Hostname: page-component-76fb5796d-zzh7m Total loading time: 0 Render date: 2024-04-26T02:29:31.718Z Has data issue: false hasContentIssue false
  • English
  • Français

A Pseudo-Outbreak due to Acinetobacter Species (GIM-1) Contamination of the Pneumatic Transport System of a Large University Hospital

Published online by Cambridge University Press:  10 May 2016

Mathias Herrmann ,
Sven Jungmann ,
Alexander Halfmann ,
Alik Dawson ,
Martin Kaase ,
Sören Gatermann ,
Lutz von Müller  and
Barbara C. Gärtner
Mathias Herrmann*
Affiliation:
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
Sven Jungmann
Affiliation:
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
Alexander Halfmann
Affiliation:
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
Alik Dawson
Affiliation:
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
Martin Kaase
Affiliation:
Institute of Medical Microbiology, Ruhr University Bochum, Bochum, Germany
Sören Gatermann
Affiliation:
Institute of Medical Microbiology, Ruhr University Bochum, Bochum, Germany
Lutz von Müller
Affiliation:
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
Barbara C. Gärtner
Affiliation:
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg, Germany
*
Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Kirrberger Strasse 100, Building 43, 66421 Homburg, Germany (mathias.herrmann@uks.eu).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To establish the source and contamination routes resulting in positive clinical and surveillance microbiological cultures with carbapenem-resistant, GIM-1 metallo-β-lactamase–positive Acinetobacter pitii and Acinetobacter radioresistens from 21 patients in 8 departments

Design.

Retrospective, descriptive study.

Setting.

A 1,300-bed tertiary care academic medical facility consisting of 90 buildings linked by a pneumatic transport system (PTS).

Methods.

Microbiological workup of the cluster strains included matrix-assisted laser desorption/ionization time-of-flight species identification, phenotypic carbapenemase tests, polymerase chain reaction–based genotyping of carbapenemase, and pulsed-field gel electrophoresis. Outbreak management procedures were employed according to institutional regulations.

Results.

The rarity of GIM-1 Acinetobacter species in the hospital and region, the lack of epidemiological links between patients, and the fact that in some patients the apparent colonization was clearly nonnosocomial prompted the suspicion of a pseudo-outbreak. Numerous environmental cultures were positive for GIM-1-positive Acinetobacter (including archived sample requisition forms, PTS capsules, cultures from line-diverter and dispenser stations, and sterilized transport capsules following PTS delivery). Moreover, it was observed that condensation fluid from subterranean PTS tubing resulted in water entry in PTS capsules, possibly conferring specimen contamination. After extensive system disinfection, environmental surveys of the PTS were negative, and no further positive patient specimens were encountered.

Conclusions.

This is the first report of a PTS-associated pseudo-outbreak. The large number of falsely positive patient-related specimens in conjunction with the potential hazard of airborne and contact spread of multidrug-resistant microorganisms (in this case, GIM-1 carbapenem-resistant Acinetobacter species) underscores the need for implementation of infection control–based monitoring and operating procedures in a hospital PTS.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 11 , November 2014 , pp. 1364 - 1372
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Savard, P, Perl, TM. A call for action: managing the emergence of multidrug-resistant Enterobacteriaceae in the acute care settings. Curr Opin Infect Dis 2012;25:371–377.Google Scholar
2. Glasner, C, Albiger, B, Buist, G, et al. Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. Euro Surveill 2013;18:pii=20525.Google Scholar
3. Steinmann, J, Kaase, M, Gatermann, S, et al. Outbreak due to a Klebsiella pneumoniae strain harbouring KPC-2 and VIM-1 in a German university hospital, July 2010 to January 2011. Euro Surveill 2011;16:pii=19944.Google Scholar
4. Wendt, C, Schutt, S, Dalpke, AH, et al. First outbreak of Klebsiella pneumoniae carbapenemase (KPC)–producing K. pneumoniae in Germany. Eur J Clin Microbiol Infect Dis 2010;29:563–570.CrossRefGoogle ScholarPubMed
5. Kaase, M, Szabados, F, Pfennigwerth, N, et al. Description of the metallo-β-lactamase GIM-1 in Acinetobacter pittii . J Antimicrob Chemother 2014;69:81–84.Google Scholar
6. Hamprecht, A, Poirel, L, Gottig, S, Seifert, H, Kaase, M, Nordmann, P. Detection of the carbapenemase GIM-1 in Enterobacter cloacae in Germany. J Antimicrob Chemother 2013;68:558–561.Google Scholar
7. Herrmann, M, Petit, C, Dawson, A, et al. Methicillin-resistant Staphylococcus aureus in Saarland, Germany: a statewide admission prevalence screening study. PLoS ONE 2013;8:e73876.Google Scholar
8. Pitout, JD, Gregson, DB, Poirel, L, McClure, JA, Le, P, Church, DL. Detection of Pseudomonas aeruginosa producing metallo-β-lactamases in a large centralized laboratory. J Clin Microbiol 2005;43:3129–3135.Google Scholar
9. Kaase, M, Szabados, F, Wassill, L, Gatermann, SG. Detection of carbapenemases in Enterobacteriaceae by a commercial multiplex PCR. J Clin Microbiol 2012;50:3115–3118.Google Scholar
10. Castanheira, M, Toleman, MA, Jones, RN, Schmidt, FJ, Walsh, TR. Molecular characterization of a β-lactamase gene, bla GIM-1, encoding a new subclass of metallo-β-lactamase. Antimicrob Agents Chemother 2004;48:4654–4661.Google Scholar
11. Woodford, N, Ellington, MJ, Coelho, JM, et al. Multiplex PCR for genes encoding prevalent OXA carbapenemases in Acinetobacter spp. Int J Antimicrob Agents 2006;27:351–353.Google Scholar
12. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
13. Gomez-Rioja, R, Fernandez-Calle, P, Alcaide, MJ, et al. Interindividual variability of hemolysis in plasma samples during pneumatic tube system transport. Clin Chem Lab Med 2013;51:e231–e233.CrossRefGoogle ScholarPubMed
14. Lance, MD, Kuiper, GJ, Sloep, M, et al. The effects of pneumatic tube system transport on ROTEM analysis and contact activation assessed by thrombin generation test. Thromb Res 2012;130:e147–e150.CrossRefGoogle ScholarPubMed
15. Dickinson, H, Webb, NJ, Chaloner, C, Wynn, RF, Bonney, DK. Pseudohyperkalaemia associated with leukaemic cell lysis during pneumatic tube transport of blood samples. Pediatr Nephrol 2012;27:1029–1031.CrossRefGoogle ScholarPubMed
16. Wallin, O, Soderberg, J, Grankvist, K, Jonsson, PA, Hultdin, J. Preanalytical effects of pneumatic tube transport on routine haematology, coagulation parameters, platelet function and global coagulation. Clin Chem Lab Med 2008;46:1443–1449.Google Scholar
17. Stadler, S. Pneumatic tube system: optimum approach to stat specimen transport. MLO Med Lab Obs 1989;21:55–52.Google ScholarPubMed
18. Alpat, SN, Ozgüneş, I, Aybey, AD, Ertem, OT, Akşit, F. Is pneumatic sample transport system also a carrier for microorganisms? [in Turkish]. Mikrobiyol Bul 2009;43:449–455.Google ScholarPubMed