence factors contribute to their persistence in nosocomial environments. We describe an outbreak caused by a multidrug-resistant P. aeruginosa strain in an ICU. Antibiotic susceptibility was determined and blaPER-1 and qnrVC were amplified via PCR. Clonality was determined using PFGE and biofilm formation was studied with a static model. A combination of antibiotics was assessed on both planktonic cells and biofilms. WGS was performed on five isolates. All isolates were clonally related, resistant to ceftazidime, cefepime, amikacin, and ceftolozane-tazobactam, and harbored blaPER-1; 11/19 possessed qnrVC. Meropenem and ciprofloxacin reduced the biofilm biomass; however, the response to antibiotic combinations with rifampicin was different between planktonic cells and biofilms. WGS revealed that the isolates belonged to ST309 and serotype O11. blaPER-1 and qnrVC6 were associated with a tandem of ISCR1 as part of a complex class one integron, with aac(6')-Il and ltrA as gene cassettes. The structure was associated upstream and downstream with Tn4662 and flanked by direct repeats, suggesting its horizontal mobilization capability as a composite transposon. ST309 is considered an emerging high-risk clone that should be monitored in the Americas.
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Affiliation(s)
- Romina Papa-Ezdra
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay
| | - Matilde Outeda
- Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Av. Italia s/n, CP 11600 Montevideo, Uruguay
| | - Nicolás F Cordeiro
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay
| | - Lucía Araújo
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay
| | - Pilar Gadea
- Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Av. Italia s/n, CP 11600 Montevideo, Uruguay
| | - Virginia Garcia-Fulgueiras
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay
| | - Verónica Seija
- Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Av. Italia s/n, CP 11600 Montevideo, Uruguay
| | - Inés Bado
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay
| | - Rafael Vignoli
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Av. Alfredo Navarro 3051, CP 11600 Montevideo, Uruguay
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5
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Armando M, Barthélémi L, Couret I, Verdier C, Dupont C, Jumas-Bilak E, Grau D. Recurrent environmental contamination in a centralized radiopharmacy unit by Achromobacter spp: results of a large microbiological investigation. Am J Infect Control 2022; 51:557-562. [PMID: 35870659 DOI: 10.1016/j.ajic.2022.07.004] [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: 04/06/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Radiopharmaceuticals preparation unit, such as every aseptic preparation units, are strictly monitored in terms of microbiological contamination. Despite all biocontamination control procedures, our radiopharmacy unit faced repeated environnmental contamination by Achromobacter spp which necessitated a large environmental investigation. METHOD Microbiological controls were carried out using Count Tact agars (Biomérieux) for flat surfaces, dry swabbing for hard to reach areas and containers were filled with a sterile water solution (then filtrated on 0.45µm membrane and seeded). Microbiological identification was performed by mass spectrometry (MALDI-TOF-MS, Brucker) on each positive sample. RESULTS Achromobacter spp was found in 10% of the 413 samples during the 8 months investigation period. The proportion of positive samples was stable among time but their location was unpredictable. The highest inoculum was finally found in the buckets used for biocleaning. DISCUSSION Samples from cleaning buckets taken by dry swabbing were at first negative, but the use of a non-routinely used sampling method allowed to discover the reservoir of this persistent contamination. CONCLUSION This investigation alerted us on the high microbiological risk associated with reusable plastic containers and the importance of a sampling method adapted to critical locations.
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Affiliation(s)
- M Armando
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France
| | - L Barthélémi
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France
| | - I Couret
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France; Unit 1194 INSERM, Team Radiobiology and targeted radiotherapy, Cancer Research Institute of Montpellier, Montpellier, France
| | - C Verdier
- Pharmaceutical Controls Laboratory, Department of Preparations and controls, UTH of Montpellier, France
| | - C Dupont
- UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| | - E Jumas-Bilak
- Infection Control Department, UTH of Montpellier, France; UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| | - D Grau
- Infection Control Department, UTH of Montpellier, France; UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
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6
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Martak D, Gbaguidi-Haore H, Meunier A, Valot B, Conzelmann N, Eib M, Autenrieth IB, Slekovec C, Tacconelli E, Bertrand X, Peter S, Hocquet D, Guther J. High prevalence of Pseudomonas aeruginosa carriage in residents of French and German long-term care facilities. Clin Microbiol Infect 2022; 28:1353-1358. [PMID: 35597505 DOI: 10.1016/j.cmi.2022.05.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/22/2022] [Accepted: 05/03/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To determine prevalence, incidence, and factors associated with Pseudomonas aeruginosa (PA) intestinal carriage in residents of long-term care facilities (LTCFs) and to understand the population structure of this pathogen in LTCFs from two European countries. METHODS We assessed the prevalence of PA intestinal carriage and the incidence of acquisition by collecting fecal samples from 403 residents of 20 LTCFs. We collected 289 environmental samples from sinks and drinking water. Factors associated with carriage and acquisition of intestinal PA were identified. All PA isolates had their antibiotic phenotypic resistance profile determined and their genome sequenced, from which we assessed the population structure of the collection and identified resistance determinants. RESULTS We found a high proportion of residents with PA intestinal carriage (51.6%) over the entire study period. Over the follow-up period, 28.6% of the residents acquired intestinal PA. Older age (Odds ratio [OR] = 1.29, 95% confidence interval [CI]: 1.09-1.52; p = 0.002), urinary incontinence (OR = 2.56, 95% CI: 1.37-4.88; p = 0.003), and male gender (OR = 2.55), 95% CI: 1.05-6.18; p = 0.039) were associated with higher probability of carriage. Wheelchair usage (OR = 4.56, 95% CI: 1.38-15.05; p = 0.013) and a body mass index >25 (OR = 3.71, 95% CI: 1.17-11.82; p = 0.026) were associated with higher risk of PA acquisition. Population structure of our isolates was mainly non-clonal with 112 different STs among the 241 isolates. Most represented STs were high risk clones ST253 (n=26), ST17 (n=11), ST244 (n=11), ST309 (n=10), and ST395 (n=10). Most PA isolates (86.3%) were susceptible to antibiotics, with no acquired genes conferring resistance to antipseudomonal agents. CONCLUSIONS We found an unexpected high prevalence of PA intestinal carriage in LTCF residents mainly associated with individual-level factors. Our study revealed a polyclonal PA population structure suggesting that individual acquisition is more frequent than resident-to-resident transmission.
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Affiliation(s)
- Daniel Martak
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France.
| | - Houssein Gbaguidi-Haore
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Alexandre Meunier
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Benoit Valot
- UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Nadine Conzelmann
- Infectious Diseases, Dept. of Internal Medicine I, University Hospital Tübingen, Tübingen, Germany
| | - Michael Eib
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Ingo B Autenrieth
- University Hospital Heidelberg, Im Neuenheimer Feld 672, 69120 Heidelberg, Germany
| | - Céline Slekovec
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Evelina Tacconelli
- Infectious Diseases, Department of Diagnostics and Public Health, University of Verona, Italy
| | - Xavier Bertrand
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France
| | - Silke Peter
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
| | - Didier Hocquet
- Service d'Hygiène Hospitalière, Centre Hospitalier Universitaire, Besançon, France; UMR 6249 Chrono-environnement, CNRS, Université de Bourgogne Franche-Comté, Besançon, France; Centre de Ressources Biologiques - Filière Microbiologique de Besançon, Centre Hospitalier Universitaire, Besançon, France
| | - Julia Guther
- Institute of Medical Microbiology and Hygiene, University Hospital Tübingen, Tübingen, Germany
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Virieux-Petit M, Hammer-Dedet F, Aujoulat F, Jumas-Bilak E, Romano-Bertrand S. From Copper Tolerance to Resistance in Pseudomonas aeruginosa towards Patho-Adaptation and Hospital Success. Genes (Basel) 2022; 13:genes13020301. [PMID: 35205346 PMCID: PMC8872213 DOI: 10.3390/genes13020301] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 01/27/2022] [Accepted: 02/01/2022] [Indexed: 02/01/2023] Open
Abstract
The hospital environment constitutes a reservoir of opportunistic pathogens responsible for healthcare-associated infections (HCAI) such as Pseudomonas aeruginosa (Pa). Pa persistence within technological niches, the increasing emergence of epidemic high-risk clones in HCAI, the epidemiological link between plumbing strains and clinical strains, make it a major nosocomial pathogen. Therefore, understanding the mechanisms of Pa adaptation to hospital water systems would be useful in preventing HCAI. This review deciphers how copper resistance contributes to Pa adaptation and persistence in a hospital environment, especially within copper water systems, and ultimately to its success as a causative agent of HCAI. Numerous factors are involved in copper homeostasis in Pa, among which active efflux conferring copper tolerance, and copper-binding proteins regulating the copper compartmentalization between periplasm and cytoplasm. The functional harmony of copper homeostasis is regulated by several transcriptional regulators. The genomic island GI-7 appeared as especially responsible for the copper resistance in Pa. Mechanisms of copper and antibiotic cross-resistance and co-resistance are also identified, with potential co-regulation processes between them. Finally, copper resistance of Pa confers selective advantages in colonizing and persisting in hospital environments but also appears as an asset at the host/pathogen interface that helps in HCAI occurrence.
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Affiliation(s)
- Maxine Virieux-Petit
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
| | - Florence Hammer-Dedet
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
| | - Fabien Aujoulat
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
| | - Estelle Jumas-Bilak
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
- Hospital Hygiene and Infection Control Team, University Hospital of Montpellier, 34093 Montpellier, France
| | - Sara Romano-Bertrand
- HydroSciences Montpellier, IRD, CNRS, Montpellier University, 34093 Montpellier, France; (M.V.-P.); (F.H.-D.); (F.A.); (E.J.-B.)
- Hospital Hygiene and Infection Control Team, University Hospital of Montpellier, 34093 Montpellier, France
- UMR 5151 HSM, Equipe Pathogènes Hydriques Santé et Environnements, U.F.R. des Sciences Pharmaceutiques et Biologiques, Université Montpellier, 15, Avenue Charles Flahault, BP 14491, CEDEX 5, 34093 Montpellier, France
- Correspondence: ; Tel.: +33-4-11-75-94-30
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8
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Fonseca ÉL, Morgado SM, Caldart RV, Freitas F, Vicente ACP. Emergence of a VIM-2-producing XDR Pseudomonas aeruginosa ST309 in South America: a comparative genomic analysis. Int J Antimicrob Agents 2021; 59:106507. [PMID: 34958864 DOI: 10.1016/j.ijantimicag.2021.106507] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 12/14/2021] [Accepted: 12/18/2021] [Indexed: 11/18/2022]
Abstract
Pseudomonas aeruginosa has been considered a top priority pathogen associated with elevated morbidity and mortality. Worldwide outbreaks have been associated with few high-risk epidemic P. aeruginosa lineages. However, the biological features involved with the persistence and spread of such lineages among clinical settings remain to be unraveled. This study reports the emergence of an XDR ST309 P. aeruginosa in South America/Brazil, more precisely, in the Amazon region. Genomic analyses were performed with 42 complete and draft ST309 genomes, giving insights into its epidemiology, resistome, and mobilome. Heterogeneous distribution of acquired antimicrobial resistance genes among ST309 genomes was observed, which included blaVIM-2, blaIMP-15, and qnrVC1, all of them associated with class 1 integrons. The mobilome mining showed the presence of Integrative and Conjugative Elements, transposons, and genomic islands harbouring a huge arsenal of heavy metal resistance determinants, which probably provided adaptive advantages to ST309 lineage.
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Affiliation(s)
- Érica L Fonseca
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil.
| | - Sérgio M Morgado
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | | | - Fernanda Freitas
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Ana Carolina P Vicente
- Laboratório de Genética Molecular de Microrganismos, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz (FIOCRUZ), Avenida Brasil 4365, Manguinhos, Rio de Janeiro, RJ, 21040-900, Brazil
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Hamilton KA, Kuppravalli A, Heida A, Joshi S, Haas CN, Verhougstraete M, Gerrity D. Legionnaires' disease in dental offices: Quantifying aerosol risks to dental workers and patients. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2021; 18:378-393. [PMID: 34161202 DOI: 10.1080/15459624.2021.1939878] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Legionella pneumophila is an opportunistic bacterial respiratory pathogen that is one of the leading causes of drinking water outbreaks in the United States. Dental offices pose a potential risk for inhalation or aspiration of L. pneumophila due to the high surface area to volume ratio of dental unit water lines-a feature that is conducive to biofilm growth. This is coupled with the use of high-pressure water devices (e.g., ultrasonic scalers) that produce fine aerosols within the breathing zone. Prior research confirms that L. pneumophila occurs in dental unit water lines, but the associated human health risks have not been assessed. We aimed to: (1) synthesize the evidence for transmission and management of Legionnaires' disease in dental offices; (2) create a quantitative modeling framework for predicting associated L. pneumophila infection risk; and (3) highlight influential parameters and research gaps requiring further study. We reviewed outbreaks, management guidance, and exposure studies and used these data to parameterize a quantitative microbial risk assessment (QMRA) model for L. pneumophila in dental applications. Probabilities of infection for dental hygienists and patients were assessed on a per-exposure and annual basis. We also assessed the impact of varying ventilation rates and the use of personal protective equipment (PPE). Following an instrument purge (i.e., flush) and with a ventilation rate of 1.2 air changes per hour, the median per-exposure probability of infection for dental hygienists and patients exceeded a 1-in-10,000 infection risk benchmark. Per-exposure risks for workers during a purge and annual risks for workers wearing N95 masks did not exceed the benchmark. Increasing air change rates in the treatment room from 1.2 to 10 would achieve an ∼85% risk reduction, while utilization of N95 respirators would reduce risks by ∼95%. The concentration of L. pneumophila in dental unit water lines was a dominant parameter in the model and driver of risk. Future risk assessment efforts and refinement of microbiological control protocols would benefit from expanded occurrence datasets for L. pneumophila in dental applications.
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Affiliation(s)
- Kerry A Hamilton
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
| | - Aditya Kuppravalli
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
- BASIS Scottsdale High School, Scottsdale, Arizona
| | - Ashley Heida
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
| | - Sayalee Joshi
- School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, Arizona
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, Tempe, Arizona
| | - Charles N Haas
- Department of Civil, Architectural, and Environmental Engineering, Drexel University, Philadelphia, Pennsylvania
| | - Marc Verhougstraete
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, Arizona
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Xiong X, Xing Y, He J, Wang L, Shen Z, Chen W, Huang Q. Keystone species determine the "selection mechanism" of multispecies biofilms for bacteria from soil aggregates. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 773:145069. [PMID: 33592465 DOI: 10.1016/j.scitotenv.2021.145069] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 01/05/2021] [Accepted: 01/05/2021] [Indexed: 06/12/2023]
Abstract
Soil aggregates are integral parts of soil structure and play paramount roles in supporting microbial diversity, nutrient cycling and water retention. The formation of multispecies biofilms is a survival strategy for bacterial adaptation to the environment and help microorganisms access more complex nutrient sources via labor sharing, especially in soil aggregates. However, very little is known about the effect of species richness and composition on bacterial multispecies biofilms formation in different size soil aggregates. A random partition design strategy was used to identify the relative importance of bacterial richness and composition in driving multispecies biofilms. The strategy can separate the effects of species richness and composition from the soil aggregates occurring bacterial assemblage. Increasing species richness was found to be always positively correlated with multispecies biofilms productivity for bacteria from the same aggregate fractions. General linear model analysis revealed that species composition contributed more than species richness to forming multispecies biofilms, suggesting that "selection mechanism" plays a more important role than "complementarity mechanism". This "selection mechanism" relies mainly on culturable keystone species that can significantly enhance the formation of multispecies biofilms. The co-occurrence network was investigated to explore whether the culturable keystone species from the random partitions experiment are consistent with the keystone taxa. Four out of 10 culturable keystone species isolated from soil aggregates were matched the keystone taxa. It is concluded that the culturable keystone species determine the multispecies biofilms formation for bacteria residing in soil aggregates. This study provides insights into the role of culturable keystone species in multispecies biofilms. Understanding the formation of multispecies biofilms is fundamental to decipher how microbes interact with each other in soil aggregates. Meanwhile, it will enhance our knowledge of the quorum behavior of complex bacterial communities.
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Affiliation(s)
- Xiang Xiong
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, China
| | - Yanfang Xing
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, China
| | - Jinzhi He
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, China
| | - Li Wang
- Key Laboratory of Arable Land Conservation (Middle and Lower Reaches of Yangtze River), Ministry of Agriculture and Rural Affairs, College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China
| | - Zhenzhen Shen
- Key Laboratory of Arable Land Conservation (Middle and Lower Reaches of Yangtze River), Ministry of Agriculture and Rural Affairs, College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China
| | - Wenli Chen
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, China.
| | - Qiaoyun Huang
- State Key Laboratory of Agricultural Microbiology, Huazhong Agricultural University, Wuhan 430070, China; Key Laboratory of Arable Land Conservation (Middle and Lower Reaches of Yangtze River), Ministry of Agriculture and Rural Affairs, College of Resources and Environment, Huazhong Agricultural University, Wuhan 430070, China
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11
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Sun X, Hill P, Liu J, Qian J, Ma Y, Zhou S. Marine-Source Quorum Quenching Enzyme YtnP to Improve Hygiene Quality in Dental Units. Mar Drugs 2021; 19:md19040225. [PMID: 33923695 PMCID: PMC8073825 DOI: 10.3390/md19040225] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 04/09/2021] [Accepted: 04/12/2021] [Indexed: 12/02/2022] Open
Abstract
Biofilm in dental unit water lines may pose a health risk to patients and dental practitioners. An AdiC-like quorum quenching enzyme, YtnP, was cloned from a deep-sea probiotic Bacillus velezensis, and heterologously expressed in E. coli to examine the application on the improvement of hygiene problems caused by biofilm infection of Pseudomonas aeruginosa in dental units. Pseudomonas bacteria were isolated from dental chair units and used to grow static biofilms in the laboratory. A water filter system was designed to test the antifouling activity of YtnP in Laboratory, to simulate the biofilm contamination on water filter in dental unit water lines. The results demonstrated that the enzyme of YtnP was able to degrade the N-acyl homoserine lactones, significantly inhibited the EPS generation, biofilm formation, and virulence factors production (pyocyanin and rhamnolipid) of P. aeruginosa, and was efficient on the antifouling against P. aeruginosa. The findings in this study indicated the possibility of YtnP as novel disinfectant reagent for hygiene treatment in dental units.
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Affiliation(s)
- Xiaohui Sun
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
- Correspondence: (X.S.); (P.H.); Tel.: +86-595-616-2305 (X.S.)
| | - Philip Hill
- School of Biosciences, Sutton Bonington Campus, University of Nottingham, Loughbrough LE12 5RD, UK
- Correspondence: (X.S.); (P.H.); Tel.: +86-595-616-2305 (X.S.)
| | - Jia Liu
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
| | - Jing Qian
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
| | - Yuting Ma
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
| | - Shufeng Zhou
- College of Chemical Engineering, Huaqiao University, Xiamen 361021, China; (J.L.); (J.Q.); (Y.M.); (S.Z.)
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Spagnolo AM, Sartini M, Cristina ML. Microbial Contamination of Dental Unit Waterlines and Potential Risk of Infection: A Narrative Review. Pathogens 2020; 9:E651. [PMID: 32823641 PMCID: PMC7460066 DOI: 10.3390/pathogens9080651] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 08/09/2020] [Accepted: 08/12/2020] [Indexed: 12/19/2022] Open
Abstract
Several studies have revealed that dental unit waterlines (DUWLs) are often contaminated by large numbers of various micro-organisms (bacteria, fungi, protozoa, viruses). Microbial contamination in DUWLs may originate from the mains water piped into the dental unit, the suck-back of patients' saliva into the line due to the lack of adequate valves, and contamination from bottled water systems. Some of the main determinants of microbial contamination in DUWLs are: a very small lumen size (0.5-2 mm) of the tubing used, high surface-to-volume ratio (6:1), low throughput and the materials of which the tubing is made, water stagnation outside of working hours. The environmental conditions present inside the conduits of the dental unit may facilitate the proliferation of micro-organisms and the consequent formation of biofilm on the interior surface of the pipes of DUWLs. During the use of handpieces, particularly high-speed rotating instruments, a spray is thrown up in the form of aerosols or spatters containing biological material (saliva, blood and dental plaque) and micro-organisms. This means that the health of both dental staff and patients could be at risk of infection. The risk of cross-infections in dental settings can be tackled by implementing combined interventions to prevent the contamination of DUWLs.
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Affiliation(s)
| | - Marina Sartini
- Department of Health Sciences, University of Genova, 16132 Genova, Italy; (A.M.S.); (M.L.C.)
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Zeinali T, Bozorgvar E, Habibi M, Akbari N, Barikbin B. Suction Hoses of Dental Units as a Potential Source of Microbial Contamination. Oman Med J 2020; 35:e107. [PMID: 32181009 PMCID: PMC7073387 DOI: 10.5001/omj.2020.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Accepted: 06/02/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES Dental units are necessary tools for modern dentistry. Microbial contamination of dental units is thought to be the result of biofilm formation in various parts of the unit. We aimed to identify the total microbial count in the suction hose of dental units, and detect the presence of Pseudomonas aeruginosa. METHODS Random sampling of suction hoses of dental units in Birjand, Iran, was performed in dental clinics on the first (n = 115) and last (n = 115) working days of the week. Total viable counts of bacteria and detection of P. aeruginosa were performed on plate count agar and cetrimide agar, respectively. Plates were incubated at 37 °C for 48 hours. RESULTS None of the samples were free from bacterial contamination. P. aeruginosa was detected in 22.6% and 18.3% of samples taken on the first and last working days, respectively. CONCLUSIONS Suction hoses were heavily contaminated with bacteria, especially opportunistic pathogens, and current disinfection does not adequately control the contamination.
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Affiliation(s)
- Tayebeh Zeinali
- Infectious Diseases Research Center, Department of Public Health, School of Health, Birjand University of Medical Sciences, Birjand, Iran
| | - Elham Bozorgvar
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Moghgan Habibi
- Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
| | - Narjes Akbari
- School of Dentistry, Birjand University of Medical Sciences, Birjand, Iran
| | - Behnam Barikbin
- Social Determinants of Health Research Center, Department of Environmental Health Engineering, School of Health, Birjand University of Medical Sciences, Birjand, Iran
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14
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Aujoulat F, Pagès S, Masnou A, Emboulé L, Teyssier C, Marchandin H, Gaudriault S, Givaudan A, Jumas-Bilak E. The population structure of Ochrobactrum isolated from entomopathogenic nematodes indicates interactions with the symbiotic system. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2019; 70:131-139. [PMID: 30790700 DOI: 10.1016/j.meegid.2019.02.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Revised: 10/14/2018] [Accepted: 02/16/2019] [Indexed: 02/02/2023]
Abstract
Entomopathogenic nematodes (EPNs) form specific mutualistic associations with bioluminescent enterobacteria. In Heterorhabditidis indica, Ochrobactrum spp. was identified beside the symbiont Photorhabdus luminescens but its involvement in the symbiotic association in the EPNs remains unclear. This study describe the population structure and the diversity in Ochrobactrum natural populations isolated from EPNs in the Caribbean basin in order to question the existence of EPN-specialized clones and to gain a better insight into Ochrobactrum-EPNs relationships. EPN-associated Ochrobactrum and Photorhabdus strains were characterized by multi-locus sequence typing, Pulsed-Field Gel Electrophoresis fingerprinting and phenotypic traits. Population study showed the absence of EPN-specialized clones in O. intermedium and O. anthropi but suggested the success of some particular lineages. A low level of genetic and genomic diversification of Ochrobactrum isolated from the natural population of Caribbean nematodes was observed comparatively to the diversity of human-associated Ochrobactrum strains. Correspondences between Ochrobactrum and P. luminescens PFGE clusters have been observed, particularly in the case of nematodes from Dominican Republic and Puerto Rico. O. intermedium and O. anthropi associated to EPNs formed less biofilm than human-associated strains. These results evoke interactions between Ochrobactrum and the EPN symbiotic system rather than transient contamination. The main hypothesis to investigate is a toxic/antitoxic relationship because of the ability of Ochrobactrum to resist to antimicrobial and toxic compounds produced by Photorhabdus.
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Affiliation(s)
- Fabien Aujoulat
- HydroSciences Montpellier, IRD, CNRS, Univ Montpellier, Montpellier, France
| | - Sylvie Pagès
- Diversité, Génomes & Interactions Microorganismes-Insectes, INRA, Univ Montpellier, Montpellier, France
| | - Agnès Masnou
- HydroSciences Montpellier, IRD, CNRS, Univ Montpellier, Montpellier, France
| | - Loic Emboulé
- CHU de Pointe-à-Pitre/Abymes, Pointe-à-Pitre, Guadeloupe, France
| | | | - Hélène Marchandin
- HydroSciences Montpellier, IRD, CNRS, Univ Montpellier, Montpellier, France
| | - Sophie Gaudriault
- Diversité, Génomes & Interactions Microorganismes-Insectes, INRA, Univ Montpellier, Montpellier, France
| | - Alain Givaudan
- Diversité, Génomes & Interactions Microorganismes-Insectes, INRA, Univ Montpellier, Montpellier, France
| | - Estelle Jumas-Bilak
- HydroSciences Montpellier, IRD, CNRS, Univ Montpellier, Montpellier, France.
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15
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Metabolic Modeling of Cystic Fibrosis Airway Communities Predicts Mechanisms of Pathogen Dominance. mSystems 2019; 4:mSystems00026-19. [PMID: 31020043 PMCID: PMC6478966 DOI: 10.1128/msystems.00026-19] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 03/29/2019] [Indexed: 01/08/2023] Open
Abstract
Cystic fibrosis (CF) is a genetic disease in which chronic airway infections and lung inflammation result in respiratory failure. CF airway infections are usually caused by bacterial communities that are difficult to eradicate with available antibiotics. Using species abundance data for clinically stable adult CF patients assimilated from three published studies, we developed a metabolic model of CF airway communities to better understand the interactions between bacterial species and between the bacterial community and the lung environment. Our model predicted that clinically observed CF pathogens could establish dominance over other community members across a range of lung nutrient conditions. Heterogeneity of species abundances across 75 patient samples could be predicted by assuming that sample-to-sample heterogeneity was attributable to random variations in the CF nutrient environment. Our model predictions provide new insights into the metabolic determinants of pathogen dominance in the CF lung and could facilitate the development of improved treatment strategies. Cystic fibrosis (CF) is a fatal genetic disease characterized by chronic lung infections due to aberrant mucus production and the inability to clear invading pathogens. The traditional view that CF infections are caused by a single pathogen has been replaced by the realization that the CF lung usually is colonized by a complex community of bacteria, fungi, and viruses. To help unravel the complex interplay between the CF lung environment and the infecting microbial community, we developed a community metabolic model comprised of the 17 most abundant bacterial taxa, which account for >95% of reads across samples, from three published studies in which 75 sputum samples from 46 adult CF patients were analyzed by 16S rRNA gene sequencing. The community model was able to correctly predict high abundances of the “rare” pathogens Enterobacteriaceae, Burkholderia, and Achromobacter in three patients whose polymicrobial infections were dominated by these pathogens. With these three pathogens removed, the model correctly predicted that the remaining 43 patients would be dominated by Pseudomonas and/or Streptococcus. This dominance was predicted to be driven by relatively high monoculture growth rates of Pseudomonas and Streptococcus as well as their ability to efficiently consume amino acids, organic acids, and alcohols secreted by other community members. Sample-by-sample heterogeneity of community composition could be qualitatively captured through random variation of the simulated metabolic environment, suggesting that experimental studies directly linking CF lung metabolomics and 16S sequencing could provide important insights into disease progression and treatment efficacy. IMPORTANCE Cystic fibrosis (CF) is a genetic disease in which chronic airway infections and lung inflammation result in respiratory failure. CF airway infections are usually caused by bacterial communities that are difficult to eradicate with available antibiotics. Using species abundance data for clinically stable adult CF patients assimilated from three published studies, we developed a metabolic model of CF airway communities to better understand the interactions between bacterial species and between the bacterial community and the lung environment. Our model predicted that clinically observed CF pathogens could establish dominance over other community members across a range of lung nutrient conditions. Heterogeneity of species abundances across 75 patient samples could be predicted by assuming that sample-to-sample heterogeneity was attributable to random variations in the CF nutrient environment. Our model predictions provide new insights into the metabolic determinants of pathogen dominance in the CF lung and could facilitate the development of improved treatment strategies.
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16
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Lizzadro J, Mazzotta M, Girolamini L, Dormi A, Pellati T, Cristino S. Comparison between Two Types of Dental Unit Waterlines: How Evaluation of Microbiological Contamination Can Support Risk Containment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E328. [PMID: 30682855 PMCID: PMC6388184 DOI: 10.3390/ijerph16030328] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 01/16/2019] [Accepted: 01/18/2019] [Indexed: 01/16/2023]
Abstract
Infection risk management in a dental unit waterline (DUWL) involves healthcare personnel and patients and is related to routine exposure to water and aerosols that may contain bacterial species. To improve water safety plans, maintenance, and sanitation procedures, analyses of heterotrophic plate counts (HPCs) at 36 °C, and two other microorganisms frequently associated with biofilms, Pseudomonas aeruginosa and Legionella spp., were performed in order to evaluate differences in microbiological contamination between two types of DUWLs: Type A, provided by a water tank, and Type B, directly connected to municipal water. The data showed that the water supply and water safety plan differentially influenced microbiological contamination: Type A DUWLs were more contaminated than Type B DUWLs for all microbiological parameters tested, with significant changes in the percentage of positive samples and contamination levels that were beyond the limits of standard guidelines. The results obtained show how the storage tank, the absence of anti-retraction valves, and the disinfection procedures performed are the main critical points of Type A DUWLs, which confirms that dental unit management (maintenance/sanitization) is often missed or not correctly applied by stakeholders, with an underestimation of the real risk of infection for patients and operators.
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Affiliation(s)
- Jessica Lizzadro
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Marta Mazzotta
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Luna Girolamini
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Ada Dormi
- Department of Medical and Surgical Science, DIMEC, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
| | - Tiziana Pellati
- GVM Care & Research, via Emaldi 10, 48124 Lugo di Ravenna, Italy.
| | - Sandra Cristino
- Department of Biological, Geological, and Environmental Sciences, BiGeA, University of Bologna, via San Giacomo 12, 40126 Bologna, Italy.
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17
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Volgenant CMC, de Soet JJ. Cross-transmission in the Dental Office: Does This Make You Ill? CURRENT ORAL HEALTH REPORTS 2018; 5:221-228. [PMID: 30524929 PMCID: PMC6244620 DOI: 10.1007/s40496-018-0201-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Recently, numerous scientific publications were published which shed new light on the possible risks of infection for dental healthcare workers and their patients. This review aimed to provide the latest insights in the relative risks of transmission of (pathogenic) micro-organisms in the dental office. RECENT FINDINGS Of all different routes of micro-organism transmission during or immediately after dental treatment (via direct contact/via blood-blood contact/via dental unit water and aerosols), evidence of transmission is available. However, the recent results put the risks in perspective; infections related to the dental office are most likely when infection control measures are not followed meticulously. SUMMARY The risk for transmission of pathogens in a dental office resulting in an infectious disease is still unknown; it seems to be limited in developed countries but it cannot be considered negligible. Therefore, maintaining high standards of infection preventive measures is of high importance for dental healthcare workers to avoid infectious diseases due to cross-contamination.
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Affiliation(s)
- C. M. C. Volgenant
- Department of Preventive Dentistry, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
- Department of Oral Kinesiology, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - J. J. de Soet
- Department of Preventive Dentistry, Academic Centre for Dentistry of Amsterdam (ACTA), University of Amsterdam and Vrije Universiteit Amsterdam, Gustav Mahlerlaan 3004, 1081 LA Amsterdam, The Netherlands
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18
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Tracking carbapenemase-producing bacteria by molecular typing: Population diversity and sampling pitfall. INFECTION GENETICS AND EVOLUTION 2018; 65:104-106. [PMID: 30030207 DOI: 10.1016/j.meegid.2018.07.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 07/14/2018] [Accepted: 07/17/2018] [Indexed: 11/23/2022]
Abstract
While typing methods are increasingly refined, the sampling of bacteria to be typed in healthcare-associated infection context retains less attention. Through 2 emblematic cases of in-hospital transmission of extensively drug-resistant bacteria producing carbapenemases, we demonstrate the impact of colony sampling in typing results. Because of intra-population diversity, typing several colonies of same species and resistotype was needed to fully track the transmission among patients. Bacterial population studies could better decipher transmission routes of healthcare-associated bacteria, thereby improving outbreak control.
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19
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Vincent AT, Charette SJ, Barbeau J. Unexpected diversity in the mobilome of a Pseudomonas aeruginosa strain isolated from a dental unit waterline revealed by SMRT Sequencing. Genome 2018; 61:359-365. [PMID: 29546998 DOI: 10.1139/gen-2017-0239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The Gram-negative bacterium Pseudomonas aeruginosa is found in several habitats, both natural and human-made, and is particularly known for its recurrent presence as a pathogen in the lungs of patients suffering from cystic fibrosis, a genetic disease. Given its clinical importance, several major studies have investigated the genomic adaptation of P. aeruginosa in lungs and its transition as acute infections become chronic. However, our knowledge about the diversity and adaptation of the P. aeruginosa genome to non-clinical environments is still fragmentary, in part due to the lack of accurate reference genomes of strains from the numerous environments colonized by the bacterium. Here, we used PacBio long-read technology to sequence the genome of PPF-1, a strain of P. aeruginosa isolated from a dental unit waterline. Generating this closed genome was an opportunity to investigate genomic features that are difficult to accurately study in a draft genome (contigs state). It was possible to shed light on putative genomic islands, some shared with other reference genomes, new prophages, and the complete content of insertion sequences. In addition, four different group II introns were also found, including two characterized here and not listed in the specialized group II intron database.
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Affiliation(s)
- Antony T Vincent
- a Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Quebec City, QC, Canada.,b Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ), Quebec City, QC, Canada.,c Département de biochimie, de microbiologie et de bio-informatique, Université Laval, Quebec City, QC, Canada
| | - Steve J Charette
- a Institut de biologie intégrative et des systèmes (IBIS), Université Laval, Quebec City, QC, Canada.,b Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec (CRIUCPQ), Quebec City, QC, Canada.,c Département de biochimie, de microbiologie et de bio-informatique, Université Laval, Quebec City, QC, Canada
| | - Jean Barbeau
- d Département de stomatologie, Faculté de médecine dentaire, Université de Montréal, Montreal, QC, Canada
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Abdouchakour F, Aujoulat F, Licznar-Fajardo P, Marchandin H, Toubiana M, Parer S, Lotthé A, Jumas-Bilak E. Intraclonal variations of resistance and phenotype in Pseudomonas aeruginosa epidemic high-risk clone ST308: A key to success within a hospital? Int J Med Microbiol 2017; 308:279-289. [PMID: 29276044 DOI: 10.1016/j.ijmm.2017.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 10/28/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022] Open
Abstract
Most multidrug-resistant (MDR) and extensively drug-resistant (XDR) P. aeruginosa strains belonged to epidemic high-risk (EHR) clones that succeeded worldwide in the context of hospital outbreaks. In order to study the intraclonal diversity in EHR P. aeruginosa, we selected clinical and environmental strains of the EHR clone ST308 that caused outbreak clusters over five years in a hospital and then persisted in the hospital environment during four additional years, causing sporadic infections. Unexpectedly, resistance phenotype was very diverse within the population, independently of the origin (environmental or human) and the period of isolation (during or after outbreaks). Most MDR/XDR strains belonged to clusters in pulsed-field gel electrophoresis (PFGE) while singleton strains instead displayed susceptible or moderately resistant phenotypes. High diversity was observed for motility and biofilm formation without correlation with the origin and the period. Resistance to biocides was not linked to epidemic success or to environmental persistence. Finally, the EHR clone ST308 did not display common adaptive traits, nor traits related to an origin or a period of isolation in the hospital. The major character of this EHR clone ST308 is its intraclonal diversity that probably warrants its adaptation and persistence in hospital whatever the conditions and therefore its epidemic behaviour. This diversity could result from adaptive radiation with the evolution of multiple lineages that fill available niches within a complex ecosystem such as a hospital.
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Affiliation(s)
- F Abdouchakour
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France
| | - F Aujoulat
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France
| | - P Licznar-Fajardo
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France; Département d'Hygiène Hospitalière, CHRU Montpellier, Hôpital St Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - H Marchandin
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France; Department of Microbiology, Nîmes University Hospital, Place du Professeur Robert Debré, 30029 Nîmes, France
| | - M Toubiana
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France
| | - S Parer
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France; Département d'Hygiène Hospitalière, CHRU Montpellier, Hôpital St Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - A Lotthé
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France; Département d'Hygiène Hospitalière, CHRU Montpellier, Hôpital St Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France
| | - E Jumas-Bilak
- Université de Montpellier, UMR 5569 HydroSciences, équipe Pathogènes Hydriques Santé Environnements, 15, Avenue Charles Flahault, BP 14491, 34093 Montpellier Cedex 5, France; Département d'Hygiène Hospitalière, CHRU Montpellier, Hôpital St Eloi, 80 Avenue Augustin Fliche, 34090 Montpellier, France.
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Dupont C, Aujoulat F, Chiron R, Condom P, Jumas-Bilak E, Marchandin H. Highly Diversified Pandoraea pulmonicola Population during Chronic Colonization in Cystic Fibrosis. Front Microbiol 2017; 8:1892. [PMID: 29056926 PMCID: PMC5635052 DOI: 10.3389/fmicb.2017.01892] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 09/15/2017] [Indexed: 01/03/2023] Open
Abstract
Several environmental bacteria are considered as opportunistic pathogens in cystic fibrosis (CF) and are able to persistently colonize the CF respiratory tract (CFRT). Beside Pseudomonas aeruginosa and Burkholderia cepacia complex, Pandoraea spp. are defined as pathogenic. During chronic colonization, adaptive evolution and diversified population have been demonstrated, notably for P. aeruginosa. However, the persistence of Pandoraea in the CFRT remains largely unexplored. We studied genomic and phenotypic traits of Pandoraea pulmonicola isolates successively recovered from the airways of a single CF patient and relate the results to qualitative and quantitative evolution of other cultivable pathogens and to patient clinical status. A total of 31 isolates recovered from 18 sputum samples over a 7-year period in a single CF patient were studied. Genome dynamics was assessed by pulsed-field gel electrophoresis, ERIC-PCR fingerprinting and 16S rRNA gene PCR-temporal temperature gel electrophoresis. Phenotypic features included antimicrobial susceptibility, motility, biofilm production, and virulence in Caenorhabditis elegans model. Variability was observed for all the characteristics studied leading to highly diversified patterns (24 patterns) for the 31 clonally related isolates. Some of these modifications, mainly genomic events were concomitantly observed with CFRT microbiota composition shifts and with severe exacerbations. The diversity of P. pulmonicola population studied, observed for isolates recovered from successive samples but also within a sample suggested that existence of a diversified population may represent a patho-adaptive strategy for host persistence in the heterogeneous and fluctuating CFRT environment.
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Affiliation(s)
- Chloé Dupont
- Equipe Pathogènes Hydriques, Santé, Environnements, UMR 5569 Hydrosciences Montpellier, U.F.R des Sciences Pharmaceutiques et Biologiques and Université Montpellier, Montpellier, France
| | - Fabien Aujoulat
- Equipe Pathogènes Hydriques, Santé, Environnements, UMR 5569 Hydrosciences Montpellier, U.F.R des Sciences Pharmaceutiques et Biologiques and Université Montpellier, Montpellier, France
| | - Raphaël Chiron
- Centre de Ressources et de Compétences pour la Mucoviscidose, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Pauline Condom
- Equipe Pathogènes Hydriques, Santé, Environnements, UMR 5569 Hydrosciences Montpellier, U.F.R des Sciences Pharmaceutiques et Biologiques and Université Montpellier, Montpellier, France
| | - Estelle Jumas-Bilak
- Equipe Pathogènes Hydriques, Santé, Environnements, UMR 5569 Hydrosciences Montpellier, U.F.R des Sciences Pharmaceutiques et Biologiques and Université Montpellier, Montpellier, France.,Laboratoire d'Hygiène Hospitalière, Hôpital Saint-Eloi, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
| | - Hélène Marchandin
- Equipe Pathogènes Hydriques, Santé, Environnements, UMR 5569 Hydrosciences Montpellier, U.F.R des Sciences Pharmaceutiques et Biologiques and Université Montpellier, Montpellier, France.,Service de Microbiologie, Hôpital Carémeau, Centre Hospitalier Universitaire de Nîmes, Nîmes, France.,Laboratoire de Bactériologie, Hôpital Arnaud de Villeneuve, Centre Hospitalier Universitaire de Montpellier, Montpellier, France
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Baranovsky S, Jumas-Bilak E, Lotthé A, Marchandin H, Parer S, Hicheri Y, Romano-Bertrand S. Tracking the spread routes of opportunistic premise plumbing pathogens in a haematology unit with water points-of-use protected by antimicrobial filters. J Hosp Infect 2017; 98:53-59. [PMID: 28760634 DOI: 10.1016/j.jhin.2017.07.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 07/24/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Water networks in hospitals are frequently contaminated by opportunistic premise plumbing pathogens (OPPPs) leading to installation of antimicrobial filters on water points-of-use (POU) in order to limit patients' exposure. AIM To assess the spread of OPPPs through secondary water routes (outside the plumbing system) in an adult haematology unit in which 52 out of 73 water POU were high risk for patients and protected by antimicrobial filters. METHODS An observational audit identified six secondary water routes for which bacteria tracking and typing were performed in 315 surface samplings. Bacterial isolates were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and compared to the infra-species level by multiplex repetitive element sequence-based polymerase chain reaction and/or by restriction fragment length polymorphism in pulse-field gel electrophoresis. FINDINGS Pseudomonas aeruginosa and Stenotrophomonas maltophilia, as well as non-pathogenic OPPP indicators, were detected in water collected upstream of antimicrobial filters. P. aeruginosa was the sole OPPP retrieved from tested surfaces (5.1%). The same clone of P. aeruginosa spread from water source to dry surfaces in the same room and cross-contaminated two sinks in different rooms. Three clones of non-pathogenic OPPP indicators spread more widely in different rooms. CONCLUSION A strategy based on filtration of most (but not all) water POU in a haematology unit could be sufficient to limit the spread of OPPPs to the environment, provided a functional mapping of 'high-risk' POU has been undertaken. The residual spread of OPPPs and OPPP indicators linked to non-filtered water POU argues for careful monitoring of non-filtered water use.
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Affiliation(s)
- S Baranovsky
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - E Jumas-Bilak
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - A Lotthé
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - H Marchandin
- UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France; Laboratoire de Bactériologie CHU Nîmes, Nîmes, France
| | - S Parer
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France
| | - Y Hicheri
- Département d'Hématologie Clinique, CHU Montpellier, Montpellier, France
| | - S Romano-Bertrand
- Département d'Hygiène Hospitalière, CHU Montpellier, Montpellier, France; UMR5569 HydroSciences Montpellier, Equipe «Pathogènes Hydriques Santé Environnements», Faculté de Pharmacie, Montpellier, France.
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Clarivet B, Grau D, Jumas-Bilak E, Jean-Pierre H, Pantel A, Parer S, Lotthé A. Persisting transmission of carbapenemase-producing Klebsiella pneumoniae due to an environmental reservoir in a university hospital, France, 2012 to 2014. ACTA ACUST UNITED AC 2017; 21:30213. [PMID: 27168586 DOI: 10.2807/1560-7917.es.2016.21.17.30213] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 01/08/2016] [Indexed: 12/17/2022]
Abstract
In France, the proportion of episodes of carbapenemase-producing Enterobacteriaceae (CPE) with no recent stay or hospitalisation abroad is increasing. In this study, we investigate epidemiological links between apparently unrelated cases of OXA-48-producing Klebsiella pneumoniae (Kp OXA-48) colonisation or infection. We genotyped detected organisms by repetitive sequence-based PCR, and used a dynamic registry of cases and contacts to cross-reference patients' hospital stays. Between 1 November 2012 and 28 February 2014, 23 Kp OXA-48 cases were detected in a university hospital in Montpellier, of which 15 were involved in three outbreaks: outbreaks I and II occurred in November 2012 and outbreak III in October 2013. Molecular comparison of bacterial strains revealed clonal identity between cases involved in outbreaks II and III and four single cases. Cross-referencing of hospital stays revealed that these single cases and the index case of outbreak III had occupied the same room. Active case search among former occupants of that room found an additional Kp OXA-48 carrier. A clonal strain was isolated from the sink of that room. The epidemiological link between the contaminated room and outbreak II remained undetected. This study is a reminder that environmental reservoirs should be considered as a source of CPE transmission.
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Affiliation(s)
- Béatrice Clarivet
- Department of Infection Control and Prevention, University Hospital of Montpellier, France
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Günther F, Merle U, Frank U, Gaida MM, Mutters NT. Pseudobacteremia outbreak of biofilm-forming Achromobacter xylosoxidans - environmental transmission. BMC Infect Dis 2016; 16:584. [PMID: 27756240 PMCID: PMC5070352 DOI: 10.1186/s12879-016-1909-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 10/11/2016] [Indexed: 01/01/2023] Open
Abstract
Background Achromobacter xylosoxidans (AX) is known for intrinsic resistance to disinfectants. Our laboratory routine surveillance system detected an unexpected rise in AX bloodstream infections in a 2200-bed hospital. An epidemiological investigation was conducted to find the source and disrupt further transmission. Methods Outbreak cases were defined as patients with at least one positive blood culture positive for AX from May 2014 to May 2015. Medical records were reviewed, affected wards, as well as the microbiology laboratory were audited. Additionally, microbiologic culture and biofilm staining for suspected antiseptic reusable tissue dispensers were performed, and isolated AX strains were typed using RAPD PCR and PFGE. Results During the outbreak period, AX were isolated from blood cultures from 26 patients. The retrospective cohort study did not reveal common risk factors. The clinical features of the case patients suggested a pseudobacteremia. The reusable tissue dispensers containing Incidin® Plus solution product were found to be contaminated with biofilm-forming AX. Typing of the isolates revealed that blood culture isolates were identical with the strains found in the dispensers. Conclusions After changing the usage of the product to single-use and educating staff, the outbreak was terminated. Contamination of dispensers occurred due to insufficient reprocessing, since biofilm disrupting steps were not included in the process.
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Affiliation(s)
- Frank Günther
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany
| | - Uta Merle
- Department of Internal Medicine, Gastroenterology and Infectious Diseases, Heidelberg University Hospital, Heidelberg, Germany
| | - Uwe Frank
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany
| | - Matthias M Gaida
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Nico T Mutters
- Department of Infectious Diseases, Heidelberg University Hospital, Im Neuenheimer Feld 324, D-69120, Heidelberg, Germany.
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