title: A cluster of nosocomial Klebsiella oxytoca bloodstream infections in a university hospital.
abstract: BACKGROUND
  On February 19, 2003, four patients (patients 1-4) in the neurology ward underwent cranial magnetic resonance angiography (MRA) and developed fever within 1 hour afterward. Klebsiella oxytoca was isolated from blood cultures of patients 1 through 3.
  
  
  OBJECTIVE
  To identify the source of this cluster of nosocomial K. oxytoca bloodstream infections.
  
  
  METHODS
  Outbreak investigation.
  
  
  METHODS
  A 1,000-bed university hospital.
  
  
  METHODS
  The infection control team reviewed patient charts and interviewed nursing staff about the preparation and administration of parenteral fluids. The procedure of cranial MRA was observed. Arbitrarily primed polymerase chain reaction (AP-PCR) was performed to show the clonal relationship among these three strains.
  
  
  RESULTS
  AP-PCR revealed that three K. oxytoca isolates had the same molecular profile. Cranial MRA was found to be the only common source among these patients. During MRA, before injection of the contrast medium, normal saline solution was infused to check the functioning of the intravenous catheter. Use of the solution for multiple patients was routine, but the access diaphragm of the bottle was not cleansed. The bottle of normal saline solution used on February 19 had already been discarded and the culture sample taken from the solution on the day of observation was sterile.
  
  
  CONCLUSIONS
  We speculate that normal saline solution became contaminated during manipulation and that successive uses might have been responsible for this cluster. Poor aseptic techniques employed during successive uses appear to be the most likely route of contamination. Use of parenteral solutions for multiple patients was discontinued.
authors.affiliation: Department of Medicine, Section of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey.
authors.forename: Yesim Cetinkaya
authors.initials: YC
authors.lastname: Sardan
authors.forename: Pinar
authors.initials: P
authors.lastname: Zarakolu
authors.forename: Belgin
authors.initials: B
authors.lastname: Altun
authors.forename: Aycan
authors.initials: A
authors.lastname: Yildirim
authors.forename: Gonul
authors.initials: G
authors.lastname: Yildirim
authors.forename: Gulsen
authors.initials: G
authors.lastname: Hascelik
authors.forename: Omrum
authors.initials: O
authors.lastname: Uzun
mesh_terms: D000368:Aged; D016470:Bacteremia / Q000382:microbiology / Q000635:transmission*; D002675:Child, Preschool; D016000:Cluster Analysis; D003428:Cross Infection / Q000382:microbiology / Q000635:transmission*; D004196:Disease Outbreaks; D004866:Equipment Contamination; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology / Q000635:transmission*; D041121:Klebsiella oxytoca / Q000302:isolation & purification; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction; D012965:Sodium Chloride
chemical_list: D012965:Sodium Chloride