A study conducted at a hospital in Ireland highlights the potential for hospital wastewater systems to serve as a reservoir for clinically relevant antibiotic-resistant pathogens, researchers reported last week in the Journal of Hospital Infection.

In the study, which was conducted at University Hospital Limerick, researchers performed a large-scale metagenomic analysis of wastewater pipes from a soon-to-be refurbished ward that has experienced multiple multidrug-resistant healthcare-associated infection outbreaks. For the analysis, they processed biofilm and extracted DNA from 20 pipe samples from patient rooms, including toilet u-bends and sink and shower drains. They also analyzed clinical isolates from patients who had been on the ward prior to refurbishment and were known to be colonized with antibiotic-resistant bacteria.

if we can stop these reservoirs from being established by improved infection control practices, we can hopefully stop patients from acquiring difficult-to-treat infections.

Sequencing of DNA from the pipe samples revealed a diverse reservoir of antibiotic-resistance genes (ARGs), and the most ARGs observed were those encoding resistant to commonly used antibiotics, including tetracyclines, fluoroquinolones, beta-lactams, and macrolides. Similarly, a diverse range of ARGs was identified in the clinical isolates, and a comparison of the clinical isolates with DNA from the wastewater pipes revealed a considerable number of identical ARGs.

"Whilst these data do not enable us to determine if resistance genes were transferred from patient to the wastewater system or indeed vice versa, they do allow us to confirm crossover in the resistome of clinically-relevant pathogens and the microbiome of the wastewater environment," the study authors wrote.

Wastewater highway

Since all pipes and drains from the hospital's wastewater system connect to the same sewage system, the authors say the findings suggest the system forms a "wastewater highway" that could spread the resistant bacteria from sinks, shower drains, and toilets throughout the hospital—a finding they believe could influence the hospital's infection control and cleaning strategies going forward.

"Such sites pose a risk for healthcare-associated infections, and if we can stop these reservoirs from being established by improved infection control practices, we can hopefully stop patients from acquiring difficult-to-treat infections," study co-author Nuala O'Connell, MD, of the University of Limerick said in a university press release.

A 39-year-old man has tested positive for Nipah virus in India's Kerala state, raising the outbreak today to six cases, India Today reported today.

Kerala Health Minister Veena George's office said the man, who is from the affected district of Kozhikode, is hospitalized under observation. He had first sought treatment at a private hospital where other Nipah patients were being treated.

In good news, tests on 11 other patients who possibly had Nipah, which had been pending, came back negative for the virus, according to The Indian Express.

List of high-risk contacts expands to 213

Also today, the list of people who have come into contact with any of the patients grew to 950 people. Of those, 213 are in the high-risk category, including 21 who have been hospitalized and 287 healthcare workers. Fifteen samples from those in the high-risk category have been sent for testing.

Of the six people with confirmed Nipah, two have died. One of the surviving patients is a 9-year-old boy on a ventilator. Officials have ordered monoclonal antibody treatment for him. Though the antiviral therapy is unproven, George said it is the only option. Today, the Times of India reported that the Indian Council of Medical Research has decided to obtain 20 more doses of the monoclonal antibody treatment from Australia.

Schools will remain closed until tomorrow, and all public gatherings have been banned till September 24. Public Friday prayers today were also canceled.

Three countries reported a total of six vaccine-derived polio cases this week, according to the latest update from the Global Polio Eradication Initiative (GPEI), while the group also published the Independent Monitoring Board's annual assessment of progress toward polio eradication, which it said will not happen in 2023 as previously hoped.

"Despite recent progress toward eradication, remaining challenges make stopping transmission of WPV1 [wild poliovirus type 1] this year unlikely, while ending all variant poliovirus outbreaks will take even more time," the monitoring board said.

Wild poliovirus is endemic in only two countries, Afghanistan and Pakistan, several other countries battle outbreaks from three strains of vaccine-derived polio, which is linked to oral polio vaccine use.

Though protected from the virus, recipients of oral polio vaccine shed the weakened virus in their stool, which can then spread to unvaccinated children in unhygienic conditions. In ordinary circumstances, this can actually extend immunization coverage, but in areas with low polio vaccine uptake, the circulating virus can mutate and cause vaccine-derived polio. Newer vaccines, however, are designed to make the vaccine virus less likely to mutate and cause disease.

Despite recent progress toward eradication, remaining challenges make stopping transmission of WPV1 [wild poliovirus type 1] this year unlikely.

Six new cases in 3 countries

The Central African Republic recorded 1 new case this past week of vaccine-derived polio, raising the year's total to 11, the GPEI said in its weekly update. In Chad, 4 cases in two regions raise the 20203 total to 33 cases. One new case was reported in Yemen; that case is just the second reported in 2023. In 2022, Yemen recorded 162 cases.