The role of outpatient clinics as a potential transmission ground for multidrug-resistant organisms (MDRO) has not been adequately investigated. Here, we report a transmission cluster of blaKPC2-positive Enterobacter cloacae among patients treated in a highly frequented outpatient department.

The hospital water environment can be a reservoir for a multiward outbreak, leading to acquisitions or transmissions of multidrug-resistant organisms in a hospital setting. The majority of Gram-negative bacteria are able to build biofilms and persist in the hospital plumbing system over a long period of time.

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