Toilet drain water as a potential source of hospital room-to-room transmission of carbapenemase-producing Klebsiella pneumoniae.
Bathroom Equipment
/ microbiology
Belgium
Cross Infection
/ etiology
Disease Outbreaks
Disease Reservoirs
/ microbiology
Drainage, Sanitary
Hospitals
Humans
Klebsiella Infections
/ microbiology
Klebsiella pneumoniae
/ classification
Phylogeny
Water Microbiology
Whole Genome Sequencing
beta-Lactamases
/ genetics
Carbapenemase-producing Enterobacterales
Drain water
Klebsiella pneumoniae
OXA-48
Outbreak
Whole-genome sequencing
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
Oct 2020
Oct 2020
Historique:
received:
16
05
2020
accepted:
15
07
2020
pubmed:
25
7
2020
medline:
16
6
2021
entrez:
25
7
2020
Statut:
ppublish
Résumé
Carbapenemase-producing Enterobacterales (CPE) have rapidly emerged in Europe, being responsible for nosocomial outbreaks. Following an outbreak in the burn unit of Ghent University Hospital, we investigated whether CPE can spread between toilets through drain water and therefrom be transmitted to patients. In 2017, the burn centre of our hospital experienced an outbreak of OXA-48-producing Klebsiella pneumoniae that affected five patients staying in three different rooms. Environmental samples were collected from the sink, shower, shower stretcher, hand rail of the bed, nursing carts, toilets, and drain water to explore a common source. Whole-genome sequencing and phylogenetic analysis was performed on K. pneumoniae outbreak isolates and two random K. pneumoniae isolates. OXA-48-producing K. pneumoniae was detected in toilet water in four out of six rooms and drain water between two rooms. The strain persisted in two out of six rooms after two months of daily disinfection with bleach. All outbreak isolates belonged to sequence type (ST) 15 and showed isogenicity (<15 allele differences). This suggests that the strain may have spread between rooms by drain water. Unexpectedly, one random isolate obtained from a patient who became colonized while residing at the geriatric ward clustered with the outbreak isolates, suggesting the outbreak to be larger than expected. Daily application of bleach tended to be superior to acetic acid to disinfect toilet water; however, disinfection did not completely prevent the presence of carbapenemase-producing K. pneumoniae in toilet water. Toilet drain water may be a potential source of hospital room-to-room transmission of carbapenemase-producing K. pneumoniae.
Sections du résumé
BACKGROUND
BACKGROUND
Carbapenemase-producing Enterobacterales (CPE) have rapidly emerged in Europe, being responsible for nosocomial outbreaks.
AIM
OBJECTIVE
Following an outbreak in the burn unit of Ghent University Hospital, we investigated whether CPE can spread between toilets through drain water and therefrom be transmitted to patients.
METHODS
METHODS
In 2017, the burn centre of our hospital experienced an outbreak of OXA-48-producing Klebsiella pneumoniae that affected five patients staying in three different rooms. Environmental samples were collected from the sink, shower, shower stretcher, hand rail of the bed, nursing carts, toilets, and drain water to explore a common source. Whole-genome sequencing and phylogenetic analysis was performed on K. pneumoniae outbreak isolates and two random K. pneumoniae isolates.
FINDINGS
RESULTS
OXA-48-producing K. pneumoniae was detected in toilet water in four out of six rooms and drain water between two rooms. The strain persisted in two out of six rooms after two months of daily disinfection with bleach. All outbreak isolates belonged to sequence type (ST) 15 and showed isogenicity (<15 allele differences). This suggests that the strain may have spread between rooms by drain water. Unexpectedly, one random isolate obtained from a patient who became colonized while residing at the geriatric ward clustered with the outbreak isolates, suggesting the outbreak to be larger than expected. Daily application of bleach tended to be superior to acetic acid to disinfect toilet water; however, disinfection did not completely prevent the presence of carbapenemase-producing K. pneumoniae in toilet water.
CONCLUSION
CONCLUSIONS
Toilet drain water may be a potential source of hospital room-to-room transmission of carbapenemase-producing K. pneumoniae.
Identifiants
pubmed: 32707194
pii: S0195-6701(20)30348-0
doi: 10.1016/j.jhin.2020.07.017
pii:
doi:
Substances chimiques
beta-Lactamases
EC 3.5.2.6
oxacillinase
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
232-239Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.