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An outbreak of pseudobacteremia caused by Enterobacter cloacae from a phlebotomist's vial of thrombin

D R Graham, E Wu, A K Highsmith

    Annals of Internal Medicine
    |November 1, 1981
    PubMed

    Insights

    A single phlebotomist caused Enterobacter cloacae bloodstream infections due to contaminated thrombin. Prompt intervention by stopping the phlebotomist and removing the thrombin source resolved the outbreak.

    Area of Science:

    • Clinical Microbiology
    • Infectious Diseases
    • Hospital Epidemiology

    Background:

    • Enterobacter cloacae is an opportunistic pathogen frequently associated with healthcare-associated infections.
    • Bloodstream infections (bacteremia) can arise from various sources, including contaminated procedures.

    Purpose of the Study:

    • To investigate an unusual cluster of Enterobacter cloacae-positive blood cultures in a small hospital.
    • To identify the source and mode of transmission of the detected bacteremia.

    Main Methods:

    • Retrospective case review of blood cultures over a 15-day period.
    • Epidemiological investigation focusing on phlebotomy procedures and materials.
    • Microbial culture and identification of potential contaminants, including thrombin vials.

    Main Results:

    • Seven patients had positive blood cultures for Enterobacter cloacae, all linked to a single phlebotomist (Phlebotomist A).
    • Phlebotomist A's blood culture samples were significantly more likely to be positive compared to other phlebotomists (p = 0.00001).
    • Enterobacter cloacae was isolated from the thrombin vials carried by Phlebotomist A, suggesting it as the contamination source.

    Conclusions:

    • Contamination of blood culture specimens with Enterobacter cloacae occurred during collection, linked to a specific phlebotomist.
    • The use of thrombin vials, which occasionally spilled on the phlebotomist's gloves, was identified as the likely source of contamination.
    • Halting the involved phlebotomist's blood collection and removing the contaminated thrombin vials immediately ceased the bacteremia cases.

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