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Outbreak of Extended-Spectrum Beta-Lactamase Producing Enterobacter cloacae with High MICs of Quaternary Ammonium Compounds in a Hematology Ward Associated with Contaminated Sinks.

Chapuis A, Amoureux L, Bador J, Gavalas A, Siebor E, Chrétien ML, Caillot D, Janin M, de Curraize C, Neuwirth C - Front Microbiol (2016)

Bottom Line: Six pulsotypes were identical between clinical and environmental isolates.Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number.Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens.

View Article: PubMed Central - PubMed

Affiliation: Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France.

ABSTRACT

Objective: To investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (10 infected and 33 colonized).

Design: We performed environmental analysis to detect multiresistant E. cloacae for comparison with clinical isolates (genotyping by pulsed-field gel electrophoresis and MLST as well as ESBL-typing) and determined the MICs of the quaternary ammonium compounds (QACs) alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC). A bleach-based cleaning-disinfection program was implemented in December 2012 after mechanical removal of the biofilm in all sinks.

Results: We have detected 17 ESBL-producing E. cloacae in patients sink drains, shower drains and medical sink drains. Sequencing of the bla genes performed on 60 strains recovered from patients and environment (n = 43 clinical and n = 17 environmental) revealed that bla CTX-M15 was predominant (37 isolates) followed by bla CTX-M9 plus bla SHV-12 (20 isolates). We observed a great diversity among the isolates: 14 pulsotypes (11 STs) in clinical isolates and 9 pulsotypes (7 STs) in environmental isolates. Six pulsotypes were identical between clinical and environmental isolates. MICs of the quaternary ammonium compounds widely used for disinfection were very high in clinical and environmental isolates. Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number. Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens.

No MeSH data available.


Related in: MedlinePlus

Epicurve with all samples of E. cloacae for newly infected or colonized patients between January 2011 and December 2013. Numbers in parenthesis are the numbers of newly hospitalized patients in the Hematology ward each month. Black arrow: implementation of the bleach-based disinfection programme after complete cleaning of the sink.
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Figure 1: Epicurve with all samples of E. cloacae for newly infected or colonized patients between January 2011 and December 2013. Numbers in parenthesis are the numbers of newly hospitalized patients in the Hematology ward each month. Black arrow: implementation of the bleach-based disinfection programme after complete cleaning of the sink.

Mentions: A total of 43 ESBL-producing E. cloacae have been isolated from 43 patients hospitalized in the Hematology ward between January 2011 and December 2013: 6 isolates in 2011, 25 in 2012 and 12 in 2013 (Figure 1). Most of the isolates have been recovered from stool but also in other sites such as throat, urine, blood (respectively 25, 8, 4, and 5) and in 1 thoracic wound (infection of the insertion site of the central catheter). The 10 patients by whom the ESBL-producing E. cloacae had been recovered from urine, thoracic wound and blood harbored clinical symptoms of infection. All other patients were considered as colonized.


Outbreak of Extended-Spectrum Beta-Lactamase Producing Enterobacter cloacae with High MICs of Quaternary Ammonium Compounds in a Hematology Ward Associated with Contaminated Sinks.

Chapuis A, Amoureux L, Bador J, Gavalas A, Siebor E, Chrétien ML, Caillot D, Janin M, de Curraize C, Neuwirth C - Front Microbiol (2016)

Epicurve with all samples of E. cloacae for newly infected or colonized patients between January 2011 and December 2013. Numbers in parenthesis are the numbers of newly hospitalized patients in the Hematology ward each month. Black arrow: implementation of the bleach-based disinfection programme after complete cleaning of the sink.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940370&req=5

Figure 1: Epicurve with all samples of E. cloacae for newly infected or colonized patients between January 2011 and December 2013. Numbers in parenthesis are the numbers of newly hospitalized patients in the Hematology ward each month. Black arrow: implementation of the bleach-based disinfection programme after complete cleaning of the sink.
Mentions: A total of 43 ESBL-producing E. cloacae have been isolated from 43 patients hospitalized in the Hematology ward between January 2011 and December 2013: 6 isolates in 2011, 25 in 2012 and 12 in 2013 (Figure 1). Most of the isolates have been recovered from stool but also in other sites such as throat, urine, blood (respectively 25, 8, 4, and 5) and in 1 thoracic wound (infection of the insertion site of the central catheter). The 10 patients by whom the ESBL-producing E. cloacae had been recovered from urine, thoracic wound and blood harbored clinical symptoms of infection. All other patients were considered as colonized.

Bottom Line: Six pulsotypes were identical between clinical and environmental isolates.Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number.Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens.

View Article: PubMed Central - PubMed

Affiliation: Laboratoire de Bactériologie Médicale et de Surveillance Environnementale, Hôpital Universitaire de Dijon Dijon, France.

ABSTRACT

Objective: To investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (10 infected and 33 colonized).

Design: We performed environmental analysis to detect multiresistant E. cloacae for comparison with clinical isolates (genotyping by pulsed-field gel electrophoresis and MLST as well as ESBL-typing) and determined the MICs of the quaternary ammonium compounds (QACs) alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC). A bleach-based cleaning-disinfection program was implemented in December 2012 after mechanical removal of the biofilm in all sinks.

Results: We have detected 17 ESBL-producing E. cloacae in patients sink drains, shower drains and medical sink drains. Sequencing of the bla genes performed on 60 strains recovered from patients and environment (n = 43 clinical and n = 17 environmental) revealed that bla CTX-M15 was predominant (37 isolates) followed by bla CTX-M9 plus bla SHV-12 (20 isolates). We observed a great diversity among the isolates: 14 pulsotypes (11 STs) in clinical isolates and 9 pulsotypes (7 STs) in environmental isolates. Six pulsotypes were identical between clinical and environmental isolates. MICs of the quaternary ammonium compounds widely used for disinfection were very high in clinical and environmental isolates. Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number. Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens.

No MeSH data available.


Related in: MedlinePlus