21 February 2019

Researchers at Radboudumc have discovered a new way of how resistant hospital bacteria can spread. In a case study on JAMA Network Open, physician microbiologist Joost Hopman describes how the rare bacterium Pseudomonas aeruginosa could spread infection from shower drains in patient rooms. He recommends measures be taken in the design of hospital rooms to minimize the risk of spreading from drainage points.

Worldwide, the problem of pathogenic bacteria becoming resistant to carbapenems is increasing. This is a category of antibiotics that is used against serious bacterial infections when regular antibiotics no longer work. If the bacterium also becomes resistant to carbapenems, the infection is very difficult to treat. The spread of carbapenem-resistant bacteria has been identified by the World Health Organization (WHO) as a current major public health problem.
 
Hopman and the interdisciplinary team involved in the risk assessment identified the new infection route of Pseudomonas aeruginosa after a patient became infected with this carbapenem-resistant bacterium after lung surgery. The infection was remarkable because resistant Pseudomonas is rare in the Netherlands. In developing countries, the bacterium is much more common, but the patient had not travelled at all. The infection would probably have to come from the hospital itself.
 
After examination of various possible sources of infection, the sanitary facilities in the hospital proved to be the most likely source. The stagnant water in shower wells and drains turned out to be a growth medium for the resistant bacteria. Air measurements showed that the bacteria could move through the air when the shower was switched on. Hopman's research exposes a hitherto unknown mechanism for the spread of such resistant bacteria.
 
“The hospital environment is part of the puzzle of the spread of this bacterium,” says Hopman. “Now that we know that, we have to consider this in the new building plans for our hospital. We will work together with our building department to reduce the risk of infection. For example, we could consider moving the sinks from the patient rooms.”
 
“It is important to look for solutions in multidisciplinary fields,” emphasizes Hopman, “and collaborate with builders, engineers and infection experts. Of course, patients should be able to shower in the hospital. It is important to ensure that infections with resistant bacteria are kept to a minimum. This year we are planning a meeting in Nijmegen, where we will work with several national and international experts to find solutions, enabling other hospitals also to take the right measures to minimize the spread of resistant bacteria.”

publication
Risk Assessment After a Severe Hospital-Acquired Infection Associated With Carbapenemase-Producing Pseudomonas aeruginosa.
Hopman J, Meijer C, Kenters N, Coolen JPM, Ghamati MR, Mehtar S, van Crevel R, Morshuis WJ, Verhagen AFTM, van den Heuvel MM, Voss A, Wertheim HFL.


Joost Hopman and Heiman Wertheim are members of theme Infectious diseases and global health.

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