title: Sources of sporadic Pseudomonas aeruginosa colonizations/infections in surgical ICUs: Association with contaminated sink trap.
abstract: BACKGROUND
  Many studies have reported the hospital outbreaks of Pseudomonas aeruginosa due to cross-contamination between patients and water fittings, but the importance of water fittings as sources of sporadic P. aeruginosa colonizations/infections remains ambiguous.
  
  
  OBJECTIVE
  To investigate the sources of sporadic P. aeruginosa colonizations/infections in a clinical intensive surveillance, and further analysis the potential of sink trap for P. aeruginosa transmission in intensive care units (ICUs).
  
  
  METHODS
  Patients monitoring and targeted environmental screening for P. aeruginosa was performed prospectively over a 27-week period, in absence of recognized outbreak, in two surgical intensive care units (SICUs). All isolates were genotyped by Pulsed field gel electrophoresis analysis.
  
  
  RESULTS
  18.9% (46/244) of water fitting samples harbored P. aeruginosa, and active screening samples from 9.2% (55/595) of hospitalized patients carried with P. aeruginosa. According to genotype results, approximately 50% of P. areuginosa colonizations/infections of patients were of exogenous origin. 64.7% (11/17) of exogenous sourced cases were associated with contaminated sink traps. There was a significant correlation between the incidence of exogenous colonization/infection and the prevalence of P. areuginosa in water fitting in SICU-2 (rs = 0.972; p = 0.014). Furthermore, P. areuginosa from sink trap possessed a higher level of resistance to multi-antibiotics as opposed to cross-transmission from other patients.
  
  
  CONCLUSIONS
  Water fitting especially sink trap act as an important role in sporadic P. aeruginosa transmission in SICU patients. This report highlights the necessity of identification of potential environmental reservoirs, such as sinks, for control of infections of environmentally hardy multi-resistant P. areuginosa.
authors.affiliation: Clinical Microbiology Laboratory, Department of Respiratory Disease, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: ZhaoYan
authors.initials: Z
authors.lastname: Zhou
authors.affiliation: Department of Infection Control, Zhongshan Hospital of Fudan University, Shanghai, China. Electronic address: hu.bijie@zs-hospital.sh.cn.
authors.forename: BiJie
authors.initials: B
authors.lastname: Hu
authors.affiliation: Department of Infection Control, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: XiaoDong
authors.initials: X
authors.lastname: Gao
authors.affiliation: Clinical Microbiology Laboratory, Department of Respiratory Disease, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: Rong
authors.initials: R
authors.lastname: Bao
authors.affiliation: Laboratory of Microbiology, Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.affiliation: Clinical Microbiology Laboratory, Department of Respiratory Disease, Zhongshan Hospital of Fudan University, Shanghai, China.
authors.forename: HuaYin
authors.initials: H
authors.lastname: Li
mesh_terms: D000328:Adult; D003428:Cross Infection / Q000209:etiology*; D004866:Equipment Contamination; D004865:Equipment and Supplies, Hospital / Q000382:microbiology*; D006801:Humans; D007362:Intensive Care Units; D011446:Prospective Studies; D011552:Pseudomonas Infections / Q000209:etiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*; D014881:Water Supply
keywords: Intensive care unit; PFGE; Pseudomonas aeruginosa; Sink; Waterborne infections