Nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae among cardiothoracic surgical patients: causes and consequences.
Aged
Aged, 80 and over
Belgium
/ epidemiology
Case-Control Studies
Cross Infection
/ epidemiology
Disease Outbreaks
Echocardiography, Transesophageal
/ adverse effects
Enterobacter cloacae
/ classification
Enterobacteriaceae Infections
/ epidemiology
Female
Genotyping Techniques
Humans
Male
Middle Aged
Multilocus Sequence Typing
Retrospective Studies
Thoracic Surgical Procedures
/ adverse effects
beta-Lactamases
/ metabolism
Cardiac surgery outbreak
Cost evaluation
Enterobacter cloacae
Intensive care unit
Outbreak
Pneumonia
Transoesophageal echocardiography
Journal
The Journal of hospital infection
ISSN: 1532-2939
Titre abrégé: J Hosp Infect
Pays: England
ID NLM: 8007166
Informations de publication
Date de publication:
May 2019
May 2019
Historique:
received:
14
10
2018
accepted:
02
01
2019
pubmed:
11
1
2019
medline:
14
6
2019
entrez:
11
1
2019
Statut:
ppublish
Résumé
Enterobacteriaceae are recognized as leading pathogens of healthcare-associated infections. To report the investigation of a nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae affecting cardiothoracic surgery patients in a Belgian academic hospital. Cases were defined based on epidemiological and microbiological investigations, including molecular typing using repetitive element-based polymerase chain reaction and multi-locus sequence typing. Case-control studies followed by field evaluations allowed the identification of a possible reservoir, and the retrospective assessment of human and financial consequences. Over a three-month period, 42 patients were infected or colonized by CTX-M-15-producing E. cloacae strains that belonged to the same clonal lineage. Acquisition mainly occurred in the intensive care unit (N = 23) and in the cardiothoracic surgery ward (N = 16). All but one patient had, prior to acquisition, undergone a cardiothoracic surgical procedure, monitored by the same transoesophageal echocardiography (TOE) probe in the operating room. Despite negative microbiological culture results, the exclusion of the suspected probe resulted in rapid termination of the outbreak. Overall, the outbreak was associated with a high mortality rate among infected patients (40%) as well as significant costs (€266,550). The outbreak was indirectly shown to be associated with the contamination of a manually disinfected TOE probe used per-operatively during cardiothoracic surgery procedures, because withdrawal of the putative device led to rapid termination of the outbreak.
Sections du résumé
BACKGROUND
BACKGROUND
Enterobacteriaceae are recognized as leading pathogens of healthcare-associated infections.
AIM
OBJECTIVE
To report the investigation of a nosocomial outbreak of extended-spectrum β-lactamase-producing Enterobacter cloacae affecting cardiothoracic surgery patients in a Belgian academic hospital.
METHODS
METHODS
Cases were defined based on epidemiological and microbiological investigations, including molecular typing using repetitive element-based polymerase chain reaction and multi-locus sequence typing. Case-control studies followed by field evaluations allowed the identification of a possible reservoir, and the retrospective assessment of human and financial consequences.
FINDINGS
RESULTS
Over a three-month period, 42 patients were infected or colonized by CTX-M-15-producing E. cloacae strains that belonged to the same clonal lineage. Acquisition mainly occurred in the intensive care unit (N = 23) and in the cardiothoracic surgery ward (N = 16). All but one patient had, prior to acquisition, undergone a cardiothoracic surgical procedure, monitored by the same transoesophageal echocardiography (TOE) probe in the operating room. Despite negative microbiological culture results, the exclusion of the suspected probe resulted in rapid termination of the outbreak. Overall, the outbreak was associated with a high mortality rate among infected patients (40%) as well as significant costs (€266,550).
CONCLUSION
CONCLUSIONS
The outbreak was indirectly shown to be associated with the contamination of a manually disinfected TOE probe used per-operatively during cardiothoracic surgery procedures, because withdrawal of the putative device led to rapid termination of the outbreak.
Identifiants
pubmed: 30630000
pii: S0195-6701(19)30003-9
doi: 10.1016/j.jhin.2019.01.001
pii:
doi:
Substances chimiques
beta-Lactamases
EC 3.5.2.6
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
54-60Informations de copyright
Copyright © 2019. Published by Elsevier Ltd.