Nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences

Noël, Audrey; Vastrade, Christelle; Dupont, Stefan A.; Barsy, Marie de; Huang, Te Din; Maerken, Tom Van; Leroux-Roels, Isabel; Delaere, Bénédicte; Melly, Ludovic; Rondelet, Benoît; Dransart, Christophe; Dincq, Anne-Sophie; Michaux, Isabelle; Bogaerts, Pierre; Glupczynski, Youri

doi:10.1016/j.jhin.2019.01.001

Cited by 14 publications

(10 citation statements)

References 20 publications

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“…Bacterial infection from such a source is a contributing factor to worsened maternal and perinatal health, increasing the rate of under-five mortality as bacterial infections are more and more shown to be an associated factor [13,14]. The presence of bacterial contaminations in Emergency services and Internal medicine departments that are frequently consulted by outpatients should be considered as an indicator of the high rate of nosocomial infections in the hospital, with a high potential of outbreaks [15]. The identified contaminants were Staphylococcus aureus, Pseudomonas aeruginosa, coagulase-negative Staphylococci, Bacillus sp, Klebsiella pneumonia, Enterobacter cloacae, Proteus vulgaris, and Escherichia coli which are commonly found in nosocomial infections across the world [16,17].…”

Section: Discussionmentioning

confidence: 99%

Types and Transmission Routes of Nosocomial Antibacterial Resistance

Bakadia¹,

Souho²,

Lamboni³

et al. 2021

IJMSHR

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To evaluate elements involved in nosocomial bacterial infections in Lubumbashi hospitals and determine the specific antimicrobial resistance types circulating in the region. Methodology:A cross-sectional study was performed in four different hospitals in Lubumbashi from March 2017 to October 2019. Hospital surfaces, medical equipment, and hospitalized patients' stools were screened. Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa isolates were identified and subjected to antibiotic sensitivity tests and screened for extended-spectrum beta-lactamase activity.Results: Most hospital surfaces and medical devices were contaminated (90.4 %), with a predominance of Staphylococcus aureus and Pseudomonas aeruginosa species. These bacteria exhibited various resistance rates, with high rates (≥ 50 %) registered towards penicillin, gentamicin, fosfomycin, fusidic acid, and ciprofloxacin. About 37.5 % of Pseudomonas aeruginosa isolates and 53 % of Staphylococcus aureus isolates showed extended-spectrum betalactamase activity. Escherichia coli isolates exhibited resistance to several antibiotics with the highest rate of resistance (91.5 %) against Trimethoprim/sulfamethoxazole and β-lactamase activity registered in 44.3 %. Conclusions:While asserting intestinal Escherichia coli as a reliable marker for the study of bacterial resistance. This study also found that surfaces and medical devices in Lubumbashi

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Section: Discussionmentioning

confidence: 99%

Types and Transmission Routes of Nosocomial Antibacterial Resistance

Bakadia¹,

Souho²,

Lamboni³

et al. 2021

IJMSHR

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“…It is striking that the epidemic returned with a different clone of ESBL-producing E. cloacae complex in January 2018. Of note, a highly similar TEE-associated outbreak of ESBL-producing E. cloacae complex in cardiac surgery patients occurred in 2015 and 2016 in another university hospital in Belgium [15]. With regard to the interval of 4 months between the first and second outbreak episode, which were caused by the same clone, possible explanations are reintroduction of the strain by a patient or untreated carrier or the presence of an environmental reservoir.…”

Section: Discussionmentioning

confidence: 99%

“…We have been cleaning and disinfecting the TEE probes manually using chlorine dioxide–generating wipes for several years, according to the manufacturer’s recommendations. The same manual reprocessing method was in use in the other Belgian university hospital that suffered from a TEE-associated outbreak of ESBL-producing E. cloacae complex in cardiac surgery patients [15]. Chlorine dioxide is a strong oxidizing agent with broad-spectrum antimicrobial activity.…”

Section: Discussionmentioning

confidence: 99%

A recurrent and transesophageal echocardiography–associated outbreak of extended-spectrum β-lactamase–producing Enterobacter cloacae complex in cardiac surgery patients

Maerken

Brabandere

Noël³

et al. 2019

Antimicrob Resist Infect Control

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Background We report a recurrent outbreak of postoperative infections with extended-spectrum β-lactamase (ESBL)–producing E. cloacae complex in cardiac surgery patients, describe the outbreak investigation and highlight the infection control measures. Methods Cases were defined as cardiac surgery patients in Ghent University Hospital who were not known preoperatively to carry ESBL-producing E. cloacae complex and who postoperatively had a positive culture for this multiresistant organism between May 2017 and January 2018. An epidemiological investigation, including a case-control study, and environmental investigation were conducted to identify the source of the outbreak. Clonal relatedness of ESBL-producing E. cloacae complex isolates collected from case patients was assessed using whole-genome sequencing–based studies. Results Three separate outbreak episodes occurred over the course of 9 months. A total of 8, 4 and 6 patients met the case definition, respectively. All but one patients developed a clinical infection with ESBL-producing E. cloacae complex, most typically postoperative pneumonia. Overall mortality was 22% (4/18). Environmental cultures were negative, but epidemiological investigation pointed to transesophageal echocardiography (TEE) as the outbreak source. Of note, four TEE probes showed a similar pattern of damage, which very likely impeded adequate disinfection. The first and second outbreak episode were caused by the same clone, whereas a different strain was responsible for the third episode. Conclusions Health professionals caring for cardiac surgery patients and infection control specialists should be aware of TEE as possible infection source. Caution must be exercised to prevent and detect damage of TEE probes.

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“…Two publications in 2019 implemented the TOE transducers in cross-contamination resulting in high mortality [41,42]. Noel et al reported on the outbreak of extended-spectrum B-lactamase (ESBL) producing Enterobacter cloacae among cardio-thoracic surgical patients [41]. Following TOE procedures during surgery, 41 patients became infected or colonized by the same clonal lineage of CTX-M-15 producing E. cloacae strain with a 40 % mortality rate.…”

Section: Outbreaks and Case Reports Of Potential Infection Transmissionmentioning

confidence: 99%

Endocavity Ultrasound Transducers: Why High-Level Disinfection Is Necessary

Westerway

Basseal

2020

Ultraschall Med

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As a medical imaging modality, ultrasound is used by a wide cross-section of practitioners including radiologists, obstetricians, gynecologists, gastroenterologists, urologists and cardiologists. The increasing popularity of ultrasound as a diagnostic tool is due not only to the ease of use and portability of systems, but also to the perceived safety aspect of the examination. This latter point needs to be examined. As with any reusable medical device, the ultrasound transducer, also known as a probe, could potentially be a vector for the transmission of pathogenic viruses and fungi between patients if not correctly disinfected after each use. This transmission risk is magnified for an endocavity transducer that has come in contact with the vagina, anal canal or oral cavity, as it could be contaminated with organisms transmitted by blood or mucosal, genital or rectal secretions. Based on the Spaulding system, transducers that come in contact with mucous membranes are classified as semi-critical devices that require high-level disinfection (HLD) after each patient procedure. This HLD process should eliminate all microorganisms except high numbers of bacterial endospores. Only a small number of countries worldwide have implemented transducer reprocessing guidelines that adhere to the Spaulding classification and recommend HLD for endocavity transducers. Overall, there is a lack of conformity among global health agencies regarding the use of HLD for endocavity transducers. This is primarily due to the perception that the infection transmission risk is negligible and that if an endocavity transducer has been covered with a single-use sheath for the procedure, then low-level disinfection provides sufficient protection against pathogen transmission. The objective of this study was to review the published risk of infection transmission from endocavity transducers. By highlighting the outbreaks and case reports that implicate pathogen transmission from transducers, we posit that HLD should be a global standard of practice for the reprocessing of endocavity transducers. It requires substantial time for national health administrations to develop and legislate new recommendations, and for practice changes to be accepted and implemented by healthcare providers. We recommend that Joint Commission International (JCI) and other equivalent organizations enforce the use of HLD of endocavity ultrasound transducers during their accreditation reviews.

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Nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences

Cited by 14 publications

References 20 publications

Types and Transmission Routes of Nosocomial Antibacterial Resistance

Types and Transmission Routes of Nosocomial Antibacterial Resistance

A recurrent and transesophageal echocardiography–associated outbreak of extended-spectrum β-lactamase–producing Enterobacter cloacae complex in cardiac surgery patients

Endocavity Ultrasound Transducers: Why High-Level Disinfection Is Necessary

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