Droplets generated from toilets during urination as a possible vehicle of carbapenem-resistant Klebsiella pneumoniae.
Aerosol Propellants
/ administration & dosage
Anions
/ administration & dosage
Bathroom Equipment
/ microbiology
Betaine
/ administration & dosage
Carbapenems
/ pharmacology
Carbonates
/ administration & dosage
Deodorants
Drug Resistance, Bacterial
Drug Resistance, Multiple
Esters
/ administration & dosage
Fatty Acids
/ administration & dosage
Fatty Alcohols
/ administration & dosage
Humans
Hydrogen-Ion Concentration
Klebsiella Infections
/ microbiology
Klebsiella pneumoniae
/ drug effects
Lipotropic Agents
/ administration & dosage
Surface-Active Agents
/ administration & dosage
Urination
Urine
/ microbiology
Foam
KPC-type carbapenemase
Multidrug-resistant bacteria
Prevention
Toilet
Journal
Antimicrobial resistance and infection control
ISSN: 2047-2994
Titre abrégé: Antimicrob Resist Infect Control
Pays: England
ID NLM: 101585411
Informations de publication
Date de publication:
20 10 2021
20 10 2021
Historique:
received:
14
07
2021
accepted:
08
10
2021
entrez:
21
10
2021
pubmed:
22
10
2021
medline:
1
3
2022
Statut:
epublish
Résumé
In the health care setting, infection control actions are fundamental for containing the dissemination of multidrug-resistant bacteria (MDR). Carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (CR-KP), can spread among patients, although the dynamics of transmission are not fully known. Since CR-KP is present in wastewater and microorganisms are not completely removed from the toilet bowl by flushing, the risk of transmission in settings where toilets are shared should be addressed. We investigated whether urinating generates droplets that can be a vehicle for bacteria and explored the use of an innovative foam to control and eliminate this phenomenon. To study droplet formation during urination, we set up an experiment in which different geometrical configurations of toilets could be reproduced and customized. To demonstrate that droplets can mobilize bacteria from the toilet bowl, a standard ceramic toilet was contaminated with a KPC-producing Klebsiella pneumoniae ST101 isolate. Then, we reproduced urination and attached culture dishes to the bottom of the toilet lid for bacterial colony recovery with and without foam. Rebound droplets invariably formed, irrespective of the geometrical configuration of the toilet. In microbiological experiments, we demonstrated that bacteria are always mobilized from the toilet bowl (mean value: 0.11 ± 0.05 CFU/cm Our study demonstrated that droplets generated from toilets during urination can be a hidden source of CR-KP transmission in settings where toilets are shared among colonized and noncolonized patients.
Sections du résumé
BACKGROUND
In the health care setting, infection control actions are fundamental for containing the dissemination of multidrug-resistant bacteria (MDR). Carbapenemase-producing Enterobacterales (CPE), especially Klebsiella pneumoniae (CR-KP), can spread among patients, although the dynamics of transmission are not fully known. Since CR-KP is present in wastewater and microorganisms are not completely removed from the toilet bowl by flushing, the risk of transmission in settings where toilets are shared should be addressed. We investigated whether urinating generates droplets that can be a vehicle for bacteria and explored the use of an innovative foam to control and eliminate this phenomenon.
METHODS
To study droplet formation during urination, we set up an experiment in which different geometrical configurations of toilets could be reproduced and customized. To demonstrate that droplets can mobilize bacteria from the toilet bowl, a standard ceramic toilet was contaminated with a KPC-producing Klebsiella pneumoniae ST101 isolate. Then, we reproduced urination and attached culture dishes to the bottom of the toilet lid for bacterial colony recovery with and without foam.
RESULTS
Rebound droplets invariably formed, irrespective of the geometrical configuration of the toilet. In microbiological experiments, we demonstrated that bacteria are always mobilized from the toilet bowl (mean value: 0.11 ± 0.05 CFU/cm
CONCLUSIONS
Our study demonstrated that droplets generated from toilets during urination can be a hidden source of CR-KP transmission in settings where toilets are shared among colonized and noncolonized patients.
Identifiants
pubmed: 34670621
doi: 10.1186/s13756-021-01023-5
pii: 10.1186/s13756-021-01023-5
pmc: PMC8527778
doi:
Substances chimiques
Aerosol Propellants
0
Anions
0
Carbapenems
0
Carbonates
0
Deodorants
0
Esters
0
Fatty Acids
0
Fatty Alcohols
0
Lipotropic Agents
0
Surface-Active Agents
0
Betaine
3SCV180C9W
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
149Informations de copyright
© 2021. The Author(s).
Références
J Appl Microbiol. 2000 Jul;89(1):137-44
pubmed: 10945790
Water Air Soil Pollut. 2018;229(8):255
pubmed: 30237637
Clin Infect Dis. 2017 May 15;64(10):1435-1444
pubmed: 28200000
Diagn Microbiol Infect Dis. 2019 Jan;93(1):74-76
pubmed: 30126624
Infect Control Hosp Epidemiol. 2016 Oct;37(10):1219-25
pubmed: 27452597
Appl Microbiol. 1975 Aug;30(2):229-37
pubmed: 169732
J Hosp Infect. 2021 May;111:155-161
pubmed: 33581244
Clin Infect Dis. 2017 Jul 15;65(2):208-215
pubmed: 28369261
Am Fam Physician. 2014 Jun 15;89(12):938-41
pubmed: 25162160
Lancet. 1959 Jun 6;1(7084):1196-200
pubmed: 13666015
Proc Natl Acad Sci U S A. 2014 Aug 19;111(33):11932-7
pubmed: 24969420
Infect Control Hosp Epidemiol. 2017 Nov;38(11):1329-1334
pubmed: 29061201
Phys Fluids (1994). 2020 Jun 1;32(6):065107
pubmed: 32574232
Clin Microbiol Infect. 2015 May;21(5):470.e1-7
pubmed: 25684452
Am J Infect Control. 2014 Jul;42(7):758-62
pubmed: 24818773
Open Forum Infect Dis. 2018 Oct 03;5(10):ofy224
pubmed: 30302351
J Appl Microbiol. 2005;99(2):339-47
pubmed: 16033465
Clin Microbiol Rev. 2020 May 13;33(3):
pubmed: 32404435
Euro Surveill. 2021 May;26(21):
pubmed: 34047273
Microb Genom. 2018 Sep;4(9):
pubmed: 29985125
J Comput Biol. 2012 May;19(5):455-77
pubmed: 22506599
Appl Environ Microbiol. 2020 Nov 24;86(24):
pubmed: 32917755
Clin Microbiol Infect. 2015 Jan;21(1):30-4
pubmed: 25636924
Lancet Infect Dis. 2019 Jan;19(1):56-66
pubmed: 30409683
Am J Infect Control. 2013 Mar;41(3):254-8
pubmed: 23040490
Virulence. 2013 Feb 15;4(2):107-18
pubmed: 23302790