Transmission of Verona Integron-Encoded Metallo-β-Lactamase-Producing Enterobacteriaceae Over a Two-Year Period Linked to Contaminated Drains
Bibliographic record
Abstract
Background. Over a 2-year period, among 8 patients colonized or infected with carbapenamase-producing Enterobacteriaceae (CPE), we identified 6 patients with Verona Integron-encoded metallo-β-Lactamase (VIM)-producing Enterobacter spp. We describe the outbreak investigation that led to examination of hospital drains as the potential source. Methods. Outbreak investigation involved a retrospective chart review to identify potential epidemiological links. Patient rectal swabs, clinical specimens and environmental specimens, which included tap water, and swabs of faucets, sinks and shower drains, were screened for CPE. Carbapenamase genes were tested by multiplex PCR and alleles confirmed by Sanger sequencing. Clonality was evaluated using pulse-field gel electrophoresis (PFGE) with restriction enzyme XbaI and BlnI. Results. Over a 2-year period, 4 patients (including one identified at a different hospital) with previous admission to a general medicine unit in our hospital were found to be colonized with a VIM-producing Enterobacter spp. An additional 2 patients had pseudo-infections with the same VIM-producing clone. Retrospective epidemiological review revealed all 6 patients had the same environmental exposure to one of 2 different rooms on the unit. VIM-producing Enterobacter spp. isolates were identified from environmental samples taken from hand hygiene sink drains and shower drains of both rooms. PFGE revealed genetic relatedness and the presence of blaVIM-1 gene was confirmed in all isolates from patients and environmental specimens. To stop the spread of CPE, both rooms were closed to patients, and sink drains and their hardware were replaced. Shower drains were chemically disinfected and steamed. All follow up environmental screening swabs have since been negative for CPE. Post-room closure and remediation, active screening of unit patients and environmental contacts has not identified additional cases. Conclusion. Contaminated drains in patient rooms are emerging as reservoirs of CPE in hospitals, and should be considered during outbreak investigations. Disclosures. A. Mcgeer, DebMed: Investigator, Research support
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".