Brief Report: Clustered Bacteremias in a Hemodialysis Unit: Cross-Contamination of Blood Tubing from Ultrafiltrate Waste

Longfield, Robert N.; Wortham, William G.; Fletcher, Linda L.; Nauscheutz, William F.

doi:10.2307/30147119

Cited by 11 publications

(10 citation statements)

References 9 publications

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“…We think that cases were clustered almost exclusively in patients with catheters in this outbetter education about asepsis is needed to engender a more critical assessment of procedures and equipment in dialysis break and a previous one [8] because the catheter lumen provides a sequestered site for bacteria or yeast, introduced centers. It is noteworthy in this outbreak and others [7,8] that dialysis personnel did not recognize when blood lines were during hemodialysis, to persist and replicate between hemodialysis treatments. Even though bloodstream contamination durbeing contaminated by contact with a nonsterile environment.…”

Section: Treatmentmentioning

confidence: 78%

“…Mock trials showed that laboratory-grown organisms inocuMock trials using 3 of the most common bloodstream pathogens showed that microorganisms present at high concentration lated onto the WHO port could contaminate the blood pathway in drain ports could enter blood line tubing by at least two negative bacteria [3 -5, 7 -10], mycobacteria [1,2], enterococci [7], and now yeast. This surveillance activity should not require routes.…”

Section: Treatmentmentioning

confidence: 99%

“…This problem has been recognized during assembly of arterial pressure balanced salts, bicarbonate, dextrose, and post-membrane organic solutes. This solution can support the growth of bacteria monitoring equipment [19] and was thought to have contributed to a previous dialysis unit outbreak [7].…”

Section: Treatmentmentioning

confidence: 99%

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An Outbreak of Bloodstream Infections Arising from Hemodialysis Equipment

et al. 1998

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An outbreak of 29 cases of bloodstream infection by 16 pathogens occurred during 8 months at two chronic hemodialysis centers. Consequences included 21 hospital admissions and removal of 23 dialysis catheters. An epidemiologic investigation comparing case-patients with uninfected controls showed that risk was significantly (P < .05) associated with having a catheter for vascular access; receiving treatment on a Monday, Wednesday, Friday schedule; and receiving treatment on one heavily contaminated dialysis machine. Culture studies and mock trials showed that bloodstream pathogens were present in a recently installed, commercially marketed attachment for disposal of spent priming saline and could enter blood line tubing directly or indirectly during dialyzer priming and tubing assembly. The outbreak was halted by measures directed at the attachment. Investigation of this problem demonstrated that microbial overgrowth in the attachment caused bloodstream infections and underscores the importance of microbiologic considerations in the design and use of hemodialysis equipment.

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Section: Treatmentmentioning

confidence: 78%

Section: Treatmentmentioning

confidence: 99%

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An Outbreak of Bloodstream Infections Arising from Hemodialysis Equipment

et al. 1998

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“…casselijlavus and E. gallinarum rarely cause infections in humans, although serious infections have been reported [20]. Hence, depending on the circumstances, it may or may not be considered an advantage to isolate enterococci with the VanC phenotype on screening media.…”

Section: Discussionmentioning

confidence: 98%

Comparison of agar-based media for primary isolation of glycopeptide-resistant enterococci

Chadwick

Brown

Wilcox

et al. 1997

Clinical Microbiology and Infection

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OBJECTIVE: To compare four vancomycin-containing agar media for the isolation of glycopeptide-resistant enterococci (GRE) from clinical fecal specimens: kanamycin---aesculin---azide (KAA) agar; bile---aesculin---polymixin (BAP) agar; aztreonam---amphotericin blood (CBAA) agar; and neomycin blood (CBN) agar. METHODS: Fecal specimens from 125 patients were inoculated onto each medium. Media were examined for enterococci after incubation for up to 48 h. Enterococci were identified to species level, and glycopeptide phenotypes were determined by measuring minimum inhibitory concentrations of vancomycin and teicoplanin. RESULTS: GRE were isolated from 44/125 samples. Enterococcus faecalis and Enterococcus faecium isolates, expressing glycopeptide resistance of the VanA or VanB phenotypes, were recovered from 27/33 (82%) specimens on BAP medium, 26/33 (79%) on KAA medium, and 21/33 (64%) on CBN and CBAA media. Enterococcus gallinarum and Enterococcus casseliflavus isolates expressing low-level glycopeptide resistance (VanC phenotype) were recovered from 14/15 (93%) specimens on CBAA medium, 7/15 (47%) on KAA and CBN media, and 6/15 (40%) on BAP medium. CONCLUSIONS: The media tested in this study, with the exception of CBN medium, detected at least 75% of patients colonized by GRE. Further development of BAP, CBAA and KAA media is warranted to improve growth and selectivity.

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“…Enterococci have been cultured from dialysate, treated HD water, and components of HD machines (88–91). The reported prevalence of VRE (generally based on rectal swab cultures) in dialysis outpatients has varied from 0 to 12% and was as high as 28% among hospitalized HD patients (92–97).…”

Section: Vre In Dialysis Patientsmentioning

confidence: 99%

Infection with Antimicrobial‐resistant Microorganisms in Dialysis Patients

Berns

2003

Seminars in Dialysis

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The prevalence of antimicrobial-resistant microorganisms in various health care settings, including outpatient dialysis facilities, has increased dramatically in the last decade. Antimicrobial use and patient-to-patient transmission of resistant strains are the two main factors that have contributed to this rapid increase. Methicillin-resistant Staphylococcus aureus (MRSA) and coagulase-negative staphylococci are commonly isolated as a cause of hemodialysis (HD) catheter-related bacteremia and peritoneal dialysis (PD)-related catheter infection and peritonitis. The widespread use of vancomycin in dialysis patients is of concern because of an increase in the prevalence of vancomycin-resistant enterococci (VRE) in dialysis patients. Staphylococci with reduced sensitivity to vancomycin have also appeared in dialysis patients. A more recent problem is the appearance of S. aureus isolates with a high degree of resistance to the topical antimicrobial agent mupirocin. This has been seen in PD patients who have received prophylactic application of mupirocin at the peritoneal catheter exit site. Appropriate antimicrobial use will help protect the efficacy of currently used antibiotics, such as vancomycin. Published guidelines for use of vancomycin should be followed. New antimicrobials such as linezolid and quinupristin/dalfopristin have activity against VRE and MRSA, but resistance to these agents has already occurred. Preventing transmission of antimicrobial-resistant microorganisms in health care settings, including outpatient dialysis facilities, is important in limiting the spread of these resistant organisms.

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Brief Report: Clustered Bacteremias in a Hemodialysis Unit: Cross-Contamination of Blood Tubing from Ultrafiltrate Waste

Cited by 11 publications

References 9 publications

An Outbreak of Bloodstream Infections Arising from Hemodialysis Equipment

An Outbreak of Bloodstream Infections Arising from Hemodialysis Equipment

Comparison of agar-based media for primary isolation of glycopeptide-resistant enterococci

Infection with Antimicrobial‐resistant Microorganisms in Dialysis Patients

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