Kenyu Hashimoto1, Kenji Gotoh2, Kenji Masunaga3, Jun Iwahashi4, Toru Sakamoto5, Miho Miura6, Rie Horita7, Yoshiro Sakai8, Kenta Murotani9, Hiroshi Watanabe5. 1. Department of Clinical Laboratory Medicine, Shin Koga Hospital, Kurume, Japan; Graduate School of Medicine, Kurume University, Kurume, Japan. 2. Department of Infection Control and Prevention, Kurume University School of Medicine, Kurume, Japan; Division of Infection Control and Prevention, Kurume University Hospital, Kurume, Japan. Electronic address: gotou_kenji@kurume-u.ac.jp. 3. Department of Infection Control and Prevention, Kurume University School of Medicine, Kurume, Japan; Department of Pediatrics, Kurume University Medical Center, Kurume, Japan. 4. Department of Infection Control and Prevention, Kurume University School of Medicine, Kurume, Japan. 5. Department of Infection Control and Prevention, Kurume University School of Medicine, Kurume, Japan; Division of Infection Control and Prevention, Kurume University Hospital, Kurume, Japan. 6. Division of Infection Control and Prevention, Kurume University Hospital, Kurume, Japan. 7. Department of Clinical Laboratory Medicine, Kurume University Hospital, Kurume, Japan. 8. Department of Pharmacy, Kurume University Hospital, Kurume, Japan. 9. Biostatistics Center, Kurume University, Kurume, Japan.
Abstract
INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa (MDRP) is a waterborne pathogen that occasionally causes hospital-acquired infection in immunocompromised or critically ill patients. Urine is frequently collected to evaluate renal function or to perform hormonal examinations, but the procedure involves risk due to the possibility of healthcare workers with contaminated hands. Our objective was to evaluate the association between the urine collection and hospital-acquired horizontal transmission of MDRP. METHODS: We monitored the urine collection rate from 2011 to 2017, as part of ongoing efforts to reduce the need to collect urine. The urine collection rate and the frequency of isolation of MDRP, Methicillin resistant S. aureus (MRSA) and extended spectrum β-lactamases (ESBL)-producing E. coli were analyzed during the same period. PFGE and MLST were also performed to analyze the identity of 5 MDRP strains detected on the same ward in 2014-2015. RESULTS: The urine collection rate was dramatically decreased from 4.8% in 2011 to less than 0.5% in 2017, because the isolation rate of MDRP was significantly positively associated (RR = 1.72, 95%CI:1.03-2.85) with the urine collection rate. Isolations of MRSA and ESBL-producing E. coli showed no significant. Molecular typing showed the PFGE patterns of 3 of 5 MDRP strains were closely related as did MLST (ST17), and the remaining 2 MDRP strains had different PFGE and MLST patterns (ST14, ST655). Our data implicated the urine collection as one of the causes of hospital-acquired MDRP infections. CONCLUSIONS: We concluded that a reducing the urine collection rate could contribute to preventing hospital-acquired horizontal transmission of MDRP.
INTRODUCTION: Multidrug-resistant Pseudomonas aeruginosa (MDRP) is a waterborne pathogen that occasionally causes hospital-acquired infection in immunocompromised or critically ill patients. Urine is frequently collected to evaluate renal function or to perform hormonal examinations, but the procedure involves risk due to the possibility of healthcare workers with contaminated hands. Our objective was to evaluate the association between the urine collection and hospital-acquired horizontal transmission of MDRP. METHODS: We monitored the urine collection rate from 2011 to 2017, as part of ongoing efforts to reduce the need to collect urine. The urine collection rate and the frequency of isolation of MDRP, Methicillin resistant S. aureus (MRSA) and extended spectrum β-lactamases (ESBL)-producing E. coli were analyzed during the same period. PFGE and MLST were also performed to analyze the identity of 5 MDRP strains detected on the same ward in 2014-2015. RESULTS: The urine collection rate was dramatically decreased from 4.8% in 2011 to less than 0.5% in 2017, because the isolation rate of MDRP was significantly positively associated (RR = 1.72, 95%CI:1.03-2.85) with the urine collection rate. Isolations of MRSA and ESBL-producing E. coli showed no significant. Molecular typing showed the PFGE patterns of 3 of 5 MDRP strains were closely related as did MLST (ST17), and the remaining 2 MDRP strains had different PFGE and MLST patterns (ST14, ST655). Our data implicated the urine collection as one of the causes of hospital-acquired MDRP infections. CONCLUSIONS: We concluded that a reducing the urine collection rate could contribute to preventing hospital-acquired horizontal transmission of MDRP.