Microbial competition in environmental nosocomial reservoirs and diffusion capacity of OXA48-Klebsiella pneumoniae: potential impact on patients and possible control methods.

BACKGROUND: We have found clusters of Klebsiella pneumoniae with OXA48-carbepenemase cases in some hospital rooms, and decided to investigate whether bathroom siphons could be a reservoir for OXA48 bacteria, as occurs with K. oxytoca with other types of carbepenemases.

METHODS: We evaluated the microbial competition between strains with OXA48 and VIM carbepenemases, in diluted nutrient-broth, on a slime germ-carrier. We compared the number of colonies at 5 and 10 days on the contaminated carriers with one or two strains. We evaluated the dissemination of K. pneumoniae with carbepenemase OXA48 or VIM from thumbs and index fingers of volunteers, to standard surfaces (20 glass germ-carrier by each volunteer). After, we counted the number of microorganisms on each carrier. Microbiological weekly studies of faecal microbiota of all patients were obtained in Traumatology and Oncology. Moreover, we studied samples of the sink in their rooms. PCR and MLST sequence-type was determined in all K. pneumoniae diagnosed from patients and sinks.

RESULTS: A large possibility of diffusion from contaminated hands, which continue to transmit high numbers of microorganisms after more than 10 successive surface contacts, was highlighted; OXA bacteria were more persistent than VIM bacteria. Microbial competition studies showed that VIM bacteria are inhibited by OXA ones. These observations can explain the concentration of cases of K. pneumoniae OXA48 in some rooms in Traumatology and Oncology, producing a significant OR between rooms with OXA48-bacteria-contaminated siphons and other rooms (3.1 and 3.3 respectively). Risk was lowered after changing or disinfecting (heat plus chlorinated disinfectant) the contaminated siphons. Siphon colonization by VIM bacteria was not related with human infections by similar microorganisms.

CONCLUSIONS: Bathroom siphons can be a reservoir for K. pneumoniae OXA48 and lead to outbreaks. Outbreaks can be controlled by replacement or heat plus chemical treatment of the sink-siphons.