Debast S B, van den Bos-Kromhout M I, de Vries-van Rossum S V, Abma-Blatter S E M, Notermans D W, Kluytmans J A J W, Immeker B, Zuur J K, Hijmering M L, Bergwerff A A, Bruins M J, Bisselink Y J W M, Hendrickx A P A, Rossen J W A
Laboratory for Medical Microbiology and Infectious Diseases, Isala Hospital, Zwolle, the Netherlands.
Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
J Hosp Infect. 2025 Aug;162:310-318. doi: 10.1016/j.jhin.2025.05.024. Epub 2025 Jun 17.
Water fixtures can be involved in hospital outbreaks with multi-resistant pathogens.
To document an outbreak of a Verona integron-encoded metallo-β-lactamase type 2-producing carbapenem-resistant Pseudomonas aeruginosa (CRPA-VIM) and evaluate infection control measures. Additionally, to overview waterborne outbreaks involving multi-resistant pathogens in Dutch healthcare institutions.
Epidemiologic analysis, selective culturing, PCR, and whole-genome sequencing (WGS) identified the outbreak sources. National surveillance databases were consulted.
In December 2023, three ICU patients tested positive for CRPA-VIM with multi-locus sequence type (MLST) ST111. Contaminated sinks were identified as the source. Despite interventions, a new cluster of five CRPA-VIM-positive patients emerged in March-April 2024. WGS linked this to a decommissioned sink (November 2021) and two patients (December 2021 and April 2023). Contact tracing and source investigations found no interpatient transmission; sinks were identified as the sole source. Measures, including contact precautions, intensified cleaning and hygiene procedures, retraining, installing and frequently replacing splash- and aerosol-reducing inlets, and faucet modifications failed to halt the transmission. No new cases occurred after the removal of all water fixtures in the ICU patient rooms. The outbreak strain was unique to the hospital and showed no genetic clustering in the national surveillance. Nationally, three to five waterborne outbreaks with highly resistant micro-organisms in hospitals are reported annually.
CRPA-VIM was transmitted from sinks to ICU patients without interpatient transmission. Infection control requires comprehensive surveillance of patients and the environment. A water-restricted and drain-free environment ended the outbreak. Future hospital design should minimize contamination from drains and sinks to reduce the nosocomial infection risk.
水设施可能与医院多重耐药病原体的暴发有关。
记录一起由产 Verona 整合子编码金属β-内酰胺酶 2 的耐碳青霉烯铜绿假单胞菌（CRPA-VIM）引起的暴发，并评估感染控制措施。此外，概述荷兰医疗机构中涉及多重耐药病原体的水传播暴发情况。
通过流行病学分析、选择性培养、聚合酶链反应（PCR）和全基因组测序（WGS）确定暴发源头。查阅国家监测数据库。
2023 年 12 月，三名重症监护病房（ICU）患者的 CRPA-VIM 检测呈阳性，多位点序列分型（MLST）为 ST111。受污染的水槽被确定为源头。尽管采取了干预措施，但在 2024 年 3 月至 4 月出现了新的一组五名 CRPA-VIM 阳性患者。WGS 将此与一个退役水槽（2021 年 11 月）和两名患者（2021 年 12 月和 2023 年 4 月）联系起来。接触者追踪和源头调查未发现患者之间的传播；水槽被确定为唯一源头。包括接触预防措施、强化清洁和卫生程序、再培训、安装并频繁更换减少飞溅和气溶胶的进水口以及水龙头改造等措施未能阻止传播。在移除 ICU 病房所有水设施后未出现新病例。暴发菌株是该医院特有的，在国家监测中未显示出基因聚类情况。在全国范围内，每年报告三至五次医院内由高耐药微生物引起的水传播暴发。
CRPA-VIM 从水槽传播至 ICU 患者，未发生患者之间的传播。感染控制需要对患者和环境进行全面监测。无水和无排水的环境结束了暴发。未来医院设计应尽量减少来自排水口和水槽的污染，以降低医院感染风险
