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Nosocomial Outbreak of a Novel Extended-Spectrum β-Lactamase Salmonella enterica Serotype Isangi Among Surgical Patients

Published online by Cambridge University Press:  25 April 2016

Geehan Suleyman ,
Robert Tibbetts ,
Mary Beth Perri ,
Dora Vager ,
Yuan Xin ,
Katherine Reyes ,
Linoj Samuel ,
Eman Chami ,
Patricia Starr  and
Jennifer Pietsch
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Geehan Suleyman*
Affiliation:
Department of Infectious Disease, Henry Ford Hospital, Detroit, Michigan
Robert Tibbetts
Affiliation:
Department of Pathology, Henry Ford Hospital, Detroit, Michigan
Mary Beth Perri
Affiliation:
Research Laboratory, Henry Ford Hospital, Detroit, Michigan
Dora Vager
Affiliation:
Research Laboratory, Henry Ford Hospital, Detroit, Michigan
Yuan Xin
Affiliation:
Public Health Sciences, Henry Ford Hospital, Detroit, Michigan
Katherine Reyes
Affiliation:
Department of Infectious Disease, Henry Ford Hospital, Detroit, Michigan
Linoj Samuel
Affiliation:
Department of Pathology, Henry Ford Hospital, Detroit, Michigan
Eman Chami
Affiliation:
Infection Control, Henry Ford Hospital, Detroit, Michigan
Patricia Starr
Affiliation:
Infection Control, Henry Ford Hospital, Detroit, Michigan
Jennifer Pietsch
Affiliation:
Infection Control, Henry Ford Hospital, Detroit, Michigan
Marcus J. Zervos
Affiliation:
Department of Infectious Disease, Henry Ford Hospital, Detroit, Michigan
George Alangaden
Affiliation:
Department of Infectious Disease, Henry Ford Hospital, Detroit, Michigan
*
Address correspondence to Geehan Suleyman, MD, Henry Ford Hospital, 2799 W. Grand Blvd, Clara Ford Suite 302, Detroit, MI 48202 (gsuleym2@hfhs.org).
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Abstract

OBJECTIVE

Nosocomial outbreaks caused by Salmonella are rare. We describe the investigation and control of a cluster of novel extended-spectrum β-lactamase (ESBL) Salmonella enterica serotype Isangi in a hospital in southeastern Michigan.

METHODS

An epidemiologic investigation, including case-control study, assessment of infection control practices and environmental cultures, was performed to identify modes of transmission. Healthcare workers (HCWs) exposed to case patients were screened. Strain relatedness was determined using pulsed-field gel electrophoresis (PFGE); ESBL confirmation was conducted using real-time PCR. Control measures were implemented to prevent further transmission.

RESULTS

Between September 2 and October 22, 2015, 19 surgical patients, including 10 organ transplant recipients and 1 HCW, had positive S. Isangi cultures. Of these case patients and HCW, 13 had gastroenteritis, 2 had bacteremia, 1 had surgical-site infection, and 4 were asymptomatic. Pulsed-field gel electrophoresis (PFGE) showed 89.5% similarity among the isolates in these cases. Isolates with resistant-phenotypes possessed plasmid-mediated CTX-M15 ESBL. A total of 19 case patients were compared with 57 control participants. Case patients had significantly higher odds of exposure to an intraoperative transesophageal (TEE) probe (adjusted odds ratio 9.0; 95% confidence interval, 1.12–72.60; P=.02). Possible cross-transmission occurred in the HCW and 2 patients. Cultures of TEE probes and the environment were negative. The outbreak ended after removal of TEE probes, modification of reprocessing procedures, implementation of strict infection control practices, and enhanced environmental cleaning.

CONCLUSIONS

We report the first nosocomial ESBL S. Isangi outbreak in the United States. Multiple control measures were necessary to interrupt transmission of this gastrointestinal pathogen. Exposure to possibly contaminated TEE probes was associated with transmission. Periodic monitoring of reprocessing procedures of TEE probes may be required to ensure optimal disinfection.

Infect Control Hosp Epidemiol 2016;37:954–961

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 8 , August 2016 , pp. 954 - 961
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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