Achromobacter bacteraemia outbreak in a paediatric onco-haematology department related to strain with high surviving ability in contaminated disinfectant atomizers

Summary Background Achromobacter spp. are Gram-negative bacilli from aqueous environments, occasionally involved in bacteraemia in immunocompromised hosts and in outbreaks. Aim We describe the characteristics of an achromobacter bacteraemia outbreak in a paediatric onco-haematology department. Metho...

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Bibliographic Details
Published in:The Journal of hospital infection 2015-02, Vol.89 (2), p.116-122
Main Authors: Hugon, E, Marchandin, H, Poirée, M, Fosse, T, Sirvent, N
Format: Article
Language:English
Subjects:
Achromobacter
Achromobacter - classification
Achromobacter - isolation & purification
Adolescent
Anti-Infective Agents - therapeutic use
Bacteraemia
Bacteremia - blood
Bacteremia - drug therapy
Bacteremia - epidemiology
Bacteremia - microbiology
Catheter-Related Infections - blood
Catheter-Related Infections - epidemiology
Catheter-Related Infections - microbiology
Catheter-Related Infections - therapy
Catheterization, Central Venous - adverse effects
Child
Child, Preschool
Children
Cross Infection - blood
Cross Infection - drug therapy
Cross Infection - epidemiology
Cross Infection - microbiology
Disease Outbreaks
Disinfectant
Environmental Microbiology
France - epidemiology
Gram-Negative Bacterial Infections - blood
Gram-Negative Bacterial Infections - drug therapy
Gram-Negative Bacterial Infections - epidemiology
Gram-Negative Bacterial Infections - microbiology
Haematological malignancy
Hematologic Neoplasms - blood
Hematologic Neoplasms - microbiology
Hematologic Neoplasms - therapy
Human health and pathology
Humans
Infant
Infectious Disease
Infectious diseases
Life Sciences
Male
Nebulizers and Vaporizers - microbiology
Outbreak
Young Adult
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Summary:Summary Background Achromobacter spp. are Gram-negative bacilli from aqueous environments, occasionally involved in bacteraemia in immunocompromised hosts and in outbreaks. Aim 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. Findings 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. Conclusion 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.
ISSN:0195-6701
1532-2939
DOI:10.1016/j.jhin.2014.07.012