ABSTRACT
INTRODUCTION: Reverse osmosis (RO), a major advance in hemodialysis (HD) safety, effectively clears most water organisms. Delftia acidovorans is an environmental water-borne pathogen that is rarely reported to cause human infections. We report a pseudo outbreak caused by colonization of RO machines with D acidovorans with no reported human infections and interventions to improve HD safety. METHODS: Repeated positive RO product water cultures triggered our hospital to initiate an investigation, RO machines were examined for mechanical integrity by biomedical engineers. Cultures of product water as well as RO parts were done. Testing for bacterial relatedness after identification was performed. An investigation was conducted in a systematic fashion to determine the cause and the extent of the problem. RESULTS: Upon formal review of policies and procedures, there were minor deficiencies. Rectifying these deviations from policies did not stop the repeated positive water cultures. A 7-step investigation and correction was successfully conducted. City water testing with filtration and concentration methods was positive for D acidovorans. Major renovation of the HD unit with replacement of all RO machines and a 2-step water filtration resulted in elimination of the pseudo outbreak. CONCLUSION: City water was the source of biofilm formation of D acidovorans in RO machines that was not possible to eradicate. Application of incoming water filters was an effective preventive strategy. Replacement of RO machines after 4 failed disinfection attempts is the most cost-effective strategy as well for persistent positive water cultures. The HD remains RO water culture negative 2 years after changes.
Subject(s)
Disease Outbreaks/prevention & control , Disinfection/methods , Filtration/methods , Renal Dialysis/methods , Cost-Benefit Analysis , Delftia acidovorans/pathogenicity , Humans , Osmosis , Water/chemistry , Water Purification/methodsABSTRACT
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Subject(s)
Aged , Female , Humans , Urinary Tract Infections/microbiology , Delftia acidovorans/pathogenicity , Gram-Negative Bacterial Infections/diagnosisABSTRACT
La intervención humana en los manantiales de aguas termales ha traído su contaminación microbiológica y química. El uso indiscriminado de los antimicrobianos, han desembocado en la contaminación de diversos ambientes acuáticos con estas sustancias y con bacterias resistentes a las mismas. En este sentido el objetivo del presente trabajo fue conocer la resistencia antimicrobiana en cepas de Pseudomonas aeruginosa aisladas de aguas termales de la región del Chimborazo, Ecuador. Se analizaron 12 muestras de agua termal procedentes de baños de la Provincia del Chimborazo. Las muestras consistieron de un volumen de 0,5 litro de agua de cada manantial. El aislamiento de Pseudomonas aeruginosa se realizó por la técnica de filtración en membrana, utilizando filtros de acetato de celulosa de 0,45 µm de poro, un volumen de muestra de 100 ml y el agar Cetrimida. Las cepas aisladas se identificaron siguiendo los esquemas de MacFadden (2004) y Barrow y Feltham (1993), complementados con las pruebas bioquímicas de las galerías API (bioMerieux). El perfil de resistencia a los antibióticos se determinó por el método de difusión de Kirby y Bauer (1966) interpretándose según el CLSI (2014). Se identificaron 15 cepas de Pseudomonas aeruginosa. Todas las cepas fueron resistentes a los antibióticos Ampicilina y Ampicilina-Sulbactam, y cinco fueron multiresistentes a seis antibióticos (Ampicilina, Ampicilina-Sulbactam, Amikacina, Ceftazidime, Cefepime y Ciprofloxacina). Los resultados nos señalan la necesidad de realizar estudios del resistoma de los ecosistemas de las aguas termales, para determinar la presencia de genes de resistencias en las bacterias autóctonas
Human intervention in the hot springs has brought its microbiological and chemical contamination. The indiscriminate use of antimicrobials, have resulted in the contamination of various aquatic environments with these substances and bacteria The objectives were meet antimicrobial resistance in Pseudomonas aeruginosa strains isolated from hot springs in the region of Chimborazo, Ecuador. 12 samples of thermal water baths from Chimborazo Province were analyzed. Samples consisted of a volume of 0.5 liters of water. Pseudomonas aeruginosa isolation was performed by the membrane filtration technique using cellulose acetate filter 0.45 um pore, a sample volume of 100 ml and Cetrimide agar. The isolates were identified following schemes MacFadden (2004) and Barrow and Feltham (1993), supplemented with biochemical tests of API (bioMerieux) galleries. The profile of antibiotic resistance was determined by the method of dissemination of Kirby and Bauer (1966) and the results were interpreted according the CLSI (2014). 15 strains of Pseudomonas aeruginosa were identified. All strains were resistant to ampicillin and ampicillin - Sulbactam antibiotics and five were multidrug resistant to six antibiotics (Ampicillin, ampicillin-Sulbactam, amikacin, ceftazidime, cefepime and ciprofloxacin). The results show us the need for studies of resistoma ecosystems hot springs, to determine the presence of resistance genes in indigenous bacteria
Subject(s)
Drug Resistance, Microbial , Drug Resistance, Microbial/genetics , Drug Resistance, Microbial/immunology , Delftia acidovorans/growth & development , Delftia acidovorans/immunology , Delftia acidovorans/pathogenicity , In Vitro Techniques/instrumentation , In Vitro Techniques/methods , In Vitro Techniques/trendsABSTRACT
Gram-negative bacilli causing infective endocarditis (IE) is rare, even in intravenous drug users. This case report underscores several clinically important aspects of Delftia acidovorans IE: the organism's ability to cause rapid destruction of normal native valves and to cause embolic occlusion of large arteries and its resistance to all aminoglycosides.
