Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-19T11:43:26.043Z Has data issue: false hasContentIssue false
  • English
  • Français

A Cluster of Nosocomial Klebsiella oxytoca Bloodstream Infections in a University Hospital

Published online by Cambridge University Press:  02 January 2015

Yesim Cetinkaya Sardan ,
Pinar Zarakolu ,
Belgin Altun ,
Aycan Yildirim ,
Gonul Yildirim ,
Gulsen Hascelik  and
Omrum Uzun
Yesim Cetinkaya Sardan*
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Pinar Zarakolu
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Belgin Altun
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Aycan Yildirim
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Gonul Yildirim
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Gulsen Hascelik
Affiliation:
Department of Microbiology and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
Omrum Uzun
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
*
Hacettepe University School of Medicine, Department of Medicine, Section of Infectious Diseases, Sihhiye, Ankara, 06100, Turkey
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3.

Objective:

To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections.

Design:

Outbreak investigation.

Setting:

A 1,000-bed university hospital.

Methods:

The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains.

Results:

AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile.

Conclusions:

We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued..

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 878 - 882
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Podschun, R, Ullmann, U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998;11:589–603.10.1128/CMR.11.4.589Google Scholar
2. French, GL, Phillips, I. Antimicrobial resistance in hospital flora and nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott Williams & Wilkins; 1999:1243–1264.Google Scholar
3. National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 2002. Document M100-S12.Google Scholar
4. Ridley, AM. Genomic fingerprinting by application of rep-PCR. In: Woodford, N, Johnson, AP, eds. Molecular Bacteriology: Protocols and Clinical Applications. Totowa, NJ: Humana Press; 1998:103–115.10.1385/0-89603-498-4:103Google Scholar
5. Struelens, MJ, Carlier, E, Maes, N, Serruys, E, Quint, WG, van Belkum, A. Nosocomial colonization and infection with multiresistant Acinetobacter baumannii: outbreak delineation using DNA macrorestriction analysis and PCR-fingerprinting. J Hosp Infect 1993;25:15–32.10.1016/0195-6701(93)90005-KGoogle Scholar
6. Jarvis, WR, Cookson, ST, Robles, MB. Prevention of nosocomial bloodstream infections: a national and international priority. Infect Control Hosp Epidemiol 1996;17:272–275.10.1086/647294Google Scholar
7. Macias, AE, Munoz, JM, Bruckner, DA, et al. Parenteral infusions bacterial contamination in a multi-institutional survey in Mexico: considerations for nosocomial mortality. Am J Infect Control 1999;27:285–290.10.1053/ic.1999.v27.a92879Google Scholar
8. Macias-Hernandez, AE, Hernandez-Ramos, I, Munoz-Barrett, JM, et al. Pediatric primary gram-negative nosocomial bacteremia: a possible relationship with infusate contamination. Infect Control Hosp Epidemiol 1996;17:276–280.10.1086/647295Google Scholar
9. Raad, I. Gram-negative bacillary bacteremia and intravenous therapy practices. Infect Control Hosp Epidemiol 2004;25:189–191.10.1086/502375Google Scholar
10. Jeong, SH, Kim, WM, Chang, CL, et al. Neonatal intensive care unit outbreak caused by a strain of Klebsiella oxytoca resistant to aztreonam due to overproduction of chromosomal beta-lactamase. J Hosp Infect 2001;48:281–288.10.1053/jhin.2001.1018Google Scholar
11. Reiss, I, Borkhardt, A, Fussle, R, Sziegoleit, A, Gortner, L. Disinfectant contaminated with Klebsiella oxytoca as a source of sepsis in babies. Lancet 2000;356:310.10.1016/S0140-6736(00)02509-5Google Scholar
12. Ransjo, U, Good, Z, Jalakas, K, et al. An outbreak of Klebsiella oxytoca septicemias associated with the use of invasive blood pressure monitoring equipment. Acta Anaesthesiol Scand 1992;36:289–291.10.1111/j.1399-6576.1992.tb03466.xGoogle Scholar
13. Longfield, R, Longfield, J, Smith, LP, Hyams, KC, Strohmer, ME. Multidose medication vial sterility: an in-use study and a review of the literature. Infect Control 1984;5:165–169.10.1017/S0195941700059154Google Scholar
14. Herwaldt, LA, Smith, SD, Carter, CD. Infection control in the outpatient setting. In: Herwaldt, LA, Decker, MD, eds. A Practical Handbook for Hospital Epidemiologists. Thorofare, NJ: SLACK Incorporated; 1998:357–402.Google Scholar
15. Newman, PE, Goodman, RA, Waring, GO III, et al. A cluster of cases of Mycobacterium chelonei keratitis associated with outpatient procedures. Am J Ophthalmol 1984;97:344–348.10.1016/0002-9394(84)90634-2Google Scholar
16. Weems, JJ Jr, Usry, G, Schwab, U. Infection due to rapidly-growing mycobacteria associated with ultrasound directed prostate biopsy. Infect Control Hosp Epidemiol 1996;17(5 part 2):P50. Abstract.Google Scholar
17. Bosi, C, Davin-Regli, A, Charrel, R, Rocca, B, Monnet, D, Boliet, C. Serratia marcescens nosocomial outbreak due to contamination of hex-etidine solution. J Hosp Infect 1996;33:217–224.10.1016/S0195-6701(96)90005-5Google Scholar
18. Grohskopf, LA, Roth, VA, Feikin, DR, et al. Serratia liquefaciens bloodstream infections from contamination of epoetin alfa at a hemodialysis center. NEngl J Med 2001;344:1491–1497.10.1056/NEJM200105173442001Google Scholar
19. Bennett, SN, McNeil, MM, Bland, LA, et al. Postoperative infections traced to contamination of intravenous anesthetic, propofol. N Engl J Med 1995;333:147–154.10.1056/NEJM199507203330303Google Scholar
20. Lalitha, MK, Kenneth, J, Jana, AK, et al. Identification of an IV-dextrose solution as the source of an outbreak of Klebsiella pneumoniae sepsis in a newborn nursery. J Hosp Infect 1999;43:70–73.10.1053/jhin.1999.0619Google Scholar
21. Archibald, LK, Ramos, M, Arduino, MJ, et al. Enterobacter cloacae and Pseudomonas aeruginosa polymicrobial bloodstream infections traced to extrinsic contamination of a dextrose multidose vial. J Pediatr 1998;133:640–644.10.1016/S0022-3476(98)70104-0Google Scholar
22. Hobson, RP, MacKenzie, FM, Gould, IM. An outbreak of multiply-resistant Klebsiella pneumoniae in the Grampian region of Scotland. J Hosp Infect 1996;33:249–262.10.1016/S0195-6701(96)90011-0Google Scholar
23. Coovadia, YM, Johnson, AP, Bhana, RH, Hutchinson, GR, George, RC, Hafferjee, IE. Multiresistant Klebsiella pneumoniae in a neonatal nursery: the importance of maintenance of infection control policies and procedures in the prevention of outbreaks. J Hosp Infect 1992;22:197–205.10.1016/0195-6701(92)90044-MGoogle Scholar