Risk assessment after a severe hospital-acquired infection associated with carbapenemase-producing Pseudomonas aeruginosa

Hopman, J; Meijer, C; Kenters, N; Coolen, JPM; Ghamati, MR; Mehtar, S; van Crevel, R; Morshuis, WJ; Verhagen, AFTM; van den Heuvel, MM; Voss, A; Wertheim, HFL

Journal article

Risk assessment after a severe hospital-acquired infection associated with carbapenemase-producing Pseudomonas aeruginosa

Abstract:: Importance Resistance of gram-negative bacilli to carbapenems is rapidly emerging worldwide. In 2016, the World Health Organization defined the hospital-built environment as a core component of infection prevention and control programs. The hospital-built environment has recently been reported as a source for outbreaks and sporadic transmission events of carbapenemase-producing gram-negative bacilli from the environment to patients.
Objective To assess risk after the identification of an unexpected, severe, and lethal hospital-acquired infection caused by carbapenemase-producing Pseudomonas aeruginosa in a carbapenemase-low endemic setting.
Design, Settings, and Participants A case series study in which a risk assessment was performed on all 11 patients admitted to the combined cardiothoracic surgery and pulmonary diseases ward and the hospital-built environment in the Radboud University Medical Center, the Netherlands, in February 2018.
Exposures Water and aerosols containing carbapenemase-producing (Verona integron-mediated metallo-β-lactamase [VIM]) P aeruginosa.
Main Outcomes and Measures Colonization and/or infection of patients and/or contamination of the environment after the detection of 1 patient infected with carbapenemase-producing (VIM) P aeruginosa.
Results A total of 5 men (age range, 60-84 years) and 6 women (age range, 55-74 years) were admitted to the combined cardiothoracic surgery and pulmonary diseases ward. The risk assessment was performed after carbapenemase-producing (VIM) P aeruginosa was unexpectedly detected in a man in his early 60s, who had undergone a left-sided pneumonectomy and adjuvant radiotherapy. No additional cases (colonization or infection) of carbapenemase-producing (VIM) P aeruginosa were detected. Plausible transmission of carbapenemase-producing P aeruginosa from the hospital environment to the patient via the air was confirmed by whole-genome sequencing, which proved the relation of Pseudomonas strains from the patient, the shower drains in 8 patient rooms, 1 sink, and an air sample.
Conclusions and Relevance This study suggests that rethinking the hospital-built environment, including shower drains and the sewage system, will be crucial for the prevention of severe and potential lethal hospital-acquired infections.

Publication status:: Published

Peer review status:: Peer reviewed

Actions

Email

Email this record

Send the bibliographic details of this record to your email address.

Your Email
Please enter the email address that the record information will be sent to.

-
Your message (optional)
Please add any additional information to be included within the email.
Cite

Cite this record

APA Style

Hopman, J., Meijer, C., Kenters, N., Coolen, J. P. M., Ghamati, M. R., Mehtar, S., van Crevel, R., Morshuis, W. J., Verhagen, A. F. T. M., van den Heuvel, M. M., Voss, A., & Wertheim, H. F. L. (2019). Risk assessment after a severe hospital-acquired infection associated with carbapenemase-producing Pseudomonas aeruginosa. JAMA Network Open, 2(2).

MLA Style

Hopman, J., et al. “Risk Assessment after a Severe Hospital-Acquired Infection Associated with Carbapenemase-Producing Pseudomonas Aeruginosa.” JAMA Network Open, vol. 2, no. 2, American Medical Association, 2019.

Chicago Style

Hopman, J, C Meijer, N Kenters, JPM Coolen, MR Ghamati, S Mehtar, R van Crevel, et al. 2019. “Risk Assessment after a Severe Hospital-Acquired Infection Associated with Carbapenemase-Producing Pseudomonas Aeruginosa.” JAMA Network Open 2 (2).
Share
Print