Dialysis Water Supply Faucet as Reservoir for Carbapenemase-Producing Pseudomonas aeruginosa

V erona-integron-encoded metallo-β-lactamase- producing carbapenem-resistant Pseudomonas aeruginosa (VIM-CRPA) and other carbapenemaseproducing organisms (CPOs) are emerging public health threats.CPOs cause infections that are often extensively drug-resistant and associated with substantial rates of illness and death.By colonizing faucet aerators and wastewater plumbing systems, CPOs can spread rapidly within healthcare facilities, including to patients (1-9).VIM is a carbapenemase, a type of enzyme that inactivates carbapenems and other β-lactam antimicrobial drugs that are frequently encoded on mobile genetic elements, which in turn can lead to horizontal spread.VIM-CRPA is uncommon in the United States; <150 isolates are reported to CDC annually (10).During June 2017-November 2019, in a city of 250,000 residents in western Texas, USA (city A), 36 patients with VIM-CRPA were identified.Most were hospitalized for >1 night at an acute-care hospital (hospital A) in the 6 months before VIM-CRPA was isolated, but patients did not have overlapping hospital stays or common procedures.We assessed water sources and plumbing in hospital A to identify potential VIM-CRPA reservoirs.Beginning in June 2017, the Texas Department of State Health Services asked clinical laboratories to voluntarily submit clinical P. aeruginosa isolates resistant to imipenem, meropenem, or doripenem to the Texas Department of State Health Services Laboratory for mechanism testing through the Antibiotic Resistance Laboratory Network (https:// www.cdc.gov/drugresistance/ar-lab-networks/domestic.html).The 2 clinical laboratories that served hospitals in city A began submitting all CRPA for mechanism testing in June 2017 (hospital A) and April 2018 (hospital B).During July 2017-January 2019, a total of 36 patients with VIM-CRPA isolated from clinical cultures were identified from city laboratories; 21 (58%) had been admitted to hospital A for >1 night in the 6 months before culture collection.We reviewed medical records from hospital A of patients with VIM-CRPA.Median patient age was 57 (range 9-84) years; 57% were male.VIM-CRPA was isolated from wounds in 9 (43%) patients, respiratory sources in 7 (33%), and urine in 5 (24%).