Cargando…

Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care

BACKGROUND: Long-term outbreaks of multidrug-resistant Gram-negative bacilli related to hospital-building water systems have been described. However, successful mitigation strategies have rarely been reported. In particular, environmental disinfection or replacement of contaminated equipment usually...

Descripción completa

Detalles Bibliográficos
Autores principales: Catho, Gaud, Martischang, R., Boroli, F., Chraïti, M. N., Martin, Y., Koyluk Tomsuk, Z., Renzi, G., Schrenzel, J., Pugin, J., Nordmann, P., Blanc, D. S., Harbarth, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376114/
https://www.ncbi.nlm.nih.gov/pubmed/34412676
http://dx.doi.org/10.1186/s13054-021-03726-y
_version_ 1783740439669506048
author Catho, Gaud
Martischang, R.
Boroli, F.
Chraïti, M. N.
Martin, Y.
Koyluk Tomsuk, Z.
Renzi, G.
Schrenzel, J.
Pugin, J.
Nordmann, P.
Blanc, D. S.
Harbarth, S.
author_facet Catho, Gaud
Martischang, R.
Boroli, F.
Chraïti, M. N.
Martin, Y.
Koyluk Tomsuk, Z.
Renzi, G.
Schrenzel, J.
Pugin, J.
Nordmann, P.
Blanc, D. S.
Harbarth, S.
author_sort Catho, Gaud
collection PubMed
description BACKGROUND: Long-term outbreaks of multidrug-resistant Gram-negative bacilli related to hospital-building water systems have been described. However, successful mitigation strategies have rarely been reported. In particular, environmental disinfection or replacement of contaminated equipment usually failed to eradicate environmental sources of Pseudomonas aeruginosa. METHODS: We report the investigation and termination of an outbreak of P. aeruginosa producing VIM carbapenemase (PA-VIM) in the adult intensive care unit (ICU) of a Swiss tertiary care hospital with active case finding, environmental sampling and whole genome sequencing (WGS) of patient and environmental strains. We also describe the implemented control strategies and their effectiveness on eradication of the environmental reservoir. RESULTS: Between April 2018 and September 2020, 21 patients became either infected or colonized with a PA-VIM strain. For 16 of them, an acquisition in the ICU was suspected. Among 131 environmental samples collected in the ICU, 13 grew PA-VIM in sink traps and drains. WGS confirmed the epidemiological link between clinical and environmental strains and the monoclonal pattern of the outbreak. After removing sinks from patient rooms and implementation of waterless patient care, no new acquisition was detected in the ICU within 8 months after the intervention. DISCUSSION: Implementation of waterless patient care with removal of the sinks in patient rooms was successful for termination of a PA-VIM ICU outbreak linked to multiple environmental water sources. WGS provides highly discriminatory accuracy to investigate environment-related outbreaks. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03726-y.
format Online
Article
Text
id pubmed-8376114
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-83761142021-08-20 Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care Catho, Gaud Martischang, R. Boroli, F. Chraïti, M. N. Martin, Y. Koyluk Tomsuk, Z. Renzi, G. Schrenzel, J. Pugin, J. Nordmann, P. Blanc, D. S. Harbarth, S. Crit Care Research BACKGROUND: Long-term outbreaks of multidrug-resistant Gram-negative bacilli related to hospital-building water systems have been described. However, successful mitigation strategies have rarely been reported. In particular, environmental disinfection or replacement of contaminated equipment usually failed to eradicate environmental sources of Pseudomonas aeruginosa. METHODS: We report the investigation and termination of an outbreak of P. aeruginosa producing VIM carbapenemase (PA-VIM) in the adult intensive care unit (ICU) of a Swiss tertiary care hospital with active case finding, environmental sampling and whole genome sequencing (WGS) of patient and environmental strains. We also describe the implemented control strategies and their effectiveness on eradication of the environmental reservoir. RESULTS: Between April 2018 and September 2020, 21 patients became either infected or colonized with a PA-VIM strain. For 16 of them, an acquisition in the ICU was suspected. Among 131 environmental samples collected in the ICU, 13 grew PA-VIM in sink traps and drains. WGS confirmed the epidemiological link between clinical and environmental strains and the monoclonal pattern of the outbreak. After removing sinks from patient rooms and implementation of waterless patient care, no new acquisition was detected in the ICU within 8 months after the intervention. DISCUSSION: Implementation of waterless patient care with removal of the sinks in patient rooms was successful for termination of a PA-VIM ICU outbreak linked to multiple environmental water sources. WGS provides highly discriminatory accuracy to investigate environment-related outbreaks. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13054-021-03726-y. BioMed Central 2021-08-19 /pmc/articles/PMC8376114/ /pubmed/34412676 http://dx.doi.org/10.1186/s13054-021-03726-y Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Catho, Gaud
Martischang, R.
Boroli, F.
Chraïti, M. N.
Martin, Y.
Koyluk Tomsuk, Z.
Renzi, G.
Schrenzel, J.
Pugin, J.
Nordmann, P.
Blanc, D. S.
Harbarth, S.
Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
title Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
title_full Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
title_fullStr Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
title_full_unstemmed Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
title_short Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
title_sort outbreak of pseudomonas aeruginosa producing vim carbapenemase in an intensive care unit and its termination by implementation of waterless patient care
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8376114/
https://www.ncbi.nlm.nih.gov/pubmed/34412676
http://dx.doi.org/10.1186/s13054-021-03726-y
work_keys_str_mv AT cathogaud outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT martischangr outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT borolif outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT chraitimn outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT martiny outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT koyluktomsukz outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT renzig outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT schrenzelj outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT puginj outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT nordmannp outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT blancds outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare
AT harbarths outbreakofpseudomonasaeruginosaproducingvimcarbapenemaseinanintensivecareunitanditsterminationbyimplementationofwaterlesspatientcare