Plasmids and bacterial strains mediating multidrug-resistant hospital-acquired infections are coresidents of the hospital environment

Hospital-acquired infections (HAIs) are a global problem. The widespread use of antibiotics continues to exacerbate the problem giving rise to antibiotic-resistant bacteria both in and outside a clinical context. The general hospital environment is an obvious important focus for the selection and spread of multiresistant bacteria and a potential direct source of HAIs. Despite this, there are few detailed studies that have investigated the relationship between strains mediating HAIs and strains coresident in the hospital. Here we isolated bacteria from patients with HAIs exhibiting resistance to β-lactam antibiotics over a 1-month period in 2011. Three of these isolates were examined in detail by molecular analysis and their multiresistance regions were compared to β-lactam resistant bacteria isolated from the immediate hospital environment over the same period. All sampled patients were in a 14-bed burns unit and the environmental sample sites included shower drains, sinks, trolleys, and door handles. It was found that identical strains carrying the same resistance regions were present in both patients and the hospital environment suggesting HAIs can arise from bacteria resident in the immediate surrounds. The three patient infections were not derived from a single source, since strains could be distinguished by the genotype and spatial location. While it seems unlikely that eradication of multiresistant bacteria from the hospital can be achieved, more effective hospital cleaning and a better hospital design may be able to reduce transmission. © Copyright 2013, Mary Ann Liebert, Inc. 2013

Is the hospital water environment a reservoir for carbapenem-resistant organisms causing hospital-acquired infections? A systematic review of the literature

Over the last 20 years there have been 32 reports of carbapenem-resistant organisms in the hospital water environment, with half of these occurring since 2010. The majority of these reports have described associated clinical outbreaks in the intensive care setting, affecting the critically ill and the immunocompromised. Drains, sinks and faucets were most frequently colonized, and Pseudomonas aeruginosa the predominant organism. IMP, KPC and VIM were the most common carbapenemases found. Molecular typing was performed in almost all studies, with pulse field gel electrophoresis being most commonly used. Seventy-two percent of studies reported controlling outbreaks, of which just over one-third eliminated the organism from the water environment. A combination of interventions appears to be most successful, including reinforcement of general infection control measures, alongside chemical disinfection. The most appropriate disinfection method however remains unclear, and it is likely that replacement of colonized water reservoirs may be required for long-term clearance

Is the hospital water environment a reservoir for carbapenem-resistant organisms causing hospital-acquired infections? A systematic review of the literature

Over the last 20 years there have been 32 reports of carbapenem-resistant organisms in the hospital water environment, with half of these occurring since 2010. The majority of these reports have described associated clinical outbreaks in the intensive care setting, affecting the critically ill and the immunocompromised. Drains, sinks and faucets were most frequently colonized, and Pseudomonas aeruginosa the predominant organism. IMP, KPC and VIM were the most common carbapenemases found. Molecular typing was performed in almost all studies, with pulse field gel electrophoresis being most commonly used. Seventy-two percent of studies reported controlling outbreaks, of which just over one-third eliminated the organism from the water environment. A combination of interventions appears to be most successful, including reinforcement of general infection control measures, alongside chemical disinfection. The most appropriate disinfection method however remains unclear, and it is likely that replacement of colonized water reservoirs may be required for long-term clearance