Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks
ObjectiveTo investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (1...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2016-07-01
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| Series: | Frontiers in Microbiology |
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| Online Access: | http://journal.frontiersin.org/Journal/10.3389/fmicb.2016.01070/full |
| _version_ | 1818470384464297984 |
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| author | Angelique Chapuis Lucie Amoureux Julien Bador Eliane Siebor Arthur Gavalas Marion Janin Marie-Lorraine Chrétien Denis Caillot Claire de Curraize Catherine Neuwirth |
| author_facet | Angelique Chapuis Lucie Amoureux Julien Bador Eliane Siebor Arthur Gavalas Marion Janin Marie-Lorraine Chrétien Denis Caillot Claire de Curraize Catherine Neuwirth |
| author_sort | Angelique Chapuis |
| collection | DOAJ |
| description | ObjectiveTo investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (10 infected and 33 colonized). DesignWe performed environmental analysis to detect multiresistant E. cloacae for comparison with clinical isolates (genotyping by pulsed-field gel electrophoresis and MLST as well as ESBL-typing) and determined the MICs of the quaternary ammonium compounds (QACs) alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC). A bleach-based cleaning-disinfection program was implemented in December 2012 after mechanical removal of the biofilm in all sinks. ResultsWe have detected 17 ESBL-producing E. cloacae in patients sink drains, shower drains and medical sink drains. Sequencing of the bla genes performed on 60 strains recovered from patients and environment (n=43 clinical and n=17 environmental) revealed that bla CTX-M15 was predominant (37 isolates) followed by bla CTX-M9 plus bla SHV-12 (20 isolates). We observed a great diversity among the isolates: 14 pulsotypes (11 STs) in clinical isolates and 9 pulsotypes (7 STs) in environmental isolates. Six pulsotypes were identical between clinical and environmental isolates. MICs of the quaternary ammonium compounds widely used for disinfection were very high in clinical and environmental isolates. Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number. Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens. |
| first_indexed | 2024-04-13T21:36:34Z |
| format | Article |
| id | doaj.art-e549a5df210e45cf84459884b8b399b6 |
| institution | Directory Open Access Journal |
| issn | 1664-302X |
| language | English |
| last_indexed | 2024-04-13T21:36:34Z |
| publishDate | 2016-07-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Microbiology |
| spelling | doaj.art-e549a5df210e45cf84459884b8b399b62022-12-22T02:28:57ZengFrontiers Media S.A.Frontiers in Microbiology1664-302X2016-07-01710.3389/fmicb.2016.01070191384Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinksAngelique Chapuis0Lucie Amoureux1Julien Bador2Eliane Siebor3Arthur Gavalas4Marion Janin5Marie-Lorraine Chrétien6Denis Caillot7Claire de Curraize8Catherine Neuwirth9University HospitalUniversity HospitalUniversity HospitalUniversity HospitalUniversity HospitalUniversity HospitalUniversity HospitalUniversity HospitalUniversity HospitalUniversity HospitalObjectiveTo investigate an outbreak of extended-spectrum beta-lactamase (ESBL) producing Enterobacter cloacae that occurred in the Hematology ward (24-bed unit) of the François Mitterrand University Hospital (Dijon, France) between January 2011 and December 2013. The outbreak involved 43 patients (10 infected and 33 colonized). DesignWe performed environmental analysis to detect multiresistant E. cloacae for comparison with clinical isolates (genotyping by pulsed-field gel electrophoresis and MLST as well as ESBL-typing) and determined the MICs of the quaternary ammonium compounds (QACs) alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC). A bleach-based cleaning-disinfection program was implemented in December 2012 after mechanical removal of the biofilm in all sinks. ResultsWe have detected 17 ESBL-producing E. cloacae in patients sink drains, shower drains and medical sink drains. Sequencing of the bla genes performed on 60 strains recovered from patients and environment (n=43 clinical and n=17 environmental) revealed that bla CTX-M15 was predominant (37 isolates) followed by bla CTX-M9 plus bla SHV-12 (20 isolates). We observed a great diversity among the isolates: 14 pulsotypes (11 STs) in clinical isolates and 9 pulsotypes (7 STs) in environmental isolates. Six pulsotypes were identical between clinical and environmental isolates. MICs of the quaternary ammonium compounds widely used for disinfection were very high in clinical and environmental isolates. Immediately after the implementation of the disinfection program we noticed a substantial fall in cases number. Our findings demonstrate the role of drains as important reservoir of ESBL-producing E. cloacae and highlight the necessity to settle drains accessible to achieve correct cleaning as well as to use disinfectant with proved activity against nosocomial pathogens.http://journal.frontiersin.org/Journal/10.3389/fmicb.2016.01070/fulloutbreakQuaternary ammoniumsMLST-genotypingESBL-producing Enterobacter cloacaeHematology wardcontaminated sinks |
| spellingShingle | Angelique Chapuis Lucie Amoureux Julien Bador Eliane Siebor Arthur Gavalas Marion Janin Marie-Lorraine Chrétien Denis Caillot Claire de Curraize Catherine Neuwirth Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks Frontiers in Microbiology outbreak Quaternary ammoniums MLST-genotyping ESBL-producing Enterobacter cloacae Hematology ward contaminated sinks |
| title | Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks |
| title_full | Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks |
| title_fullStr | Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks |
| title_full_unstemmed | Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks |
| title_short | Outbreak of extended-spectrum beta-lactamase producing Enterobacter cloacae with high MICs of quaternary ammonium compounds in a Hematology ward associated with contaminated sinks |
| title_sort | outbreak of extended spectrum beta lactamase producing enterobacter cloacae with high mics of quaternary ammonium compounds in a hematology ward associated with contaminated sinks |
| topic | outbreak Quaternary ammoniums MLST-genotyping ESBL-producing Enterobacter cloacae Hematology ward contaminated sinks |
| url | http://journal.frontiersin.org/Journal/10.3389/fmicb.2016.01070/full |
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