Surveillance of surgical site infections by Pseudomonas aeruginosa and strain characterization in Tanzanian hospitals does not provide proof for a role of hospital water plumbing systems in transmission

Abstract

BackgroundThe role of hospital water systems in the development of Pseudomonas aeruginosa (P. aeruginosa) surgical site infections (SSIs) in low-income countries is barely studied. This study characterized P. aeruginosa isolates from patients and water in order to establish possible epidemiological links.MethodsBetween December 2014 and September 2015, rectal and wound swabs, and water samples were collected in the frame of active surveillance for SSIs in the two Tanzanian hospitals. Typing of P. aeruginosa was done by multi-locus sequence typing.ResultsOf 930 enrolled patients, 536 were followed up, of whom 78 (14.6%, 95% CI; 11.6–17.5) developed SSIs. P. aeruginosa was found in eight (14%) of 57 investigated wounds. Of the 43 water sampling points, 29 were positive for P. aeruginosa. However, epidemiological links to wound infections were not confirmed. The P. aeruginosa carriage rate on admission was 0.9% (8/930). Of the 363 patients re-screened upon discharge, four (1.1%) possibly acquired P. aeruginosa during hospitalization. Wound infections of the three of the eight P. aeruginosa SSIs were caused by a strain of the same sequence type (ST) as the one from intestinal carriage. Isolates from patients were more resistant to antibiotics than water isolates.ConclusionsThe P. aeruginosa SSI rate was low. There was no evidence for transmission from tap water. Not all P. aeruginosa SSI were proven to be endogenous, pointing to other routes of transmission.

Contamination of microbial pathogens and their antimicrobial pattern in operating theatres of peri-urban eastern Uganda: a cross-sectional study

“…Our findings are of great public health importance in view of fecal contamination and nosocomial infection transmission respectively. E. coli has been found to complicate wound sepsis resulting into poor patient prognosis [ 25 , 26 ].…”

Surgical Site Infection in a 1000-Bed Tertiary-Care Teaching Hospital in New Delhi, India

“…In other parts of the world such as Turkey (22.8%) and Brazil (15.3%), E. coli has been the most prevalent pathogen in SSI. Klebsiella pneumoniae as a gram-negative multidrugresistant organism prevalent in hospital settings was responsible for 12.5% of SSI in this study (24)(25)(26).…”

Water as a Source of Antimicrobial Resistance and Healthcare-Associated Infections

“…Specifically, three studies detected CRE, one from a plumbing fixture, one from a water sample and one sample site was unspecified [ 21 , 52 , 56 ]. MDR P. aeruginosa strains were also found in 12 studies, most commonly from potable water samples (7 studies), sinks (3 studies) and faucets (2 studies) [ 14 , 15 , 16 , 33 , 39 , 40 , 43 , 49 , 50 , 57 , 58 , 59 ]. Eight studies reported AMR Acinetobacter spp.…”

“…Of the studies investigating P. aeruginosa, four papers used membrane filtration methods followed by plating onto selective media such as R2A, cetrimide, and Columbia with horse blood, one of which referenced the ISO 16266:2008—detection and enumeration of P. aeruginosa specifically [ 38 , 39 , 43 , 48 ]. One paper alternatively inoculated malachite-green broth with the individual environmental water sample and subcultured onto cetrimide agar to isolate P. aeruginosa [ 40 ]. Bacterial species from biofilm and swab samples taken from water-related devices were isolated using a variety of methods including direct inoculation onto cetrimide, MacConkey, tegritol-7, or deoxycholate agar, and centrifugation to resuspend a pellet for inoculation onto selective agar, as shown in Table 1 [ 33 , 37 , 42 , 45 , 49 ].…”