Role of the Environment in Transmission of Multiresistant Enterobacter cloacae in a Hematology-Oncology Department

• DOI: 10.1017/ice.2020.1012
• Publication Date: 2020-11-02T14:52:50Z
• Authors: Wil Van der Zwet; Yvonne Nijsen; Lieke Van Alphen; Christian Von Win...; Erik Beckers; Paul Savelkoul
• Keywords: Enterobacter cloacae; Colistin; Hematology

Background: The patient environment is increasingly considered a major source of transmission nosocomial bacteria to patients. In May 2019, cluster 3 patients with multiresistant Enterobacter cloacae was discovered in the hematology-oncology department Maastricht University Medical Center (built 1991). strains had an identical antibiogram: ESBL-positive, ciprofloxacin R, cotrimoxazole meropenem S, and colistin S. One neutropenic positive blood culture for this strain, resistant empiric treatment piperacillin-tazobactam, but recovered after switching antibiotic regimen meropenem. All were determined be by amplified-fragment length polymorphism whole-genome multi-locus sequencing typing (genotype A). New cases occurred, despite introduction contact isolation Therefore, weekly point-prevalence screening introduced, which more newly colonized identified subsequent weeks. Attention hand hygiene enforced, hypothesis contamination from “wet” environmental locations tested performing cultures sinks shower drains. June July, 47 241 (19.5%) E. antibiogram, among some typed as genotype A. To diminish contamination, all siphons replaced, disinfection drains intensified using chlorine soda on daily basis. Replacement not possible. After intervention, incidence declined gradually. A change selective gut decontamination hematology alternative decrease new cases, implemented. final round at end August revealed 8 cultures, 5 retrospect, finding could explained fact that cleaning team did follow instructions disinfection. From week 29, no longer cultured screenings. Based observation, it important (re)building plans hospitals, master plan prevention incorporated. Funding: None Disclosures: