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Misidentification as Pseudomonas aeruginosa in hospital water supply samples
S Taudien1, W Leszczynski1, T Mayer2
1Department of Infection Control and Infectious Diseases, University Medical Center Göttingen, Georg August University Göttingen, Göttingen, Germany.
Abstract:
Drinking water in hospitals is often tested for Pseudomonas aeruginosa because of its virulence potential. This article describes a case where, based on EN ISO 16266, seven of 11 (64%) samples taken simultaneously from the drinking water system at a single hospital tested positive for P. aeruginosa. This resulted in extensive investigations and interventions, and a number of measures were implemented. However, supplementary analyses with more discriminatory power (matrix-assisted laser desorption/ionization time-of-flight mass spectrometry, 16S-rRNA sequencing) ruled out P. aeruginosa completely. The authors wish to raise awareness of this problem, and suggest that diagnostic uncertainty of results obtained by EN ISO 16266 should be indicated on laboratory reports. Wrongly assuming the presence of P. aeruginosa in hospital water supply systems can lead to unnecessary control measures, as analytical uncertainty massively influences the health risk assessment and the remediation measures initiated in medical environments.
Insights
Hospital water testing for Pseudomonas aeruginosa using EN ISO 16266 can yield false positives. Advanced methods like MALDI-TOF MS and 16S-rRNA sequencing are crucial for accurate P. aeruginosa detection and to avoid unnecessary interventions.
Area of Science:
- Microbiology
- Clinical Diagnostics
- Public Health
Background:
- Pseudomonas aeruginosa is a significant pathogen often monitored in hospital water systems due to its virulence.
- Accurate detection of P. aeruginosa in drinking water is critical for patient safety and infection control in healthcare settings.
Purpose of the Study:
- To investigate a case of suspected P. aeruginosa contamination in a hospital's drinking water system.
- To evaluate the diagnostic accuracy of the EN ISO 16266 standard for P. aeruginosa detection in hospital water.
- To highlight the implications of analytical uncertainty on risk assessment and remediation strategies.
Main Methods:
- Water samples from a hospital drinking water system were tested using the EN ISO 16266 standard.
- Positive results were further investigated using more discriminatory techniques, including matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and 16S-rRNA gene sequencing.
Main Results:
- Initial testing with EN ISO 16266 indicated P. aeruginosa in 64% of the sampled hospital drinking water.
- Subsequent, more advanced analyses (MALDI-TOF MS and 16S-rRNA sequencing) conclusively ruled out the presence of P. aeruginosa.
- The discrepancy highlights potential limitations and diagnostic uncertainty associated with the EN ISO 16266 method.
Conclusions:
- The EN ISO 16266 method may produce false-positive results for P. aeruginosa in hospital water systems.
- Laboratory reports should indicate the diagnostic uncertainty of EN ISO 16266 results.
- Accurate identification of P. aeruginosa is essential to prevent unnecessary and costly interventions in healthcare environments.
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