Advertisement
American Journal of Infection Control
Advanced searchSave search
Major article| Volume 42, ISSUE 7, P731-734, July 2014

Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center

DOI:https://doi.org/10.1016/j.ajic.2014.03.007
Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center
Previous ArticleSustained reduction of central line–associated bloodstream infections outside the intensive care unit with a multimodal intervention focusing on central line maintenance
Next ArticleQuality improvement intervention reduces episodes of long-term acute care hospital central line–associated infections

      Background

      Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center.

      Methods

      Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing.

      Results

      Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%).

      Conclusions

      Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Register: Create an account
      Institutional Access: Sign in to ScienceDirect

      References

        • Forbi J.C.
        • Purdy M.A.
        • Campo D.S.
        • Vaughan G.
        • Dimitrova Z.E.
        • Ganova-Raeva L.M.
        • et al.
        Epidemic history of hepatitis C virus infection in two remote communities in Nigeria, West Africa.
        J Gen Virol. 2012; 93: 1410-1421
        View in Article
        • Ramachandran S.
        • Xia G.L.
        • Ganova-Raeva L.M.
        • Nainan O.V.
        • Khudyakov Y.
        End-point limiting-dilution real-time PCR assay for evaluation of hepatitis C virus quasispecies in serum: performance under optimal and suboptimal conditions.
        J Virol Methods. 2008; 151: 217-224
        View in Article
        • Watson J.T.
        • Jones R.C.
        • Siston A.M.
        • Fernandez J.R.
        • Martin K.
        • Beck E.
        • et al.
        Outbreak of catheter-associated Klebsiella oxytoca and Enterobacter cloacae bloodstream infections in an oncology chemotherapy center.
        Arch Intern Med. 2005; 165: 2639-2643
        View in Article
        • Abe K.
        • D'Angelo M.T.
        • Sunenshine R.
        • Noble-Wang J.
        • Cope J.
        • Jensen B.
        • et al.
        Outbreak of Burkholderia cepacia bloodstream infection at an outpatient hematology and oncology practice.
        Infect Control Hosp Epidemiol. 2007; 28: 1311-1313
        View in Article
        • Radcliffe R.
        • Meites E.
        • Briscoe J.
        • Gupta R.
        • Fosheim G.
        • McAllister S.K.
        • et al.
        Severe methicillin-susceptible Staphylococcus aureus infections associated with epidural injections at an outpatient pain clinic.
        Am J Infect Control. 2012; 40: 144-149
        View in Article

      6. MacCannell T, Perz JF, Srinivasan A, Schaefer MK. Bacterial and parasitic infections associated with extrinsically contaminated injectable medications, United States 1999-2009 [abstract]. Presented at Fifth Decennial International Conference on Healthcare-Associated Infections 2010, Atlanta, Georgia, March 18-22, 2010. Available at: http://shea.confex.com/shea/2010/webprogram/Paper2113.html. Accessed February 27, 2013.

        View in Article
        • Macedo de Oliveria A.
        • White K.L.
        • Leschinsky D.P.
        • Beecham B.D.
        • Vogt T.M.
        • Moolenaar R.L.
        • et al.
        An outbreak of hepatitis C virus infections among outpatients at a hematology/oncology clinic.
        Ann Intern Med. 2005; 142: 898-902
        View in Article
        • Greeley R.D.
        • Semple S.
        • Thompson N.D.
        • High P.
        • Rudowski E.
        • Handschur E.
        • et al.
        Hepatitis B outbreak associated with a hematology-oncology office practice in New Jersey, 2009.
        Am J Infect Control. 2011; 39: 663-670
        View in Article
        • Perz J.F.
        • Thompson N.D.
        • Schaefer M.K.
        • Patel P.R.
        US outbreak investigations highlight the need for safe injection practices and basic infection control.
        Clin Liver Dis. 2010; 14: 137-151
        View in Article

      10. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings, 2007. Available at: http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf. Accessed February 27, 2013.

        View in Article

      11. Centers for Disease Control and Prevention. Preventing infections in cancer patients. Available at: http://www.cdc.gov/cancer/preventinfections/. Accessed February 27, 2013.

        View in Article

      12. Centers for Disesae Control and Prevention. Basic infection and control prevention plan for outpatient oncology settings. Available at: http://www.cdc.gov/hai/pdfs/guidelines/basic-infection-control-prevention-plan-2011.pdf Accessed February 27, 2013.

        View in Article

      Article info

      Footnotes

      The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

      Conflict of interest: None to report.

      Identification

      DOI: https://doi.org/10.1016/j.ajic.2014.03.007

      Copyright

      © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

      ScienceDirect

      Access this article on ScienceDirect

      The content on this site is intended for healthcare professionals.


      We use cookies to help provide and enhance our service and tailor content. To update your cookie settings, please visit the Cookie Preference Center for this site.
      Copyright © 2023 Elsevier Inc. except certain content provided by third parties.


      RELX