Transmission of a multiresistant Pseudomonas aeruginosa strain at a German University Hospital

doi:10.1053/jhin.2000.0880

Journal of Hospital Infection

Volume 47, Issue 2, February 2001, Pages 125-130

https://doi.org/10.1053/jhin.2000.0880 Get rights and content

Abstract

Over 15 months, 60 patients at a German University Hospital became infected or colonized by a multiresistant Pseudomonas aeruginosa strain, which was isolated from tracheal secretions, blood, urine, venous catheters, ascites and several wounds. Most patients had undergone invasive treatment (surgery, cancer therapy).

The genetic relationship of the isolates was investigated by pulsed field gel electrophoresis. The isolates were resistant to β-lactam antibiotics, including carbapenems and aztreonam, to aminoglycosides and quinolones. The only in vitro susceptibility was to polymyxin B.

Extensive sampling was carried out to identify contaminated medical devices, surfaces or media (water, food). Samples were taken from doctors and nursing staff and various treatment procedures were observed for several weeks. The handling of respirators, resuscitation tubes, urine bottles, and bedpans resulted in the contamination of the patients' environment, although most devices were cleaned and disinfected with automatic washer/disinfectors. Several wash basins on the intensive care unit were contaminated, but none of the drinking water samples showed any growth of P. aeruginosa.

We recommend the strict use of gloves and strict application of alcoholic hand disinfectants immediately after discarding the gloves. The chain of infection ceased after strict cohort isolation and the subsequent introduction of the specific hygiene regime.

References (17)

HJ Kolmos et al.
Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients
J Hosp Inf
(1993)
A Ferroni et al.
Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a paediatric surgical unit associated with tap-water contamination
J Hosp Inf
(1998)
F Bert et al.
Multiresistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit
J Hosp Inf
(1998)
MJ Struelens et al.
Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis
Am J Med
(1993)
GB Orsi et al.
Lack of association between clinical and environmental isolates of Pseudomonas aeruginosa in hospital wards
J Hosp Inf
(1994)
WR Jarvis et al.
Predominant pathogens in hospital infections
J Antimicrob Chemoth
(1992)
F Bert et al.
Comparative distribution of resistance patterns and serotypes in Pseudomonas aeruginosa isolates from intensive care units and other wards
J Antimicrob Chemoth
(1996)
AF Widmer et al.
Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: Probable transmission via hands of a health care worker
Clin Inf Dis
(1993)

There are more references available in the full text version of this article.

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^f1: correspondence: Professor F. A. Pitten.E-mail:[email protected]

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Journal of Hospital Infection

Abstract

References (17)

Outbreak of infection in a burns unit due to Pseudomonas aeruginosa originating from contaminated tubing used for irrigation of patients

J Hosp Inf

Outbreak of nosocomial urinary tract infections due to Pseudomonas aeruginosa in a paediatric surgical unit associated with tap-water contamination

J Hosp Inf

Multiresistant Pseudomonas aeruginosa outbreak associated with contaminated tap water in a neurosurgery intensive care unit

J Hosp Inf

Pseudomonas aeruginosa and Enterobacteriaceae bacteremia after biliary endoscopy: an outbreak investigation using DNA macrorestriction analysis

Am J Med

Lack of association between clinical and environmental isolates of Pseudomonas aeruginosa in hospital wards

J Hosp Inf

Predominant pathogens in hospital infections

J Antimicrob Chemoth

Comparative distribution of resistance patterns and serotypes in Pseudomonas aeruginosa isolates from intensive care units and other wards

J Antimicrob Chemoth

Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: Probable transmission via hands of a health care worker

Clin Inf Dis

Cited by (49)

An intensive care unit outbreak with multi-drug-resistant Pseudomonas aeruginosa – spotlight on sinks

It's a trap! The development of a versatile drain biofilm model and its susceptibility to disinfection

Decontamination of hand washbasins and traps in hospitals

Imipenem and ciprofloxacin consumption as factors associated with high incidence rates of resistant Pseudomonas aeruginosa in hospitals in northern France

Common Approaches to the Control of Multidrug-resistant Organisms Other Than Methicillin-resistant Staphylococcus aureus (MRSA)

Profile of anesthetic infection control in Taiwan: a questionnaire report

Regular ArticleTransmission of a multiresistant Pseudomonas aeruginosa strain at a German University Hospital

Abstract

J Hosp Inf

J Hosp Inf

J Hosp Inf

Am J Med

J Hosp Inf

Predominant pathogens in hospital infections

J Antimicrob Chemoth

Comparative distribution of resistance patterns and serotypes in Pseudomonas aeruginosa isolates from intensive care units and other wards

J Antimicrob Chemoth

Outbreak of Pseudomonas aeruginosa infections in a surgical intensive care unit: Probable transmission via hands of a health care worker

Clin Inf Dis

Regular Article
Transmission of a multiresistant Pseudomonas aeruginosa strain at a German University Hospital