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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

Plan of the Hematology ward. Numbers indicate room numbers. ESBL-producing E. cloacae were isolated from samples collected in gray rooms. Patient number contaminated by sink is indicated in the occurring room.
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Figure 2: Plan of the Hematology ward. Numbers indicate room numbers. ESBL-producing E. cloacae were isolated from samples collected in gray rooms. Patient number contaminated by sink is indicated in the occurring room.

Mentions: The transfer of pathogens from sink to patients may occur in several situations resulting from a splash-back that leads to contamination of an area that can reach at least 1 m from the sink (Hota et al., 2009). Therefore, the patient can be contaminated during teeth brushing or hands washing or showering. The health-care workers are also at risk of hand contamination leading possibly to transfer the pathogen to the patients during care. The phenomenon is amplified when the water flows directly into the sink drain as we observed in nearly all patients rooms. This is considered as inadequate sink design (Breathnach et al., 2012). The mode of contamination is difficult to establish for most of our patients mainly because of hospital stays in different rooms. Nevertheless, for 4 of them the correlation between their colonization/infection and their stay in a contaminated room was easy to perform (Figure 2).


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)

Plan of the Hematology ward. Numbers indicate room numbers. ESBL-producing E. cloacae were isolated from samples collected in gray rooms. Patient number contaminated by sink is indicated in the occurring room.
© Copyright Policy
Related In: Results  -  Collection

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

Figure 2: Plan of the Hematology ward. Numbers indicate room numbers. ESBL-producing E. cloacae were isolated from samples collected in gray rooms. Patient number contaminated by sink is indicated in the occurring room.
Mentions: The transfer of pathogens from sink to patients may occur in several situations resulting from a splash-back that leads to contamination of an area that can reach at least 1 m from the sink (Hota et al., 2009). Therefore, the patient can be contaminated during teeth brushing or hands washing or showering. The health-care workers are also at risk of hand contamination leading possibly to transfer the pathogen to the patients during care. The phenomenon is amplified when the water flows directly into the sink drain as we observed in nearly all patients rooms. This is considered as inadequate sink design (Breathnach et al., 2012). The mode of contamination is difficult to establish for most of our patients mainly because of hospital stays in different rooms. Nevertheless, for 4 of them the correlation between their colonization/infection and their stay in a contaminated room was easy to perform (Figure 2).

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