Nosocomial Outbreak of a Novel Extended-Spectrum β-LactamaseSalmonella entericaSerotype Isangi Among Surgical Patients

2016 ◽  
Vol 37 (8) ◽  
pp. 954-961 ◽  
Author(s):  
Geehan Suleyman ◽  
Robert Tibbetts ◽  
Mary Beth Perri ◽  
Dora Vager ◽  
Yuan Xin ◽  
...  
Keyword(s):  
Infection Control ◽  
Gel Electrophoresis ◽  
Organ Transplant ◽  
The United States ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Surgical Patients ◽  
Multiple Control ◽  
Pulsed Field ◽  
Extended Spectrum

OBJECTIVENosocomial outbreaks caused bySalmonellaare rare. We describe the investigation and control of a cluster of novel extended-spectrum β-lactamase (ESBL)Salmonella entericaserotype Isangi in a hospital in southeastern Michigan.METHODSAn epidemiologic investigation, including case-control study, assessment of infection control practices and environmental cultures, was performed to identify modes of transmission. Healthcare workers (HCWs) exposed to case patients were screened. Strain relatedness was determined using pulsed-field gel electrophoresis (PFGE); ESBL confirmation was conducted using real-time PCR. Control measures were implemented to prevent further transmission.RESULTSBetween September 2 and October 22, 2015, 19 surgical patients, including 10 organ transplant recipients and 1 HCW, had positiveS.Isangi cultures. Of these case patients and HCW, 13 had gastroenteritis, 2 had bacteremia, 1 had surgical-site infection, and 4 were asymptomatic. Pulsed-field gel electrophoresis (PFGE) showed 89.5% similarity among the isolates in these cases. Isolates with resistant-phenotypes possessed plasmid-mediated CTX-M15 ESBL. A total of 19 case patients were compared with 57 control participants. Case patients had significantly higher odds of exposure to an intraoperative transesophageal (TEE) probe (adjusted odds ratio 9.0; 95% confidence interval, 1.12–72.60;P=.02). Possible cross-transmission occurred in the HCW and 2 patients. Cultures of TEE probes and the environment were negative. The outbreak ended after removal of TEE probes, modification of reprocessing procedures, implementation of strict infection control practices, and enhanced environmental cleaning.CONCLUSIONSWe report the first nosocomial ESBLS. Isangi outbreak in the United States. Multiple control measures were necessary to interrupt transmission of this gastrointestinal pathogen. Exposure to possibly contaminated TEE probes was associated with transmission. Periodic monitoring of reprocessing procedures of TEE probes may be required to ensure optimal disinfection.Infect Control Hosp Epidemiol2016;37:954–961

scholarly journals Endoscopic Retrograde Cholangiopancreatography–Associated AmpCEscherichia coliOutbreak

2015 ◽  
Vol 36 (6) ◽  
pp. 634-642 ◽  
Author(s):  
Kristen A. Wendorf ◽  
Meagan Kay ◽  
Christopher Baliga ◽  
Scott J. Weissman ◽  
Michael Gluck ◽  
...  
Keyword(s):  
Infection Control ◽  
Endoscopic Retrograde Cholangiopancreatography ◽  
Gel Electrophoresis ◽  
Gene Sequencing ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Biliary Disease ◽  
Endoscopic Retrograde ◽  
Pulsed Field ◽  
E Coli

BACKGROUNDWe identified an outbreak of AmpC–producingEscherichia coliinfections resistant to third-generation cephalosporins and carbapenems (CR) among 7 patients who had undergone endoscopic retrograde cholangiopancreatography at hospital A during November 2012–August 2013. Gene sequencing revealed a shared novel mutation in ablaCMYgene and a distinctivefumC/ fimHtyping profile.OBJECTIVETo determine the extent and epidemiologic characteristics of the outbreak, identify potential sources of transmission, design and implement infection control measures, and determine the association between the CRE. coliand AmpCE. colicirculating at hospital A.METHODSWe reviewed laboratory, medical, and endoscopy reports, and endoscope reprocessing procedures. We obtained cultures from endoscopes after reprocessing as well as environmental samples and conducted pulsed-field gel electrophoresis and gene sequencing on phenotypic AmpC isolates from patients and endoscopes. Cases were those infected with phenotypic AmpC isolates (both carbapenem-susceptible and CR) and identicalblaCMY-2,fumC, andfimHalleles or related pulsed-field gel electrophoresis patterns.RESULTSThirty-five of 49 AmpCE. colitested met the case definition, including all CR isolates. All cases had complicated biliary disease and had undergone at least 1 endoscopic retrograde cholangiopancreatography at hospital A. Mortality at 30 days was 16% for all patients and 56% for CR patients. Two of 8 reprocessed endoscopic retrograde cholangiopancreatography scopes harbored AmpC that matched case isolates by pulsed-field gel electrophoresis. Environmental cultures were negative. No breaches in infection control were identified. Endoscopic reprocessing exceeded manufacturer’s recommended cleaning guidelines.CONCLUSIONRecommended reprocessing guidelines are not sufficient.Infect Control Hosp Epidemiol2015;00(0): 1–9

Molecular strain typing ofCampylobacter jejuniby pulsed-field gel electrophoresis in a single day

2001 ◽  
Vol 47 (7) ◽  
pp. 667-669 ◽  
Author(s):  
Sophie Michaud ◽  
Robert D Arbeit ◽  
Christiane Gaudreau
Keyword(s):  
Infection Control ◽  
Molecular Epidemiology ◽  
Campylobacter Jejuni ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Strain Typing ◽  
High Quality ◽  
Pulsed Field ◽  
Infection Control Measures

Rapid molecular strain typing is critical for effective outbreak investigation and implementation of infection control measures. Pulsed-field gel electrophoresis is a highly discriminatory technique for Campylobacter jejuni, but generally requires 3–5 days. We describe a simplified protocol for pulsed-field gel electrophoresis that provides high quality typing of C. jejuni isolates in a single day.Key words: pulsed-field gel electrophoresis, Campylobacter jejuni, molecular epidemiology.

Antimicrobial Resistance of Salmonella enterica Isolates from Bulk Tank Milk and Milk Filters in the United States†

2013 ◽  
Vol 76 (1) ◽  
pp. 18-25 ◽  
Author(s):  
J. S. VAN KESSEL ◽  
J. SONNIER ◽  
S. ZHAO ◽  
J. S. KARNS
Keyword(s):  
Antimicrobial Resistance ◽  
Gel Electrophoresis ◽  
Salmonella Enterica ◽  
Pulsed Field Gel Electrophoresis ◽  
Class I ◽  
Bulk Tank Milk ◽  
Pulsed Field ◽  
Extended Spectrum ◽  
Class I Integrons ◽  
Bulk Tank

Salmonella isolates were recovered from bulk tank milk as part of the National Animal Health Monitoring System (NAHMS) Dairy 2002 and 2007 surveys. In-line milk filters were also tested in the 2007 survey. The objective of this study was to determine the prevalence of antimicrobial resistance among Salmonella enterica isolates from bulk milk and milk filters in the NAHMS Dairy 2002 and 2007 surveys and to further characterize resistant isolates. Susceptibilities to 15 antibiotics were determined for 176 Salmonella isolates of 26 serotypes using an automated antimicrobial susceptibility system. Resistant isolates were screened by PCR for the presence of the extended-spectrum β-lactamase (blaCMY) gene and class I integrons and further characterized by pulsed-field gel electrophoresis. Thirty isolates (17.0%) representing six S. enterica serotypes exhibited resistance to at least one antimicrobial agent (serotypes Newport [14 of 14 isolates exhibited resistance], Dublin [7 of 7], Typhimurium [3 of 5], Kentucky [4 of 22], Anatum [1 of 13], and Infantis [1 of 2]). Twenty isolates (11.4%), including all 14 Newport, 3 Dublin, 2 Typhimurium, and 1 Infantis isolate, displayed the typical multidrug-resistant, blaCMY-positive (MDR-AmpC) phenotype which included resistance to ampicillin, chloramphenicol, streptomycin, sulfonamide, and tetracycline, plus resistance to amoxicillin–clavulanic acid and extended-spectrum cephalosporins. Five of the MDR-AmpC isolates carried class I integrons (2.8%). Two-enzyme (XbaI and BlnI) pulsed-field gel electrophoresis discerned clades within serotypes and, together with the resistance profiles, identified strains that appeared to have persisted temporally and geographically. These results suggest that there is a low but appreciable risk of infection with MDR Salmonella from consumption of nonpasteurized milk and dairy products.

scholarly journals Comparison of Virulence Gene Identification, Ribosomal Spacer PCR, and Pulsed-Field Gel Electrophoresis for Typing of Staphylococcus aureus Strains Isolated from Cases of Subclinical Bovine Mastitis in the United States

2016 ◽  
Vol 54 (7) ◽  
pp. 1871-1876 ◽  
Author(s):  
Pamela R. F. Adkins ◽  
John R. Middleton ◽  
Lawrence K. Fox
Keyword(s):  
United States ◽  
Staphylococcus Aureus ◽  
Gel Electrophoresis ◽  
Virulence Gene ◽  
The United States ◽  
Pulsed Field Gel Electrophoresis ◽  
Gene Identification ◽  
Content Type ◽  
Pulsed Field

Staphylococcus aureusis one of the most important pathogens causing contagious mastitis in dairy cattle worldwide. The objectives of this study were to determine if recently describedS. aureusgenotype B was present among previously characterized isolates from cases of bovine intramammary infection in the United States and to compare pulsed-field gel electrophoresis (PFGE) to the combination of ribosomal spacer PCR (RS-PCR) and virulence gene identification for typing ofS. aureusstrains. The hypothesis was that isolates that were previously characterized as contagious would be identified as genotype B and that the results of the two strain-typing methods would be comparable. Isolates were selected from a collection ofS. aureusisolates from eight dairy farms. Mammary quarter milk somatic cell count (SCC) andN-acetyl-β-d-gluconaminidase (NAGase) activity data were known and used to evaluate strain pathogenicity. RS-PCR was performed with conventional gel electrophoresis, and PCR was used for toxin gene identification. RS-PCR patterns were associated with a specific virulence gene pattern, as previously reported. Five RS-PCR banding patterns were identified. None of the isolates were characterized as genotype B. No association between RS-PCR types and milk SCC was found; however, NAGase activity was significantly higher in milk from mammary glands infected with RS-PCR banding type 1 (RSP type 1) than in milk from those infected with RSP type 2. The discriminatory power values were 1.0 and 0.46 for PFGE and RS-PCR, respectively. These data suggest that genotype B may have a limited geographic distribution and that PFGE is more discriminatory than RS-PCR performed with conventional gel electrophoresis for typing ofS. aureusisolates of bovine origin.

Listeria monocytogenes From Farm to Fork in a Brazilian Pork Production Chain

2020 ◽  
Vol 83 (3) ◽  
pp. 485-490 ◽  
Author(s):  
DANILO A. L. SILVA ◽  
CLARISSE V. BOTELHO ◽  
BRUNA T. F. MARTINS ◽  
RAFAELA M. TAVARES ◽  
ANDERSON C. CAMARGO ◽  
...  
Keyword(s):  
Listeria Monocytogenes ◽  
Gel Electrophoresis ◽  
Virulence Genes ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Production Chain ◽  
Pork Production ◽  
Pulsed Field ◽  
Genetic Profiles ◽  
Different Sources

ABSTRACT Listeria monocytogenes contamination was assessed in different steps of a pork production chain. Ten lots of pigs were sampled at termination barns, at slaughter (after bleeding, after buckling, after evisceration, and after final washing), at processing (knives, deboning tables, and employees' hands), and of end products (ribs, shoulder, ham, and sausage). All samples (n = 670) were subjected to L. monocytogenes detection, and the obtained isolates (n = 18, identified as Listeria spp.) were characterized by their biochemical characteristics, serogroups, virulence genes, pulsed-field gel electrophoresis profiles, antibiotic resistances (ampicillin, penicillin, gentamicin, and sulfamethoxazole-trimethoprim), and adhesion abilities. The results revealed the low occurrence of Listeria spp. in the evaluated pork production chain. However, four tested sausage samples (40%) were positive for Listeria spp., with L. monocytogenes identified in two (20%) of these samples. Ten isolates were identified as L. monocytogenes (eight from serogroup 1/2a or 3a and two from serogroup 4b, 4d, or 4e): all isolates were also positive for the virulence-related genes hlyA, iap, plcA, actA, inlA, inlB, inlC, and inlJ and susceptible to the tested antibiotics. One sausage sample was contaminated by both serogroups 1/2a or 3a and 4b, 4d, or 4e. Isolates from serogroup 1/2a or 3a obtained during visits 5 and 6 presented distinct genetic profiles by pulsed-field gel electrophoresis, indicating that contamination may come from different sources. The adhesion potential exhibited by Listeria spp. isolates (n = 18) ranged from weak (serogroup 4b, 4d, or 4e) to moderate (L. innocua and L. monocytogenes serogroup 1/2a or 3a). Despite the low occurrence of L. monocytogenes, pathogenic serogroups were detected in sausages, demanding control measures by the industry. HIGHLIGHTS

scholarly journals Nosocomial Spread of Colistin-Only-Sensitive Sequence Type 235 Pseudomonas aeruginosa Isolates Producing the Extended-Spectrum β-Lactamases GES-1 and GES-5 in Spain

2009 ◽  
Vol 53 (11) ◽  
pp. 4930-4933 ◽  
Author(s):  
Esther Viedma ◽  
Carlos Juan ◽  
Joshi Acosta ◽  
Laura Zamorano ◽  
Joaquín R. Otero ◽  
...  
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Gel Electrophoresis ◽  
Multilocus Sequence Typing ◽  
Resistance Mechanisms ◽  
Pulsed Field Gel Electrophoresis ◽  
Sequence Type ◽  
Pulsed Field ◽  
Resistance Determinants ◽  
Extended Spectrum ◽  
Spanish Hospital

ABSTRACT The mechanisms responsible for the increasing prevalence of colistin-only-sensitive (COS) Pseudomonas aeruginosa isolates in a Spanish hospital were investigated. Pulsed-field gel electrophoresis revealed that 24 (50%) of the studied isolates belonged to the same clone, identified as the internationally spread sequence type 235 (ST235) through multilocus sequence typing. In addition to several mutational resistance mechanisms, an integron containing seven resistance determinants was detected. Remarkably, the extended-spectrum β-lactamase GES-1 and its Gly170Ser carbapenem-hydrolyzing derivative GES-5 were first documented to be encoded in a single integron. This work is the first to describe GES enzymes in Spain and adds them to the growing list of β-lactamases of concern (PER, VIM, and OXA) detected in ST235 clone isolates.

Rapid Eradication of a Cluster ofSerratia marcescensin a Neonatal Intensive Care Unit: Use of Epidemiologic Chromosome Profiling by Pulsed-Field Gel Electrophoresis

2004 ◽  
Vol 25 (9) ◽  
pp. 730-734 ◽  
Author(s):  
Kwan Kew Lai ◽  
Stephen P. Baker ◽  
Sally A. Fontecchio
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Neonatal Intensive Care Unit ◽  
Gel Electrophoresis ◽  
Neonatal Intensive Care ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Measures ◽  
Pulsed Field ◽  
Contact Precautions ◽  
Control Study

AbstractObjective:To investigate a cluster of patients infected and colonized withSerratia marcescensin a neonatal intensive care unit (NICU).Methods:In June 2001, two neonates in the NICU had clinical infections withS. marcescensand one died. Infection control surveillance data for the NICU revealed that S.marcescenswas rarely isolated from clinical specimens. Surveillance and environmental cultures were performed and isolates were typed using pulsed-field gel electrophoresis. Staff and neonates were cohorted and a waterless, alcohol-based handwashing agent was introduced. A case-control study was performed.Results:From June 2 through August 20, 2001, 11 neonates withS. marcescensinfection and colonization were identified. The incidence ofS. marcescensinfections increased from 0.19 per 1,000 patient-days in 2000 to 0.52 per 1,000 patient-days in 2001 (P< .0001). In the first 3 weeks of the investigation, there were 2 sets of patients and sinks with indistinguishable strains; however, in subsequent weeks, all isolates were of unique strains, signifying no further transmission of the two initial predominant strains. Neonates withS. marcescenswere more likely to have a lower gestational age and birth weight. There was no association between cases and healthcare workers (HCWs).Conclusions:A cluster ofS. marcescenswas quickly terminated after the introduction of preventive measures including cohorting of infected and colonized neonates and HCWs, contact precautions, surveillance cultures, and a waterless, alcohol-based hand antiseptic. Chromosomal typing determined that strains with an indistinguishable pattern were no longer present in the unit after control measures were implemented.

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