Handwashing sinks as the source of transmission of ST16 carbapenem-resistant Klebsiella pneumoniae, an international high-risk clone, in an intensive care unit

Y Feng; L Wei; S Zhu; F Qiao; X Zhang; Y Kang; L Cai; M Kang; A McNally; Z Zong

doi:10.1016/j.jhin.2019.10.006

Handwashing sinks as the source of transmission of ST16 carbapenem-resistant Klebsiella pneumoniae, an international high-risk clone, in an intensive care unit

J Hosp Infect. 2020 Apr;104(4):492-496. doi: 10.1016/j.jhin.2019.10.006. Epub 2019 Oct 10.

Authors

Y Feng¹, L Wei², S Zhu², F Qiao², X Zhang¹, Y Kang³, L Cai³, M Kang⁴, A McNally⁵, Z Zong⁶

Affiliations

¹ Centre of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China; Centre for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China.
² Department of Infection Control, West China Hospital, Sichuan University, Chengdu, China.
³ Intensive Care Unit, West China Hospital, Sichuan University, Chengdu, China.
⁴ Laboratory of Clinical Microbiology, Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, China.
⁵ Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
⁶ Centre of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China; Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China; Centre for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China; Department of Infection Control, West China Hospital, Sichuan University, Chengdu, China. Electronic address: [email protected].

PMID: 31606433
DOI: 10.1016/j.jhin.2019.10.006

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates (carrying the carbapenemase gene bla_NDM-5) of sequence type 16 caused hospital-acquired bloodstream infection or gut colonization in two patients in an intensive care unit (ICU). It was hypothesized that handwashing sinks were the source, and all handwashing sinks in the ICU were sampled. Whole-genome sequencing and analysis revealed that one sink was the source of CRKP colonization/infection in both patients, instead of direct transmission of a common clone between the patients. This study highlights handwashing sinks as an important source of multi-drug-resistant organisms. Sink management, including prohibition of disposal of body fluids and daily disinfection with chlorine, curbed the transmission.

Keywords: Carbapenem resistance; Carbapenemases; Klebsiella pneumoniae; Sinks.

MeSH terms

Carbapenem-Resistant Enterobacteriaceae / genetics*
Carbapenem-Resistant Enterobacteriaceae / isolation & purification*
China
Cross Infection
Databases, Nucleic Acid
Hand Disinfection
Humans
Intensive Care Units
Klebsiella Infections
Klebsiella pneumoniae / genetics*
Klebsiella pneumoniae / isolation & purification*
Wastewater / microbiology*
Water Microbiology*
Whole Genome Sequencing

Substances

Waste Water

Grants and funding

MR/S013660/1/MRC_/Medical Research Council/United Kingdom