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

AbstractBackground: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..

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An Outbreak of Ralstonia pickettii Bloodstream Infection Associated with an Intrinsically Contaminated Normal Saline Solution

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.327 ◽

2017 ◽

Vol 38 (4) ◽

pp. 444-448 ◽

Cited By ~ 4

Author(s):

Yin-Yin Chen ◽

Wan-Tsuei Huang ◽

Chia-Ping Chen ◽

Shu-Mei Sun ◽

Fu-Mei Kuo ◽

...

Keyword(s):

Bloodstream Infection ◽

Normal Saline ◽

Saline Solution ◽

Medical Center ◽

Bloodstream Infections ◽

Venous Access ◽

Ralstonia Pickettii ◽

Control And Prevention ◽

Saline Solutions ◽

Hospital Wards

OBJECTIVERalstonia pickettii has caused contamination of pharmaceutical solutions in many countries, resulting in healthcare infections or outbreak events. We determined the source of the outbreak of R. pickettii bloodstream infection (BSI).METHODSThis study was conducted in a 3,000-bed tertiary referral medical center in Taiwan with >8,500 admissions during May 2015. Patients had been treated in the injection room or chemotherapy room at outpatient departments, emergency department, or hospital wards. All patients who were culture positive for R. pickettii from May 3 to June 11, 2015, were eligible for the study. The aim of the survey was to conduct clinical epidemiological and microbiological investigations to identify possible sources of infection.RESULTSWe collected 57 R. pickettii–positive specimens from 30 case patients. We performed 24 blood cultures; 14 of these revealed >2 specimens and 6 used fluid withdrawn from Port-a-Cath implantable venous access devices. All patients received an injection of 20 mL 0.9% normal saline via catheter flushing. In addition, 2 unopened ampules of normal saline solution (20 mL) were confirmed positive for R. pickettii. The Taiwan Centers for Disease Control and Prevention performed sampling and testing of the same manufactured batch and identified the same strain of R. pickettii. Pulsed-field gel electrophoresis tests revealed that all clinical isolates had similarity of >90%, validating the outbreak of the same clone of R. pickettii.CONCLUSIONSR. pickettii can grow in saline solutions and cause bloodstream infections. Hospital monitoring mechanisms are extremely important measures in identifying and ending such outbreaks.Infect Control Hosp Epidemiol 2017;38:444–448

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Outbreak ofBurkholderia CepaciaBacteremia Traced to Contaminated Hospital Water Used for Dilution of an Alcohol Skin Antiseptic

Infection Control and Hospital Epidemiology ◽

10.1086/502384 ◽

2004 ◽

Vol 25 (3) ◽

pp. 231-239 ◽

Cited By ~ 62

Author(s):

Rana M. Nasser ◽

Amal C. Rahi ◽

Mona F. Haddad ◽

Ziad Daoud ◽

Noha Irani-Hakime ◽

...

Keyword(s):

Polymerase Chain Reaction ◽

Restriction Fragment ◽

Fragment Length ◽

Burkholderia Cepacia ◽

Tap Water ◽

Bloodstream Infections ◽

University Hospital ◽

Chain Reaction ◽

Polymerase Chain ◽

Restriction Fragment Length

AbstractObjective:To identify the source of an epidemic ofBurkholderia cepaciabloodstream infections during 7 years (411 episodes in 361 patients).Design:Outbreak investigation.Setting:A 250-bed university hospital in Beirut, Lebanon.Methods:Matched case-control and retrospective cohort studies, and microbiological surveillance and polymerase chain reaction–restriction fragment length ascertainment were employed. Special media and filtration techniques were used to isolate organisms from water and diluted alcohol solutions.Results:In a group of 50 randomly selected case-matched patients from 1999, the positive blood cultures were concomitant with fever in 98%, intravenous phlebitis in 44%, and recurrent bacteremia in 20%. Fever disappeared approximately 6 hours after intravenous catheter removal. Polymerase chain reaction–restriction fragment length polymorphism revealed strain homogeneity in patient, water, and alcohol isolates. Contaminated tap water had been used to dilute alcohol for skin antisepsis and for decontamination of the caps of heparin vials. Only sporadic cases directly attributable to breach of protocol were reported after single-use alcohol swabs were substituted.Conclusion:This is potentially the largest single-source nosocomial bloodstream infection outbreak ever reported, and the first report of an alcohol skin antiseptic contaminated by tap water as a source for nosocomial bacteremia.

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53. Incidence of Bloodstream Infections and Outcomes in Patients with Severe COVID-19 Pneumonia

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.363 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S156-S157

Author(s):

Aikaterini Papamanoli ◽

Jeanwoo Yoo ◽

Azad Mojahedi ◽

Robin Jacob ◽

Prabhjot Grewal ◽

...

Keyword(s):

Length Of Stay ◽

Medical Records ◽

Bloodstream Infections ◽

Blood Stream ◽

Blood Cultures ◽

High Flow ◽

University Hospital ◽

Skin Microbiota ◽

Prolonged Recovery ◽

The Impact

Abstract Background Coronavirus disease 19 (COVID-19) leading to acute respiratory distress syndrome is associated with need for intensive care (IC), mechanical ventilation (MV), and prolonged recovery. These patients are thus predisposed to blood stream infections which can worsen outcomes. This risk may be aggravated by adjunctive therapies. Methods We reviewed the medical records of all adults admitted to Stony Brook University Hospital, NY, from March 1 to April 15, 2020 with severe COVID-19 pneumonia (requiring high-ﬂow O2). Patients who received MV or died within 24h were excluded. Patients were followed until death or hospital discharge. We reviewed positive blood cultures (PBC) for pathogenic microorganisms, and calculated the incidence of bacteremia, rates of infective endocarditis (IE), and impact on mortality. Microbes isolated only once and belonging to groups defined as commensal skin microbiota were labelled as contaminants. We also examined the impact of adjunctive therapies with immunosuppressive potential (steroids and tocilizumab), on bacteremia. Results A total of 469 patients with severe COVID-19 pneumonia were included (Table 1). Of these, 199 (42.4%) required IC and 172 (36.7%) MV. Median length of stay was 13 days (8–22) and 94 (20.0%) had PBC. Of these, 43 were considered true pathogens (bacteremia), with predominance of E. faecalis and S. epidermidis, and 51 were considered contaminants (Table 2). The incidence of bacteremia (43/469, 9.2%) was 5.1 per 1000 patient-days (95%CI 3.8–6.4). An echocardiogram was performed in 21 patients, 1 had an aortic valve vegetation (IE) by methicillin sensitive S. aureus. Bacteremia rates were nonsignificantly higher with steroids (5.9 vs 3.7 per 1000 patient-days; P=0.057). Use of tocilizumab was not associated with bacteremia (5.8 vs 4.8 per 1000 patient-days; P=0.28). Mortality was nonsignificantly higher in patients with (15/43, 34.9%) vs. without (108/426, 25.4%) bacteremia (P=0.20). Length of stay was the strongest predictor of bacteremia, with risk increasing by 7% (95%CI 6%-9%, P< 0.001) per additional day. Cohort Characteristics of Patients with Severe COVID-19 Pneumonia on High-Flow O2 (N= 469) All Microorganisms Isolated from Blood Cultures Conclusion The incidence of bacteremia was relatively low and IE was uncommon in this study of severe COVID-19 patients. Risk of bacteremia increased with longer hospital stay and with steroids use, but not with tocilizumab. Disclosures All Authors: No reported disclosures

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Demonstration of the indolepyruvate decarboxylase gene homologue in different auxin-producing species of the Enterobacteriaceae

Canadian Journal of Microbiology ◽

10.1139/m94-170 ◽

1994 ◽

Vol 40 (12) ◽

pp. 1072-1076 ◽

Cited By ~ 17

Author(s):

Wolfgang Zimmer ◽

Barbara Hundeshagen ◽

Edith Niederau

Keyword(s):

Polymerase Chain Reaction ◽

Klebsiella Oxytoca ◽

Pyruvate Decarboxylase ◽

Enterobacter Agglomerans ◽

Chain Reaction ◽

Acetic Acid Production ◽

Conserved Regions ◽

Polymerase Chain ◽

Gene Homologue ◽

Indole 3 Acetic Acid

Different Enterobacteriaceae were assayed for their ability to produce the plant hormone indole-3-acetate with the aim to study the distribution of the indole-3-pyruvate pathway, which is known to be involved in the production of indole-3-acetate in a root-associated Enterobacter cloacae strain. Other E. cloacae strains, and also Enterobacter agglomerans strains, Pantoea agglomerans, Klebsiella aerogenes, and Klebsiella oxytoca were found to convert tryptophan into indole-3-acetate. As it was also intended to identify the conserved regions of the indole-3-pyruvate decarboxylase, which is involved in producing indole-3-acetate in the E. cloacae strain, oligonucleotide primers were synthesized for different regions of the corresponding gene. One pair of these primers allowed us to amplify a segment of the predicted size by the polymerase chain reaction with DNA of the seven different Enterobacteriaceae that produce indole-3-acetate. Segments of five strains were cloned and sequenced. All sequences showed significant homology to the indole-3-pyruvate decarboxylase gene. As in addition a positive DNA–DNA hybridization signal was detected in the seven strains using the E. cloacae or E. agglomerans segments as a probe, indole-3-acetate biosynthesis is suggested to be catalyzed via the indole-3-pyruvate pathway not only in E. cloacae but also in the other soil-living Enterobacteriaceae. Conserved regions were detected in the indole-3-decarboxylase by alignment of the now-available five different partial sequences. These regions should enable identification of the gene in other bacterial families or even in plants.Key words: indole-3-pyruvate decarboxylase, indole-3-acetic acid production, auxin, polymerase chain reaction, Enterobacteriaceae.

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Alteplase: Stability and Bioactivity after Dilution in Normal Saline Solution

Journal of Vascular and Interventional Radiology ◽

10.1097/01.rvi.0000052297.26939.05 ◽

2003 ◽

Vol 14 (1) ◽

pp. 99-102 ◽

Cited By ~ 9

Author(s):

Charles P. Semba ◽

Suzanne Weck ◽

Thomas Patapoff

Keyword(s):

Normal Saline ◽

Saline Solution

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CASE OF TRANSFUSION OF THE NORMAL SALINE SOLUTION.

The Lancet ◽

10.1016/s0140-6736(00)49967-8 ◽

1889 ◽

Vol 133 (3420) ◽

pp. 527 ◽

Cited By ~ 1

Author(s):

WalterHenry Brown

Keyword(s):

Normal Saline ◽

Saline Solution

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Review of Best Practices for CLABSI Prevention and the Impact of Recent Legislation on CLABSI Reporting

SAGE Open ◽

10.1177/2158244016677747 ◽

2016 ◽

Vol 6 (4) ◽

pp. 215824401667774 ◽

Cited By ~ 1

Author(s):

Benjamin Woodward ◽

Reba Umberger

Keyword(s):

Best Practices ◽

Healthcare Providers ◽

Bloodstream Infections ◽

Central Line ◽

Mandatory Reporting ◽

Future Research ◽

Common Source ◽

Healthcare Associated Infection ◽

Extrinsic Factors ◽

The Impact

Central line-associated bloodstream infections (CLABSI) are a very common source of healthcare-associated infection (HAI). Incidence of CLABSI has been significantly reduced through the efforts of nurses, healthcare providers, and infection preventionists. Extrinsic factors such as recently enacted legislation and mandatory reporting have not been closely examined in relation to changes in rates of HAI. The following review will examine evidence-based practices related to CLABSI and how they are reported, as well as how the Affordable Care Act, mandatory reporting, and pay-for-performance programs have affected these best practices related to CLABSI prevention. There is a disconnect in the methods and guidelines for reporting CLABSI between these programs, specifically among local monitoring agencies and the various federal oversight organizations. Future research will focus on addressing the gap in what defines a CLABSI and whether or not these programs to incentivize hospital to reduce CLABSI rates are effective.

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