Outbreak Investigation of GES-5 Containing Carbapenem-Resistant Enterobacteraceae in a Tertiary Care Hospital
Bibliographic record
Abstract
Nosocomial spread of carbapenem-resistant enterobacteraceae (CRE) is an emerging threat worldwide. A contaminated hospital environment often serves as a source for the spread of resistant genes via health care workers. In this study, we investigate the source of a prolonged but sporadic nosocomial outbreak of a unique blaGES-5 containing CRE and the epidemiological link between cases identified at a large tertiary care hospital from October 2010 through August 2015. Patients were identified as being colonized or infected with a blaGES-5 containing CRE through clinical cultures. After the outbreak was identified, further cases were identified through screening or surveillance cultures. Multiple environmental samples were collected from patients’ rooms in attempt to identify a source. Seven patients were infected or colonized with bacteria harboring the blaGES-5 gene over a 5-year period. A blaGES-5Escherichia coli was isolated from two patients in cardiovascular intensive care (CVICU), Serratia marcescens was isolated from three patients in general systems intensive care (GSICU), and Raoutella planticola was isolated from two patients in CVICU. All patients acquired infection or colonization >2 weeks after hospitalization. Environmental swabs were taken from all rooms where positive patients were identified. Positive results were identified from sink drains in two rooms in CVICU. After increased cleaning, the sink drains from one of the CVICU rooms was persistently culture negative while the drain from the other room remained positive. The sinks were replaced and the new sinks were tested for the presence of blaGES-5 on a monthly basis and were negative for a period of 6 months but then became positive again. This coincided with a shortage of the accelerated hydrogen peroxide gel that was used on a weekly basis. When this product was reintroduced, the sink again became negative. The most likely source of the outbreak was a contaminated sink given the persistence of the growth despite measures being taken to eradicate the bacteria. This highlights the difficulty in eradicating biofilm in hospital water systems. In the absence of eradication, diligence with respect to hand hygiene and ongoing surveillance is of paramount importance. All authors: No reported disclosures.
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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 | 0.001 | 0.001 |
| 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 | 0.001 |
| Open science | 0.001 | 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".