Hospitalizations Due to Selected Infections Caused by Opportunistic Premise Plumbing Pathogens and Reported Drug Resistance in the United States Older Adult Population
ELENA N. NAUMOVA, ALEXANDER LISS, JYOTSNA S. JAGAI, IRMGARD BEHLAU, JEFFREY K. GRIFFITHSPALGRAVE MACMILLAN, JOURNAL OF PUBLIC HEALTH POLICY, SEPTEMBER 2016 IntroductionThe study explores the health implications of opportunistic premise plumbing pathogens (OPPP) in US drinking water, particularly focusing on vulnerable populations like the elderly. These pathogens have gained attention due to the Flint Water Crisis, which exposed unresolved social, environmental, and public health issues related to changes in water source and treatment procedures. The study aims to understand the impact of OPPP, such as Legionella pneumophila, Mycobacterium avium, and Pseudomonas aeruginosa, and highlights the need for improved monitoring and prevention. ResultsAnalyzing 108,202 hospitalization records from 1991 to 2006, the study reveals significant findings about OPPP-related hospitalizations among the elderly. Legionella pneumophila resulted in 7,933 cases of Legionnaires’ disease. Pseudomonas aeruginosa and gram-negative anaerobes contributed to 544,643 hospitalizations. Among non-tuberculous mycobacteria (NTM), pulmonary infection caused by Mycobacterium avium-intracellulare totaled 71% of the 48,854 cases. Reported drug resistance was observed in 1.68% of Pseudomonas infections, 1.05% of NTM infections, and 0.6% of Legionnaires’ disease cases. Drug resistance led to a 32.8% increase in Medicare charges. The estimated cost of Pseudomonas infections was $8.8 billion USD over 15 years, with a per-case differential payment of $14,510 for resistant cases. ConclusionThe study highlights a substantial economic burden of OPPP-related hospitalizations in the elderly, with antibiotic resistance significantly impacting costs. There is an urgent need for enhanced identification, reporting, and prevention strategies for these pathogens in premise plumbing systems. The authors emphasize the importance of interdisciplinary collaboration and increased efforts in monitoring and regulatory measures to address the growing issue of OPPP infections. The study underscores the need for comprehensive research to mitigate the health risks posed by these pathogens in drinking water. Full study
CDC Report Links Cluster of Healthcare-Associated Infections to Water System
A report published in CDC’s Morbidity and Mortality Weekly Report on August 4, 2023 linked a cluster of healthcare-associated infections to an Idaho hospital’s potable water system. According to the report, two patients who stayed in the same ICU room four months apart were found to be infected with carbapenemase-producing carbapenem-resistant Pseudomonas aeruginosa (CP-CRPA). Carbapenem-resistant organisms, such as CRPA, are gram-negative bacteria resistant to the carbapenem class of antibiotics, a broad-spectrum antibiotic considered a “last resort.” Certain carbapenem-resistant organisms are resistant because they produce carbapenemase enzymes that make carbapenems ineffective. Infections from carbapenemase-producing organisms are difficult to treat and associated with high mortality. Pseudomonas aeruginosa can carry genes encoded with carbapenemases that can be transferred between strains and across bacterial species, leading to the spread of antibiotic resistance. CP-CRPA infections are typically transmitted from person-to-person or acquired from environmental sources, like water, sink drains, and toilets. Investigation and resultsA collaborative investigation involving the Idaho Division of Public Health, the Idaho Bureau of Laboratories, the Utah Public Health Laboratory, and the CDC was undertaken to identify the cause of the infection. The investigative team focused on the plumbing in the ICU room because Pseudomonas aeruginosa is known to persist in biofilm, a collection of microorganisms that adhere to one another and to a surface, such as a pipe. Water samples and swabs from two sinks and one toilet were collected. CP-CRPA with the same gene type isolated in the patients was found in one of the sinks, including swab samples from the drain, p-trap (a bend in a sink drain that holds water to block sewer gases), and sink counter. Water samples from the same sink’s p-trap and a toilet also tested positive for a different strain of CP-CRPA. Due to the genetic link between the patient isolate and sink isolate, the investigative team concluded that the most likely source of the outbreak was the ICU room sink. Prevention and control measuresUpon identifying the sink as the likely infection source, suggested measures for prevention and control were immediately instituted. These included the application of biofilm disinfectants, a screening regimen for future patients occupying the room, and a commitment towards forwarding any CP-CRPA isolates to public health laboratories for detailed molecular profiling, prevention, and control. On conducting a retest, no further CP-CRPA strains were detected in the environmental samples. As of December 2022, no additional CP-CRPA isolates have been reported by the hospital. These findings underpin the important relationship between biofilm, building water systems, and healthcare-associated infections. Long-term strategies to control and prevent biofilm in plumbing systems, such as through continuous disinfection of the entire building water system, are crucial to reducing healthcare-associated infections and ensuring patient safety. Read the full report. ReferencesCenters for Disease Control and Prevention. (2023). Carbapenemase-Producing Organisms (CPO). Carbapenemase-Producing Organisms (CPO) 2023 Case Definition | CDC Minnesota Department of Health. (2023). Carbapenem Resistant Pseudomonas aeruginosa (CRPA). Carbapenem Resistant Pseudomonas aeruginosa (CRPA) – MN Dept. of Health (state.mn.us) Centers for Disease Control and Prevention. (2023). Cluster of Carbapenemase-Producing Carbapenem-Resistant Pseudomonas aeruginosa Among Patients in an Adult Intensive Care Unit. Morbidity and Mortality Weekly Report | CDC
