Pseudomonas aeruginosa outbreak in a pediatric intensive care unit linked to a humanitarian organization residential center.
BACKGROUND
Pseudomonas aeruginosa commonly colonizes the hospital environment. Between April 2006 and September 2008, we investigated an outbreak of P. aeruginosa infection occurring in a pediatric intensive care unit. We conducted epidemiologic and molecular investigations to identify the source of the outbreak.


METHODS
Retrospective case finding; surveillance cultures of patients and environmental sites; admission screening; case-control study; and molecular typing.


METHODS
Infants and children in a pediatric intensive care unit of a tertiary-care institution.


RESULTS
Thirty-seven cases of P. aeruginosa infection or colonization were detected between April 2006 and September 2008, including 3 fatal bloodstream infections. A closely-related strain was detected in 4 residents of a humanitarian nongovernmental organization (NGO) center who developed an infection, from 4 additional residents upon their hospital admission, and from a sink drain at the NGO residential center. NGO recipients represented 65% (24/37) of the total number of cases of P. aeruginosa colonization or infection during the outbreak period. Investigation at the residential center showed widespread contamination of the sewage system (10/14 sinks and shower drains, 70%) and a high prevalence (38%) of P. aeruginosa carriage among children.


CONCLUSIONS
These findings suggest that the probable cause of the outbreak was the contamination of the NGO residential center with further nosocomial transmission after admission, and highlight the importance of considering external sources when investigating hospital outbreaks.
Longtin
Yves
Y
Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
Troillet
Nicolas
N
Touveneau
Sylvie
S
Boillat
Noémie
N
Rimensberger
Peter
P
Dharan
Sasi
S
Gervaix
Alain
A
Pittet
Didier
D
Harbarth
Stephan
S
D000293:Adolescent; D015373:Bacterial Typing Techniques; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D016358:Contact Tracing; D003428:Cross Infection / Q000453:epidemiology*; D016172:DNA Fingerprinting; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008297:Male; D017720:Molecular Epidemiology; D011552:Pseudomonas Infections / Q000453:epidemiology*; D011550:Pseudomonas aeruginosa / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies