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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.

Original publication




Journal article


Clin Infect Dis

Publication Date





1435 - 1444


carbapenem-resistant, carbapenemase, healthcare-associated infections, outbreak, water., Anti-Bacterial Agents, Bacterial Proteins, Carbapenem-Resistant Enterobacteriaceae, Carbapenems, Cross Infection, Disease Outbreaks, Disease Reservoirs, Disinfection, Drug Resistance, Bacterial, Electrophoresis, Gel, Pulsed-Field, Equipment and Supplies, Hospital, Hospitals, Humans, Klebsiella Infections, Klebsiella pneumoniae, Microbial Sensitivity Tests, Molecular Typing, Pseudomonas Infections, Pseudomonas aeruginosa, Water Microbiology, Water Supply, beta-Lactamases