Control of Multidrug-Resistant Pseudomonas aeruginosa in Allogeneic Hematopoietic Stem Cell Transplant Recipients by a Novel Bundle Including Remodeling of Sanitary and Water Supply Systems. (18th May 2017)

• Record Type: Journal Article
• Authors: Kossow, Annelene; Kampmeier, Stefanie; Willems, Stefanie; Berdel, Wolfgang E.; Groll, Andreas H; Burckhardt, Birgit; Rossig, Claudia; Groth, Christoph; Idelevich, Evgeny A; Kipp, Frank; Mellmann, Alexander; Stelljes, Matthias
• Is Part Of: Clinical infectious diseases. Volume 65:Number 6(2017)
• Page Start: 935
• Page End: 942
• Publication Date: 2017-05-18
• Subjects: multidrug-resistant Pseudomonas aeruginosa -- infection control -- hospital acquired infection -- immunocompromised hosts -- hospital water system; Communicable diseases -- Periodicals; 616.905
• DOI: 10.1093/cid/cix465
• Languages: English
• ISSNs: 1058-4838

Abstract

Summary: Through major reconstruction of the water and sanitary system, we were able to significantly reduce the burden of Pseudomonas aeruginosa infections and colonizations in allogeneic hematopoietic stem cell transplant recipients as a high-risk patient group. Abstract: Background: Infections by multidrug-resistant Pseudomonas aeruginosa (MDRPa) are an important cause of morbidity and mortality in patients after allogeneic hematopoietic stem cell transplantation (HSCT). Humid environments can serve as a reservoir and source of infection by this pathogen. To minimize the risk of infection from these reservoirs, we performed extensive remodeling of sanitation and water installations as the focus of our hygiene bundle. Methods: During the reconstruction of our transplantation unit (April 2011–April 2014) we implemented several technical modifications to reduce environmental contamination by and subsequent spreading of MDRPa, including a newly designed shower drain, disinfecting siphons underneath the sinks, and rimless toilets. During a 3-year study period (2012–2014), we tracked the number of patients affected by MDRPa (colonized and/or infected) and the outcome of infected patients, and monitored the environmental occurrence of this pathogen. We further performed whole-genome sequencing of nosocomial MDRPa strains to evaluate genotypic relationships between isolates. Results: Whereas 31 (9.2%; 18 colonized, 13 infected) patients were affected in 2012 and 2013, the number decreased to 3 in 2014 (17%; 3 colonized, 0 infected). Lethality by MDRPa similarly decreased from 3.6% to 0%. Environmental detection of MDRPa decreased in toilets from 18.9% in 2012–2013 to 6.1% in the following year and from 8.1% to 3.0%, respectively, in shower outlets. Whole-genome sequencing showed close relationships between environmental and patient-derived isolates. Conclusions: Hospital construction measures aimed at controlling environmental contamination by and spread of MDRPa are effective at minimizing the risk of highly lethal MDRPa infections.