Whole-genome sequencing reveals two prolonged simultaneous outbreaks involving Pseudomonas aeruginosa high-risk strains ST111 and ST235 with resistance to quaternary ammonium compounds

URN to cite this document:

urn:nbn:de:bvb:355-epub-578871 Copy

DOI to cite this document:

10.5283/epub.57887 Copy

Rath, A. ; Kieninger, B. ; Fritsch, J. ; Caplunik-Pratsch, A. ; Blaas, S. ; Ochmann, M. ; Pfeifer, M. ; Hartl, J. ; Holzmann, T. ; Schneider-Brachert, W.

License: Creative Commons Attribution Non-commercial No Derivatives 4.0 PDF - Published Version (536kB)

Date of publication of this fulltext: 12 Mar 2024 10:23

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Details

Item type:	Article
Open Access Type:	DEAL (Elsevier)
Journal or Publication Title:	Journal of Hospital Infection
Publisher:	Elsevier
Volume:	145
Page Range:	pp. 155-164
Date:	28 January 2024
Institutions:	Medicine > Lehrstuhl für Innere Medizin II Medicine > Abteilung für Krankenhaushygiene und Infektiologie
Identification Number:	Value Type 10.1016/j.jhin.2024.01.009 DOI
Keywords:	Pseudomonas aeruginosa, Infection control, Outbreak, Water drain, WGS
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Partially
Item ID:	57887

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Abstract

Objective Water-bearing systems are known as frequent Pseudomonas aeruginosa (PA) outbreak sources. However, many older buildings continue to have sanitary facilities in high-risk departments such as the ICU. We present two simultaneous prolonged multi-drug-resistant (MDR) PA outbreaks detected at the ICU of a pulmonology hospital, which were resolved by whole-genome sequencing ...

Abstract

Objective
Water-bearing systems are known as frequent Pseudomonas aeruginosa (PA) outbreak sources. However, many older buildings continue to have sanitary facilities in high-risk departments such as the ICU. We present two simultaneous prolonged multi-drug-resistant (MDR) PA outbreaks detected at the ICU of a pulmonology hospital, which were resolved by whole-genome sequencing (WGS).
Methods
Outbreak management and investigations were initiated in August 2019 after detecting two patients with nosocomial VIM-2-positive MDR PA. The investigations involved weekly patient screenings for four months and extensive environmental sampling for 15 months. All patient and environmental isolates were collected and analysed by WGS.
Results
From April to September 2019, we identified 10 patients with nosocomial MDR PA, including five VIM-2-positive strains. VIM-2-positive strains were also detected in nine sink drains, two toilets, and a cleaning bucket. WGS revealed that of 16 VIM-2-positive isolates, 14 were ST111 that carried qacE, or qacEΔ1 genes, whereas 13 isolates clustered (difference of ≤11 alleles by cgMLST). OXA-2 (two toilets), and OXA-2, OXA-74, PER-1 (two patients, three toilets) qacEΔ1-positive ST235 isolates dominated among VIM-2-negative isolates. The remaining seven PA strains were ST17, ST233, ST273, ST309 and ST446. Outbreak containment was achieved by replacing U-bends, and cleaning buckets, and switching from quaternary ammonium compounds (QUATs) to oxygen-releasing disinfectant products.
Conclusion
Comprehension and management of two simultaneous MDR PA outbreaks involving the high-risk strains ST111 and ST235 were facilitated by precise control due to identification of different outbreak sources per strain, and by the in-silico detection of high-level QUATs resistance in all isolates.

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Metadata last modified: 16 Jan 2025 15:00

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