Original Article

Outbreak of Tsukamurella Species Bloodstream Infection among Patients at an Oncology Clinic, West Virginia, 2011–2012

Isaac See, MD,1,2 Duc B. Nguyen, MD,1,2 Somu Chatterjee, MD, MPH,3 Thein Shwe, MPH, MS, MBBS,3 Melissa Scott, RN,3 Sherif Ibrahim, MD, MPH,3 Heather Moulton-Meissner, PhD,2 Steven McNulty, BS,4 Judith Noble-Wang, PhD,2 Cindy Price, RN, BSN, CIC,5 Kim Schramm, MT(ASCP),6Danae Bixler, MD, MPH,3 and Alice Y. Guh, MD, MPH2
1. Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
2. Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
3. Division of Infectious Disease Epidemiology, West Virginia Bureau for Public Health, Charleston, West Virginia
4. Department of Microbiology, University of Texas Health Science Center, Tyler, Texas
5. Department of Infection Control, Ohio Valley Medical Center, Wheeling, West Virginia
6. Department of Microbiology, Ohio Valley Medical Center, Wheeling, West Virginia
Address correspondence to Isaac See, MD, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-24, Atlanta, GA 30333 (isee@cdc.gov).
Objective. To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility.
Design. Epidemiologic investigation of the outbreak with a case-control study.
Methods. A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.
Results. Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September–October 2011 (P= .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.
Conclusion. Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.
Received September 30, 2013; accepted November 17, 2013; electronically published January 29, 2014