An outbreak of hemodialysis catheter-related bacteremia with sepsis caused by Streptococcus agalactiae in a hemodialysis unit.
BACKGROUND
Rates of invasive group B Streptococcus (GBS; Streptococcus agalactiae) disease in adults are on the rise. Invasive GBS disease can be community- or healthcare-associated. We report an outbreak of GBS catheter-related bacteremia in a hemodialysis (HD) unit.


METHODS
Two patients undergoing HD at the same outpatient HD unit were admitted on the same day (within a few hours of each other) with catheter-related GBS bacteremia. A retrospective study was undertaken at the HD unit to address risk factors for febrile illness on the last HD session day. A detailed questionnaire was completed by all HD patients treated on the same day as the two GBS patients and by all members of the nursing and medical staff. Medical and nursing records of the HD unit were reviewed, as well as infection control and catheter care practices. Patients and staff members submitted swabs for culture.


RESULTS
No rectal or vaginal culture of any HD patient or staff member was positive for GBS. The development of recent febrile disease was significantly associated with the presence of a hemodialysis catheter (p=0.028) and care for more than 30min by a specific nurse during the last two HD sessions (p=0.007).


CONCLUSIONS
We speculate that the GBS strain was transmitted from one patient to the other through the hands of medical personnel. No such outbreak has ever been reported in HD patients. The importance of strict infection control practices in HD units and the avoidance of catheters for long-term HD should be emphasized.
Baraboutis
Ioannis G
IG
Internal Medicine, Division of Infectious Diseases, Evaggelismos General Hospital, Ipsilantou 45-47, Athens, Attiki 10676, Greece. ioannisbaraboutis@yahoo.gr
Doris
Konstantinos
K
Papanikolaou
Konstantinos
K
Tsagalou
Eleftheria P
EP
Chatsiou
Konstantina
K
Papathanasiou
Evripidis
E
Platsouka
Evaggelia
E
Papastamopoulos
Vassilios
V
Belesiotou
Helen
H
Apostolou
Theofanis
T
Paniara
Olga
O
Skoutelis
Athanasios T
AT
D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D002408:Catheters, Indwelling / Q000382:microbiology*; D004196:Disease Outbreaks; D005260:Female; D006115:Greece / Q000453:epidemiology; D006436:Hemodialysis Units, Hospital / Q000458:organization & administration; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000379:methods; D013290:Streptococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D011795:Surveys and Questionnaires