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Risk Factors for Epidemic Xanthomonas Maltophilia Infection/Colonization in Intensive Care Unit Patients

Published online by Cambridge University Press:  21 June 2016

Margarita E. Villarino ,
Lane E. Stevens ,
Barbara Schable ,
Gwendolyn Mayers ,
J. Michael Miller ,
John P. Burke  and
William R. Jarvis
Margarita E. Villarino*
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Lane E. Stevens
Affiliation:
Division of Infectious Disease, LDS Hospital, Salt Lake City, Utah
Barbara Schable
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
Gwendolyn Mayers
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
J. Michael Miller
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
John P. Burke
Affiliation:
Division of Infectious Disease, LDS Hospital, Salt Lake City, Utah
William R. Jarvis
Affiliation:
Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Georgia
*
Hospital Infections Program, Mailstop A-07, Centers for Disease Control, Atlanta GA, 30333
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Abstract

Objective:

To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.

Design:

Surveillance and cohort study.

Setting:

A 470-bed tertiary trauma-referral community hospital.

Patients:

From January 1, 1988 to March 17, 1989,106 intensive care unit patients developed X maltophilia infection/colonization. We defined a case as any intensive care unit patient who, from July 15, 1988, through March 17, 1989 (epidemic period), had X maltophilia infection/colonization ≥48 hours after intensive care unit admission. We identified 45 case patients and 103 control patients (persons in the shock-trauma intensive care unit for ≥72 hours during the epidemic period who had no X maltophilia-positive culture).

Results:

Cases were significantly more likely to occur in the shock-trauma intensive care unit than in all other intensive care units combined. Mechanical ventilation, tracheostomy, being transported to the hospital by airplane, and receipt of a higher mean number of antimicrobials were risk factors for X maltophilia infection/colonization. Risk of X maltophilia infection/colonization was significantly greater among cases exposed to a patient with a X maltophilia surgical wound infection than among those without such exposure (relative risk= 1.3, p= .03). Animate and inanimate cultures revealed X maltophilia contamination of the hospital room of a patient with an X maltophilia surgical wound infection, of respiratory therapy equipment in this patient% room, of respirometers shared between patients, and of shock-trauma intensive care unit personnel’s hands. Related environmental and clinical isolates were serotype 10.

Conclusions:

Mechanically ventilated patients receiving antimicrobials in the shock-trauma intensive care unit were at increased risk of X maltophilia infection/colonization. Patients with draining X maltophilia surgical wound infections served as reservoirs for X maltophilia, and contamination of the respirometers and the hands of shock-trauma intensive care unit personnel resulted in patient-to-patient transmission of X maltophilia.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 13 , Issue 4 , April 1992 , pp. 201 - 206
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1992

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