Highlights
- •Stenotrophomonas maltophilia is a Gram-negative, nonfermentative aerobic bacterium widely found in humid and aqueous environments.
- •S. maltophilia is a Gram-negative bacterium widely found in humid environments.
- •A commercial needless blood gas injector was responsible for the outbreak. Detection of S. maltophilia in ECMO heater devices raises concerns about safety.
- •Routine surveillance should include ECMO water reservoirs.
Background
Despite low virulence of Stenotrophomonas maltophilia, it represents one of the leading drug-resistant bacteria. We report a large outbreak
of S. maltophilia infection associated with an unexpected source, which turned out to be a commercial
needleless blood gas injector.
Methods
Over a period from January 1 to December10, 2021, 113 patients were identified to
have S. maltophilia infection as documented by positive cultures from the clinical samples, extracorporeal
membrane oxygenation (ECMO) water heater devices and commercial needleless blood gas
injectors.
Results
Sixty-seven isolates (59 clinical, 4 ECMO, 4 blood gas injectors) were sent for molecular
analysis. Both arbitrarily primed polymerase chain reaction and pulsed-field gel electrophoresis
analyses showed 12 distinct genotypes. Of 67 isolates, 58 were clonally related (86.6%),
with 52 indistinguishable strains from 4 blood gas needleless injectors, 46 patients’
samples (78%), and 2 ECMO samples (50%). Two ECMO samples and 1 clinical sample were
clonally identical.
Conclusions
In the event that eradication of infections would not be possible despite taking all
environmental disinfection measures including the ECMO devices, unexpected sources,
such as a commercial needleless blood gas injector, should not be omitted from the
list for surveillance. In addition, obtaining surveillance cultures of ECMO water
reservoirs should be placed in the routine clinical practice.
Key Words
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Article Info
Publication History
Published online: July 18, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Conflicts of interest: None declared.
Identification
Copyright
© 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
