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Long-term contamination of sink drains by carbapenemase-producing Enterobacterales in three intensive care units: characteristics and transmission to patients

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Summary

This study aimed to describe the contamination of sink drains (SDs) with carbapenemase-producing Enterobacterales (CPE) in three intensive care units (ICUs), and to assess the risk of transmission to hospitalized patients. All SDs were sampled monthly for CPE screening by culture. Rectal screening for CPE carriage was conducted weekly for hospitalized patients. CPE were isolated from 22% of SD samples. Some SDs remained colonized with the same strain for several months. No CPE acquisition occurred among hospitalized patients during the study. Certain strategies, such as systematic sampling of SDs in ICUs for screening for contamination by CPE, should be discouraged apart from during outbreaks.

Introduction

Carbapenemase-producing Enterobacterales (CPE) are an important and increasing threat to global health as treatment options for infected patients are severely limited [1]. Sink drain (SD) contamination with CPE has been reported from intensive care units (ICUs) in CPE outbreaks [2,3], and SD contamination has been considered to be involved in some outbreaks [2]. The authors recently reported the isolation of two closely related isolates of OXA-48-producing Klebsiella pneumoniae in the same SD of a surgical ICU in October 2015 and April 2019 without identifying patient acquisition during this period despite active surveillance by weekly rectal screening [4]. However, the absence of SD sampling within this period (nearly 4 years) meant that the authors were unable to determine whether or not the SD was contaminated continuously. Overall, the risk of CPE transmission to patients from contaminated SDs remains unclear, and it would be interesting to estimate this risk in the case of long-term SD contamination.

The objective of this study was to prospectively describe the contamination of SDs in three ICUs, and assess the risk of transmission to hospitalized patients.

Section snippets

Methods

This prospective study was conducted over a 1-year period (1st October 2019–1st October 2020) in the Department of Medical Intensive Care at a French teaching hospital. This department consists of three ICUs (ICU1, ICU2 and ICU3) with eight single rooms in each ICU. Each room had one sink, used routinely for handwashing and for eliminating water used for washing the patient in bed, potentially containing body fluids. The SDs did not have a self-disinfecting system, but the local recommendation

Results

Due to the coronavirus disease 2019 pandemic and the high proportion of infected patients in the Department of Medical Intensive Care, SDs were not sampled for 2 months (mid-March to mid-May 2020) corresponding with the lockdown period in France. Overall, 14 sampling campaigns were performed in ICU1, 13 were performed in ICU2 and 13 were performed in ICU3. In total, 255 specimens were collected; this equated to 79.7% of the number planned initially.

The proportion of CPE-positive specimens among

Discussion

The risk of CPE transmission to patients from contaminated SDs appears to be very limited. Despite recurrent contamination of one-third of SDs, no cases of CPE acquisition were recorded among the patients. Although it would not be reasonable to deny the possibility of hidden transmission with a mean length of hospitalization of 7.5 days, the high number of clinical samples and the strategy of active screening provided acceptable sensitivity for carrier identification. On the contrary, the

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