Querin Benjamin, Danjean Maxime, Jolivet Sarah, Couturier Jeanne, Oubbéa Soumaya, Jouans Claire, Lazare Christelle, Montagne Théo, Chamming's Aurélia, Luce Solweig, Dhenin Gil, Audrain Nathalie, Fieux Fabienne, Verdonk Franck, Decousser Jean-Winoc, Stordeur Florence, Barbut Frédéric
Unité de Prévention du Risque Infectieux, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France.
Equipe Opérationnelle d'Hygiène, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
Antimicrob Resist Infect Control. 2025 Aug 4;14(1):95. doi: 10.1186/s13756-025-01599-2.
Pseudomonas aeruginosa is frequently responsible for hospital-acquired infections. It may be isolated in healthcare environment where it can survive. Between January 2018 and June 2024, a growing number of VIM-producing Pseudomonas aeruginosa (PA-VIM) were isolated from patients hospitalized in our surgical intensive care unit (SICU). The aim of this study was to investigate SICU long-term PA-VIM outbreaks involving a persistent environmental reservoir.
Investigations included an active case finding, a matched case-control study to identify factors associated with PA-VIM acquisition, the identification of environmental reservoirs, a whole-genome sequencing analysis of patient and environmental strains, and the implementation of control measures.
During these outbreaks, 32 patients were colonized or identified with at least one PA-VIM positive clinical sample during their SICU stay. Factors significantly associated with the PA-VIM acquisition in the conditional univariate analysis included exposure to antibiotics (e.g., carbapenem) and antifungals, and the use of a nasogastric tube and enteral nutrition. Among 342 environmental samples collected in the SICU (including sink drains, syringes and glasses containing syringes used for enteral nutrition), 67 (19.6%) were found positive for PA-VIM. Core-genome Multi-Locus Sequence Typing analysis identified 2 major clones, each including patients and environmental strains.
These long-lasting outbreaks of PA-VIM were associated to a persistent environmental contamination of sink drains. All the strategies aiming at eradicating PA-VIM reservoirs (disinfection, descaling, or replacement of sink drains) failed or only showed a temporary effect.
铜绿假单胞菌常导致医院获得性感染。它可能在能使其存活的医疗环境中被分离出来。在2018年1月至2024年6月期间，从我们外科重症监护病房（SICU）住院患者中分离出越来越多产VIM的铜绿假单胞菌（PA-VIM）。本研究的目的是调查涉及持续环境储源的SICU长期PA-VIM暴发情况。
调查包括主动病例发现、一项匹配病例对照研究以确定与PA-VIM获得相关的因素、环境储源的识别、患者和环境菌株的全基因组测序分析以及控制措施的实施。
在这些暴发期间，32名患者在其SICU住院期间被至少一份PA-VIM阳性临床样本定植或鉴定出感染。在条件单变量分析中与PA-VIM获得显著相关的因素包括接触抗生素（如碳青霉烯类）和抗真菌药，以及使用鼻胃管和肠内营养。在SICU收集的342份环境样本（包括水槽排水口、注射器以及用于肠内营养的装有注射器的杯子）中，67份（19.6%）PA-VIM检测呈阳性。核心基因组多位点序列分型分析确定了2个主要克隆群，每个克隆群均包括患者和环境菌株。
这些PA-VIM的长期暴发与水槽排水口的持续环境污染有关。所有旨在根除PA-VIM储源的策略（消毒、除垢或更换水槽排水口）均失败或仅显示出暂时效果。
