title: Outbreak of bacterial meningitis among patients undergoing myelography at an outpatient radiology clinic.
abstract: OBJECTIVE
  To investigate an outbreak of bacterial meningitis at an outpatient radiology clinic (clinic A) and to determine the source and implement measures to prevent additional infections.
  
  
  METHODS
  A case was defined as bacterial meningitis in a patient undergoing myelography at clinic A from October 11 to 25, 2010. Patients who underwent myelography and other procedures at clinic A during that period were interviewed, medical records were reviewed, and infection prevention practices were assessed. Case-patient cerebrospinal fluid (CSF) specimens, oral specimens from health care personnel (HCP), and opened iohexol vials were tested for bacteria. Bacterial isolates were compared using pulsed-field gel electrophoresis. A culture-negative CSF specimen was tested using a real-time polymerase chain reaction assay.
  
  
  RESULTS
  Three cases were identified among 35 clinic A patients who underwent procedures from October 11 to 25, 2010. All case-patients required hospitalization, 2 in an intensive care unit. Case-patients had myelography performed by the same radiology physician assistant and technician on October 25; all patients who underwent myelography on October 25 were affected. HCP did not wear facemasks and reused single-dose iohexol vials for multiple patients. Streptococcus salivarius (a bacteria commonly found in oral flora) was detected in the CSF of 2 case-patients (1 by culture, 1 using real-time polymerase chain reaction) and in HCP oral specimens; 1 opened iohexol vial contained Staphylococcus epidermidis. Pulsed-field gel electrophoresis profiles from the case-patient S salivarius and the radiology physician assistant were indistinguishable.
  
  
  CONCLUSIONS
  Bacterial meningitis likely occurred because HCP performing myelography did not wear facemasks; lapses in injection practices may have contributed to transmission. Targeted education regarding mask use and safe injection practices is needed among radiology HCP.
authors.affiliation: Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, Division of Healthcare Quality Promotion, Atlanta, GA 30333, USA. achitnis@cdc.gov
authors.forename: Amit S
authors.initials: AS
authors.lastname: Chitnis
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Guh
authors.forename: Isaac
authors.initials: I
authors.lastname: Benowitz
authors.forename: Velusamy
authors.initials: V
authors.lastname: Srinivasan
authors.forename: Robert E
authors.initials: RE
authors.lastname: Gertz
authors.forename: Patricia L
authors.initials: PL
authors.lastname: Shewmaker
authors.forename: Bernard W
authors.initials: BW
authors.lastname: Beall
authors.forename: Heather
authors.initials: H
authors.lastname: O'Connell
authors.forename: Judith
authors.initials: J
authors.lastname: Noble-Wang
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Gornet
authors.forename: Chris
authors.initials: C
authors.lastname: Van Beneden
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Patrick
authors.forename: George
authors.initials: G
authors.lastname: Turabelidze
authors.forename: Priti R
authors.initials: PR
authors.lastname: Patel
mesh_terms: D000553:Ambulatory Care / Q000379:methods; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000458:organization & administration*; D017757:Infectious Disease Transmission, Professional-to-Patient / Q000517:prevention & control*; D008297:Male; D016920:Meningitis, Bacterial / Q000453:epidemiology* / Q000209:etiology; D009192:Myelography / Q000009:adverse effects* / Q000379:methods; D012189:Retrospective Studies; D018570:Risk Assessment; D014481:United States