Abstract
| Original language | English |
|---|---|
| Journal | Antimicrobial Resistance and Infection Control |
| Volume | 6 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 2017 |
Keywords
- Carbapenem resistance
- Central venous catheter
- Oncologic patients
- Outbreak
- Ralstonia mannitolilytica
- beta lactamase AmpC
- carbapenem
- RNA 16S
- adult
- aged
- antibiotic resistance
- Article
- bacterial colonization
- bacterium identification
- bacterium isolation
- chill
- clinical article
- controlled study
- enzyme activity
- female
- fever
- Gram negative infection
- high risk patient
- human
- male
- middle aged
- nonhuman
- oncology
- phenotype
- pulsed field gel electrophoresis
- Ralstonia
- Ralstonia mannitolilytica infection
- RNA sequence
- very elderly
- ward
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Ralstonia mannitolilytica infections in an oncologic day ward: Description of a cluster among high-risk patients. / Lucarelli, C.; Di Domenico, E.G.; Toma, L.; Bracco, D.; Prignano, G.; Fortunati, M.; Pelagalli, L.; Ensoli, F.; Pezzotti, P.; Garc�a-Fern�ndez, A.; Pantosti, A.; Ingrosso, L.
In: Antimicrobial Resistance and Infection Control, Vol. 6, No. 1, 2017.Research output: Contribution to journal › Article › peer-review
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TY - JOUR
T1 - Ralstonia mannitolilytica infections in an oncologic day ward: Description of a cluster among high-risk patients
AU - Lucarelli, C.
AU - Di Domenico, E.G.
AU - Toma, L.
AU - Bracco, D.
AU - Prignano, G.
AU - Fortunati, M.
AU - Pelagalli, L.
AU - Ensoli, F.
AU - Pezzotti, P.
AU - Garc�a-Fern�ndez, A.
AU - Pantosti, A.
AU - Ingrosso, L.
N1 - Export Date: 10 April 2018 Correspondence Address: Lucarelli, C.; European Centre for Disease Prevention and Control, (ECDC), European Program for Public Health Microbiology Training (EUPHEM)Sweden; email: claudia.lucarelli@iss.it Chemicals/CAS: carbapenem, 83200-96-8 References: Ryan, M.P., Adley, C.C., Ralstonia spp.: emerging global opportunistic pathogens (2014) Eur J Clin Microbiol Infect Dis, 33 (3), pp. 291-304; Gr�bner, S., Heeg, P., Autenrieth, I.B., Schulte, B., Monoclonal outbreak of catheter-related bacteraemia by Ralstonia mannitolilytica on two haemato-oncology wards (2007) J Infect, 55 (6), pp. 539-544; Mikulska, M., Durando, P., Molinari, M.P., Alberti, M., Del Bono, V., Dominietto, A., Outbreak of Ralstonia pickettii bacteraemia in patients with haematological malignancies and haematopoietic stem cell transplant recipients (2009) J Hosp Infect, 72 (2), pp. 187-188; Daxboeck, F., Stadler, M., Assadian, O., Marko, E., Hirschl, A.M., Koller, W., Characterization of clinically isolated Ralstonia mannitolilytica strains using random amplification of polymorphic DNA (RAPD) typing and antimicrobial sensitivity, and comparison of the classification efficacy of phenotypic and genotypic assays (2005) J Med Microbiol, 54, pp. 55-61; Ann, H.M., An unusual case of bacterial meningitis caused by Burkholderia pickettii (1998) Clin Microbiol Newsl, pp. 102-103; Bonatti, H., Stelzmueller, I., Laimer, I., Obwegeser, A., Ralstonia pickettii meningitis in a child with hydrocephalus (2009) Eur J Pediatr Surg, 19 (5), pp. 341-342; Marroni, M., Pasticci, M.B., Pantosti, A., Colozza, M.A., Stagni, G., Tonato, M., Outbreak of infusion-related septicemia by Ralstonia pickettii in the Oncology Department (2003) Tumori, 89 (5), pp. 575-576; Weist, K., Stolze, H., Sohr, D., Wickmann, L., Liebeskind, A.K., R�den, H., P14.03 Ralstonia pickettii septicemia in pediatric oncology patients associated with the use of contaminated heparin-saline-solution (2006) J Hosp Infect, 64, p. 74; Pasticci, M.B., Baldelli, F., Camilli, R., Cardinali, G., Colozza, A., Marroni, M., Pulsed field gel electrophoresis and random amplified polymorphic DNA molecular characterization of Ralstonia pickettii isolates from patients with nosocomial central venous catheter related bacteremia (2005) New Microbiol, 28 (2), pp. 145-149; 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(2014) The Joint Commission, (52). , https://www.jointcommission.org/assets/1/6/SEA_52.pdf, June 16 Accessed 9 Jan 2017; (2017), https://www.cdc.gov/injectionsafety/cdcposition-singleusevial.html, Accessed 9 Jan; Dotis, J., Printza, N., Orfanou, A., Papathanasiou, E., Papachristou, F., Peritonitis due to Ralstonia mannitolilytica in a pediatric peritoneal dialysis patient (2012) New Microbiol, 35 (4), pp. 503-506; Maroye, P., Doermann, H.P., Rogues, A.M., Gachie, J.P., M�graud, F., Investigation of an outbreak of Ralstonia pickettii in a paediatric hospital by RAPD (2000) J Hosp Infect, 44 (4), pp. 267-272; Vaneechoutte, M., De Baere, T., Wauters, G., Steyaert, S., Claeys, G., Vogelaers, D., One case each of recurrent meningitis and hemoperitoneum infection with Ralstonia mannitolilytica (2001) J Clin Microbiol, 39 (12), pp. 4588-4590; Nordmann, P., Poirel, L., Kubina, M., Casetta, A., Naas, T., Biochemical-genetic characterization and distribution of OXA-22, a chromosomal and inducible class D beta-lactamase from Ralstonia (Pseudomonas) pickettii (2000) Antimicrob Agents Chemother, 44 (8), pp. 2201-2204; 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PY - 2017
Y1 - 2017
N2 - Background: Ralstonia spp, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by Ralstonia mannitolilytica in oncology patients. Methods: Case definition: Oncology outpatients attending a day ward, with positive blood and/or central venous catheter (CVC) culture for Ralstonia spp from September 2013 - June 2014. We analysed medical records, procedures and environmental samples. R. mannitolilytica was identified by 16S rRNA sequencing, and typed by Pulsed Field Gel Electrophoresis (PFGE); resistance to carbapenemes was investigated by phenotypic and molecular methods. Results: The patients (N=22) had different malignancies and received different therapy; all had a CVC and 16 patients presented chills and/or fever. R. mannitolilytica was isolated from both blood and CVC (n=12) or only blood (n=6) or CVC tips (n=4). The isolates had indistinguishable PFGE profile, and showed resistance to carbapenems. All the isolates were negative for carbapenemase genes while phenotypic tests suggests the presence of an AmpC β-lactamase activity,responsible for carbapenem resistance. All patients had had CVC flushed with saline to keep the venous access pervious or before receiving chemotherapy at various times before the onset of symptoms. After the first four cases occurred, the multi-dose saline bottles used for CVC flushing were replaced with single-dose vials; environmental samples were negative for R. mannitolilytica. Conclusions: Although the source of R. mannitolilytica remains unidentified, CVC flushing with contaminated saline solution seems to be the most likely origin of R. mannitolilytica CVC colonization and subsequent infections. In order to prevent similar outbreaks we recommend removal of any CVC that is no longer necessary and the use of single-dose solutions for any parenteral treatment of oncology patients. � 2017 The Author(s).
AB - Background: Ralstonia spp, an environmental microorganism, has been occasionally associated with healthcare infections. The aim of this study was to investigate an outbreak caused by Ralstonia mannitolilytica in oncology patients. Methods: Case definition: Oncology outpatients attending a day ward, with positive blood and/or central venous catheter (CVC) culture for Ralstonia spp from September 2013 - June 2014. We analysed medical records, procedures and environmental samples. R. mannitolilytica was identified by 16S rRNA sequencing, and typed by Pulsed Field Gel Electrophoresis (PFGE); resistance to carbapenemes was investigated by phenotypic and molecular methods. Results: The patients (N=22) had different malignancies and received different therapy; all had a CVC and 16 patients presented chills and/or fever. R. mannitolilytica was isolated from both blood and CVC (n=12) or only blood (n=6) or CVC tips (n=4). The isolates had indistinguishable PFGE profile, and showed resistance to carbapenems. All the isolates were negative for carbapenemase genes while phenotypic tests suggests the presence of an AmpC β-lactamase activity,responsible for carbapenem resistance. All patients had had CVC flushed with saline to keep the venous access pervious or before receiving chemotherapy at various times before the onset of symptoms. After the first four cases occurred, the multi-dose saline bottles used for CVC flushing were replaced with single-dose vials; environmental samples were negative for R. mannitolilytica. Conclusions: Although the source of R. mannitolilytica remains unidentified, CVC flushing with contaminated saline solution seems to be the most likely origin of R. mannitolilytica CVC colonization and subsequent infections. In order to prevent similar outbreaks we recommend removal of any CVC that is no longer necessary and the use of single-dose solutions for any parenteral treatment of oncology patients. � 2017 The Author(s).
KW - Carbapenem resistance
KW - Central venous catheter
KW - Oncologic patients
KW - Outbreak
KW - Ralstonia mannitolilytica
KW - beta lactamase AmpC
KW - carbapenem
KW - RNA 16S
KW - adult
KW - aged
KW - antibiotic resistance
KW - Article
KW - bacterial colonization
KW - bacterium identification
KW - bacterium isolation
KW - chill
KW - clinical article
KW - controlled study
KW - enzyme activity
KW - female
KW - fever
KW - Gram negative infection
KW - high risk patient
KW - human
KW - male
KW - middle aged
KW - nonhuman
KW - oncology
KW - phenotype
KW - pulsed field gel electrophoresis
KW - Ralstonia
KW - Ralstonia mannitolilytica infection
KW - RNA sequence
KW - very elderly
KW - ward
U2 - 10.1186/s13756-017-0178-z
DO - 10.1186/s13756-017-0178-z
M3 - Article
VL - 6
JO - Antimicrobial Resistance and Infection Control
JF - Antimicrobial Resistance and Infection Control
SN - 2047-2994
IS - 1
ER -