Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

Nurjadi, Dennis; Scherrer, M; Frank, Uwe; Mutters, Nico T.; Heininger, Alexandra; Späth, Isabel; Eichel, Vanessa; Jabs, Jonas M; Probst, Katja; Müller‐Tidow, Carsten; Brandt, Juliane; Heeg, Klaus; Boutin, Sébastien

doi:10.1128/spectrum.01380-21

Cited by 16 publications

(8 citation statements)

References 44 publications

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“… Enterobacter spp. can colonize the gastrointestinal tract, as well as surfaces or devices in the NICU, constituting an important reservoir of HAIs ( 13 – 15 ). Improved methodologies for identifying and monitoring outbreaks are necessary to reduce HAIs in NICUs.…”

Section: Introductionmentioning

confidence: 99%

Contaminated Incubators: Source of a Multispecies Enterobacter Outbreak of Neonatal Sepsis

et al. 2022

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Section: Introductionmentioning

confidence: 99%

Contaminated Incubators: Source of a Multispecies Enterobacter Outbreak of Neonatal Sepsis

et al. 2022

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“…They explained that cleaning and disinfection alone are usually ineffective in eliminating microbial colonisation of washbasins due to biofilm. Nurjadi et al also confirmed that a complete eradication is not possible with routine disinfection measures [ 23 ] but succeeded in preventing new cases of OXA-48 CPE after implementation of weekly autoclaved removable shower inserts. Vergara et al [ 24 ] also reported that the replacement of contaminated washbasin drains alone did not stop occurrence of new cases.…”

Section: Discussionmentioning

confidence: 99%

Outbreak of carbapenemase-producing Citrobacter farmeri in an intensive care haematology department linked to a persistent wastewater reservoir in one hospital room, France, 2019 to 2022

Regad,

Lizon,

Alauzet

et al. 2024

Eurosurveillance

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In 2019–2022, a prolonged outbreak of oxacillinase (OXA)-48-producing Citrobacter farmeri due to a persistent environmental contamination, occurred in our haematology intensive care unit. In April 2019, we isolated OXA-48-producing C. farmeri from rectal samples of two patients in weekly screenings. The cases had stayed in the same hospital room but 4 months apart. We screened five patients who had stayed in this room between the two cases and identified a third case. Over the following 3 years, five other cases were detected, the last case in September 2022. In total, eight cases were detected: seven colonised with the bacterium and one infected with a lethal outcome. All cases stayed in the same hospital room. We detected OXA-48-producing C. farmeri from a shower, washbasin drains and wastewater drainage of the bathroom of the hospital room. Molecular typing confirmed that all C. farmeri isolates from the environment and the cases were indistinguishable. Despite bundle measures to control the outbreak, the bacterium persisted in the system, which resulted in transmission to new patients. A design defect in the placement of wastewater drains contributed to the persistence and proliferation of the bacterium. The room was closed after the last case and the bathroom rebuilt.

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“…Only a few studies reporting success stated the duration of follow-up after the intervention, which ranged, from 2 months to 3.5 years. (22,35,39,40) In our situation, we continued microbiological screening of sink traps for 12 months after the identi cation of the last positive patient and 5 months after the completion of the sink's disinfection protocol, providing proof for a successful and persistent control of the outbreak.…”

Section: Discussionmentioning

confidence: 99%

Successful eradication of an environmental reservoir of NDM-producing Klebsiella pneumoniae associated with nosocomial transmissions in a low-incidence setting

Moulin,

Filippidis,

Paire-Ficout

et al. 2024

Preprint

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Background The hospital wastewater system has been reported as a source of nosocomial acquisition of carbapenemase producing Enterobacteriaceae(CPE) in various settings. Cleaning and disinfection protocols or replacement of contaminated equipment often fail to eradicate these environmental reservoirs, which can lead to long-term transmission of CPE. We report a successful multimodal approach to control a New Delhi metallo-beta-lactamase positive Klebsiella pneumoniae (NDM-KP) nosocomial outbreak implicating contamination of sink traps in a low-incidence setting. Methods Following the incidental identification of NDM-KP in a urine culture of an inpatient, we performed an epidemiological investigation, including patient and environmental CPE screening, and whole genome sequencing (WGS) of strains. We also implemented multimodal infection prevention and control (IPC) measures, namely the isolation of cases, waterless patient care, replacement of contaminated sink traps and connecting pieces, and bleach and steam disinfection of sinks for 6 months, followed by patient and environmental screenings for eradication. Results Between February and May 2022, five NDM-KP cases were identified in an eight-bed neurosurgical intermediate care unit. Among the eight sink traps of the unit, three were positive for NDM-KP. Patient and environmental isolates belonged to multilocus sequence typing ST-268. All isolate genomes were genetically very similar suggesting cross-transmission and a potential role of the environment as the source of transmissions. Thanks to the combined IPC measures, no new case was subsequently detected, and sink traps remained negative for NDM-KP within 6 months after the intervention. Conclusion The implementation of multimodal IPC measures, including waterless patient care combined with the replacement and disinfection of sink traps and connecting pieces, was successful in the eradication of NDM-KP after eight months. In a low-incidence setting, this approach has made it possible to pursue the objective of zero transmission of carbapenemase-producing Enterobacteriaceae (CPE).

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Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

Cited by 16 publications

References 44 publications

Contaminated Incubators: Source of a Multispecies Enterobacter Outbreak of Neonatal Sepsis

Contaminated Incubators: Source of a Multispecies Enterobacter Outbreak of Neonatal Sepsis

Outbreak of carbapenemase-producing Citrobacter farmeri in an intensive care haematology department linked to a persistent wastewater reservoir in one hospital room, France, 2019 to 2022

Successful eradication of an environmental reservoir of NDM-producing Klebsiella pneumoniae associated with nosocomial transmissions in a low-incidence setting

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