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Background: Hospitals with their high antimicrobial selection pressure represent the presumably most important reservoir of multidrug-resistant human pathogens. Antibiotics administered in the course of treatment are excreted and discharged into the wastewater system. Not only in patients, but also in the sewers, antimicrobial substances exert selection pressure on existing bacteria and promote the emergence and dissemination of multidrug-resistant clones. In previous studies, two main clusters were identified in all sections of the hospital wastewater network that was investigated, one K. pneumoniae ST147 cluster encoding NDM- and OXA-48 carbapenemases and one VIM-encoding P. aeruginosa ST823 cluster. In the current study, we investigated if NDM- and OXA-48-encoding K. pneumoniae and VIM-encoding P. aeruginosa isolates recovered between 2014 and 2021 from oncological patients belonged to those same clusters. Methods: The 32 isolates were re-cultured, whole-genome sequenced, phenotypically tested for their antimicrobial susceptibility, and analyzed for clonality and resistance genes in silico. Results: Among these strains, 25 belonged to the two clusters that had been predominant in the wastewater, while two others belonged to a sequence-type less prominently detected in the drains of the patient rooms. Conclusion: Patients constantly exposed to antibiotics can, in interaction with their persistently antibiotic-exposed sanitary facilities, form a niche that might be supportive for the emergence, the development, the dissemination, and the maintenance of certain nosocomial pathogen populations in the hospital, due to antibiotic-induced selection pressure. Technical and infection control solutions might help preventing transmission of microorganisms from the wastewater system to the patient and vice versa, particularly concerning the shower and toilet drainage. However, a major driving force might also be antibiotic induced selection pressure and parallel antimicrobial stewardship efforts could be essential. [ABSTRACT FROM AUTHOR]

We report on a 38-year-old male patient with disseminated gonococcal infection. Preceding the discharge diagnosis, the patient was treated regarding rheumatoid arthritis, which resulted in the deterioration of the patient's medical condition due to the immunomodulatory nature of the applied medication. The causative agent was identified by culturing joint puncture fluid inoculated into blood culture vials. Primary infection with the pathogen could not be pinpointed in terms of time, but on further questioning, the patient reported intimate contacts with a number of different male partners, which may be assumed to have included the infection source. The case hereby demonstrates the impact that an early misdiagnosis and a limited anamnesis can have on the progress of a patient's disease. Furthermore, this case has helped us to propose possible improvements in both clinical and microbiological diagnostic approaches. [ABSTRACT FROM AUTHOR]