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Wu PC, Lo WT, Chen SJ, Wang CC. Molecular characterization of Group A streptococcal isolates causing scarlet fever and pharyngitis among young children: A retrospective study from a northern Taiwan medical center. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2014; 47:304-10. [DOI: 10.1016/j.jmii.2013.02.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 01/03/2013] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
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Changing epidemiology of Streptococcus pyogenes emm types and associated invasive and noninvasive infections in Southern Taiwan. J Clin Microbiol 2009; 47:2658-61. [PMID: 19515840 DOI: 10.1128/jcm.01078-09] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A total of 242 isolates were recovered from 76 patients with invasive diseases, 89 with scarlet fever, and 77 with pharyngitis. The most frequent emm types were types 12 (43.4%), 4 (18.2%), and 1 (16.9%). emm12 reemerged in 2005 and peaked in 2007. emm11 was recovered only from patients with invasive disease.
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Chiou CS, Wang YW, Chen PL, Wang WL, Wu PF, Wei HL. Association of the shuffling of Streptococcus pyogenes clones and the fluctuation of scarlet fever cases between 2000 and 2006 in central Taiwan. BMC Microbiol 2009; 9:115. [PMID: 19486515 PMCID: PMC2697166 DOI: 10.1186/1471-2180-9-115] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Accepted: 06/01/2009] [Indexed: 11/10/2022] Open
Abstract
Background The number of scarlet fever occurrences reported between 2000 and 2006 fluctuated considerably in central Taiwan and throughout the nation. Isolates of Streptococcus pyogenes were collected from scarlet fever patients in central Taiwan and were characterized by emm sequencing and a standardized pulsed-field gel electrophoresis (PFGE) method. National weekly report data were collected for investigating epidemiological trends. Results A total of 23 emm types were identified in 1,218 S. pyogenes isolates. The five most prevalent emm types were emm12 (50.4%), emm4 (23.2%), emm1 (16.4%), emm6 (3.8%) and emm22 (3.0%). PFGE analysis with SmaI suggested that, with a few exceptions, strains with a common emm type belonged to the same clone. There were two large emm12 clones, one with DNA resistant to cleavage by SmaI. Each prevalent emm clone had major PFGE strain(s) and many minor strains. Most of the minor strains emerged in the population and disappeared soon after. Even some major strains remained prevalent for only 2–3 years before declining. The large fluctuation of scarlet fever cases between 2000 and 2006 was associated with the shuffling of six prevalent emm clones. In 2003, the dramatic drop in scarlet fever cases in central Taiwan and throughout the whole country was associated with the occurrence of a severe acute respiratory syndrome (SARS) outbreak that occurred between late-February and mid-June in Taiwan. Conclusion The occurrences of scarlet fever in central Taiwan in 2000–2006 were primarily caused by five emm types, which accounted for 96.8% of the isolates collected. Most of the S. pyogenes strains (as defined by PFGE genotypes) emerged and lasted for only a few years. The fluctuation in the number of scarlet fever cases during the seven years can be primarily attributed to the shuffling of six prevalent emm clones and to the SARS outbreak in 2003.
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Affiliation(s)
- Chien-Shun Chiou
- The Central Region Laboratory, Center for Research and Diagnostics, Centers for Disease Control, Taichung City 40855, Taiwan.
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Commons R, Rogers S, Gooding T, Danchin M, Carapetis J, Robins-Browne R, Curtis N. Superantigen genes in group A streptococcal isolates and their relationship with emm types. J Med Microbiol 2008; 57:1238-1246. [DOI: 10.1099/jmm.0.2008/001156-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Robert Commons
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
| | - Susan Rogers
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
| | - Travis Gooding
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
| | - Margie Danchin
- Infectious Diseases Unit, Department of General Medicine, Royal Children’s Hospital Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
| | - Jonathan Carapetis
- Infectious Diseases Unit, Department of General Medicine, Royal Children’s Hospital Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
| | - Roy Robins-Browne
- Department of Microbiology & Immunology, The University of Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
| | - Nigel Curtis
- Infectious Diseases Unit, Department of General Medicine, Royal Children’s Hospital Melbourne, Australia
- Murdoch Children’s Research Institute, Royal Children’s Hospital Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Australia
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Yang SG, Dong HJ, Li FR, Xie SY, Cao HC, Xia SC, Yu Z, Li LJ. Report and analysis of a scarlet fever outbreak among adults through food-borne transmission in China. J Infect 2007; 55:419-24. [PMID: 17719644 DOI: 10.1016/j.jinf.2007.07.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2007] [Revised: 07/11/2007] [Accepted: 07/12/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Scarlet fever is caused by group A beta-hemolytic streptococci (GAS). The clinical syndrome has receded in recent years, but occasionally explosive outbreaks do occur likely due to the emergence of GAS with virulence factors peculiar to this syndrome. METHODS Following the notification of an unexpectedly large number of scarlet fever cases amongst adults associated with a school in Ningbo, China, in June 2006, the epidemiological and clinical features of the outbreak were investigated. Logistic regression was conducted to investigate the risk factors of the outbreak and its transmission route. RESULTS Forty five individuals suffered scarlet fever with an attack rate of 4.98% (45/904). There was a single peak in the epidemic curve, with the majority of the cases occurring during the first two days of the outbreak. The median age of cases was 35.5 years (range 17-65). Most patients had fever (43/45), sore throat (40/45), scarlatinoid rash (39/45) and strawberry-like tongue (30/45). In laboratory detection, 45 cases' throat swabs samples were collected and GAS were isolated from 8 throat swabs samples. All of the cases, except for 2, had eaten the Plain Boiled Chicken (PBC) for lunch on June 6th, and teaching staff and students who had not eaten the PBC were not affected by the epidemic. Logistic regression analysis indicated that PBC was a key risk factor (OR=21.0, P<0.05). The chef of the school refectory was responsible for washing, braising, cutting, and distributing the PBC, and was identified as the likely source. CONCLUSIONS We describe an outbreak of scarlet fever caused by GAS-contaminated food.
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Affiliation(s)
- Shi-Gui Yang
- Key Laboratory of Infectious Diseases, Ministry of Health of China, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, China
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Chiou CS, Liao TL, Wang TH, Chang HL, Liao JC, Li CC. Epidemiology and molecular characterization of Streptococcus pyogenes recovered from scarlet fever patients in central Taiwan from 1996 to 1999. J Clin Microbiol 2004; 42:3998-4006. [PMID: 15364982 PMCID: PMC516299 DOI: 10.1128/jcm.42.9.3998-4006.2004] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
One hundred seventy-nine Streptococcus pyogenes isolates recovered from scarlet fever patients from 1996 to 1999 in central Taiwan were characterized by emm, Vir, and pulsed-field gel electrophoresis (PFGE) typing methods. The protocols for Vir and PFGE typing were standardized. A database of the DNA fingerprints for the isolates was established. Nine emm or emm-like genes, 19 Vir patterns, and 26 SmaI PFGE patterns were detected among the isolates. Among the three typing methods, PFGE was the most discriminatory. However, it could not completely replace Vir typing because some isolates with identical PFGE patterns could be further differentiated into several Vir patterns. The prevalent emm types were emm4 (n = 81 isolates [45%]), emm12 (n = 64 [36%]), emm1 (n = 14 [8%]), and emm22 (n = 13 [7%]). Some emm type isolates could be further differentiated into several emm-Vir-PFGE genotypes; however, only one genotype in each emm group was usually predominant. DNA from nine isolates was resistant to SmaI digestion. Further PFGE analysis with SgrAI showed that the SmaI digestion-resistant strains could be derived from indigenous strains by horizontal transfer of exogenous genetic material. The emergence of the new strains could have resulted in an increase in scarlet fever cases in central Taiwan since 2000. The emm sequences, Vir, and PFGE pattern database will serve as a basis for information for the long-term evolutionary study of local S. pyogenes strains.
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Affiliation(s)
- Chien-Shun Chiou
- The Central Branch Office, Center for Disease Control, 5F 20 Wen-Sin South 3rd Rd., Taichung City 408, Taiwan.
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Yan JJ, Liu CC, Ko WC, Hsu SY, Wu HM, Lin YS, Lin MT, Chuang WJ, Wu JJ. Molecular analysis of group A streptococcal isolates associated with scarlet fever in southern Taiwan between 1993 and 2002. J Clin Microbiol 2004; 41:4858-61. [PMID: 14532243 PMCID: PMC254326 DOI: 10.1128/jcm.41.10.4858-4861.2003] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Collected between 1993 and 2002 at a Taiwanese university hospital, 77 group A streptococcus isolates associated with scarlet fever were grouped by emm typing and pulsed-field gel electrophoresis. The predominance of an emm1 clone before 1996 and the presence of genetically diverse emm1 and emm4 strains thereafter were found.
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Affiliation(s)
- Jing-Jou Yan
- Department of Pathology, College of Medicine National Cheng Kung University, Tainan, Taiwan
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Perea-Mejía LM, Inzunza-Montiel AE, Cravioto A. Molecular characterization of group A Streptococcus strains isolated during a scarlet fever outbreak. J Clin Microbiol 2002; 40:278-80. [PMID: 11773132 PMCID: PMC120127 DOI: 10.1128/jcm.40.1.278-280.2002] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Forty group A streptococcus (GAS) isolates, recovered during a scarlet fever outbreak, were grouped based on their DdeI restriction profiles from emm amplicons. Twenty-seven isolates were identified by sequencing as emm2. The emm2 isolates showed the speA1, speB1, and speC1 alleles. Isolation of this GAS type from scarlet fever outbreaks is uncommon.
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Affiliation(s)
- Luis M Perea-Mejía
- Departamento de Salud Pública, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad Universitaria, DF México, 04510, Mexico
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Huang YC, Hsueh PR, Lin TY, Yan DC, Hsia SH. A family cluster of streptococcal toxic shock syndrome in children: clinical implication and epidemiological investigation. Pediatrics 2001; 107:1181-3. [PMID: 11331706 DOI: 10.1542/peds.107.5.1181] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most invasive group A streptococcal (GAS) disease occurs sporadically. Reports of family clusters of these infections are scanty, and most invasive disease occurs in adults. We describe a family cluster of streptococcal toxic shock syndrome (STSS) involving 3 children and present the results of an epidemiologic investigation. PATIENTS AND METHODS During a 16-day period, 3 children in a family developed STSS with an interval of 7 and 9 days, respectively, between the onset of disease. Cases 2 and 3 had GAS isolated from blood culture. Case 2 was fatal. Pharyngeal culture survey of the family members and schoolchildren was conducted. Antibiogram, serotyping, detection of exotoxin genes, and random amplified polymorphic DNA patterns of the disease strains and survey strains were examined. RESULTS One of 15 family members sampled-the sister of the index case-and 7 (5.6%) of 125 schoolchildren sampled had GAS isolated from pharyngeal cultures. Of the 10 strains examined, 2 isolates from the patients, 1 from the sister of index case, and 2 from the classmates of case 2 (the fatal case) had an identical pattern of both genotype and phenotype. CONCLUSION We describe a family cluster of STSS involving 3 children caused by a single clone and provide additional data regarding invasive GAS infection subsequent to household contact. Additional studies should be conducted in conjunction with surveillance to define better the magnitude of risk in household contacts and to identify settings in which subsequent infections may occur.
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Affiliation(s)
- Y C Huang
- Division of Pediatric Infectious Diseases, National Taiwan University Hospital, Chang Gung University, Kweishan, Taoyuan, Taiwan.
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Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC. Bacterial Diseases. Dermatology 2000. [DOI: 10.1007/978-3-642-97931-6_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Kaplan EL, Johnson DR, Del Rosario MC, Horn DL. Susceptibility of group A beta-hemolytic streptococci to thirteen antibiotics: examination of 301 strains isolated in the United States between 1994 and 1997. Pediatr Infect Dis J 1999; 18:1069-72. [PMID: 10608626 DOI: 10.1097/00006454-199912000-00008] [Citation(s) in RCA: 101] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Because of continuing reports from many countries of increasing resistance of group A streptococci to macrolide antibiotics, we determined the antibiotic susceptibility of recent group A streptococcal isolates from the United States. METHODS We evaluated 301 Streptococcus pyogenes isolates (245 from patients with uncomplicated pharyngitis and 56 isolates from patients with invasive systemic infections) for susceptibility using the Etest technique. The isolates came from 24 states and the District of Columbia during the years 1994 through 1997. Thirteen antibiotics (azithromycin, ceftriaxone, cephalothin, chloramphenicol, ciprofloxacin, clindamycin, erythromycin, imipenem, levofloxacin, oxacillin, penicillin G, tetracycline and trimethoprim-sulfamethoxazole) were studied. RESULTS The MIC90 for penicillin was 0.016 microg/ml, which is not significantly different from previous reports. Of the 301 isolates only 2.6% were resistant to a macrolide antibiotic and only 4% were resistant to tetracycline. CONCLUSIONS These data indicate that antibiotic resistance among recent isolates of group A streptococci (including those from patients with severe infections) currently is not a clinically significant problem in the United States.
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Affiliation(s)
- E L Kaplan
- Department of Pediatrics, World Health Organization Collaborating Center, for Reference and Research on Streptococci, University of Minnesota Medical School, Minneapolis, USA
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Hsueh PR, Teng LJ, Yang PC, Pan HJ, Chen YC, Wang LH, Ho SW, Luh KT. Dissemination of two methicillin-resistant Staphylococcus aureus clones exhibiting negative staphylase reactions in intensive care units. J Clin Microbiol 1999; 37:504-9. [PMID: 9986803 PMCID: PMC84445 DOI: 10.1128/jcm.37.3.504-509.1999] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
From December 1997 to March 1998, 25 methicillin-resistant Staphylococcus aureus (MRSA) isolates exhibiting negative Staphylase (Oxoid Ltd., Basingstoke, England) reactions were identified from various clinical specimens from 13 patients in six intensive care units (ICUs) or in wards following a stay in an ICU at the National Taiwan University Hospital. The characteristics of these isolates have not been previously noted in other MRSA isolates from this hospital. Colonies of all these isolates were grown on Trypticase soy agar supplemented with 5% sheep blood and were nonhemolytic and unpigmented. Seven isolates, initially reported as Staphylococcus haemolyticus (5 isolates) and Staphylococcus epidermidis (2 isolates) by the routine identification scheme and with the Vitek GPI system (bioMerieux Vitek, Inc., Hazelwood, Mo.), were subsequently identified as S. aureus by positive tube coagulase tests, standard biochemical reactions, and characteristic cellular fatty acid chromatograms. The antibiotypes obtained by the E test, coagulase types, restriction fragment length polymorphism profiles of the staphylococcal coagulase gene, and random amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates disclosed that two major clones disseminated in the ICUs. Clone 1 (16 isolates) was resistant to clindamycin and was susceptible to trimethoprim-sulfamethoxazole (TMP-SMZ) and was coagulase type II. Clone 2 (eight isolates) was resistant to clindamycin and TMP-SMZ and was coagulase type IV. These two epidemic clones from ICUs are unique and underline the need for caution in identifying MRSA strains with colonial morphologies not of the typical type and with negative Staphylase reactions.
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Affiliation(s)
- P R Hsueh
- Departments of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Hsueh PR, Teng LJ, Lee LN, Yang PC, Ho SW, Luh KT. Dissemination of high-level penicillin-, extended-spectrum cephalosporin-, and erythromycin-resistant Streptococcus pneumoniae clones in Taiwan. J Clin Microbiol 1999; 37:221-4. [PMID: 9854097 PMCID: PMC84215 DOI: 10.1128/jcm.37.1.221-224.1999] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/1998] [Accepted: 10/15/1998] [Indexed: 11/20/2022] Open
Abstract
Sixty-seven clinical isolates of Streptococcus pneumoniae (40 of serotype 23F, 19 of serotype 19F, and 8 of serotype 6B) with decreased susceptibilities to penicillin and erythromycin were characterized by antimicrobial susceptibility patterns; DNA restriction endonuclease cleavage profiles of the penicillin-binding protein genes pbp1a, pbp2b, and pbp2x; random amplified polymorphic DNA (RAPD) patterns generated by arbitrarily primed PCR; and chromosomal macrorestriction profiles based on pulsed-field gel electrophoresis. A total of 22 clones (identical or closely related pulsotypes and identical RAPD patterns) were identified; 14 clones of 23F, 6 of 19F, and 2 of 6B. Three 23F clones (26 isolates) and one 19F clone (9 isolates) expressed high-level resistance to penicillin, cefotaxime, and erythromycin (MICs >/= 256 microg/ml). These data strongly suggest that multiple high-level penicillin-, extended-spectrum cephalosporin-, and macrolide-resistant clones of S. pneumoniae have been disseminated in Taiwan.
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Affiliation(s)
- P R Hsueh
- Departments of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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Hsueh PR, Teng LJ, Pan HJ, Chen YC, Sun CC, Ho SW, Luh KT. Outbreak of Pseudomonas fluorescens bacteremia among oncology patients. J Clin Microbiol 1998; 36:2914-7. [PMID: 9738043 PMCID: PMC105087 DOI: 10.1128/jcm.36.10.2914-2917.1998] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
From 7 to 24 March 1997, four patients developed Pseudomonas fluorescens bacteremia at the hospital; one on the oncology ward and the other three in the chemotherapy room. These patients all had underlying malignancies and had the Port-A-Cath (Smiths Industries Medical Systems, Deltec, Inc., St. Paul, Minn.) implants. Three patients had primary bacteremia, and one had Port-A-Cath-related infection. None of these patients had received a blood transfusion before the episodes of bacteremia. All patients recovered: two received antimicrobial agents with in vitro activity against the isolates, and the other two did not have any antibiotic treatment. A total of eight blood isolates were recovered from these patients during the febrile episodes that occurred several minutes after the infusion of chemotherapeutic agents via the Port-A-Cath. These isolates were initially identified as P. fluorescens or Pseudomonas putida (four), Burkholderia (Ralstonia) pickettii (three), and a non-glucose-fermenting gram-negative bacillus (one) by routine biochemical methods and the Vitek GNI card. These isolates were later identified as P. fluorescens on the basis of the characteristic cellular fatty acid chromatogram and the results of supplemental biochemical tests. The identification of identical antibiotypes by the E test and the random amplified polymorphic DNA patterns generated by arbitrarily primed PCR of the isolates showed that the outbreak was caused by a single clone of P. fluorescens. Surveillance cultures of the possibly contaminated infusion fluids and disinfectants, which were performed 7 days after recognition of the last infected patient, failed to isolate P. fluorescens. This report of a small outbreak caused by P. fluorescens suggests that timely, accurate identification of unusual nosocomial pathogens is crucial for early initiation of an epidemiological investigation and timely control of an outbreak.
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Affiliation(s)
- P R Hsueh
- Departments of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
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