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Invasion of superbugs: Cockroach-driven outbreak of multidrug-resistant Enterobacter in an ICU
Jennifer Hanrahan1, Nicholas Schouten2, Steven H Fyffe1
1MetroHealth Medical Center, Cleveland, OH, USA.
Objective:
To describe factors in an outbreak of multidrug-resistant Enterobacter cloacae (MRE) in an intensive care unit (ICU) over a 20-month period including the likely contribution of cockroaches to the outbreak.
Design:
This is a retrospective descriptive study.
Setting:
ICU in an urban hospital.
Patients:
All patients admitted to the ICU during the 20-month outbreak period were included in the study.
Interventions:
Infection prevention interventions included contact isolation, hand hygiene, dedicated patient equipment, environmental cultures, and pest control.
Results:
25 patients were identified as being colonized or infected with MRE. Relatedness of the outbreak strain and strains found in cockroaches was demonstrated by pulse field gel electrophoresis. Standard IP interventions did not have an impact on the outbreak until pest control was added. Once additional pest control measures were put in place, the outbreak ended.
Conclusions:
Insects have a potential role in transmission of pathogens in hospitals and their role should be considered when outbreaks are being investigated.
Insights
Cockroaches likely contributed to a multidrug-resistant Enterobacter cloacae outbreak in an ICU. Enhanced pest control measures were crucial in ending the outbreak, highlighting insects' role in hospital pathogen transmission.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Microbiology
Background:
- Multidrug-resistant Enterobacter cloacae (MRE) outbreaks pose significant challenges in intensive care units (ICUs).
- Understanding transmission dynamics is critical for effective outbreak control in healthcare settings.
Purpose of the Study:
- To investigate factors contributing to a 20-month MRE outbreak in an urban hospital ICU.
- To assess the potential role of cockroaches in the transmission of MRE during the outbreak.
Main Methods:
- Retrospective descriptive study of patients admitted to the ICU during the outbreak period.
- Implementation of standard infection prevention (IP) interventions: contact isolation, hand hygiene, dedicated equipment, environmental cultures.
- Inclusion of enhanced pest control measures as part of the intervention strategy.
Main Results:
- Twenty-five patients were identified with MRE colonization or infection.
- Pulse field gel electrophoresis confirmed the relatedness of MRE strains from patients and cockroaches.
- Standard IP interventions were ineffective until pest control was intensified; the outbreak ceased after enhanced pest control implementation.
Conclusions:
- Cockroaches may play a significant role in the transmission of multidrug-resistant pathogens within hospital environments.
- Integrated pest management should be considered a critical component of outbreak investigations and control strategies in healthcare facilities.
