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Ochrobactrum anthropi meningitis in pediatric pericardial allograft transplant recipients
H J Chang1, J C Christenson, A T Pavia
1Hospital Infections Program, National Center for Infectious Disease, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Abstract:
An epidemiologic investigation was done after 3 patients contracted Ochrobactrum anthropi meningitis at one hospital in October 1994. Neurosurgical patients with pericardial tissue implants were at greater risk of infection than other neurosurgical patients (3/14 vs. 0/566; P<.001). Cultures of implants removed from 2 case-patients, an implant at implantation, a nonimplanted pericardial tissue, and an unwrapped but unopened bottle of Hank's balanced salt solution (HBSS) grew O. anthropi. Patient and tissue isolates had identical genotypes; the isolate from the HBSS bottle had a unique genotype. Culture samples from an unopened HBSS bottle and from pericardial tissue grew Pseudomonas stutzeri of the same genotype; however, no P. stutzeri infections were detected. The investigation documented intrinsic P. stutzeri contamination of HBSS. O. anthropi contamination of tissues occurred during processing, possibly due to extrinsic contamination of HBSS. Active surveillance is needed to detect infection in patients receiving transplanted tissues, and rigorous infection control practice are necessary during tissue harvesting and processing to ensure sterility.
Insights
Ochrobactrum anthropi meningitis outbreaks in neurosurgical patients were linked to contaminated pericardial tissue implants. Contamination likely originated from Hank
Area of Science:
- Epidemiology
- Infectious Diseases
- Microbiology
Background:
- Ochrobactrum anthropi meningitis is a rare but serious infection.
- Neurosurgical patients receiving tissue implants are vulnerable to healthcare-associated infections.
- A cluster of O. anthropi meningitis cases prompted an investigation into potential sources.
Purpose of the Study:
- To investigate the cause of O. anthropi meningitis in neurosurgical patients.
- To identify the source and transmission route of the pathogen.
- To recommend preventive measures against future outbreaks.
Main Methods:
- Epidemiologic investigation including case-control analysis.
- Microbiologic cultures of patient implants, tissue samples, and Hank's balanced salt solution (HBSS).
- Genotyping of bacterial isolates to determine strain relatedness.
Main Results:
- Neurosurgical patients with pericardial tissue implants had a significantly higher risk of O. anthropi infection.
- O. anthropi was isolated from patient implants, tissues, and an HBSS bottle.
- Pseudomonas stutzeri, a contaminant of HBSS, was also identified but not linked to patient infections.
Conclusions:
- Intrinsic contamination of HBSS with P. stutzeri was documented.
- Extrinsic contamination of HBSS during tissue processing likely led to O. anthropi contamination of implants.
- Active surveillance and stringent infection control during tissue handling are crucial to prevent infections.