title: Outbreak of Pseudomonas aeruginosa and Klebsiella pneumoniae bloodstream infections at an outpatient chemotherapy center.
abstract: BACKGROUND
  Four patients were hospitalized July 2011 with Pseudomonas aeruginosa bloodstream infection (BSI), 2 of whom also had Klebsiella pneumoniae BSI. All 4 patients had an indwelling port and received infusion services at the same outpatient oncology center.
  
  
  METHODS
  Cases were defined by blood or port cultures positive for K pneumoniae or P aeruginosa among patients receiving infusion services at the oncology clinic during July 5-20, 2011. Pulsed-field gel electrophoresis (PFGE) was performed on available isolates. Interviews with staff and onsite investigations identified lapses of infection control practices. Owing to concerns over long-standing deficits, living patients who had been seen at the clinic between January 2008 and July 2011 were notified for viral blood-borne pathogen (BBP) testing; genetic relatedness was determined by molecular testing.
  
  
  RESULTS
  Fourteen cases (17%) were identified among 84 active clinic patients, 12 of which involved symptoms of a BSI. One other patient had a respiratory culture positive for P aeruginosa but died before blood cultures were obtained. Available isolates were indistinguishable by PFGE. Multiple injection safety lapses were identified, including overt syringe reuse among patients and reuse of syringes to access shared medications. Available BBP results did not demonstrate iatrogenic viral infection in 331 of 623 notified patients (53%).
  
  
  CONCLUSIONS
  Improper preparation and handling of injectable medications likely caused the outbreak. Increased infection control oversight of oncology clinics is critical to prevent similar outbreaks.
authors: Mississippi State Department of Health, Jackson, MS. Electronic address: thomas.dobbs@msdh.state.ms.us.
authors: Thomas E
authors: TE
authors: Dobbs
authors: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Alice Y
authors: AY
authors: Guh
authors: Mississippi State Department of Health, Jackson, MS.
authors: Peggy
authors: P
authors: Oakes
authors: Mississippi State Department of Health, Jackson, MS.
authors: Mary Jan
authors: MJ
authors: Vince
authors: Division of Viral Hepatitis, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Joseph C
authors: JC
authors: Forbi
authors: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Bette
authors: B
authors: Jensen
authors: Division of Healthcare Quality Promotion, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA.
authors: Heather
authors: H
authors: Moulton-Meissner
authors: Mississippi State Department of Health, Jackson, MS.
authors: Paul
authors: P
authors: Byers
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities; D000970:Antineoplastic Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D004358:Drug Therapy / Q000379:methods; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy; D011552:Pseudomonas Infections / Q000453:epidemiology*; D011550:Pseudomonas aeruginosa / Q000145:classification / Q000235:genetics / Q000302:isolation & purification
chemical_list: D000970:Antineoplastic Agents
keywords: Injection safety; Klebsiella pneumonia; Outpatient oncology care; Pseudomonas aeruginosa