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Environment less important in hospital transmission of CRE
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Carbapenem-resistant Enterobacteriaceae occurred infrequently and at low levels in the hospital rooms of infected patients, according to recent study data.
“CRE survives poorly compared to other important health care-associated pathogens on a variety of surfaces, including cloth, Formica, vinyl, and steel,” David J. Weber, MD, MPH, of the University of North Carolina Health Care, and colleagues wrote in Infection Control and Hospital Epidemiology. “Our data suggest that the environment will likely play a less important role in the transmission of these pathogens compared with more common health care-associated pathogens, although this hypothesis will need to be confirmed by more detailed study of transmission dynamics.”
Weber and colleagues collected five Rodac plates from surfaces in 15 rooms where seven patients with CRE were housed. Surfaces included bed rails, overbed tables, chair arms, sinks, toilets, bathroom floors, supply/medicine carts and linen hamper tops.
Samples were incubated for 48 hours, and the researchers then inoculated the test surfaces with carbapenem-resistant strains of Klebsiella pneumoniae, Escherichia coli or Enterobacter spp. When dry, they collected additional Rodac plates from each surface.
The surface cultures in the rooms of patients colonized or infected with CRE revealed six strains of Enterobacter spp. and one strain of K. pneumoniae.
The results showed that 8.4% of surfaces were contaminated. Only the bed rail, sink and toilet were found to be contaminated more than once.
“The mean level of CRE for contaminated surfaces was only 5.1 CFU per surface (120 cm2),” the researchers wrote.
Except for K. pneumoniae on Formica, all three pathogens had a less than 15% 24-hour survival on the test surfaces, the researchers wrote. At 48 hours, all pathogens had a less than 5% survival rate; at 72 hours, all cultures were negative.
Compared with K. pneumoniae and Enterobacter spp., E. coli survived worse on environmental surfaces, the authors wrote.
“Our data demonstrate that CRE can only infrequently be isolated from environmental surfaces in the rooms of infected patients and that when isolated, only relatively small numbers are cultured,” the researchers concluded. – by Colleen Owens
Disclosures: Weber reports being a consultant for Johnson & Johnson and Clorox. Rutala reports being a consultant for Advanced Sterilization Products and Clorox. All other researchers report no relevant financial disclosures.
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