Contaminated oral intubation equipment associated with an outbreak of carbapenem-resistant pseudomonas in an intensive care unit

Kikuchi, Tetsuhiro; Nagashima, Goro; Taguchi, Kazumi; Kuraishi, Hiroshi; Nemoto, Hitoshi; Yamanaka, M.; Kawano, Rumiko; Ugajin, Kazuhisa; Tazawa, Sakiko; Marumo, Kenji

doi:10.1016/j.jhin.2006.07.017

Cited by 23 publications

(14 citation statements)

References 10 publications

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“…This episode suggests that environmental sources other than faucets should also be suspected when a P. aeruginosa outbreak involves several patients. This is in accordance with other studies reporting on P. aeruginosa outbreaks involving the environment [20–24].…”

Section: Discussionsupporting

confidence: 94%

Molecular epidemiology of Pseudomonas aeruginosa in intensive care units over a 10-year period (1998-2007)

Cuttelod

Senn

Terletskiy

et al. 2011

Clinical Microbiology and Infection

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Pseudomonas aeruginosa is one of the leading nosocomial pathogens in intensive care units (ICUs). The source of this microorganism can be either endogenous or exogenous. The proportion of cases as a result of transmission is still debated, and its elucidation is important for implementing appropriate control measures. To understand the relative importance of exogenous vs. endogenous sources of P. aeruginosa, molecular typing was performed on all available P. aeruginosa isolated from ICU clinical and environmental specimens in 1998, 2000, 2003, 2004 and 2007. Patient samples were classified according to their P. aeruginosa genotypes into three categories: (A) identical to isolate from faucet; (B) identical to at least one other patient sample and not found in faucet; and (C) unique genotype. Cases in categories A and B were considered as possibly exogenous, and cases in category C as possibly endogenous. A mean of 34 cases per 1000 admissions per year were found to be colonized or infected by P. aeruginosa. Higher levels of faucet contamination were correlated with a higher number of cases in category A. The number of cases in category B varied from 1.9 to 20 cases per 1000 admissions. This number exceeded 10/1000 admissions on three occasions and was correlated with an outbreak on one occasion. The number of cases considered as endogenous (category C) was stable and independent of the number of cases in categories A and B. The present study shows that repeated molecular typing can help identify variations in the epidemiology of P. aeruginosa in ICU patients and guide infection control measures.

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Section: Discussionsupporting

confidence: 94%

Molecular epidemiology of Pseudomonas aeruginosa in intensive care units over a 10-year period (1998-2007)

Cuttelod

Senn

Terletskiy

et al. 2011

Clinical Microbiology and Infection

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“…Doripenem was the most active drug against these resistant isolates (12). The presence of carbapenem-nonsusceptible P. aeruginosa isolates has been described worldwide, particularly in relation to outbreaks (1,5,6,17,18,25,28,30,31,37). Most of these studies focused on clinical isolates, and genetic relatedness was established using molecular typing tools based on macrorestriction-fragment analysis or PCR of repetitive DNA sequences on the chromosome.…”

mentioning

confidence: 99%

Wide Dispersion of ST175 Clone despite High Genetic Diversity of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Clinical Strains in 16 Spanish Hospitals

et al. 2011

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During the COMParative Activity of Carbapenems Testing (COMPACT) surveillance study, 448 Pseudomonas aeruginosa clinical isolates were obtained from 16 Spanish hospitals. Nonsusceptibility (EUCAST breakpoints) to imipenem (35%), meropenem (33%), and/or doripenem (33%) was observed with 175 isolates (39%). Simultaneous resistance to these three drugs was observed with 126 of the 175 isolates (72%). Except for colistin, high resistance rates were observed among noncarbapenem antibiotics. Clonal relatedness was investigated by pulsed-field gel electrophoresis (PFGE) with SpeI, discriminating 68 patterns. Multilocus sequence typing (MLST) was performed on 84 isolates representing different PFGE types and all participating hospitals. Thirty-nine sequence types (STs) could be distinguished, and of these, ST175 (48 isolates, 10 hospitals), ST646 (16 isolates, 4 hospitals), ST532 (13 isolates, 3 hospitals), and ST111 (13 isolates, 7 hospitals) were the most frequently encountered. Minimum-spanning tree analysis confirmed a wide dissemination of different clones among participant hospitals, particularly ST175. PFGE pattern comparison within the four most frequent STs revealed that ST175 isolates were relatively uniform, while ST646, ST532, and ST111 isolates were highly diverse, with almost every isolate belonging to a unique pulsotype, even when originating from the same center. The population of carbapenem-nonsusceptible P. aeruginosa isolates from 16 hospitals is highly diverse, with one ST (ST175) representing a highly conserved clone disseminated in 10 of the 16 participant hospitals. This ST175 clone should be added to the list of P. aeruginosa clones at high risk for epidemic spread, such as the Liverpool, Manchester, and Melbourne clones previously found in cystic fibrosis patients and ST235 in the nosocomial setting.Antibiotic surveillance studies are necessary not only for the better understanding of bacterial epidemiology, but also for the design of control strategies for preventing bacterial resistance and establishing therapeutic guidelines. In this context, the COMParative Activity of Carbapenems Testing (COMPACT) multicenter study was performed in 16 European countries, including Spain (23). The main objectives of this surveillance study were to test the activity of currently used carbapenems against Pseudomonas aeruginosa clinical isolates and to detect carbapenem nonsusceptible isolates (12).In this multicenter study, Spanish authors concluded that percentages of carbapenem resistance among P. aeruginosa clinical isolates in their country (range of 21.4% to 32.6%) are very similar to those previously reported in other European countries. Doripenem was the most active drug against these resistant isolates (12). The presence of carbapenem-nonsusceptible P. aeruginosa isolates has been described worldwide, particularly in relation to outbreaks (1,5,6,17,18,25,28,30,31,37). Most of these studies focused on clinical isolates, and genetic relatedness was established using molecular typing tools based on macror...

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“…Previous reports have demonstrated that nosocomial outbreaks of P. aeruginosa have been caused by contaminated mouth swabs or reused bite blocks. 20,21 Proper use of oral-care devices is an essential part of safe oral-care practices. The provision of professional oral care by dentists or dental hygienists is reportedly beneficial in preventing pneumonia among older residents of LTCFs.…”

Section: Discussionmentioning

confidence: 99%

Successful control of an outbreak of GES-5 extended-spectrum β-lactamase-producing Pseudomonas aeruginosa in a long-term care facility in Japan

Kanayama

Kawahara

Yamagishi

et al. 2016

Journal of Hospital Infection

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Contaminated oral intubation equipment associated with an outbreak of carbapenem-resistant pseudomonas in an intensive care unit

Cited by 23 publications

References 10 publications

Molecular epidemiology of Pseudomonas aeruginosa in intensive care units over a 10-year period (1998-2007)

Molecular epidemiology of Pseudomonas aeruginosa in intensive care units over a 10-year period (1998-2007)

Wide Dispersion of ST175 Clone despite High Genetic Diversity of Carbapenem-Nonsusceptible Pseudomonas aeruginosa Clinical Strains in 16 Spanish Hospitals

Successful control of an outbreak of GES-5 extended-spectrum β-lactamase-producing Pseudomonas aeruginosa in a long-term care facility in Japan

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