![]() ![]() The group of Leitner published an article about contaminated handwashing sinks as the source of a clonal outbreak with a resistant Klebsiella oxytoca strain on a hematology ward. ![]() Roux and co-workers found that 31% of the 185 sinks in their ICU were contaminated with ESBL positive Klebsiella and Enterobacter species. During a five month observation period, four patients became colonized with ESBL positive bacteria that were genetically identical to those that had previously been isolated from the sink. Wolf and colleagues discovered that mechanically ventilated patients were sometimes colonized with bacteria positive for ESBLs. Cultures from hand washing sinks in the ICU unit yielded Klebsiella oxytoca with identical molecular patterns to cultures from the patients. ![]() The group of Lowe described an outbreak with an ESBL producing Klebsiella oxytoca. Environmental sampling led to the conclusion that the plughole of the sink was the source of transmission. Starlander and co-workers noticed that four patients became infected or colonized by an ESBL producing Klebsiella pneumoniae strain during a seven month period on the neurological ICU. They found that 100% of the sinks in a neonatal ICU were contaminated with GN rods. Kramer and colleagues described that sinks can be hidden reservoirs generating large quantities of aerosols. Contaminated sinks have been implicated in several outbreaks. These bacteria can colonize/infect the patient via different transmission routes. It is described that sink drains beneath washbasins in hospitals contain 10 6–10 10 colony forming units (CFU)/ml of bacteria of which approximately 10 3–10 5 CFU/ml are Gram-negative (GN) rods, especially waterborne bacteria. Despite screening and enhanced cleaning, the incidence rose further in the first half of 2015 and could be linked to contaminated sinks. Patients in the intensive care unit (ICU) comprised the majority of all colonized or infected patients with CPE. Between 20, our healthcare facility was confronted with a rising number of CPE positive patients, with 26 confirmed cases by 2014. Treatment of patients infected by CPE is a challenge since only a few drugs remain active against these strains. This outbreak highlights that hospital sink drains can accumulate strains with resistance genes and become a potential source of CPE.Ĭarbapenemase-producing Enterobacteriaceae (CPE) represent a major public threat in both the acute and chronic care sectors as well as in the community. ![]() To control the outbreak, the sinks and their plumbings were replaced by new ones with another structure, they were flushed every morning with a glucoprotamin solution and routines regarding sink practices were improved leading to discontinuation of the outbreak. In total, 7 of 8 sinks in the isolation rooms of the ICU were found to be CPE contaminated. The strains isolated from patients and the sink in the implicated room were highly related and pointed to sink-to-patient transmission. To investigate the phylogenetic relationschip between those strains, pulsed-field gel electrophoresis was performed. Besides other strains, Citrobacter freundii type OXA-48 was frequently isolated from patients and sinks. Methods and resultsĮnvironmental samples suggested that a contaminated sink was the source of the outbreak. Since the time period between those patients was relatively short and the strains belonged to different species with different antibiograms and mechanisms of resistance, the hypothesis was that the environment could be a possible source of transmission. Between January and August 2015, five patients became infected/colonized with CPE during their stay in the same room in the intensive care unit (ICU). In the University Hospital of Brussels, the incidence of new patients with CPE rose from 1 case in 2010 to 35 cases in 2015. Carbapenemase-producing Enterobacteriaceae (CPE) are emerging pathogens that represent a major public health threat. ![]()
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