Infection Control & Hospital Epidemiology (2018), 39, 997–999 doi:10.1017/ice.2018.126
Concise Communication
A cluster of Chryseobacterium indologenes cases related to drainage water in intensive care units
Mireia Cantero MD, MPH, PhD1, Lina M. Parra MD, MPH1, Elena Muñez MD, PhD2, Reyes Iranzo MD3, Maria Isabel Sánchez-Romero MD, PhD4, Jesús Oteo MD, PhD5 and Angel Asensio MD, PhD1 1Preventive Medicine Department, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain, 2Internal Medicine Department, Infectious
Disease Unit, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain, 3Anesthesiology Department, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain, 4Department of Microbiology, Puerta de Hierro Majadahonda University Hospital, Majadahonda, Madrid, Spain and 5Antibiotic Laboratory, Department of Bacteriology, Centro Nacional de Microbiología, Instituto de Salud Carlos III, Majadahonda, Madrid, Spain
Abstract
In this outbreak, 12 patients in intensive care units acquired a Chryseobacterium indologenes infection. Cultures from sinkholes and air samples were positive for C. indologenes. After removing wash basins, no new cases appeared. Sinkholes, potentially contaminated, can act as a reservoir for C. indologenes and other microorganisms. Thus, patients and equipment should be protected from sink splashes to avoid contamination.
(Received 13 January 2018; accepted 6 May 2018; electronically published June 21, 2018)
Hospital water is an important source of healthcare-associated infections, mostly caused by Pseudomonas aeruginosa. Never- theless, other nonfermentative gram-negative bacilli (NFGNB) present in water are increasingly recognized as a cause of infec- tion, especially in immunocompromised and critically ill patients.1 Chryseobacterium indologenes is an NFGNB primarily found in soil and water.2 It has intrinsic resistance to several antimicrobial classes, such as cephalosporins and carbapenems, due to the presence of metallo-β-carbapenemases.3 Since 2009, Chryseobacterium has been identified in environmental samples from hospital tap water, disinfectants, and respiratory equipment. It has also been postulated to be a potential pathogen in critically ill patients.1,4–6 Several healthcare-facility outbreaks of NFGNB and
Enterobacteriaceae related to contaminated drainage system water have been described.7,8 Immunocompromised host and critically ill adults as well as neonates are the groups most commonly affected.9 This study describes a cluster of C. indologenes infections and colonizations, probably related to sink drainage water, in inten- sive care unit (ICU) patients and the measures implemented to control it.
Methods
The study was conducted in 2 adult ICUs in a 613-bed tertiary-care hospital. The hospital attends a range of patients referred from
Author for correspondence: Mireia Cantero, Preventive Medicine Department,
Puerta de Hierro Majadahonda University Hospital, C/Manuel de Falla Nº 1, Majada- honda, Madrid, 28222 Spain. E-mail:
mireia.cantero@
salud.madrid.org Cite this article: Cantero M, et al. (2018). A Cluster of Chryseobacterium indologenes
Cases Related to Drainage Water in Intensive Care Units. Infection Control & Hospital Epidemiology 2018, 39, 997–999. doi: 10.1017/ice.2018.126
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved.
other hospitals. The medical ICU admits coronary as well as any other nonsurgical adult patients; the ICU comprises 2 units of 11 single rooms with 1 handwashing sink per bed. Patients from most surgical specialties, including heart, lung, liver, and kidney trans- plant, are attended in the surgical ICU, which has two 10-bed bays sharing 6 handwashing sinks per bay. A room for reprocessing and storage of respiratory devices for the surgical ICU occasionally serves both ICUs. The ICUs do not share healthcare personnel. All patients admitted to these critical units are sampled for methicillin-resistant Staphylococcus aureus (MRSA; nasal and pharyngeal swabs) and for extended-spectrum beta-lactamase (ESBL) and/or carbapenem-resistant gram-negative bacilli (GNB; rectal and respiratory tract samples) at admission and weekly thereafter. A case patient was defined as an ICU patient in whom C.
indologenes was isolated from a clinical or surveillance culture. A patient was considered infected when (1) the patient met Centers for Disease Control and Prevention (CDC) criteria for healthcare- associated infection10 or (2) the patient developed changes in clinico-physiologic parameters (ie, systemic inflammatory response syndrome) concurrently with C. indologenes isolation. Colonized patients were those who did not meet any of the above criteria. Swab samples from tap, faucet aerators, sinkholes, hemodia-
lysis draining traps, and wash basins, as well as tap and distilled water, bronchoscope rinse water, dialysate solution, intravenous infusions, and aqueous chlorhexidine were obtained. Free residual chlorine tests of ICU tap water were performed. Air sampling was performed using an SAS-SuperISO-180 air sampler (International PBI, Milano, Italy) in a standard blood-agar media. One cubic meter of air was sampled close to the basin (within 50 cm) while flushing tap water. All microbiological samples were seeded on blood agar. Identification of isolates from patients and environment samples
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