Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 15, Number 3—March 2009
Letter

Cockroaches (Ectobius vittiventris) in an Intensive Care Unit, Switzerland1

On This Page
Article Metrics
11
citations of this article
EID Journal Metrics on Scopus

Cite This Article

To the Editor: Ectobius vittiventris (Costa) is a field-dwelling cockroach and 1 of 4,000 cockroach species worldwide (1). We describe a cockroach infestation of an intensive care unit (ICU). Successful management required knowledge of the ecology of cockroaches and highlighted the need for species-level identification to tailor control strategies.

The University of Geneva Hospitals are a 2,200-bed tertiary healthcare center. The 18-bed medical ICU is located on the ground floor next to an outdoor recreational area and admits ≈1,400 patients/year. Smoking inside hospital buildings by patients and healthcare workers (HCWs) is strictly prohibited. On August 25, 2006, ≈30 cockroaches were observed in the ICU hiding inside oxygen masks, moving around on the light panels below the ceilings, or dropping onto intubated patients during the night.

An outbreak investigation was initiated. All work areas, including sinks and material stock areas, were thoroughly searched for cockroaches. External pest control experts identified only 1 species, E. vittiventris, which had presumably entered the ICU through windows facing the outdoor recreational area. The investigation showed that despite verbal recommendations and being repeatedly forbidden to do so, HCWs had opened the windows secretly with screwdrivers so that they could smoke during night shifts. The infestation was halted within 3 days after information regarding the infestation was provided to HCWs and all windows were bolted shut. In contrast to measures required to deal with a reported infestation in a neonatal ICU (2), no other measures such as use of insecticides, review of the air circulation system, or changes in architectural structures were necessary to stop the infestation reported here.

Cockroaches can cause 2 potentially serious health problems. First, they may provoke allergic reactions (3). Second, they have been suggested as possible vectors of multidrug-resistant pathogens. In particular, cockroaches that live and breed in hospitals have higher bacterial loads than cockroaches in the community (46). Up to 98% of “nosocomial” cockroaches may carry medically important microorganisms on their external surfaces or in their alimentary tracts (49) and may disseminate these microorganisms by fecal–oral transmission.

Cockroaches are capable of harboring Escherichia coli (6,7), Enterobacter spp. (6,8,9), Klebsiella spp. (6,7,9), Pseudomonas aeruginosa (6,9), Acinetobacter baumannii (2), other nonfermentative bacteria (7,9), Serratia marcescens (7,9), Shigella spp. (6), Staphylococcus aureus (6,7), group A streptococci (6,7,9), Enterococcus spp. (6,7), Bacillus spp. (7), various fungi (68), and parasites and their cysts (6). An outbreak of extended-spectrum β-lactamase–producing Klebsiella pneumoniae in a neonatal unit was attributed to cockroaches (2). Pulsed-field gel electrophoresis did not distinguish organisms from the insects from those colonizing infants or causing clinical disease (2). Unlike other investigators, we did not cultivate the cockroaches (6,9).

E. vittiventris cockroaches are easily confused with Blattella germanica (Linnaeus) (the German or croton cockroach), which is probably the most important cockroach pest worldwide (1,9). In contrast to B. germanica (6,9) and other species (Technical Appendix ), E. vittiventris cockroaches are considered to be harmless and have not been associated with human disease or transmission of pathogens. We did not observe any allergic reactions or an increase in colonization or infection rates of multidrug-resistant organisms. B. germanica cockroaches are nocturnal, cannot fly, are always encountered within human habitations, and require specialized measures for eradication (10).

E. vittiventris cockroaches live in outdoor areas, do not avoid light, and are active during daytime. Buildings are not a natural habitat. In summer, adult insects can fly inside at night, but because these cockroaches are unable to reproduce inside buildings (1), stopping entry from outside halts the infestation. Entry can be stopped by closing windows or using mosquito nets. There is no existing insecticide for eradication of E. vittiventris cockroaches (10), and even if there were, it would not be effective because insects from untreated areas outside would enter continuously (1).

E. vittiventris cockroaches have been recently discovered in Geneva (10) and have become the most frequently encountered cockroaches in urban areas of Switzerland for several years (1). The reason for this finding remains unknown. The summer of 2003 was remarkably hot and dry in central Europe, thus representing a subtropical climate that usually favors the growth and development of cockroach populations (1,7). If this warming trend persists, populations of E. vittiventris cockroaches may continue to expand and similar infestations may occur.

In conclusion, effective control strategies for cockroach infestations depend on identification of cockroach species. In this report, permanent closure of all windows was sufficient to stop the infestation. However, to ensure compliance, it was critical to discuss the purposes of the intervention with HCWs.

Top

Acknowledgment

We thank Rosemary Sudan for editorial assistance, the ICU team of the University of Geneva Hospitals for collaboration, and Manadou Diallo for expert advice.

Top

Ilker Uçkay, Hugo Sax, Sandrine Longet Di Pietro, Hannes Baur, Marie-France Boulch, Christophe Akakpo, Jean-Claude Chevrolet, and Didier PittetComments to Author 
Author affiliations: University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland (I. Uçkay, H. Sax, S. Longet-Di Pietro, M.-F. Boulc’h, C. Akakpo, J.-C. Chevrolet, D. Pittet); Natural History Museum, Bern, Switzerland (H. Baur)

Top

References

  1. Baur  H, Landau-Lüscher  I, Müller  G, Schmidt  M, Coray  A. Taxonomy of the field-dwelling cockroach Ectobius vittiventris and its distribution in Switzerland. Rev Suisse Zool. 2004;111:395424.
  2. Cotton  MF, Wasserman  E, Pieper  CH, Theron  DC, van Tubbergh  D, Campbell  G, Invasive disease due to extended spectrum beta-lactamase-producing Klebsiella pneumoniae in a neonatal unit: the possible role of cockroaches. J Hosp Infect. 2000;44:137. DOIPubMedGoogle Scholar
  3. Tungtrongchitr  A, Sookrung  N, Munkong  N, Mahakittikun  V, Chinabut  P, Chaicumpa  W, The levels of cockroach allergen in relation to cockroach species and allergic diseases in Thai patients. Asian Pac J Allergy Immunol. 2004;22:11521.PubMedGoogle Scholar
  4. Paul  S, Khan  AM, Baqui  MA, Muhibullah  M. Evaluation of the common cockroach Periplaneta americana (L.) as carrier of medically important bacteria. J Commun Dis. 1992;24:20610.PubMedGoogle Scholar
  5. Fotedar  R, Shriniwas  UB, Verma  A. Cockroaches (Blattella germanica) as carriers of microorganisms of medical importance in hospitals. Epidemiol Infect. 1991;107:1817.PubMedGoogle Scholar
  6. Salehzadeh  A, Tavacol  P, Mahjub  H. Bacterial, fungal and parasitic contamination of cockroaches in public hospitals of Hamadan, Iran. J Vector Borne Dis. 2007;44:10510.PubMedGoogle Scholar
  7. Pai  HH, Chen  WC, Peng  CF. Cockroaches as potential vectors of nosocomial infections. Infect Control Hosp Epidemiol. 2004;25:97984. DOIPubMedGoogle Scholar
  8. Lemos  AA, Lemos  JA, Prado  MA, Pimenta  FC, Gir  E, Silva  HM, Cockroaches as carriers of fungi of medical importance. Mycoses. 2006;49:235. DOIPubMedGoogle Scholar
  9. Elgderi  RM, Ghenghesh  KS, Berbash  N. Carriage by the German cockroach (Blattella germanica) of multiple-antibiotic-resistant bacteria that are potentially pathogenic to humans, in hospitals and households in Tripoli, Libya. Ann Trop Med Parasitol. 2006;100:5562. DOIPubMedGoogle Scholar
  10. Fédération Suisse des Désinfestateurs [cited 2007 Nov 7]. Available from http://www.fsd-vss.ch.

Top

Cite This Article

DOI: 10.3201/eid1503.071484

1Parts of this research have been presented as a poster at the Annual Meeting of the Swiss Society for Infectious Diseases, Zurich, Switzerland, June 14, 2007.

Related Links

Top

Table of Contents – Volume 15, Number 3—March 2009

EID Search Options
presentation_01 Advanced Article Search – Search articles by author and/or keyword.
presentation_01 Articles by Country Search – Search articles by the topic country.
presentation_01 Article Type Search – Search articles by article type and issue.

Top

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Didier Pittet, Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, 24 Rue Micheli-du-Crest, 1211 Geneva 14, Switzerland;

Send To

10000 character(s) remaining.

Top

Page created: December 07, 2010
Page updated: December 07, 2010
Page reviewed: December 07, 2010
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external