Control of legionellae in a new healthcare facility following implementation of a thermal control strategy.

INTRODUCTION: The management of the Legionella risk in hospitals is essentially related to preventive measures of the hot-water supplies. AIM: To monitor the control of legionellae before and after moving to a new hospital facility. METHODS: We implemented a survey program based on the surveillance of the temperature of the hot-water supply and detection and counting of Legionella pneumophila and Legionella spp. by quantitative polymerase chain reaction and culture methods. RESULTS: Our survey program revealed that the hot-water system was colonized by L. pneumophila and Legionella spp. before the arrival of the first patients, despite the implementation of preventive measures. Thus, maintenance on the hot-water production system and subsequent cleaning and superheat disinfection of the hot-water supplies were performed, leading to the eradication of L. pneumophila reservoirs and the decrease of Legionella spp. reservoirs. No reservoirs of L. pneumophila and only rare persistent reservoirs of Legionella spp. were detected after the transfer of hospitalized patients to the new healthcare facility and during the following four years, demonstrating the effectiveness of our corrective measures, without using biocides. L. anisa was identified as the only strain of viable and cultivable Legionella spp. and was undetected during the last year. CONCLUSIONS: The strict application of our survey program before and after moving to the new hospital associated with strict implementation of corrective measures allowed us to efficiently manage the Legionella-linked risk during this period.

Environmental contamination with extended-spectrum ß-lactamases: is there any difference between Escherichia coli and Klebsiella spp?

BACKGROUND: The hospital environment contributes to the spread of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-PE) during outbreaks. We aimed to assess the rate of environmental contamination in rooms occupied by ESBL carriers or infected children and to identify risk factors associated with contamination. METHODS: Five environmental surface samples were systematically performed in rooms occupied by ESBL-PE carrier or infected children. RESULTS: Forty-six Escherichia coli and 48 Klebsiella infected/carrier patients were included in the study. Nineteen (4%) of the 470 environmental samples performed yielded ESBL-PE. Klebsiella spp was the most frequent species isolated (16, 89%), whereas E coli and Citrobacter freundii were reported twice and once, respectively. Ten of the 19 (52%) isolates were identical to the corresponding strains isolated from children. Multivariate analysis highlighted ESBL-producing Klebsiella carriage/infection as the only risk factor significantly associated with surface contamination (P = .024). CONCLUSION: Our data suggest that hospital environmental contamination is more frequent in instances of fecal carriage or infection with ESBL-producing Klebsiella than ESBL-producing E coli. Reinforcing hygiene measures around ESBL-producing Klebsiella might be necessary to reduce the spread of ESBL-PE in hospital environments.

Nationwide study of the prevalence, characteristics, and molecular epidemiology of extended-spectrum-beta-lactamase-producing Enterobacteriaceae in France.

Among 10,872 isolates of Enterobacteriaceae from a nationwide study of 88 French hospitals in 2005, 169 (1.7%) expressed an extended-spectrum beta-lactamase. The most prevalent species were Escherichia coli (48.5%), Enterobacter aerogenes (23.7%), and Klebsiella pneumoniae (14.8%). Molecular analysis underlined the polyclonal spread of CTX-M-expressing E. coli, primarily isolates of the CTX-M-1 subgroup.