scholarly journals Outbreak of OXA-48-producing Enterobacterales in a haematological ward associated with an uncommon environmental reservoir, France, 2016 to 2019

2021 ◽  
Vol 26 (21) ◽  
Author(s):  
Sarah Jolivet ◽  
Jeanne Couturier ◽  
Xavier Vuillemin ◽  
Cyril Gouot ◽  
Didier Nesa ◽  
...  
Keyword(s):  
Water Environment ◽  
Drainage System ◽  
Control Measures ◽  
Hospital Environment ◽  
Enterobacter Sakazakii ◽  
Infection Control Measures ◽  
Potential Reservoir ◽  
Environmental Reservoir ◽  
Epidemiological Link ◽  
Genome Comparisons

The hospital water environment, including the wastewater drainage system, is increasingly reported as a potential reservoir for carbapenemase-producing Enterobacterales (CPE). We investigated a persistent outbreak of OXA-48 CPE (primarily Citrobacter freundii) in a haematological ward of a French teaching hospital by epidemiological, microbiological and environmental methods. Between January 2016 and June 2019, we detected 37 new OXA-48 CPE-colonised and/or ‑infected patients in the haematological ward. In October 2017, a unit dedicated to CPE-colonised and/or ‑infected patients was created. Eleven additional sporadic acquisitions were identified after this date without any obvious epidemiological link between patients, except in one case. Environmental investigations of the haematological ward (June–August 2018) identified seven of 74 toilets and one of 39 drains positive for OXA-48 CPE (seven C. freundii, one Enterobacter sakazakii, one Escherichia coli). Whole genome comparisons identified a clonal dissemination of OXA-48-producing C. freundii from the hospital environment to patients. In addition to strict routine infection control measures, an intensive cleaning programme was performed (descaling and bleaching) and all toilet bowls and tanks were changed. These additional measures helped to contain the outbreak. This study highlights that toilets can be a possible source of transmission of OXA-48 CPE.

Molecular Characterization ofStenotrophomonas maltophiliaIsolates from Cystic Fibrosis Patients and the Hospital Environment

2009 ◽  
Vol 30 (8) ◽  
pp. 753-758 ◽  
Author(s):  
Carolina Marzuillo ◽  
Maria De Giusti ◽  
Daniela Tufi ◽  
Alessandra Giordano ◽  
Angela Del Cimmuto ◽  
...  
Keyword(s):  
Cystic Fibrosis ◽  
Monitoring Program ◽  
Control Measures ◽  
Hospital Environment ◽  
Molecular Heterogeneity ◽  
Infection Control Measures ◽  
Clonal Spread ◽  
Multiple Strains ◽  
Outpatient Settings ◽  
And Control

Objectives.To ascertain whether cystic fibrosis (CF) patients are colonized or infected with unique or multiple strains ofStenotrophomonas maltophilia; to understand whether some strains colonize or infect more than 1 patient, indicating clonal spread; and to explore the molecular heterogeneity of hospital water isolates and their correlation with clinical isolates.Setting.The regional CF center of Policlinico “Umberto I” of Rome, Italy.Methods.The study was carried out on a random sample ofS. maltophiliaisolates (n= 110) collected from CF patients (n= 50) during the period 2002–2005 and on 24 water isolates obtained during a monitoring program in the first 6 months of 2005. Home environmental samplings were not performed. All isolates, which were recovered from cultures of specimens obtained in both inpatient and outpatient settings, were genotyped with DNA macrorestriction analysis with the restriction enzymeXbaland pulsed-field gel electrophoresis.Results.One-third of the patients with repeated episodes ofS. maltophiliainfection or colonization hosted more than 1 strain. A potential transmission, defined as the isolation of the same strain in 2 or more patients, occurred 5 times, showing a frequency of potential transmission episodes slightly higher than previously reported. Water, taps, and sinks of the different rooms of the CF center tended to be persistently colonized with the same strain ofS. maltophilia, with no correlation between clinical and water-associated isolates.Conclusions.The study does not provide sufficient data to conclude definitively that isolation of colonized or infected CF patients and control of hospital water systems contamination would be beneficial infection control measures. Epidemiologic analytical studies that correlate the presence ofS. maltophiliawith clinical outcomes are strongly needed.

scholarly journals Rapid implementation of real-time SARS-CoV-2 sequencing to investigate healthcare-associated COVID-19 infections

2020 ◽  
Author(s):  
Luke W Meredith ◽  
William L Hamilton ◽  
Ben Warne ◽  
Charlotte J Houldcroft ◽  
Myra Hosmillo ◽  
...  
Keyword(s):  
Infection Control ◽  
Real Time ◽  
Genomic Analysis ◽  
Epidemiological Data ◽  
Control Measures ◽  
Rapid Review ◽  
Epidemiological Analysis ◽  
Infection Control Measures ◽  
Healthcare Associated ◽  
Epidemiological Link

Background The burden and impact of healthcare-associated COVID-19 infections is unknown. We aimed to examine the utility of rapid sequencing of SARS-CoV-2 combined with detailed epidemiological analysis to investigate healthcare-associated COVID-19 infections and to inform infection control measures. Methods We set up rapid viral sequencing of SARS-CoV-2 from PCR-positive diagnostic samples using nanopore sequencing, enabling sample-to-sequence in less than 24 hours. We established a rapid review and reporting system with integration of genomic and epidemiological data to investigate suspected cases of healthcare-associated COVID-19. Results Between 13 March and 24 April 2020 we collected clinical data and samples from 5191 COVID-19 patients in the East of England. We sequenced 1000 samples, producing 747 complete viral genomes. We conducted combined epidemiological and genomic analysis of 299 patients at our hospital and identified 26 genomic clusters involving 114 patients. 66 cases (57.9%) had a strong epidemiological link and 15 cases (13.2%) had a plausible epidemiological link. These results were fed back clinical, infection control and hospital management teams, resulting in infection control interventions and informing patient safety reporting. Conclusions We established real-time genomic surveillance of SARS-CoV-2 in a UK hospital and demonstrated the benefit of combined genomic and epidemiological analysis for the investigation of healthcare-associated COVID-19 infections. This approach enabled us to detect cryptic transmission events and identify opportunities to target infection control interventions to reduce further healthcare-associated infections.

scholarly journals Molecular Identification of Fusarium Species Recovered from Hospital Environment in Jos, Nigeria

2020 ◽  
pp. 303-308
Author(s):  
GE Kim ◽  
MO Okolo ◽  
UC Essien ◽  
UE Umeh ◽  
CC Iheukwumere
Keyword(s):  
Fusarium Species ◽  
Health Care Facilities ◽  
Control Measures ◽  
Hospital Environment ◽  
Chain Reaction ◽  
Opportunistic Fungi ◽  
Infection Control Measures ◽  
Hospital Environments ◽  
Care Facilities ◽  
Polymerase Chain

Fusariums pecies are opportunistic fungi that play an important role in nosocomial infection. The reservoir of Fusarium species in the hospital is not well understood in our environment. Therefore, the present study sought to identify the reservoir of Fusarium species in hospital environment. Three hundred and sixty (360) samples were collected from the environment of two tertiary health care facilities A and B. The sample consists of water (120), soil (120) and plants (120) which were sourced from hospital environments. Cultures of these samples were performed and polymerase chain reaction was used to confirm Fusarium species. The most predominant specie was Fusarium oxysporum Hospital A:(57.3%) and Hospital B:(64.4%). Most of the Fusarium isolates (76.7%) were recovered from soil samples, followed by water (45.0%) and the least were from plants (30.8%). In conclusion the present study has demonstrated that hospital environment is a reservoir for Fusarium species. However, identification of such reservoir would further enhance effective infection control measures.

scholarly journals Sink traps as the source of transmission of OXA-48–producing Serratia marcescens in an intensive care unit

2018 ◽  
Vol 39 (11) ◽  
pp. 1307-1315 ◽  
Author(s):  
Gili Regev-Yochay ◽  
Gill Smollan ◽  
Ilana Tal ◽  
Nani Pinas Zade ◽  
Yael Haviv ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tap Water ◽  
Medical Center ◽  
Common Factor ◽  
Control Measures ◽  
Root Cause ◽  
Infection Control Measures ◽  
Single Clone ◽  
Environmental Reservoir

AbstractBackgroundCarbapenemase-producing Enterobacteriaceae (CPE) outbreaks are mostly attributed to patient-to-patient transmission via healthcare workers.ObjectiveWe describe successful containment of a prolonged OXA-48–producing S. marcescens outbreak after recognizing the sink traps as the source of transmission.MethodsThe Sheba Medical Center intensive care unit (ICU), contains 16 single-bed, semi-closed rooms. Active CPE surveillance includes twice-weekly rectal screening of all patients. A case was defined as a patient detected with OXA-48 CPE >72 hours after admission. A root-cause analysis was used to investigate the outbreak. All samples were inoculated on chrom-agar CRE, and carbapenemase genes were detected using commercial molecular Xpert-Carba-R. Environmental and patient S. marcescens isolates were characterized using PFGE.ResultsFrom January 2016 to May 2017, 32 OXA-48 CPE cases were detected, and 81% of these were S. marcescens. A single clone was the cause of all but the first 2 cases. The common factor in all cases was the use of relatively large amounts of tap water. The outbreak clone was detected in 2 sink outlets and 16 sink traps. In addition to routine strict infection control measures, measures taken to contain the outbreak included (1) various sink decontamination efforts, which eliminated the bacteria from the sink drains only temporarily and (2) educational intervention that engaged the ICU team and lead to high adherence to ‘sink-contamination prevention guidelines.’ No additional cases were detected for 12 months.ConclusionsDespite persistence of the outbreak clones in the environmental reservoir for 1 year, the outbreak was rapidly and successfully contained. Addressing sink traps as hidden reservoirs played a major role in the intervention.

scholarly journals Decreasing Prevalence of Multidrug-Resistant Acinetobacter Baumannii in Rīga East University Hospital / Multirezistentās Acinetobacter Baumannii Izplatības Mazināšanās Rīgas Austrumu Klīniskajā Universitātes Slimnīcā

2016 ◽  
Vol 70 (4) ◽  
pp. 232-236
Author(s):  
Māris Liepiņš ◽  
Raimonds Sīmanis ◽  
Aivars Lejnieks
Keyword(s):  
Infection Control ◽  
Acinetobacter Baumannii ◽  
Venous Catheter ◽  
Multidrug Resistant ◽  
Control Measures ◽  
University Hospital ◽  
Hospital Environment ◽  
Central Venous ◽  
Infection Control Measures ◽  
Time Period

Abstract There has been an increasing tendency of infections caused by multidrug-resistant organisms (MDRO), including multidrug-resistant Acinetobacter baumannii (MDRAB), in the Rīga East University Hospital (REUH) during the last decade. Over the last two years (2014-2015), this tendency has reversed and the prevalence of MDRAB has decreased considerably. In this study we assessed the prevalence of MDRAB in intensive care units (ICUs), internal medicine, surgery units and analysed antibiotic sensitivity profiles. In addition, we determined if current infection control measures are preventing further increase of infections caused by MDRAB in REUH. Retrospective Acinetobacter baumannii prevalence data were collected for the period from 2009 until 2012. For the time period from the beginning of 2013 until 2015, after implementing such infection control measures as control of compliance to hand hygiene guidelines, a review of central venous catheter insertion protocols and regular search for sources of MDRAB in hospital environment, prospective follow-up of new cases was conducted. Antimicrobial sensitivity profiles were assessed for the period from 2013 until 2015. Data were processed with the statistical software WHONET 5.5. Bacteria identification and antibiotic susceptibility testing were performed by VITEK 2 compact, BioMerieux, France. The prevalence of MDRAB in the period 2009 to 2013 increased from 71 to 217 cases per year, but from between 2013 (time of implementing infection control measures) and 2015 it decreased to 113 cases in 2015. In the three year period (2013-2015), the proportion of MDRAB causing bloodstream infections (BSI) and central nervous system infections (CNSI) was 15.85% from all identified MDRAB cases. Of the 113 MDRAB infections diagnosed in 2015, BSI was found in 16.81% cases (n = 19). Antibiotic resistance testing showed that colistin is the most effective drug against MDRAB. The majority of Acinetobacter baumannii isolates were resistant to Ampicillin/Sulbactam, Piperacillin/Tazobactam, Ceftazidime, Cefepime, Imipenem, Meropenem, Amikacin, Gentamicin, Tobramycin, and Ciprofloxacin. Over the last two years (2014-2015), prevalence of MDRAB infections decreased considerably. In the time period from 2013 to 2014, resistance of Acinetobacter baumannii increased to imipenem, ciprofloxacin and colistin, while decreased slightly to amikacin. Rigorous infection control measures, such as identification and elimination of new MDRAB sources in environment, review of the central venous catheter insertion protocol and improvements in hand hygiene, are crucial for decreasing distribution of and invasive infections caused by MDRAB in the hospital environment.

scholarly journals Genomic Analysis of Hospital Plumbing Reveals Diverse Reservoir of Bacterial Plasmids Conferring Carbapenem Resistance

mBio ◽  
2018 ◽  
Vol 9 (1) ◽  
Author(s):  
Rebecca A. Weingarten ◽  
Ryan C. Johnson ◽  
Sean Conlan ◽  
Amanda M. Ramsburg ◽  
John P. Dekker ◽  
...  
Keyword(s):  
Infection Control ◽  
Control Strategies ◽  
Resistance Mechanism ◽  
Genomic Analysis ◽  
Carbapenem Resistance ◽  
Epidemiological Survey ◽  
Hospital Environment ◽  
Potential Reservoir ◽  
Environmental Reservoir ◽  
Comprehensive Survey

ABSTRACT The hospital environment is a potential reservoir of bacteria with plasmids conferring carbapenem resistance. Our Hospital Epidemiology Service routinely performs extensive sampling of high-touch surfaces, sinks, and other locations in the hospital. Over a 2-year period, additional sampling was conducted at a broader range of locations, including housekeeping closets, wastewater from hospital internal pipes, and external manholes. We compared these data with previously collected information from 5 years of patient clinical and surveillance isolates. Whole-genome sequencing and analysis of 108 isolates provided comprehensive characterization of bla KPC/bla NDM-positive isolates, enabling an in-depth genetic comparison. Strikingly, despite a very low prevalence of patient infections with bla KPC-positive organisms, all samples from the intensive care unit pipe wastewater and external manholes contained carbapenemase-producing organisms (CPOs), suggesting a vast, resilient reservoir. We observed a diverse set of species and plasmids, and we noted species and susceptibility profile differences between environmental and patient populations of CPOs. However, there were plasmid backbones common to both populations, highlighting a potential environmental reservoir of mobile elements that may contribute to the spread of resistance genes. Clear associations between patient and environmental isolates were uncommon based on sequence analysis and epidemiology, suggesting reasonable infection control compliance at our institution. Nonetheless, a probable nosocomial transmission of Leclercia sp. from the housekeeping environment to a patient was detected by this extensive surveillance. These data and analyses further our understanding of CPOs in the hospital environment and are broadly relevant to the design of infection control strategies in many infrastructure settings. IMPORTANCE Carbapenemase-producing organisms (CPOs) are a global concern because of the morbidity and mortality associated with these resistant Gram-negative bacteria. Horizontal plasmid transfer spreads the resistance mechanism to new bacteria, and understanding the plasmid ecology of the hospital environment can assist in the design of control strategies to prevent nosocomial infections. A 5-year genomic and epidemiological survey was undertaken to study the CPOs in the patient-accessible environment, as well as in the plumbing system removed from the patient. This comprehensive survey revealed a vast, unappreciated reservoir of CPOs in wastewater, which was in contrast to the low positivity rate in both the patient population and the patient-accessible environment. While there were few patient-environmental isolate associations, there were plasmid backbones common to both populations. These results are relevant to all hospitals for which CPO colonization may not yet be defined through extensive surveillance.

Postoperative Infections Following Cardiac Surgery: Association with an Environmental Reservoir in a Cardiothoracic Intensive Care Unit

1984 ◽  
Vol 5 (8) ◽  
pp. 378-384 ◽  
Author(s):  
Peter C. Dandalides ◽  
William A. Rutala ◽  
Felix A. Sarubbi
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Control Measures ◽  
The North ◽  
Infection Control Measures ◽  
Environmental Reservoir ◽  
Lower Infection ◽  
Control Study ◽  
Lower Infection Rate

AbstractDuring 1981, 39 nosocomial infections occurred in 27 of 223 patients undergoing cardiac surgery in the North Carolina Memorial Hospital. The peak attack rate (23.7%) occurred in August and September compared to 10.1% in January through July. A case-control study demonstrated that the only risk factor common to poor and stable health groups compared to controls was duration of stay in the cardiothoracic intensive care unit (CTICU). Microbiologic studies of the environment, personnel and patients showed that colonization or infection of patients occurred 1 to 6 days after admission to the CTICU and that nosocomial pathogens were found: 1) in and around the unit's soiled utility sink, 2) in pooled handwashing cultures of unit personnel, and 3) on contaminated clean hands and air near the soiled utility sink, plus nearby bedside air only while the water in the sink was running. Environmental and personnel hand contamination by soiled utility sink aerosols likely contributed to these infections. Infection control measures, including discontinued use of the soiled utility sink, resulted in a significantly lower infection rate (5.6%).

scholarly journals Identification of Nasal Carriage of Staphylococcus aureus among Nursing Students during Curricular Clinical Internships: An Observational Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Maria João Coelho ◽  
Ricardo Magalhães ◽  
Inês Lopes Cardoso ◽  
Cristina Pina ◽  
Maria Pia Ferraz
Keyword(s):  
Staphylococcus Aureus ◽  
Nursing Students ◽  
Nasal Carriage ◽  
Control Measures ◽  
Hospital Environment ◽  
Emergency Rooms ◽  
Clinical Exposure ◽  
Clinical Rotations ◽  
Infection Control Measures ◽  
Mrsa Colonization

Staphylococcus aureus is considered one of the most frequently isolated bacteria in the community and in the hospital environment, being associated with several infections. Healthcare professionals represent a group vulnerable to Staphylococcus aureus and MRSA colonization, therefore being potential disseminators of these microorganisms during their care activities. The aim of this study was to evaluate the dynamics of S. aureus and MRSA nasal colonization among nursing students over the four years of university attendance, including pre-clinical exposure and at different moments during clinical rotations. Samples were collected from students from the 1st, 2nd, 3rd and 4th year. The study identified 55.9% MSSA positive samples and 31.4% MRSA positive samples from the total studied population. Simultaneous carriage of MRSA and MSSA was observed in students from all years of the nursing degree, but a highest MSSA colonization (61.5%) was linked to a lower MRSA colonization (30.8%). MRSA colonization seems to be dependent on the type of clinical internship, since the group attending internship in emergency rooms and surgery wards presented a significant increase in the amount of MRSA samples. Nursing students should be educated on the risks involved in carrying S. aureus and MRSA and informed about infection control measures.

scholarly journals Prevalence of carbapenemase-producing Klebsiella pneumoniae in the Gomel Region

2019 ◽  
pp. 53-58
Author(s):  
D. V. Tapalski ◽  
T. A. Petrovskaya ◽  
N. A. Bonda ◽  
A. I. Kozlova ◽  
O. V. Osipkina
Keyword(s):  
Klebsiella Pneumoniae ◽  
Monitoring Program ◽  
Control Measures ◽  
Hospital Environment ◽  
Healthcare Organizations ◽  
Antibacterial Drugs ◽  
Infection Control Measures ◽  
District Hospitals ◽  
Central District ◽  
Regional Centers

Aim. Within the microbiological monitoring program, to study the prevalence of carbapenemase-producing K. pneumoniae in the healthcare organizations of the Gomel region and assess their level of resistance to antibacterial drugs. Materials and methods. For 91 clinical isolates of Klebsiella pneumoniae with multiple antibiotic resistance, isolated in Gomel and Gomel region, carbapenemase genes were detected by real-time PCR and sensitivity to antibacterial drugs was determined. Results. 68 carbapenemase producers were revealed: KPC — 1 isolate, OXA-48 — 47 isolates, NDM — 20 isolates. Carbapenemase producers were found in 11 Gomel health organizations and 8 central district hospitals of the regional centers of the Gomel region. All of them had an associated resistance to most antibiotics and retained sensitivity to colistin (91.2% sensitive isolates) and tigecycline (98.5%). Conclusion. The spread of carbapenemase-producing K. pneumoniae isolates in healthcare organizations makes it very difficult to conduct effective antibiotic therapy for patients and requires the introduction of appropriate infection control measures aimed at limiting their circulation in the hospital environment.

scholarly journals Candida auris: Emergência Recente de um Fungo Patogénico Multirresistente

2020 ◽  
Vol 33 (10) ◽  
pp. 680
Author(s):  
Francisco Antunes ◽  
Cristina Veríssimo ◽  
Álvaro Ayres Pereira ◽  
Raquel Sabino
Keyword(s):  
Mortality Rates ◽  
Fungal Species ◽  
Species Level ◽  
Control Measures ◽  
Hospital Environment ◽  
Candida Auris ◽  
Infection Control Measures ◽  
The United Kingdom ◽  
Invasive Infections ◽  
A New Species

Candida auris was first described as a new species back in 2009. Although it differs markedly from other Candida species, this species can be misidentified as other yeasts in the routine microbiology laboratories. Therefore, its identification to species level should be confirmed by reference laboratories. Candida auris exhibits potential to cause invasive infections, and frequently shows a multidrugresistance pattern, and it is associated with high mortality rates. Outbreaks caused by Candida auris and associated with health care institutions have been reported in several countries around the world, including some European countries, such as the United Kingdom and Spain. In Portugal, to our knowledge, there are no known infections or colonization cases caused by Candida auris. This species can survive in the environment for several weeks and once introduced into the hospital environment, the risk of transmission is high, requiring strict infection control measures in order to prevent transmission. This paper intends to raise the awareness of the emergence of this fungal species, as well as to discuss the consequences of this situation.

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