Hostname: page-component-78c5997874-8bhkd Total loading time: 0 Render date: 2024-11-02T21:04:04.990Z Has data issue: false hasContentIssue false
  • English
  • Français

A Pseudoepidemic Due to Laboratory Contamination Deciphered by Molecular Analysis

Published online by Cambridge University Press:  02 January 2015

Thomas Morris ,
Stephen M. Brecher ,
Diarme Fitzsimmons ,
Annette Durbin ,
Robert D. Arbeit  and
Joel N. Maslow
Thomas Morris
Affiliation:
Section of infectious Diseases, Medical Service, Veterans Affairs Medical Center, and the Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
Stephen M. Brecher
Affiliation:
Department of Laboratoy, Medicine and Pathology, Veterans Affairs Medical Center, Boston, Massachusetts
Diarme Fitzsimmons
Affiliation:
Department of Laboratoy, Medicine and Pathology, Veterans Affairs Medical Center, Boston, Massachusetts
Annette Durbin
Affiliation:
Department of Laboratoy, Medicine and Pathology, Veterans Affairs Medical Center, Boston, Massachusetts
Robert D. Arbeit
Affiliation:
Section of infectious Diseases, Medical Service, Veterans Affairs Medical Center, and the Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
Joel N. Maslow*
Affiliation:
Section of infectious Diseases, Medical Service, Veterans Affairs Medical Center, and the Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
*
Research Service (151), VA Medical Center; 150 S. Huntington Ave., Boston, MA 02130
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

A clinical, microbiological, and molecular analysis to identify the source of a cluster of pseudoinfections.

Design:

Retrospective analysis of the cases, prospective epidemiologic survey, and laboratory investigation. Molecular analysis of the isolates was performed using pulsed-field gel electrophoresis (PFGE).

Setting:

A tertiary Veterans Affairs medical center.

Patients:

Three patients admitted over a Z-week period with musculoskeletal complaints had one or more joint fluid specimens submitted for culture. In each case, anaerobic chopped meat-glucose broth (CMGB) tubes yielded one or more organisms not typically associated with septic arthritis (Enterobacter cloacae, Enterococcus faecium, Enterococcus casseliflavus, Enterococcus faecalis, Escherichia hermannii, and Pseudomonas diminuti). The first three organisms were isolated from specimens from multiple patients. Two patients had multiple positive cultures; for two patients, separate cultures yielded additional organisms on solid media.

Results:

Laboratory investigation yielded an isolate of E faecium from 1 of 30 sham-inoculated CMGB tubes. PFGE analysis demonstrated that a single strain of E cloacae was isolated from four CMGB tubes representing all three patients, and a single strain of E faecium was isolated from CMGB tubes representing two patients and the sham-inoculated tube.

Conclusions:

The application of molecular typing clearly demonstrated clonality among the isolates and indicated that a common source of contamination, most likely the CMGB tubes, was responsible for these cases.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 16 , Issue 2 , February 1995 , pp. 82 - 87
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1995 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Weinstein, RA, Stamm, WE. Pseudoepidemics in hospital. Lancet 1977;11:862–864.CrossRefGoogle Scholar
2. Maslow, JN, Slutsky, AM, Arbeit, RD. The application of pulsed field gel electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TF; Tenover, FC, White, TJ, ed. Diagnostic Molecular Microbiology: Principles and Applications. Washington, DC: American Society of Microbiology; 1993:563–572.Google Scholar
3. Arbeit, RD. Laboratory procedures for the epidemiologic analysis of microorganisms. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH, ed. Manual of Clinical Microbiology, 6th ed. Washington, DC: American Society for Microbiology. In press.Google Scholar
4. Maki, DG. Through a glass darkly: nosocomial pseudoepidemics and oseudobacteremias. Arch Intern Med 1980;140:26–28.CrossRefGoogle Scholar
5. Fraser, VJ, Jones, M, Murray, PR, Medoff, G, Zhang, Y, Wallace, RJ Jr. Contamination of flexible fiberoptic bronchoscopes with Mycobacterium chelonae linked to an automated bronchoscope disinfection machine. Am Rev Respir Dis 1992;145:853–855.CrossRefGoogle Scholar
6. Centers for Disease Control. Nosocomial infection and pseudoinfection from contaminated endoscopes and bronchoscopes-Wisconsin and Missouri. MMWR 1991;40:675–678.Google Scholar
7. Berkelman, RL, Lewin, S, Allen, JR, et al. Pseudobacteremia attributed to contamination of povidone-iodine with Pseudomonas cepacia. Ann Intern Med 1981;95:32–36.CrossRefGoogle ScholarPubMed
8. Semel, JD, Trenholme, GM, Harris, AA, Jupa, JE, Levin, S. Pseudomonas maltophilia pseudosepticemia. Am J Med 1978;64:403–406.CrossRefGoogle ScholarPubMed
9. Graham, L Jr, Warren, NG, Tsang, AY Dalton, HP Mycobacterium avium complex pseudobacteriuria from a hospital water supply. J Clin Microbiol 1988;26:1034-1036.CrossRefGoogle Scholar
10. Auerbach, SB, McNeil, MM, Brown, JM, Lasker, BA Jarvis, WR. Outbreak of pseudoinfection with Tsukamurella paurometabolum traced to laboratory contamination: efficacy of joint epidemiological and laboratory investigation. Clin Infect Dis 1992;14:1015–1022.CrossRefGoogle ScholarPubMed
11. Bradley, SF, Wilson, KH, Rosloniec, MA, Kauffman, CA. Recurrent pseudobacteremias traced to a radiometric blood culture device. Infect Control 1987;8:281–283.CrossRefGoogle ScholarPubMed
12. Washington, JA. The microbiology of evacuated blood collection tubes. Ann Intern Med 1977;86:186–188.CrossRefGoogle ScholarPubMed
13. Spivack, ML, Shannon, R, Natsios, GA, Wood, J. Two epidemics of pseudobacteremia due to Staphylococcus aureus and Aerococcus viridans . Infect Control 1980;1:321–323.CrossRefGoogle ScholarPubMed
14. Graham, DR, Wu, E, Highsmith, AK, Ginsburg, ML. An outbreak of pseudobacteremia caused by Enterobacter cloacae from a phlebotomist's vial of thrombin. Ann Intern Med 1981;95:585–588.CrossRefGoogle ScholarPubMed
15. Maki, DG, Rhame, FS, Mackel, DC, Bennett, JV. Nationwide epidemic of septicemia caused by contaminated intravenous products, I: epidemiologic and clinical features. Am J Med 1976;60:471–485.CrossRefGoogle ScholarPubMed