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Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic—Illinois, 2012-2013

Published online by Cambridge University Press:  06 December 2016

Brian R. Yablon ,
Raymund Dantes ,
Victoria Tsai ,
Rachel Lim ,
Heather Moulton-Meissner ,
Matthew Arduino ,
Bette Jensen ,
Megan Toth Patel ,
Michael O. Vernon  and
Yoran Grant-Greene
...Show all authors
Brian R. Yablon
Affiliation:
Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia
Raymund Dantes
Affiliation:
Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
Victoria Tsai
Affiliation:
Illinois Department of Public Health, Chicago, Illinois Council of State and Territorial Epidemiologists Applied Epidemiology Fellowship, Altanta, Georgia
Rachel Lim
Affiliation:
West Suburban Medical Center, Oak Park, Illinois
Heather Moulton-Meissner
Affiliation:
CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
Matthew Arduino
Affiliation:
CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
Bette Jensen
Affiliation:
CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
Megan Toth Patel
Affiliation:
Cook County Department of Public Health, Oak Forest, Illinois
Michael O. Vernon
Affiliation:
Cook County Department of Public Health, Oak Forest, Illinois
Yoran Grant-Greene
Affiliation:
Centers for Disease Control and Prevention (CDC), Epidemic Intelligence Service Program, Atlanta, Georgia Illinois Department of Public Health, Chicago, Illinois
Demian Christiansen
Affiliation:
Cook County Department of Public Health, Oak Forest, Illinois
Craig Conover
Affiliation:
Illinois Department of Public Health, Chicago, Illinois
Alexander Kallen
Affiliation:
CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
Alice Y. Guh*
Affiliation:
CDC Division of Healthcare Quality Promotion, Atlanta, Georgia
*
Address correspondence to Alice Y. Guh, MD, MPH, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, MS A-16, Atlanta, GA 30329-4027 (aguh@cdc.gov).
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Abstract

OBJECTIVE

To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections.

DESIGN

Epidemiologic investigation of the outbreak.

SETTING

Oncology clinic (clinic A).

METHODS

Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012–May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility’s water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis.

RESULTS

Twelve cases were identified; median (range) age was 65 (41–78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates.

CONCLUSIONS

Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed.

Infect Control Hosp Epidemiol 2017;38:314–319

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 3 , March 2017 , pp. 314 - 319
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Previous presentation: CDC’s 2014 Epidemic Intelligence Service Conference; Atlanta, Georgia; May 1, 2014; and the 2014 Council of State and Territorial Epidemiologists’ Conference; Nashville, Tennessee; June 23, 2014 (Abstract #3255).

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