Faculty of Medical Sciences, Division of Infection and Immunity, University College London, London, UK; Environmental Research Laboratory, University College London Hospitals NHS Foundation Trust, London, UK.
Faculty of Medical Sciences, Division of Infection and Immunity, University College London, London, UK; Environmental Research Laboratory, University College London Hospitals NHS Foundation Trust, London, UK.
J Hosp Infect. 2024 Oct;152:42-46. doi: 10.1016/j.jhin.2024.07.005. Epub 2024 Jul 18.
Pseudomonas aeruginosa is a leading cause of healthcare-associated infections in patients exposed to hospital waters. A rising incidence of P. aeruginosa bacteraemia at our tertiary teaching hospital prompted investigation.
Microbiological screening at patient admission to support early identification of acquisition.
A 41-bed haematology ward (800-bed teaching-hospital, London) was surveyed between January 24, 2020 and May 13, 2020. Concurrent rectal and groin swabs were collected in duplicate upon admission weekly. Results were compared with historical shower, drain, and tap water contamination data.
A total of 606 groin/rectal swabs were collected from 154 patients; 61 female and 93 male. Six out of 154 patients admitted (3.9%) were positive for P. aeruginosa. Two patients (1.3%; 95% confidence interval (CI): 0.16 to 4.6) were colonized at admission while four patients (2.6%; CI: 0.7 to 6.5) became colonized by 33 days (interquartile range: 13 to 54) of stay. Concurrent duplicate sampling yielded both positive and negative results in all colonized patient-cases. One patient subsequently developed P. aeruginosa bacteraemia. Shower water and corresponding drains from the four patient rooms where P. aeruginosa was acquired were heavily contaminated (>300 cfu/100 mL) with P. aeruginosa 265 days (median; range: 247-283) before patient admission.
Rectal/groin swab-screening at admission to hospital might be valuable for early detection of patient colonization but it is intrusive, resource-demanding, and yield may be low. In high-risk settings, enhanced environmental monitoring, decontamination of surfaces and drains, and point-of-use filter-barriers is recommended, especially if expected duration of stay exceeds 30 days.
铜绿假单胞菌是暴露于医院用水的患者发生医院获得性感染的主要原因。我们的三级教学医院铜绿假单胞菌菌血症的发病率不断上升，促使我们进行了调查。
对患者入院时进行微生物筛查，以支持早期识别感染。
2020 年 1 月 24 日至 5 月 13 日期间，我们对 41 张病床的血液科病房（800 张病床的教学医院，伦敦）进行了调查。入院时每周采集两次直肠和腹股沟拭子的双份样本。结果与历史上的淋浴水、排水和自来水污染数据进行了比较。
从 154 名患者中采集了 606 份腹股沟/直肠拭子；其中 61 名女性和 93 名男性。154 名入院患者中有 6 名（3.9%）检测出铜绿假单胞菌阳性。2 名患者（1.3%；95%置信区间（CI）：0.16 至 4.6）入院时定植，4 名患者（2.6%；CI：0.7 至 6.5）在入住 33 天（中位数 13 至 54 天）时定植。所有定植患者的两次重复采样均产生阳性和阴性结果。随后有 1 名患者发生铜绿假单胞菌菌血症。在获得铜绿假单胞菌的 4 个患者房间的淋浴水和相应的排水中，在患者入院前 265 天（中位数；范围：247-283）就已受到严重污染（>300 cfu/100 mL）。
在医院入院时进行直肠/腹股沟拭子筛查可能有助于早期发现患者定植，但它具有侵入性、资源需求大，且可能检测率低。在高风险环境中，建议进行增强的环境监测、表面和排水渠的去污以及使用即用型过滤屏障，尤其是如果预计住院时间超过 30 天。
