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A long-lasting Sphingomonas paucimobilis outbreak: A potential for pathogens to persist on environmental devices
Şirin Menekşe1, Elif Seren Tanrıverdi2, Ece Altınay3
1Infection Control Unit, Koşuyolu High Specialization Education and Research Hospital, İstanbul, Turkey.
Background:
Sphingomonas paucimobilis, an aerobic, non-fermentative, Gram-negative opportunistic bacillus, can colonize everywhere in hospital settings where water is used. We reported a hospital S paucimobilis outbreak that persisted for nearly 2 years despite all necessary preventive measures.
Methods:
Over a period from February 13, 2020 to December 3, 2021, 67 patients were identified to have S paucimobilis as documented by positive cultures from clinical samples, along with 19 positive environmental samples.
Results:
Bacterial regrowth for molecular analysis could be obtained in 49 isolates (39 clinical, 4 extracorporeal membrane oxygenation (ECMO) water heater devices, 1 unused mouthwash solution, 5 water samples from thoracic drainage aspirators). Two distinct clonally indistinguishable genotypes were detected in AP-PCR and PFGE analyses, with 100% consistency. The main cluster was obtained consistently throughout the outbreak from 30 samples (61.2%: 24 clinical, 4 ECMO, 1 unused mouthwash solution, 1 water sample from the thoracic drainage aspirator). The other cluster involved 15 clinical samples and 4 water samples from the thoracic drainage aspirators.
Conclusions:
Given that waterborne pathogens can spread to a wide range of equipment used in healthcare environments, the pathogens can persist on the surfaces of environmental devices even after recommended disinfection measures have been applied. Therefore, individual tracking of all devices used in critical care settings, such as thoracic drainage aspirators and ECMO water heater devices, with records of pre- and post-disinfection procedures is of paramount importance for complete elimination of the source of infection.
Insights
A hospital outbreak of Sphingomonas paucimobilis, a waterborne pathogen, lasted nearly two years. Enhanced tracking of medical devices is crucial for eliminating persistent healthcare-associated infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Sphingomonas paucimobilis is an opportunistic Gram-negative bacillus commonly found in hospital water systems.
- This opportunistic pathogen can colonize various hospital environments, posing a persistent infection risk.
Purpose of the Study:
- To report a prolonged hospital outbreak of Sphingomonas paucimobilis.
- To investigate the persistence and sources of this waterborne pathogen in a healthcare setting.
Main Methods:
- Retrospective analysis of clinical and environmental samples collected over a 2-year period (February 2020 - December 2021).
- Molecular typing using AP-PCR and PFGE to determine bacterial clonality.
- Identification of 67 patients and 19 environmental samples positive for S. paucimobilis.
Main Results:
- Two distinct, clonally indistinguishable genotypes of S. paucimobilis were identified.
- The primary genotype was consistently detected in clinical samples and associated with ECMO water heaters and thoracic drainage aspirators.
- The outbreak persisted for nearly two years despite implemented preventive measures.
Conclusions:
- Waterborne pathogens like S. paucimobilis can persist on medical devices despite disinfection.
- Rigorous tracking of devices in critical care, including pre- and post-disinfection records, is essential for infection control.
- Enhanced surveillance and device management are vital to eliminate persistent sources of healthcare-associated infections.
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