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Volume 26, Number 8—August 2020
Dispatch

Spread of Multidrug-Resistant Bacteria by Moth Flies from Hospital Waste Water System

Thomas Rupprecht1, Annette Moter, Alexandra Wiessener, Joerg Reutershan, Klaus Lang-Schwarz, Michael Vieth, Christian Rupprecht, Ruediger Wagner, and Thomas Bollinger1Comments to Author 
Author affiliations: Klinikum Bayreuth, Bayreuth, Germany (T. Rupprecht, J. Reutershan, K. Lang-Schwarz, M. Vieth, T. Bollinger); Friedrich-Alexander University, Erlangen, Germany (T. Rupprecht, M. Vieth); Charité-Universitätsmedizin, Berlin, Germany (A. Moter, A. Wiessener); Eberhard Karls University, Tübingen, Germany (J. Reutershan); University of Oxford, Oxford, UK (C. Rupprecht); Universität Kassel, Kassel, Germany (R. Wagner); University Hospital Schleswig-Holstein, Lübeck, Germany (T. Bollinger)

Main Article

Table 2

Multidrug resistant bacteria on moth flies and biofilm in a hospital, Germany*

No. Specimens tested Location found Species identified† Can produce biofilm? Resistance level‡ Macroscopic/
histologic findings
1
Biofilm
Sewage line
Achromobacter xylosoxidans
Yes
Not classified
Biofilm, Candida, mucin, eggs
2 Biofilm Sewage line Pseudomonas spp. Yes Potential XDR§ Biofilm, cocoons, eggs
Escherichia coli MDR



Lysinibacillus fusiformis



3
Moth fly
OR 7
Bacillus spp., Citrobacter freundii
Yes
MDR
NA
4 Biofilm Endoscopy of sewage lines in washroom, OR 7 Advenella species Yes Potential XDR§ Extensive biofilm in all sewage lines, mucin, Candida
Bacillus spp. Yes
Pseudomonas aeuginosa Yes
Stenotrophomonas maltophilia

Moth fly
Washroom OR 7
Sterile
NA
ND
NA
5
Moth fly
Corridor OR 7
P. mosseliiS. maltophilia
Yes
Potential XDR§
NA
7
Moth fly
Corridor OR 1-6
Bacillus spp.
B. megatariume
Yes
Yes
ND
NA
8
Moth fly
Corridor ICU CS
Bacillus spp.
Yes

NA
9 Moth fly Toilet (A3-40) S. maltophilia Potential XDR§

2 moth flies
Toilet (A3-40)
Sterile
NA
ND
NA
10 Moth fly Doctors room (A3-43) Bacillus spp.
P. nitroreducens Yes
Yes ND NA

Moth fly
Doctors room (A3-43)
B. cereusB. thuringienses
Yes
Yes
ND
NA
14
Moth fly
Toilet (A3-06)
Bacillus spp.
B. cereusChryseobacterium indologenses
Yes
ND
NA
16 Biofilm Shower drain B. cereusBacillus spp.P. putida Yes ND Biofilm, eggs, Candida albicans
Moth fly Shower (F3-07) Bacillus cereusL. sphaericusStaphylococcus epidermidis Yes ND NA

2 moth flies
Shower (F3-07)
S. maltophiliaB. thuringiensis
Yes
Potential XDR
NA
17 Moth fly Shower (F3-31) Enterococcus faecium (vanA)Bacillus spp.
S. maltophilia Yes Possible XDR¶
Potential XDR§ NA

Moth fly
Shower (F3-31)
E. faecium
Yes
MDR
NA
24 Moth fly ICU floor C Sterile NA ND NA

*Numbers at left are patient numbers, which correspond to the numbers in Table 1 and Figure 1, panel C. CS, cardiosurgery; C, cardiology; ICU, intensive care unit; MDR, multidrug resistant; OR, operating room; NA, not applicable; ND, not detected; XDR, extensively drug resistant.
†Microbiology, histology, and fluorescence in situ hybridization findings in the investigated specimens. Note that not every moth fly from the Table 1 count column was analyzed.
‡Resistance levels defined in Magiorakos et al. (13).
§Potential XDR means that the international standards have not been applied to the bacterium S. maltophilia. Additional details are available in the Appendix.
¶Possible XDR means that it could be XDR but not all antimicrobial categories were tested. Additional details are available in the Appendix.

Main Article

References
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1These authors were co–principal investigators.

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