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Multiresistant Pseudomonas aeruginosa outbreak in a pediatric oncology ward related to bath toys
J P Buttery1, S J Alabaster, R G Heine
1Department of Microbiology and Infectious Diseases, Royal Children's Hospital, Melbourne, Victoria, Australia. jim.buttery@paediatrics.oxford.ac.uk
Insights
Nosocomial Pseudomonas aeruginosa outbreaks in pediatric wards can be linked to contaminated bath toys. This study identified bath toys as a source of multidrug-resistant P. aeruginosa, highlighting risks for immunocompromised children.
Area of Science:
- Infectious Diseases
- Pediatric Oncology
- Hospital Epidemiology
Background:
- Nosocomial outbreaks of Pseudomonas aeruginosa (P. aeruginosa) pose significant risks in pediatric hospitals, particularly for neonates and immunocompromised patients.
- These infections can lead to substantial morbidity and mortality.
Purpose of the Study:
- To investigate a multidrug-resistant P. aeruginosa outbreak in a pediatric oncology ward.
- To identify the source and risk factors associated with the outbreak.
Main Methods:
- Collected specimens from infected patients and the hospital environment.
- Characterized bacterial isolates using antibiotic susceptibility and pulsed-field gel electrophoresis (PFGE) for DNA fingerprinting.
- Conducted a case-control study to determine risk factors for infection.
Main Results:
- Identified eight patients with P. aeruginosa infections, including bacteremia and localized infections.
- Isolated multidrug-resistant P. aeruginosa from water-retaining bath toys and a toy box in the ward.
- PFGE confirmed identical P. aeruginosa strains from patients and environmental sources.
- Found significant associations between infection and the use of bath toys, bubble bath, prolonged hospital stay, and prior antibiotic exposure.
Conclusions:
- This study reports the first nosocomial outbreak linked to contaminated toys.
- Recommends against the use of water-retaining bath toys in pediatric wards caring for immunocompromised children to prevent P. aeruginosa transmission.
Background:
Nosocomial outbreaks of Pseudomonas aeruginosa in pediatric hospitals frequently involve neonates and immunosuppressed patients and can cause significant morbidity and mortality.
Objective:
To describe the investigation of a multidrug-resistant P. aeruginosa outbreak in a pediatric oncology ward at the Royal Children's Hospital, Melbourne, Australia.
Design And Methods:
Specimens were collected from infected patients and the ward environment. Bacterial isolates were characterized by antibiotic susceptibility patterns and bacterial DNA fingerprinting performed by pulsed-field gel electrophoresis (PFGE). A case-control study was carried out to assess possible risk factors for infection.
Results:
Eight patients had clinical illnesses including bacteremia (n = 5) and infections of skin (n = 2), central venous catheter site (n = 1) and urinary tract (n = 1). The environmental ward survey yielded isolates of multiresistant P. aeruginosa from a toy box containing water-retaining bath toys, as well as from three of these toys. Pulsed-field gel electrophoresis of bacterial DNA demonstrated identical band patterns of the isolates from patients, toys and toy box water. A case-control study involving the 8 cases and 24 disease-matched controls demonstrated a significant association between P. aeruginosa infection and use of bath toys (P = 0.004), use of bubble bath (P = 0.014), duration of stay (P = 0.007) and previous antibiotic exposure (P = 0.026). Cultures from the bubble bath liquid were negative.
Conclusion:
This is the first description of a nosocomial outbreak associated with toys. We caution against the use of water-retaining bath toys in wards treating immunocompromised children.