Antibiotic-resistant organisms establish reservoirs in new hospital built environments and are related to patient blood infection isolates

Sukhum, Kimberley V.; Newcomer, Erin P.; Cass, Candice; Wallace, Meghan A.; Johnson, Caitlin; Fine, Jeremy D.; Sax, Steven; Barlet, Margaret H.; Dantas, Gautam; Kwon, Jennie H.

doi:10.1038/s43856-022-00124-5

Cited by 34 publications

(31 citation statements)

References 95 publications

(99 reference statements)

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“…Third, hospital water systems enable the "source-sink" dynamics of SMC populations 43 . Hospital sinks, particularly those located in ICUs, are increasingly identified as reservoirs of multidrug-resistant Pseudomonas and Enterobacterales, with most of the available studies focusing on identifying the origin of outbreaks or the impact of interventions to control bacterial transmission 5,6,[44][45][46] . The absence of long-term analysis of microbial populations with frequent and systematic sampling of patients and sinks during non-outbreak periods precludes the understanding of the transmission pathways of opportunistic pathogens and the ecology of microbial populations in the hospital-built environment.…”

Section: Discussionmentioning

confidence: 99%

Long-term dynamics of the “Serratia marcescenscomplex” in the hospital-built environment

Aracil-Gisbert,

Fernández-De-Bobadilla,

Guerra-Pinto

et al. 2023

Preprint

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Serratia marcescensis an opportunistic pathogen historically associated with abrupt, unpredictable, and severe outbreaks in hospital intensive care units (ICUs) and, more recently, with the spread of acquired genes encoding carbapenem resistance. However, the population biology and ecology ofS. marcescensin the hospital ecosystem is still poorly understood. Here, we combine epidemiological information of 1417Serratiaisolates collected from the sinks of a large ICU ward that underwent significant demographic and operational changes (2019-2020) and 99 non-redundant outbreak/non-outbreak isolates from the same hospital (2003-2019), with genomic data of 165 isolates. We first report hospital sinks as reservoirs of heterogeneous and coexistent populations of theS. marcescens complex(SMC). A novel SMC clade congruent with the recently describedSerratia neveispecies is predominant, exhibiting chromosomal AmpC β-lactamase with an unusual basal expression in contrast to one of the major features ofS. marcescens. PersistentSerratiasink strains are identical to those involved in clonal and polyclonal outbreaks of VIM-1 and OXA-48 producers since at least 2017. The 'source-sink' dynamics of SMC populations able to acquire the highly conserved plasmids such as IncL carryingblaVIM-1 orblaOXA-48 offer novel insights that might improve interventions to control outbreaks and treatSerratiainfections in high-risk hospital areas.

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Section: Discussionmentioning

confidence: 99%

Long-term dynamics of the “Serratia marcescenscomplex” in the hospital-built environment

Aracil-Gisbert,

Fernández-De-Bobadilla,

Guerra-Pinto

et al. 2023

Preprint

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“…Patient 27 is just such an example, but the lack of early sampling (2000-2010) and incomplete collection thereafter precludes a definitive answer. Indeed, other scenarios cannot be discounted, with a recent study showing sinks in a newly built ICU were already contaminated with an outbreak clone of P. aeruginosa before the arrival of the first patients 17 .…”

Section: Discussionmentioning

confidence: 99%

Detecting, mapping, and suppressing the spread of a decade-longPseudomonas aeruginosanosocomial outbreak with genomics

Stribling

Hall

Powell

et al. 2023

Preprint

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Whole-genome sequencing is revolutionizing outbreak investigation. In 2020, prospective and retrospective surveillance detected aP. aeruginosaoutbreak with 254 isolates collected from 82 patients in 27 wards of a hospital. Its origin was dated to the late 90s, just after the facility opened, and patient-to-patient and environment-to-patient cases of transmission were inferred. Over time, two epidemic subclones evolved in separate hosts and hospital areas, including newly opened wards, and hospital-wide sampling confirmed reservoirs persisted in the plumbing. Pathoadaptive mutations in genes associated with virulence, cell wall biogenesis, and antibiotic resistance were identified. While the latter correlated with the acquisition of phenotypic resistances to 1st (cephalosporin), 2nd (carbapenems) and 3rd (colistin) lines of treatment, maximum parsimony suggested that a truncation in a lipopolysaccharide component coincided with the emergence of a subclone prevalent in chronic infections. Since initial identification, extensive infection control efforts have proved successful at slowing transmission.

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“…Two studies reported S. maltophilia as a highly prevalent microorganism in high touch surfaces and hospital sinks, exceeding the prevalence of A. baumannii and P. aeruginosa [50,51]. Sink drains seemed to harbour S. maltophilia for several months, even in newly built ICU facilities [52]. This might explain the increasing prevalence of this microorganism in HCAIs.…”

Section: Text Of Reviewmentioning

confidence: 99%

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

Koulenti,

Vandana,

Rello

2023

Current Opinion in Infectious Diseases

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Purpose of review This article aims to review the epidemiology of nonfermenting Gram-negative bacilli (NFGNB) based on recent literature reports, particularly, of the less common, but with emerging clinical significance species. Recent findings The reported frequency of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa is increasing, with very significant variability, however, between different countries. Apart from the major NFGNB, that is, A. baumannii and P. aeruginosa, already recognized as of critical importance healthcare risks, several other NFGNB genera have been increasingly associated with diverse severe infections, such as Stenotrophomonas maltophilia, Burkholderia spp., Elizabethkingia spp., Chryseobacterium spp., Achromobacter spp., Alcaligenes spp., Sphingomonas spp., Shewanella spp. and Ralstonia spp., among others. Summary The exploration of the epidemiology, as well as the pathogenic potential of the of the less frequent, but emerging and increasingly reported NFGNB, is crucial, not only for immunocompromised patients, but also for critically ill patients without overt immunosuppression. As we are heading fast towards a postantibiotic era, such information would contribute to the optimal antimicrobial management, that is, providing prompt, appropriate antimicrobial coverage when needed and, at the same time, avoiding overuse and/or inappropriate use of antimicrobial therapy. Also, it would help to better understand their transmission dynamics and to develop effective prevention strategies.

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Antibiotic-resistant organisms establish reservoirs in new hospital built environments and are related to patient blood infection isolates

Cited by 34 publications

References 95 publications

Long-term dynamics of the “Serratia marcescenscomplex” in the hospital-built environment

Long-term dynamics of the “Serratia marcescenscomplex” in the hospital-built environment

Detecting, mapping, and suppressing the spread of a decade-longPseudomonas aeruginosanosocomial outbreak with genomics

Current viewpoint on the epidemiology of nonfermenting Gram-negative bacterial strains

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