title: [An outbreak of gram-negative bacteremia (GNB), especially enterobacter cloacae, in patients with long-term tunnelled haemodialysis catheters].
abstract: Vascular access through a venous catheter for haemodialysis is associated with increased risk of thrombosis, central venous stenosis, short access survival and inadequate dialysis. The most important catheter-related complications, which determine method survival, are infection and dysfunction. In particular, infectious episodes are in some studies the leading cause for untimely catheter removal and for catheter-related morbidity but also for morbidity in dialysis patients. Double-lumen central venous catheters used for haemodialysis, are common causes of septicaemia. Most cases are caused by staphylococci. Episodes of gram-negative bacteriemia have been traced to bacterial contamination of water and/or dialysate, errors in dialyzer reprocessing, and improper setup procedures. In this paper, we describe and outbreak of gram-negative bacteremia, firstly E. cloacae, in an outpatients haemodialysis unit, in the patients with long-term tunnelled haemodialysis catheters. We describe the epidemic investigation that we achieved to identify the source of contaminating bacteria and the route by which bacteria gained access to the bloodstream. We prove the contamination by gram-negative bacterium of the water-distribution lines and haemodialysis machines. Moreover, E. cloacae strains isolated from the lines and machines are genotypically identical to the isolated from the patients. Also, we prove that the hands of health care personnel are unintentional carriers. The outbreak was finished when decontamination of dialysis machines was enhanced and dialyzer-priming fluid was modified.
authors.affiliation: Unidad de Nefrología, Corporación Parc Taulí, Sabadell.
authors.forename: A
authors.initials: A
authors.lastname: Rodríguez Jornet
authors.forename: M
authors.initials: M
authors.lastname: García García
authors.forename: D
authors.initials: D
authors.lastname: Mariscal
authors.forename: D
authors.initials: D
authors.lastname: Fontanals
authors.forename: P
authors.initials: P
authors.lastname: Cortés
authors.forename: P
authors.initials: P
authors.lastname: Coll
authors.forename: J
authors.initials: J
authors.lastname: Falcó
authors.forename: N
authors.initials: N
authors.lastname: Ramírez
authors.forename: S
authors.initials: S
authors.lastname: Mayor
authors.forename: N
authors.initials: N
authors.lastname: Mañé
authors.forename: X
authors.initials: X
authors.lastname: Miret
authors.forename: E
authors.initials: E
authors.lastname: Yuste
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D002408:Catheters, Indwelling / Q000382:microbiology*; D004196:Disease Outbreaks; D016972:Enterobacter cloacae / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects / Q000295:instrumentation; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D014871:Water Microbiology; D014881:Water Supply