Whole-genome sequencing (WGS) is increasingly used to characterize hospital outbreaks of cabapenemase-producing Enterobacterales (CPE); however, access to WGS is variable and testing is often associated with reporting delays. An eight-year study conducted at a hospital in Sydney, Australia, demonstrated the importance of embedding WGS in routine surveillance with results reported in real time. The authors described how their WGS approach identified 9 outbreaks and helped optimize local CPE control measures.
Noting similarities to a 2021 outbreak, clinicians diagnosed and promptly reported two tuberculosis (TB) cases among bone allograft recipients. The subsequent public health investigation confirmed a bone allograft-related outbreak affecting 36 recipients. This second outbreak of bone allograft-related TB in recent years underscores the urgency of implementing improved donor screening and culture-based testing to prevent tissue-derived Mycobacterium tuberculosis transmission.
Two outbreaks of genetically unrelated carbapenem-resistant New Delhi metallo- β-lactamase-producing Escherichia coli were caused by contaminated duodenoscopes. The occurrence of these two outbreaks within a few months, despite improvements in HLD compliance, supports the research team’s hypothesis of contamination from inaccessible parts of the elevator channels. Using endoscopes with disposable end caps, adherence to the manufacturer’s reprocessing instructions, routine audits, and manufacturer evaluation are critical in preventing such outbreaks.
A retrospective case series found that an outbreak of Staphylococcus epidermidis after immediate sequential bilateral cataract surgery (ISBCS) at a community-based eye clinic was likely due to a systemic breach of sterility. The same strain of bacteria was detected in all cultures of three consecutive patients who presented with bilateral simultaneous postoperative endophthalmitis (BSPOE) after undergoing ISBCS on the same day at the same clinic in Denmark. The outbreak highlighted the importance of strict adherence to guideline-recommended precautions for safe ISBCS.
Fruit cup products were implicated in an outbreak of salmonellosis in two hospitals. Investigators encountered several challenges related to control selection, small sample sizes, missing data, and differences in operations between facilities. The researchers are featured in the latest episode of the American Journal of Infection Control’s podcast, Science Into Practice, where they discuss lessons learned and share insights related to communication between hospitals and health departments and other aspects of healthcare-related foodborne outbreaks.
Mycobacterium abscessus, a nontuberculous mycobacterium found in water and soil, is an opportunistic pathogen responsible for waterborne illness outbreaks in health care settings. On September 29, 2022, the Pennsylvania Department of Health (PADOH) received notification of M. abscessus–positive respiratory isolates from ventilator-dependent residents of a 34-bed pediatric facility. The facility is licensed for residential services, but not as a health care facility. A case was defined as the first M. abscessus–positive culture identified from a resident of this facility during March–August 2022. Three cases were identified: two colonizations and one clinical infection. PADOH investigated this outbreak to identify risk factors and recommend infection prevention and control (IPC) measures.
A medical center’s whole genome sequencing (WGS) surveillance program detected 2 cases of extensively drug-resistant Pseudomonas aeruginosa matching the recent national outbreak associated with contaminated artificial tears. This was made possible through open data sharing of representative outbreak isolate genomes and strain-identifying genetic information provided by the CDC. The authors advocate for more widespread adoption of WGS-based surveillance with open data sharing, to accelerate detection of medical product-related outbreaks.
An analysis of MRSA outbreak reports (n=124) from New York State neonatal units from 2001-2017 documented increased use of IPC measures such as hand hygiene, Contact Precautions, active surveillance testing, and enhanced environmental cleaning. However, MRSA outbreaks in neonatal units continued to be frequent occurrences, perhaps because neonatal units have been caring for an increasingly complex population (e.g., neonates born at earlier gestational ages).
A review was conducted from May 2018-December 2022 for transfusion-transmitted sepsis cases in the U.S. attributable to polymicrobial contaminated apheresis platelet components, including Acinetobacter calcoaceticus-baumannii complex or Staphylococcus saprophyticus isolated from patients and components. Seven sepsis cases from 6 platelet donations from 6 different donors were identified in patients from 6 states; 3 patients died. Whole-genome sequencing showed environmental isolates from the manufacturer were closely related genetically to patient and platelet isolates, indicating the manufacturer was the most probably source of recurrent polymicrobial contamination.
A cystoscopy-associated outbreak of Pseudomonas aeruginosa from contaminated irrigation plugs occurred in a UK tertiary care center. Fifteen confirmed infections occurred, including bacteraemia, septic arthritis and urinary tract infection. While failure of decontamination likely occurred because the plugs were not dismantled prior to reprocessing, the manufacturer’s reprocessing instructions were also incompatible with standard UK practice.
