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Pseudo-Outbreak of Klebsiella oxytoca Spontaneous Bacterial Peritonitis Attributed to Contamination of Multidose Vials of Culture Medium Supplement

Published online by Cambridge University Press:  10 May 2016

Federico Perez ,
Abhishek Deshpande ,
Sirisha Kundrapu ,
Andrea M. Hujer ,
Robert A. Bonomo  and
Curtis J. Donskey
Federico Perez*
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
Abhishek Deshpande
Affiliation:
Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
Sirisha Kundrapu
Affiliation:
Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
Andrea M. Hujer
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
Robert A. Bonomo
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
Curtis J. Donskey
Affiliation:
Research Service, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, Ohio Department of Medicine, Division of Infectious Diseases, Case Western Reserve University School of Medicine, Cleveland, Ohio
*
Infectious Diseases Section 1110 (W), Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, OH 44106 (perezfederico@yahoo.com)
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Abstract

Objective.

To determine the source of a cluster of Klebsiella oxytoca isolates cultured from peritoneal fluid of 3 patients with cirrhosis on a single day.

Design.

Outbreak investigation and before-after study.

Setting.

A Veterans Affairs medical center.

Methods.

Epidemiologic investigation, analysis of antimicrobial susceptibility testing results and molecular typing of K. oxytoca isolates with repetitive sequence-based polymerase chain reaction (rep-PCR), review of microbiology laboratory procedures for processing peritoneal fluid cultures, and comparison of peritoneal fluid contamination rates 18 months before and after modification of laboratory procedures for culturing peritoneal fluid.

Results.

Each of the peritoneal fluid samples that grew K. oxytoca was inoculated into blood culture bottles by different clinicians at different hospital locations. None of the patients had clinical findings suggestive of peritonitis or elevated polymorphonuclear cell counts in peritoneal fluid (range, 3-25 cells/μL). Molecular typing with rep-PCR demonstrated that the K. oxytoca isolates were genetically related (greater than 95% similarity). Laboratory procedures included the routine addition of a culture medium supplement of yeast extract and dextrose from a multidose vial into blood culture bottles with peritoneal fluid. After discontinuing use of the culture medium supplement, there was a marked reduction in the number of peritoneal fluid cultures deemed as contaminants (14.3% vs 0.9%; P <.001).

Conclusion.

A pseudo-outbreak of K. oxytoca peritonitis and high rates of contamination of peritoneal fluid were attributable to contamination of a multidose culture medium supplement. This article highlights the importance of discouraging the use of multidose vials in all clinical settings.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 2 , February 2014 , pp. 139 - 143
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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