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Hamerlinck H, Aerssens A, Boelens J, Dehaene A, McMahon M, Messiaen AS, Vandendriessche S, Velghe A, Leroux-Roels I, Verhasselt B. Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting. Antimicrob Resist Infect Control 2023; 12:58. [PMID: 37337245 DOI: 10.1186/s13756-023-01261-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 05/29/2023] [Indexed: 06/21/2023] Open
Abstract
BACKGROUND Accumulating evidence shows a role of the hospital wastewater system in the spread of multidrug-resistant organisms, such as carbapenemase producing Enterobacterales (CPE). Several sequential outbreaks of CPE on the geriatric ward of the Ghent University hospital have led to an outbreak investigation. Focusing on OXA-48 producing Citrobacter freundii, the most prevalent species, we aimed to track clonal relatedness using whole genome sequencing (WGS). By exploring transmission routes we wanted to improve understanding and (re)introduce targeted preventive measures. METHODS Environmental screening (toilet water, sink and shower drains) was performed between 2017 and 2021. A retrospective selection was made of 53 Citrobacter freundii screening isolates (30 patients and 23 environmental samples). DNA from frozen bacterial isolates was extracted and prepped for shotgun WGS. Core genome multilocus sequence typing was performed with an in-house developed scheme using 3,004 loci. RESULTS The CPE positivity rate of environmental screening samples was 19.0% (73/385). Highest percentages were found in the shower drain samples (38.2%) and the toilet water samples (25.0%). Sink drain samples showed least CPE positivity (3.3%). The WGS data revealed long-term co-existence of three patient sample derived C. freundii clusters. The biggest cluster (ST22) connects 12 patients and 8 environmental isolates taken between 2018 and 2021 spread across the ward. In an overlapping period, another cluster (ST170) links eight patients and four toilet water isolates connected to the same room. The third C. freundii cluster (ST421) connects two patients hospitalised in the same room but over a period of one and a half year. Additional sampling in 2022 revealed clonal isolates linked to the two largest clusters (ST22, ST170) in the wastewater collection pipes connecting the rooms. CONCLUSIONS Our findings suggest long-term circulation and transmission of carbapenemase producing C. freundii clones in hospital sanitary installations despite surveillance, daily cleaning and intermittent disinfection protocols. We propose a role for the wastewater drainage system in the spread within and between rooms and for the sanitary installations in the indirect transmission via bioaerosol plumes. To tackle this problem, a multidisciplinary approach is necessary including careful design and maintenance of the plumbing system.
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Affiliation(s)
- Hannelore Hamerlinck
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium.
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium.
| | - Annelies Aerssens
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Jerina Boelens
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
| | - Andrea Dehaene
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Michael McMahon
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | | | | | - Anja Velghe
- Department of Geriatrics, Ghent University Hospital, Ghent, Belgium
| | - Isabel Leroux-Roels
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
- Department of Infection Control, Ghent University Hospital, Ghent, Belgium
| | - Bruno Verhasselt
- Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Diagnostic Sciences, Ghent University, Ghent, Belgium
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Wright J, Driver EM, Bowes DA, Johnston B, Halden RU. Comparison of high-frequency in-pipe SARS-CoV-2 wastewater-based surveillance to concurrent COVID-19 random clinical testing on a public U.S. university campus. Sci Total Environ 2022; 820:152877. [PMID: 34998780 PMCID: PMC8732902 DOI: 10.1016/j.scitotenv.2021.152877] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 05/14/2023]
Abstract
Wastewater-based epidemiology (WBE) is utilized globally as a tool for quantifying the amount of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) within communities, yet the efficacy of community-level wastewater monitoring has yet to be directly compared to random Coronavirus Disease of 2019 (COVID-19) clinical testing; the best-supported method of virus surveillance within a single population. This study evaluated the relationship between SARS-CoV-2 RNA in raw wastewater and random COVID-19 clinical testing on a large university campus in the Southwestern United States during the Fall 2020 semester. Daily composites of wastewater (24-hour samples) were collected three times per week at two campus locations from 16 August 2020 to 1 January 2021 (n = 95) and analyzed by reverse transcriptase-quantitative polymerase chain reaction (RT-qPCR) targeting the SARS-CoV-2 E gene. Campus populations were estimated using campus resident information and anonymized, unique user Wi-Fi connections. Resultant trends of SARS-CoV-2 RNA levels in wastewater were consistent with local and nationwide pandemic trends showing peaks in infections at the start of the Fall semester in mid-August 2020 and mid-to-late December 2020. A strong positive correlation (r = 0.71 (p < 0.01); n = 15) was identified between random COVID-19 clinical testing and WBE surveillance methods, suggesting that wastewater surveillance has a predictive power similar to that of random clinical testing. Additionally, a comparative cost analysis between wastewater and clinical methods conducted here show that WBE was more cost effective, providing data at 1.7% of the total cost of clinical testing ($6042 versus $338,000, respectively). We conclude that wastewater monitoring of SARS-CoV-2 performed in tandem with random clinical testing can strengthen campus health surveillance, and its economic advantages are maximized when performed routinely as a primary surveillance method, with random clinical testing reserved for an active outbreak situation.
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Affiliation(s)
- Jillian Wright
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; OneWaterOneHealth, The Arizona State University Foundation, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA
| | - Erin M Driver
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Devin A Bowes
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; OneWaterOneHealth, The Arizona State University Foundation, The Biodesign Institute, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; School for Engineering of Matter, Transport, and Energy, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Bridger Johnston
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA
| | - Rolf U Halden
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; School for Engineering of Matter, Transport, and Energy, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; School for Sustainable Engineering and the Built Environment, Arizona State University, 1001 S. McAllister Ave, AZ 85287-8101, USA; Global Futures Laboratory, Arizona State University, 800 S. Cady Mall, Tempe, AZ 85281, USA.
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Domokos E, Sebestyén V, Somogyi V, Trájer AJ, Gerencsér-Berta R, Oláhné Horváth B, Tóth EG, Jakab F, Kemenesi G, Abonyi J. Identification of sampling points for the detection of SARS-CoV-2 in the sewage system. Sustain Cities Soc 2022; 76:103422. [PMID: 34729296 PMCID: PMC8554011 DOI: 10.1016/j.scs.2021.103422] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 09/10/2021] [Accepted: 09/30/2021] [Indexed: 06/13/2023]
Abstract
A suitable tool for monitoring the spread of SARS-CoV-2 is to identify potential sampling points in the wastewater collection system that can be used to monitor the distribution of COVID-19 disease affected clusters within a city. The applicability of the developed methodology is presented through the description of the 72,837 population equivalent wastewater collection system of the city of Nagykanizsa, Hungary and the results of the analytical and epidemiological measurements of the wastewater samples. The wastewater sampling was conducted during the 3rd wave of the COVID-19 epidemic. It was found that the overlap between the road system and the wastewater network is high, it is 82 %. It was showed that the proposed methodological approach, using the tools of network science, determines confidently the zones of the wastewater collection system and provides the ideal monitoring points in order to provide the best sampling resolution in urban areas. The strength of the presented approach is that it estimates the network based on publicly available information. It was concluded that the number of zones or sampling points can be chosen based on relevant epidemiological intervention and mitigation strategies. The algorithm allows for continuous effective monitoring of the population infected by SARS-CoV-2 in small-sized cities.
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Affiliation(s)
- Endre Domokos
- Sustainability Solutions Research Lab, University of Pannonia, Egyetem str. 10, Veszprém H-8200, Hungary
| | - Viktor Sebestyén
- Sustainability Solutions Research Lab, University of Pannonia, Egyetem str. 10, Veszprém H-8200, Hungary
- MTA-PE "Lendület" Complex Systems Monitoring Research Group, University of Pannonia, Egyetem str. 10, Veszprém H-8200, Hungary
| | - Viola Somogyi
- Sustainability Solutions Research Lab, University of Pannonia, Egyetem str. 10, Veszprém H-8200, Hungary
| | - Attila János Trájer
- Sustainability Solutions Research Lab, University of Pannonia, Egyetem str. 10, Veszprém H-8200, Hungary
| | - Renáta Gerencsér-Berta
- Soós Ernö Research and Development Center, University of Pannonia, Zrínyi M Str. 18, Nagykanizsa H-8800, Hungary
| | - Borbála Oláhné Horváth
- Soós Ernö Research and Development Center, University of Pannonia, Zrínyi M Str. 18, Nagykanizsa H-8800, Hungary
| | - Endre Gábor Tóth
- National Laboratory of Virology, János Szentágothai Research Centre, University of Pécs, Pécs 7624, Hungary
| | - Ferenc Jakab
- National Laboratory of Virology, János Szentágothai Research Centre, University of Pécs, Pécs 7624, Hungary
| | - Gábor Kemenesi
- National Laboratory of Virology, János Szentágothai Research Centre, University of Pécs, Pécs 7624, Hungary
| | - János Abonyi
- MTA-PE "Lendület" Complex Systems Monitoring Research Group, University of Pannonia, Egyetem str. 10, Veszprém H-8200, Hungary
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Barrios RE, Lim C, Kelley MS, Li X. SARS-CoV-2 concentrations in a wastewater collection system indicated potential COVID-19 hotspots at the zip code level. Sci Total Environ 2021; 800:149480. [PMID: 34392211 PMCID: PMC8330136 DOI: 10.1016/j.scitotenv.2021.149480] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 05/03/2023]
Abstract
Wastewater based epidemiology (WBE) has been successfully applied for SARS-CoV-2 surveillance at the city and building levels. However, sampling at the city level does not provide sufficient spatial granularity to identify COVID-19 hotspots, while data from building-level sampling are too narrow in scope for broader public health application. The objective of this study was to examine the feasibility of using wastewater from wastewater collection systems (WCSs) to monitor COVID-19 hotspots at the zip code level. In this study, 24-h composite wastewater samples were collected from five manholes and two wastewater treatment plants (WWTPs) in the City of Lincoln, Nebraska. By comparing to the reported weekly COVID-19 case numbers, we identified different hotspots responsible for two COVID-19 surges during the study period. One zip code was the only sampling locations that was consistently tested positive during the first COVID-19 surge. In comparison, nearly all the zip codes tested exhibited virus concentration increases that overlapped with the second COVID-19 surge, suggesting broader spread of the virus at that time. These findings demonstrate the feasibility of using WBE to monitor COVID-19 at the zip code level. Highly localized disease surveillance methods can improve public health prevention and mitigation measures at the community level.
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Affiliation(s)
- Renys E Barrios
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, United States
| | - Chin Lim
- City of Lincoln Transportation and Utilities, Lincoln, NE 68521, United States
| | - Megan S Kelley
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 68583, United States.
| | - Xu Li
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, United States.
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