title: Achromobacter bacteraemia outbreak in a paediatric onco-haematology department related to strain with high surviving ability in contaminated disinfectant atomizers.
abstract: BACKGROUND
  Achromobacter spp. are Gram-negative bacilli from aqueous environments, occasionally involved in bacteraemia in immunocompromised hosts and in outbreaks.
  
  
  OBJECTIVE
  We describe the characteristics of an achromobacter bacteraemia outbreak in a paediatric onco-haematology department.
  
  
  METHODS
  Throughout a one-year period, 16 blood cultures from seven patients were positive for Achromobacter sp. All patients were immunocompromised, febrile, and central venous catheter (CVC) holders. A microbiological study was performed in patients' rooms, completed with an analysis of the disinfectant atomizers (didecyl diammonium chloride 0.25%, Surfanios, DMA). In total, 41 clinical and environmental strains were analysed by enterobacterial repetitive intergenic consensus (ERIC) polymerase chain reaction (PCR), repetitive PCR, and random amplified polymorphic DNA (RAPD)-PCR, and pulsed-field gel electrophoresis (PFGE). The bactericidal activity of DMA was studied on two Achromobacter sp. representative strains and one Pseudomonas aeruginosa reference strain, comparing biofilm and planktonic growth models.
  
  
  RESULTS
  The seven patients, including two severe cases, were successfully treated by systemic antimicrobial therapy and/or catheter removal. The 25 environmental isolates were recovered with the following chronology: hospital filtered tap water, disinfectant atomizers, and patients' rooms. All environmental, patient, and atomizer strains had identical PCR and PFGE patterns. The disinfectant susceptibility assay revealed that the strain isolated from the atomizers had high survival abilities in biofilm conditions and remained resistant to DMA after short contact periods.
  
  
  CONCLUSIONS
  The use of disinfectant atomizers associated with the survival of Achromobacter in the atomizer pipes may explain the contamination and colonization of the CVC. Control measures (non-atomizer containers and use of sterile water) allowed the eradication of the source and the outbreak control.
authors.affiliation: Unité d'onco-hématologie pédiatrique, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Hugon
authors.affiliation: Laboratoire de Bactériologie, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France; UMR 5119, U.F.R. des Sciences Pharmaceutiques et Biologiques, Université Montpellier 1, Montpellier, France.
authors.forename: H
authors.initials: H
authors.lastname: Marchandin
authors.affiliation: Unité d'onco-hématologie pédiatrique, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: M
authors.initials: M
authors.lastname: Poirée
authors.affiliation: Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Nice, Nice, France.
authors.forename: T
authors.initials: T
authors.lastname: Fosse
authors.affiliation: Unité d'onco-hématologie pédiatrique, Centre Hospitalier Régional Universitaire de Montpellier, Montpellier, France. Electronic address: n-sirvent@chu-montpellier.fr.
authors.forename: N
authors.initials: N
authors.lastname: Sirvent
mesh_terms: D042402:Achromobacter / Q000145:classification / Q000302:isolation & purification*; D000293:Adolescent; D000890:Anti-Infective Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D055499:Catheter-Related Infections / Q000097:blood / Q000453:epidemiology / Q000382:microbiology / Q000628:therapy; D002405:Catheterization, Central Venous / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D005602:France / Q000453:epidemiology; D016905:Gram-Negative Bacterial Infections / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D019337:Hematologic Neoplasms / Q000097:blood / Q000382:microbiology* / Q000628:therapy; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers / Q000382:microbiology; D055815:Young Adult
chemical_list: D000890:Anti-Infective Agents
keywords: Achromobacter; Bacteraemia; Children; Disinfectant; Haematological malignancy; Outbreak