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Armando M, Barthélémi L, Couret I, Verdier C, Dupont C, Jumas-Bilak E, Grau D. Recurrent environmental contamination in a centralized radiopharmacy unit by Achromobacter spp: results of a large microbiological investigation. Am J Infect Control 2022; 51:557-562. [PMID: 35870659 DOI: 10.1016/j.ajic.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Radiopharmaceuticals preparation unit, such as every aseptic preparation units, are strictly monitored in terms of microbiological contamination. Despite all biocontamination control procedures, our radiopharmacy unit faced repeated environnmental contamination by Achromobacter spp which necessitated a large environmental investigation. METHOD Microbiological controls were carried out using Count Tact agars (Biomérieux) for flat surfaces, dry swabbing for hard to reach areas and containers were filled with a sterile water solution (then filtrated on 0.45µm membrane and seeded). Microbiological identification was performed by mass spectrometry (MALDI-TOF-MS, Brucker) on each positive sample. RESULTS Achromobacter spp was found in 10% of the 413 samples during the 8 months investigation period. The proportion of positive samples was stable among time but their location was unpredictable. The highest inoculum was finally found in the buckets used for biocleaning. DISCUSSION Samples from cleaning buckets taken by dry swabbing were at first negative, but the use of a non-routinely used sampling method allowed to discover the reservoir of this persistent contamination. CONCLUSION This investigation alerted us on the high microbiological risk associated with reusable plastic containers and the importance of a sampling method adapted to critical locations.
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Affiliation(s)
- M Armando
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France
| | - L Barthélémi
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France
| | - I Couret
- Radiopharmacy Unit, Department of Preparations and controls, University Teaching Hospital (UTH) of Montpellier, France; Unit 1194 INSERM, Team Radiobiology and targeted radiotherapy, Cancer Research Institute of Montpellier, Montpellier, France
| | - C Verdier
- Pharmaceutical Controls Laboratory, Department of Preparations and controls, UTH of Montpellier, France
| | - C Dupont
- UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| | - E Jumas-Bilak
- Infection Control Department, UTH of Montpellier, France; UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
| | - D Grau
- Infection Control Department, UTH of Montpellier, France; UMR 5569 HSM, Team "Pathogènes Hydriques Santé et Environnements", Unit of Bacteriology, University of Pharmacy, Montpellier, France
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Steiner V, Rosel AC, Ruppitsch W, Allerberger F, Carranza Valencia A, Markovic M, Luckschander-Zeller N, Szostak MP, Spergser J, Loncaric I, Künzel F. The First Bacterial Endocarditis Due to Achromobacter xylosoxidans in a Dog. Pathogens 2021; 10:pathogens10121580. [PMID: 34959535 PMCID: PMC8709460 DOI: 10.3390/pathogens10121580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 11/21/2021] [Accepted: 11/30/2021] [Indexed: 12/04/2022] Open
Abstract
Infectious endocarditis (IE) in dogs is often associated with a high mortality rate as diagnostic work-up as well as antibiotic treatment might be challenging. The present case describes bacteremia in a dog caused by Achromobacter xylosoxidans, leading to an infectious endocarditis. Achromobacter xylosoxidans (A. xylosoxidans) is an aerobic Gram-negative rod-shaped bacterium, which has been associated with multiple nosocomial opportunistic diseases in human medicine. One such manifestation of A. xylosoxidans infection is endocarditis. A. xylosoxidans infections are challenging to treat due to the reduced effectiveness of a wide range of antimicrobial agents. To date, only a few case reports of infections with A. xylosoxidans in animals have been described. This is the first case report of A. xylosoxidans endocarditis in a dog. Whole-genome sequencing was performed to determine the sequencing type and to gain more information about this bacterium regarding its intrinsic resistance genes. With this case report, we seek to increase awareness of A. xylosoxidans as an opportunistic nosocomial pathogen in dogs and to provide a short summary regarding the current state of general knowledge and known resistance patterns.
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Affiliation(s)
- Verena Steiner
- Department for Companion Animals and Horses, Clinical Unit of Internal Medic and Small Animals, University of Veterinary Medicine, 1210 Vienna, Austria; (A.C.V.); (M.M.); (N.L.-Z.); (F.K.)
- Correspondence:
| | - Adriana Cabal Rosel
- Institute of Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, 1090 Vienna, Austria; (A.C.R.); (W.R.); (F.A.)
| | - Werner Ruppitsch
- Institute of Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, 1090 Vienna, Austria; (A.C.R.); (W.R.); (F.A.)
| | - Franz Allerberger
- Institute of Medical Microbiology and Hygiene, Austrian Agency for Health and Food Safety, 1090 Vienna, Austria; (A.C.R.); (W.R.); (F.A.)
| | - Alejandra Carranza Valencia
- Department for Companion Animals and Horses, Clinical Unit of Internal Medic and Small Animals, University of Veterinary Medicine, 1210 Vienna, Austria; (A.C.V.); (M.M.); (N.L.-Z.); (F.K.)
| | - Mato Markovic
- Department for Companion Animals and Horses, Clinical Unit of Internal Medic and Small Animals, University of Veterinary Medicine, 1210 Vienna, Austria; (A.C.V.); (M.M.); (N.L.-Z.); (F.K.)
| | - Nicole Luckschander-Zeller
- Department for Companion Animals and Horses, Clinical Unit of Internal Medic and Small Animals, University of Veterinary Medicine, 1210 Vienna, Austria; (A.C.V.); (M.M.); (N.L.-Z.); (F.K.)
| | - Michael P. Szostak
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (M.P.S.); (J.S.); (I.L.)
| | - Joachim Spergser
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (M.P.S.); (J.S.); (I.L.)
| | - Igor Loncaric
- Institute of Microbiology, University of Veterinary Medicine, 1210 Vienna, Austria; (M.P.S.); (J.S.); (I.L.)
| | - Frank Künzel
- Department for Companion Animals and Horses, Clinical Unit of Internal Medic and Small Animals, University of Veterinary Medicine, 1210 Vienna, Austria; (A.C.V.); (M.M.); (N.L.-Z.); (F.K.)
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Arjun R, John KE, Niyas VKM, Nair SR, Mohan V, Ratheesh RS. Achromobacter spp. bacteremia outbreak related to contaminated furosemide ampoules. LE INFEZIONI IN MEDICINA 2021; 29:427-433. [PMID: 35146348 PMCID: PMC8805504 DOI: 10.53854/liim-2903-14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 07/27/2021] [Indexed: 06/14/2023]
Abstract
Nosocomial outbreaks related to medication contamination are reported world-wide. A sudden increase in cases of Achromobacter spp. bacteremia led to an outbreak investigation in our setting. Line listing and environmental sampling led to identification of contaminated furosemide ampoules as the source. Molecular identification helped in species identification and in this outbreak more than one species was identified. Prompt withdrawal of the contaminated batch of ampoules curtailed the outbreak.
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Affiliation(s)
- Rajalakshmi Arjun
- Department of Infectious Diseases, KIMSHEALTH, Thiruvananthapuram, Kerala, India
| | - Kalpana E John
- Department of Microbiology, KIMSHEALTH, Thiruvananthapuram, Kerala, India
| | | | - Sreerekha R Nair
- Department of Hospital Infection Control, KIMSHEALTH, Thiruvananthapuram, Kerala, India
| | - Viji Mohan
- Department of Microbiology, KIMSHEALTH, Thiruvananthapuram, Kerala, India
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André C, Durand ML, Buckley T, Cadorette J, Gilmore MS, Ciolino JB, Bispo PJM. A Cluster of Corneal Donor Rim Cultures Positive for Achromobacter Species Associated With Contaminated Eye Solution. Cornea 2021; 40:223-227. [PMID: 33395117 PMCID: PMC8551930 DOI: 10.1097/ico.0000000000002473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To investigate a cluster of corneoscleral rim cultures positive for Achromobacter species over a 6-month period at Massachusetts Eye and Ear. METHODS An increased rate of positive corneal donor rim cultures was noted at Massachusetts Eye and Ear between July and December 2017. Positive cultures were subjected to identification and antimicrobial susceptibility testing by phenotypic (MicroScan WalkAway) and genotypic (16S rDNA sequencing) methods. Samples of the eye wash solution (GeriCare) used in the eye bank were also evaluated. Antimicrobial activity of Optical-GS against Achromobacter spp. at 4°C and 37°C was assessed by time-kill kinetics assay. RESULTS Of 99 donor rims cultured, 14 (14.1%) grew bacteria with 11 (78.6%) due to uncommon nonfermenting Gram-negative bacilli. These had been identified by standard automated methods as Achromobacter (n = 3), Alcaligenes (n = 3), Ralstonia (n = 2), Pseudomonas (n = 2), and Stenotrophomonas (n = 1). Eight of these 11 isolates were subsequently available for molecular identification, and all were identified as Achromobacter spp. Six bottles of eyewash solution were evaluated and were positive for abundant Achromobacter spp. (3.4 × 105 ± 1.1 CFU/mL). Optisol-GS had no bactericidal activity against Achromobacter spp. at 4°C after 24-hour incubation but was bactericidal at 37°C. None of the patients who had received the contaminated corneas developed postoperative infection. CONCLUSIONS An eyewash solution arising from a single lot was implicated in the contamination of donor rims by Achromobacter spp. The isolates were able to survive in the Optisol-GS medium at the recommended storage temperature. This highlights the need to continue improving protocols for tissue preparation and storage.
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Affiliation(s)
- Camille André
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA. Dr. André is now with Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Marlene L. Durand
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA. Dr. André is now with Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Department of Medicine, Massachusetts General Hospital, Boston, MA
| | | | - James Cadorette
- Henry Whittier Porter Bacteriology Laboratory, Massachusetts Eye and Ear, Boston, MA
| | - Michael S. Gilmore
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA. Dr. André is now with Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
- Department of Microbiology and Immunobiology, Harvard Medical School, Boston, MA
| | - Joseph B. Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA. Dr. André is now with Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
| | - Paulo J. M. Bispo
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA. Dr. André is now with Centre International de Recherche en Infectiologie (CIRI), Inserm U1111, Université Claude Bernard Lyon 1, CNRS UMR5308, Ecole Normale Supérieure de Lyon, Lyon, France
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Hematogenous pleural infection caused by Achromobacter xylosoxidans in a patient undergoing maintenance hemodialysis. J Infect Chemother 2019; 26:389-392. [PMID: 31837898 DOI: 10.1016/j.jiac.2019.11.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/10/2019] [Accepted: 11/16/2019] [Indexed: 12/22/2022]
Abstract
A 78-year-old Japanese man, undergoing maintenance hemodialysis for 20 years and having received coronary artery bypass grafting two months before, was hospitalized because of fever with subclinical left-sided pleurisy. Achromobacter xylosoxidans strains exhibiting identical genomic patterns on a macrorestriction analysis were isolated from the blood and the pleural effusion obtained on admission. Physical and radiological examinations did not reveal any lesions in either chest wall or lung adjacent to the effusion, indicating that the organism in the effusion had entered the pleural space via the bloodstream. Immunocompromising conditions due to undergoing maintenance hemodialysis and the presence of the antecedently accumulated pleural effusion may have been associated with the development of hematogenous dissemination. The patient fully recovered only with antibiotic therapy. To our knowledge, the present report is the first describing a case of hematogenous pleural infection caused by A. xylosoxidans.
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Haviari S, Cassier P, Dananché C, Hulin M, Dauwalder O, Rouvière O, Bertrand X, Perraud M, Bénet T, Vanhems P. Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropi Infections after Prostate Biopsies, France, 2014. Emerg Infect Dis 2018; 22:1412-9. [PMID: 27434277 PMCID: PMC4982167 DOI: 10.3201/eid2208.151423] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report an outbreak of healthcare-associated prostatitis involving rare environmental pathogens in immunocompetent patients undergoing transrectal prostate biopsies at Hôpital Édouard Herriot (Lyon, France) during August 13-October 10, 2014. Despite a fluoroquinolone-based prophylaxis, 5 patients were infected with Achromobacter xylosoxidans and 3 with Ochrobactrum anthropi, which has not been reported as pathogenic in nonimmunocompromised persons. All patients recovered fully. Analysis of the outbreak included case investigation, case-control study, biopsy procedure review, microbiologic testing of environmental and clinical samples, and retrospective review of hospital records for 4 years before the outbreak. The cases resulted from asepsis errors during preparation of materials for the biopsies. A low-level outbreak involving environmental bacteria was likely present for years, masked by antimicrobial drug prophylaxis and a low number of cases. Healthcare personnel should promptly report unusual pathogens in immunocompetent patients to infection control units, and guidelines should explicitly mention asepsis during materials preparation.
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L5-S1 Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of lumbosacral disc herniation: a case report and review of the literature. Spine (Phila Pa 1976) 2014; 39:E413-6. [PMID: 24384664 DOI: 10.1097/brs.0000000000000195] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report and literature review. OBJECTIVE To present a unique case of Achromobacter xylosoxidans infection secondary to oxygen-ozone therapy for the treatment of L5-S1 disc herniation. SUMMARY OF BACKGROUND DATA Oxygen-ozone therapy is a minimally invasive technique for the treatment of lumbar disc herniations, with unproven efficacy and few reported complications. Achromobacter xylosoxidans is an opportunistic pathogen that inhabits aquatic environments and is a rare cause of osteomyelitis. To the best of our knowledge, this is the first report of A. xylosoxidans spondylodiscitis in the lumbar spine and the third report of spinal infection after intradiscal oxygen-ozone chemonucleolysis in the English literature. METHODS The medical records, operative reports, and radiographical imaging studies of a single patient were retrospectively reviewed. RESULTS A 29-year-old female patient who previously underwent oxygen-ozone therapy for L5-S1 disc herniation presented to our institution with a 5-month history of intractable back and leg pain. The patient's laboratory studies were within normal limits and did not indicate signs of an active infection. Her physical examination revealed globally decreased muscle strength (4/5) and hyperesthesia in the lower extremities. Magnetic resonance imaging and computed tomography revealed severe disc degeneration and vertebral body endplate changes at L5-S1, in addition to paravertebral soft tissue swelling consistent with a previous infection. Given the severity of symptoms, the patient underwent anterior lumbar interbody fusion and posterior segmental instrumentation at L5-S1. Histopathological evaluation of the disc material confirmed the diagnosis of chronic osteomyelitis and septic discitis at L5-S1. Intraoperative cultures grew A. xylosoxidans and Propionibacterium acnes. The patient had prompt improvement in her level of pain and was discharged on a 6-week course of piperacillin-tazobactam without complication. CONCLUSION This first report of A. xylosoxidans vertebral infection secondary to oxygen-ozone therapy illustrates the wide variety of environmental pathogens that can complicate the percutaneous treatment of degenerative vertebral disease.
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Wittmann J, Dreiseikelmann B, Rohde C, Rohde M, Sikorski J. Isolation and characterization of numerous novel phages targeting diverse strains of the ubiquitous and opportunistic pathogen Achromobacter xylosoxidans. PLoS One 2014; 9:e86935. [PMID: 24466294 PMCID: PMC3899368 DOI: 10.1371/journal.pone.0086935] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022] Open
Abstract
The clinical relevance of nosocomially acquired infections caused by multi-resistant Achromobacter strains is rapidly increasing. Here, a diverse set of 61 Achromobacter xylosoxidans strains was characterized by MultiLocus Sequence Typing and Phenotype MicroArray technology. The strains were further analyzed in regard to their susceptibility to 35 antibiotics and to 34 different and newly isolated bacteriophages from the environment. A large proportion of strains were resistant against numerous antibiotics such as cephalosporines, aminoglycosides and quinolones, whereas piperacillin-tazobactam, ticarcillin, mezlocillin and imipenem were still inhibitory. We also present the first expanded study on bacteriophages of the genus Achromobacter that has been so far a blank slate with respect to phage research. The phages were isolated mainly from several waste water treatment plants in Germany. Morphological analysis of all of these phages by electron microscopy revealed a broad diversity with different members of the order Caudovirales, including the families Siphoviridae, Myoviridae, and Podoviridae. A broad spectrum of different host ranges could be determined for several phages that lysed up to 24 different and in part highly antibiotic resistant strains. Molecular characterisation by DNA restriction analysis revealed that all phages contain linear double-stranded DNA. Their restriction patterns display distinct differences underlining their broad diversity.
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Affiliation(s)
- Johannes Wittmann
- Leibniz Institute DSMZ – German Collection of Microorganisms and Cell Cultures, Department of Microorganisms, Braunschweig, Germany
- * E-mail:
| | - Brigitte Dreiseikelmann
- Department of Microbiology/Genetechnology, Faculty of Biology, University of Bielefeld, Bielefeld, Germany
| | - Christine Rohde
- Leibniz Institute DSMZ – German Collection of Microorganisms and Cell Cultures, Department of Microorganisms, Braunschweig, Germany
| | - Manfred Rohde
- Helmholtz Centre for Infection Research, Department of Medical Microbiology, Central Facility for Microscopy, Braunschweig, Germany
| | - Johannes Sikorski
- Leibniz Institute DSMZ – German Collection of Microorganisms and Cell Cultures, Department of Microbial Ecology and Diversity Research, Braunschweig, Germany
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Tena D, Martínez NM, Losa C, Solís S. Skin and soft tissue infection caused by Achromobacter xylosoxidans: report of 14 cases. ACTA ACUST UNITED AC 2013; 46:130-5. [PMID: 24325336 DOI: 10.3109/00365548.2013.857043] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Skin and soft tissue infections (SSTIs) caused by Achromobacter xylosoxidans are very infrequent. The aim of the present study was to investigate the clinical and microbiological characteristics of this infection. METHODS We carried out a retrospective review of 14 cases of SSTI due to A. xylosoxidans that occurred at the University Hospital of Guadalajara (Spain) from January 2007 to December 2012. RESULTS The infection was secondary to vascular diseases, trauma, and recent surgery in 12 patients (85.7%). The most frequent clinical presentation was infection of a vascular ulcer (5 cases). The infection was monomicrobial in 7 patients (50%) and 9 cases were community-acquired (64.2%). The clinical outcome of the patients was uniformly good after antibiotic treatment, except in 4 patients who suffered recurrence of the infection. CONCLUSION A. xylosoxidans should be considered a potential pathogen in patients with SSTIs, especially in patients with vascular diseases or after surgery or trauma. A history of contact with water should be investigated in all cases. Treatment can be difficult due to the high level of antibiotic resistance. Trimethoprim-sulfamethoxazole may be useful for treatment in outpatients with community-acquired infections.
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Affiliation(s)
- Daniel Tena
- From the Sección de Microbiología, Hospital Universitario de Guadalajara , Guadalajara , Spain
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Achromobacter species endocarditis: A case report and literature review. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2012; 22:e17-20. [PMID: 22942890 DOI: 10.1155/2011/527412] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Endocarditis due to Achromobacter species is a rare, yet serious, endovascular infection. Achromobacter species infective endocarditis is associated with underlying immunodeficiencies or prosthetic heart valves and devices. A case of prosthetic pulmonary valve endocarditis secondary to Achromobacter xylosoxidans subspecies denitrificans is described in the present report. This life-threatening infection was successfully treated with combined valve replacement and prolonged antibiotic therapy. A Medline/PubMed literature review of Achromobacter endocarditis was also performed. Achromobacter species are an uncommon, yet important, cause of nosocomial endocarditis. Given the significant associated morbidity and mortality, along with a high degree of intrinsic antibiotic resistance, Achromobacter species infective endocarditis remains a clinical treatment challenge.
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Achromobacter xylosoxidans infection presenting as a pulmonary nodule mimicking cancer. J Clin Microbiol 2011; 49:2751-4. [PMID: 21593259 DOI: 10.1128/jcm.02571-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Achromobacter xylosoxidans is typically isolated from pulmonary sources, presenting as pneumonia in immunosuppressed individuals. We describe a novel clinical presentation of A. xylosoxidans infection presenting as multiple spiculated, pulmonary nodules mimicking cancer for which the patient underwent a wedge resection of the lung for diagnosis and staging of presumptive cancer.
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An Outbreak of Klebsiella pneumoniae and Enterobacter aerogenes Bacteremia After Interventional Pain Management Procedures, New York City, 2008. Reg Anesth Pain Med 2010; 35:496-9. [DOI: 10.1097/aap.0b013e3181fa1163] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Muller AE, Huisman I, Roos PJ, Rietveld AP, Klein J, Harbers JBM, Dorresteijn JJ, van Steenbergen JE, Vos MC. Outbreak of severe sepsis due to contaminated propofol: lessons to learn. J Hosp Infect 2010; 76:225-30. [PMID: 20692067 DOI: 10.1016/j.jhin.2010.06.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2009] [Accepted: 06/11/2010] [Indexed: 11/24/2022]
Abstract
Nosocomial infections are a frequent concern in healthcare. Despite the available knowledge on nosocomial infections and preventive measures, outbreaks of infections continue to occur. An outbreak of severe sepsis in patients who underwent minor procedures in an operating theatre during two consecutive days is described and analysed in this study. We performed a retrospective cohort study using epidemiological data in order to investigate the source of infection together with microbiological and on-site investigations and interviews. Seven patients met the case definition of postoperative systemic inflammatory response syndrome (SIRS). All other patients operated on over the same period served as controls. Of the risk factors investigated, general anaesthesia and propofol were statistically significant (P=0.003). Klebsiella pneumoniae and Serratia marcescens were cultured from opened vials of propofol, propofol-related devices and from blood cultures from two of the patients. These strains were genotypically indistinguishable. Lapses in aseptic preparation, handling and storage of the propofol were observed, and were the most probable cause of the extrinsic contamination. The daily procedure of handling propofol was not performed according to the manufacturer's recommendations, the main departure being the use of a single-use vial for multiple patients. This study documents the risk of infection due to contaminated propofol and the importance of having written guidelines for its handling.
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Affiliation(s)
- A E Muller
- Department of Medical Microbiology & Infectious Diseases, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
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Tena D, González-Praetorius A, Pérez-Balsalobre M, Sancho O, Bisquert J. Urinary tract infection due toAchromobacter xylosoxidans: Report of 9 cases. ACTA ACUST UNITED AC 2009; 40:84-7. [PMID: 17852927 DOI: 10.1080/00365540701558714] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Urinary tract infection (UTI) due to Achromobacter xylosoxidans is rare. The aims were to know the frequency and clinical characteristics of this infection in our area. We performed a retrospective analysis of 9 patients with UTI caused by this organism diagnosed over a period of 13 y. The mean age was 63.1 y. All patients had underlying diseases or urological abnormalities. The most frequent underlying diseases were solid or hematological malignancies (3 cases). Seven patients (77.7%) had urological abnormalities. Eight patients had symptoms of cystitis and 1 remained asymptomatic. Seven patients had community acquired UTIs. Clinical outcome was favourable in 5 patients after antibiotic treatment and recurrence occurred in 3 patients who had urological abnormalities. All isolates were susceptible to imipenem and piperacillin-tazobactam, 88.8% were susceptible to ceftazidime and 77.7% were susceptible to trimethoprim-sulfamethoxazole. High frequencies of resistance to ampicillin (100%), amoxicillin/clavulanic acid (78%), cefuroxime (100%), cefotaxime (67%), norfloxacin (89%), ciprofloxacin (78%), nitrofurantoin (89%) and gentamicin (67%) were observed. UTI due to A. xylosoxidans was predominantly observed in elderly patients with predisposing factors, especially urological abnormalities, malignancies and immunosuppression. Treatment can be difficult due to the high level of antibiotic resistance. Trimethoprim-sulfamethoxazole may be useful for treatment, particularly in outpatients with community acquired infections.
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Affiliation(s)
- Daniel Tena
- Section of Microbiology, University Hospital of Guadalajara, Guadalajara, Spain.
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Outbreak of Serratia marcescens bloodstream and central nervous system infections after interventional pain management procedures. Clin J Pain 2008; 24:374-80. [PMID: 18496300 DOI: 10.1097/ajp.0b013e31816157db] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To determine the cause of an outbreak of Serratia marcescens infections in patients after interventional pain management procedures at an outpatient pain clinic. METHODS We conducted a case-control study and collected clinical and environmental samples. RESULTS We identified 5 culture-confirmed case-patients and 2 presumptive case-patients who had no bacteria recovered from cultures. The 7 case-patients were compared with 28 controls who underwent procedures at the same clinic but did not develop symptoms of infection. All confirmed case-patients had S. marcescens bloodstream infections; 2 had concurrent S. marcescens central nervous system infections. Case-patients were more likely than controls to have procedures that used contrast solution or entered the epidural or intervertebral disc space (P< or =0.01 for each). All S. marcescens clinical isolates were indistinguishable by pulsed-field gel electrophoresis. We did not isolate S. marcescens from medications or environmental samples; however, S. marcescens was shown to survive and grow in contrast solution that was experimentally contaminated for up to 30 days. Single-dose vials of medication, including contrast solution, were used for multiple procedures; multiple medications were accessed with a common needle and syringe. DISCUSSION The findings of this investigation suggest contamination of a common medication, likely contrast solution, as the source of the outbreak. Practices, such as reusing single-dose medication vials and using a common needle and syringe to access multiple medications, could have led to contamination and propagation of S. marcescens and should be avoided in interventional pain management procedures.
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Kim MJ, Bancroft E, Lehnkering E, Donlan RM, Mascola L. Alcaligenes xylosoxidansBloodstream Infections in Outpatient Oncology Office. Emerg Infect Dis 2008. [PMCID: PMC2600348 DOI: 10.3201/eid1407.070894] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Gaps in infection control led to biofilm production in central venous catheters and resultant bloodstream infection. In 2002, we investigated a cluster of patients with Alcaligenes xylosoxidans bloodstream infections by conducting a matched case–control study and a prospective study. Pulsed-field gel electrophoresis (PFGE) was performed on blood culture isolates, and 1 explanted central venous catheter (CVC) was tested for biofilm. We identified 12 cases of A. xylosoxidans bloodstream infection. Case-patients were more likely than controls to have had a CVC (7/7 [100%] vs 4/47 [8.7%], respectively; p<0.0001). Ten case isolates were indistinguishable by PFGE analysis, and A. xylosoxidans biofilm from the CVC matched the outbreak strain. We observed multiple breaches in infection control, which may have caused contamination of multidose vials used to flush the CVCs. Our study links A. xylosoxidans with CVC biofilm and highlights areas for regulation and oversight in outpatient settings.
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Affiliation(s)
- Moon J. Kim
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Elizabeth Bancroft
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Eleanor Lehnkering
- Los Angeles County Department of Public Health, Los Angeles, California, USA
| | - Rodney M. Donlan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Laurene Mascola
- Los Angeles County Department of Public Health, Los Angeles, California, USA
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17
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18
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Tena D, Carranza R, Barberá JR, Valdezate S, Garrancho JM, Arranz M, Sáez-Nieto JA. Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a hemodialysis unit. Eur J Clin Microbiol Infect Dis 2006; 24:727-32. [PMID: 16283217 DOI: 10.1007/s10096-005-0028-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Achromobacter xylosoxidans is a rare cause of bacteremia. Over a 2-week period, A. xylosoxidans subsp. xylosoxidans was isolated from blood cultures of four hemodialysis patients with long-term intravascular catheters. A culture from one atomizer that contained diluted 2.5% chlorhexidine, which had been used to disinfect the skin, yielded A. xylosoxidans subsp. xylosoxidans. No further cases were diagnosed once the use of this atomizer was discontinued. Five outbreak-related strains from the four patients and the atomizer were tested by pulsed-field gel electrophoresis (PFGE) under XbaI restriction. The isolates from the first three patients and the atomizer had identical PFGE patterns, confirming the atomizer as the source of the outbreak. The strain isolated from the fourth patient had six more bands than the outbreak strain and was considered possibly related to the outbreak strain. All patients were treated with intravenous levofloxacin. The catheter was removed in only one patient. The three patients in whom the catheter was left in place were also treated with antibiotic lock therapy with levofloxacin. All four patients were cured. This is believed to be the first reported outbreak of central venous catheter-related bacteremia due to A. xylosoxidans and the second reported outbreak with this organism associated with chlorhexidine atomizers. The use of diluted chlorhexidine via atomizers can be dangerous for the care of venous catheters and should be called into question. Patients with long-term intravascular catheter-related bacteremia due to this organism can be treated successfully with systemic antimicrobial therapy in addition to antibiotic lock therapy without catheter removal.
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Affiliation(s)
- D Tena
- Laboratory of Microbiology, Hospital General La Mancha Centro, Avenida de la Constitución no. 3, 13600 Alcázar de San Juan, Ciudad Real, Spain.
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Gómez-Cerezo J, Suárez I, Ríos JJ, Peña P, García de Miguel MJ, de José M, Monteagudo O, Linares P, Barbado-Cano A, Vázquez JJ. Achromobacter xylosoxidans bacteremia: a 10-year analysis of 54 cases. Eur J Clin Microbiol Infect Dis 2003; 22:360-3. [PMID: 12750959 DOI: 10.1007/s10096-003-0925-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Fifty-four cases of Achromobacter xylosoxidans bacteremia diagnosed over a 10-year period in patients from 2 months to 87 years of age were reviewed. Fifty-two episodes were nosocomial. The most frequent underlying condition was neoplasm (solid or hematological). The source of infection was a contaminated intravenous catheter in 35 patients (60%) and pneumonia in 6 patients. Eight (15%) patients died. The only risk factors significantly associated with mortality were age over 65 years and neutropenia. The results of in vitro susceptibility studies of the isolates showed that antibiotic therapy with antipseudomonal penicillins or carbapenems would be a reasonable choice. An epidemiological study conducted in the hemodialysis unit showed Achromobacter xylosoxidans in tap water and on the hands of two healthcare workers but not in the hemodialysis systems. Patients were probably contaminated when healthcare workers manipulated the intravenous catheters without wearing gloves.
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Affiliation(s)
- J Gómez-Cerezo
- Department of Internal Medicine, Hospital Universitario La Paz, Po Castellana 261, 28046 Madrid, Spain
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20
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Knippschild M, Ansorg R. Epidemiological typing of Alcaligenes xylosoxidans subsp. xylosoxidans by antibacterial susceptibility testing, fatty acid analysis, PAGE of whole-cell protein and pulsed-field gel electrophoresis. ZENTRALBLATT FUR BAKTERIOLOGIE : INTERNATIONAL JOURNAL OF MEDICAL MICROBIOLOGY 1998; 288:145-57. [PMID: 9728414 DOI: 10.1016/s0934-8840(98)80113-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Antibacterial susceptibility testing, fatty acid analysis, protein analysis and DNA analysis of Alcaligenes xylosoxidans subsp. xylosoxidans were compared to determine the efficiency of the methods available for strain typing. Thirty isolates were investigated: 20 clinical isolates from a nonsocomial outbreak in Essen (Germany), 9 clinical isolates from sporadic nosocomial cases in Paris (France) and reference strain ATCC 2402. The highest microbiological discriminative power was exhibited by pulsed-field gel electrophoresis (PFGE) yielding nine types, followed by fatty acid methyl ester (FAME) analysis with six types, and antibacterial susceptibility testing and polyacrylamide gel electrophoresis with five types each. By combining the results of the four typing methods, 14 varieties could be differentiated. Protein analysis and fatty acid analysis failed to discriminate between isolates from Essen and Paris and the reference strain, while antibacterial susceptibility testing and DNA analysis clearly discriminated them. It is concluded that a combination of antibacterial susceptibility testing and PFGE typing is most suitable for epidemiological typing of Alcaligenes xylosoxidans subsp. xylosoxidans strains.
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Affiliation(s)
- M Knippschild
- Institut für Medizinische Mikrobiologie, Universität Essen, Germany
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21
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Granowitz EV, Keenholtz SL. A pseudoepidemic of Alcaligenes xylosoxidans attributable to contaminated saline. Am J Infect Control 1998; 26:146-8. [PMID: 9584810 DOI: 10.1016/s0196-6553(98)80035-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Alcaligenes xylosoxidans is an uncommon but serious cause of nosocomial epidemics. This report describes a cluster of two patients who underwent revision of hip arthroplasties and one patient who had a lumbar puncture. Cultures obtained during all three procedures showed A. xylosoxidans with similar antibiotic sensitivity patterns. An investigation found that saline used to process these specimens was contaminated with this organism.
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Affiliation(s)
- E V Granowitz
- Division of Infectious Diseases, Beverly Hospital, Massachusetts, USA
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22
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Lin YH, Liu PY, Shi ZY, Lau YJ, Hu BS. Comparison of polymerase chain reaction and pulsed-field gel electrophoresis for the epidemiological typing of Alcaligenes xylosoxidans subsp. xylosoxidans in a burn unit. Diagn Microbiol Infect Dis 1997; 28:173-8. [PMID: 9327244 DOI: 10.1016/s0732-8893(97)00062-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Eighteen isolates of Alcaligenes xylosoxidans subsp. xylosoxidans were collected from clinical specimens of 15 patients in a burn unit and a plastic surgery ward over a 16-month period. Pulsed-field gel electrophoresis and polymerase chain reaction (PCR) were compared for the epidemiologic typing of these 18 isolates and fifteen epidemiologically unrelated strains. These 18 isolates demonstrated an identical fingerprint pattern and were easily distinguished from the 15 epidemiologically unrelated strains by pulsed-field gel electrophoresis typing and both enterobacterial repetitive intergenic concensus and repetitive extragenic palindrome-primed PCR fingerprinting. We conclude that pulsed-field gel electrophoresis analysis of XbaI-digested genomic DNA is a highly discriminatory and reproducible method for epidemiological typing of A. xylosoxidans subsp. xylosoxidans isolates. However, poor resolution due to frequent cutting in the smaller fragments (< 145.5 Kb) may lead to difficulty in interpretation. PCR is a rapid and highly discriminatory, but less reproducible, technique with occasional loss of major bands. The fingerprints produced by repetitive extragenic palindrome primed PCR had more intense bands and were easier to read than those produced by enterobacterial repetitive intergenic concensus-primed PCR in this study.
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Affiliation(s)
- Y H Lin
- Section of Infectious Diseases, Taichung Veterans General Hospital, Taiwan
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Martino R, Martínez C, Pericas R, Salazar R, Solá C, Brunet S, Sureda A, Domingo-Albós A. Bacteremia due to glucose non-fermenting gram-negative bacilli in patients with hematological neoplasias and solid tumors. Eur J Clin Microbiol Infect Dis 1996; 15:610-5. [PMID: 8874083 DOI: 10.1007/bf01709374] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Twenty-six patients with hematological or solid tumors who developed bacteremia caused by Stenotrophomonas maltophilia (n = 10), Pseudomonas putida (n = 6), Sphingomonas paucimobilis complex (n = 4) or Alcaligenes xylosoxidans (n = 6) in the period between 1993 and 1995 were studied. Seventeen patients were neutropenic during the infection, and 13 were undergoing bone marrow or peripheral blood stem cell transplantation. Twenty-three patients had catheter-related infections; only 3 of the 26 patients developed septic complications (all due to Stenotrophomonas maltophilia). Twenty patients were cured following catheter removal, either as primary measure (n = 8) or salvage measure (n = 12). Four responded to antibiotic therapy only, and two died of septic complications. Such infections in hematological and oncological patients have increased in this hospital from no cases in 1975 to 11 cases in 1995.
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Affiliation(s)
- R Martino
- Unitat d'Hematologia Clinica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Decré D, Arlet G, Bergogne-Bérézin E, Philippon A. Identification of a carbenicillin-hydrolyzing beta-lactamase in Alcaligenes denitrificans subsp. xylosoxydans. Antimicrob Agents Chemother 1995; 39:771-4. [PMID: 7793891 PMCID: PMC162624 DOI: 10.1128/aac.39.3.771] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Eleven strains of Alcaligenes denitrificans subsp. xylosoxydans produced a beta-lactamase with a pI of 5.7 with kinetic data characteristic of a PSE-1-type enzyme. A CARB-type enzyme was identified by using an intragenic DNA probe of blaCARB. Hybridization of genomic DNA after XbaI restriction and pulsed-field electrophoresis suggested a chromosomal location for the gene.
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Affiliation(s)
- D Decré
- Service de Microbiologie, Hôpital Bichat-Claude Bernard, Paris, France
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25
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Cheron M, Abachin E, Guerot E, el-Bez M, Simonet M. Investigation of hospital-acquired infections due to Alcaligenes denitrificans subsp. xylosoxydans by DNA restriction fragment length polymorphism. J Clin Microbiol 1994; 32:1023-6. [PMID: 7913093 PMCID: PMC267173 DOI: 10.1128/jcm.32.4.1023-1026.1994] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
We demonstrate that DNA restriction fragment length polymorphism determined by pulsed-field gel electrophoresis is very useful in the investigation of the epidemiology of hospital-acquired infections caused by Alcaligenes denitrificans subsp. xylosoxydans. This approach showed that hospital-acquired infections caused by this opportunistic pathogen over a 6-month period in 10 patients hospitalized in an intensive care unit and a surgical unit were not a true outbreak. In addition, this molecular typing method established that the respiratory therapy equipment was the source of the contamination of two patients.
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Affiliation(s)
- M Cheron
- Laboratoire de Bactériologie-Virologie, Hôpital Boucicaut, Paris, France
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