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. 2025 Aug 4;14(1):95.
doi: 10.1186/s13756-025-01599-2.

Protracted outbreaks of VIM-producing Pseudomonas aeruginosa in a surgical intensive care unit in France, January 2018 to June 2024

Benjamin Querin  1 , Maxime Danjean  2   3 , Sarah Jolivet  1   4 , Jeanne Couturier  5   6 , Soumaya Oubbéa  1 , Claire Jouans  1 , Christelle Lazare  5 , Théo Montagne  5 , Aurélia Chamming's  5 , Solweig Luce  1 , Gil Dhenin  1 , Nathalie Audrain  1 , Fabienne Fieux  7 , Franck Verdonk  7 , Jean-Winoc Decousser  2   3 , Florence Stordeur  1   8 , Frédéric Barbut  9   10   11
Affiliations

Protracted outbreaks of VIM-producing Pseudomonas aeruginosa in a surgical intensive care unit in France, January 2018 to June 2024

Benjamin Querin et al. Antimicrob Resist Infect Control. .

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Pseudomonas aeruginosa; CgMLST; Outbreak; Sink drains; Surgical intensive care unit; VIM; Whole-genome sequencing.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the local Committee of Healthcare Infection Prevention and Control. According to French law, informed consent for this observational, non-interventional study is not mandatory. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Map of the adult surgical intensive care (units A and B, 9 single-bed rooms each)
Fig. 2
Fig. 2
Epidemic curve of VIM-producing Pseudomonas aeruginosa (PA-VIM) cases in the surgical intensive care unit (SICU). Surgical Intensive Care Unit (SICU), VIM-producing Pseudomonas aeruginosa (PA-VIM)
Fig. 3
Fig. 3
Genomic distance of VIM-producing Pseudomonas aeruginosa (PA-VIM) strains by pairwise comparison of core-genes allelic profiles Each VIM-producing Pseudomonas aeruginosa (PA-VIM) strain is represented by a circle. Each sequence type (ST) is represented by a colour (dark blue: ST357; light blue: undetermined ST; orange: ST298; dark green: ST235; light green: ST823). Each cluster (based on the 14 alleles difference threshold) is represented by a rectangle. Genomes with an allelic distance of zero are aggregated into a single, larger circle. The size of the circle is directly proportional to the number of aggregated genomes. The allelic distance between two strains is represented by a line with a number. A full line means that the allelic distance < 50, while a dotted line means that the distance > 100
See this image and copyright information in PMC

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