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. 2023 Apr 11;10(5):ofad194.
doi: 10.1093/ofid/ofad194. eCollection 2023 May.

Containment of a Verona Integron-Encoded Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Outbreak Associated With an Acute Care Hospital Sink-Tennessee, 2018-2020

Allison Chan  1 , Katie Thure  1 , Kelley Tobey  1 , Alicia Shugart  2 , Sarah Schmedes  3 , James Albert Burks 4th  4 , Henrietta Hardin  4 , Christina Moore  4 , Tina Carpenter  5 , Stephanie Brooks  5 , Paige Gable  2 , Heather Moulton Meissner  2 , Gillian McAllister  2 , Adrian Lawsin  2 , Alison Laufer Halpin  2 , Maroya Spalding Walters  2 , Amelia Keaton  1
Affiliations

Containment of a Verona Integron-Encoded Metallo-Beta-Lactamase-Producing Pseudomonas aeruginosa Outbreak Associated With an Acute Care Hospital Sink-Tennessee, 2018-2020

Allison Chan et al. Open Forum Infect Dis. .

Abstract

Background: Contaminated healthcare facility wastewater plumbing is recognized as a source of carbapenemase-producing organism transmission. In August 2019, the Tennessee Department of Health (TDH) identified a patient colonized with Verona integron-encoded metallo-beta-lactamase-producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA). A record review revealed that 33% (4 of 12) of all reported patients in Tennessee with VIM had history of prior admission to acute care hospital (ACH) A intensive care unit (ICU) Room X, prompting further investigation.

Methods: A case was defined as polymerase chain reaction detection of blaVIM in a patient with prior admission to ACH A from November 2017 to November 2020. The TDH performed point prevalence surveys, discharge screening, onsite observations, and environmental testing at ACH A. The VIM-CRPA isolates underwent whole-genome sequencing (WGS).

Results: In a screening of 44% (n = 11) of 25 patients admitted to Room X between January and June 2020, we identified 36% (n = 4) colonized with VIM-CRPA, resulting in 8 cases associated with Room X from March 2018 to June 2020. No additional cases were identified in 2 point-prevalence surveys of the ACH A ICU. Samples from the bathroom and handwashing sink drains in Room X grew VIM-CRPA; all available case and environmental isolates were found to be ST253 harboring blaVIM-1 and to be closely related by WGS. Transmission ended after implementation of intensive water management and infection control interventions.

Conclusions: A single ICU room's contaminated drains were associated with 8 VIM-CRPA cases over a 2-year period. This outbreak highlights the need to include wastewater plumbing in hospital water management plans to mitigate the risk of transmission of antibiotic-resistant organisms to patients.

Keywords: carbapenem-resistant; carbapenemase; healthcare-associated infections; opportunistic pathogens of premise plumbing; outbreak.

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Conflict of interest statement

Potential conflicts of interest. All authors: No reported conflicts of interest.

Figures

Figure 1.
Figure 1.
Verona integron-encoded metallo-beta-lactamase cases by month of specimen collection, location of collection, and timeline of interventions from March 2018 to November 2020 (N = 8). *No organism was viable for culture. ACH, acute care hospital; LTACH, long-term acute care hospital; vSNF, ventilator-capable skilled nursing facility.
See this image and copyright information in PMC

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