Journal Article

The Hospital Water Environment as a Reservoir for Carbapenem-Resistant Organisms Causing Hospital-Acquired Infections—A Systematic Review of the Literature

Cheong, Elaine Y. L., Stoesser, Nicole, Mathers, Amy J., Walker, A. Sarah, Gottlieb, Thomas, Peto, Timothy E. A., Gordon, Alice E. Kizny, Kotay, Shireen, Crook, Derrick W.

2017

Overview

Over the last 20 years there have been 32 reports of carbapenem-resistant organisms in the hospital water environment, with half of these occurring since 2010. The majority of these reports have described associated clinical outbreaks in the intensive care setting, affecting the critically ill and the immunocompromised. Drains, sinks, and faucets were most frequently colonized, and Pseudomonas aeruginosa the predominant organism. Imipenemase (IMP), Klebsiella pneumoniae carbapenemase (KPC), and Verona integron-encoded metallo-β-lactamase (VIM) were the most common carbapenemases found. Molecular typing was performed in almost all studies, with pulse field gel electrophoresis being most commonly used. Seventy-two percent of studies reported controlling outbreaks, of which just more than one-third eliminated the organism from the water environment. A combination of interventions seems to be most successful, including reinforcement of general infection control measures, alongside chemical disinfection. The most appropriate disinfection method remains unclear, however, and it is likely that replacement of colonized water reservoirs may be required for long-term clearance.

• Publisher: Oxford University Press
• Subject: Anti-Bacterial Agents - therapeutic use / Antibiotics / Bacterial Proteins - biosynthesis / beta-Lactamases - biosynthesis / Carbapenem-Resistant Enterobacteriaceae - drug effects / Carbapenem-Resistant Enterobacteriaceae - enzymology / Carbapenem-Resistant Enterobacteriaceae - genetics / Carbapenemase / Carbapenems - pharmacology / Coding / Cross Infection - epidemiology / Cross Infection - microbiology / Disease Outbreaks - prevention & control / Disease Reservoirs - microbiology / Disinfection / Drains / Drug Resistance, Bacterial / Electrophoresis, Gel, Pulsed-Field / Equipment and Supplies, Hospital - microbiology / Faucets / Gel electrophoresis / Hospitals / Humans / Inosine monophosphate / Klebsiella / Klebsiella Infections - drug therapy / Klebsiella Infections - epidemiology / Klebsiella Infections - microbiology / Klebsiella pneumoniae - drug effects / Klebsiella pneumoniae - enzymology / Klebsiella pneumoniae - genetics / Literature reviews / Marine environment / Metallography / Microbial Sensitivity Tests / Molecular Typing / Multidrug resistant organisms / Nosocomial infections / Outbreaks / Pseudomonas aeruginosa / Pseudomonas aeruginosa - drug effects / Pseudomonas aeruginosa - enzymology / Pseudomonas aeruginosa - genetics / Pseudomonas Infections - drug therapy / Pseudomonas Infections - epidemiology / Pseudomonas Infections - microbiology / Reinforcement / REVIEW ARTICLE / Sinkholes / Systematic review / Typing / Water / Water Microbiology / Water Supply