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

doi:10.1093/ofid/ofad194

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

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

Authors

Allison Chan¹, Katie Thure¹, Kelley Tobey¹, Alicia Shugart², Sarah Schmedes³, James Albert Burks 4th⁴, Henrietta Hardin⁴, Christina Moore⁴, Tina Carpenter⁵, Stephanie Brooks⁵, Paige Gable², Heather Moulton Meissner², Gillian McAllister², Adrian Lawsin², Alison Laufer Halpin², Maroya Spalding Walters², Amelia Keaton¹

Affiliations

¹ Healthcare Associated Infections and Antimicrobial Resistance Program, Communicable and Environmental Diseases and Emergency Preparedness, Tennessee Department of Health, Nashville, Tennessee, USA.
² Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, Georgia, USA.
³ Florida Department of Health, Bureau of Public Health Laboratories, Jacksonville, Florida, USA.
⁴ Division of Laboratory Services, Tennessee Department of Health, Nashville, Tennessee, USA.
⁵ North Knoxville Medical Center, Knoxville, Tennessee, USA.

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 bla_VIM 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 bla_VIM-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.