Korean J Clin Microbiol.  2008 Apr;11(1):5-10. 10.5145/KJCM.2008.11.1.5.

Pseudo-outbreak of Klebsiella oxytoca fromBronchial Washing Specimens

• Lee JY
• Shin JH
• Lee HK
• Yu SM
• Park EH
• Lee HR
• Kim JH
• Kim HR
• Moon CS
• Kim YJ
• Lee JN

• KMID: 2089801
• DOI: http://doi.org/10.5145/KJCM.2008.11.1.5

Abstract

BACKGROUND: We noticed a sudden increase in the isolation of Klebsiella oxytoca from bronchial washing specimens during May to June 2006. An epidemiological investigation was conducted to identify the cause of the outbreak and to implement appropriate infection control measures.
METHODS
A total of 18 isolates of K. oxytoca were found. The 14 bronchial washing specimens that yielded K. oxytoca were taken in the outpatient bronchoscopy suite, and the other 4 specimens were obtained by a portable bronchoscopy. The medical records and microbiologic findings of these patients were reviewed. Environmental samples from two bronchoscopes and the bronchoscopy suite were cultured. The relations between the available 10 isolates from bronchial washing fluid were investigated by pulsed-field gel electrophoresis (PFGE).
RESULTS
No patients were judged to have had true infections attributable to K. oxytoca either before or after bronchoscopy. Cultures of samples from two bronchoscopes and related environment did not grow K. oxytoca. The PFGE analysis showed that 8 of 10 isolates had a similar pattern of DNA fragments. An infection control strategy was implemented, including adequately cleaning and disinfecting the bronchoscopes, and a sharp reduction in the incidence of K. oxytoca from bronchial washing samples followed.
CONCLUSION
The sudden increase of K. oxytoca from bronchial washing specimens was a pseudo-outbreak. We presumed that the bronchoscopes became contaminated during a procedure in a patient colonized with K. oxytoca in the upper-respiratory tract.

Keyword

Klebsiella oxytoca; Psuedo-outbreak; Bronchial washing; Pulsed-field gel electrophoresis

MeSH Terms

Bronchoscopes
Bronchoscopy
Colon
DNA
Electrophoresis, Gel, Pulsed-Field
Humans
Incidence
Infection Control
Klebsiella
Klebsiella oxytoca
Medical Records
Outpatients
DNA

Figure

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  Fig. 1. Pulsed-field gel electrophoresis patterns of K. oxytoca isolates from bronchial washings.

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  Fig. 2. Epidemic curve of K. oxytoca isolates from bronchial washing samples collected during May and June. Solid bars, number of isolates related to the outbreak determined by PFGE analysis; striped bars, number of isolates unrelated to the outbreak determined by PFGE; open bars, number of isolates unavailable for PFGE.

Reference

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