Background: Carbapenem-resistant Enterobacterales, particularly those producing carbapenemases (CPE), pose a major threat to human health, being listed among critical-priority resistant pathogens by the World Health Organization. Aim: In this study we report on a large nosocomial spread of CPE of different species producing VIM-type carbapenemases, and on the infection prevention and control measures thata were adopted to contrast the spread. Methods: Conventional culture and molecular methods were used for detection and identification of VIM-positive CPE (VIM-CPE) causing infections or colonizing patients or present in environmental specimens. Whole genome sequencing analysis of selected isolates was carried out to investigate clonal relatedness. Basic (active surveillance, contact precautions, close contacts screening, cases cohorting, surface cleaning, hand hygiene) and advanced (weekly point prevalence surveys for rectal colonization, additional training of healthcare workers, extraordinary ward sanification, extraordinary maintenance interventions, and environmental microbiological screening, single-use equipment, ward re-location) infection prevention and control (IPC) measures were implemented to contrast the spread. Findings: Spread of VIM-CPE involving 151 patients (mostly colonizations) was documented in a single hospital ward from November 2021 to December 2023. The spread involved several different species of Enterobacterales, with clonal expansion documented in some cases. Implementation of basic and advanced IPC measures was temporarily successful at mitiganting the spread, but multiple relapses were observed suggesting the presence of an unidentified environmental reservoir. Conclusions: The study highlights the potential of VIM-CPE to cause large and complex nosocomial outbreaks in hospital environments, and underscores the challenges that can be encountered for their control by IPC practices.
Large, protracted, multispecies and multiclonal spread of VIM-type Metallo-ß-Lactamase-Producing Enterobacterales in an Italian Hospital / Olivieri, Raffaela; Riccobono, Eleonora; Gonnelli, Stefano; Basagni, Claudia; Tumbarello, Mario; Cusi, Maria Grazia; Rossolini, Gian Maria. - In: THE JOURNAL OF HOSPITAL INFECTION. - ISSN 0195-6701. - ELETTRONICO. - (2024), pp. 0-0. [10.1016/j.jhin.2024.12.003]
Large, protracted, multispecies and multiclonal spread of VIM-type Metallo-ß-Lactamase-Producing Enterobacterales in an Italian Hospital
Tumbarello, Mario;Rossolini, Gian Maria
2024
Abstract
Background: Carbapenem-resistant Enterobacterales, particularly those producing carbapenemases (CPE), pose a major threat to human health, being listed among critical-priority resistant pathogens by the World Health Organization. Aim: In this study we report on a large nosocomial spread of CPE of different species producing VIM-type carbapenemases, and on the infection prevention and control measures thata were adopted to contrast the spread. Methods: Conventional culture and molecular methods were used for detection and identification of VIM-positive CPE (VIM-CPE) causing infections or colonizing patients or present in environmental specimens. Whole genome sequencing analysis of selected isolates was carried out to investigate clonal relatedness. Basic (active surveillance, contact precautions, close contacts screening, cases cohorting, surface cleaning, hand hygiene) and advanced (weekly point prevalence surveys for rectal colonization, additional training of healthcare workers, extraordinary ward sanification, extraordinary maintenance interventions, and environmental microbiological screening, single-use equipment, ward re-location) infection prevention and control (IPC) measures were implemented to contrast the spread. Findings: Spread of VIM-CPE involving 151 patients (mostly colonizations) was documented in a single hospital ward from November 2021 to December 2023. The spread involved several different species of Enterobacterales, with clonal expansion documented in some cases. Implementation of basic and advanced IPC measures was temporarily successful at mitiganting the spread, but multiple relapses were observed suggesting the presence of an unidentified environmental reservoir. Conclusions: The study highlights the potential of VIM-CPE to cause large and complex nosocomial outbreaks in hospital environments, and underscores the challenges that can be encountered for their control by IPC practices.
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