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Infection

, Volume 47, Issue 2, pp 233–238 | Cite as

Dialysis drains as a possible source for carbapenem-resistant pathogens causing an ICU outbreak

  • Birgit RossEmail author
  • Marco Krull
  • Peter Rath
  • Andreas Kribben
  • Dana Dopadlik
  • Irmgard Erlemann
  • Ina Wiegard‑Szramek
  • Bartosz Tyczynski
  • Jan Buer
  • Frank Herbstreit
Original Paper

Abstract

Objective design

We describe a case series of patients colonized with KPC-producing Enterobacteriaceae related to dialysis drains at patient’s bedside.

Setting

The study was set at the intensive care unit (ICU) of a tertiary referral hospital.

Patients

In March 2016, we discovered four ICU patients to be colonized with KPC-producing Enterobacteriaceae in routine screening. All of these patients had already received contact isolation, and all of them were treated with continuous veno-venous dialysis. Environmental examinations showed KPC-producing Enterobacteriaceae in dialysis drains in different ICU rooms and even in rooms not hosting KPC-colonized patients.

Interventions

Based on our findings, we suspected the dialysis drains as a reservoir of KPC-producing Enterobacteriaceae with a potential risk for the patients. Therefore, we decided to change the dialysis waste management.

Results

As a result, no KCP-producing Enterobacteriaceae were detected during the following weekly screening of the patients.

Conclusions

Installation of dialysis connection units including a drain system at the patient’s bedside is a comfortable way to provide water supply. In many ICUs, such dialysis drains are installed near the patients’ head and directly besides the infusion systems. When the drains are not used properly, in our opinion, they pose a risk of transmission of pathogens from the drain to the patient. Our findings support the need of specific precautions.

Keywords

Dialysis drains Dialysis wastewater Carbapenem resistance ICU 

Notes

Funding

None reported.

Compliance with ethical standards

Conflict of interest

All authors report no conflicts of interest relevant to this article.

References

  1. 1.
    Hajime Kanamori DJ, Weber WA. Rutala healthcare outbreaks associated with a water reservoir and infection prevention strategies. Clin Infect Dis 2016;62:1423–1435.CrossRefGoogle Scholar
  2. 2.
    Ashita Tolwani MD. Continuous renal-replacement therapy for acute kidney injury. N Engl J Med. 2012;367:2505–14.CrossRefGoogle Scholar
  3. 3.
    Kaufman J, Dhakal M, Patel B, et al. Community-acquired acute renal failure. Am J Kidney Dis. 1991;17:191–8.CrossRefGoogle Scholar
  4. 4.
    Lameire N, Van Biesen W, Vanholder R. The changing epidemiology of acute renal failure. Nat Clin Pract Nephrol. 2006;2:364–77.CrossRefGoogle Scholar
  5. 5.
    Uchino S, Kellum JA, Bellomo R, et al. Acute renal failure in critically ill patients: a multinational, multicenter study. JAMA. 2005;294:813–8.CrossRefGoogle Scholar
  6. 6.
    Carstens A, Kepper U, Exner M, Hauri Kaase M, Wendt C. Plasmid-vermittelter Multispezies-Ausbruch mit Carbapenem-resistenten Enterobacteriaceae. Epid Bull. 2014;47:455–9. https://www.rki.de.Google Scholar
  7. 7.
    Robert Koch-Institut. Häufung von KPC-2 produzierenden Stämmen verschiedener Enterobacteriaceae-Spezies in Hessen. Epid Bull. 2014;21:183–4.Google Scholar
  8. 8.
    Mathers AJ, Cox HL, Kitchel B, Bonatti H, Brassinga AK, Carroll J, Scheld WM, Hazen KC, Sifri CD. Molecular dissection of an outbreak of carbapenem-resistant enterobacteriaceae reveals Intergenus KPC carbapenemase transmission through a promiscuous plasmid. MBio. 2011;2:e00204–11 (21:183–184) CrossRefGoogle Scholar
  9. 9.
    Modul HAND-KISS_S. Referenzdaten. Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen. http://www.nrz-hygiene.de/fileadmin/nrz/module /hand/HAND_S_Referenzdaten_2015_DE.pdf. Published May 17, 2016. Accessed 2 Jan 2018.
  10. 10.
    Falagas ME, Tansarli GS, Karageorgopoulos DE, et al. Deaths attributable to carbapenem-resistant Enterobacteriaceae infections. Emerg Infect Dis. 2014;20:1170–5.CrossRefGoogle Scholar
  11. 11.
    Salm F, Deja M, Kola A, et al. Prolonged outbreak of clonal MDR Pseudomonas aeruginosa on an intensive care unit: contaminated sinks and contamination of ultra-filtrate bags as possible route of transmission? Antimicrob Resist Infect Control. 2016;5:53.CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Birgit Ross
    • 1
    Email author
  • Marco Krull
    • 1
  • Peter Rath
    • 2
  • Andreas Kribben
    • 3
  • Dana Dopadlik
    • 1
  • Irmgard Erlemann
    • 1
  • Ina Wiegard‑Szramek
    • 3
  • Bartosz Tyczynski
    • 3
  • Jan Buer
    • 2
  • Frank Herbstreit
    • 4
  1. 1.KrankenhaushygieneUniversitätsmedizin EssenEssenGermany
  2. 2.Institut für Medizinische MikrobiologieUniversität Duisburg-Essen and Universitätsklinikum EssenEssenGermany
  3. 3.Klinik für NephrologieUniversität Duisburg-Essen and Universitätsklinikum EssenEssenGermany
  4. 4.Klinik für Anästhesiologie and IntensivmedizinUniversität Duisburg-Essen and Universitätsklinikum EssenEssenGermany

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