Outbreak of Achromobacter xylosoxidans pseudobacteremia in a neonatal care unit related to contaminated chlorhexidine solution

Molina‐Cabrillana, Jesús; Santana-Reyes, Candelaria; González-García, Andrés; Bordes-Benítez, Ana; Horcajada, Iballa

doi:10.1007/s10096-007-0311-7

Cited by 47 publications

(25 citation statements)

References 10 publications

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“…was not demonstrated herein, and the isolates presented a potential tolerance to chlorhexidine, which is the most used antiseptic in odontology. Resistance of Achromobacter xylosoxidans to chlorhexidine has been previously demonstrated in two cases of infections caused by the use of contaminated chlorhexidine solution to disinfect the patient's skin or medical devices (38)(39)(40).…”

Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa and Achromobacter sp. Clonal Selection Leads to Successive Waves of Contamination of Water in Dental Care Units

Abdouchakour

Dupont

Grau

et al. 2015

Appl Environ Microbiol

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Dental care unit waterlines (DCUWs) consist of complex networks of thin tubes that facilitate the formation of microbial biofilms. Due to the predilection toward a wet environment, strong adhesion, biofilm formation, and resistance to biocides, Pseudomonas aeruginosa, a major human opportunistic pathogen, is adapted to DCUW colonization. Other nonfermentative Gramnegative bacilli, such as members of the genus Achromobacter, are emerging pathogens found in water networks. We reported the 6.5-year dynamics of bacterial contamination of waterlines in a dental health care center with 61 dental care units (DCUs) connected to the same water supply system. The conditions allowed the selection and the emergence of clones of Achromobacter sp. and P. aeruginosa characterized by multilocus sequence typing, multiplex repetitive elements-based PCR, and restriction fragment length polymorphism in pulsed-field gel electrophoresis, biofilm formation, and antimicrobial susceptibility. One clone of P. aeruginosa and 2 clones of Achromobacter sp. colonized successively all of the DCUWs: the last colonization by P. aeruginosa ST309 led to the closing of the dental care center. Successive dominance of species and clones was linked to biocide treatments. Achromobacter strains were weak biofilm producers compared to P. aeruginosa ST309, but the coculture of P. aeruginosa and Achromobacter enhanced P. aeruginosa ST309 biofilm formation. Intraclonal genomic microevolution was observed in the isolates of P. aeruginosa ST309 collected chronologically and in Achromobacter sp. clone A. The contamination control was achieved by a complete reorganization of the dental health care center by removing the connecting tubes between DCUs. D ental instruments on dental care units (DCUs), such as ultrasonic scalers, air scalers, and high-speed turbine dental handpieces, are cooled by DCU-supplied water, which also irrigates and cools the tooth surface during dental treatment (1). Water is also supplied to the DCU cup filler outlet used by patients for oral rinsing and to the bowl rinse outlet rinsing the DCU spittoon. Therefore, DCU waterlines (DCUWs) consist of a complex network formed by meters of narrow-bore plastic tubing of mostly 2-to 3-mm internal diameter. In narrow-bore tubes, a thin immobile layer of fluid, called the hydrodynamic boundary layer, exists at the interface of the lumen wall and the moving water (2). This hydrodynamic phenomenon is associated with water stagnation when the DCU is not used, and heating of water to at least 20°C enhances the development of microbial biofilm in the tubes (3).The DCUWs appear to be a technological niche in which complex interactions occur among members of the microbial community (4-6). Regarding bacteria, DCUWs have been shown to promote the formation of biofilm, predominantly seeded from environmental bacteria in the water supply (4-6). More rarely, human bacteria such as staphylococci or oral bacteria have been detected, indicating a retraction of oral fluids from the surgical devices to the wate...

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Section: Discussionmentioning

confidence: 99%

Pseudomonas aeruginosa and Achromobacter sp. Clonal Selection Leads to Successive Waves of Contamination of Water in Dental Care Units

Abdouchakour

Dupont

Grau

et al. 2015

Appl Environ Microbiol

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“…It is also a prevalent nosocomial colonizer and has been isolated from multiple types of aqueous solutions found in the health care setting, such as nonbacteriostatic saline (24), dialysis solutions (33), contact lens solutions (15), intravenous CT contrast solutions (32), chlorhexidine gluconate solutions (35), and ultrasound gel (28). A. xylosoxidans also colonizes fomites such as mechanical ventilators (6), neonatal incubators (25,29), faucet aerators (17,43), intravenous catheters (1,17,20,24), epidural catheters (30), urinary catheters (29), intravascular pressure transducers (17), pacemaker leads (2,26,33,36), and extracorporeal membrane oxygenation machines (21).…”

Section: Case Reportmentioning

confidence: 99%

Achromobacter xylosoxidans Infection Presenting as a Pulmonary Nodule Mimicking Cancer

et al. 2011

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“…To date, in hospitals, A. xylosoxidans has been involved in many procedure-related infections, being associated for instance with contaminated disinfectants (17), dialysis fluids (7), and ultrasound gel (18). There are a few reports of A. xylosoxidans being found in outdoor environments, including in some plants (19,20), in polluted soils (21,22), and in an indoor swimming pool (23).…”

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confidence: 99%

Detection of Achromobacter xylosoxidans in Hospital, Domestic, and Outdoor Environmental Samples and Comparison with Human Clinical Isolates

Amoureux

Bador

Fardeheb

et al. 2013

Appl Environ Microbiol

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Achromobacter xylosoxidans is an aerobic nonfermentative Gram-negative rod considered an important emerging pathogen among cystic fibrosis (CF) patients worldwide and among immunocompromised patients. This increased prevalence remains unexplained, and to date no environmental reservoir has been identified. The aim of this study was to identify potential reservoirs of A. xylosoxidans in hospital, domestic, and outdoor environments and to compare the isolates with clinical ones. From 2011 to 2012, 339 samples were collected in Dijon's university hospital, in healthy volunteers' homes in the Dijon area, and in the outdoor environment in Burgundy (soil, water, mud, and plants). We designed a protocol to detect A. xylosoxidans in environmental samples based on a selective medium: MCXVAA (MacConkey agar supplemented with xylose, vancomycin, aztreonam, and amphotericin B). Susceptibility testing, genotypic analysis by pulsed-field gel electrophoresis, and bla OXA-114 sequencing were performed on the isolates. A total of 50 strains of A. xylosoxidans were detected in hospital (33 isolates), domestic (9 isolates), and outdoor (8 isolates) samples, mainly in hand washing sinks, showers, and water. Most of them were resistant to ciprofloxacin (49 strains). Genotypic analysis and bla OXA-114 sequencing revealed a wide diversity among the isolates, with 35 pulsotypes and 18 variants of oxacillinases. Interestingly, 10 isolates from hospital environment were clonally related to clinical isolates previously recovered from hospitalized patients, and one domestic isolate was identical to one recovered from a CF patient. These results indicate that A. xylosoxidans is commonly distributed in various environments and therefore that CF patients or immunocompromised patients are surrounded by these reservoirs.

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Outbreak of Achromobacter xylosoxidans pseudobacteremia in a neonatal care unit related to contaminated chlorhexidine solution

Cited by 47 publications

References 10 publications

Pseudomonas aeruginosa and Achromobacter sp. Clonal Selection Leads to Successive Waves of Contamination of Water in Dental Care Units

Pseudomonas aeruginosa and Achromobacter sp. Clonal Selection Leads to Successive Waves of Contamination of Water in Dental Care Units

Achromobacter xylosoxidans Infection Presenting as a Pulmonary Nodule Mimicking Cancer

Detection of Achromobacter xylosoxidans in Hospital, Domestic, and Outdoor Environmental Samples and Comparison with Human Clinical Isolates

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