Stenotrophomonas maltophilia outbreak with a commercial blood gas injector as the culprit and interventions for source and prevention: A possible passage between patient and ECMO water heater device

• Published in: American journal of infection control Vol. 51; no. 5; pp. 533 - 538
• Main Authors: Menekşe, Şirin, Tanrıverdi, Elif Seren, Oğuş, Halide, Altınay, Ece, Kaya, Çiğdem, Çağlayan, Elif, Aydoğan, Arzu Ateşoğlu, Otlu, Barış, Kırali, Mehmet Kaan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2023
• Subjects: Disease Outbreaks; ECMO water heater; Extracorporeal Membrane Oxygenation; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Gram-Negative Bacterial Infections - prevention & control; Hospital outbreak; Humans; Injectors; Stenotrophomonas maltophilia - genetics; Water; ECMO water heater; Hospital outbreak; Injectors
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2022.07.012

•Stenotrophomonas maltophilia is a Gram-negative, nonfermentative aerobic bacterium widely found in humid and aqueous environments.•S. maltophilia is a Gram-negative bacterium widely found in humid environments.•A commercial needless blood gas injector was responsible for the outbreak. Detection of S. maltophilia in ECMO heater devices raises concerns about safety.•Routine surveillance should include ECMO water reservoirs. Despite low virulence of Stenotrophomonas maltophilia, it represents one of the leading drug-resistant bacteria. We report a large outbreak of S. maltophilia infection associated with an unexpected source, which turned out to be a commercial needleless blood gas injector. Over a period from January 1 to December10, 2021, 113 patients were identified to have S. maltophilia infection as documented by positive cultures from the clinical samples, extracorporeal membrane oxygenation (ECMO) water heater devices and commercial needleless blood gas injectors. Sixty-seven isolates (59 clinical, 4 ECMO, 4 blood gas injectors) were sent for molecular analysis. Both arbitrarily primed polymerase chain reaction and pulsed-field gel electrophoresis analyses showed 12 distinct genotypes. Of 67 isolates, 58 were clonally related (86.6%), with 52 indistinguishable strains from 4 blood gas needleless injectors, 46 patients’ samples (78%), and 2 ECMO samples (50%). Two ECMO samples and 1 clinical sample were clonally identical. In the event that eradication of infections would not be possible despite taking all environmental disinfection measures including the ECMO devices, unexpected sources, such as a commercial needleless blood gas injector, should not be omitted from the list for surveillance. In addition, obtaining surveillance cultures of ECMO water reservoirs should be placed in the routine clinical practice.