An outbreak of serious Klebsiella infections related to food blenders

Klebsiella pneumoniae: Prevalence, Reservoirs, Antimicrobial Resistance, Pathogenicity, and Infection: A Hitherto Unrecognized Zoonotic Bacterium

Klebsiella pneumoniae is considered an opportunistic pathogen, constituting an ongoing health concern for immunocompromised patients, the elderly, and neonates. Reports on the isolation of K. pneumoniae from other sources are increasing, many of which express multidrug-resistant (MDR) phenotypes. Three phylogroups were identified based on nucleotide differences. Niche environments, including plants, animals, and humans appear to be colonized by different phylogroups, among which KpI (K. pneumoniae) is commonly associated with human infection. Infections with K. pneumoniae can be transmitted through contaminated food or water and can be associated with community-acquired infections or between persons and animals involved in hospital-acquired infections. Increasing reports are describing detections along the food chain, suggesting the possibility exists that this could be a hitherto unexplored reservoir for this opportunistic bacterial pathogen. Expression of MDR phenotypes elaborated by these bacteria is due to the nature of various plasmids carrying antimicrobial resistance (AMR)-encoding genes, and is a challenge to animal, environmental, and human health alike. Raman spectroscopy has the potential to provide for the rapid identification and screening of antimicrobial susceptibility of Klebsiella isolates. Moreover, hypervirulent isolates linked with extraintestinal infections express phenotypes that may support their niche adaptation. In this review, the prevalence, reservoirs, AMR, Raman spectroscopy detection, and pathogenicity of K. pneumoniae are summarized and various extraintestinal infection pathways are further narrated to extend our understanding of its adaptation and survival ability in reservoirs, and associated disease risks.

Salmonella Enteritidis infections associated with a contaminated immersion blender at a cAMP

More than 100 foodborne salmonellosis outbreaks occur each year in the United States. Contaminated food preparation equipment is implicated in approximately 32% of Salmonella outbreaks with a known source. In April 2009, we investigated reported Salmonella infections at a camp in New Hampshire. Camp attendees were contacted to complete a standard questionnaire. The questionnaire asked about foods eaten while at the camp, symptoms of gastrointestinal illness, visits to healthcare providers, and specimen submission for pathogen testing. Laboratory and environmental investigations were conducted, including testing of foods and food preparation equipment. A total of 133 ill persons, including 47 laboratory-confirmed Salmonella Enteritidis infections, were identified during this investigation. A total of 142 (80%) of 178 camp attendees completed a standard questionnaire and 109 cases of gastrointestinal illness and 33 healthy individuals were identified. Statistical analysis of survey data indicated that people who ate pudding were 15 times more likely to become ill with salmonellosis than those who did not eat pudding (risk ratio, 15.2; 95% confidence interval, 2.3-102.3). Salmonella Enteritidis was identified in leftover pudding and in the internal mixing components of the blender used to mix the pudding. All patient, food, and blender isolates exhibited the same pulsed-field gel electrophoresis pattern. This outbreak of Salmonella Enteritidis was caused by a Salmonella-contaminated hand-held immersion blender used to prepare pudding at a camp. A malfunctioning blender shaft seal is suspected to have resulted in contamination of the blender and subsequently pudding prepared using the blender.

Outbreak of infection with a multiresistant Klebsiella pneumoniae strain associated with contaminated roll boards in operating rooms

An outbreak with a multiresistant Klebsiella pneumoniae (MRKP) strain among seven patients admitted to the adult intensive care unit (ICU) of a regional teaching hospital in The Netherlands was investigated. Epidemiologic investigations revealed a short delay between an operation and the acquisition of the MRKP strain. A case-control study comprising 7 cases and 14 controls was conducted to identify the risk factors associated with the acquisition of the MRKP strain. An operation at each of two operation rooms was strongly associated with the acquisition of the MRKP strain: odds ratio of 36 (95% confidence interval, 2.7 to 481.2; P=0.003, Fisher exact two-tailed test). Cultures of environmental specimens of the operation rooms revealed contamination of the roll boards used to transport patients from the bed to the operation table with the MRKP strains. Molecular genotyping of the isolates revealed clonal similarity between the isolates of the seven cases, isolates from environmental specimen cultures, and in addition, an MRKP isolate from a re-patriated ICU patient from earlier that year. The outbreak ended after cleaning and replacement of the roll boards in the operation rooms and implementation of additional barrier precautions for colonized or infected patients. It was concluded that two operation rooms played a significant role in the transmission of an MRKP strain between ICU patients during the presented outbreak.

Condições higiênico-sanitárias de uma dieta hospitalar

Buscou-se avaliar as condições higiênico-sanitárias da dieta branda servida em um hospital geral da cidade de Belém, Pará, através da análise microbiológica de seus componentes (coliformes fecais, Staphylococcus aureus e Salmonella) e dos utensílios, equipamentos e mãos de funcionários (coliformes fecais, Staphylococcus aureus), bem como elaborar um Relatório Técnico de Inspeção da Unidade de Alimentação e Nutrição do hospital, baseado no Anexo II da Portaria 1428 de 26/11/1993, para a implantação das Boas Práticas de Fabricação. Em nenhuma das amostras foi detectada a presença de Salmonella ou Staphylococcus aureus; entretanto, os componentes da dieta, equipamentos e utensílios apresentaram 100% de coliformes fecais, assim como as mãos de duas funcionárias. Os principais pontos observados para o relatório técnico foram: padrão de identidade e qualidade, condições ambientais, instalações e saneamento, equipamentos e utensílios, recursos humanos, tecnologia empregada, controle de qualidade, garantia de qualidade, armazenagem, desinfecção e desinfestação. Através desta avaliação foram constatadas as péssimas condições higiênico-sanitárias da referida Unidade de Alimentação e Nutrição.

Reducing bacterial contamination in enteral tube feeds

It is well known that enteral tube feeds may become contaminated with bacteria and other microorganisms during preparation and administration and that this may lead to the development of infectious complications in patients. This article describes potential sources and routes of microbial contamination of these feeds and suggests procedures that can be implemented to reduce the risk of contamination.

Evaluation of "closed" vs "open" systems for the delivery of peptide-based enteral diets

BACKGROUND

The study was designed to quantitate factors such as preparation time, waste, and contamination associated with three different feeding systems for peptide-based diets and to determine appropriate hang times.

METHODS

Intensive care unit patients were randomized to receive a peptide-based diet in 1500-mL prefilled, sterile closed-system containers (CS) infused more than 24 hours, as open systems decanted from cans (OS-Can), or as open systems mixed from powder (OS-Powder). Open-system groups were provided a 12-hour supply twice daily in commercially clean 1-L bags with preattached sets. Samples were taken for culture during preparation and after infusion. Preparation time, initial and final microbial concentrations, and total waste were quantified.

RESULTS

Preparation time was significantly shorter for CS than for OS-Can or for OS-Powder (2 minutes vs 7.5 minutes vs 13.0 minutes). Initially, 100% of the OS-Powder and 30% of the OS-Can bags were contaminated, with significant contamination exceeding 10(4) colony-forming units/mL in 40% and in 5% of the bags, respectively. On final culture, significant contamination occurred in only 2% of the CS bags compared with 83% of the OS-Powder and 60% of the OS-Can bags. Average time from potential initial contamination to final culture in CS was 49.9 hours vs 38.8 hours for OS-Can and 32 hours for OS-Powder. Total waste was greater in CS than in OS-Can or OS-Powder but could be eliminated by extending allowable hang times.

CONCLUSIONS

Nonvented closed-delivery containers may be safely infused for up to 48 hours. They are associated with reduced labor and contamination.

Cleaning and disinfection of blenders used in hospital kitchens

The efficiency of a range of methods used to clean and disinfect blenders was compared. Blenders with metal, plastic and glass goblets were experimentally contaminated with Klebsiella aerogenes after which they were cleaned and disinfected by (a) cold water rinse, (b) detergent wash, (c) detergent wash and disinfectant soak, (d) detergent wash and boiling water rinse and (e) autoclaving. Autoclaving was the only procedure that sterilized the blenders but this could only be used for blenders with metal goblets. A detergent wash with or without chemical disinfection followed by a boiling water rinse was found to be the most effective method of cleaning and disinfecting all three types of blender.