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    Rights statement: This is the author’s version of a work that was accepted for publication in Journal of Hospital Infection. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Hospital Infection, 93, 2, 2016 DOI: 10.1016/j.jhin.2016.03.007

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Carbapenemase-producing Enterobacteriaceae in hospital wastewater: a reservoir that may be unrelated to clinical isolates [star]

Research output: Contribution to journalJournal article

Published
  • Leila White
  • Katie Hopkins
  • Danièle Meunier
  • Claire L. Perry
  • Rachel Pike
  • Paul Wilkinson
  • Roger William Pickup
  • John Cheesbrough
  • Neil Woodford
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<mark>Journal publication date</mark>06/2016
<mark>Journal</mark>Journal of Hospital Infection
Issue number2
Volume93
Number of pages7
Pages (from-to)145-151
Publication StatusPublished
Early online date24/03/16
<mark>Original language</mark>English

Abstract

Summary
Background: Carbapenemase-producing Enterobacteriaceae (CPE) are an emerging infection control problem in hospitals worldwide. Identifying carriers can help reduce potential spread and infections.
Aim: To assess whether testing hospital wastewater for CPE can supplement patient based screening for infection prevention purposes in a hospital without a recognised endemic CPE problem.
Methods: Wastewater collected from hospital pipework on 16 occasions during February-March 2014 was screened for CPE using chromID®CARBA agar and chromID®CPS agar with a 10 μg ertapenem disc and combination disc testing. MICs were determined using British Society for Antimicrobial Chemotherapy methodology and carbapenemase genes detected by PCR or wholegenome
sequencing. Selected isolates were typed by PFGE.
Findings: Suspected CPE were recovered from all 16 wastewater samples. Of 17 isolates sent to Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, six (four Citrobacter freundii and two Enterobacter cloacae complex) were New Delhi metallo–beta-lactamase (NDM) producers and the remaining 11 (six Klebsiella oxytoca and five Enterobacter cloacae complex),
Guiana-Extended-Spectrum-5 (GES-5) producers, the first to be described in Enterobacteriaceae in the UK. The four NDM-producing C. freundii, two NDM-producing E. cloacae complex and 4/5 GES-5-producing E. cloacae complex were each indistinguishable isolates of the same three strains,
whereas the six GES-5-producing K. oxytoca overall shared 79% similarity.
Conclusion: CPE are readily isolated from hospital wastewater using simple culture methods. There are either undetected carriers of CPE excreting into the wastewater, or these CPE represent colonisation of the pipework. Surveillance of hospital wastewater for CPE does not appear helpful for infection control purposes.

Bibliographic note

This is the author’s version of a work that was accepted for publication in Journal of Hospital Infection. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Hospital Infection, 93, 2, 2016 DOI: 10.1016/j.jhin.2016.03.007