Table 1.
Selected papers describing the transmission of multidrug-resistant Gram-negative organisms from the environment to the patient
| Sites | Organisms | Molecular methods | Number of Samples | Time | Setting | Ref |
|---|---|---|---|---|---|---|
| Aqueous environment | ||||||
| Sinks and ultra-filtrate bags | Multidrug-resistant Pseudomonas aeruginosa | Repetitive element palindromic polymerase chain reaction (Rep-PCR) |
21 unique patients Environmental samples from 5 sinks |
Jan 2012 – February 2014 | Intensive care unit | [18] |
| Plumbing (Shower drains, sink taps, sink drain tailpieces, sink drain strainers, sink trap water, toilet bowls) | Carbapenem-resistant Enterobacteriaceae | Whole Genome Sequencing single nucleotide variation |
268 clinical isolates 927 environmental samples |
April 2014–December 2014 | General wards | [21] |
| Sink faucet aerators | Carbapenem-resistant Pseudomonas aeruginosa | Amplified Fragment Length Polymorphisms |
46 unique patients 236 environmental samples |
February 2009 – January 2012 | Intensive care unit | [22] |
| Sink drains (drainage pipe in the wall) | Metallo-β-lactamase-producing Pseudomonas aeruginosa | Pulsed-field gel electrophoresis |
14 unique patients Environmental samples from 12 sink drain in patients’ rooms |
2008–2014 | General wards | [23] |
| Sink faucets, water samples (Hospital plumbing infrastructure) | Multidrug-resistant Sphingomonas koreensis | Whole Genome Sequencing Average nucleotide identity |
12 unique patients Environmental samples (Sinks, faucets, pipes, valves, aerators, other plumbing fixtures) |
2006–2016 | Intensive care unit and General wards | [24] |
| Dry Environmental Surfaces | ||||||
| Bedside | Extensively drug-resistant Acinetobacter baumannii | Rep-PCR |
8 unique patient samples An unknown number of non-clinical samples |
March–May 2014 | Intensive care unit | [36] |
| Patient Environment |
OXA-48-Enterobacteriaceae MDR Acinetobacter baumannii |
Clone specific PCR |
13 OXA-48 producing Enterobacteriaceae 18 MDR A. baumannii An unknown number of non-clinical samples |
July–October 2015 | Intensive care unit | [37] |
| Medical equipment and other appliances | ||||||
| Velcro of blood pressure cuffs | Carbapenem-resistant Acinetobacter baumanii (CRAB) | Pulsed-field gel electrophoresis | 20 unique patient samples First round: 222 environmental samples Second round: 97 environmental samples (including 2 blood pressure cuffs velcro and 13 healthcare workers) | December 2011 – April 2012 | Intensive care unit | [48] |
| Positioning pillow | Carbapenem-resistant Klebsiella pneumoniae | Whole Genome Sequencing, Multilocus Sequence Typing (rpoB, gapA, mdh, pgi, phoE, infB and tonB) | 89 unique patient samples, 1030 environmental samples, 24 miscellaneous samples (animals, surrounding hospitals, other countries) | July 2010 – April 2013 | Intensive care unit and general wards | [49] |
| Ice machine | Carbapenem-resistant Acinetobacter baumannii | Multilocus Sequence Typing, Rep-PCR | 20 unique patient samples, ~ 75 non-clinical samples (50 environmental, ~ 10 from 2 ice machines, 15 HCWs) | September 2015 | Spinal Cord Unit | [50] |
| Cold tea dispenser | Carbapenem-resistant Enterobacteriaceae | Whole Genome Sequencing, Multilocus Sequence Typing | 145 unique patient samples, 195 environmental samples | May 2014 – December 2014 | Paediatric wards | [52] |