Elizabethkingia Meningoseptica Research Articles

Evolving the Promiscuity of Elizabethkingia meningoseptica Oleate Hydratase for the Regio- and Stereoselective Hydration of Oleic Acid Derivatives.

The addition of water to non‐activated carbon–carbon double bonds catalyzed by fatty acid hydratases (FAHYs) allows for highly regio‐ and stereoselective oxyfunctionalization of renewable oil feedstock. So far, the applicability of FAHYs has been limited to free fatty acids, mainly owing to the requirement of a carboxylate function for substrate recognition and binding. Herein, we describe for the first time the hydration of oleic acid (OA) derivatives lacking this free carboxylate by the oleate hydratase from Elizabethkingia meningoseptica (OhyA). Molecular docking of OA to the OhyA 3D‐structure and a sequence alignment uncovered conserved amino acid residues at the entrance of the substrate channel as target positions for enzyme engineering. Exchange of selected amino acids gave rise to OhyA variants which showed up to an 18‐fold improved conversion of OA derivatives, while retaining the excellent regio‐ and stereoselectivity in the olefin hydration reaction.

Neumonía bullosa secundaria a Elizabethkingia meningoseptica, su evolución clínica y radiológica

Elizabethkingia meningoseptica is an opportunistic pathogen with a high mortality and an increasing incidence in the intensive care units. We present a 4-year-old patient with a history of atresia of the biliary tract and a liver transplant at 11 months of age, who was admitted for acute respiratory infection with hypoxemia. During the hospitalization, she required mechanical ventilation. Due to persistent fever and hypoxemia, mini bronchoalveolar lavage was performed with a positive culture for Elizabethkingia meningoseptica. She received vancomycin, trimethoprim/sulfamethoxazole and ciprofloxacin for 14 days with a good response. A chest tomography showed the presence of mosaic hypoperfusion, cystic images, and bilateral bronchiectasis. During the following 2 years, she presented good clinical progress, with scarce respiratory infections, isolated symptoms and good tolerance to exercise. The resolution of the majority of the initial lesions was evidenced at 20 months of follow-up.

Graft-Associated Elizabethkingia meningoseptica Bacteremia Managed With Long-Term Oral Ciprofloxacin and Rifampicin

Elizabethkingia meningoseptica is an uncommon pathogen that has been associated with nosocomial infections and can pose a therapeutic challenge. It is resistant to most conventional agents used in treatment of gram-negative organisms and as such use of these agents may be unfavorable. Oral therapy with the appropriate agents to address this infection in certain patients may be successful. We report a case of graft infection with E. meningoseptica causing bacteremia in a dialysis patient who responded to oral agents. J Med Cases. 2019;10(3):93-95 doi: https://doi.org/10.14740/jmc3274

Treatment of Elizabethkingia meningoseptica Neonatal Meningitis with Combination Systemic and Intraventricular Therapy.

Elizabethkingia meningoseptica, a gram negative bacillus ubiquitous in the hospital environment, is known to infrequently cause serious neonatal infections, particularly meningitis which is associated with high mortality and neuromorbidity in survivors. The authors describe a healthy term newborn with no apparent risk factors who developed Elizabethkingia meningoseptica sepsis and meningitis on day 6 of life. Diagnosis could be established only after a week of the illness by which time the baby developed refractory status epilepticus, ventriculitis and hydrocephalus. The isolate was susceptible to only ciprofloxacin, tigecycline and rifampicin and resistant to vancomycin. Apart from systemic combination therapy for 12 wk, intraventricular vancomycin was given through an external ventricular drain for 4 wk and later a ventriculo-peritoneal (VP) shunt was inserted. With this regime, authors demonstrated microbiologic and clinical cure. The baby is neurologically normal over a 6 mo follow-up.

Uncertainties in Identification of Elizabethkingia meningoseptica

To the Editors: With reference to the article entitled “Isolation of Methicillin Resistant Staphylococcus aureus and Multidrug Resistant Elizabethkingia meningoseptica From Neonates Within Minutes of Birth” by Kwambana-Adams et al,1 we would like to comment on the automated API (Analytical Profile Index) system (BioMerieux, Basingstoke, United Kingdom), used by the authors for identification of bacterial isolates including E. meningoseptica. According to a recent study by Lin et al,2 where they compared 4 automated systems with 16S rRNA gene sequencing for identification of Elizabethkingia species, overall correct rate for identification was 24.5% for API/ID 32 v3.1system. Although API system identified 12 of 13 E. meningoseptica isolates, all other Elizabethkingia species such as Elizabethkingia anophelis and Elizabethkingia miricola were also misidentified as E. meningoseptica because of absence of database coverage for these species. Moreover, an isolate of Chryseobacterium species was also misidentified as E. meningoseptica by the automated system. These data add to the identification inaccuracies of the API system with regard to Elizabethkingia species. To the best of our efforts, we could not find any other study which used API system for the identification of this organism. Even the review article3 cited by Kwambana-Adams et al1 did not mention the identification methods for Elizabethkingia species. Correct identification of the organism is crucial for the diagnosis and management strategies as E. anophelis has also recently emerged as a nosocomial neonatal pathogen.4 Hence, differentiation between E. anophelis and E. meningoseptica requires accurate microbial identification. MALDI-TOF MS (Matrix Assisted Laser Desorption/Ionization-Time Of Flight Mass Spectrometry) is a valuable tool for diagnosis of such unusual pathogens. However, more comparative studies are required with expanded databases of MALDI-TOF MS with species-specific spectra for reliable diagnosis of this pathogen. Also, we recommend database updation of API system for Elizabethkingia species other than E. meningoseptica. Gurmeet R. Rahim, PhDNeha Gupta, MDDepartment of MicrobiologyShah SatnamJi Speciality HospitalsSirsa, Haryana, India[email protected]

Graft-Associated Elizabethkingia meningoseptica Bacteremia Managed With Long-Term Oral Ciprofloxacin and Rifampicin

Graft-Associated <i>Elizabethkingia meningoseptica</i> Bacteremia Managed With Long-Term Oral Ciprofloxacin and Rifampicin

Comparison of Clinical Manifestations, Antimicrobial Susceptibility Patterns, and Mutations of Fluoroquinolone Target Genes between Elizabethkingia meningoseptica and Elizabethkingia anophelis Isolated in Taiwan.

Elizabethkingia meningoseptica and Elizabethkingia anophelis are two major pathogens in the genus Elizabethkingia. Studies have revealed that Elizabethkingia anophelis is frequently misidentified as E. meningoseptica. Therefore, our aim was to explore the clinical and molecular differences between these two species. The database of a clinical microbiology laboratory in a university-affiliated hospital of Taiwan was searched to identify patients with Elizabethkingia infections between January 2005 and June 2018. Species were reidentified using 16S ribosomal RNA gene sequencing. Twenty E. meningoseptica and 72 E. anophelis samples were collected from consecutive patients. E. meningoseptica was significantly more frequently isolated from the cerebrospinal fluid than was E. anophelis. The most susceptible antibiotic for all Elizabethkingia isolates was minocycline (91.3%), followed by levofloxacin (52.2%), tigecycline (23.9%), and piperacillin tazobactam (23.9%). Compared with E. anophelis, E. meningoseptica was significantly less susceptible to piperacillin tazobactam, minocycline, and levofloxacin. Regarding nonsynonymous substitutions in the quinolone-resistance determining regions of DNA gyrase, six sites were recognized in E. meningoseptica and one site was recognized in E. anophelis. E. meningoseptica had a significantly higher rate of fluoroquinolone target gene mutations than did E. anophelis. Because of less susceptibility to multiple antibiotics than E. anophelis, empirical antimicrobial therapy of E. meningoseptica should be more rigorous.

1258. The Eyes Have It: Investigating a Cluster of Non-lactose Fermenting Gram-Negative Bacilli From Donor Corneal Rim Tissue

BackgroundFollowing corneal transplant, donor corneal rim tissue are sometimes cultured to help predict the risk of post-keratoplasty endophthalmitis. In July 2016, the Infection Control (IC) team was notified by the microbiology laboratory of three donor corneal rim cultures growing non-lactose fermenting (NLF) Gram-negative bacilli, which was unusual for this type of specimen. The IC team initiated an epidemiological outbreak investigation to determine the source of the NLF Gram-negative bacilli.MethodsA 12-month retrospective review of donor corneal rim cultures was performed from July 2015 to July 2016, with continual prospective monitoring of donor corneal rim cultures. The protocols used to prepare corneal donor tissues were reviewed. The standard protocol included flooding the tissue with povidone iodine followed by rinsing with a sterile saline solution and then placement in a sterile container with Opitsol GS (a preservative solution with gentamycin and streptomycin). The sterile saline rinse that was normally used for processing had been on back order and had been replaced with an alternative brand from March 2016 to July 2016. Unopened bottles of the alternative brand of sterile saline fluid and Optisol GS were sent to an outside laboratory for bacterial culture and remaining product was temporarily quarantined.ResultsMicrobiology review revealed seven donor corneal rim cultures positive for NLF Gram-negative bacilli from May to July 2016. Organisms isolated from the donor corneal rim tissue included Achromobacter xylosoxidans (4), Burkholderia cepacia (3), Stenotrophomonas maltophilia (2), and Elizabethkingia meningoseptica (1). Sterility cultures of Opitsol GS demonstrated no growth. Sterility cultures of the sterile saline rinse grew Gram-positive and -negative bacteria from all samples. A FDA MedWatch was submitted in July 2016, and on September 6, 2016 an FDA recall notice was published. The quarantined saline was permanently removed. No clinical infections associated with the positive donor corneal rim cultures were identified.ConclusionMicrobiologists are the front line for IC surveillance. Close partnership between the IC team and the microbiology laboratory can help identify potential outbreaks by alerting them of the growth of atypical organisms or clusters.Disclosures All authors: No reported disclosures.

Aislamiento y susceptibilidad de especies bacterianas sin reporte previo como causantes de infección ocular en segmento anterior

A great number of microorganisms produce infections in the eyes. The lack of bacteriologic cultures in the ophthalmic practice may lead to an under registration of bacterial etiological agents which cause infections outside the eyes, due to they are not identified. This article reports six isolated bacterial species in patients with infections outside the eyes, some without previous report; and it also mentions the presumptive clinic diagnosis and the susceptibility found in front of the commonly used antibiotics in the ophthalmic field. 286 eye samples were bacteriologically evaluated from patients with a clinic diagnosis of conjunctivitis; Gram coloration, bacterial cultures and susceptibility tests were made. The statistical analysis was made in EPI-INFO and ESTATA 6.0 programs. Out of the 286 cultures, 177 microorganisms were isolated, from which 6 microbial genres were identified, not very associated to infections in the anterior segment, some without any pervious report in literature, Enterococcus (n=6), S.Group D no enterococcus (n=3), Alcaligenes feacalis (n=3), Citrobacter sp (n=2), Kluyvera ascorbata (n=2) and Chryseobacterium meningosepticum (n=1). Regarding resistance, Trimethroprim sulfamethoxazole (SXT), Cephalotin (CF), and Tobramicina (NN) were the antibiotics which organisms presented a higher resistance. Based on the results, it is necessary to implement cultures and antibiograms in the ophthalmic practice in order to identify and document these microorganisms; to be able to relate them with different eye pathologies by its frequency; to determine the definite implication as eye pathogens; and to contribute also to the study of the changes in the epidemiology of infections and to the monitoring of sensibility variations and bacterial resistance.

Clinical features and antimicrobial susceptibilities of elizabethkingia meningoseptica - An emerging pathogen from a tertiary care hospital in mangalore

Objectives: Elizabethkingia meningoseptica has been known to infect the immunocompromised, preterm children, those exposed to antibiotics in critical care units, and those with comorbidities. Multidrug resistance seen in E. meningoseptica makes it daunting to choose the right antimicrobial agents for treating infections caused by this organism. The present study was undertaken to establish the incidence of E. meningoseptica infections, to investigate the clinical features and risk factors associated with these infections, and to study the antimicrobial susceptibility pattern of E. meningoseptica isolates over 2 years. Methods: Medical records of the patient positive for E. meningoseptica from January 2015 to December 2016 were studied retrospectively. The demographic and clinical data of the patients and the antibiotic sensitivity patterns were collected and analyzed. Results: E. meningoseptica was isolated from 13 patients. The mean age was 71.09 years with males being more frequently infected (81.8%). Maximum isolates were from blood (38.5%) with sepsis being the final diagnosis in 53.8% of the patients, followed by respiratory tract infection (46.1%). Two pediatric patients presented with both sepsis and meningitis. Nine patients (69.2%) recovered, and death occurred in four patients (30.8%). Susceptibility testing revealed 100% in vitro resistance to most of the antibiotics such as amikacin, aztreonam, cefepime, ceftazidime, colistin, gentamicin, meropenem, and polymyxin B which are used to treat Gram-negative bacterial infections. The isolates were most susceptible to minocycline and piperacillin. Conclusion: E. meningoseptica is an emerging pathogen and is being isolated more frequently now. An expeditious and prompt institution of appropriate therapy is essential because of its inherent resistance to many antimicrobial agents commonly used to treat infections caused by Gramnegative bacteria

Comparisons of clinical features and outcomes between Elizabethkingia meningoseptica and other glucose non-fermenting Gram-negative bacilli bacteremia in adult ICU patients.

Clinical information of Elizabethkingia meningoseptica (EM) bacteremia in intensive care unit (ICU) patients is limited and the impact on outcomes uncertain. The aim of this study was to investigate the clinical features and impact of EM bacteremia compared to other glucose non-fermenting Gram-negative bacilli (GNF-GNB) bacteremia in ICU patients. This retrospective cohort study enrolled 70 patients who developed GNF-GNB bacteremia after ICU admission, including 19 cases of EM bacteremia (19/70, 27.1%). The main outcome measure was in-hospital mortality. The patients with EM bacteremia had a lower rate of appropriate antibiotic therapy (15.8% vs. 62.7%, p<0.001) and a longer time to appropriate antibiotic therapy (76.8±46.4 vs. 35.1±38.7h, p<0.001), but with a less severity in acute physiology and chronic health evaluation (APACHE) II score and shock status (p<0.05) at the onset of bacteremia, compared to those with non-EM bacteremia. The in-hospital mortality between those with EM bacteremia and non-EM bacteremia was similar (63.2% vs. 51.0%, p=0.363). However, primary bacteremia was more frequently noted in EM compared with non-EM group (57.9% vs. 25.5%, p=0.011), and odds ratio 4.294 (95% confidence interval 1.292-14.277, p=0.017) in multivariate regression analysis. Among the patients with GNF-GNB bacteremia, the numbers of the cases with primary bacteremia and inappropriate therapy were significantly more in EM group than those in non-EM group.

Elizabethkingia Meningoseptica Causing Meningitis after Decompressive Craniectomy for Traumatic Brain Injury in a Immunocompetent Adult: Serious Neurocritical Care Concern

Abstract Elizabethkingia is aerobic Gram negative bacteria is widely distributed in soil, food and food. It is very rarely pathogenic for human and especially those who are immunocompromised and various risk factors includes intravenous catheter, ventilatory support. We report a case, who had undergone decompressive craniectomy for traumatic brain injury, developed meningitis, CSF culture showed growth of Elizabethkingia and treated successfully with antibiotics therapy. This study reminds that rare pathogen should also be considered as causative organism for meningitis especially in postoperative cases and it responds well to antimicrobial therapy.

Multidrug resistant Elizabethkingia meningoseptica bacteremia - Experience from a level 1 trauma centre in India.

Elizabethkingia meningoseptica (E. meningoseptica) is a non-fermenting gram negative organism that is commonly detected in the soil and water but is rarely reported to cause human infection. However it is emerging as a nosocomial pathogen in patients admitted in intensive care units (ICUs). Infections caused by this organism have a high mortality rate due to lack of effective therapeutic regimens and its intrinsic resistance to multiple antibiotics. We report our experience in managing Elizabethkingia meningoseptica (E. meningoseptica) septicemia in our ICU patients with septic shock during prolonged intensive care management. Over a two year period four cases were admitted into the polytrauma ICU developed sepsis due to E. meningoseptica. All these patients were on mechanical ventilation, had central venous catheter (CVC) and were exposed to various broad spectrum antibiotics. Of the four patients, three died and one recovered. E. meningoseptica infection should be considered as a possible etiological agent of sepsis in patients who do not respond to empirical therapy, as this results in an inappropriate choice of antimicrobial therapy, leading to increased morbidity and mortality of patients. Its unusual resistance pattern along with inherent resistance to colistin makes this organism difficult to treat unless susceptibility patterns are available.

Production of Universal Group O Red Blood Cells by Alpha-N-Acetylgalactosaminidase Enzyme Expressed in Pichia pastoris.

Enzymatic removal of blood groups antigens A and B is an efficient method for production of universal red blood cells. In this research, an α-N-acetylgalactosaminidase (NAGA) enzyme was expressed in Pichia pastoris for digestion of the A blood antigen. DNA sequence of the gene NAGA, originally expressed in Elizabethkingia meningosepticum (NAGA-EM), was ordered for optimization and synthesis. It was then expressed in P. pastoris (KM71H and GS115 strains). Expression of the recombinant NAGA was evaluated by dot blot, SDS-PAGE, and Western blotting. The activity of the enzyme was measured using a synthetic substrate in addition to the conversion of group A red blood cells to the O cells. Expression of NAGA-EM with an apparent molecular mass of 55kDa was verified by dot blot, SDS-PAGE and Western blot analysis. The maximum enzyme activity in the supernatant of KM71H was higher than that in the GS115 (250 vs. 200 U/ml). Treated group A RBCs did not react with the anti-A antiserum or with the sera from individuals with blood groups B and O. The results of this study indicated that NAGA-EM is an efficient enzyme for production of universal O blood cells.

Epidemiological analysis of Elizabethkingia meningoseptica infection cluster among mechanically ventilated pediatric intensive care patients

Background: Elizabethkingia meningoseptica is frequently found in hospital environments and usually associated with healthcare-associated infections (HAIs), particularly in patients in the intensive care units (ICU). The current study report an outbreak of E. meningoseptica infection/colonization in the pediatric intensive care unit, highlighted the infection control methods used to stem the spread.Methods: During a period of 7 months, May-November 2015, 4 patients were infected/ colonized by E. meningoseptica. Infection control measures were re-emphasized after each case and environmental swabs were cultured to detect possible source. Follow up for 25 months to ensure eradication of the pathogen.Results: Four patients were colonized/ infected with E. meningoseptica, their mean age 22 months. The average time patients spent in ICU between admission and isolation of E. meningoseptica was 27.5±19.2 days. All patients were mechanically ventilated. 25% E. meningoseptica isolated from blood causing healthcare associated Central Line Associated Blood Stream Infection (CLABSI) while it was isolated from endotracheal tube (ETT) secretion in 75% as healthcare associated colonization. The 4 isolates confirmed as identical using pulsed field gel electrophoresis (PFGE).Conclusions: Intensive infection control measures including healthcare workers education, emphasizing hand hygiene, comprehensive cleaning and disinfection of equipment and the environment are important to eradicate the bacterium.

Successful control of Elizabethkingia meningoseptica outbreak in a neuro-surgical intensive care unit of a tertiary care hospital in North India

Elizabethkingia meningoseptica has been found to be associated with a broad range of infectious etiologies, most notably outbreaks of neonatal meningitis. In adults, it can also cause pneumonia, endocarditis, bacteremia, meningitis and even skin and soft tissue infections, primarily in immunocompromised individuals. We report a cluster of 3 cases with E. meningoseptica infection in an adult neurology critical care unit of a 400-bedded tertiary care hospital situated in Gurugram (Delhi-National Capital Region), India. Two patients were diagnosed with ventilator-associated-pneumonia (VAP) and one was a patient in whom the organism was isolated from a cerebrospinal fluid (CSF) sample. Clinical details were studied and outbreak investigation was carried out. We found the following common risk factors for infection: Prolonged ICU stay, exposure to multiple antibiotics, presence of underlying co-morbidities and insertion of multiple invasive medical devices. E. meningoseptica was isolated from the catheter mount connected between endotracheal tube and ventilation circuit of one patient but clonality could not be studied. Strict infection control protocols and environmental cleaning procedures terminated the outbreak.

Comparison of clinical characteristics of bacteremia from Elizabethkingia meningoseptica and other carbapenem-resistant, non-fermenting Gram-negative bacilli at a tertiary medical center.

Acquired carbapenem resistance among non-fermenting Gram-negative bacilli (NFGNB), such as Pseudomonas aeruginosa and Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB complex), is a serious problem in nosocomial infections. We previously reported that patients infected with the intrinsically carbapenem-resistant Elizabethkingia meningoseptica were associated with high mortality. However, little information is available regarding the clinical outcome of E. meningoseptica bacteremia when compared to that of other carbapenem-resistant NFGNB. We conducted an observational study that included consecutive patients with E. meningoseptica, carbapenem-resistant ACB complex, carbapenem-resistant P. aeruginosa, and Stenotrophomonas maltophilia bacteremia at a Taiwanese medical center in 2015. We compared the clinical characteristics and outcomes between patients with E. meningoseptica bacteremia and those with other carbapenem-resistant NFGNB bacteremia. We identified 30 patients with E. meningoseptica, 71 with carbapenem-resistant ACB complex, 25 with S. maltophilia, and 17 with carbapenem-resistant P. aeruginosa bacteremia. The clinical characteristics, disease severity, and previous antibiotic exposures were similar between patients with bacteremia either due to E. meningoseptica or other carbapenem-resistant NFGNB. Patients with E. meningoseptica bacteremia had a higher rate of appropriate empirical antibiotics than those with other carbapenem-resistant NFGNB and was less associated with central venous catheterization. The 28-day mortality rates were similar between patients with E. meningoseptica and the other carbapenem-resistant NFGNB bacteremia (46.7% vs 46%, p=0.949). The mortality rate of E. meningoseptica bacteremia was as high as other carbapenem-resistant NFGNB infections. The emerging E. meningoseptica infection calls for active surveillance and continued awareness from clinical physicians for this serious carbapenem-resistant infection.

Emerging Infection with Elizabethkingia Meningoseptica in Neonate. A Case Report.

BackgroundElizabethkingia meningoseptica are Gram-negative rod bacteria which are commonly found in the environment. The bacteria have also been associated with nosocomial infections, having been isolated on contaminated medical equipment, especially in neonatal wards.Case reportHere, we present the case of a premature female infant born at 33 weeks’ gestational age, with neonatal meningitis. The onset was marked by fever, in the 5th day of life, while in the Neonatal Intensive Care Unit. The patient was commenced on Gentamicin and Ampicillin, but her clinical condition worsened. Psychomotor agitation and food refusal developed in the 10th day of life, and a diagnosis of bacterial meningitis was made based on clinical and cerebrospinal fluid findings. A strain of Elizabethkingia meningoseptica sensitive to Vancomycin, Rifampicin and Clarithromycin was isolated from cerebrospinal fluid. First-line antibiotic therapy with Meropenem and Vancomycin was adjusted by replacing Meronem with Piperacillin/Tazobactam and Rifampicin. The patient’s clinical condition improved, although some isolated febrile episodes were still present. The cerebrospinal fluid was normalized after 6 weeks of antibiotic treatment, although periventriculitis and tetraventricular hydrocephalus were revealed by imaging studies. Neurosurgical drainage was necessary.ConclusionElizabethkingia meningoseptica can cause severe infection, with high risk of mortality and neurological sequelae in neonates. Intensive care and multidisciplinary interventions are crucial for case management.

Evaluation of propolis extract as a disinfectant of Japanese quail (Coturnix coturnix japonica) hatching eggs

This study was carried out to evaluate the effectiveness of an alcoholic propolis extract (15%) as a disinfectant for Japanese quail (Coturnix coturnix japonica) hatching eggs. A total of 600 eggs were randomly divided into four experimental groups: 1) negative control (NC), without disinfection, 2) control (C), fumigated with formaldehyde gas, 3) (A), sprayed with 96% alcohol, and 4) (P), sprayed with 15% alcoholic propolis extract. The eggs were incubated artificially in a BIOS hatching apparatus under standard conditions. On the 14th day, the eggs were candled to determine the number of infertile eggs and dead embryos and samples were collected for microbial analysis. After 17.5 d, fertility, hatchability, embryonic mortality, and eggshell conductance were calculated. Fertile eggs sprayed with propolis were shown to have a lower eggshell conductance constant (egg weight loss) than eggs from groups C and A. Total microbial activity on the eggshells did not differ significantly between groups, but Staphylococcus aureus, Micrococcus spp., Bordetella spp., and Chryseobacterium meningosepticum isolates were significantly affected by the propolis treatment. There were no significant differences between treatments for total hatchability, embryonic mortality, and chick body weight on the 1st, 7th, and 14th days of life. The total chick survivability during the first 2 wk was significantly higher in group P than in the other groups. The results indicate that spraying hatching eggs with 15% propolis as a disinfectant can be recommended as a safe and natural sanitizer in place of formaldehyde, with no negative effect on quail chicks.

Under-utilization of taps in intensive care unit as a cause of reservoirs of nonfermenting gram-negative bacilli

IntroductionThe under-utilisation of taps is associated with the generation of reservoirs of non-fermenting gram-negative bacilli with the ability to disseminate. We describe the detection and approach of the problem in an ICU. MethodsObservational descriptive study in an ICU with individual cubicles with their own sink. We collected clinical samples from patients and environmental samples from tap aerators and reviewed the unit's hygiene measures. ResultsWe detected four cases due to Chryseobacterium indologenes, one to Elizabethkingia meningoseptica and another to Pseudomonas aeruginosa; they were identified both in clinical and the environmental samples. The healthcare professionals reported that almost every hand hygiene opportunity was performed with a hydroalcoholic solution. After considered the daily flushing of water outlets as inefficient, it was decided to remove them. ConclusionsNational recommendations were insufficient for preventing, detecting and controlling tap contamination in units with a high risk of infection. The management of taps in these units needs to be improved.