Biofilm removal in hospital sink drains drives unintended surges in antibiotic resistance
Murray, C. J. et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 399, 629–655 (2022).
Google Scholar
Cassini, A. et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect. Dis. 19, 56–66 (2019).
Google Scholar
Kizny Gordon, A. E. et al. Is the hospital water environment a reservoir for carbapenem-resistant organisms causing hospital-acquired infections? A systematic review of the literature. Clin. Infect. Dis. (2017).
Parkes, L. O. & Hota, S. S. Sink-related outbreaks and mitigation strategies in healthcare facilities. Curr. Infect. Dis. Rep. 20, 42 (2018).
Google Scholar
Kotay, S., Chai, W., Guilford, W., Barry, K. & Mathers, A. J. Spread from the sink to the patient: in situ study using green fluorescent protein (GFP) expressing- Escherichia coli to model bacterial dispersion from hand washing sink trap reservoirs. Appl. Environ. Microbiol. (2017).
Karkman, A., Do, T. T., Walsh, F. & Virta, M. P. J. Antibiotic-resistance genes in waste water. Trends Microbiol. 26, 220–228 (2018).
Google Scholar
Bope, A. et al. Translating research to policy at the NCSE 2017 symposium “Microbiology of the Built Environment: Implications for Health and Design”. Microbiome 6, 160 (2018).
Google Scholar
Chibwe, K. et al. Intra-hospital microbiome variability is driven by accessibility and clinical activities. Microbiol. Spectr. 12, e0029624 (2024).
Google Scholar
Mahnert, A. et al. Man-made microbial resistances in built environments. Nat. Commun. 10, 968 (2019).
Google Scholar
Weingarten, R. A. et al. Genomic analysis of hospital plumbing reveals diverse reservoir of bacterial plasmids conferring carbapenem resistance. MBio 9. (2018).
Mathers, A. J. et al. Developing a framework for tracking antimicrobial resistance gene movement in a persistent environmental reservoir. npj Antimicrob. Resist. 2, 50 (2024).
Google Scholar
French, G., Shannon, K. & Simmons, N. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectrum cephalosporins and beta-lactam-beta-lactamase inhibitor combinations by hyperproduction of SHV-5 beta-lactamase. J. Clin. Microbiol. 34, 358–363 (1996).
Google Scholar
Hota, S. et al. Outbreak of Multidrug-resistant pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect. Control Hosp. Epidemiol. 30, 25–33 (2009).
Google Scholar
Gbaguidi-Haore, H. et al. A bundle of measures to control an outbreak of Pseudomonas aeruginosa associated with P-trap contamination. Infect. Control Hosp. Epidemiol. 39, 164–169 (2018).
Google Scholar
Stjarne Aspelund, A. et al. Acetic acid as a decontamination method for sink drains in a nosocomial outbreak of metallo-beta-lactamase-producing Pseudomonas aeruginosa. J. Hosp. Infect. 94, 13–20 (2016).
Google Scholar
Tofteland, S., Naseer, U., Lislevand, J., Sundsfjord, A. & Samuelsen, O. A long-term low-frequency hospital outbreak of KPC-producing Klebsiella pneumoniae involving intergenus plasmid diffusion and a persisting environmental reservoir. Plos ONE 8. (2013).
Vergara-Lopez, S., Dominguez, M., Conejo, M., Pascual, A. & Rodriguez-Bano, J. Wastewater drainage system as an occult reservoir in a protracted clonal outbreak due to metallo-beta-lactamase-producing Klebsiella oxytoca. Clin. Microbiol. Infect. 19, E490–E498 (2013).
Google Scholar
Varghese, M. M., Torres-Teran, M. M., Greentree, D. H., Cadnum, J. L. & Donskey, C. J. What is the optimal frequency of sink drain decontamination with a foam disinfectant? Infect. Control Hosp. Epidemiol. 45, 1–3 (2024).
Breathnach, A. S., Cubbon, M. D., Karunaharan, R. N., Pope, C. F. & Planche, T. D. Multidrug-resistant Pseudomonas aeruginosa outbreaks in two hospitals: association with contaminated hospital waste-water systems. J. Hosp. Infect. 82, 19–24 (2012).
Google Scholar
Decraene, V. et al. A large, refractory nosocomial outbreak of Klebsiella pneumoniae Carbapenemase-producing Escherichia coli demonstrates Carbapenemase gene outbreaks involving sink sites require novel approaches to infection control. Antimicrob. Agents Chemother. 62, e01689–01618 (2018).
Google Scholar
La Forgia, C. et al. Management of a multidrug-resistant Acinetobacter baumannii outbreak in an intensive care unit using novel environmental disinfection: a 38-month report. Am. J. Infect. Control 38, 259–263 (2010).
Google Scholar
Wendel, A. F. & MacKenzie, C. R. Characterization of a novel metallo-beta-lactamase variant, GIM-2, from a clinical isolate of Enterobacter cloacae in Germany. Antimicrob. Agents Chemother. 59, 1824–1825 (2015).
Google Scholar
Mathers, A. J. et al. Intensive care unit wastewater interventions to prevent transmission of multispecies Klebsiella pneumoniae Carbapenemase-producing organisms. Clin. Infect. Dis. 67, 171–178 (2018).
Google Scholar
Mathers, A. J. et al. Risk factors for Klebsiella pneumoniae carbapenemase (KPC) gene acquisition and clinical outcomes across multiple bacterial species. J. Hosp. Infect. 104, 456–468 (2020).
Google Scholar
Stoesser, N. et al. Genomic epidemiology and longitudinal sampling of ward wastewater environments and patients reveals complexity of the transmission dynamics of blaKPC-carbapenemase-producing Enterobacterales in a hospital setting. JAC-Antimicrob. Resist. 6, dlae140 (2024).
Google Scholar
De Geyter, D. et al. The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit. Antimicrob. Resist. Infect. Control 6. (2017).
Cordovana, M., Deni, A., Kostrzewa, M., Abdalla, M. & Ambretti, S. First report of Methylobacterium radiotolerans bacteraemia identified by MALDI-TOF mass spectrometry. N. Microbes N. Infect. 30, 100546. (2019).
Google Scholar
Barahona, F. & Slim, J. Sphingobacterium multivorum: case report and literature review. N. Microbes N. Infect. 7, 33–36 (2015).
Google Scholar
Medici, I. F. et al. The distinct cell physiology of Bradyrhizobium at the population and cellular level. BMC Microbiol 24, 129 (2024).
Google Scholar
Efrati Epchtien, R. et al. Characterization of Enterobacterales growing on selective CPE screening plates with a focus on non-carbapenemase-producing strains. Microbiol. Spectr. 13, e02079–02024 (2025).
Google Scholar
Klümper, U. et al. Environmental microbiome diversity and stability is a barrier to antimicrobial resistance gene accumulation. Commun. Biol. 7, 706 (2024).
Google Scholar
Snell, L. B. et al. The drainome: longitudinal metagenomic characterization of wastewater from hospital ward sinks to characterize the microbiome and resistome and to assess the effects of decontamination interventions. J. Hosp. Infect. 153, 55–62 (2024).
Google Scholar
Chng, K. R. et al. Cartography of opportunistic pathogens and antibiotic resistance genes in a tertiary hospital environment. Nat. Med. 26, 941–951 (2020).
Google Scholar
Tsukada, M. et al. The outbreak of multispecies carbapenemase-producing Enterobacterales associated with pediatric ward sinks: IncM1 plasmids act as vehicles for cross-species transmission. Am. J. Infect. Control 52, 801–806 (2024).
Google Scholar
Winter, S. E. & Bäumler, A. J. Gut dysbiosis: Ecological causes and causative effects on human disease. Proc. Natl. Acad. Sci. 120, e2316579120 (2023).
Google Scholar
Seidel, D. et al. Impact of climate change and natural disasters on fungal infections. Lancet Microbe 5, e594–e605 (2024).
Google Scholar
van der Putten, W. H., Klironomos, J. N. & Wardle, D. A. Microbial ecology of biological invasions. ISME J. 1, 28–37 (2007).
Google Scholar
Rodriguez, R. L., Gunturu, S., Tiedje, J. M., Cole, J. R. & Konstantinidis, K. T. Nonpareil 3: fast estimation of metagenomic coverage and sequence diversity. mSystems 3. (2018).
TrimGalore- A Wrapper Tool Around Cutadapt and FastQC to Consistently Apply Quality and Adapter Trimming to FastQ Files (2015).
Wood, D. E. & Salzberg, S. L. Kraken: ultrafast metagenomic sequence classification using exact alignments. Genome Biol. 15, R46 (2014).
Google Scholar
Lu, J., Breitwieser, F. P., Thielen, P. & Salzberg, S. L. Bracken: estimating species abundance in metagenomics data. PeerJ Comput. Sci. 3, e104 (2017).
Google Scholar
Bushnell, B. BBMap: a Fast, Accurate, Splice-Aware Aligner (LBNL Report #: LBNL-7065E, Lawrence Berkeley National Laboratory (LBL Publications, 2014).
Jia, B. et al. CARD 2017: expansion and model-centric curation of the comprehensive antibiotic resistance database. Nucleic Acids Res. 45, D566–D573 (2017).
Google Scholar
Gweon, H. S. et al. The impact of sequencing depth on the inferred taxonomic composition and AMR gene content of metagenomic samples. Environ. Microbiome 14, 7 (2019).
Google Scholar
Vegan: Community Ecology Package. R Package Version 1.8–5 (2007).
Rahnavard, G. et al. High-sensitivity Pattern Discovery in Large Multi’omic Datasets. (2017).
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