Title: Pseudomonas aeruginosa Infection in Augmented Care: Detecting Transmission from Water Using Whole Genome Sequencing
Funder: Department of Health (England)

Abstract: Background Pseudomonas aeruginosa is a bacterium which can cause severe infections in patients in intensive care or undergoing other specialist treatment which renders them vulnerable to infection. Recently there have been some high-profile outbreaks, notably in a neonatal unit in Northern Ireland, where water outlets in the units were implicated as the source of these bacteria. Subsequently, national guidance has been published giving recommendations for sampling of water and implementing control measures where Pseudomonas is found in the water. Despite this, we have little idea of how important water really is as a source of transmission of infection in daily practice. Aims in relation to the issue to be addressed This study aims to undertake a defined snapshot survey to investigate the burden of P aeruginosa infection or colonisation in adults caused by transmission from water in the non-outbreak augmented care setting and to investigate the impact of the implementation of the national guidance on the presence and transmission of P aeruginosa in this setting. Research plan and methods of investigation Participating NHS hospitals that are currently implementing the national Pseudomonas guidance concerning sampling in augmented care will be recruited. During the twelve-week sample collection period, each hospital would store patient isolates of P. aeruginosa from the target population of adult patients nursed in augmented care for more than 48 hours. Basic, unlinked demographic data would be collected on these patients. Information would also be collected on the patient’s journey, including bed occupation during their stay in augmented care. During the same period each hospital would sample every water outlet in the same setting, using methods described in the national guidance, on three separate occasions; at the start of the study, at six weeks and at the end of the study. Based on our experience with the burns project, we estimate that approximately 125 isolates per hospital will be collected over the course of the study. P. aeruginosa isolates from all of these water samples would be saved for further study. Additional data to be collected would be the type of outlet, service history, the time of sampling, and the exact position of the outlet in the augmented care setting such that strains could be matched to patient positions. Any water fittings that were removed for disposal or replacement would additionally be collected for metagenomics analysis. ALL isolates of P. aeruginosa would be submitted to the University of Birmingham for DNA extraction and whole-genome sequencing using the Illumina MiSeq platform (3). Strains would also be available for relevant further study e.g. propensity for biofilm formation, virulence factors. Research team: dr. Oppenheim is a Consultant Microbiologist and will be overseeing the work proposed in this project. dr. Loman is an expert in microbial genome bioinformatics and will oversee the sample processing and data analysis. dr. Walker is a Public Health England microbiology expert and will provide expert advice and oversight throughout the project. Potential impact/influence on relevant policy field, users and wider stakeholders These results will enable the researchers to determine the role of water in the transmission of Pseudomonas in augmented care. The DH will be able to use the outputs to determine whether the Pseudomonas guidance already introduced is currently appropriate or whether it should be revised in due course.


Research activity codes: 3.2 INTERVENTIONS TO ALTER PHYSICAL AND BIOLOGICAL ENVIRONMENTAL RISKS;2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT
Health categories: INFECTION