Table 1 Selected papers describing the transmission of multidrug-resistant Gram-negative organisms from the environment to the patient
From: The role of hospital environment in transmissions of multidrug-resistant gram-negative organisms
Sites | Organisms | Molecular methods | Number of Samples | Time | Setting | Ref |
|---|---|---|---|---|---|---|
Aqueous environment | ||||||
 Sinks and ultra-filtrate bags | Multidrug-resistant Pseudomonas aeruginosa | Repetitive element palindromic polymerase chain reaction (Rep-PCR) | 21 unique patients Environmental samples from 5 sinks | Jan 2012 – February 2014 | Intensive care unit | [18] |
 Plumbing (Shower drains, sink taps, sink drain tailpieces, sink drain strainers, sink trap water, toilet bowls) | Carbapenem-resistant Enterobacteriaceae | Whole Genome Sequencing single nucleotide variation | 268 clinical isolates 927 environmental samples | April 2014–December 2014 | General wards | [21] |
 Sink faucet aerators | Carbapenem-resistant Pseudomonas aeruginosa | Amplified Fragment Length Polymorphisms | 46 unique patients 236 environmental samples | February 2009 – January 2012 | Intensive care unit | [22] |
 Sink drains (drainage pipe in the wall) | Metallo-β-lactamase-producing Pseudomonas aeruginosa | Pulsed-field gel electrophoresis | 14 unique patients Environmental samples from 12 sink drain in patients’ rooms | 2008–2014 | General wards | [23] |
 Sink faucets, water samples (Hospital plumbing infrastructure) | Multidrug-resistant Sphingomonas koreensis | Whole Genome Sequencing Average nucleotide identity | 12 unique patients Environmental samples (Sinks, faucets, pipes, valves, aerators, other plumbing fixtures) | 2006–2016 | Intensive care unit and General wards | [24] |
Dry Environmental Surfaces | ||||||
 Bedside | Extensively drug-resistant Acinetobacter baumannii | Rep-PCR | 8 unique patient samples An unknown number of non-clinical samples | March–May 2014 | Intensive care unit | [36] |
 Patient Environment | OXA-48-Enterobacteriaceae MDR Acinetobacter baumannii | Clone specific PCR | 13 OXA-48 producing Enterobacteriaceae 18 MDR A. baumannii An unknown number of non-clinical samples | July–October 2015 | Intensive care unit | [37] |
Medical equipment and other appliances | ||||||
 Velcro of blood pressure cuffs | Carbapenem-resistant Acinetobacter baumanii (CRAB) | Pulsed-field gel electrophoresis | 20 unique patient samples First round: 222 environmental samples Second round: 97 environmental samples (including 2 blood pressure cuffs velcro and 13 healthcare workers) | December 2011 – April 2012 | Intensive care unit | [48] |
 Positioning pillow | Carbapenem-resistant Klebsiella pneumoniae | Whole Genome Sequencing, Multilocus Sequence Typing (rpoB, gapA, mdh, pgi, phoE, infB and tonB) | 89 unique patient samples, 1030 environmental samples, 24 miscellaneous samples (animals, surrounding hospitals, other countries) | July 2010 – April 2013 | Intensive care unit and general wards | [49] |
 Ice machine | Carbapenem-resistant Acinetobacter baumannii | Multilocus Sequence Typing, Rep-PCR | 20 unique patient samples, ~ 75 non-clinical samples (50 environmental, ~ 10 from 2 ice machines, 15 HCWs) | September 2015 | Spinal Cord Unit | [50] |
 Cold tea dispenser | Carbapenem-resistant Enterobacteriaceae | Whole Genome Sequencing, Multilocus Sequence Typing | 145 unique patient samples, 195 environmental samples | May 2014 – December 2014 | Paediatric wards | [52] |