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Published on: December 8, 2017
Cupriavidus spp. and other waterborne organisms in healthcare water systems across the UK
T Inkster1, G Wilson2, J Black2
1Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK; NHS Assure, National Services Scotland, Edinburgh, UK.
Background:
Cupriavidus pauculus is a rare clinical pathogen, cases of which have been linked to contaminated hospital water systems. An outbreak of three cases of C. pauculus and other waterborne organisms was reported in a Glasgow hospital in 2018.
Aims:
To determine whether Cupriavidus spp. are present in hospital water systems elsewhere in Scotland and the UK, and to ascertain the optimal laboratory methodology for detection. This study also sought to establish where in the water system these organisms are detected, and whether a selective media could be developed for isolation. In addition, water samples were tested for the presence of other Gram-negative waterborne organisms.
Methods:
Water samples were received from 10 UK National Health Service hospitals and from various parts of the water system. Isolates were plated on to tryptone soya agar (TSA) and Pseudomonas isolation agar, and were further identified using matrix-assisted laser desorption ionization-time of flight mass spectrometry and 16S polymerase chain reaction.
Findings:
Cupriavidus spp. were detected in four of 10 hospitals tested, and all five isolates were from the periphery of the water system. All hospitals had evidence of other opportunistic premise plumbing pathogens. Cupriavidus spp. were identified using TSA, with some isolates growing on Pseudomonas isolation agar; as such, they may be detected inadvertently when testing water specifically for Pseudomonas aeruginosa.
Conclusion:
Isolation of Cupriavidus spp. was not unique to the Glasgow incident, and these bacteria are present in hospital water systems elsewhere in the UK. Water testing in response to clinical cases is recommended. Consideration should also be given to water testing following bacteraemias due to other rare and unusual water-borne pathogens.
Insights
Cupriavidus pauculus, a rare pathogen, was found in four of 10 UK hospitals, indicating its presence beyond a single incident. Routine water testing is recommended to detect these opportunistic premise plumbing pathogens.
Area of Science:
- Clinical Microbiology
- Environmental Microbiology
- Hospital Water Systems
Background:
- Cupriavidus pauculus is a rare pathogen linked to hospital water contamination.
- A 2018 outbreak in Glasgow involved C. pauculus and other waterborne organisms.
Purpose of the Study:
- Investigate the prevalence of Cupriavidus spp. in UK hospital water systems.
- Determine optimal laboratory methods for Cupriavidus detection and isolation.
- Identify locations within water systems where Cupriavidus is found.
- Assess for other Gram-negative waterborne pathogens.
Main Methods:
- Collected water samples from 10 UK hospitals.
- Utilized tryptone soya agar (TSA) and Pseudomonas isolation agar for plating.
- Employed matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and 16S rRNA gene sequencing for identification.
Main Results:
- Cupriavidus spp. detected in 4 out of 10 hospitals, exclusively from peripheral water system sites.
- All tested hospitals showed evidence of other opportunistic premise plumbing pathogens.
- TSA effectively identified Cupriavidus spp.; some grew on Pseudomonas isolation agar, suggesting potential incidental detection during Pseudomonas aeruginosa testing.
Conclusions:
- Cupriavidus spp. are present in UK hospital water systems, not just in the Glasgow incident.
- Water testing is advised in response to clinical cases of Cupriavidus.
- Consider water testing for other rare, waterborne pathogens following bacteraemia.
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