Hostname: page-component-586b7cd67f-2brh9 Total loading time: 0 Render date: 2024-11-30T20:12:41.805Z Has data issue: false hasContentIssue false
  • English
  • Français

Risk Factors for Epidemic Xanthomonas Maltophilia Infection/Colonization in Intensive Care Unit Patients

Published online by Cambridge University Press:  21 June 2016

Margarita E. Villarino ,
Lane E. Stevens ,
Barbara Schable ,
Gwendolyn Mayers ,
J. Michael Miller ,
John P. Burke  and
William R. Jarvis
Margarita E. Villarino*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Lane E. Stevens
Affiliation:
Division of Infectious Disease, LDS Hospital, Salt Lake City, Utah
Barbara Schable
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Gwendolyn Mayers
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
J. Michael Miller
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
John P. Burke
Affiliation:
Division of Infectious Disease, LDS Hospital, Salt Lake City, Utah
William R. Jarvis
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
*
Hospital Infections Program, Mailstop A-07, Centers for Disease Control, Atlanta GA, 30333
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.

Design:

Surveillance and cohort study.

Setting:

A 470-bed tertiary trauma-referral community hospital.

Patients:

From January 1, 1988 to March 17, 1989,106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization ≥48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for ≥72 hours during the epidemic period who had no X maltophilia-positive culture).

Results:

Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk= 1.3, p= .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient% room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel’s hands. Related environmental and clinical isolates were serotype 10.

Conclusions:

Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 4 , April 1992 , pp. 201 - 206
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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. Morrison, AJ, Hoffman, KK, Wenzel, RP. Associated mortality and clinical characteristics of nosocomial Pseudomonas maltophilia in a university hospital. J Clin Microbiol. 1986;24:52–55.Google Scholar
2. Muder, RR, Yu, VL, Dummer, JS, et al. Infections caused by Pseudomonas maltophilia: expanding clinical spectrum. Arch Intern Med. 1987;147:1672–1674.Google Scholar
3. Khadori, N, Elting, L, Wong, E, et al. Nosocomial infections due to Xanthomonas maltophilia (Pseudomonas maltophilia) in patients with cancer. Rev Infect Dis. 1990;12:997–1003.Google Scholar
4. Elting, LS, Khadori, N, Bodey, GP, et al. Nosocomial infection caused by Xanthomonas maltophilia: a case-control study of predisposing factors. Infect Control Hosp Epidemiol. 1990;11:134–138.Google Scholar
5. Evans, RS, Larsen, RA, Burke, JP, et al. Computer surveillance of hospital-acquired infections and antibiotic use. JAMA. 1986;256:1007–1011.Google Scholar
6. Knaus, WA, Draper, EA, Wagner, DP, et al. APACHE-II: a severity of disease classification system. Crit Cure Med. 1985;13:381–386.Google ScholarPubMed
7. Dean, AG, Dean, JA, Burton, AH, et al. Epi Info, Version 5: A Word Processing, Database, and Statistics Program for Epidemiology on Microcomputers. Atlanta, Ga: Centers for Disease Control; 1990.Google Scholar
8. Dixon, WJ, Brown, MB, Engelman, L, et al. BMDP Statistical Software Manual. Vol. 2. Berkeley, Calif.: University of California Press; 1988.Google Scholar
9. Clark, WA, Hollis, DG, Weaver, RE, et al. Identification of Unusual Pathogenic Gram-Negative Aerobic and Facultatively Anaerobic Bacteria. Atlanta, Ga: Centers for Disease Control; 1984.Google Scholar
10. Schable, B, Rhoden, DL, Hugh, R, et al. Serological classification of Xanthomonas maltophilia (Pseudomonas maltophilia) based on heat-stable O antigens./ J Clin Microbiol. 1989;27:1011–1014.Google Scholar
11. Garner, JS, Jarvis, WR, Emori, TG, et al. CDC definitions for nosocomial infections, 1988. Am J Infect Control. 1988;16:128–140.CrossRefGoogle ScholarPubMed
12. Goularte, TA, Lichtenber, DA, Craven, DE. Gastric colonization in patients receiving antacids and mechanical ventilation: a mechanism for pharyngeal colonization. Am/Infect Control. 1986;14:88–92.Google Scholar
13. Daschner, F, Kapstein, I, Engels, I, et al. Stress ulcer prophylaxis and ventilation pneumonia: prevention by antibacterial cytoprotective agents? Infect Control Hosp Epidemiol. 1988;9:59–65.Google Scholar
14. Driks, MR, Craven, DE, Celli, BR, et al. Nosocomial pneumonia in intubated patients given sucralfate as compared with antacids or histamine type 2 blockers. N Engl J Med. 1987;26:1376–1382.CrossRefGoogle Scholar
15. Johanson, WG, Pierce, AK, Sanford, JP, et al. Nosocomial respiratory infections with gram-negative bacilli: the significance of colonization of the respiratory tract. Ann Intern Med. 1972;77:701–706.CrossRefGoogle ScholarPubMed
16. Johanson, WG, Pierce, AK, Sanford, JP. Changing pharyngeal bacterial flora of hospitalized patients: emergence of gramnegative bacilli. N Eng J Med. 1969;281:1137–1140.Google Scholar
17. Pugliese, G, Lichtenberg, DA. Nosocomial bacterial pneumonia: anoverview . Am J Infect Control, 1987;15:249–265.Google Scholar
18. Celis, R, Torres, A, Gatell, JM, Almela, M, et al. Nosocomial pneumonia. A multivariate analysis of risk and prognosis. Chest. 1989;93:318–324.Google Scholar
19. LeFrock, JL, Ellis, CA, Weinstein, L. The relation between aerobic fecal and oropharyngeal microflora in hospitalized patients. Am J Med Science. 1979;277:275–280.Google Scholar
20. Sprunt, K, Redman, W. Evidence suggesting the importance of the role of interbacterial inhibition in maintaining balance of normal flora. Ann Intern Med. 1968:68:579–590.CrossRefGoogle ScholarPubMed
21. Jarvis, WR. Non-aeruginosa pseudomonads. Presented at the 31st Interscience Conference on Antimicrobial Agents and Chemotherapy. September 29October 2. 1991. Chicago, Ill.Google Scholar