title: The Hospital Water Environment as a Reservoir for Carbapenem-Resistant Organisms Causing Hospital-Acquired Infections-A Systematic Review of the Literature.
abstract: 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.
authors.affiliation: Modernising Medical Microbiology Consortium, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, and.
authors.forename: Alice E
authors.initials: AE
authors.lastname: Kizny Gordon
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville.
authors.forename: Amy J
authors.initials: AJ
authors.lastname: Mathers
authors.affiliation: Department of Microbiology & Infectious Diseases, Concord Repatriation Hospital, Sydney, and.|University of Sydney, Australia.
authors.forename: Elaine Y L
authors.initials: EYL
authors.lastname: Cheong
authors.affiliation: Department of Microbiology & Infectious Diseases, Concord Repatriation Hospital, Sydney, and.|University of Sydney, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Gottlieb
authors.affiliation: Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville.
authors.forename: Shireen
authors.initials: S
authors.lastname: Kotay
authors.affiliation: Modernising Medical Microbiology Consortium, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, and.|Oxford Biomedical Research Centre, United Kingdom.
authors.forename: A Sarah
authors.initials: AS
authors.lastname: Walker
authors.affiliation: Modernising Medical Microbiology Consortium, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, and.|Oxford Biomedical Research Centre, United Kingdom.
authors.forename: Timothy E A
authors.initials: TEA
authors.lastname: Peto
authors.affiliation: Modernising Medical Microbiology Consortium, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, and.|Oxford Biomedical Research Centre, United Kingdom.
authors.forename: Derrick W
authors.initials: DW
authors.lastname: Crook
authors.affiliation: Modernising Medical Microbiology Consortium, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, and.
authors.forename: Nicole
authors.initials: N
authors.lastname: Stoesser
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis; D000073182:Carbapenem-Resistant Enterobacteriaceae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks / Q000517:prevention & control; D004197:Disease Reservoirs / Q000382:microbiology*; D004203:Disinfection; D024881:Drug Resistance, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004865:Equipment and Supplies, Hospital / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000201:enzymology / Q000235:genetics; D014871:Water Microbiology; D014881:Water Supply; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D001618:beta-Lactamases; C063912:carbapenemase
keywords: carbapenem-resistant; carbapenemase; healthcare-associated infections; outbreak; water.