Transmission of metallo-β-lactamase-producing Pseudomonas aeruginosa in a nephrology-transplant intensive care unit with potential link to the environment

Ambrogi, Vanina; Cavalié, Laurent; Mantion, Benoit; Ghiglia, M.-J.; Cointault, Olivier; Dubois, Damien; Prère, Marie-Françoise; Levitzki, N.; Kamar, Nassim; Malavaud, S.

doi:10.1016/j.jhin.2015.09.007

Cited by 32 publications

(15 citation statements)

References 9 publications

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“…Data from different dispersal experiments suggest that although P-traps can act as the source or the reservoir of pathogens, the physical presence of the organism in the sink bowl or colonization of the strainer is necessary for the dispersal to occur. Colonization of strainers or drains reported in earlier studies (7,10,13,24,37) was perhaps a result of ascending biofilm growth from the P-trap to the strainer or introduction through contaminated fluids. Many of the studies used swab samples, which likely sampled the strainer rather than P-trap water (17,20).…”

Section: Discussionmentioning

confidence: 91%

Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs

Kotay

Chai

Guilford

et al. 2017

Appl Environ Microbiol

142

128

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There have been an increasing number of reports implicating Gammaproteobacteria as often carrying genes of drug resistance from colonized sink traps to vulnerable hospitalized patients. However, the mechanism of transmission from the wastewater of the sink P-trap to patients remains poorly understood. Herein we report the use of a designated hand-washing sink lab gallery to model dispersion of green fluorescent protein (GFP)-expressing Escherichia coli from sink wastewater to the surrounding environment. We found no dispersion of GFP-expressing E. coli directly from the P-trap to the sink basin or surrounding countertop with coincident water flow from a faucet. However, when the GFP-expressing E. coli cells were allowed to mature in the P-trap under conditions similar to those in a hospital environment, a GFP-expressing E. coli-containing putative biofilm extended upward over 7 days to reach the strainer. This subsequently resulted in droplet dispersion to the surrounding areas (<30 in.) during faucet operation. We also demonstrated that P-trap colonization could occur by retrograde transmission along a common pipe. We postulate that the organisms mobilize up to the strainer from the P-trap, resulting in droplet dispersion rather than dispersion directly from the P-trap. This work helps to further define the mode of transmission of bacteria from a P-trap reservoir to a vulnerable hospitalized patient.IMPORTANCE Many recent reports demonstrate that sink drain pipes become colonized with highly consequential multidrug-resistant bacteria, which then results in hospital-acquired infections. However, the mechanism of dispersal of bacteria from the sink to patients has not been fully elucidated. Through establishment of a unique sink gallery, this work found that a staged mode of transmission involving biofilm growth from the lower pipe to the sink strainer and subsequent splatter to the bowl and surrounding area occurs rather than splatter directly from the water in the lower pipe. We have also demonstrated that bacterial transmission can occur via connections in wastewater plumbing to neighboring sinks. This work helps to more clearly define the mechanism and risk of transmission from a wastewater source to hospitalized patients in a world with increasingly antibiotic-resistant bacteria that can thrive in wastewater environments and cause infections in vulnerable patients.

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Section: Discussionmentioning

confidence: 91%

Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs

Kotay

Chai

Guilford

et al. 2017

Appl Environ Microbiol

142

128

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“…Recent reports have implicated hand-washing sinks as a primary reservoir of antibiotic resistant pathogens within patient-care environments(1–27). Many of these reports have been published since 2016 highlighting the global recognition that biofilms located in and on sinks can have in disseminating clinically important drug resistant gram-negative bacteria(14–27). Retrospective and prospective surveillance investigations affirm that hospital sinks provide habitats for several opportunistic pathogens, raising serious concerns(8, 24, 26, 28).…”

Section: Introductionmentioning

confidence: 99%

Droplet rather than Aerosol Mediated Dispersion is the Primary Mechanism of Bacterial transmission from Contaminated Hand Washing Sink Traps

Kotay

Donlan

Ganim

et al. 2018

Preprint

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“…Hospital outbreaks of P. aeruginosa have been described in transplant units. 101 – 103 Contaminated water fittings, including drinking water, tap water, faucets, showers, water outlet, sinks, and waste water system, have been reported as the sources of many outbreaks of P. aeruginosa infection. 102 – 110 Soap, contaminated mouth swabs, or a contaminated graft can also act as a reservoir of P. aeruginosa .…”

Section: Methodsmentioning

confidence: 99%

“… 116 Replacing reservoirs; point-of-use filtration; and decontaminating using bleach, hydrogen peroxide vapor, acetic acid, hot water, UV light, ozonation, and aldehyde-based disinfectants, were effective to end the outbreak. 103 , 117 Each method has advantages and disadvantages related to ease of implementation, cost, maintenance issues, and short- and long-term effectiveness. Point-of-use filtration and replacing reservoirs were thought to be a very effective method over the long term.…”

Section: Methodsmentioning

confidence: 99%

<em>Pseudomonas aeruginosa</em> bacteremia among liver transplant recipients

Liu¹,

Zhang²,

Wan³

2018

IDR

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Pseudomonas aeruginosa bacteremia remains as a life-threatening complication after liver transplantation (LT) and is intractable because of the high rate of drug resistance to commonly used antibiotics. To better understand the characteristics of this postoperative complication, PubMed and Embase searches as well as reference mining was done for relevant literature from the start of the databases through August 2018. Among LT recipients, the incidence of P. aeruginosa bacteremia ranged from 0.5% to 14.4% and mortality rates were up to 40%. Approximately 35% of all episodes of bloodstream infections (BSIs) were P. aeruginosa bacteremia, of which 47% were multidrug resistant and 63% were extensively drug resistant. Several factors are known to affect the mortality of LT recipients with P. aeruginosa bacteremia, including hypotension, mechanical ventilation, and increasing severity of illness. In LT recipients with P. aeruginosa bacteremia, alteration in DNA gyrase A genes and overexpression of proteins involved in efflux systems, namely the expression of KPC-2-type carbapenemase, NDM-1, and VIM-2-type MBL, contribute to the high resistance of P. aeruginosa to a wide variety of antibiotics. Because of complicated mechanisms of drug resistance, P. aeruginosa causes high morbidity and mortality in bacteremic LT patients. Consequently, early detection and treatment with adequate early targeted coverage for P. aeruginosa BSI are of paramount importance in the early posttransplantation period to obtain a better prognosis for LT patients.

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Transmission of metallo-β-lactamase-producing Pseudomonas aeruginosa in a nephrology-transplant intensive care unit with potential link to the environment

Cited by 32 publications

References 9 publications

Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs

Spread from the Sink to the Patient: In Situ Study Using Green Fluorescent Protein (GFP)-Expressing Escherichia coli To Model Bacterial Dispersion from Hand-Washing Sink-Trap Reservoirs

Droplet rather than Aerosol Mediated Dispersion is the Primary Mechanism of Bacterial transmission from Contaminated Hand Washing Sink Traps

<em>Pseudomonas aeruginosa</em> bacteremia among liver transplant recipients

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