ESKAPE Pathogens 0$/',72)0LFURELRORJLFDO&RQ˂UPDWLRQV Understanding Nosocomial Risk Factors Matrix Assisted Laser Desorption/Ionisation Time of Flight Mass The monitoring of water used in care homes and Acinetobacter baumannii $/6 (QYLURQPHQWDO DUH RQH RI WKH ˂UVW 8. ODERUDWRULHV WR YDOLGDWH DQG KDYH 7KHWHFKQLTXHLVXVHGWRDQDO\VHWKHSURWHLQɆ˂QJHUSULQWɇ healthcare facilities is covered by several pieces of Health Acinetobacter baumannii is a rapidly emerging pathogen in accredited to ISO 17025:2005 and the Drinking Water Testing Standard (DWTS), RIDPLFURRUJDQLVPSURGXFLQJDQLGHQWL˂FDWLRQXVLQJD and Safety Guidance (HSG). The majority of the guidance the health care system. A. baumannii is usually introduced DFFUHGLWWKHUDSLGLGHQWL˂FDWLRQRISRVLWLYH0LFURELRORJLFDOVDPSOHVE\0DWUL[ validated reference library. is on the monitoring of Legionella and is supported by the into a hospital by a colonised patient. 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The ESKAPE pathogens are settings due to the constant use of antibiotics by patients )RUPLQJ 8QLWV &)8 7KH LPSDFW RI 0$/',7R) FRQ˂UPDWLRQ RQ WKH (6.$3( incubation, which is the stage that incurs additional time. emerging pathogens of concern. ALS Environmental are in the hospital and causes a wide range of infection pathogens is highlighted in the table below. Depending on the organism being tested, this additional DEOH WR RIIHU UDSLG LGHQWL˂FDWLRQ RI WKHVH EDFWHULD XVLQJ including bacteremia, pneumonia, meningitis, urinary tract time can be anything from 4 hours to 5 or more days. Incubation &RQ˂UPDWLRQ &RQ˂UPDWLRQ RXU UHYROXWLRQDU\ 0$/',7R) FRQ˂UPDWLRQ WHFKQLTXH7KH infection, and wound infection. The organism’s ability to Bacteria MALDI-ToF Saving ESKAPE Pathogens are: survive under a wide range of environmental conditions, Time Traditional MALDI-ToF The method was developed in consultation with both Enterococci 2 days 1 day Minutes 1 day the United Kingdom Accreditation Service (UKAS) and Enterococcus faecium and to persist for extended periods of time on surfaces, PDNHLWDIUHTXHQWFDXVHRIRXWEUHDNVRILQIHFWLRQDQGDQ Staphylococcus aureus 2 days 1 day Minutes 1 day the Drinking Water Inspectorate (DWI). As a result, we Enterococcus faecium; formerly known as Streptococcus endemic, health care–associated pathogen. Klebsiella pneumoniae 1 day 1 day Minutes 1 day have full ISO 17025 UKAS accreditation, since December faecium until its re-categorization in 1984, is a human Acinetobacter baumannii 1 day 1 day Minutes 1 day 2013. This was extended to include Drinking Water Testing pathogen that causes nosocomial bacteremia, surgical Pseudomonas aeruginosa Pseudomonas aeruginosa 2 day 1 day Minutes 1 day 6SHFL˂FDWLRQ ':76 LQ )HEUXDU\ $OWKRXJK WKH wound infection, endocarditis, and urinary tract infections. The monitoring for Pseudomonas is covered in HTM04- technology has been used extensively in the clinical sector Enterobacteriaceae 1 day 1 day Minutes 1 day The bacteria can survive for long periods of time inside 01 Addendum. Serious infections of P. aeruginosa usually IRUDQXPEHURI\HDUV$/6LVWKH˂UVW8.(QYLURQPHQWDO Stenotrophomonas 1 day 1 day Minutes 1 day hospitals on a variety of surfaces as well as in soil and occur in the immunocompromised. Infections of the laboratory to use and accredit this technology. sewage. Growth temperatures range from 10oC to 45oC in blood, pneumonia, and infections following surgery can basic or acidic environments, and in environments which lead to severe illness and death in these people. The Legionella 10 days 2 days Minutes 2 days $VɆWUDGLWLRQDOɇFXOWXUHEDVHGPHWKRGVDUHVWLOOXVHGIRUWKH are isotonic or hypertonic. Ent. faecium can be highly highly susceptible nosocomial patients include those on E-coli 1 day 1 day Minutes 1 day isolation, compliance with standards is maintained. We drug resistant. The spread of the disease occurs between breathing machines, premature babies and patients with Coliforms 1 day 1 day Minutes 1 day are therefore fully compliant with ACoP L8 (and HSG274), patients in hospitals due to transfer of the pathogen by wounds from surgery or from burns. Additionally, healthy Clostridium Perfringens 1 day 1 day Minutes 1 day The Water Supply (Water Quality) Regulations, The Private hands or medical instruments. Also, antibiotic use can people can also develop mild illnesses with Pseudomonas Salmonella 4 days 2 days Minutes 2 days Water Supply Regulations and HTM guidance. decrease the number of other intestinal bacteria that are aeruginosa, especially after exposure to water. Ear Listeria 4 days 2 days Minutes 2 days susceptible to the antibiotic and decrease competition for infections, especially in children, and more generalised 7KH UHGXFWLRQ LQ FRQ˂UPDWLRQ WLPHV UHPRYHV WKH ULVN the drug resistant Ent. faecium. VNLQ UDVKHV PD\ RFFXU DIWHU H[SRVXUH WR LQDGHTXDWHO\ 7KH LQVWDQW FRQ˂UPDWLRQ RI WKH (6.$3( EDFWHULD DOORZV LQIHFWLRQ FRQWURO DQG associated with acting (or not acting) on presumptive chlorinated hot tubs or swimming pools. Staphylococcus aureus water treatment to make rapid decisions on any potential remedial works that GDWDE\SURYLGLQJDQDFFUHGLWHGFRQ˂UPHGUHVXOWZLWKLQ may need to be undertaken. The MALDIToF can be used to identify any positive minutes of the presumptive result being generated. The The carriage of Staphylococcus aureus is an important Enterobacter species bacteria, including Legionella. DGGHGEHQH˂WLVWKDWLQDGGLWLRQWRDUDSLGFRQ˂UPDWLRQ VRXUFH RI QRVRFRPLDO LQIHFWLRQ DQG FRPPXQLW\DFTXLUHG The genus Enterobacter is a member of the coliform methicillin-resistant Staph. aureus (MRSA). Staph. aureus is group of bacteria. Enterobacter species, particularly E. UHVXOWLQWKHPDMRULW\RIFDVHVVSHFLHVOHYHOLGHQWL˂FDWLRQ Legionella will also be available. ALS will provide this additional common and often found in the nose or on the skin. Most cloacae and E. aerogenes, are important nosocomial 7KH 0$/',7R) FRQ˂UPDWLRQ RI /HJLRQHOOD UHPRYHV WKH SUHVXPSWLYH VWDJH information as part of the standard service. of the time these bacteria do not cause any symptoms. pathogens responsible for various infections; including PHDQLQJWKDW$/6(QYLURQPHQWDOUHSRUWSRVLWLYHFRQ˂UPHG/HJLRQHOODRQWKH The ability of the nasal passages to harbour Staph. aureus bacteremia, lower respiratory tract infections, skin RULJLQDOUHDGGD\V FXUUHQWO\GD\VDQG 7KLVLVTXLFNHUWKDQWKH results from a combination of a compromised host immune and softtissue infections. Risk factors for nosocomial ,I\RXZRXOGOLNHPRUHLQIRUPDWLRQRQVSHFL˂FRUJDQLVPV traditional approach and is fully ISO 17025:2005 accredited. ALS Environmental that we are able to identify, please contact our customer system combined with the bacteria’s ability to evade a Enterobacter infections include hospitalisation of greater have one of the world’s largest Legionella species libraries held within our MALDI- services department. host’s innate immunity. The spectrum of Staphylococcus than 2 weeks, invasive procedures in the past 72 hours, 7R):LWKRQO\NQRZQVSHFLHVXQLGHQWL˂DEOHWZRRIWKHVHDUH9LDEOH%XW1RW infections can range from skin abscess to life-threatening treatment with antibiotics in the past 30 days, and the &XOWXUDEOH 9%1& DQGWKH˂QDOVSHFLHVLVEHLQJVRXUFHGE\RXUODERUDWRU\ infections such as septicaemia or endocarditis. SUHVHQFHRIDFHQWUDOYHQRXVFDWKHWHU6SHFL˂FULVNIDFWRUV for infection with nosocomial multidrug-resistant strains Klebsiella pneumoniae of Enterobacter species include the recent use of broad- In nosocomial settings, Klebsiella bacteria can be spread spectrum cephalosporins or aminoglycosides and ICU care. LEGIONELLA SPECIES TABLE through person-to-person contact or by contamination of the environment; it is important to note that the bacteria Stenotrophomonas Maltophilia Name of species Number of serotypes Linked to humaninfection Geographic origin Common Matrix Type are not spread through the air. Patients in healthcare Stenotrophomonas maltophilia is an organism of low Legionella anisa YES USA Process, Drinking, Surface and Recreational settings may be exposed to Klebsiella when they are YLUXOHQFHZKLFKFDQIUHTXHQWO\FRORQLVH˃XLGVXVHGLQWKH Legionella adelaidensis Unknown Adelaide in South Australia Process Water on ventilators, or have intravenous catheters or wounds. KRVSLWDOVHWWLQJ HJLUULJDWLRQVROXWLRQVLQWUDYHQRXV˃XLGV Unfortunately, these medical tools and conditions may and patient secretions (eg, respiratory secretions, urine, Legionella beliardensis Unknown Montbeliard in France Process Water allow Klebsiella to enter the body and cause infection; wound exudates). S. maltophilia usually bypasses normal Legionella birminghamensis YES %LUPLQJKDP$ODEDPD86$ Process Water which can be fatal in the immuno-compromised. host’s defenses to cause human infection. The growth of Legionella bozemanii (bozemanae) 2 YES 1DPHGDIWHU)0DULO\Q%R]HPDQ