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Outbreak of Shewanella algae and Shewanella putrefaciens Infections Caused by a Shared Measuring Cup in a General Surgery Unit in Korea

Published online by Cambridge University Press:  02 January 2015

Hyang Soon Oh
Affiliation:
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
Kyung Ah Kum
Affiliation:
Infection Control Service, Seoul National University Hospital, Seoul, Republic of Korea
Eui-Chong Kim
Affiliation:
Departments of Laboratory Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Hoan-Jong Lee*
Affiliation:
Department of Pediatrics, Seoul National University Hospital, Seoul, Republic of Korea
Kang Won Choe
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
Myoung Don Oh
Affiliation:
Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
*
Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Hospital, 28 Yongon-dong, Chongno-gu, Seoul, 110-744, Republic of Korea (hoanlee@snu.ac.kr)

Abstract

Objective.

To control an outbreak of Shewanella algae and S. putrefaciens infections by identifying the risk factors for infection and transmission.

Design.

Matched case-control study.

Setting.

A university-affiliated tertiary acute care hospital in Seoul, Republic of Korea, with approximately 1,600 beds.

Patients.

From June 20, 2003, to January 16, 2004, a total of 31 case patients with Shewanella colonization or infection and 62 control patients were enrolled in the study.

Interventions.

Requirement to use single-use measuring cups and standard precautions (including hand washing before and after patient care and use of gloves).

Results.

S. algae or S. putrefaciens was isolated from blood, for 9 (29.0%) of 31 patients who acquired one of the organisms; from bile, for 8 (25.8%), and from ascitic fluid, for 8 (25.8%). The attack rate of this outbreak was 5.8% (31 patients infected or colonized, of 534 potentially exposed on ward A) and the pathogenicity of the two species together was 77.4% (24 patients infected, of 31 who acquired the pathogens). The estimated incubation period for Shewanella acquisition was 3–49 days. Using logistic analysis, we identified the following risk factors: presence of external drainage catheters in the hepatobiliary system (odds ratio [OR], 20; P < .001), presence of hepatobiliary disease (OR, 6.4; P < .001), admission to the emergency department of the hospital (OR, 2.9; P = .039), wound classification of “contaminated” or “dirty or infected” (OR, 16.5; P = .012), an American Society of Anesthesiologists score of 3 or higher (OR, 8.0; P = .006), duration of stay in ward A (OR, 1.1; P < .001), and, for women, an age of 60–69 years (OR, 13.3; P = .028). A Shewanella isolate was recovered from the surface of a shared measuring cup, and 12 isolates of S. algae showed the same pulsed-field gel electrophoresis pattern.

Conclusions.

This Shewanella outbreak had a single-source origin and spread by contact transmission via a contaminated measuring cup. Shewanella species are emerging as potentially serious human pathogens in hospitals and could be included in hospital infection surveillance systems.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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