title: Risk factors for epidemic Xanthomonas maltophilia infection/colonization in intensive care unit patients.
abstract: OBJECTIVE
  To determine risk factors for and modes of transmission of Xanthomonas maltophilia infection/colonization.
  
  
  METHODS
  Surveillance and cohort study.
  
  
  METHODS
  A 470-bed tertiary trauma-referral community hospital.
  
  
  METHODS
  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 greater than or equal to 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 greater than or equal to 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's 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.
authors.affiliation: National Center for Infectious Diseases, Centers for Disease Control, Atlanta, GA 30333.
authors.forename: M E
authors.initials: ME
authors.lastname: Villarino
authors.forename: L E
authors.initials: LE
authors.lastname: Stevens
authors.forename: B
authors.initials: B
authors.lastname: Schable
authors.forename: G
authors.initials: G
authors.lastname: Mayers
authors.forename: J M
authors.initials: JM
authors.lastname: Miller
authors.forename: J P
authors.initials: JP
authors.lastname: Burke
authors.forename: W R
authors.initials: WR
authors.lastname: Jarvis
mesh_terms: D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D004197:Disease Reservoirs; D016905:Gram-Negative Bacterial Infections / Q000453:epidemiology*; D006745:Hospital Bed Capacity, 300 to 499; D006764:Hospitals, Community; D006801:Humans; D017053:Infection Control; D007362:Intensive Care Units; D011159:Population Surveillance; D012307:Risk Factors; D014589:Utah / Q000453:epidemiology; D014974:Xanthomonas / Q000254:growth & development