Detection and termination of an extended low-frequency hospital outbreak of GIM-1–producing Pseudomonas aeruginosa ST111 in Germany

Wendel, Andreas; Kolbe-Busch, Susanne; Ressina, Sofija; Schulze-Röbbecke, Roland; Kindgen‐Milles, Detlef; Lorenz, Christian; Pfeffer, Klaus; MacKenzie, Colin R.

doi:10.1016/j.ajic.2015.02.024

Cited by 50 publications

(51 citation statements)

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“…11 The presence of moisture facilitates bacterial survival and an increasing number of outbreaks have been linked to hospital sinks and taps. [12][13][14] This study seeks to determine the extent and variation in ESBL-carrying Gram-negative species in different types of hospital ward environment and to demonstrate the potential pathogenic importance of environmental reservoirs of ESBL-producing bacteria in the transmission of Gram-negative infection in the healthcare setting.…”

Section: Introductionmentioning

confidence: 99%

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

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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.

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Section: Introductionmentioning

confidence: 99%

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

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“…Environmental sampling targeting wet locations was performed on the surgical intensive care unit (SICU) from February to April 2012 and in March 2013 as described previously (12), as well as on one medical ward (MW3) in July 2012 and May 2013. On the SICU a total of 45 sinks and two hair washbasins and on the MW3 a total number of 10 sinks were sampled.…”

Section: Methodsmentioning

confidence: 99%

“…On the SICU a total of 45 sinks and two hair washbasins and on the MW3 a total number of 10 sinks were sampled. Sampling was conducted using liquid medium swabs (eSwab; Copan Diagnostics, Italy), and samples were inoculated on selective blood agar medium (containing 5 mg/liter meropenem and 5 mg/liter vancomycin) and enrichment broth (brain heart infusion [BHI] with and without 32 mg/liter imipenem) as previously described (12).…”

Section: Methodsmentioning

confidence: 99%

“…Genotyping additionally revealed a clone of GIM-1-carrying P. aeruginosa involved in a long-term outbreak in an intensive care unit from 2002 to 2013. The outbreak was successfully contained with adequate infection control measures targeting the sinks as the environmental reservoir where the outbreak strain was detected (12). Since the persistence of the metallo-beta-lactamase GIM-1 in a location for over 10 years suggests the presence of an environmental source, we sought to describe the reservoir and gain insight into the mobile genetic elements of bla GIM-1 .…”

mentioning

confidence: 99%

“…Since the persistence of the metallo-beta-lactamase GIM-1 in a location for over 10 years suggests the presence of an environmental source, we sought to describe the reservoir and gain insight into the mobile genetic elements of bla GIM-1 . Environmental sampling was carried out on the intensive care unit on which the outbreak of P. aeruginosa was described (12) and in addition on a medical ward in which patients carrying different GIM-1-carrying bacteria (mainly clonally related Enterobacter cloacae but also K. oxytoca, P. aeruginosa, and Pseudomonas putida [11]) were treated. The present study focuses on the genetic context of the environmental GIM-1-producing bacteria.…”

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confidence: 99%

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Species Diversity of Environmental GIM-1-Producing Bacteria Collected during a Long-Term Outbreak

Wendel

Ressina

Kolbe-Busch

et al. 2016

Appl Environ Microbiol

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Reports of outbreaks concerning carbapenemase-producing Gram-negative bacteria in which the main source of transmission is the hospital environment are increasing. This study describes the results of environmental sampling in a protracted polyspecies metallo-beta-lactamase GIM-1 outbreak driven by plasmids and bacterial clones of Enterobacter cloacae and Pseudomonas aeruginosa in a tertiary care center. Environmental sampling targeting wet locations (especially sinks) was carried out on a surgical intensive care unit and on a medical ward on several occasions in 2012 and 2013. We were able to demonstrate 43 bla GIM-1 -carrying bacteria (mainly nonfermenters but also Enterobacteriaceae) that were either related or unrelated to clinical strains in 30 sinks and one hair washbasin. GIM-1 was found in 12 different species, some of which are described here as carriers of GIM-1. Forty out of 43 bacteria displayed resistance to carbapenems and, in addition, to various non-beta-lactam antibiotics. Colistin resistance was observed in two E. cloacae isolates with MICs above 256 mg/liter. The bla GIM-1 gene was harbored in 12 different class 1 integrons, some without the typical 3= end. The bla GIM-1 gene was localized on plasmids in five isolates. In vitro plasmid transfer by conjugation was successful in one isolate. The environment, with putatively multispecies biofilms, seems to be an important biological niche for multidrug-resistant bacteria and resistance genes. Biofilms may serve as a "melting pot" for horizontal gene transfer, for dissemination into new species, and as a reservoir to propagate future hospital outbreaks. IMPORTANCEIn Gram-negative bacteria, resistance to the clinically relevant broad-spectrum carbapenem antibiotics is a major public health concern. Major reservoirs for these resistant organisms are not only the gastrointestinal tracts of animals and humans but also the (hospital) environment. Due to the difficulty in eradicating biofilm formation in the latter, a sustained dissemination of multidrug-resistant bacteria from the environment can occur. In addition, horizontal transfer of resistance genes on mobile genetic elements within biofilms adds to the total "resistance gene pool" in the environment. To gain insight into the transmission pathways of a rare and locally restricted carbapenemases resistance gene (bla GIM-1 ), we analyzed the genetic background of the bla GIM-1 gene in environmental bacteria during a long-term polyspecies outbreak in a German hospital.

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Die Umwelt als Reservoir für Antibiotikaresistenzen

Westphal-Settele

Konradi

Balzer

et al. 2018

Bundesgesundheitsbl

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Antimicrobial resistance (AMR) is a threat to public and animal health on the global scale. The origin of the genes associated with resistance has long been unknown. Recently, there is a growing body of evidence demonstrating that environmental bacteria are resistant to a multitude of antibiotic substances and that this environmental reservoir of AMR is still growing. The analysis of the genomes of bacterial pathogens indicates that they have acquired their resistance profiles by incorporating different genetic elements through horizontal gene transfer. The ancestors of pathogenic bacteria, as well as the origin of resistance determinants, lay most likely in the environmental microbiota. Indeed, there is some evidence that at least some clinically relevant resistance genes have originated in environmental bacterial species. Thus, feasible measures are required to reduce the risks posed by AMR genes and resistant bacteria that occur in the environment. It has been shown that a concurrence of factors, such as high concentrations of antibiotics or heavy metals used as biocides and high bacterial densities, promote development and spread of antimicrobial resistance. For this purpose, it is essential to restrict the use of antibiotics for the treatment of livestock and humans to medical necessity, as well as to reduce the application of biocides and heavy metals in animal husbandry. Moreover, it is important to further develop sanitary measures at the interface between the environment and clinical settings or livestock farming.

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Detection and termination of an extended low-frequency hospital outbreak of GIM-1–producing Pseudomonas aeruginosa ST111 in Germany

Cited by 50 publications

References 31 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

Species Diversity of Environmental GIM-1-Producing Bacteria Collected during a Long-Term Outbreak

Die Umwelt als Reservoir für Antibiotikaresistenzen

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