Impact of intensive care unit relocation and role of tap water on an outbreak of Pseudomonas aeruginosa expressing OprD-mediated resistance to imipenem

To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem (PA-OprD). The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before...

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Bibliographic Details
Published in:The Journal of hospital infection 2018-11, Vol.100 (3), p.e105-e114
Main Authors: Tran-Dinh, A., Neulier, C., Amara, M., Nebot, N., Troché, G., Breton, N., Zuber, B., Cavelot, S., Pangon, B., Bedos, J.P., Merrer, J., Grimaldi, D.
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Antimicrobial resistance
beta-Lactam Resistance
Colonization
Cross Infection - epidemiology
Cross Infection - prevention & control
Disease Outbreaks
Drinking Water - microbiology
Electrophoresis, Gel, Pulsed-Field
Female
Genotype
Humans
Imipenem
Imipenem - pharmacology
Infection
Infection Control - methods
Intensive care unit
Intensive Care Units
Male
Middle Aged
Molecular Epidemiology
Molecular Typing
Porins - genetics
Pseudomonas aeruginosa
Pseudomonas aeruginosa - classification
Pseudomonas aeruginosa - drug effects
Pseudomonas aeruginosa - genetics
Pseudomonas aeruginosa - isolation & purification
Pseudomonas Infections - epidemiology
Pseudomonas Infections - prevention & control
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Summary:To assess the impact of the incidental relocation of an intensive care unit (ICU) on the risk of colonizations/infections with Pseudomonas aeruginosa exhibiting OprD-mediated resistance to imipenem (PA-OprD). The primary aim was to compare the proportion of PA-OprD among P. aeruginosa samples before and after an incidental relocation of the ICU. The role of tap water as a route of contamination for colonization/infection of patients with PA-OprD was assessed as a secondary aim. A single-centre, observational, before/after comparison study was conducted from October 2013 to October 2015. The ICU was relocated at the end of October 2014. All P. aeruginosa-positive samples isolated from patients hospitalized ≥48 h in the ICU were included. Tap water specimens were collected every three months in the ICU. PA-OprD strains isolated from patients and tap water were genotyped using pulse-field gel electrophoresis. A total of 139 clinical specimens of P. aeruginosa and 19 tap water samples were analysed. The proportion of PA-OprD strains decreased significantly from 31% to 7.7% after the relocation of the ICU (P = 0.004). All PA-OprD clinical specimens had a distinct genotype. Surprisingly, tap water was colonized with a single PA-OprD strain during both periods, but this single clone has never been isolated from clinical specimens. Relocation of the ICU was associated with a marked decrease in P. aeruginosa strains resistant to imipenem. The polyclonal character of PA-OprD strains isolated from patients and the absence of tap-water-to-patient contamination highlight the complexity of the environmental impact on the endogenous colonization/infection with P. aeruginosa.
ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2018.05.016