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

Details

• Alternative Title:
  Am J Infect Control
• Personal Author:
  Dobbs, Thomas E. ; Guh, Alice Y. ; Oakes, Peggy ; Vince, Mary Jan ; Forbi, Joseph C. ; Jensen, Bette ; Moulton-Meissner, Heather ; Byers, Paul
• Description:
  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.
  
  
• Subjects:
  Aged Aged, 80 And Over Ambulatory Care Facilities Antineoplastic Agents Article Bacteremia Disease Outbreaks Drug Therapy Electrophoresis, Gel, Pulsed-Field Female Genotype Humans Injection Safety Klebsiella Infections Klebsiella Pneumonia Klebsiella Pneumoniae Male Middle Aged Molecular Typing Neoplasms Outpatient Oncology Care Pseudomonas Aeruginosa Pseudomonas Infections

  More +
• Source:
  Am J Infect Control. 42(7):731-734
• Pubmed ID:
  24969124
• Pubmed Central ID:
  PMC6489134
• Document Type:
  Journal Article
• Funding:
  CC999999/Intramural CDC HHS/United States
• Volume:
  42
• Issue:
  7
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:9b13b1aa3bd71a8078dc55196921e6da82801f19e5566a4146bbd7f6af8f86d4
• Download URL:
  https://stacks.cdc.gov/view/cdc/78296/cdc_78296_DS1.pdf
• File Type:
  [PDF - 247.86 KB ]