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7. Sierra-Camerino R, Ortiz C. Prevalence of infections and systemic inflammatory response syndrome in southern Spanish ICUs. Intensive Care Med 2001;27:791e792. 8. Gastmeier P, Kampf G, Wischnewski N, Schumacher M, Daschner F, Ruden H. Importance of the surveillance method: national prevalence studies on nosocomial infections and the limits of comparison. Infect Control Hosp Epidemiol 1998; 19:661e667.
S. Fariaa,* L. Sodanob M. Dauric A.F. Sabatoc A. Gjatad I. Kitod E. Llazod A. Bilajd O. Mertirajd N. Schinaiaa and the Prevalence Study Groupe a National Institute of Health, Rome, Italy b ‘San CamilloeForlanini’ Hospital, Rome, Italy c University of Rome ‘Tor Vergata’, Department of Anaesthesiology and Intensive Care Unit, Rome, Italy d University Hospital Centre ‘Mother Teresa’, Tirana, Albania e National Institute of Health, Rome, Italy: Y. Kodra, I. Itro, L. Avellis, C. Bumbaca; University Hospital Centre ‘Mother Teresa’, Tirana, Albania: D. Bozaxhiu, M. Kalaja, A. Misha, A. Tafaj, E. Shalari, I. Krasinski, E. Kuci, A. Simaku, J. Hyskaj, A. Ibrahimi, G. Stroni, A. Alesi, S. Brozi. E-mail address:
[email protected] Available online 17 March 2008
* Corresponding author. Address: Department of Infectious Diseases, National Institute of Health, Via Bagno a Ripoli 12, 00146 Rome, Italy. Tel: þ39 0620900756; fax: þ39 0620904790. ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.01.029
Cluster of nosocomial campylobacteriosis, Austria 2006
Madam, We report a nosocomial outbreak of Campylobacter jejuni and Campylobacter coli affecting at least seven patients from five different wards and 14 staff
members at a tertiary care hospital over a 14 day period. Isolates were available from three of seven culture-confirmed patient cases and from two of six confirmed staff cases. Another eight clinicale epidemiological cases of campylobacteriosis among healthcare personnel were identified. Case-series investigation revealed that consumption of poultry dishes prepared in the hospital kitchen was the only common factor. Two of the three patient isolates were C. coli, one was C. jejuni. Both staff isolates were C. jejuni. Using restriction enzymes SmaI, SalI and KpnI, the C. coli isolates showed indistinguishable pulsed-field gel electrophoresis (PFGE) patterns. The C. jejuni patient isolate was indistinguishable from one of the two C. jejuni staff isolates. Isolates from sporadic community cases (two C. coli isolates, 16 C. jejuni isolates) at the same time and in the same province as the nosocomial outbreak showed no clonal concordance with the hospital-associated isolates. Molecular investigation revealed a Campylobacter isolate from an outbreak case with high genetic homology to a poultry isolate obtained from an epidemiologically related slaughterhouse which indicated a possible reservoir of one of the outbreak strains. C. fetus subsp. fetus and C. jejuni cause nosocomial outbreaks of neonatal meningitis, and outbreaks of nosocomial diarrhoea due to C. jejuni have been reported with the source of infection remaining unclear.1e6 Investigation of outbreaks of campylobacteriosis, including molecular subtyping of isolates, is important for elucidating the chain of transmission and the reservoir of the organism.3 Conventional epidemiological investigation in our outbreak revealed consumption of poultry dishes prepared by the hospital kitchen as the only common link (18 of 21 cases) which suggested poultry causatively involved in the outbreak e either as source of contamination or of infection. Using PFGE typing we were able to demonstrate that a C. jejuni isolate obtained eight weeks before the outbreak from a chicken of a batch from one of the three slaughterhouses serving the hospital kitchen was closely related to a C. jejuni isolate of one of the outbreak cases. This finding of high genetic homology raises two hypotheses: the tested slaughter batch was the direct vehicle for Campylobacter infection, or the finding merely reflects the occurrence of one of the causative outbreak clones in a supplying poultry production plant, i.e. different batches harbouring the same strain. The persistence of certain clones of C. jejuni during successive broiler flock rotations has been observed previously.7 In addition, C. jejuni isolates from three sporadic community cases originating in the affected province were found to be
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indistinguishable by PFGE typing from another C. jejuni poultry isolate obtained from the same slaughterhouse. Hence, these results of PFGE typing highlight the value of molecular investigation in elucidating Campylobacter outbreaks and the origin of sporadic community cases. The clustering of isolates in the dendrogram according to PFGE patterns was, in all but one case, in accordance with susceptibility testing results. Two isolates of C. jejuni, one from a 12-year-old patient case and the other from a staff case who had no direct contact with this patient, showed indistinguishable PFGE patterns but differed in susceptibility to ciprofloxacin and nalidixic acid. In the case of the staff member, the stool specimen was collected after a 10 day ‘unsuccessful’ treatment with ciprofloxacin (500 mg per twice daily orally). The isolate was resistant to ciprofloxacin. Food-borne outbreaks and sporadic cases of campylobacteriosis are often caused by consumption of undercooked poultry or poultry products and by cross-contamination in the kitchen from raw poultry to other raw food. Consumption of poultry dishes prepared by the hospital kitchen was the only common link between our cases. The fact that a hazard analysis and critical control point (HACCP) concept was not in place for a recently established cookechill system may have contributed to food-borne transmission of Campylobacter in the affected hospital. As demonstrated by Wilkinson et al., cookechill catering in a hospital represents a system with negligible microbiological hazards only when all procedures are controlled by appropriate methods such as the HACCP approach.8 To our knowledge, this nosocomial Campylobacter outbreak is the largest described so far and the first involving more than one species. Conflict of interest statement None declared.
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subspecies fetus in a neonatal intensive care unit. Acta Paediatr Jpn 1992;34:530e533. Goossens H, Henocque G, Kremp L, et al. Nosocomial outbreak of Campylobacter jejuni meningitis in newborn infants. Lancet 1986;2(8499):146e149. Llovo J, Mateo E, Mun ˜oz A, Urquijo M, On SL, Ferna ´ndezAstorga A. Molecular typing of Campylobacter jejuni isolates involved in a neonatal outbreak indicates nosocomial transmission. J Clin Microbiol 2003;41:3926e3928. van Dijk WC, van der Straaten PJ. An outbreak of Campylobacter jejuni infection in a neonatal intensive care unit. J Hosp Infect 1988;11:91e92. Hershkowici S, Barak M, Cohen A, Montag J. An outbreak of Campylobacter jejuni infection in a neonatal intensive care unit. J Hosp Infect 1987;9:54e59. Haase A, Schousboe M, Mee A, Hawkins A. Use of molecular typing to identify a nosocomial-acquired Campylobacter infection. N Z Med J 1995;108:112. Petersen L, Wedderkopp A. Evidence that certain clones of Campylobacter jejuni persist during successive broiler flock rotations. Appl Environ Microbiol 2001;67:2739e2745. Wilkinson PJ, Dart SP, Hadlington CJ. Cookechill, cooke freeze, cookehold, sous vide: risks for hospital patients? J Hosp Infect 1991;18(Suppl. A):222e229.
S. Jelovcana D. Schmida I. Lederera M. Hellb K. Rehbergera D. Arnholda G. Krassniga H. Lassniga G. Romaneka P. Plessc M. Maaßb A. Wojnab F. Allerbergera,* a Austrian Agency for Health and Food Safety (AGES), Vienna, Austria b Medical University of Salzburg, Salzburg, Austria c Department of Veterinary Affairs, Graz, Austria E-mail address:
[email protected] Available online 10 March 2008
Funding sources None.
References 1. Morooka T, Takeo H, Yasumoto S, Mimatsu T, Yukitake K, Oda T. Nosocomial meningitis due to Campylobacter fetus
* Corresponding author. Address: Austrian Agency for Health and Food Safety, MED, Spargelfeldstraße 191, A-1220 Vienna, Austria. Tel.: þ43 (0) 50555 35500; fax: þ43 (0) 50555 25802. ª 2008 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jhin.2008.01.010
