title: Identification and control of a Pseudomonas spp (P. fulva and P. putida) bloodstream infection outbreak in a teaching hospital in Beijing, China.
abstract: OBJECTIVE
  An outbreak of bacteremia caused by Pseudomonas spp (P. fulva and P. putida) was first identified in our hospital in the summer of 2010 and reoccurred in the following year. Based on the epidemiological data collected in these 2 years, we initiated an investigation on the source of the outbreak. The aim of this study was to report the results of the investigation, as well as the intervention strategies that resulted in successful control of the outbreak.
  
  
  METHODS
  An infection control team was set up consisting of infectious disease specialists, microbiologists, infection control practitioners, and head nurses. The microbiology and medical records of case-patients with P. fulva or P. putida bloodstream infections were reviewed. Environmental samples and intravenous (IV) solutions from the wards and the pharmacy center were collected for culturing. The molecular characteristics of the bacterial isolates were studied by pulsed-field gel electrophoresis (PFGE). Strict infection control strategies were implemented.
  
  
  RESULTS
  A total of 20 case-patients from five inpatient wards were identified during three summer seasons from 2010 to 2012. Nineteen of them recovered with proper antibiotics. Unfortunately one died from complications of heart failure. A total of 19 isolates of P. fulva and four of P. putida were identified, of which 20 were from blood, two from environmental surface samples from the hospital pharmacy, and one from an in-use compounded solution from a case-patient in the cardiology ward. Molecular analysis revealed that the P. fulva isolated from the in-use compounded solution (5% glucose solution containing insulin, isosorbide dinitrate, and potassium magnesium aspartate) and the environmental samples had the same PFGE type as the clinical isolates.
  
  
  CONCLUSIONS
  The investigation identified that contaminated IV solution was the source of the P. fulva bacteremia, which prompted us to implement intensified control measures that resulted in successful control of the outbreak.
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China.
authors.forename: Yingmei
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Department of Infection Control, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People's Republic of China.
authors.forename: Kun
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China.
authors.forename: Xiaomin
authors.initials: X
authors.lastname: Yu
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China.
authors.forename: Binbin
authors.initials: B
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang South Road, Chaoyang District, Beijing 100020, People's Republic of China; Beijing Institute of Respiratory Medicine, Beijing, People's Republic of China; Beijing Key Laboratory of Respiratory and Pulmonary Circulation, Beijing, People's Republic of China. Electronic address: caobin1999@gmail.com.
authors.forename: Bin
authors.initials: B
authors.lastname: Cao
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D057785:Catheters / Q000382:microbiology; D002681:China / Q000453:epidemiology; D004269:DNA, Bacterial / Q000302:isolation & purification; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006784:Hospitals, Teaching; D006801:Humans; D017053:Infection Control / Q000379:methods; D008297:Male; D008875:Middle Aged; D057947:Parenteral Nutrition Solutions / Q000009:adverse effects / Q000627:therapeutic use; D011549:Pseudomonas / Q000235:genetics / Q000302:isolation & purification*; D016958:Pseudomonas putida / Q000235:genetics / Q000302:isolation & purification*; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D057947:Parenteral Nutrition Solutions
keywords: Infection control; Outbreak; P. fulva bloodstream infection; P. putida; PFGE