Polymicrobial Outbreak of Intermittent Peritoneal Dialysis Peritonitis during External Wall Renovation at a Dialysis Center

Abstract

Objective To investigate an outbreak of peritonitis in intermittent peritoneal dialysis (IPD) patients. Design An outbreak investigation was performed to identify the etiology of the polymicrobial outbreak, and a retrospective case-control study was conducted to assess the risk factors for development of peritonitis. Setting Renal dialysis center. Patients Ten episodes of peritonitis occurred in 8 of 61 patients over a 6-month period in which 669 IPD procedures were analyzed. Interventions Field visit to renal dialysis center to examine the entire IPD procedure, inspect the hospital environment, and perform air bacterial count. Main Outcome Measures The environmental factors and risk factors contributing to the polymicrobial peritonitis outbreak in IPD patients. The incidence of IPD peritonitis was determined before and after interventions. Results The causative organisms included Acinetobacter baumanii ( 6 ), Stenotrophomonas maltophilia ( 2 ), Pseudomonas aeruginosa ( 1 ), Candida albicans ( 1 ), C. tropicalis ( 1 ), Enterococcus ( 3 ), and Enterobacteriaceae ( 2 ). Four episodes of peritonitis involved infection by more than one organism. Air sampling of the environment detected a median of 110 colony forming units of bacteria per cubic meter of air, 10% of which were found to be Acinetobacter baumanii. The source of this polymicrobial outbreak was attributed to the bamboo scaffolding structure covering the external wall of the hospital during renovation. A retrospective case-control study indicated that the absence of the flush-before-fill step was a risk factor for development of peritonitis. Conclusion In addition to invasive aspergillosis in transplant or oncology patients, Acinetobacter peritonitis in dialysis patients should be considered another microbial cause of outbreak associated with hospital renovation.

Catheter-Related Polymicrobial Bloodstream Infections among Pediatric Bone Marrow Transplant Outpatients—Atlanta, Georgia, 2007

“…In addition, the move to the new facility might have contributed to environmental contamination or contamination of supplies. 13 In response to the recommendations derived from the outbreak investigation, clinic staff instituted several practice changes. Medications are now drawn at the time of use, and single-dose vials are used to administer only 1 dose of medication.…”

Stenotrophomonas maltophilia: an emerging pathogen in dialysis units

“…The earliest reports recommended a prolonged antibiotic treatment and the removal of catheters (Berbari et al , 1993; Szeto et al , 1997; Taylor et al , 1999; Alhilali et al , 2000), perhaps due to the severity of the infection and also as is usual clinical practice. In more recent years, a tunneled catheter was removed in a woman with exit site infection due to S. maltophilia with multi-resistant antibacterial spectrum, a condition at high risk of peritonitis (Cheng et al , 2001). Nevertheless, as described by Taylor et al (1999), three out of seven catheters were saved after a prolonged systemic therapy.…”

Successful control of vancomycin-resistant <i>Enterococcus faecium</i> outbreak in a neurosurgical unit at non-endemic region

“…Their demographic data, clinical features, use of antibiotics, and co-morbidity were obtained using a standardized record form as previously described. 17 , 18 A case–control study was performed to assess the risk factors for acquisition of VREfm, with the control patients being selected as those who had been staying within the same cubicle as the cases in hospital A and B, but with a negative stool or rectal swab culture for VRE. The study was approved by the institutional review board.…”