Prolonged hospital and community-based listeriosis outbreak caused by ready-to-eat scalded sausages

• Published in: The Journal of hospital infection Vol. 73; no. 2; pp. 121 - 128
• Main Authors: Winter, C.H, Brockmann, S.O, Sonnentag, S.R, Schaupp, T, Prager, R, Hof, H, Becker, B, Stegmanns, T, Roloff, H.U, Vollrath, G, Kuhm, A.E, Mezger, B.B, Schmolz, G.K, Klittich, G.B, Pfaff, G, Piechotowski, I
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.10.2009
• Subjects: Aged; Aged, 80 and over; Animals; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Cross Infection - epidemiology; Cross Infection - microbiology; Disease Outbreaks; Electrophoresis, Gel, Pulsed-Field; Female; Food Contamination - analysis; Food Industry; Food Microbiology; Food-Processing Industry; Foodborne Diseases - epidemiology; Foodborne Diseases - microbiology; Foodborne outbreak; Hospital; Humans; Immunocompromised Host; Immunocompromised patients; Infectious Disease; Listeria monocytogenes; Listeria monocytogenes - classification; Listeria monocytogenes - genetics; Listeria monocytogenes - isolation & purification; Listeriosis - epidemiology; Listeriosis - microbiology; Male; Meat products; Meat Products - microbiology; Medical Records; Middle Aged; Pulsed-field gel electrophoresis; Ready-to-eat; Serotyping; Germany, Baden-Wuerttemberg; Pulsed-field gel electrophoresis; Foodborne outbreak; Listeria monocytogenes; Hospital; Ready-to-eat; Immunocompromised patients; Meat products
• ISSN: 0195-6701; 1532-2939
• DOI: 10.1016/j.jhin.2009.06.011

Summary Listeria monocytogenes is a foodborne bacterial pathogen. Immunocompromised patients are at higher risk of developing invasive listeriosis with high fatality rates. After notification of two patients with Listeria that had stayed in the same hospital (hospital A) before the onset of infection, we began an investigation to ascertain the extent of the outbreak, identify its source and prevent further infections. We conducted active case finding by contacting hospital A, reviewing medical records and retrospectively investigating listeriosis notifications from the German surveillance system (SurvNet). The kitchen (hospital A) and its meat supplier (company X) were inspected and environmental and food samples were taken for microbiological testing. All isolates of L. monocytogenes , together with patient and food-related isolates from Baden-Württemberg 2006 to 2008, were characterised by pulsed-field gel electrophoresis (PFGE). Altogether, 16 cases of listeriosis were identified. Serotype 4b with the indistinguishable PFGE patterns ( Asc I 17a/ Apa I 10) was detected from nine patients, five environmental and three ready-to-eat scalded sausage samples from company X, and two food samples from hospital A. All 11 patient cases linked to hospital A were immunosuppressed and were regularly served food during their hospital stay. Ten of these patients received corticosteroids and proton pump inhibitors (PPIs). Five cases were fatal. Our investigations indicate that ready-to-eat scalded sausages from company X caused this outbreak of listeriosis. Hospital food suppliers should guarantee the absence of L. monocytogenes in ready-to-eat meat products, controlled through optimised quality assurance.