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Pseudomonas pickettii infections in a paediatric oncology unit
1Department of Medical Microbiology, South African Institute for Medical Research, Johannesburg Hospital.
Abstract:
Over a 3-month period, seven patients in a paediatric oncology unit developed Pseudomonas pickettii septicaemias. The outbreak was difficult to recognize since the cases occurred at widely spaced intervals and problems were experienced with the identification of the isolates. Many of the isolates were initially misidentified on the basis of a short sugar set used in the laboratory for identification of the non-fermenting Gram-negative bacilli. Moreover, the organisms had varying sensitivity patterns. The source of the organisms proved to be vials of 'sterile' distilled water which had been used for flushing the patients' indwelling Hickman lines. No further cases occurred once the use of this water was discontinued.
Insights
A Pseudomonas pickettii outbreak in a pediatric oncology unit was linked to contaminated distilled water used for Hickman lines. Discontinuation of the water source halted the spread of these difficult-to-identify bacterial infections.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Hospital Epidemiology
Background:
- Pseudomonas pickettii is a non-fermenting Gram-negative bacillus that can cause opportunistic infections.
- Septicemia in immunocompromised patients, such as those undergoing pediatric oncology treatment, poses a significant clinical challenge.
- Outbreaks of healthcare-associated infections require prompt identification and source control to prevent further morbidity.
Observation:
- Seven cases of Pseudomonas pickettii septicemia occurred over three months in a pediatric oncology unit.
- The outbreak was challenging to detect due to widely spaced intervals between cases.
- Isolates exhibited variable antimicrobial sensitivity patterns, complicating initial identification and treatment.
- Initial misidentification of isolates occurred due to limitations in the short sugar set identification method for non-fermenting Gram-negative bacilli.
Findings:
- The source of the Pseudomonas pickettii outbreak was identified as 'sterile' distilled water vials.
- This contaminated water was used for flushing patients' indwelling Hickman lines.
- The outbreak ceased immediately after the use of the implicated distilled water was discontinued.
Implications:
- Highlights the critical importance of stringent quality control for medical supplies, including 'sterile' water.
- Underscores the need for advanced laboratory identification methods for non-fermenting Gram-negative bacilli in clinical settings.
- Emphasizes the potential for seemingly innocuous supplies to act as reservoirs for serious hospital-acquired infections in vulnerable patient populations.