Successful control of an environmental reservoir of NDM-producing Klebsiella pneumoniae associated with nosocomial transmissions in a low-incidence setting.
Details
Serval ID
serval:BIB_C2B619CBDCD1
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Successful control of an environmental reservoir of NDM-producing Klebsiella pneumoniae associated with nosocomial transmissions in a low-incidence setting.
Journal
Antimicrobial resistance and infection control
ISSN
2047-2994 (Electronic)
ISSN-L
2047-2994
Publication state
Published
Issued date
29/10/2024
Peer-reviewed
Oui
Volume
13
Number
1
Pages
130
Language
english
Notes
Publication types: Journal Article
Publication Status: epublish
Publication Status: epublish
Abstract
The hospital wastewater system has been reported as a source of nosocomial acquisition of carbapenemase producing Enterobacteriaceae (CPE) in various settings. Cleaning and disinfection protocols or replacement of contaminated equipment often fail to eradicate these environmental reservoirs, which can lead to long-term transmission of CPE. We report a successful multimodal approach to control a New Delhi metallo-beta-lactamase positive Klebsiella pneumoniae (NDM-KP) nosocomial outbreak implicating contamination of sink traps in a low-incidence setting.
Following the incidental identification of NDM-KP in a urine culture of an inpatient, we performed an epidemiological investigation, including patient and environmental CPE screening, and whole genome sequencing (WGS) of strains. We also implemented multimodal infection prevention and control (IPC) measures, namely the isolation of cases, waterless patient care, replacement of contaminated P-traps and connecting pieces, and bleach and steam disinfection of sinks for 6 months, followed by patient and environmental screenings for eradication.
Between February and May 2022, five NDM-KP cases were identified in an eight-bed neurosurgical intermediate care unit. Among the eight sink traps of the unit, three were positive for NDM-KP. Patient and environmental isolates belonged to multilocus sequence typing ST-268. All isolate genomes were genetically very similar suggesting cross-transmission and a potential role of the environment as the source of transmissions. Following the introduction of combined IPC measures, no new case was subsequently detected and sink traps remained negative for NDM-KP within 6 months after the intervention.
The implementation of multimodal IPC measures, including waterless patient care combined with the replacement and disinfection of P-traps and connecting pieces, was successful in the control of NDM-KP after eight months. In a low-incidence setting, this approach has made it possible to pursue the objective of zero transmission of carbapenemase-producing Enterobacteriaceae (CPE).
Following the incidental identification of NDM-KP in a urine culture of an inpatient, we performed an epidemiological investigation, including patient and environmental CPE screening, and whole genome sequencing (WGS) of strains. We also implemented multimodal infection prevention and control (IPC) measures, namely the isolation of cases, waterless patient care, replacement of contaminated P-traps and connecting pieces, and bleach and steam disinfection of sinks for 6 months, followed by patient and environmental screenings for eradication.
Between February and May 2022, five NDM-KP cases were identified in an eight-bed neurosurgical intermediate care unit. Among the eight sink traps of the unit, three were positive for NDM-KP. Patient and environmental isolates belonged to multilocus sequence typing ST-268. All isolate genomes were genetically very similar suggesting cross-transmission and a potential role of the environment as the source of transmissions. Following the introduction of combined IPC measures, no new case was subsequently detected and sink traps remained negative for NDM-KP within 6 months after the intervention.
The implementation of multimodal IPC measures, including waterless patient care combined with the replacement and disinfection of P-traps and connecting pieces, was successful in the control of NDM-KP after eight months. In a low-incidence setting, this approach has made it possible to pursue the objective of zero transmission of carbapenemase-producing Enterobacteriaceae (CPE).
Keywords
Humans, Klebsiella pneumoniae/genetics, Cross Infection/prevention & control, Cross Infection/microbiology, beta-Lactamases/genetics, beta-Lactamases/metabolism, Klebsiella Infections/transmission, Klebsiella Infections/prevention & control, Klebsiella Infections/epidemiology, Klebsiella Infections/microbiology, Whole Genome Sequencing, Incidence, Infection Control/methods, Disease Outbreaks, Carbapenem-Resistant Enterobacteriaceae/genetics, Carbapenem-Resistant Enterobacteriaceae/isolation & purification, Male, Disinfection/methods, Female, Middle Aged, Bacterial Proteins/genetics, Bacterial Proteins/metabolism, Wastewater/microbiology, Carbapenemase, NDM, Nosocomial outbreak, Sink traps, Wastewater drains reservoir, Whole genome sequencing
Pubmed
Web of science
Open Access
Yes
Create date
01/11/2024 15:21
Last modification date
20/12/2024 7:19