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Clin Infect Dis. 2017 May 15;64(10):1435-1444. doi: 10.1093/cid/cix132.

The Hospital Water Environment as a Reservoir for Carbapenem-Resistant Organisms Causing Hospital-Acquired Infections-A Systematic Review of the Literature.

Author information

Modernising Medical Microbiology Consortium, Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, and.
Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia Health System, Charlottesville.
Department of Microbiology & Infectious Diseases, Concord Repatriation Hospital, Sydney, and.
University of Sydney, Australia.
Oxford Biomedical Research Centre, United Kingdom.


Over the last 20 years there have been 32 reports of carbapenem-resistant organisms in the hospital water environment, with half of these occurring since 2010. The majority of these reports have described associated clinical outbreaks in the intensive care setting, affecting the critically ill and the immunocompromised. Drains, sinks, and faucets were most frequently colonized, and Pseudomonas aeruginosa the predominant organism. Imipenemase (IMP), Klebsiella pneumoniae carbapenemase (KPC), and Verona integron-encoded metallo-β-lactamase (VIM) were the most common carbapenemases found. Molecular typing was performed in almost all studies, with pulse field gel electrophoresis being most commonly used. Seventy-two percent of studies reported controlling outbreaks, of which just more than one-third eliminated the organism from the water environment. A combination of interventions seems to be most successful, including reinforcement of general infection control measures, alongside chemical disinfection. The most appropriate disinfection method remains unclear, however, and it is likely that replacement of colonized water reservoirs may be required for long-term clearance.


carbapenem-resistant; carbapenemase; healthcare-associated infections; outbreak; water.

[Indexed for MEDLINE]

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