Alcaligenes xylosoxidans Bloodstream Infections in Outpatient Oncology

Table.

Characteristics of 12 Case-patients With Bacteremia Caused by Alcaligenes xylosoxidans*

Figure 1.

Scanning electron micrograph of lumen of segment of central venous catheter removed from an asymptomatic patient. Biofilm contains rod-shaped bacteria (Alcaligenes xylosoxidans) in association with fibrinlike material on the catheter surface.

Figure 2.

Pulsed-field gel electrophoresis of isolates from patients with Alcaligenes xylosoxidans bloodstream infection. Lane 1, laboratory standard; lanes 2 and 6, community strains of A. xylosoxidans; lanes 3–5 and 7–13, outbreak strains; lane 14, central venous catheter (CVC) port biofilm outbreak strain; lane 15, CVC port outbreak stain.

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Author(s)

Moon Kim, MD, MPH

Los Angeles County Department of Public Health, Los Angeles, California

Disclosures

Disclosure: Moon Kim, MD, MPH, has disclosed no relevant financial relationships.

Elizabeth Bancroft, MD, SM

Los Angeles County Department of Public Health, Los Angeles, California

Disclosures

Disclosure: Elizabeth Bancroft, MD, SM, has disclosed no relevant financial relationships.

Eleanor Lehnkering, MS

Los Angeles County Department of Public Health, Los Angeles, California

Disclosures

Disclosure: Eleanor Lehnkering, MS, has disclosed no relevant financial relationships.

Rodney M. Donlan, PhD

Centers for Disease Control and Prevention, Atlanta, Georgia

Disclosures

Disclosure: Rodney M. Donlan, PhD, has disclosed no relevant financial relationships.

Laurene Mascola, MD, MPH

Los Angeles County Department of Public Health, Los Angeles, California

Disclosures

Disclosure: Laurene Mascola, MD, MPH, has disclosed that she has served has an advisor or consultant to Merck and MedImmune. Dr. Mascola has also disclosed that she has served as a speaker for Merck.

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Abstract and Introduction

Abstract

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.

Introduction

Alcaligenes xylosoxidans, also known as Achromobacter xylosoxidans, is a gram-negative, water-borne organism that causes healthcare-associated infections^[1-7] and bacteremia in immunocompromised patients with indwelling catheters;^[6-11] it can also contaminate liquids.^[2,5,12-14]A. xylosoxidans is found in soil and water and grows in saline.^[15,16] On January 16, 2002, the Acute Communicable Disease Control (ACDC) program of the Los Angeles County Department of Public Health was notified by a local hospital epidemiologist about a cluster of patients with A. xylosoxidans bloodstream infections.^[17] The patients had been admitted to Hospital A over a period of 2 months.

To confirm the presence of an outbreak, ACDC conducted a telephone survey, which asked the microbiology laboratories of Hospital A and 4 surrounding hospitals for a list of all patients who had had positive blood cultures for A. xylosoxidans in the past 3 months. One laboratory identified 3 such patients, and Hospital A laboratory identified 7; all 9 patients (1 case-patient had positive blood cultures reported from both laboratories) were associated with a single outpatient oncology office, Office B. The other 3 hospitals reported that they had not identified any A. xylosoxidans bloodstream infections in the past 3 months. To identify the source of the outbreak and risk factors for infection and to implement control measures, ACDC then initiated an outbreak investigation.

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Alcaligenes xylosoxidans Bloodstream Infections in Outpatient Oncology Office

Abstract and Introduction

Abstract

Introduction

Table of Contents

Table.

Figure 1.

Figure 2.

References

Faculty and Disclosures

Author(s)

Moon Kim, MD, MPH

Elizabeth Bancroft, MD, SM

Eleanor Lehnkering, MS

Rodney M. Donlan, PhD

Laurene Mascola, MD, MPH

Alcaligenes xylosoxidans Bloodstream Infections in Outpatient Oncology Office

Abstract and Introduction

Abstract

Introduction

Table of Contents