Comparing Resistant Microorganisms Isolated from Patients and Environment in an Intensive Care Unit

Quésia Souza  Damaceno; Robert  Iquiapaza; Adriana C.  Oliveira

doi:10.4236/aid.2014.41006

Quésia Souza Damaceno, Robert Iquiapaza, Adriana C. Oliveira

Abstract: Background: Recently, the probable involvement of surfaces from the hospital environment as a disseminating source of resistant bacteria has been highlighted. The aim of the study was to compare resistant microorganisms isolated from inanimate surfaces, equipments and patient blood culture samples in an Intensive Care Unit from Belo Horizonte, Brazil. Methods: A cross-sectional study was performed from July to October 2009. Data sources were microbiologic samples from environment and patient blood culture. Duplicate samples were obtained by swabs from up to seven different touch sites around two different patients in four different days. Jointly with the environmental samples, bacterial isolates from an adult ICU patients’ routine blood cultures were obtained from hospital laboratory. The samples were identified, tested for sensitivity and compared by rep-PCR test to verify similarity. Results: Difference among the averages of Colony Forming Units was found within the environment samples (p < 0.004). In the environment were identified antibiotic resistant microorganisms such as Vancomycin resistant Enterococcus faecalis, imipenem and ciprofloxacin Pseudomonas aeruginosa and multidrug-resistant Acinetobacter baumannii. Similarities (60% -80%) were established among environmental and blood culture samples. Conclusion: The environmental sampling showed different averages of contamination of the surfaces and equipment. The similarity among the bacterial isolates of patients’ blood cultures and environmental samples reinforces the hypothesis of the horizontal transference of pathogens.

Keywords: Cross Infection; Bacterial; Drug Resistance; Intensive Care Units; Environment; Contamination

Cite this paper: Damaceno, Q. , Iquiapaza, R. and Oliveira, A. (2014) Comparing Resistant Microorganisms Isolated from Patients and Environment in an Intensive Care Unit. Advances in Infectious Diseases, 4, 30-35. doi: 10.4236/aid.2014.41006.

References

[1] Hardy, K.J., Oppenheim, B.A., Gossain, S., Gao, F. and Hawkey, P.M. (2006) A Study of the Relationship between Environmental Contamination with Methicillin-Resistant Staphylococcus Aureus (MRSA) and Patients’ Acquisition of MRSA. Infection Control and Hospital Epidemiology, 27, 127-132. http://dx.doi.org/10.1086/500622

[2] Sexton, T., Clark, P., O’Neill, E., Dillane, T. and Humphreys, H. (2006) Environmental Reservoirs of Methicillin-Resistant Staphylococcus aureus in Isolation Rooms: Correlation with Patient Isolates and Implications for Hospital Hygiene. Journal of Hospital Infection, 62, 187-194.
http://dx.doi.org/10.1016/j.jhin.2005.07.017

[3] Hayden, M.K., Blom, D.W., Lyle, E.A., Moore, C.G. and Weistein, R.A. (2008) Risk of Hand or Glove Contamination after Contact with Vancomycin-Resistant Enterococcus or the Colonized Patients’ Environment. Infection Control and Hospital Epidemiology, 29, 149-154.
http://dx.doi.org/10.1086/524331

[4] Sehulster, L.M., Chinn, R.Y.W., Arduino, M.J., Carpenter, J., Donlan, R. and Ashford, D. (2003) Guidelines for Environmental Infection Control in Health-Care Facilities. Recommendations from Centers for Disease Control and Prevention (CDC) and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago: American Society for Healthcare Engineering/American Hospital Association.
http://www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf. Accessed 13 January 2012.

[5] Dancer, S.J. (2004) How Do We Assess Hospital Cleaning? A Proposal for Microbiological Standards for Surfaces Hygiene in Hospital. Journal of Hospital Infection, 56, 10-15.
http://dx.doi.org/10.1016/j.jhin.2003.09.017?

[6] Huang, S.S., Datta, R. and Plat, R. (2006) Risk of Acquiring Antibiotic-Resistant Bacteria from Prior Room Occupants. Archives of Internal Medicine, 166, 1945-1951.
http://dx.doi.org/10.1001/archinte.166.18.1945

[7] Bures, S., Fishbain, J.T., Uyehara, C.F.T., Parker, J.M. and Berg, B.W. (2000) Computer Keyboards and Faucet Handles as Reservoirs of Nosocomial Pathogens in Intensive Care Unit. American Journal of Infect Infection Control, 28, 465-470. http://dx.doi.org/10.1067/mic.2000.107267

[8] Corona-Nakamura, A.L., Miranda-Novales, M.G. and Leãnos-Miranda, B. (2001) Epidemiologic Study of Pseudomonas aeruginosa in Critical Patients and Reservoirs. Archives of Medical Research, 32, 238-242.
http://dx.doi.org/10.1016/S0188-4409(01)00267-3

[9] Drees, M., Snydman, D.R., Schmid, C.H., Barefoot, L., Hansjosten, K., Vue, P.M., Cronin, M., Nasraway, S.A. and Golan, Y. (2008) Prior Environmental Contamination Increases the Risk of Acquisition of Vancomycin-Resistant Enterococci. Clinical Infectious Diseases, 46, 678-685.
http://dx.doi.org/10.1086/527394

[10] Lemmen, S.W., Häfner, H., Zolldann, D., Stanzel, S. and Lüttichen, R. (2004) Distribuition of Multi-Resistant GramNegative versus Gram-Positive Bacteria in the Hospital Inanimate Environment. Journal of Hospital Infection, 56, 191-197. http://dx.doi.org/10.1016/j.jhin.2003.12.004

[11] Rohr, U., Kaminski, A., Wilhelm, M., Jurzik, L., Gatermann, S. and Muhr, G. (2009) Colonization of Patients and Contamination of the Patients’ Environment by MRSA under Conditions of Single-Room Isolation. International Journal of Hygiene and Environmental Health, 212, 209-15. http://dx.doi.org/10.1016/j.ijheh.2008.05.003

[12] Clinical and Laboratory Standards Institute (2009) Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard. 10th Edition, CLSI Document M02-A10. Clinical and Laboratory Standards Institute (CLSI), Wayne.

[13] Carling, P.C., Parry, M.F., Bruno-Murta, L.A. and Dick, B. (2010) Improving Environmental Hygiene in 27 Intensive Care Units to Decrease Multidrug-Resistant Bacterial Transmission. Critical Care Medicine, 38, 1054-1059.
http://dx.doi.org/10.1097/CCM.0b013e3181cdf705

[14] Hardy, K.J., Gossain, S., Henderson, N., Drugan, C., Oppenheim, B.A., Gao, F. and Hawkey, P.M. (2007) Rapid Recontamination with MRSA of the Environment of an Intensive Care Unit after Decontamination with Hydrogen Peroxide Vapour. Journal of Hospital Infection, 66, 360-368. http://dx.doi.org/10.1016/j.jhin.2007.05.009

[15] Manian, F.A., Griesenauer, S., Senkel, D., Setzer, J.M., Doll, S.A., Perry, A.M. and Wiechens, M. (2011) Isolation of Acinetobacter baumannii Complex and Methicillin-Resistant Staphylococcus aureus from Hospital Rooms Following Terminal Cleaning and Disinfection: Can We Do Better? Infection Control and Hospital Epidemiology, 32, 667-672.

[16] El Shafie, S.S., Alishaq, M. and Garcia, M.L. (2004) Investigation of an Outbreak of Multidrug-Resistant Acinetobacter baumannii in Trauma Intensive Care Unit. Journal of Hospital Infection, 56, 101-105.
http://dx.doi.org/10.1016/j.jhin.2003.09.024

[17] Rutalla, A.W., White, M.S., Gergen, M.F. and Weber, D.J. (2006) Bacterial Contamination of Keyboards: Efficacy and Functional Impact of Disinfectants. Infection Control and Hospital Epidemiology, 27, 372-377.
http://dx.doi.org/10.1086/503340

[18] Petignat, C., Francioli, P., Nahimana, N., Wenger, A., Bille, J., Schaller, M.D., Revelly, J.P., Zanetti, G. and Blanc, D.S. (2006) Exogenous Source of Pseudomonas aeruginosa in an Intensive Care Unit Patients: Implementation of Infection Control and Follow-Up with Molecular Typing. Infection Control and Hospital Epidemiology, 27, 953-957.
http://dx.doi.org/10.1086/506409

[19] Rogues, A.M., Boulestreau, H., Lashe’ras, A., Boyer, A., Gruson, D., Merle, C., Castaing, Y., Bébear, C.M. and Gachie, J.P. (2007) Contribution of Tap Water to Patient Colonisation with Pseudomonas aeruginosa in a Medical Intensive Care Unit. Journal of Hospital Infection, 67, 72-78. http://dx.doi.org/10.1016/j.jhin.2007.06.019

[20] Wayne, L.G., Brender, D.J., Colewll, R.R., Grimont, P.A.D., Kandler, O., Krichevsky, L.H., Moore, L.H., Moore, E.C., Murray, R.G.E., Stachebrandt, E., Starr, M.P. and Truper, H.G. (1987) Report of the Ad Hoc Committee on Reconciliation of Approaches to Bacterial Systematics. International Journal of Systematic Bacteriology, 37, 463-464. http://dx.doi.org/10.1099/00207713-37-4-463