Contaminated sinks in intensive care units: an underestimated source of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the patient environment

Roux, Damien; Aubier, Benjamin; Cochard, Hélène; Quentin, Roland; Mee-Marquet, Nathalie van der

doi:10.1016/j.jhin.2013.07.006

Cited by 85 publications

(79 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…23 Drain biofilms harbour large populations of bacteria, 24 including antibioticresistant strains and hospital sink drains have been implicated in a number of outbreaks of multidrug-resistant bacteria. [25][26][27][28][29] Our study confirmed that the drain of the handwash basin in patient room is a potential reservoir for ESBLproducing Enterobacteriacae and P. aeruginosa. It accounted for 62% of ESBL-positive sites.…”

Section: Discussionsupporting

confidence: 72%

“…Similarly, a single ICU drain harboured ESBL-K. pneumoniae, K. oxytoca and P. aeruginosa. Eradication of ESBL-producing Enterobacteriacae from sinks is difficult 14,29 and, consequently, contaminated drains can act as long-term reservoirs of multi-drug resistant bacteria and facilitate the contamination of the ward environment. Studies have demonstrated that drain contents can be dispersed on to surfaces outside of the drain, via splash-back and/or aerosolisation.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that drain contents can be dispersed on to surfaces outside of the drain, via splash-back and/or aerosolisation. 14,29 Many of the environmental bacteria (e.g. Pantoea sp, Raoultella sp.)…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

Muzslay

Moore

Alhussaini

et al. 2017

Journal of Hospital Infection

View full text Add to dashboard Cite

SUMMARY BackgroundThe increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriacae in the healthcare setting and in the community despite established infection control guidelines indicates that these microorganisms may possess survival strategies that allow them to persist in the environment. Aims To determine the extent and variation in endemic ESBL-carrying species in different ward environments. To investigate the potential for cephalosporin resistance to be transferred from environmental isolates to human pathogens. Methods Conventional microbiological methods were used to sample 1436 environmental surfaces for ESBL-producing bacteria. Transconjugation assays (broth mating experiments) were performed using environmental ESBL-producing isolates as donors and streptomycin-resistant Escherichia coli (NCTC 50237) as the recipient. FindingsThe prevalence of ESBL-producing bacteria on surfaces in a non-outbreak setting was low (45/1436; 3.1%). The sites most likely to be contaminated were the drains of handwash basins (28/105; 26.7%) and floors (14/160; 8.8%). Fifty-nine ESBL-carrying organisms were isolated. Of these, Klebsiella spp (33.9%), Enterobacter spp (20.3%), Pantoea spp (15.3%) and Citrobacter spp (13.6%), were the most common isolates. ESBL determinants were successfully transferred from three representative environmental isolates (Pantoea calida, Klebsiella oxytoca, Raoultella ornithinolytica) to the human pathogen E. coli. Conclusion ESBL-producing Gram-negative isolates were recovered from the hospital environment in the absence of any ESBL infection on the wards. The drains of hand wash basins should be considered potential long-term reservoirs of multi-drug resistant bacteria and drug resistance genes. These genes can reside in various genera of hardy environmental organisms and be a potential source of ESBL for more common human pathogens.

show abstract

Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

Muzslay

Moore

Alhussaini

et al. 2017

Journal of Hospital Infection

View full text Add to dashboard Cite

show abstract

“…transfer, and ultimately infection [5]. Clearly there is a complex interplay between patient microbes, health care workers, and the environment, which serves as a mechanism for the storage and transmission of resistance genes.…”

Section: Discussionmentioning

confidence: 99%

Whence Resistance?

Guidry

Davies

Metzger

et al. 2015

Surgical Infections

View full text Add to dashboard Cite

Background: Antimicrobial resistance results from a complex interaction between pathogenic and non-pathogenic bacteria, antimicrobial pressure, and genes, which together comprise the total body of potential resistance elements. The purpose of this study is to review and evaluate the importance of antimicrobial pressure on the development of resistance in a single surgical intensive care unit. Methods: We reviewed a prospectively collected dataset of all intensive care unit (ICU)-acquired infections in surgical and trauma patients over a 6-y period at a single hospital. Resistant gram-negative pathogens (rGNR) included those resistant to all aminoglycosides, quinolones, penicillins, cephalosporins, or carbapenems; resistant gram-positive infections (rGPC) included methicillin-resistant Staphylococcus aureus (MRSA) or vancomycinresistant enterococci (VRE). Each resistant infection was evaluated for prior or concomitant antibiotic use, previous treatment for the same (non-resistant) organism, and concurrent infection with the same organism (genus and species, although not necessarily resistant) in another ICU patient. Results: Three hundred and thirty resistant infections were identified: 237 rGNR and 93 rGPC. Infections with rGNR occurred frequently while receiving antibiotic therapy (65%), including the sensitive form of the subsequent resistant pathogen (42.2%). Infections with rGPC were also likely to occur on antimicrobial therapy (50.6%). Treatment of a different patient for an infection with the same resistant pathogen in the ICU at the time of diagnosis, implying potential patient-to-patient transmission occurred more frequently with rGNR infections (38.8%). Conclusion: Antimicrobial pressure exerts a substantial effect on the development of subsequent infection. Our data demonstrate a high estimated rate of de novo emergence of resistance after treatment, which appears to be more common than patient-to-patient transmission. These data support the concept that efforts to limit antimicrobial usage will be more efficacious than enhanced isolation procedures when trying to reduce antimicrobial resistance.

show abstract

“…However, the application of the traditional patient-to-patient route of nosocomial infection transmission does not fully account for the observed cases [3]. Environmental reservoirs, particularly sinks, may play a major role in transmission [4][5][6]. It is therefore important to understand the risk factors associated with the spread of this infection and to develop an approach to prevent it.…”

Section: Introductionmentioning

confidence: 99%

Spatiotemporal Visualization and Modeling of Nosocomial Infections

Vilankar¹

View full text Add to dashboard Cite

The Centers for Disease Control and Prevention (CDC) estimates that more than two million people contract antibiotic-resistant infections every year, and at least 23,000 die as a result of these infections in the U.S. alone. Traditionally, tracking hospital outbreaks with drug-resistant pathogens focuses on transmission chains of infected or colonized patients as the reservoir for organisms to be transferred to new patients via healthcare workers, but it has become increasingly recognized that non-patient reservoirs within the hospital may play a larger role than previously realized in acting as a niche for the transmission of drug-resistant pathogens. Non-patient sources for pathogen acquisition may require incorporating environmental culture data into existing transmission models. However, the number of risk factors, potential interactions and inherent complexity of the data continue to increase, and thus, exploratory analysis is required to aid in knowledge discovery. Interactive visualization of these data over space and time enables exploration and hypothesis generation to better inform transmission models. This thesis presents an interactive visualization system for the analysis of spatiotemporal environmental and patient data to aid in understanding nosocomial infection. Interactive dashboards allow users to view patient movement through hospital environments while overlaying multivariate environmental microbiological data as it evolves over time. Furthermore, a multivariate logistic regression model is constructed to understand the factors associated with sink contamination. The results show that temporal factors, including the presence of infected patients in the past 14 days and use of interventions in the past 7 days, and spatial factors, including the presence of infected patients in adjacent rooms and the presence of contaminated sinks in adjacent rooms, are significant factors in sink contamination.ii Acknowledgements I would like to thank individuals and organizations that have assisted me throughout this research and my time at University of Virginia. Thank you Prof. Laura Barnes for giving me the opportunity to work on this thesis. I am grateful to her for her continuous support, insightful thoughts and patient guidance throughout this work. Her high expectations pushed me beyond limits known to me and were instrumental in successful completion of this work. Next I wish to thank my committee chair, Dr. Brown for his valuable statistical guidance and constructive comments. Most importantly he served as a role model and inspiration. I also want to thank Dr. Amy Mathers for her contribution of time, ideas and domain expertise throughout this study. I thank Dr. Hyojung Kang for always being there when I needed advice on my thesis and appreciate her thoughtful comments and feedback on literature review.I also want to thank following people for their helpful discussions and suggestions:

show abstract

Contaminated sinks in intensive care units: an underestimated source of extended-spectrum beta-lactamase-producing Enterobacteriaceae in the patient environment

Cited by 85 publications

References 16 publications

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

ESBL-producing Gram-negative organisms in the healthcare environment as a source of genetic material for resistance in human infections

Whence Resistance?

Spatiotemporal Visualization and Modeling of Nosocomial Infections

Contact Info

Product

Resources

About