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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
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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

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