Bathroom contamination by antibiotic-resistant Enterobacterales (ESBLPE and CPE): an experimental study

Sevin, Thibaud; Goldstein, Valérie; Lolom, Isabelle; Lenne, F.; Gaudonnet, Yannick; Baptiste, Anne Laure; Bendjelloul, G.; Armand-Lefèvre, Laurence; Lucet, Jean Christophe

doi:10.1016/j.jhin.2020.07.033

Cited by 16 publications

(3 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recently, the sources of pathogenic organisms associated with nosocomial transmission have occasionally been identified in connection with the hospitals' plumbing system 3,4,7,9,11,[17][18][19] .…”

Section: Discussionmentioning

confidence: 99%

Transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae associated with sinks in a surgical hospital ward, confirmed by single-nucleotide polymorphism analysis

Nakamura

Yamaguchi

Miura

et al. 2021

Journal of Hospital Infection

View full text Add to dashboard Cite

show abstract

Section: Discussionmentioning

confidence: 99%

Transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae associated with sinks in a surgical hospital ward, confirmed by single-nucleotide polymorphism analysis

Nakamura

Yamaguchi

Miura

et al. 2021

Journal of Hospital Infection

View full text Add to dashboard Cite

show abstract

“…By toilet flushing and subsequent bioaerosol plume formation (pathogenic) bacteria can spread in the area (> 0.5 m) and stay in the air for extended periods of time (> 15 min) leading to transmission via skin contact, surface contamination or inhalation [ 41 , 42 ]. Additionally transmission can occur via the spreading of droplets during toilet flushing and urination [ 13 , 43 ]. A study by Klein et al suggests a short contact time (e.g.…”

Section: Discussionmentioning

confidence: 99%

Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting

Hamerlinck,

Aerssens,

Boelens

et al. 2023

Antimicrob Resist Infect Control

View full text Add to dashboard Cite

Background Accumulating evidence shows a role of the hospital wastewater system in the spread of multidrug-resistant organisms, such as carbapenemase producing Enterobacterales (CPE). Several sequential outbreaks of CPE on the geriatric ward of the Ghent University hospital have led to an outbreak investigation. Focusing on OXA-48 producing Citrobacter freundii, the most prevalent species, we aimed to track clonal relatedness using whole genome sequencing (WGS). By exploring transmission routes we wanted to improve understanding and (re)introduce targeted preventive measures. Methods Environmental screening (toilet water, sink and shower drains) was performed between 2017 and 2021. A retrospective selection was made of 53 Citrobacter freundii screening isolates (30 patients and 23 environmental samples). DNA from frozen bacterial isolates was extracted and prepped for shotgun WGS. Core genome multilocus sequence typing was performed with an in-house developed scheme using 3,004 loci. Results The CPE positivity rate of environmental screening samples was 19.0% (73/385). Highest percentages were found in the shower drain samples (38.2%) and the toilet water samples (25.0%). Sink drain samples showed least CPE positivity (3.3%). The WGS data revealed long-term co-existence of three patient sample derived C. freundii clusters. The biggest cluster (ST22) connects 12 patients and 8 environmental isolates taken between 2018 and 2021 spread across the ward. In an overlapping period, another cluster (ST170) links eight patients and four toilet water isolates connected to the same room. The third C. freundii cluster (ST421) connects two patients hospitalised in the same room but over a period of one and a half year. Additional sampling in 2022 revealed clonal isolates linked to the two largest clusters (ST22, ST170) in the wastewater collection pipes connecting the rooms. Conclusions Our findings suggest long-term circulation and transmission of carbapenemase producing C. freundii clones in hospital sanitary installations despite surveillance, daily cleaning and intermittent disinfection protocols. We propose a role for the wastewater drainage system in the spread within and between rooms and for the sanitary installations in the indirect transmission via bioaerosol plumes. To tackle this problem, a multidisciplinary approach is necessary including careful design and maintenance of the plumbing system.

show abstract

“…The inclusion of environmental isolates in the analysis showed that this outbreak was related to environmental acquisition from the sinks and drains of all three affected wards as the potential sources, which highlights the importance of source control measures due to environmental reservoirs facilitating nosocomial outbreaks. Indeed, hospital sanitary facilities, including sinks, drains, and toilets, have been repeatedly identified as a potential source and reservoir for nosocomial outbreaks of multidrug-resistant Gram-negative bacilli ( 21 – 24 ), and the presence of an environmental reservoir has been associated with long-term outbreaks ( 25 , 26 ). Over time, biofilm can form in these reservoirs, providing an ideal niche for persistence and evolution.…”

Section: Discussionmentioning

confidence: 99%

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

et al. 2021

View full text Add to dashboard Cite

show abstract

Bathroom contamination by antibiotic-resistant Enterobacterales (ESBLPE and CPE): an experimental study

Cited by 16 publications

References 17 publications

Transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae associated with sinks in a surgical hospital ward, confirmed by single-nucleotide polymorphism analysis

Transmission of extended-spectrum β-lactamase-producing Klebsiella pneumoniae associated with sinks in a surgical hospital ward, confirmed by single-nucleotide polymorphism analysis

Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains

Contact Info

Product

Resources

About