Investigation of a pseudo-outbreak of ‘Pseudomonas thomasii’ in a special-care baby unit by numerical analysis of SDS–PAGE protein patterns

Costas, M.; Holmes, B.; Sloss, L. L.; Heard, S.R.

doi:10.1017/s0950268800047725

Cited by 14 publications

(11 citation statements)

References 20 publications

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“…Although the study of King et al (1979) was not conclusive and failed to establish ' P. thomasii ' as a valid species, Costas et al (1990) concluded that SDS-PAGE of whole-cell proteins provided clear evidence that R. pickettii and ' P. thomasii ' were separate taxa, a finding confirmed by this study. On the other hand, Pan et al (1992) reported that HPLC analysis of cell wall fatty acids could not distinguish R. pickettii biovar Va-1 from R. pickettii biovar 3\' thomasii ', findings also confirmed by this study.…”

Section: Differentiation Of R Mannitolytica At the Species And Genussupporting

confidence: 52%

“…Retrospectively, a strain stored previously as P. fluorescens and isolated repeatedly from an abdominal haematoma of a patient with cholangiocarcinoma and a strain from an outbreak due to contaminated water in the neonatal intensive care department of the Ghent University Hospital, Belgium (GUH), in 1990 could also be identified as R. mannitolytica. Several nosocomial outbreaks with R. pickettii biovar 3\' thomasii ', mostly due to contaminated fluids, have been described (Costas et al, 1990 ;Pan et al, 1992 ;Phillips et al, 1972), but no life-threatening infections have been reported yet to our knowledge.…”

Section: Introductionmentioning

confidence: 99%

“…Shortly before this, King et al (1979) had concluded that R. ('Pseudomonas ') pickettii contained several biovars, including the strains originally isolated from clinical samples in St Thomas ' Hospital, London, UK (Phillips & Eykyn, 1972 ;Phillips et al, 1972), and which had been designated ' Pseudomonas thomasii '. Although this name was never validated, it has been used several times (Baird et al, 1976 ;King et al, 1979 ;Costas et al, 1990). According to Pickett (1994), the present taxonomic situation of R. pickettii should be reduced to the recognition of three biovars, with biovar 1 equal to CDC group Va-1, biovar 2 equal to CDC group Va-2 and biovar 3 mostly consistent with the invalid ' Pseudomonas thomasii ' (Pickett, 1994).…”

Section: Introductionmentioning

confidence: 99%

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Classification of Ralstonia pickettii biovar 3/'thomasii' strains (Pickett 1994) and of new isolates related to nosocomial recurrent meningitis as Ralstonia mannitolytica sp. nov.

Baère¹,

Steyaert²,

Wauters³

et al. 2001

International Journal of Systematic and Evolutionary Microbiology

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Section: Differentiation Of R Mannitolytica At the Species And Genussupporting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Classification of Ralstonia pickettii biovar 3/'thomasii' strains (Pickett 1994) and of new isolates related to nosocomial recurrent meningitis as Ralstonia mannitolytica sp. nov.

Baère¹,

Steyaert²,

Wauters³

et al. 2001

International Journal of Systematic and Evolutionary Microbiology

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“…thomasii." A pseudo-outbreak has been described as well (4). Although no serious non-outbreak-related infections have been described thus far, the clinical importance of R. mannitolilytica may have been overlooked, possibly due to misidentification as P. fluorescens, B. multivorans, and/or R. pickettii.…”

Section: Reduction Of Nitratementioning

confidence: 99%

One Case Each of Recurrent Meningitis and Hemoperitoneum Infection with Ralstonia mannitolilytica

et al. 2001

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Two clinical cases of infection with). R. mannitolilytica can be distinguished from all described Ralstonia species by its acidification of D-arabitol and mannitol and by its lack of nitrate reduction and of alkalinization of tartrate. In order to determine the true prevalence of infections with this species, colistin-resistant "P. fluorescens" strains and strains growing on B. cepacia selective medium deserve further attention. CASE REPORTSCase report 1. In 1997, a Caucasian woman, 38 years old, presented with fever of unknown origin. At the age of 17 she had received a ventriculoatrial draining for hydrocephalia after an intracerebral hematoma. Twenty years later, after a localized epileptic insult, further neurological testing and imaging pointed to a diagnosis of cavernous hemangiomas, for which she was treated surgically. The nonfunctional ventricular drain was partially removed, leaving the intrathoracic part in place. Postoperatively, the patient developed meningitis. Culture remained negative, and the patient was treated with 2 g of ceftriaxone intravenously (i.v.) twice daily during 2 weeks. Two days after antibiotic therapy was stopped, the meningitis recurred. Culture of the liquor yielded a gram-negative bacillus that could grow on Burkholderia cepacia selective medium (Mast Diagnostics, Merseyside, United Kingdom) and therefore was first identified as B. cepacia. The same organism was cultured from the removed intracerebral catheter segment. Ceftriaxone (2 g i.v. twice per day) was started, and ciprofloxacin (400 mg i.v. thrice per day) was added. Fever subsided and liquor cultures remained negative.In February 1998, the patient presented in a private hospital with a generalized epileptic insult and high fever (39.5°C) and was treated with amoxicillin and clavulanic acid. The fever subsided, and the single blood culture, positive for "Pseudomonas fluorescens," was considered contaminated. From March 1998 onwards, the patient had repeatedly febrile episodes and lost 10 kg of weight. Blood cultures were not performed. In November 1998, the patient was admitted in the same private hospital for high fever and tonic-clonic insults. Seven blood cultures were found positive for "P. fluorescens," and the patient was referred to the Ghent University Hospital for removal of the endovascular catheter segment. Cultures of the removed catheter were positive and were identified as Ralstonia pickettii biovar 3/"thomasii." Retrospectively, it was shown that this was also the correct identification for the "P. fluorescens" isolates that had been obtained from the private hospital. The strain was resistant to ampicillin, gentamicin, temocillin, and aztreonam but was susceptible to cotrimoxazole, piperacilin, cefuroxime, cefotaxime, ceftazidime, imipenem, and quinolones. The patient was treated, according to the susceptibility testing results, with cotrimoxazole and doxycycline. Since then, the patient has been doing well.Case report 2. In December 1997, primary cholangiocarcinoma with extensive hepatic involvement wa...

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“…Environmental contamination of medical and laboratory equipment resulting in outbreaks and pseudo-outbreaks is often due to multiple species/strains of microorganisms (12,13). This is in contrast to the situation in outbreaks and pseudo-outbreaks due to point sources, where a single strain of microbe is often involved (14).…”

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confidence: 99%

Characterization of a Tsukamurella Pseudo-Outbreak by Phenotypic Tests, 16S rRNA Sequencing, Pulsed-Field Gel Electrophoresis, and Metabolic Footprinting

Fung

Teng

et al. 2013

J Clin Microbiol

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We report a pseudo-outbreak of Tsukamurella due to improperly wrapped scissors used for processing of tissue specimens. A polyphasic approach, involving biochemical, genetic, and metabolomic techniques, was used in the laboratory investigation. This report highlights that early recognition of pseudo-outbreaks is important in preventing unnecessary and incorrect treatment of patients. Laboratory contamination of clinical specimens can lead to erroneous microbiology reports which can adversely affect patient management (1). Early recognition of such pseudo-outbreaks is important for clinical microbiology laboratories. In 2010, five isolates of Tsukamurella were isolated from the tissue specimens of four patients within 10 days in our clinical microbiology laboratory. Outbreak investigation revealed that the recovery of Tsukamurella was due to laboratory contamination during processing of the tissue samples. In this article, we report the investigation of this pseudo-outbreak and characterization of the outbreak strains using a polyphasic approach.The index patient was a 28-year-old female veterinarian, admitted for fever of unknown origin with right axillary lymphadenopathy (Table 1, patient 1). A direct Gram smear of the right axillary lymph node biopsy specimen in our laboratory revealed Gram-positive bacilli. A lymph node biopsy specimen was culture positive for Tsukamurella. However, the histological section, processed by the pathology laboratory, showed coalescent epithelioid cell granulomas, and no organisms were revealed by Gram staining, Ziehl-Neelsen staining, periodic acid-Schiff diastase staining, or Grocott staining. Bartonella henselae serology showed a Ͼ4-fold rise in IgG level for sera collected 6 days apart. PCR amplification and sequencing for the 16S rRNA gene of B. henselae was also positive on the right axillary lymph node. Since the clinical syndrome was compatible with cat scratch disease, there was a suspicion of contamination of the lymph node biopsy specimen. Contamination at the level of specimen processing in the microbiology laboratory was suspected because it was seen in the direct Gram smear that was processed in the microbiology laboratory but not in the biopsy specimens processed in the pathology laboratory.Within a period of 9 days, 4 additional tissue specimens from 3 patients also grew Tsukamurella. A direct Gram smear of these 4 specimens performed in the clinical microbiology laboratory was negative. Line listing was performed for the 4 cases as described previously (Table 1) (2). A review of our laboratory records revealed that in the 24-month period before the outbreak, only 3

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Investigation of a pseudo-outbreak of ‘Pseudomonas thomasii’ in a special-care baby unit by numerical analysis of SDS–PAGE protein patterns

Cited by 14 publications

References 20 publications

Classification of Ralstonia pickettii biovar 3/'thomasii' strains (Pickett 1994) and of new isolates related to nosocomial recurrent meningitis as Ralstonia mannitolytica sp. nov.

Classification of Ralstonia pickettii biovar 3/'thomasii' strains (Pickett 1994) and of new isolates related to nosocomial recurrent meningitis as Ralstonia mannitolytica sp. nov.

One Case Each of Recurrent Meningitis and Hemoperitoneum Infection with Ralstonia mannitolilytica

Characterization of a Tsukamurella Pseudo-Outbreak by Phenotypic Tests, 16S rRNA Sequencing, Pulsed-Field Gel Electrophoresis, and Metabolic Footprinting

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