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A Cluster of Nosocomial Klebsiella oxytoca Bloodstream Infections in a University Hospital

Published online by Cambridge University Press:  02 January 2015

Yesim Cetinkaya Sardan ,
Pinar Zarakolu ,
Belgin Altun ,
Aycan Yildirim ,
Gonul Yildirim ,
Gulsen Hascelik  and
Omrum Uzun
Yesim Cetinkaya Sardan*
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Pinar Zarakolu
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Belgin Altun
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Aycan Yildirim
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Gonul Yildirim
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
Gulsen Hascelik
Affiliation:
Department of Microbiology and Clinical Microbiology, Hacettepe University School of Medicine, Ankara, Turkey
Omrum Uzun
Affiliation:
Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
*
Hacettepe University School of Medicine, Department of Medicine, Section of Infectious Diseases, Sihhiye, Ankara, 06100, Turkey
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Abstract

Background:

On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3.

Objective:

To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections.

Design:

Outbreak investigation.

Setting:

A 1,000-bed university hospital.

Methods:

The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains.

Results:

AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile.

Conclusions:

We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued..

Type
Orginal Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 10 , October 2004 , pp. 878 - 882
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004 

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