{Reference Type}: Journal Article
{Title}: Epidemiology of healthcare-associated Pseudomonas aeruginosa in intensive care units: are sink drains to blame?
{Author}: Volling C;Mataseje L;Graña-Miraglia L;Hu X;Anceva-Sami S;Coleman BL;Downing M;Hota S;Jamal AJ;Johnstone J;Katz K;Leis JA;Li A;Mahesh V;Melano R;Muller M;Nayani S;Patel S;Paterson A;Pejkovska M;Ricciuto D;Sultana A;Vikulova T;Zhong Z;McGeer A;Guttman DS;Mulvey MR;
{Journal}: J Hosp Infect
{Volume}: 148
{Issue}: 0
{Year}: 2024 Jun 28
{Factor}: 8.944
{DOI}: 10.1016/j.jhin.2024.03.009
{Abstract}: <B>BACKGROUND: </B>Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infection (PA-HAI) in the intensive care unit (ICU).<BR><B>OBJECTIVE: </B>To describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and to identify episodes of sink-to-patient PA transmission.<BR><B>METHODS: </B>This was a prospective cohort study of patients in six ICUs from 2018 to 2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial-resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole-genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained ≥48 h after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to collection date of the relevant patient specimen.<BR><B>RESULTS: </B>Over ten months, 72 PA-HAIs occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU-days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median: 26 vs 3 days uninfected; P < 0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAIs. Four patients with five PA-HAIs (6.9%) had closely related isolates previously recovered from their room/bedspace sinks.<BR><B>CONCLUSIONS: </B>Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAIs were associated with sink-to-patient transmission. Sinks may be an under-recognized reservoir for HAIs.