Skip to main content

Advertisement

SpringerLink
Log in

Nosocomial outbreak linked to a flexible gastrointestinal endoscope contaminated with an amikacin-resistant ST17 clone of Pseudomonas aeruginosa

  • Original Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

Endoscope contamination is infrequent but can be the source of nosocomial infections and outbreaks. In August 2016, an unexpected increase in the incidence of amikacin-resistant P. aeruginosa isolates (AK-Pae) was observed at a tertiary care center in the south of Spain. An epidemiological and microbiological investigation (August-October 2016) was performed to explain this finding. Isolates from clinical and environmental samples (2 endoscopes used for retrograde cholangiopancreatography; ERCP) were identified by MALDI-TOF. Antimicrobial susceptibility testing was performed using the MicroScan system. Whole-Genome-Sequencing (Miseq, Illumina) was performed to determine the resistome and virulome. Clonal relatedness among isolates was assessed by SpeI-PFGE and MLST. A Caenorhabditis elegans killing assay was performed for virulence testing. Biofilm formation was performed using a colorimetric assay. Four of the 5 patients infected and/or colonized with AK-Pae in August 2016 had undergone ERCP ≤5 days before sample collection. Two endoscopes were contaminated with AK-Pae. Isolates from one endoscope showed an identical PFGE pattern to 9 isolates (cluster I) and differed (1–2 bands) to 5 isolates (cluster II). Isolates from these clusters belonged to the ST17 clone. This S17 clone was characterized by its low virulence in the C. elegans killing assay, and its biofilm-forming ability, slightly superior to that of high-risk clones of P. aeruginosa ST175 and ST235. This outbreak was caused by an endoscope used for ERCP contaminated with an invasive, moderately virulent, biofilm-forming AK-Pae ST17 clone, suggesting the possible emergence of a new high-risk lineage of this clone.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Valentini M, Gonzalez D, Mavridou DA, Filloux A (2018) Lifestyle transitions and adaptive pathogenesis of Pseudomonas aeruginosa. Curr Opin Microbiol 41:15–20

    Article  CAS  Google Scholar 

  2. Oliver A, Mulet X, López-Causapé C, Juan C (2015) The increasing threat of Pseudomonas aeruginosa high-risk clones. Drug Resist Updat 21-22:41–59

    Article  Google Scholar 

  3. Ciofu O, Tolker-Nielsen T (2019) Tolerance and resistance of Pseudomonas aeruginosa biofilms to antimicrobial agents-how P. aeruginosa can escape antibiotics. Front Microbiol 10:913

    Article  Google Scholar 

  4. Hervé RC (2017) Endoscopy in the twenty-first century: minimally invasive state-of-the-art medical technology or a future main vector of hospital-acquired infections? J Hosp Infect 97:329–330

    Article  Google Scholar 

  5. Rahman MR, Perisetti A, Coman R, Bansal P, Chhabra R, Goyal H (2019) Duodenoscope-associated infections: update on an emerging problem. Dig Dis Sci 64:1409–1418

    Article  Google Scholar 

  6. Saliou P, Baron R (2015) Outbreaks linked to duodenoscopes: microbiological control should be improved. Endoscopy 47:1058

    Article  Google Scholar 

  7. Beilenhoff U, Biering H, Blum R, Brljak J, Cimbro M, Dumonceau JM et al (2018) Reprocessing of flexible endoscopes and endoscopic accessories used in gastrointestinal endoscopy: position statement of the European Society of Gastrointestinal Endoscopy (ESGE) and European Society of Gastroenterology Nurses and Associates (ESGENA) – update 2018. Endoscopy 50:1205–1234

    Article  Google Scholar 

  8. García-Castillo M, Del Campo R, Morosini MI, Riera E, Cabot G, Willems R et al (2011) Wide dispersion of ST175 clone despite high genetic diversity of carbapenem-nonsusceptible Pseudomonas aeruginosa clinical strains in 16 Spanish hospitals. J Clin Microbiol 49:2905–2910

    Article  Google Scholar 

  9. García I, Ballesta S, Gilaberte Y, Rezusta A, Pascual Á (2015) Antimicrobial photodynamic activity of hypericin against methicillin-susceptible and resistant Staphylococcus aureus biofilms. Future Microbiol 10:347–356

    Article  Google Scholar 

  10. Sánchez-Diener I, Zamorano L, López-Causapé C, Cabot G, Mulet X, Peña C et al (2017) Interplay among resistance profiles, high-risk clones, and virulence in the Caenorhabditis elegans Pseudomonas aeruginosa infection model. Antimicrob Agents Chemother 61:e01586–e01517

    Article  Google Scholar 

  11. Fraser TG, Reiner S, Malczynski M, Yarnold PR, Warren J, Noskin GA (2004) Multidrug-resistant Pseudomonas aeruginosa cholangitis after endoscopic retrograde cholangiopancreatography: failure of routine endoscope cultures to prevent an outbreak. Infect Control Hosp Epidemiol 25:856–859

    Article  Google Scholar 

  12. Robertson P, Smith A, Mead A, Smith I, Khanna N, Wright P et al (2015) Risk-assessment-based approach to patients exposed to endoscopes contaminated with Pseudomonas spp. J Hosp Infect 90:66–69

    Article  CAS  Google Scholar 

  13. Kizny Gordon AE, Mathers AJ, Cheong EYL, Gottlieb T, Kotay S, Walker AS et al (2017) The hospital water environment as a reservoir for carbapenem-resistant organisms causing hospital-acquired infections-a systematic review of the literature. Clin Infect Dis 64:1435–1444

    Article  Google Scholar 

  14. Decraene V, Ghebrehewet S, Dardamissis E, Huyton R, Mortimer K, Wilkinson D et al (2018) An outbreak of multidrug-resistant Pseudomonas aeruginosa in a burns service in the north of England: challenges of infection prevention and control in a complex setting. J Hosp Infect 100:e239–e245

    Article  CAS  Google Scholar 

  15. Gutiérrez O, Juan C, Cercenado E, Navarro F, Bouza E, Coll P et al (2007) Molecular epidemiology and mechanisms of carbapenem resistance in Pseudomonas aeruginosa isolates from Spanish hospitals. Antimicrob Agents Chemother 51:4329–4335

    Article  Google Scholar 

  16. Quale J, Bratu S, Gupta J, Landman D (2006) Interplay of efflux system, ampC, and oprD expression in carbapenem resistance of Pseudomonas aeruginosa clinical isolates. Antimicrob Agents Chemother 50:1633–1641

    Article  CAS  Google Scholar 

  17. Danel F, Hall LM, Gur D, Livermore DM (1995) OXA-14, another extended-spectrum variant of OXA-10 (PSE-2) beta-lactamase from Pseudomonas aeruginosa. Antimicrob Agents Chemother 39:1881–1884

    Article  CAS  Google Scholar 

  18. Alfa MJ (2019) Biofilms on instruments and environmental surfaces: do they interfere with instrument reprocessing and surface disinfection? Review of the literature. Am J Infect Control 47S:A39–A45

    Article  Google Scholar 

  19. Lee JY, Peck KR, Ko KS (2013) Selective advantages of two major clones of carbapenem-resistant Pseudomonas aeruginosa isolates (CC235 and CC641) from Korea: antimicrobial resistance, virulence and biofilm-forming activity. J Med Microbiol 62:1015–1024

    Article  CAS  Google Scholar 

  20. Römling U, Kader A, Sriramulu DD, Simm R, Kronvall G (2005) Worldwide distribution of Pseudomonas aeruginosa clone C strains in the aquatic environment and cystic fibrosis patients. Environ Microbiol 7:1029–1038

    Article  Google Scholar 

  21. Mustafa MH, Chalhoub H, Denis O, Deplano A, Vergison A, Rodriguez-Villalobos H et al (2016) Antimicrobial susceptibility of Pseudomonas aeruginosa isolated from cystic fibrosis patients in northern Europe. Antimicrob Agents Chemother 60:6735–6741

    Article  CAS  Google Scholar 

Download references

Acknowledgments

We would like to thank the Reference Laboratory, Program for the Prevention and Control of Healthcare-Associated Infections and Antimicrobial Stewardship in Andalucía (PIRASOA, Servicio Andaluz de Salud) for their collaboration.

Availability of data and material

Not applicable.

Code availability

Not applicable.

Author information

Authors and Affiliations

  1. UGC Enfermedades Infecciosas, Microbiología Clínica y Medicina Preventiva, Hospital Universitario Virgen Macarena, Sevilla, Spain

    Felipe Fernández-Cuenca, Lorena López-Cerero, Julio López-Méndez, Esther Recacha, Inés Portillo, Jesús Rodríguez-Baño & Álvaro Pascual

  2. Instituto de Biomedicina de Sevilla (IBIS)/ CSIC, Sevilla, Spain

    Felipe Fernández-Cuenca, Lorena López-Cerero, Esther Recacha, Inés Portillo, Jesús Rodríguez-Baño & Álvaro Pascual

  3. Spanish Network for the Research in Infectious Diseases (REIPI RD16/0016), Instituto de Salud Carlos III, Madrid, Spain

    Felipe Fernández-Cuenca, Lorena López-Cerero, Gabriel Cabot, Antonio Oliver, Esther Recacha, Inés Portillo, Jesús Rodríguez-Baño & Álvaro Pascual

  4. Departamento de Microbiología, Facultad de Medicina, Universidad de Sevilla, Sevilla, Spain

    Lorena López-Cerero & Álvaro Pascual

  5. Servicio de Microbiología, Hospital Son Espases, Instituto de Investigación Sanitaria Illes Balears (IdISBa), Palma de Mallorca, Spain

    Gabriel Cabot & Antonio Oliver

Authors
  1. Felipe Fernández-Cuenca
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorena López-Cerero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriel Cabot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Antonio Oliver
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Julio López-Méndez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Esther Recacha
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Inés Portillo
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jesús Rodríguez-Baño
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Álvaro Pascual
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Felipe Fernández-Cuenca.

Ethics declarations

Conflict of interests

Not applicable.

Ethics approval

Not applicable.

Consent to participate

Not applicable.

Consent for publication

Not applicable.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fernández-Cuenca, F., López-Cerero, L., Cabot, G. et al. Nosocomial outbreak linked to a flexible gastrointestinal endoscope contaminated with an amikacin-resistant ST17 clone of Pseudomonas aeruginosa. Eur J Clin Microbiol Infect Dis 39, 1837–1844 (2020). https://doi.org/10.1007/s10096-020-03915-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-020-03915-7

Keywords

Search

Navigation