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Wastewater drains: epidemiology and interventions in 23 carbapenem-resistant organism outbreaks

Published online by Cambridge University Press:  28 June 2018

Philip C. Carling
Philip C. Carling*
Affiliation:
Infectious Diseases Section, Steward Carney Hospital, Boston, Massachusetts Boston University School of Medicine, Boston, Massachusetts
*
Author for correspondence: Philip C. Carling, MD, Infectious Diseases Section, Steward Carney Hospital, 2100 Dorchester Avenue, Boston, MA 02124. E-mail: [email protected]
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Abstract

For many years, patient-area wastewater drains (ie, sink and shower drains) have been considered a potential source of bacterial pathogens that can be transmitted to patients. Recently, evolving genomic epidemiology tools combined with new insights into the ecology of wastewater drain (WWD) biofilm have provided new perspectives on the clinical relevance and hospital-associated infection (HAI) transmission risks related to these fixtures. To further clarify the clinical relevance of WWD-associated pathogen transmission, reports of outbreaks attributed to WWDs were selected for review that (1) investigated the outbreak epidemiology of WWD-associated transmission of bacterial pathogens, (2) utilized advanced microbiologic methods to establish clonality of outbreak pathogens and/or resistance genes, or (3) described interventions implemented to mitigate transmission of the outbreak pathogens from WWDs. These reports were collated, compared, and analyzed, and the results are presented here.

Type
Review
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 8 , August 2018 , pp. 972 - 979
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. 

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References

1. Decker, B, Palmore, TN. Hospital water and opportunities for infection prevention. Curr Infect Dis Rep Oct 2014;16:432.Google Scholar
2. Berrouane, YF, McNutt, LA, Buschelman, BJ, et al. Outbreak of severe Pseudomonas aeruginosa infections caused by a contaminated drain in a whirlpool bathtub. Clin Infect Dis 2000;31:1331–1337.Google Scholar
3. Yomoda, S, Okubo, T, Takahashi, A, Murakami, M, Lyobe, S. Presence of Pseudomonas putida strains harboring plasmids bearing the metallo-beta-lactmase gene bla(IMP) in a hospital in Japan. J Clin Microbiol 2003;Sep;41:4246–4251.Google Scholar
4. Hota, S, Hirji, Z, Stockton, K, et al. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol 2009;30:25–33.Google Scholar
5. La Forgia, C, Franke, J, Hacek, DM, Thompson, RB Jr, Robicsek, A, Peterson, LR. Management of a multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit using novel environmental disinfection: a 38-month report. Am J Infect Control 2010;38:259–263.Google Scholar
6. Snitkin, ES, Zelazny, AM, Thomas, PJ, et al. Tracking a hospital outbreak of carbapenem-resistant Klebsiella pneumonia with whole-genome sequencing. Sci Trans Med 2012;4:148.Google Scholar
7. Starlander, G, Melhus, A. Minor outbreak of extended-spectrum beta-lactamase–producing Klebsiella pneumonia in an intensive care unit due to a contaminated sink. J Hosp Infect 2012;82:122–124.Google Scholar
8. Lowe, C, Willey, B, O’Shaughnessy, A, et al. Outbreak of extended-spectrum beta-lactamase–producing Klebsiella oxytoca infections associated with contaminated handwashing sinks. Emerg Infect Dis 2012;18:1242–1247.Google Scholar
9. Leung, G, Gray, TJ, YL Cheong, E, Haertsch, P, Gottlieb, T. Persistence of related bla-IMP-4 metallo-beta-lactamase–producing Enterobacteriaceae from clinical and environmental specimens within a burns unit in Australia—a six-year retrospective study. Antimicrob Resist Infect Control 2013;2:1–8.Google Scholar
10. Vergara-Lopez, S, Dominguez, MC, Conejo, MC, Pascual, A, Rodriguez-Bano, J. Wastewater drainage system as an occult reservoir in a protracted clonal outbreak due to metallo-B-lactamase–producing Klebsiella oxytoca . Clin Microbiol Infect 2013;19:E490–E498.Google Scholar
11. Breathnach, AS, Cubbon, MD, Karunaharan, RN, Pope, CF. Multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals: association with contaminated hospital wastewater systems. J Hosp Infect 2012;82:19–24.Google Scholar
12. Tofteland, S, Naseer, U, Lislevand, JH, Sundsfjord, A, Samuelsen, O. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumonia involving intergenus plasmid diffusion and a persisting environmental reservoir. Plos One 2013;8:1–8.Google Scholar
13. Kotsanas, D, Cheong, WRPLI, Korman, TM, et al. “Down the drain”: carbapenem-resistant bacteria in intensive care unit patient’s and hand washing sinks. Med J Austral 2013;198:267–269.Google Scholar
14. Wolf, I, Bergervoet, PWM, Sebens, FW, van den Oever, HLA, Savelkoul, PHM, van der Zwet, WC. The sink as a correctable source of extended-spectrum beta-lactamase contamination for patients in the intensive care unit. J Hosp Infect 2014;87:126–130.Google Scholar
15. Wendel, AF, Kolbe-Busch, S, Ressina, S, Schulze-Robbecke, R, Kindgen-Milles, D. Detection and termination of an extended low-frequency hospital outbreak of GIM-1–producing Pseudomonas aeruginosa ST111 in Germany. Am J Infect Control 2015;43:635–639.Google Scholar
16. Leitner, E, Zarfel, G, Luxner, J, et al. Contaminated handwashing sinks as the source of a clonal outbreak of KPC-2–producing Klebsiella oxytoca on a hematology ward. Antimicrob Agent Chemo 2015;59:714–716.Google Scholar
17. Davis, RJ, Jensen, SO, Van Hal, S, et al. Whole-genome sequencing in real-time investigation and management of a Pseudomonas aeruginosa outbreak on a neonatal intensive care unit. Infect Control Hosp Epidemiol 2015;36:1058–1064.Google Scholar
18. Chapuis, A, Amoureux, L, Bador, J, et al. Outbreak of extended-spectrum beta-lactamase–producing Enterobacter cloacae with high MIC’s of quaternary ammonium compounds in a hematology ward associated with contaminated sinks. Front Microbiol 2016;7:1070.Google Scholar
19. Stjarne Aspelund, A, Sjostrom, K, Liljequist, BO, Morgelin, M, Melander, E, Pahlman, LI. Acetic acid as a decontamination method for sink drains in a nosocomial outbreak of metallo-beta-lactamase–producing. Pseudomonas aeruginosa. J Hosp Infect 2016;94:13–20.Google Scholar
20. Bousquet, A, Mee-Marquet, N, Dubost, C, et al. Outbreak of CTX-M-15–producing Enterobacter cloacae associated with therapeutic beds and syphons in an intensive care unit. Am J Infect Control 2017;45:1160–1164.Google Scholar
21. Amoureux, L, Riedweg, K, Chapuis, A, et al. Nosocomial infections with IMP-19–producing Pseudomonas aeruginosa linked to contaminated sinks, France. Emerg Infect Dis 2017;23:304–307.Google Scholar
22. Mahida, N, Clarke, M, White, G, Vaughan, N, Bowell, T. Outbreak of Enterobacter cloacae with New Delhi metallo-beta-lactamase (NDM)-1: challenges in epidemiological investigation and environmental decontamination. J Hosp Infect 2017;97:64–65.Google Scholar
23. DeGeyter, D, Blommaert, L, Verbraeken, N, et al. The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit. Antimicrob Resist Infect Control 2017;6:1–6.Google Scholar
24. Gbaguidi-Haore, H, Varin, A, Cholley, P, Thouverez, M, Hocquet, D, Bertrand, X. A bundle of measures to control an outbreak of Pseudomonas aeruginosa associated with P-trap contamination. Infect Control Hosp Epidemiol 2018;39:164–169.Google Scholar
25. Kac, G, Podglajen, I, Vaupre, S, Colardelle, N, Buu-Hof, A, Gutmann, L. Molecular epidemiology of extended-spectrum beta-lactamase–producing Enterobacteriaceae isolated from environmental and clinical specimens in a cardiac surgery intensive care unit. Infect Control Hosp Epidemiol 2004;25:852–855.Google Scholar
26. Tokatlidou, D, Tsivitanidou, M, Pournaras, S, Ikonomidis, A. Outbreak caused by a multidrug-resistant Klebsiella pneumonia clone carrying blaVIM-12 in a university hospital. J Clin Microbiol 2008;46:1005–1008.Google Scholar
27. Suarez, C, Peria, C, Arch, O, Dominguez, MA, Tubau, F, Juan, C, Gavalda, L, Sora, M. A large sustained endemic outbreak of multiresistant Pseudomonas aeruginosa: a new epidemiological scenario for nosocomial acquisition. BMC Infect Dis 2011;11:272.Google Scholar
28. Betteridge, T, Merlino, J, Natoli, J, Cheong, EY, Gottlieb, T, Stokes, HW. Plasmids and bacterial strains mediating multidrug-resistant hospital-acquired infections are coresidents of the hospital environment. Microb Drug Resist 2013;19:104–109.Google Scholar
29. Seara, N, Oteo, J, Carillo, R, et al. Interhospital spread of NDM-7-producing Klebsiella pneumonia belonging to ST437 in Spain. Int J Antimicrob Agents 2015;46:169–173.Google Scholar
30. Kossow, A, Kampmeier, S, Willems, S, et al. Control of multidrug-resistant Pseudomonas aeruginosa in allogeneic hematopoietic stem cell transplant recipients by a novel bundle including remodeling of sanitary and water supply systems. Clin Inf Dis 2017;65:935–942.Google Scholar
31. Varin, A, Valot, B, Cholley, P, Morel, C, Thouverez, M, Hocquet, D, Bertrand, X. High prevalence and moderate diversity of Pseudomonas aeruginosa in the U-bends of high-risk units in hospital. Int J Hyg Environ Health 2017;220:880–885.Google Scholar
32. Paopradit, P, Srinitiwarawong, K, Ingviya, N, Singkhamanan, K, Vuddhakul, V. Distribution and characterization of Stenotrophomonas maltophilia isolates from environmental and clinical samples in Thailand. J Hosp Infect 2017;97:185–191.Google Scholar
33. Jencson, AL, Cadnum, JL, Piedrahita, C, Donskey, CJ. Hospital sinks are a potential nosocomial source of Candida infections. Clinical Infect Dis 2017;65:1954–1955.Google Scholar
34. Khariman, CA, Weingarten, RA, Conlan, S, et al. Horizontal transfer of carbapenemase-encoding plasmids and comparison with hospital epidemiology data. Antimicrob Agents Chemother 2016;60:4910–4919.Google Scholar
35. Kotay, S, Chai, W, Guilford, W, Barry, K, Mathers, AJ. Spread from the sink to the patient: in situ study using green fluorescent protein (GFP)-expressing Escherichia coli to model bacterial dispersion from hand-washing sink-trap reservoirs. Appl Environ Microbiol 2017;83:e03327–16.Google Scholar
36. Grabowski, ME, Kang, H, Wells, KM, Sifri, CD, Mathers, AJ, Lobo, JM. Provider role in transmission of carbapenem-resistant Enterobacteriaceae . Infect Control Hosp Epidemiol 2017;38:1329–1334.Google Scholar
37. Roux, D, Aubier, B, Cochard, H, Quentin, R, van der Mee-Marquet, N. Contaminated sinks in intensive care units: an underestimated source of extended-spectrum beta-lactamase–producing Enterobacteriaceae in the patient environment. J Hosp Infect 2013;85:106–111.Google Scholar
38. Chen, LF, Anderson, DJ, Paterson, DL. Overview of the epidemiology and the threat of Klebsiella pneumonia carbapenemase (KPC) resistance. Infect Drug Resist 2012;5:133–141.Google Scholar
39. Moquet, O, Bouchiat, C, Kinana, A, et al. Class D OXA-48 carbapenemase in multidrug-resistant Enterobacteria, Senegal. Emerg Infect Dis 2011;17:143–144.Google Scholar
40. Khan, AS, Dancer, SJ, Humphreys, H. Priorities in the prevention and control of multidrug-resistant Enterobacteriaceae in hospitals. J Hosp Infect 2012;82:85–93.Google Scholar
41. Palmore, TN, Henderson, DK. Intensifying the focus of the contribution of the inanimate environment to healthcare-associated infections. Ann Intern Med Oct 20 2015;163:642–643.Google Scholar
42. Bloomfield, S, Exner, M, Flemming, HC, Goroncy-Bermes, P, Rutala, W. Less-known or hidden reservoirs of infection and implications for adequate prevention strategies: where to look and what to look for. GMS Hyg Infect Control 2015;10:Doc04.Google Scholar
43. Kanamori, H, Weber, DJ, Rutala, WA. Healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis 2016;62:1423–1435.Google Scholar
44. Kizny Gordon, AE, Mathers, AJ, Cheong, EYL, Gottlieb, T, Kotay, S, Walker, AS. The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections—a systematic review of the literature. Clin Infect Dis 2017;64:1435–1444.Google Scholar
45. Wendel, AF, Ressina, S, Kolbe-Busch, S, Pfeffer, K, MacKenzie, CR. Species diversity of environmental GIM-1–producing bacteria collected during a long-term outbreak. Appl Environ Microbiol 2016;82:3605–3610.Google Scholar
46. Michalikova, L, Brnova, J, Hnilicova, S, Streharova, A, Liskova, A, Krcmery, V. Transferable resistance in gram-negative bacteria isolated from hospital environment in Slovakia. Antimicrob Resist Infect Control 2017;6(Suppl 3):P65.Google Scholar
47. Stoesser, N, Sheppard, A, Eyre, D, Dudley, S, Sebra, R, Peto, T. Prevalence and genetic diversity of bla KPC-isolates identified in sink drains and P-traps in an intensive care unit. Abstracts of the European Congress of Clinical Microbiology and Infectious Diseases. Vienna, Austria; April 22, 2017.Google Scholar
48. Strich, JR, Palmore, TN. Preventing transmission of multidrug-resistant pathogens in the intensive care unit. Infect Dis Clin N Am 2017;31:535–550.Google Scholar
49. Friedman, DN, Carmeli, Y, Walton, AL, Schwaber, MJ. Carbapenem-resistant Enterobacteracae. A strategic roadmap for infection control. Infect Control Hosp Epidemiol 2017;38:580–594.Google Scholar
50. Munier, AL, Biard, L, Rousseau, C, Legrand, M, Lafaurie, M, Lomomt, A. Incidence, risk factors, and outcome of multidrug-resistant Acinetobacter baumannii acquisition during an outbreak in a burns unit. J Hosp Infect 2017;97:226–233.Google Scholar
51. Multidrug-resistant Enterobacteriacae carriage in highly exposed nursing homes: prevalence in western France. J Hosp Infect 2017;97:258–259.Google Scholar
52. Mansour, W, Haenni, M, Saras, E, et al. Outbreak of colistin-resistant carbapenemase-producing Klebsiella pneumonia in Tunisia. J Glob Antimicrob Resist 2017;10:88–94.Google Scholar
53. Guducuoglu, H, Gursoy, NC, Yakupogullari, Y, Pariak, M, Karasin, G. Hospital outbreak of a colistin-resistant, NDM-1– and OXA-48–producing Klebsiella pneumonia: high mortality from pandrug resistance. Microb Drug Resist 2017. doi: 10.1089/mdr.2017.0173.Google Scholar
54. Borgmann, S, Pfeifer, Y, Becker, L, Rieß, B, Siegmund, R, Sagel, U. Findings from an outbreak of carbapenem-resistant Klebsiella pneumonia emphasize the role of antibiotic treatment for cross transmission. Infection 2018;46:103–112.Google Scholar
55. Chaves, L, Tomich, LM, Salomao, M, et al. High mortality of bloodstream infection outbreak caused by carbapenem-resistant P. aeruginosa producing SPM-1 in a bone marrow transplant unit. J Med Microbiol 2017;66:1722–1729.Google Scholar
56. Robustillo-Rodela, A, Perez-Blanco, V, Ruiz, E, Ruiz Carrascoso, G. Successful control of 2 simultaneous outbreaks of OXA-48 carbapenemase-producing Enterobacteriaceae and multidrug-resistant Acinetobacter baumannii in an intensive care unit. Am J Infect Control 2017;45:1356–1362.Google Scholar