Identifying and quantifying ESKAPEE pathogens in and around sinks in high burden hospitals

Area of Science:

• Environmental microbiology
• Hospital infection control
• Pathogen transmission

Background:

• Hospital-acquired infections (HAIs) pose a significant threat, with ESKAPEE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli) being major contributors.
• Premise plumbing, including sinks and drains, acts as a reservoir for these pathogens, facilitating their dissemination into patient environments through aerosolization and surface contamination.

Purpose of the Study:

• To investigate the presence and abundance of viable ESKAPEE pathogens and microbial communities in and around hospital sinks in high-burden settings.
• To determine the role of sink environments in the dissemination of ESKAPEE pathogens within two hospitals in La Paz, Bolivia.

Main Methods:

• A prospective observational study was conducted in two high-burden hospitals in La Paz, Bolivia.
• Surface swabs (n=233) and air samples (n=39) were collected from sink-related areas and room air.
• Samples were analyzed using selective culture media for ESKAPEE identification and quantification, alongside 16S rDNA gene sequencing (PacBio Revio) for microbial community profiling.

Main Results:

• Viable presumptive ESKAPEE pathogens were detected in 74.7% of surface swabs and 74.4% of air samples.
• Sink basins exhibited the highest contamination levels (mean 31 CFU/100 cm²), with pathogen concentrations decreasing with distance from the drain.
• Klebsiella/Enterobacter spp. were most abundant, while Staphylococcus aureus was most frequently detected (54.4% of samples). Significant hospital-specific differences in pathogen prevalence and microbial community composition were observed.

Conclusions:

• Hospital sinks are significant reservoirs and dissemination points for ESKAPEE pathogens, contributing to the burden of HAIs.
• Effective control measures targeting sink environments are crucial for reducing pathogen transmission and improving patient safety in healthcare settings.