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Colonization of the central venous catheter by Stenotrophomonas maltophilia in an ICU setting: An impending outbreak managed in time

Published:November 01, 2021DOI:https://doi.org/10.1016/j.ajic.2021.10.026

      Highlights

      • Stenotrophomonas maltophilia is an aerobic, non-fermentative Gram-negative bacteria.
      • Outbreaks may happen because of a lack of appropriate cleaning and disinfection.
      • This study illustrates role of suction fluid and normal saline in outbreak.
      • Proper surveillance and monitoring can prevent further outbreaks.

      Abstract

      Background

      Stenotrophomonas maltophiliacauses opportunistic infections in immunocompromised and patients in intensive care units (ICUs). An outbreak of S. maltophilia in ICU is described which highlights the importance of the risk of infection from contaminated medical devices and suction fluids in ventilated patients.

      Methods

      The investigation of the outbreak was carried out. Environmental sampling was done. This was followed by MALDI-TOF MS typing and recA gene-based-phylogeny.

      Results

      In February, S. maltophilia was reported from the central line blood of six patients from ICU within a span of two weeks. The peripheral line blood cultures were sterile in all patients. Relevant environmental sampling of the high-touch surface and fluids revealed S. maltophilia strains in normal saline used for suction and in the inspiratory circuit of two patients. The isolated strains from patients and environment (inspiratory fluid) showed a minimum of 95.41% recA gene sequence identity between each other. Strict cleaning and disinfection procedures were followed. Continuous surveillance was done and no further case of S. maltophilia was detected. Timely diagnosis and removal of central line prevented development of central-line associated blood stream infection.

      Conclusion

      This outbreak report illustrates that environmental sources like suction fluid and normal saline could be the source of S. maltophilia in ICU patients.

      Key Words

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      References

        • Brooke JS.
        Stenotrophomonas maltophilia: an emerging global opportunistic pathogen.
        Clin Microbiol Rev. 2012; 25: 2-41
        • Safdar A
        • Rolston KV
        Stenotrophomonas maltophilia: changing spectrum of a serious bacterial pathogen in patients with cancer.
        Clin Infect Dis. 2007; 45: 1602-1609
        • Trouillet JL
        • Chastre J
        • Vuagnat A
        • et al.
        Ventilator-associated pneumonia caused by potentially drug-resistant bacteria.
        Am J Respir Crit Care Med. 1998; https://doi.org/10.1164/ajrccm.157.2.9705064
        • Guyot A
        • Turton JF
        • Garner D.
        Outbreak of Stenotrophomonas maltophilia on an intensive care unit.
        J Hosp Infect. 2013; https://doi.org/10.1016/j.jhin.2013.09.007
        • Waite TD
        • Georgiou A
        • Abrishami M
        • Beck CR.
        Pseudo-outbreaks of Stenotrophomonas maltophilia on an intensive care unit in England.
        J Hosp Infect. 2016; https://doi.org/10.1016/j.jhin.2015.12.014
        • Verweij PE
        • Meis JFGM
        • Christmann V
        • et al.
        Nosocomial outbreak of colonization and infection with Stenotrophomonas maltophilia in preterm infants associated with contaminated tap water.
        Epidemiol Infect. 1998; https://doi.org/10.1017/S0950268898008735
        • Brooks∗ K
        • Dauenhauer S
        • Milligan S
        • Washburn R.
        Stenotrophomonas maltophilia Pseudooutbreak Related to Bronchoscope Reprocessing Procedures.
        Am J Infect Control. 2004; https://doi.org/10.1016/j.ajic.2004.04.096
        • Barchitta M
        • Cipresso R
        • Giaquinta L
        • et al.
        Acquisition and spread of Acinetobacter baumannii and Stenotrophomonas maltophilia in intensive care patients.
        Int J Hyg Environ Health. 2009; https://doi.org/10.1016/j.ijheh.2008.07.001
        • Alfieri N
        • Ramotar K
        • Armstrong P
        • et al.
        Two consecutive outbreaks of stenotrophomonas maltophilia (Xanthomonas Maltophilia) in an intensive-care unit defined by restriction fragment-length polymorphism typing.
        Infect Control Hosp Epidemiol. 1999; 20: 553-556
        • Thompson JD
        • Higgins DG
        • Gibson TJ
        • Clustal W
        improving the sensitivity of progressive multiple sequence alignment through sequence weighting, position-specific gap penalties and weight matrix choice.
        Nucleic Acids Res. 1994; 22: 4673-4680
        • Letunic I
        • Bork P.
        Interactive Tree Of Life (iTOL) v4: recent updates and new developments.
        Nucleic Acids Res. 2019; 47: W256-W259
        • Eisen J.
        The RecA protein as a model molecule for molecular systematic studies of bacteria: comparison of trees of RecAs and 16S rRNAs from the same species.
        J Mol Evol. 1995; 41https://doi.org/10.1007/BF00173192
        • Muder RR
        • Harris AP
        • Muller S
        • et al.
        Bacteremia due to Stenotrophomonas (Xanthomonas) maltophilia: a prospective, multicenter study of 91 episodes.
        Clin Infect Dis. 1996; 22: 508-512
        • Souza Dias MB
        • Habert AB
        • Borrasca V
        • et al.
        Salvage of long-term central venous catheters during an outbreak of Pseudomonas putida and Stenotrophomonas maltophilia infections associated with contaminated heparin catheter-lock solution.
        Infect Control Hosp Epidemiol. 2008; 29: 125-130
        • Chang YT
        • Lin CY
        • Chen YH
        • Hsueh PR.
        Update on infections caused by Stenotrophomonas maltophilia with particular attention to resistance mechanisms and therapeutic options.
        Front Microbiol. 2015; https://doi.org/10.3389/fmicb.2015.00893
        • Paez JIG
        • Costa SF.
        Risk factors associated with mortality of infections caused by Stenotrophomonas maltophilia: a systematic review.
        J Hosp Infect. 2008; https://doi.org/10.1016/j.jhin.2008.05.020
        • Brooke JS.
        Pathogenic bacteria in sink exit drains.
        J Hosp Infect. 2008; https://doi.org/10.1016/j.jhin.2008.06.017
        • Lanotte P
        • Cantagrel S
        • Mereghetti L
        • et al.
        Spread of Stenotrophomonas maltophilia colonization in a pediatric intensive care unit detected by monitoring tracheal bacterial carriage and molecular typing.
        Clin Microbiol Infect. 2003; 9: 1142-1147
        • Sah R
        • Siwakoti S
        • Baral R
        • Rajbhandari RS
        • Khanal B.
        Stenotrophomonas maltophilia causing blood stream infection in neonates and infants: a cause for concern.
        Trop Doct. 2018; 48: 227-229
        • Klausner JD
        • Zukerman C
        • Limaye AP
        • Corey L.
        Outbreak of stenotrophomonas maltophilia bacteremia among patients undergoing bone marrow transplantation: association with faulty replacement of handwashing soap.
        Infect Control Hosp Epidemiol. 1999; 20: 756-758
        • Johnson EH
        • Al-Busaidy R
        • Hameed MS.
        An outbreak of lymphadenitis associated with stenotrophomonas (Xanthomonas) maltophilia in omani goats.
        J Vet Med Ser B. 2003; 50: 102-104
        • Jayol A
        • Corlouer C
        • Haenni M
        • et al.
        Are animals a source of Stenotrophomonas maltophilia in human infections? Contributions of a nationwide molecular study.
        Eur J Clin Microbiol Infect Dis. 2018; 37: 1039-1045
        • Lloyd A
        • Sharp P.
        Evolution of the recA gene and the molecular phylogeny of bacteria.
        J Mol Evol. 1993; 37https://doi.org/10.1007/BF00178869
        • Yahara K
        • Nakayama S
        • Shimuta K
        • et al.
        Genomic surveillance of Neisseria gonorrhoeae to investigate the distribution and evolution of antimicrobial-resistance determinants and lineages.
        Microb Genomics. 2018; 4https://doi.org/10.1099/mgen.0.000205