Hospital water environment and antibiotic use: Key factors in a nosocomial outbreak of carbapenemase-producing Serratia marcescens

Uh Jin Kim; Su-Mi Choi; Minji Kim; Sarah Kim; Sung Un Shin; Sa-Rang Oh; Ji-Won Park; Hwa Young Shin; You Jung Kim; Unhee Lee; Ok-Ja Choi; Hyun-Young Park; Jong-Hee Shin; Seong Eun Kim; Seung-Ji Kang; Sook In Jung; Kyung-Hwa Park

doi:10.1016/j.jhin.2024.04.021

Hospital water environment and antibiotic use: Key factors in a nosocomial outbreak of carbapenemase-producing Serratia marcescens

J Hosp Infect. 2024 May 11:S0195-6701(24)00167-1. doi: 10.1016/j.jhin.2024.04.021. Online ahead of print.

Authors

Uh Jin Kim¹, Su-Mi Choi², Minji Kim², Sarah Kim², Sung Un Shin², Sa-Rang Oh³, Ji-Won Park³, Hwa Young Shin³, You Jung Kim³, Unhee Lee³, Ok-Ja Choi³, Hyun-Young Park⁴, Jong-Hee Shin⁵, Seong Eun Kim¹, Seung-Ji Kang¹, Sook In Jung¹, Kyung-Hwa Park⁶

Affiliations

¹ Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
² Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea.
³ Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea.
⁴ Department of Pharmacy, Chonnam National University Hospital, Gwangju, Republic of Korea.
⁵ Department of Laboratory Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea.
⁶ Department of Infectious Diseases, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infection Control Unit, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Infectious Diseases, Chonnam National University Medical School, Gwangju, Republic of Korea. Electronic address: iammedkid@naver.com.

PMID: 38740300
DOI: 10.1016/j.jhin.2024.04.021

Abstract

Background: The healthcare water environment is a potential reservoir of carbapenem-resistant organisms (CROs). Here, we report the role of the water environment as a reservoir and the infection control measures applied to suppress a prolonged outbreak of Klebsiella pneumoniae carbapenemase-producing Serratia marcescens (KPC-SM) in two intensive care units (ICUs).

Methods: The outbreak occurred in the ICUs of a tertiary hospital from October 2020 to July 2021. Comprehensive patient contact tracing and environmental assessments were conducted, and a case-control study was performed to identify factors associated with the acquisition of KPC-SM. Associations among isolates were assessed via pulsed-field gel electrophoresis (PFGE). Antibiotic usage was analyzed. .

Results: The outbreak consisted of two waves involving a total of 30 patients with KPC-SM. Multiple environmental cultures identified KPC-SM in a sink, a dirty utility room, and a communal bathroom shared by the ICUs, together with the waste bucket of a continuous renal replacement therapy (CRRT) system. The genetic similarity of the KPC-SM isolates from patients and the environment was confirmed by PFGE. A retrospective review of 30 cases identified that the use of CRRT and antibiotics were associated with acquisition of KPC-SM (p < 0.05). There was a continuous increase in the use of carbapenems; notably, the use of colistin has increased since 2019.

Conclusion: Our study demonstrates that CRRT systems, along with other hospital water environments, are significant potential sources of resistant microorganisms, underscoring the necessity of enhancing infection control practices in these areas.

Keywords: Carbapenemase; Hospital water; Infection control; Intensive care unit; Serratia marcescens.