Does Pseudomonas aeruginosa colonization influence morbidity and mortality in the intensive care unit patient? Experience from an outbreak caused by contaminated oral swabs (original) (raw)
Related papers
Pseudomonas aeruginosa contamination of mouth swabs during production causing a major outbreak
Annals of Clinical Microbiology and Antimicrobials, 2007
Background: In 2002 we investigated an outbreak comprising 231 patients in Norway, caused by Pseudomonas aeruginosa and linked to the use of contaminated mouth swabs called Dent-O-Sept. Here we describe the extent of contamination of the swabs, and identify critical points in the production process that made the contamination possible, in order to prevent future outbreaks.
Journal of Infection, 2008
Objective: Pseudomonas aeruginosa is an opportunistic pathogen that may cause invasive disease. We describe the epidemiology of invasive P. aeruginosa infection in Norway and identify associated clinical factors. Methods: All patients with invasive P. aeruginosa and Pseudomonas not identified at the species level (Pseudomonas spp.) in Norway 1992e2002 were included. Detailed information was collected for all cases during 1999e2002. Population and health institution statistics were obtained from national databases. Results: In 1999e2002 the incidence rate was 3.16 per 100 000 person-years at risk or 0.20 per 1000 hospital stays. For hospital-acquired infection the rate was 671 per 100 000 person-years as compared with 1.13 for community-acquired infection, and 37 in nursing homes. The highest risk for invasive Pseudomonas disease was found in patients with malignant neoplasms of lymphoid and haematopoietic tissue (risk per 1000 hospital stays 1.9; 95% CI 1.5e2.3) and other diseases of blood and blood-forming organs (2.2; 95% CI 1.2e3.7). The case fatality rate was 35%. Conclusions: The incidence of invasive P. aeruginosa infection in this population-based study was much lower than in most single-hospital studies. The nationwide study design and prudent antibiotic use may explain some of the difference. Infection risk is strongly associated with certain underlying diseases.
The journal of hygiene, 1975
One hundred and fifty-six infections or episodes of infection associated with Pseudomonas aeruginosa in six hospitals over 14 months were investigated. Pyocine typing and serotyping suggested that 145 distinct episodes had occurred, caused by 78 different strains. During this period 15 distinct strains were isolated from the environment at one of the hospitals; 12 of these were apparently unassociated with infection in the same ward during the period, and 4 were of types not encountered in infective processes at any hospital. There appeared to be a rather higher proportion of unclassifiable pyocine inhibition patterns among the environmental strains; in general these strains also produced smaller amounts of haemolysin. If failure to produce haemolysin in vitro is correlated with lack of virulence in vivo, this may partially explain the sporadic nature of hospital infection with Ps. aeruginosa, despite the prevalence of strains of this species in the environment.
Clinical Infectious Diseases, 1993
Forty-one Pseudomonas aeruginosa isolates with extended-spectrum -lactamases (ESBLs) from a hospital in Warsaw, Poland, were analyzed. Thirty-seven isolates from several wards were collected over 9 months in 2003 and 2004. The isolates were recovered from patients with multiple types of infections, mostly respiratory tract and postoperative wound infections. All 41 isolates produced the PER-1 ESBL, originally observed in Turkey but recently also identified in several countries in Europe and the Far East. The bla PER-1 gene resided within the Tn1213 composite transposon, which was chromosomally located. Pulsed-field gel electrophoresis and multilocus sequence typing (MLST) revealed the presence of three separate clones among the isolates. Two of these, corresponding to sequence types (STs) ST244 and ST235, were responsible for parallel outbreaks. Apart from PER-1, all the isolates produced OXA-2 oxacillinase. ST235 isolates additionally expressed a novel enzyme, OXA-74, differing by one amino acid from the OXA-17 ESBL identified originally in PER-1-and OXA-2-positive P. aeruginosa isolates from Ankara, Turkey, in 1992. These earlier Ankara isolates with PER-1, OXA-2, and OXA-17 were also classified into ST235, which is a single-locus variant of two other STs, ST227 and ST230. ST227, ST230, and ST235 all correspond to the recently described clonal complex BG11, which seems to be internationally distributed, having spread in Turkey, Greece, Italy, Hungary, Poland, Sweden, and much of Russia. It is associated with various -lactamases, including PER-1 and VIM metalloenzymes. This work further demonstrates the value of MLST of P. aeruginosa.
Clinical Microbiology and Infection, 2010
Clin Microbiol Infect 2011; 17: 57–62Clin Microbiol Infect 2011; 17: 57–62AbstractPseudomonas aeruginosa is one of the leading nosocomial pathogens in intensive care units (ICUs). The source of this microorganism can be either endogenous or exogenous. The proportion of cases as a result of transmission is still debated, and its elucidation is important for implementing appropriate control measures. To understand the relative importance of exogenous vs. endogenous sources of P. aeruginosa, molecular typing was performed on all available P. aeruginosa isolated from ICU clinical and environmental specimens in 1998, 2000, 2003, 2004 and 2007. Patient samples were classified according to their P. aeruginosa genotypes into three categories: (A) identical to isolate from faucet; (B) identical to at least one other patient sample and not found in faucet; and (C) unique genotype. Cases in categories A and B were considered as possibly exogenous, and cases in category C as possibly endogenous. A mean of 34 cases per 1000 admissions per year were found to be colonized or infected by P. aeruginosa. Higher levels of faucet contamination were correlated with a higher number of cases in category A. The number of cases in category B varied from 1.9 to 20 cases per 1000 admissions. This number exceeded 10/1000 admissions on three occasions and was correlated with an outbreak on one occasion. The number of cases considered as endogenous (category C) was stable and independent of the number of cases in categories A and B. The present study shows that repeated molecular typing can help identify variations in the epidemiology of P. aeruginosa in ICU patients and guide infection control measures.Pseudomonas aeruginosa is one of the leading nosocomial pathogens in intensive care units (ICUs). The source of this microorganism can be either endogenous or exogenous. The proportion of cases as a result of transmission is still debated, and its elucidation is important for implementing appropriate control measures. To understand the relative importance of exogenous vs. endogenous sources of P. aeruginosa, molecular typing was performed on all available P. aeruginosa isolated from ICU clinical and environmental specimens in 1998, 2000, 2003, 2004 and 2007. Patient samples were classified according to their P. aeruginosa genotypes into three categories: (A) identical to isolate from faucet; (B) identical to at least one other patient sample and not found in faucet; and (C) unique genotype. Cases in categories A and B were considered as possibly exogenous, and cases in category C as possibly endogenous. A mean of 34 cases per 1000 admissions per year were found to be colonized or infected by P. aeruginosa. Higher levels of faucet contamination were correlated with a higher number of cases in category A. The number of cases in category B varied from 1.9 to 20 cases per 1000 admissions. This number exceeded 10/1000 admissions on three occasions and was correlated with an outbreak on one occasion. The number of cases considered as endogenous (category C) was stable and independent of the number of cases in categories A and B. The present study shows that repeated molecular typing can help identify variations in the epidemiology of P. aeruginosa in ICU patients and guide infection control measures.
Nosocomial outbreak of severe Pseudomonas aeruginosa infections in haematological patients
European Journal of Epidemiology, 1993
an outbreak of Pseudomonas aeruginosa infections in neutropenic patients admitted to the Haematological Wards of"Ospedali Riuniti" in Bergamo, Italy, was detected. Out of 11 cases of P. aeruginosa infections, 8 were bacteremic. Of these, 7 died within few days of onset (mortality rate: 87.5%). Consequently, possible sources of infection were investigated, and moist areas of the hospital environment were shown to be highly contaminated by P. aeruginosa. A clinical and microbiological follow-up of patients admitted to the Haematological Wards was performed for a 10 month period following the outbreak. Adequate measures for cleaning and disinfection were shown to reduce the frequency of P. aeruginosa hospital infections.
Eastern Mediterranean Health Journal, 2013
This study aimed to characterize Pseudomonas aeruginosa isolates in 2 intensive care units in Egypt and Saudi Arabia. P. aeruginosa isolates from patients' and staff hands and environmental samples were typed using antibiotyping and ERIC-PCR. In Egypt, isolates from suction apparatus tubing and drainage containers (A7) and AV tubing (A8) were linked to those from patients who had these antibiotypes. In Saudi Arabia, isolates from suction apparatus tubing (A6) and AV tubing (A7) were linked to patients with the same antibiotypes. In Egypt, patients' isolates had ERIC VII, VIII and IX patterns linked to suction apparatus tubing, AV machine tubes and drainage containers. In Saudi Arabia, patients' isolates had ERIC VIII and XI patterns linked to suction apparatus tubing and AV machines. In Egypt and Saudi Arabia, ERIC typing gave higher discriminatory indices (0.801 and 0.785 respectively) than the antibiotyping (0.7123 and 0.728 respectively). ERIC was superior to antibiotyping and should be used in tracing sources of infection.
BMC Microbiology, 2014
Background: The persistence of microbial communities and how they change in indoor environments is of immense interest to public health. Moreover, hospital acquired infections are significant contributors to morbidity and mortality. Evidence suggests that, in hospital environments agent transfer between surfaces causes healthcare associated infections in humans, and that surfaces are an important transmission route and may act as a reservoir for some of the pathogens. This study aimed to evaluate the diversity of microorganisms that persist on noncritical equipment and surfaces in a main hospital in Portugal, and are able to grow in selective media for Pseudomonas, and relate them with the presence of Pseudomonas aeruginosa. Results: During 2 years, a total of 290 environmental samples were analyzed, in 3 different wards. The percentage of equipment in each ward that showed low contamination level varied between 22% and 38%, and more than 50% of the equipment sampled was highly contaminated. P. aeruginosa was repeatedly isolated from sinks (10 times), from the taps' biofilm (16 times), and from the showers and bedside tables (two times). Two ERIC clones were isolated more than once. The contamination level of the different taps analyzed showed correlation with the contamination level of the hand gels support, soaps and sinks. Ten different bacteria genera were frequently isolated in the selective media for Pseudomonas. Organisms usually associated with nosocomial infections as Stenotrophomonas maltophilia, Enterococcus feacalis, Serratia nematodiphila were also repeatedly isolated on the same equipment. Conclusions: The environment may act as a reservoir for at least some of the pathogens implicated in nosocomial infections. The bacterial contamination level was related to the presence of humidity on the surfaces, and tap water (biofilm) was a point of dispersion of bacterial species, including potentially pathogenic organisms. The materials of the equipment sampled could not be related to the microbial contamination level. The presence of a disinfectant in the isolation medium suggests that the number of microorganism in the environment could be higher and shows the diversity of disinfectant resistant species. The statistical analysis suggests that the presence of bacteria could increase the risk of transmission by hand manipulation.
Pseudomonas aeruginosa infection in an intensive care unit
International Journal of Infection Control, 2007
P. aeruginosa is a well-known cause of hospital-acquired pneumonia (HAP) in intensive care units (ICU). We conducted an epidemiologic and molecular investigation of endemic P. aeruginosa infection in an ICU. P. aeruginosa strains isolated from hospitalized patients and environmental samples in the ICU of the National Medical Center (NMC) were collected by the hospital infection laboratory of National Center for Disease Control and Public Health, October 2005-April 2007. The antimicrobial susceptibility of the isolates in vitro was assessed by an agar disk diffusion method, as recommended by the Clinical and Laboratory Standards Institute. The antimicrobial susceptibility data were analyzed using WHONET software. Isolates resistant to cefepime, imipenem, aztreonam, ciprofloxacin, piperacillin, and gentamicin were defined as multidrug resistant (MDR). P. aeruginosa was isolated in 89 specimens obtained from 53 patients with HAP. The incidence rate of MDR P. aeruginosa infection was 15,8/100 patient admissions per year. MDR strains were common, making up 28/89 (31,5%) of all P. aeruginosa isolates in this study. In March-August 2006 there was an outbreak of HAP caused by P. aeruginosa. During the outbreak P. aeruginosa was isolated from 25 patients with HAP. Using PFGE typing, it was observed that twelve P. aeruginosa had the same genetic pattern. Environmental investigations demonstrated the presence of P. aeruginosa in the ventilation equipment. In one case, MDR P. aeruginosa was found in the microfilter of an AV machine. The most predominant etiological factor responsible for HAP in ICU of NMC was endemic P. aeruginosa.