Aquatic reservoir-associated outbreaks of multidrug-resistant bacteria: a hospital outbreak report of Pseudomonas aeruginosa in perspective from the Dutch national surveillance databases.

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-06-16 DOI:10.1016/j.jhin.2025.05.024

S B Debast, M I van den Bos-Kromhout, S V de Vries-van Rossum, S E M Abma-Blatter, D W Notermans, J A J W Kluytmans, B Immeker, J K Zuur, M L Hijmering, A A Bergwerff, M J Bruins, Y J W M Bisselink, A P A Hendrickx, J W A Rossen

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引用次数: 0

Abstract

Background: Water fixtures can be involved in hospital outbreaks with multi-resistant pathogens.

Aim: To document an outbreak of a Verona integron-encoded metallo-β-lactamase type 2-producing carbapenem-resistant Pseudomonas aeruginosa (CRPA-VIM) and evaluate infection control measures. Additionally, to overview waterborne outbreaks involving multi-resistant pathogens in Dutch healthcare institutions.

Methods: Epidemiologic analysis, selective culturing, PCR, and whole genome sequencing (WGS) identified the outbreak sources. National surveillance databases were consulted.

Findings: In December 2023, three ICU patients tested positive for CRPA-VIM with multi-locus sequence type (MLST) ST111. Contaminated sinks were identified as the source. Despite interventions, a new cluster of five CRPA-VIM-positive patients emerged in March-April 2024. WGS linked this to a decommissioned sink (November 2021) and two patients (December 2021 and April 2023). Contact tracing and source investigations found no interpatient transmission; sinks were identified as the sole source. Measures, including contact precautions, intensified cleaning and hygiene procedures, retraining, installing and frequently replacing splash- and aerosol-reducing inlets, and faucet modifications failed to halt the transmission. No new cases occurred after the removal of all water fixtures in the ICU patient rooms. The outbreak strain was unique to the hospital and showed no genetic clustering in the national surveillance. Nationally, three to five waterborne outbreaks with highly resistant microorganisms in hospitals are reported annually.

Conclusions: CRPA-VIM was transmitted from sinks to ICU patients without interpatient transmission. Infection control requires comprehensive surveillance of patients and the environment. A water-restricted and drain-free environment ended the outbreak. Future hospital design should minimise contamination from drains and sinks to reduce the nosocomial infection risk.

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水生水库相关的多重耐药细菌暴发：来自荷兰国家监测数据库的铜绿假单胞菌医院暴发报告

背景：水装置可参与医院暴发与多重耐药病原体。目的：记录一种维罗纳整合子编码的金属β-内酰胺酶2型产生碳青霉烯耐药铜绿假单胞菌（CRPA-VIM）的爆发并评价感染控制措施。此外，概述荷兰卫生保健机构中涉及多重耐药病原体的水传播疫情。方法：流行病学分析、选择性培养、PCR和全基因组测序（WGS）确定暴发源。咨询了国家监测数据库。结果：2023年12月，3例ICU患者检测出多位点序列型（MLST） ST111的CRPA-VIM阳性。污染的水槽被确定为源头。尽管采取了干预措施，2024年3月至4月出现了5名crpa - vim阳性患者。WGS将其与一个退役的水槽（2021年11月）和两名患者（2021年12月和2023年4月）联系起来。接触者追踪和源头调查未发现患者间传播；水槽被确定为唯一的来源。包括接触预防措施、加强清洁和卫生程序、再培训、安装和经常更换减少飞溅和气溶胶的入口以及改装水龙头在内的措施未能阻止传播。拆除ICU病房所有水装置后，无新增病例发生。暴发菌株是该院独有的，在全国监测中未显示出遗传聚集性。在全国范围内，每年在医院报告三到五次高耐药性微生物的水传播疫情。结论：CRPA-VIM通过水槽传播至ICU患者，无患者间传播。感染控制需要对患者和环境进行全面监测。限水和无排水的环境结束了疫情。未来的医院设计应尽量减少下水道和水槽的污染，以降低医院感染的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.