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Outbreak and control of Achromobacter denitrificans at an academic hospital in Pretoria, South Africa

Published online by Cambridge University Press:  28 March 2022

Mohamed Said Open the ORCID record for Mohamed Said [Opens in a new window] ,
Barend Mitton Open the ORCID record for Barend Mitton [Opens in a new window] ,
Lebogang Busisiwe Skosana Open the ORCID record for Lebogang Busisiwe Skosana [Opens in a new window] ,
Katlego Kopotsa ,
Rashmika Naidoo  and
Victoria Amutenya
Mohamed Said*
Affiliation:
Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa National Health Laboratory Services, Tshwane Academic Division, Pretoria, Gauteng, South Africa
Barend Mitton
Affiliation:
Department of Medical Microbiology, Universitas Academic Laboratory complex, National Health Laboratory Service, Bloemfontein, Free State, South Africa Department of Medical Microbiology, School of Pathology, Faculty of Health Sciences, University of the Free State, Bloemfontein, Free State, South Africa
Lebogang Busisiwe Skosana
Affiliation:
Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa National Health Laboratory Services, Tshwane Academic Division, Pretoria, Gauteng, South Africa
Katlego Kopotsa
Affiliation:
Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa
Rashmika Naidoo
Affiliation:
Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa
Victoria Amutenya
Affiliation:
Department of Medical Microbiology, University of Pretoria, Pretoria, Gauteng, South Africa National Health Laboratory Services, Tshwane Academic Division, Pretoria, Gauteng, South Africa
*
Author for correspondence: Mohamed Said, E-mail: Mohamed.said@up.ac.za
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Abstract

Objective:

In this study, we sought to determine the source of an outbreak of Achromobacter denitrificans infections in patients at a tertiary-care academic hospital.

Design:

Outbreak report study with intervention. The study period extended from February 2018 to December 2018.

Setting:

The study was conducted at a tertiary-care academic hospital in Pretoria, South Africa.

Patients and participants:

All patients who cultured A. denitrificans from any site were included in this study. During the study period, 43 patients met this criterion.

Interventions:

Once an outbreak was confirmed, the microbiology laboratory compiled a list of affected patients. A common agent, chlorhexidine-and-water solution, was used as a disinfectant–antiseptic for all affected patients. The laboratory proceeded to culture this solution. Environmental and surface swabs were also cultured from the hospital pharmacy area where this solution was prepared. Repetitive-element, sequence-based, polymerase chain reaction (rep-PCR) was performed on the initial clinical isolates to confirm the relatedness of the isolates.

Results:

In total, 43 isolates of A. denitrificans were cultured from patient specimens during the outbreak. The laboratory cultured A. denitrificans from all bottles of chlorhexidine-and-water solutions sampled from the wards and the pharmacy. The culture of the dispenser device used to prepare this solution also grew A. denitrificans. The rep-PCR confirmed the clonality of the clinical isolates with 2 genotypes dominating.

Conclusions:

Contaminated chlorhexidine-and-water solutions prepared at the hospital pharmacy was determined to be the source of the outbreak. Once this item was removed from the hospital, the laboratory did not culture any further A. denitrificans isolates from patient specimens.

Keywords

OutbreakAchromobacterchlorhexidine and waterhealthcare associated infectionspharmacy
Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 1 , January 2023 , pp. 24 - 30
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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Footnotes

PREVIOUS PRESENTATION: The preliminary findings of this study were presented as a poster at the 2019 International Conference on Prevention and Infection Control (ICPIC), on September 10–13, 2018, in Geneva, Switzerland, Abstract number P197.

References

Mandell, JE, Dollin, R, Mandell, Blaser MJ., Douglas and Bennett’s Principles and Practice of Infectious Diseases, Ninth Edition. Philadelphia: Elsevier; 2020.Google Scholar
Günther, F, Merle, U, Frank, U, Gaida, MM, Mutters, NT. Pseudobacteremia outbreak of biofilm forming Achromobacter xylosoxidans—environmental transmission. BMC Infect Dis 2016;16:584.CrossRefGoogle ScholarPubMed
Fisher, RG. Feigin and Cherry’s Textbook of Paediatric Infectious Diseases, Eighth Edition. Philadelphia: Elsevier; 2019;122:1128–1130.Google Scholar
Marion-Sanchez et al. Achromobacter spp healthcare-associated infections in the French West Indies: a longitudinal study from 2006 to 2016. BMC Infect Dis 2019;19:795.CrossRefGoogle Scholar
Isler, B, Kidd, TS, Stewart, AG, Harris, P, Paterson, DL. Achromobacter infections and treatment options. Antimicrob Agents Chemother 2020;64(11):e01025–20.CrossRefGoogle ScholarPubMed
CLSI. Performance Standards for Antimicrobial Susceptibility Testing, 28th edition. CLSI supplement M100. Pittsburgh, PA: Clinical and Laboratory Standards Institute; 2018.Google Scholar
Iraz, M, Özad Düzgün, A, Sandallı, C, et al. Distribution of β-lactamase genes among carbapenem-resistant Klebsiella pneumoniae strains isolated from patients in Turkey. Ann Lab Med 2015;35:595–601.CrossRefGoogle ScholarPubMed
Spigaglia, P, Mastrantonio, P. Evaluation of repetitive element sequence-based PCR as a molecular typing method for Clostridium difficile . J Clin Microbiol 2003;41:2454–2457.CrossRefGoogle ScholarPubMed
Molina-Cabrillana, J, Santana-Reyes, C, Gonzalez-Garcia, A, Bordes-Benitez, A, Horcajada, I. Outbreak of Achromobacter xylosoxidans pseudobacteramianin a neonatal care unit related to contaminated chlorhexidine solution. Eur J Clin Microbiol Infect Dis 2007;26:435–437.CrossRefGoogle ScholarPubMed
Tena, D, Carranza, R, Barbera, JR, Valdezate, S, Garrancho, JM, Arranz, M. Outbreak of long-term intravascular catheter-related bacteremia due to Achromobacter xylosoxidans subspecies xylosoxidans in a haemodialysis unit. Eur J Clin Microbiol Infect Dis 2005;24:727–732.CrossRefGoogle Scholar
Haviari, S, Cassier, P, Dananche’, C et al. Outbreak of Achromobacter xylosoxidans and Ochrobactrum anthropic infections after prostate biopsies, France, 2014. Emerg Infect Dis 2016;22:1412–1419.CrossRefGoogle Scholar
Turel, O, Kavuncuoglu, S, Hosaf, E, Ozbek, S, Aldemir, E, Uygur, T, Hatipoglu, N, Siraneci, R. Bacteremia due to Achromobacter xylosoxidans in neonates: clinical features and outcome. Braz J Infect Dis 2013;17:450–454.CrossRefGoogle ScholarPubMed
Aisenberg, G, Rolston, K, Safdar, A. Bacteremia caused by Achromobacter and Alcaligenes species in 46 patients with cancer. Cancer 2004;101:2134–2140.CrossRefGoogle ScholarPubMed
Ahmed, MS, Nistal, C, Jayan, R, Kuduvalli, M, Anijeet, H. Achromobacter xylosoxidans, an emerging pathogen in prosthetic valve endocarditis: a case report and review of the literature. Clin Nephrol 2009;71:350–354.CrossRefGoogle Scholar
Echeverri, LM, Atehortúa, S, Tamayo, M, Restrepo, DM, Valencia, N. Brote hospitalario de Achromobacter denitrificans relacionado con el uso de clorhexidina contaminada. Infectio 2012;16:112–116.CrossRefGoogle Scholar
Almuzarra, M, Limansky, A, Ballerini, V, Galanternik, L, Famiglietti, A, Vay, C. In vitro susceptibiloity of Achromobacter spp isolates: comparison of disk diffusion, Etest and agar dilution methods. Int J Antimicrob Agents 2010;35:68–71.CrossRefGoogle Scholar
Ramos, JM, Domine, M, Ponte, MC, Soriano, F. Bacteraemia caused by Alcaligines (Achromobacter) xylosoxidans. Description of 3 cases and review of the literature. Enferm Infect Microbiol Clin 1996;14:436–440.Google Scholar
Singh, G, Biswal, M, Hallur, V, et al. Utility of whole-cell repetitive extragenic palindromic sequence-based PCR (REP-PCR) for the rapid detection of nosocomial outbreaks of multidrug-resistant organisms: experience at a tertiary-care center in North India. Indian J Med Microbiol 2015;33:221–224.CrossRefGoogle Scholar
Gould, CV, Umscheid, CA, Agarwai, RK, Kuntz, G, Pesueo, DA. Guideline for prevention of catheter associated urinary tract infections. Centers for Disease Control and Prevention website. http://www.cdc.gov/ncidod/dhqp/pdf/guidelines/CAUTI_guideline2009final. Published 2009. Accessed March 9, 2022.Google Scholar