Microbial contamination of ‘sterile water’ used in Japanese hospitals

doi:10.1016/S0195-6701(98)90175-X

Journal of Hospital Infection

Volume 38, Issue 1, January 1998, Pages 61-65

https://doi.org/10.1016/S0195-6701(98)90175-X Get rights and content

Abstract

We examined the following samples of water from 10 hospitals for microbial contamination: water obtained using an ultra filtration system (UF water), a reverse osmosis system (RO water), a water distillation system (distilled water) and tap water. UF water and RO water are used for handwashing before surgery, and distilled water for the preparation of drugs. All 10 samples of tap water examined were contaminated with <10 colony forming units (cfu)/mL. Thirteen (68%) of 19 samples of UF water, nine (53%) of 17 samples of RO water and 15 (79%) of 19 samples of distilled water were contaminated with 10¹–10⁴ cfu/mL. The majority of microorganisms were non-fermentative bacteria such as Sphingomonas pauicimobilis and CDC gr. IV C-2. Japanese hospitals commonly use UF water and RO water for preoperative handwashing under the assumption that it is sterile. Our results suggest, however, that these types of water are inferior microbiologically to tap water. Distilled water from the dispensary was also contaminated with micro-organisms. The available chlorine content of tap water was 0·17–0·42 ppm and that of UF water (from tap water) 0–0·06 ppm. There was no available chlorine in RO water or distilled water (each trom tap water). The reduction or disappearance of available chlorine appears to be associated with microbial contamination of UF water, RO water and distilled water.

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Novosphingobium spp. presented a low number of antibiotic resistance phenotypes to some beta-lactams and colistin (Table 2). The range of values of total heterotrophic counts observed in the current study were similar to those reported for hospital tap water in Finland, Greece, Thailand, Japan or Egypt (Arvanitidou et al., 1999; El-Zanfaly et al., 2012; Harnroongroj et al., 2012; Kusnetsov et al., 2003; Oie et al., 1998). The comparison with sites external to this hospital, but served by the same municipal water distribution system was possible based on the studies of Vaz-Moreira et al. (2011b, 2013), with samples collected about two years before those of the current study.
The aim of this study was to infer about the modes and extent of dispersion of Sphingomonadaceae via tap water. Sphingomonadaceae isolated from tap water samples in different places of a hospital were compared, based on intra-species genetic variability and antibiotic resistance phenotypes. These isolates were also compared with others isolated before from houses and dental chairs, served by the same municipal water supply system. Sphingomonadaceae from hospital tap water comprised members of the genera Sphingomonas, Sphingobium, Novosphingobium and Blastomonas. In general, distinct genotypes of Sphingomonadaceae were detected in different hospital areas and in tap water outside the hospital, suggesting these bacteria are not persistent or widespread in the urban water distribution system. Possible intrinsic antibiotic resistance, observed in most or all members of the family or of a genus, was observed for colistin in Sphingomonadaceae, aminoglycosides in the genus Blastomonas and beta-lactams in the genus Sphingobium. Possible acquired resistance phenotypes, not common to all members of a given species, comprised fluoroquinolones, cephalosporins and sulphonamides. Although the potential of Sphingomonadaceae as opportunistic pathogens may be low, the capacity of these bacteria to thrive in water supply systems, combined with the intrinsic or acquired antibiotic resistance, may raise the risk associated with their occurrence in hospital tap water.
A novel selective growth medium-PCR assay to isolate and detect Sphingomonas in environmental samples
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Sphingomonas species can be found ubiquitously in the environment and can be frequently found in surface biofilms. Some Sphingomonas strains are well known for metabolizing complex organic pollutants but some are opportunistic human pathogens. Despite the importance of the Sphingomonas species, a reliable system to isolate this group of bacteria from the environment has not been developed. In this study, a combined streptomycin–piperacillin selective growth medium/polymerase chain reaction (PCR) detection approach is developed to isolate and identify the Sphingomonas bacteria. A total of 72 known Sphingomonas strains (including 21 different Sphingomonas species type strains) and 14 non-Sphingomonas species were tested using a new Sphingomonas-specific growth medium containing 100 and 50 µg/ml streptomycin and piperacillin, respectively. All the Sphingomonas strains showed positive growth on the selective medium and no growth was shown by the non-Sphingomonas species. In addition, two sets of PCR primers targeting the serine palmitoyltransferase gene (spt), a crucial sphingolipid biosynthesis gene, were developed. With the exception of the Sphingomonas subarctica type strain, 71 of the 72 known Sphingomonas samples were amplified positively by either one or both of the spt-specific primers. None of the non-Sphingomonas bacteria were amplified by the spt primers. To verify the effectiveness of this novel approach for use in environmental screening applications the Sphingomonas selective medium was used to isolate 165 potential Sphingomonas isolates, including 101 yellow, 4 orange and 58 unpigmented isolates, from the influent water and biofilm samples of a pulp and paper mill in Northwestern Ontario. Screening of these isolates with the two Sphingomonas spt–PCR primer sets showed that 98% of the yellow isolates and 100% of the orange isolates were positive to the spt–PCR test. None of the unpigmented isolates was positive to the spt–PCR assay. The 16S rDNA of 17% of the spt + ve and − ve isolates were sequenced and analyzed. All of the yellow and orange pigmented isolates were Sphingomonas while none of the unpigmented isolates were Sphingomonas. REP-PCR was performed on 79 Sphingomonas samples randomly selected from the paper mill and hospital isolates and showed that a diverse group of Sphingomonas can be grown or isolated by our Sphingomonas selective growth medium. Therefore, by using the streptomycin–piperacillin selective growth medium in combination with the colour pigmentation and the positive spt–PCR reactions of the isolates, a diverse population of Sphingomonas strains can be isolated and identified from complex microbial communities with high accuracy.
Sphingomonas paucimobilis: A persistent Gram-negative nosocomial infectious organism
2010, Journal of Hospital Infection
Citation Excerpt :
S. paucimobilis is a yellow-pigmented, aerobic, glucose non-fermenting, Gram-negative bacillus that is widely distributed in the natural environment such as in soil and water.24 S. paucimobilis has been shown to form biofilm in water piping and it has been identified in ultrapure water in industrial systems, in the Space Shuttle water system, in laboratory-based ultrapure water systems in hospital water and in dental water.11,25–29 S. paucimobilis is not considered to be a major pathogen and its virulence is thought to be low, therefore it is not usually checked for in routine hospital analysis.
Non-fermenting Gram-negative bacilli create a significant problem in clinical settings, being the most widespread cause of nosocomial infections. They are opportunistic pathogens that take advantage of underlying conditions and diseases. Sphingomonas paucimobilis, a non-fermenting Gram-negative bacillus, is regarded as of minor clinical significance; however, many instances of infections with this organism can be found in the literature. Infections include bacteraemia/septicaemia caused by contaminated solutions, e.g. distilled water, haemodialysis fluid and sterile drug solutions. Cases of pseudobacteraemia have been recorded in association with S. paucimobilis, as have many cases of unusual infections both invasive and severe, e.g. septic arthritis and osteomyelitis. No cases of death have been recorded in the literature related to S. paucimobilis. This review illustrates that S. paucimobilis is a more important pathogen than previously thought.
Contamination with Sphingomonas paucimobilis: about seven cases isolated on conservation and transport mediums of corneal grafts
2007, Pathologie Biologie
De septembre à décembre 2004, des contaminations ont été retrouvées dans 15 milieux de conservation et de transport de greffons cornéens provenant de la banque de tissus de Brest, dont sept à Sphingomonas paucimobilis. L'électrophorèse en champ pulsé a permis d'établir le profil génotypique de chacune des souches et de les comparer. Des similitudes ont été retrouvées entre certaines des souches des milieux contaminés et celles isolées dans le bain-marie thermostaté de la banque de tissus. Le lien entre la contamination des milieux et leur décongélation dans le bain-marie a ainsi été établi. Des mesures de prévention sont actuellement proposées comme l'utilisation de portoirs pour décongeler les flacons ou l'utilisation d'un bain à sec en remplacement du bain-marie thermostaté actuel.
From September to December 2004, contaminations were found in fifteen conservation and transport mediums of corneal grafts at the tissue bank of Brest, including seven by Sphingomonas paucimobilis. The pulsed-field gel electrophoresis made it possible to establish the genotypic profiles of each strain and to compare them. Similarities were found between certain strains of the contaminated mediums and those of the thermostated double boiler of the tissue bank. The link between the contamination and the defrosting of the mediums in the double boiler was thus established. Measures of prevention are currently proposed to defrost the bottles like the use of a dry bath to replace the current one.
Bacteremia due to Cupriavidus pauculus (formerly CDC Group IVc-2) in a hemodialysis patient
2007, Clinical Microbiology Newsletter
Postoperative endophthalmitis caused by Sphingomonas paucimobilis
2006, Journal of Cataract and Refractive Surgery
Citation Excerpt :
In the hospital setting, it has been isolated from reverse osmosis plants generating water for hemodialysis.3 It has been reported as the causative organism of septicemia in immunocompromised patients originating from the hospital's water supply and as the cause of other nosocomial infections.4–7 The source of this organism causing postoperative endophthalmitis in our patient remains uncertain.
We present a case in which a new organism, Sphingomonas paucimobilis, caused endophthalmitis after phacoemulsification in a 73-year-old woman. The case shows a recurrent acute endophthalmitis with complete resolution only after vitrectomy. This organism has not been described as a cause of endophthalmitis and was resistant to initial medical management. We also describe an interaction between this organism and a co-infective organism that may account for the unusual clinical course.

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Journal of Hospital Infection

Abstract

References (12)

Outbreak of Pseudomonas cepacia infection due to contaminated anaesthetics

Lancet

Pseudomonas aeruginosa in postoperative wounds from chlorhexidine solutions

J Hosp Infect

Nosocomial infections by chlorhexidine solution contaminated with Pseudomonas pickettii Biovar VA-1

J Infect

Nosocomial legionellosis associated with use of oxygen bubble humidifiers and under-water chest drains

J Hosp Infect

Sources of the slow-growing pigmented water bacteria

Health Lab Sci

Microbial contamination of medicines administered to hospital patients

Pharmaceutical J

Cited by (35)

Genotypic diversity and antibiotic resistance in Sphingomonadaceae isolated from hospital tap water

A novel selective growth medium-PCR assay to isolate and detect Sphingomonas in environmental samples

Sphingomonas paucimobilis: A persistent Gram-negative nosocomial infectious organism

Contamination with Sphingomonas paucimobilis: about seven cases isolated on conservation and transport mediums of corneal grafts

Bacteremia due to Cupriavidus pauculus (formerly CDC Group IVc-2) in a hemodialysis patient

Postoperative endophthalmitis caused by Sphingomonas paucimobilis

Original articleMicrobial contamination of ‘sterile water’ used in Japanese hospitals

Abstract

Lancet

J Hosp Infect

J Infect

J Hosp Infect

Sources of the slow-growing pigmented water bacteria

Health Lab Sci

Microbial contamination of medicines administered to hospital patients

Pharmaceutical J

Original article
Microbial contamination of ‘sterile water’ used in Japanese hospitals