SG-APSIC1118: Introduction of carbapenemase-producing Enterobacterales (CPE) in the aqueous environment of the newly built National Centre for Infectious Diseases (NCID) in Singapore. (February 2023)

• Record Type: Journal Article
• Authors: Ong, Chong Hui Clara; Linn, Kyaw Zaw; Farhanah, Sharifah; Xiaowei, Huan; Loo, Liang Hui; Tan, Danielle Hui Ru; Hamad, Nur Hafizah Binte; Lim, Allie Yin; Poon, Chu Ying; Tang, Ying Wei; Hon, Pei Yun; Vasoo, Shawn; Ng, Oon Tek; Marimuthu, Kalisvar
• Is Part Of: Antimicrobial stewardship & healthcare epidemiology. Volume 3(2023)Supplement 1
• Page Start: s11
• Page End: s12
• Publication Date: 2023-02
• Subjects: Anti-infective agents -- Periodicals; Nosocomial infections -- Prevention -- Periodicals; Epidemiology -- Periodicals; 614.44
• DOI: 10.1017/ash.2023.36
• Languages: English
• ISSNs: 2732-494X

Abstract

Abstract : Objectives: In healthcare facilities, environmental reservoirs of CPE are associated with CPE outbreaks. In the newly built NCID building, we studied the introduction of CPE in the aqueous environment. Methods: We sampled the aqueous environments (ie, sink, sink strainer, and shower drain-trap with Copan E-swabs and sink P-trap water) of 4 NCID wards (ie, 2 multidrug-resistant organism (MDRO) wards and 2 non-MDRO wards). Two sampling cycles (cycle 1, June–July 2019 and cycle 2, September–November 2019) were conducted in all 4 wards. Cycle 3 (November 2020) was conducted in 1 non-MDRO ward to investigate CPE colonization from previous cycles. Enterobacterales were identified using MALDI-TOF MS and underwent phenotypic (mCIM and eCIM) and confirmatory PCR tests for CPE. Results: We collected 448, 636, and 96 samples in cycles 1, 2, and 3, respectively. MDRO and non-MDRO wards were operational for 1 and 7 months during the first sampling cycle. The CPE prevalence rates in MDRO wards were 1.67% (95% CI, 0.46% – 4.21%) in cycle 1 and 1.76% (95% CI, 0.65% – 3.80%) in cycle 2. In the aqueous environments in MDRO wards, multiple species were detected (cycle 1: 2 K. pneumoniae, 1 E. coli, and 1 S. marcescens ; cycle 2: 5 K. pneumoniae and 1 R. planticola ), and multiple genotypes were detected (cycle 1: 3 bla OXA48; cycle 2: 5 bla OXA48 and 1 bla KPC). The CPE prevalence in non-MDRO wards was 1.92% (95% CI, 0.53%–4.85%) in cycle 1. The prevalence rate increased by 5.51% (95% CI, 1.99%–9.03%) to 7.43% (95% CI, 4.72%–11.04%; P = .006) in cycle 2, and by another 2.98% (95% CI, −3.82% to 9.79%) to 10.42% (95% CI, 5.11% – 18.3%; P = .353) in cycle 3. Only bla OXA48 S. marcescens were detected in all cycles (except 1 bla OXA48 K. pneumoniae in cycle 2) in the non-MDRO ward. Conclusions: CPE established rapidly in the aqueous environment of NCID wards, more so in MDRO wards than non-MDRO wards. Longitudinal studies to understand the further expansion of the CPE colonization and its impact on patients are needed.