Sink traps as the source of transmission of OXA-48–producing <i>Serratia marcescens</i> in an intensive care unit

Regev‐Yochay, Gili; Smollan, Gill; Tal, Ilana; Zade, Nani Pinas; Haviv, Yael; Nudelman, Valery; Gal-Mor, Ohad; Jaber, Hanaa; Zimlichman, Eyal; Keller, Natan; Rahav, Galia

doi:10.1017/ice.2018.235

Cited by 51 publications

(39 citation statements)

References 34 publications

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“…Owing to the emergence of resistance of gram-negative microorganisms to antibiotics and disinfectants, it is becoming pivotal to limit the presence of the preferred moist habitat of those bacteria as much as possible in hospitals worldwide. 22 , 23 Sinks and hoppers have been reported as sources for outbreaks and sporadic transmission events of gram-negative bacilli from the environment to patients, and interventions to reduce the transmission from these sources to the patients should therefore be prioritized when trying to protect the patient. Removal of a source for carbapenemase-producing bacilli is the most efficient intervention to stop transmission.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2019

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“…3). Health care-associated outbreaks have also been described in various other countries, including Greece (70,71), Australia (72), Israel (73,74), the United Kingdom (75,76), the Netherlands (77,78), Ireland (79,80), Spain (81)(82)(83)(84)(85), France (86)(87)(88), Germany (89,90), Mexico (91), China (92), Belgium (93), Norway (94), Poland (95), Taiwan (96), South Africa (97), Croatia (98), and Slovenia (99).…”

Section: Geographical Distribution Of Oxa-48mentioning

confidence: 99%

“…OXA-48 was first described for K. pneumoniae, and it remains the most common global bacterium associated with health care-associated infections due to organisms with bla OXA-48 (47,48). Subsequently OXA-48 was reported from several members of the Enterobacterales, especially E. coli (108), the E. cloacae complex (109), Citrobacter freundii (98), Serratia marcescens (74), Proteus mirabilis (110), Kluyvera spp. (111), Klebsiella oxytoca (112), and Salmonella spp.…”

Section: Bacteria Producing Oxa-48mentioning

confidence: 99%

The Global Ascendency of OXA-48-Type Carbapenemases

et al. 2019

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SUMMARY Surveillance studies have shown that OXA-48-like carbapenemases are the most common carbapenemases in Enterobacterales in certain regions of the world and are being introduced on a regular basis into regions of nonendemicity, where they are responsible for nosocomial outbreaks. OXA-48, OXA-181, OXA-232, OXA-204, OXA-162, and OXA-244, in that order, are the most common enzymes identified among the OXA-48-like carbapenemase group. OXA-48 is associated with different Tn1999 variants on IncL plasmids and is endemic in North Africa and the Middle East. OXA-162 and OXA-244 are derivatives of OXA-48 and are present in Europe. OXA-181 and OXA-232 are associated with ISEcp1, Tn2013 on ColE2, and IncX3 types of plasmids and are endemic in the Indian subcontinent (e.g., India, Bangladesh, Pakistan, and Sri Lanka) and certain sub-Saharan African countries. Overall, clonal dissemination plays a minor role in the spread of OXA-48-like carbapenemases, but certain high-risk clones (e.g., Klebsiella pneumoniae sequence type 147 [ST147], ST307, ST15, and ST14 and Escherichia coli ST38 and ST410) have been associated with the global dispersion of OXA-48, OXA-181, OXA-232, and OXA-204. Chromosomal integration of blaOXA-48 within Tn6237 occurred among E. coli ST38 isolates, especially in the United Kingdom. The detection of Enterobacterales with OXA-48-like enzymes using phenotypic methods has improved recently but remains challenging for clinical laboratories in regions of nonendemicity. Identification of the specific type of OXA-48-like enzyme requires sequencing of the corresponding genes. Bacteria (especially K. pneumoniae and E. coli) with blaOXA-48, blaOXA-181, and blaOXA-232 are emerging in different parts of the world and are most likely underreported due to problems with the laboratory detection of these enzymes. The medical community should be aware of the looming threat that is posed by bacteria with OXA-48-like carbapenemases.

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“…Using Polymerase Chain Reaction, other reports have demonstrated that K. pneumoniae, E. coli, C. freundii, P. mirabilis, Enterobacter sp. and Serratia marcescens are OXA-48 producers [33,34]. The results of the current study demonstrated that SSIs due OXA-48-carbapenemase-producing Enterobacteriaceae is a major clinical challenge.…”

Section: Discussionmentioning

confidence: 56%

Biofilm Formation and Antibiotic resistance of Enterobacteriaceae isolates from Surgical Site infections in Hôpital de Référence Saint Joseph, Kinshasa, Democratic Republic of Congo

Iyamba

Mabankama

Lukukula

et al. 2020

Preprint

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Background: Enterobacteriaceae are one of the most predominant pathogen in surgical site infections. In recent years we oberved increase in resistance among bacteria from surgical site infections. The aim of this study was to evaluate antimicrobial suceptibility pattern of Enterobacteriaceae isolates from surgical site infections, the biofilm formation and the production of OXA-48 carbapenemase.Methods: A total of 41 Enterobacteriaceae (19 Escherchia coli, 8 Enterobacter sp., 9 Citrobacter sp., and 5 Serratia sp. ) clinical isolates were collected from patients with SSI in Hôpital Saint Joseph (Kinshasa) for diagnostic purposes. The pus samples were cultured and the antibiotic susceptibility profile of the isolates were determined by disk-diffusion method following Clinical and Laboratory Standards Institute 2012 recommendations. OXA-48-producing Enterobacteriaceae were detected using ChromaticTM OXA-48 chromogenic medium. Crystal Violet Staining Method was used to assess the ability of bacteria strains to form a biofilm. Results: All Enterobacteriacea isolates studied were biofilm producers and highly resistant to the majority of antibiotics tested. E. coli, Enterobacter sp., Citrobacter sp., and Serratia sp. were 100 % resistant cefotaxime, imipenem, and amoxicillin-clavulanic acid, and ampicillin. Serratia sp. isolates were 100% and 80% sensitive to norfloxacine and amikacine respectively. There was relationship between antibiotic resistance and biofilm production. E. coli, Enterobacter sp., and Citrobacter sp. strains were all OXA-48 producers.Conclusion: The results of the present study demonstrate the emergence of multidrug resistant organisms, the correlation between antibiotic resistance- biofilm formation and OXA-48 production. These results suggest the implementation of antimicrobial resistance survey programm in order to prevent and combat the spread of multidrug resistant organisms in hospital and community in Democratic Republic of Congo.

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

Cited by 51 publications

References 34 publications

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

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

The Global Ascendency of OXA-48-Type Carbapenemases

Biofilm Formation and Antibiotic resistance of Enterobacteriaceae isolates from Surgical Site infections in Hôpital de Référence Saint Joseph, Kinshasa, Democratic Republic of Congo

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