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Nosocomial CDC group IV c-2 bacteremia: epidemiological investigation by randomly amplified polymorphic DNA analysis
D Moissenet1, M D Tabone, J P Girardet
1Service of Microbiologie, Hôpital d'Enfants Armand-Trousseau, Paris, France.
Abstract:
The CDC group IV c-2 bacterium is a gram-negative bacillus rarely isolated from clinical specimens. This organism caused catheter-related bacteremia in five immunocompromised children hospitalized in two distinct wards of our institution between November 1993 and October 1994. Three patients recovered on empiric antibacterial chemotherapy combining ceftazidime and amikacin, and a fourth patient required imipenem instead of ceftazidime. The fifth patient recovered without treatment. Catheter removal was never necessary. The randomly amplified polymorphic DNA technique with three different primers was applied to nine isolates recovered by culturing blood from the five children and showed that all of the patients harbored isolates of the same genotype. The source of the outbreak could not be determined.
Insights
A rare gram-negative bacillus caused catheter-related bacteremia in immunocompromised children. Genotyping confirmed a single source outbreak, though the exact origin remained elusive. Antibiotics were effective, and catheter removal was unnecessary.
Area of Science:
- Medical microbiology
- Infectious diseases
- Clinical bacteriology
Background:
- CDC group IV c-2 is a rarely isolated gram-negative bacillus.
- Catheter-related infections pose significant risks, especially in immunocompromised patients.
- Understanding the epidemiology of rare bacterial pathogens is crucial for infection control.
Purpose of the Study:
- To report a cluster of catheter-related bacteremia caused by CDC group IV c-2 in children.
- To investigate the genotypic relatedness of the causative isolates.
- To describe the clinical management and outcomes of affected patients.
Main Methods:
- Retrospective analysis of clinical data for five immunocompromised children.
- Bacteriological culture and identification of CDC group IV c-2 from blood samples.
- Randomly amplified polymorphic DNA (RAPD) typing using three primers to assess isolate relatedness.
Main Results:
- Five cases of catheter-related bacteremia occurred between November 1993 and October 1994.
- All isolates belonged to the same genotype based on RAPD analysis, indicating a common source outbreak.
- Most patients responded to empiric antibiotic therapy (ceftazidime/amikacin or imipenem); catheter removal was not required.
- The source of the outbreak could not be identified.
Conclusions:
- CDC group IV c-2 can cause significant nosocomial infections like catheter-related bacteremia in vulnerable populations.
- Genotyping confirmed a clonal outbreak, highlighting the importance of molecular epidemiology in outbreak investigations.
- Prompt and appropriate antibiotic treatment is effective, and invasive procedures like catheter removal may be avoided in select cases.