title: Outbreak of Pantoea agglomerans Bloodstream Infections at an Oncology Clinic-Illinois, 2012-2013.
abstract: OBJECTIVE To determine the source of a healthcare-associated outbreak of Pantoea agglomerans bloodstream infections. DESIGN Epidemiologic investigation of the outbreak. SETTING Oncology clinic (clinic A). METHODS Cases were defined as Pantoea isolation from blood or catheter tip cultures of clinic A patients during July 2012-May 2013. Clinic A medical charts and laboratory records were reviewed; infection prevention practices and the facility's water system were evaluated. Environmental samples were collected for culture. Clinical and environmental P. agglomerans isolates were compared using pulsed-field gel electrophoresis. RESULTS Twelve cases were identified; median (range) age was 65 (41-78) years. All patients had malignant tumors and had received infusions at clinic A. Deficiencies in parenteral medication preparation and handling were identified (eg, placing infusates near sinks with potential for splash-back contamination). Facility inspection revealed substantial dead-end water piping and inadequate chlorine residual in tap water from multiple sinks, including the pharmacy clean room sink. P. agglomerans was isolated from composite surface swabs of 7 sinks and an ice machine; the pharmacy clean room sink isolate was indistinguishable by pulsed-field gel electrophoresis from 7 of 9 available patient isolates. CONCLUSIONS Exposure of locally prepared infusates to a contaminated pharmacy sink caused the outbreak. Improvements in parenteral medication preparation, including moving chemotherapy preparation offsite, along with terminal sink cleaning and water system remediation ended the outbreak. Greater awareness of recommended medication preparation and handling practices as well as further efforts to better define the contribution of contaminated sinks and plumbing deficiencies to healthcare-associated infections are needed. Infect Control Hosp Epidemiol 2017;38:314-319.
authors.affiliation: 1Centers for Disease Control and Prevention (CDC),Epidemic Intelligence Service Program,Atlanta, Georgia.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Yablon
authors.affiliation: 1Centers for Disease Control and Prevention (CDC),Epidemic Intelligence Service Program,Atlanta, Georgia.
authors.forename: Raymund
authors.initials: R
authors.lastname: Dantes
authors.affiliation: 3Illinois Department of Public Health,Chicago,Illinois.
authors.forename: Victoria
authors.initials: V
authors.lastname: Tsai
authors.affiliation: 5West Suburban Medical Center,Oak Park, Illinois.
authors.forename: Rachel
authors.initials: R
authors.lastname: Lim
authors.affiliation: 2CDC Division of Healthcare Quality Promotion,Atlanta,Georgia.
authors.forename: Heather
authors.initials: H
authors.lastname: Moulton-Meissner
authors.affiliation: 2CDC Division of Healthcare Quality Promotion,Atlanta,Georgia.
authors.forename: Matthew
authors.initials: M
authors.lastname: Arduino
authors.affiliation: 2CDC Division of Healthcare Quality Promotion,Atlanta,Georgia.
authors.forename: Bette
authors.initials: B
authors.lastname: Jensen
authors.affiliation: 6Cook County Department of Public Health,Oak Forest, Illinois.
authors.forename: Megan Toth
authors.initials: MT
authors.lastname: Patel
authors.affiliation: 6Cook County Department of Public Health,Oak Forest, Illinois.
authors.forename: Michael O
authors.initials: MO
authors.lastname: Vernon
authors.affiliation: 1Centers for Disease Control and Prevention (CDC),Epidemic Intelligence Service Program,Atlanta, Georgia.
authors.forename: Yoran
authors.initials: Y
authors.lastname: Grant-Greene
authors.affiliation: 6Cook County Department of Public Health,Oak Forest, Illinois.
authors.forename: Demian
authors.initials: D
authors.lastname: Christiansen
authors.affiliation: 3Illinois Department of Public Health,Chicago,Illinois.
authors.forename: Craig
authors.initials: C
authors.lastname: Conover
authors.affiliation: 2CDC Division of Healthcare Quality Promotion,Atlanta,Georgia.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kallen
authors.affiliation: 2CDC Division of Healthcare Quality Promotion,Atlanta,Georgia.
authors.forename: Alice Y
authors.initials: AY
authors.lastname: Guh
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000175:diagnosis*; D003428:Cross Infection / Q000175:diagnosis*; D004196:Disease Outbreaks; D004340:Drug Contamination; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination; D005260:Female; D006801:Humans; D007087:Illinois; D008297:Male; D008875:Middle Aged; D016522:Oncology Service, Hospital; D020636:Pantoea / Q000302:isolation & purification*