388. Longitudinal Analysis of ICU Surface Multidrug Resistant Organism Contamination in the US and Pakistan
Session: Poster Abstract Session: HAI: MDRO-GNR/Emerging Resistant Bacterial Pathogens
Thursday, October 5, 2017
Room: Poster Hall CD

Background: The objective of the study was to characterize the  environmental reservoirs of multidrug resistant organism (MDROs) in an intensive care unit (ICU) in Pakistan and the US.

Methods: Environmental samples from 4 ICU rooms at Barnes-Jewish Hospital (St. Louis, MO) and Military Hospital (Rawalpindi, Pakistan) were taken every other week for 3 months, for 7 total samplings (Figure 1). Tap water was also cultured at a subsequent time point. MDROs were cultivated using selective agar. DNA extracted from a “sweep” of the growth on blood agar was used as input for metagenomic sequencing. Metaphlan2 was used to identify species in the metagenomic surface samples.

Results:  18 and 928 MDRO isolates were recovered from the US and the Pakistani ICU, respectively. Acinetobacter baumanii (n=13) and Escherichia coli (n=5) were recovered from the US, from the same room. A. baumannii (n=238), Enterococcus faecium (n=152), Klebsiella pneumoniae (n=136), and Pseudomonas aeruginosa (n=108) were the most common isolates obtained from the Pakistan. Carbapenem-resistant strains were recovered at both sites (Table 1). Pakistani tap water culture revealed: Aeromonas hydrophilia/punctata, Citrobacter freundii, Comomonas aquaticus, A. baumannii, Acinetobacter haemolyticus, Acinetobacter johnsonii; the first 4 organisms tested positive for a carbapenemase.

Conclusion: The environmental MDRO burden was higher in Pakistan compared to the US. The MDROs recovered at both sites are nosocomial pathogens. Whole genome sequencing of all recovered isolates and antibiotic susceptibility testing is underway to determine clonality, extent of multidrug resistance, and mechanisms of carbapenem resistance.

Figure 1: Sampling and Specimen Analysis


Table 1: Carbapenem Resistant Strains


Meropenem-Resistant Isolates

Isolates Positive for Carbapenemase







57 (R)

11 (I)



Acinetobacter spp.





Pseudomonas aeruginosa











Jennie H. Kwon, DO, MSCI1, Alaric D' Souza, BS2, Robert Potter, BS3, Meghan Wallace, BS4, Angela Shupe, BS5, Sanket Patel, MS5, Danish Gul, BS6, Saadia Andleeb, PhD7, Carey-Ann D. Burnham, PhD2 and Gautam Dantas, PhD8, (1)Infectious Diseases, Washington University School of Medicine, St. Louis, MO, (2)Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, (3)Pathology and Immunology, Washington University School of Medicine, 63110, MO, (4), Washington University School of Medicine, St. Louis, MO, (5)Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, (6)National University of Science and Technology, Islamabad, Pakistan, (7)Atta-ur-Rahman School of Applied Biosciences, Islamabad, Pakistan, (8)Washington University in St. Louis, St. Louis, MO


J. H. Kwon, None

A. D' Souza, None

R. Potter, None

M. Wallace, None

A. Shupe, None

S. Patel, None

D. Gul, None

S. Andleeb, None

C. A. D. Burnham, bioMerieux: Grant Investigator , Research grant
ThermoFisher: Consultant , Salary
Cepheid: Grant Investigator , Research grant

G. Dantas, None

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