Journal
CLINICAL INFECTIOUS DISEASES
Volume 64, Issue 10, Pages 1435-1444Publisher
OXFORD UNIV PRESS INC
DOI: 10.1093/cid/cix132
Keywords
carbapenem-resistant; carbapenemase; healthcare-associated infections; outbreak; water
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Funding
- National Institute for Health Research/University of Oxford
- Academy of Medical Sciences (United Kingdom)
- Oxford Biomedical Research Centre
- National Institute for Health Research
- National Institutes of Health Research (NIHR) [RP-PG-0514-20015] Funding Source: National Institutes of Health Research (NIHR)
- Academy of Medical Sciences (AMS) [SGL015\\1027] Funding Source: researchfish
- National Institute for Health Research [NF-SI-0508-10279, RP-PG-0514-20015, NF-SI-0513-10110] Funding Source: researchfish
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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-beta-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.
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