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Seeking the source of Pseudomonas aeruginosa infections in a recently opened hospital: an observational study using whole-genome sequencing.

Quick J, Cumley N, Wearn CM, Niebel M, Constantinidou C, Thomas CM, Pallen MJ, Moiemen NS, Bamford A, Oppenheim B, Loman NJ - BMJ Open (2014)

Bottom Line: Screening patients who subsequently developed a positive P. aeruginosa microbiology result were subject to enhanced environmental surveillance.Isolates from three patients had identical genotypes compared with water isolates from the same room.This study reveals that WGS can be used for source tracking of P. aeruginosa in a hospital setting, and that acquisitions can be traced to a specific source within a hospital ward.

View Article: PubMed Central - PubMed

Affiliation: Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK.

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Related in: MedlinePlus

The high-resolution phylogenetic reconstruction of Clade E isolates. This demonstrates the clustering of genotypes by bed space. Patient associated samples are contained within a room 11 clade. This clade contains water samples from the shower and environmental samples from the shower, drain and trolley. The water samples from the room 11 tap are in a distinct clade, indicating the biofilm within the tap has a distinct genotype to the shower. This suggests environmental contamination was more likely to arise from contaminated shower water than tap water. Details of sampling site, days since start of study and presence of pBURNS plasmids are also shown. The likely phylogenetic position of Pseudomonas aeruginosa detected in a biofilm from a thermostatic mixer valve is shown in the clade associated with room 9 and indicated ‘TMV’.
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BMJOPEN2014006278F3: The high-resolution phylogenetic reconstruction of Clade E isolates. This demonstrates the clustering of genotypes by bed space. Patient associated samples are contained within a room 11 clade. This clade contains water samples from the shower and environmental samples from the shower, drain and trolley. The water samples from the room 11 tap are in a distinct clade, indicating the biofilm within the tap has a distinct genotype to the shower. This suggests environmental contamination was more likely to arise from contaminated shower water than tap water. Details of sampling site, days since start of study and presence of pBURNS plasmids are also shown. The likely phylogenetic position of Pseudomonas aeruginosa detected in a biofilm from a thermostatic mixer valve is shown in the clade associated with room 9 and indicated ‘TMV’.

Mentions: WGS has been reported previously for source tracking, but never for the detection of transmission events from hospital water.40 Phylogenetic reconstruction within Clade E, the most commonly detected water clone demonstrated additional diversity within this clone, with a total of 46 mutations detected an average genetic distance between isolates of 4.1 mutations (figure 3). The reconstruction demonstrated clear evidence of clustering of genotypes both by room and outlet (figure 3). When P. aeruginosa was detected in the wet environment (eg, shower rosettes and drains) these genotypes were most often identical to those found in water, indicating that the water was likely the ultimate source of that clone. Genotypic variation was seen between outlets within the same room. For example, tap water sampled from room 11 had a distinct genotype from that sampled from shower water in the same room and this was consistently found over multiple samplings. Notably, isolates from two patients fell within the cluster originating from shower water, indicating that shower hydrotherapy was the most likely source of infection. Two plasmids (designated pBURNS1 and pBURNS2) were detected in this study set, which both demonstrated geographical clustering, with pBURNS1 only being detectable in isolates from room 8 and pBURNS2 only being detectable in isolates from the shower water in room 9.


Seeking the source of Pseudomonas aeruginosa infections in a recently opened hospital: an observational study using whole-genome sequencing.

Quick J, Cumley N, Wearn CM, Niebel M, Constantinidou C, Thomas CM, Pallen MJ, Moiemen NS, Bamford A, Oppenheim B, Loman NJ - BMJ Open (2014)

The high-resolution phylogenetic reconstruction of Clade E isolates. This demonstrates the clustering of genotypes by bed space. Patient associated samples are contained within a room 11 clade. This clade contains water samples from the shower and environmental samples from the shower, drain and trolley. The water samples from the room 11 tap are in a distinct clade, indicating the biofilm within the tap has a distinct genotype to the shower. This suggests environmental contamination was more likely to arise from contaminated shower water than tap water. Details of sampling site, days since start of study and presence of pBURNS plasmids are also shown. The likely phylogenetic position of Pseudomonas aeruginosa detected in a biofilm from a thermostatic mixer valve is shown in the clade associated with room 9 and indicated ‘TMV’.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4225241&req=5

BMJOPEN2014006278F3: The high-resolution phylogenetic reconstruction of Clade E isolates. This demonstrates the clustering of genotypes by bed space. Patient associated samples are contained within a room 11 clade. This clade contains water samples from the shower and environmental samples from the shower, drain and trolley. The water samples from the room 11 tap are in a distinct clade, indicating the biofilm within the tap has a distinct genotype to the shower. This suggests environmental contamination was more likely to arise from contaminated shower water than tap water. Details of sampling site, days since start of study and presence of pBURNS plasmids are also shown. The likely phylogenetic position of Pseudomonas aeruginosa detected in a biofilm from a thermostatic mixer valve is shown in the clade associated with room 9 and indicated ‘TMV’.
Mentions: WGS has been reported previously for source tracking, but never for the detection of transmission events from hospital water.40 Phylogenetic reconstruction within Clade E, the most commonly detected water clone demonstrated additional diversity within this clone, with a total of 46 mutations detected an average genetic distance between isolates of 4.1 mutations (figure 3). The reconstruction demonstrated clear evidence of clustering of genotypes both by room and outlet (figure 3). When P. aeruginosa was detected in the wet environment (eg, shower rosettes and drains) these genotypes were most often identical to those found in water, indicating that the water was likely the ultimate source of that clone. Genotypic variation was seen between outlets within the same room. For example, tap water sampled from room 11 had a distinct genotype from that sampled from shower water in the same room and this was consistently found over multiple samplings. Notably, isolates from two patients fell within the cluster originating from shower water, indicating that shower hydrotherapy was the most likely source of infection. Two plasmids (designated pBURNS1 and pBURNS2) were detected in this study set, which both demonstrated geographical clustering, with pBURNS1 only being detectable in isolates from room 8 and pBURNS2 only being detectable in isolates from the shower water in room 9.

Bottom Line: Screening patients who subsequently developed a positive P. aeruginosa microbiology result were subject to enhanced environmental surveillance.Isolates from three patients had identical genotypes compared with water isolates from the same room.This study reveals that WGS can be used for source tracking of P. aeruginosa in a hospital setting, and that acquisitions can be traced to a specific source within a hospital ward.

View Article: PubMed Central - PubMed

Affiliation: Institute of Microbiology and Infection, University of Birmingham, Birmingham, UK NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, UK.

Show MeSH
Related in: MedlinePlus