ArticleAntimicrobial resistance and infection control2023
Sanitary installations and wastewater plumbing as reservoir for the long-term circulation and transmission of carbapenemase producing Citrobacter freundii clones in a hospital setting.
Article in Antimicrobial resistance and infection control, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 1 of them a synthesis that pooled it.
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Who cites it
26 citing papers in PubMed, 1 synthesis or guideline pooled it, 42 citations in OpenAlex.
- Epidemiology of Citrobacter spp. infections among hospitalized patients: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Identifying and quantifying ESKAPEE pathogens in and around sinks in high burden hospitals.The Journal of hospital infection · 2026Observational
- Long-term dissemination of NDM-producing Enterobacterales in two French hospitals (2020-2024): outbreak complexity and the role of drains as environmental reservoirs.Antimicrobial resistance and infection control · 2026Article
- Two clusters of carbapenemase-producing bacteria linked to hospital utility room wastewater drains - an outbreak report.Antimicrobial resistance and infection control · 2026Article
- Epidemiological and Molecular Surveillance of Multiresistant Citrobacter freundii Complex in a Tertiary Care Hospital: A Retrospective Cohort Study.The Journal of infectious diseases · 2026Article
- Identifying and quantifying ESKAPEE pathogens in and around sinks in high burden hospitals.medRxiv : the preprint server for health sciences · 2026Article
- Complete genome sequence of the multidrug-resistantMicrobiology resource announcements · 2026Article
- TheInternational journal of molecular sciences · 2026Review
- Rising incidence of carbapenem-resistantMicrobiology spectrum · 2026Article
- Plasmids of the multidrug-resistantMicrobiology spectrum · 2026Article
- Characterization of a conjugative IncFII/IncR plasmid harboring blaBMC microbiology · 2026Article
- Resolving plasmid-encoded carbapenem resistance dynamics and reservoirs in a hospital setting through nanopore sequencing.Microbial genomics · 2026Article
- Distribution of ST116 carbapenem-resistantFrontiers in cellular and infection microbiology · 2026Article
- Effectiveness of chlorine for the control of carbapenem-resistant gram-negative bacilli in the drainage network of a high-complexity healthcare facility.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- New Delhi metallo-β-lactamase-1 -producingInfection prevention in practice · 2025Article
- Development and validation of a core genome multilocus sequence typing scheme forJournal of clinical microbiology · 2025Article
- Article
- Hospital toilets and drainage systems as a reservoir for a long-term polyclonal outbreak of clinical infections with multidrug-resistantInfection prevention in practice · 2025Article
- Nosocomial transmission of NDM-1-containing Klebsiella pneumoniae ST147 in a Dutch pediatric oncology center associated with patients from Ukraine.BMC infectious diseases · 2024Article
- Persistence of OXA-48-producing ST-22Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin · 2024Article
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Authors and funding
10 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAccumulating evidence shows a role of the hospital wastewater system in the spread of multidrug-resistant organisms, such as carbapenemase producing Enterobacterales (CPE). Several sequential outbreaks of CPE on the geriatric ward of the Ghent University hospital have led to an outbreak investigation. Focusing on OXA-48 producing Citrobacter freundii, the most prevalent species, we aimed to track clonal relatedness using whole genome sequencing (WGS). By exploring transmission routes we wanted to improve understanding and (re)introduce targeted preventive measures.
methodsEnvironmental screening (toilet water, sink and shower drains) was performed between 2017 and 2021. A retrospective selection was made of 53 Citrobacter freundii screening isolates (30 patients and 23 environmental samples). DNA from frozen bacterial isolates was extracted and prepped for shotgun WGS. Core genome multilocus sequence typing was performed with an in-house developed scheme using 3,004 loci.
resultsThe CPE positivity rate of environmental screening samples was 19.0% (73/385). Highest percentages were found in the shower drain samples (38.2%) and the toilet water samples (25.0%). Sink drain samples showed least CPE positivity (3.3%). The WGS data revealed long-term co-existence of three patient sample derived C. freundii clusters. The biggest cluster (ST22) connects 12 patients and 8 environmental isolates taken between 2018 and 2021 spread across the ward. In an overlapping period, another cluster (ST170) links eight patients and four toilet water isolates connected to the same room. The third C. freundii cluster (ST421) connects two patients hospitalised in the same room but over a period of one and a half year. Additional sampling in 2022 revealed clonal isolates linked to the two largest clusters (ST22, ST170) in the wastewater collection pipes connecting the rooms.
conclusionsOur findings suggest long-term circulation and transmission of carbapenemase producing C. freundii clones in hospital sanitary installations despite surveillance, daily cleaning and intermittent disinfection protocols. We propose a role for the wastewater drainage system in the spread within and between rooms and for the sanitary installations in the indirect transmission via bioaerosol plumes. To tackle this problem, a multidisciplinary approach is necessary including careful design and maintenance of the plumbing system.
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