Carbapenemase-producing Enterobacteriaceae in hospital wastewater : a reservoir that may be unrelated to clinical isolates [star]

White, Leila and Hopkins, Katie and Meunier, Danièle and Perry, Claire L. and Pike, Rachel and Wilkinson, Paul and Pickup, Roger William and Cheesbrough, John and Woodford, Neil (2016) Carbapenemase-producing Enterobacteriaceae in hospital wastewater : a reservoir that may be unrelated to clinical isolates [star]. Journal of Hospital Infection, 93 (2). pp. 145-151. ISSN 0195-6701

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Summary Background: Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging infection control problem in hospitals worldwide. Identifying carriers can help reduce potential spread and infections. Aim: To assess whether testing hospital wastewater for CPE can supplement patient based screening for infection prevention purposes in a hospital without a recognised endemic CPE problem. Methods: Wastewater collected from hospital pipework on 16 occasions during February-March 2014 was screened for CPE using chromID®CARBA agar and chromID®CPS agar with a 10 μg ertapenem disc and combination disc testing. MICs were determined using British Society for Antimicrobial Chemotherapy methodology and carbapenemase genes detected by PCR or wholegenome sequencing. Selected isolates were typed by PFGE. Findings: Suspected CPE were recovered from all 16 wastewater samples. Of 17 isolates sent to Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, six (four Citrobacter freundii and two Enterobacter cloacae complex) were New Delhi metallo–beta-lactamase (NDM) producers and the remaining 11 (six Klebsiella oxytoca and five Enterobacter cloacae complex), Guiana-Extended-Spectrum-5 (GES-5) producers, the first to be described in Enterobacteriaceae in the UK. The four NDM-producing C. freundii, two NDM-producing E. cloacae complex and 4/5 GES-5-producing E. cloacae complex were each indistinguishable isolates of the same three strains, whereas the six GES-5-producing K. oxytoca overall shared 79% similarity. Conclusion: CPE are readily isolated from hospital wastewater using simple culture methods. There are either undetected carriers of CPE excreting into the wastewater, or these CPE represent colonisation of the pipework. Surveillance of hospital wastewater for CPE does not appear helpful for infection control purposes.

Item Type:
Journal Article
Journal or Publication Title:
Journal of Hospital Infection
Additional Information:
This is the author’s version of a work that was accepted for publication in Journal of Hospital Infection. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Hospital Infection, 93, 2, 2016 DOI: 10.1016/j.jhin.2016.03.007
Uncontrolled Keywords:
?? guiana-extended-spectrum-5 (ges-5)metallo-β-lactamasecarbapenem resistancesurveillanceinfectious diseasesmicrobiology (medical) ??
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Deposited On:
08 Apr 2016 15:34
Last Modified:
19 Jan 2024 00:14