Dialysis drains as a possible source for carbapenem-resistant pathogens causing an ICU outbreak

• Published in: Infection 2019-04, Vol.47 (2), p.233-238
• Main Authors: Ross, Birgit, Krull, Marco, Rath, Peter, Kribben, Andreas, Dopadlik, Dana, Erlemann, Irmgard, Wiegard‑Szramek, Ina, Tyczynski, Bartosz, Buer, Jan, Herbstreit, Frank
• Format: Article
• Language: English
• Subjects: Antibiotics; Bacteria; Carbapenems - pharmacology; Cross Infection - epidemiology; Cross Infection - microbiology; Dialysis; Disease Outbreaks - statistics & numerical data; Disease prevention; Disease transmission; Drains; Drug Resistance, Bacterial; Enterobacteriaceae; Family Medicine; General Practice; Germany - epidemiology; Hemodialysis; Infectious Diseases; Intensive care; Intensive Care Units - statistics & numerical data; Internal Medicine; Medicine; Medicine & Public Health; Original Paper; Outbreaks; Pathogens; Patients; Renal Dialysis - instrumentation; Screening; Surgical drains; Tertiary Care Centers - statistics & numerical data; Waste management; Water supply
• ISSN: 0300-8126; 1439-0973
• DOI: 10.1007/s15010-018-1239-9

Objective design We describe a case series of patients colonized with KPC-producing Enterobacteriaceae related to dialysis drains at patient’s bedside. Setting The study was set at the intensive care unit (ICU) of a tertiary referral hospital. Patients In March 2016, we discovered four ICU patients to be colonized with KPC-producing Enterobacteriaceae in routine screening. All of these patients had already received contact isolation, and all of them were treated with continuous veno-venous dialysis. Environmental examinations showed KPC-producing Enterobacteriaceae in dialysis drains in different ICU rooms and even in rooms not hosting KPC-colonized patients. Interventions Based on our findings, we suspected the dialysis drains as a reservoir of KPC-producing Enterobacteriaceae with a potential risk for the patients. Therefore, we decided to change the dialysis waste management. Results As a result, no KCP-producing Enterobacteriaceae were detected during the following weekly screening of the patients. Conclusions Installation of dialysis connection units including a drain system at the patient’s bedside is a comfortable way to provide water supply. In many ICUs, such dialysis drains are installed near the patients’ head and directly besides the infusion systems. When the drains are not used properly, in our opinion, they pose a risk of transmission of pathogens from the drain to the patient. Our findings support the need of specific precautions.