Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca,...
Transcript of Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca,...
![Page 1: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/1.jpg)
Ochrobactrum anthropi, Klebsiella oxytoca, and
Stenotrophomonas maltophilia: What do we do with these?!
Ginette Dobbins Minnesota Department of Health
Public Health Laboratory
![Page 2: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/2.jpg)
Background February 2011
• An infection preventionist from a local hospital contacted Minnesota Department of Health (MDH) epidemiologists about a cluster of 4 patients with Ochrobactrum anthropi (OA) bacteremia
• All patients were from the same surgical floor
• MDH epidemiologists initiated an investigation and notified PFGE
• Additional bacterial species were identified from the original patients by the reporting hospital
- Klebsiella oxytoca (KO) and Stenotrophomonas maltophilia (SM)
![Page 3: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/3.jpg)
All Positive Blood Cultures (n=35) for K. oxytoca (KO), O. anthropi (OA), and/or
S. maltophilia (SM) for Case-Patients
Num
ber o
f Blo
od C
ultu
res
2
3 4 5
6 7
8 9
10
1 K
Week and Year of Culture
2010 2011
K
K K
K K K O K K O
K
O
O
K K K
K K O
Week and Month Week and Month
K
41 40 42 43 2 3 5 4 6 7 8 9 10 45 46 48 47 49 50 51 52 44 11 12 1 39 13
Oct Jan Nov Feb Dec Mar
K K
K
K K K K,S
O
K
K
K
O
K,O S
K,O,S
K
K
![Page 4: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/4.jpg)
Klebsiella oxytoca
• Aerobic Gram negative rod • Formerly Aerobacter sp. • Ubiquitous in nature • Klebsiella spp. Responsible for 8% of
nosocomial infections in the US and Europe • Tends to colonize mucosal membranes, but
can colonize anywhere
![Page 5: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/5.jpg)
Ochrobactrum anthropi
• Aerobic Gram negative rod • Formerly Achromobacter sp. • Common soil organism • Becoming increasingly common as an
opportunistic and nosocomial infection • Can be found in indwelling medical devices
like catheters and drainage tubes
![Page 6: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/6.jpg)
Stenotrophomonas maltophilia
• Aerobic Gram negative rod • Formerly Pseudomonas sp. and Xanthomonas sp. • Commonly found in aqueous environments • Increasingly common as an opportunistic and
nosocomial infection • Multi-drug resistant • Can colonize breathing tubes, urinary catheters,
and the respiratory tract
![Page 7: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/7.jpg)
PFGE testing • MDH Microbiology lab received the first OA
and KO isolates from the hospital in late February – SM isolates received in early March
• Lab personnel did a literature search for PFGE protocols for each organism – PulseNet summary of PFGE for other organisms
had protocols for KO and SM – Found several journal articles with PFGE
protocols for OA
![Page 8: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/8.jpg)
Initial trial – KO and OA K. oxytoca O. anthropi
XbaI SpeI XbaI SpeI XbaI XbaI SpeI
KO and OA samples were initially run with the Salmonella PulseNet protocol
![Page 9: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/9.jpg)
Ochrobactrum anthropi trials
Salmonella Listeria GAS - fast Staph - fast B. pertussis XbaI SpeI XbaI SpeI XbaI SpeI XbaI SpeI XbaI SpeI
![Page 10: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/10.jpg)
Initial trial - SM
SM samples were initially run with the Salmonella PulseNet protocol
Routine Salmonella S. maltophilia XbaI XbaI XbaI XbaI XbaI XbaI
![Page 11: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/11.jpg)
Final protocols
Organism Agarose plug
casting Enzymes (1st & 2nd)
Initial and final switch times
K. oxytoca PN E. coli protocol *
XbaI SpeI
2.2 s and 64.0 s (PN Salmonella)
O. anthropi PN Listeria protocol
SpeI XbaI
2.2 s and 64.0 s (PN Salmonella)
S. maltophilia PN E. coli protocol XbaI 2.2 s and 64.0 s
(PN Salmonella)
* No proteinase K was added to plug.
• Run with H9812 Standard • Digested for up to 2 hours
![Page 12: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/12.jpg)
Epidemiology results Many areas of the hospital were investigated:
• Microbiology lab
• Phlebotomy practices
• Environmental contamination
• Surgical and anesthetic practices
• Pharmaceutical contamination (manufacturer, pharmacy, or staff)
![Page 13: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/13.jpg)
Dice (Tol 1.5%-1.5%) (H>0.0% S>0.0%) [0.0%-100.0%]PFGE-XbaI
100
80PFGE-XbaI
ID
7
21
26
5
18
21
2
6
23
21
21
26
N/A
N/A
TypeDetails
Blood
FDA, hydromorphone bag C (#2BC)
FDA, hydromorphone bag D (#2CA)
Blood
Blood
Blood
Blood
Blood
Blood
SCH, hydromorphone bag A
FDA, hydromorphone bag C (#2BB)
SCH, hydromorphone bag B
SPCU bathroom drain
Surgery 1A drain
MN Xba1 PFGE
KOXY2*
KOXY2*
KOXY2
KOXY3*
KOXY1
KOXY1*
KOXY1
KOXY1
KOXY1
KOXY1
KOXY1
KOXY1
KOXY9*
KOXY8*
Klebsiella oxytoca PFGE results
![Page 14: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/14.jpg)
Ochrobactrum anthropi PFGE results Dice (Opt:1.50%) (Tol 1.5%-1.5%) (H>0.0% S>0.0%) [0.0%-100.0%]PFGE-SpeI
100
8060
PFGE-SpeI
ID
N/A
N/A
7
18
5
3
21
20
14
14
N/A
N/A
SourceSite
FDA, saline bottle (#1A)
FDA, saline bottle (#1B)
Blood
Blood
Blood
Blood
Blood
Blood
Blood
Blood
Quality control organism
Cornea
MN Spe1 PFGE
OANT9*
OANT9
OANT4
OANT4
OANT4*
OANT4
OANT4
OANT4
OANT6
OANT6*
OANT5*
OANT7*
![Page 15: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/15.jpg)
Stenotrophomonas maltophilia PFGE results
Dice (Tol 1.5%-1.5%) (H>0.0% S>0.0%) [0.0%-100.0%]PFGE-XbaI
100
80
PFGE-XbaI
ID
21
26
15
N/A
TypeDetails
SCH, hydromorphone bag A
SCH, hydromorphone bag B
Blood
Surgery 1A drain
MN Xba1 PFGE
SMALT1
SMALT1*
SMALT1
SMALT6*
![Page 16: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/16.jpg)
PFGE Results from Patient Isolates, Narcotic bags, and Saline Bottle
# 21
KOXY1
SMALT1
KOXY2
# 18 # 2 # 7 # 5 # 6 # 23 # 20 #14 #15
OANT9 KOXY1
KOXY1
KOXY2
KOXY2
OANT4
SMALT1
SMALT1
Saline Bottle A Hydromorphone
Bag A # 21
Hydromorphone Bag B # 26
Hydromorphone Bag C # 21
Hydromorphone Bag D # 26
KOXY1
OANT4
KOXY1
OANT4
KOXY3
OANT4 OANT4 OANT4
KOXY1 KOXY1
Bacteremias
Hydromorphone Bags Saline Bottle
![Page 17: Ochrobactrum anthropi, Klebsiella oxytoca, and - APHL · Ochrobactrum anthropi, Klebsiella oxytoca, and Stenotrophomonas maltophilia: What do we do with these?! Ginette Dobbins Minnesota](https://reader031.fdocuments.in/reader031/viewer/2022022807/5ce908d288c993b5168b6450/html5/thumbnails/17.jpg)
Acknowledgements
MDH lab Selina Jawahir, Victoria Lappi, Jackie Mahon,
Dave Boxrud
MDH epidemiology Aaron DeVries, Jane Harper, Lindsey Lesher,
Melissa Schaefer, Richard Danila, Ruth Lynfield