title: An outbreak of hemodialysis catheter-related bacteremia with sepsis caused by Streptococcus agalactiae in a hemodialysis unit.
abstract: 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.
authors.affiliation: Internal Medicine, Division of Infectious Diseases, Evaggelismos General Hospital, Ipsilantou 45-47, Athens, Attiki 10676, Greece. ioannisbaraboutis@yahoo.gr
authors.forename: Ioannis G
authors.initials: IG
authors.lastname: Baraboutis
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Doris
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Papanikolaou
authors.forename: Eleftheria P
authors.initials: EP
authors.lastname: Tsagalou
authors.forename: Konstantina
authors.initials: K
authors.lastname: Chatsiou
authors.forename: Evripidis
authors.initials: E
authors.lastname: Papathanasiou
authors.forename: Evaggelia
authors.initials: E
authors.lastname: Platsouka
authors.forename: Vassilios
authors.initials: V
authors.lastname: Papastamopoulos
authors.forename: Helen
authors.initials: H
authors.lastname: Belesiotou
authors.forename: Theofanis
authors.initials: T
authors.lastname: Apostolou
authors.forename: Olga
authors.initials: O
authors.lastname: Paniara
authors.forename: Athanasios T
authors.initials: AT
authors.lastname: Skoutelis
mesh_terms: 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