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Unleashing the Warrior Against Antibiotic Resistance: A Detailed Analysis of A Multispecies Outbreak At a Pediatric Ward

A rigorous investigation at the Toho University Omori Medical Center in Tokyo divulges the underlying challenges in controlling a multispecies outbreak of carbapenemase-producing Enterobacterales (CPE) that occurred in the year 2017. Highlighted in the American Journal of Infection Control, the scholarly piece of work underscores the high vulnerability of sinks and water sources in the transmission process of this robust antibiotic-resistant microbe. Interestingly, the replacement of all ward sinks couldn’t halt this potent outbreak indicating the tenacity and adaptability of these life-threatening bacteria.

The widespread impact of CPE in the public health domain is alarming due to its inherent multidrug resistance making antimicrobial resistance a growing epidemic. Their capability to pass the resistance mechanism from one species to another intensifies their dominance, posing a formidable challenge to healthcare systems worldwide.

The research narrative from this academic health center commences in June 2016, where the detection of CPE in a single patient led to an outbreak from March to October 2017 impacting 19 children. Following this, an extensive sampling from the pediatric ward’s environment and patients was undertaken by the infection prevention team. Interestingly nine sinks were identified as hotspots of CPE contamination, correlating the sink locations with the presence of CPE positive patients.

The team also performed genome analysis of the bacterial strains contributing to the outbreak, including Klebsiella variicola, Klebsiella quasipneumoniae, and Escherichia coli. The DNA sequence similarities pointed towards potential transmission of the resistance mechanism among different bacterial species within the hospital.

Despite the replacement and thorough disinfection of all the ward’s sinks with hydrogen peroxide, the CPE contamination pursued relentlessly. This led investigators to theorize the possibility of pathogen transmission via drains and interconnected plumbing systems.

The committed infection prevention team comprising doctors, nurses, pharmacists, and microbiologists rolled out several stringent measures like hand disinfection after sink usage, disposable sink cleaning tools, prohibition of sink water usage for mouthwashing, and meticulous disinfection procedures for items exposed to sink water. These resilient efforts led to no further CPE contamination detection post-October 2017.

Dr. Sadako Yoshizawa, the corresponding author of the study, highlights the critical role of sinks and water-related areas in hospital wards that serve as a key battleground in combating antibiotic resistance. Further, Tania Bubb, PhD, RN, CIC, FAPIC, 2024 APIC president emphasizes the essence of a comprehensive and holistic approach in infection prevention to control such outbreaks effectively.

The report serves as a valuable lesson for infection prevention professionals, accentuating the vitality of an all-encompassing strategy, the use and disinfection of hospital sinks, and the importance of adhering to hand hygiene protocols. This eventually represents a triumphant defiance against the growing menace of antibiotic-resistant organisms.


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