Risk Assessment After a Severe Hospital-Acquired Infection Associated With Carbapenemase-Producing Pseudomonas aeruginosa

Abstract

Importance Resistance of gram-negative bacilli to carbapenems is rapidly emerging worldwide. In 2016, the World Health Organization defined the hospital-built environment as a core component of infection prevention and control programs. The hospital-built environment has recently been reported as a source for outbreaks and sporadic transmission events of carbapenemase-producing gram-negative bacilli from the environment to patients. Objective To assess risk after the identification of an unexpected, severe, and lethal hospital-acquired infection caused by carbapenemase-producing Pseudomonas aeruginosa in a carbapenemase-low endemic setting. Design, Settings, and Participants A case series study in which a risk assessment was performed on all 11 patients admitted to the combined cardiothoracic surgery and pulmonary diseases ward and the hospital-built environment in the Radboud University Medical Center, the Netherlands, in February 2018. Exposures Water and aerosols containing carbapenemase-producing (Verona integron-mediated metallo-β-lactamase [VIM]) P aeruginosa. Main Outcomes and Measures Colonization and/or infection of patients and/or contamination of the environment after the detection of 1 patient infected with carbapenemase-producing (VIM) P aeruginosa . Results A total of 5 men (age range, 60-84 years) and 6 women (age range, 55-74 years) were admitted to the combined cardiothoracic surgery and pulmonary diseases ward. The risk assessment was performed after carbapenemase-producing (VIM) P aeruginosa was unexpectedly detected in a man in his early 60s, who had undergone a left-sided pneumonectomy and adjuvant radiotherapy. No additional cases (colonization or infection) of carbapenemase-producing (VIM) P aeruginosa were detected. Plausible transmission of carbapenemase-producing P aeruginosa from the hospital environment to the patient via the air was confirmed by whole-genome sequencing, which proved the relation of Pseudomonas strains from the patient, the shower drains in 8 patient rooms, 1 sink, and an air sample. Conclusions and Relevance This study suggests that rethinking the hospital-built environment, including shower drains and the sewage system, will be crucial for the prevention of severe and potential lethal hospital-acquired infections.

Molecular surveillance of carbapenemase-producing Pseudomonas aeruginosa at three medical centres in Cologne, Germany

“…P. aeruginosa can reside in the sink drains in the patient room for long periods. The spreading and distribution of MDR P. aeruginosa in the shower and sink drains, and sewage system of the ward is quite complex as several studies have shown [11, 34]. We found direct and indirect evidence for both modes of transmission (patient-to-patient and room-to-patient).…”

The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms

“…In a CR Sphingomonas koreensis outbreak, sink aerators, faucets, mixing valves, pipes and other plumbing fixtures were also found to be contaminated [24]. Shower drains have also been implicated with CRPA outbreak [25]. In a study by Stjärne et al, investigation of a CRPA outbreak revealed contamination of sinks with isolates closely related to CRPA from patients [23].…”

“…Retrograde contamination from common sewage pipes can also occur in showers [25]. The use of showers may result in airborne or droplet transmission from shower drains to patients.…”

Antimicrobiële resistentie en residuen van diergeneesmiddelen (antibiotica) in een circulaire veehouderij : Tegengaan van verspreiding via mest en milieu

“…Maar toch blijven ook voor Nederland veel riskante situaties (Hopman et al, 2019). Daarbij is AMR ook een globale problematiek en is het dus ook belangrijk om beleidsmatig op mogelijke epidemieën en uitbraken te anticiperen.…”