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485 Sphingomonas paucimobilis BSI Outbreak in Neonatal ECMO Patients

Sunday, April 3, 2011
Trinity Ballroom (Hilton Anatole)
Annabelle L. Hendrix, BS , Kansas City University of Medicine and Bios, kansas City, MO
Marc Mazade, MD , Cooks Children's Physician Network, Fort Worth, TX
Lisa C. Schlaefli, BSN , Cook-Fort Worth Children's Med, Fort Worth, TX
James J. Dunn, PhD , Cook-Fort Worth Children's Med, Fort Worth, TX
Mark Shelton, MD , Cook-Fort Worth Children's Med, Fort Worth, TX
Background: Extracorporeal membrane oxygenation (ECMO) is an aggressive highly invasive life support procedure that has come into frequent usage in neonatal intensive care units (NICU).  ECMO creates an additional nosocomial infection risk for seriously ill neonates.   Sphingomonas paucimobilis is an opportunistic Gram negative rod associated with colonization of aqueous environments, and has been associated with nosocomial infections.

Objective: We would like to report an apparent outbreak of nosocomial S.  paucimobilis BSI in patients receiving ECMO treatment in the NICU at a tertiary children’s hospital over an 8 month period between May 2009 to January 2010.  An outbreak investigation was initiated to determine if the cases were related. 

Methods: Routine surveillance identified three patients in the NICU receiving ECMO treatment that developed nosocomial BSI with S. paucimobilis.   Several isolates of S. paucimobilis were obtained from the infected patients and from environmental samples. All isolates were identified as S. paucimobilis using routine microbiology techniques.  These isolates were compared using antibiotic susceptibility patterns.  Available clinical and environmental specimens were further analyzed using pulse field gel electrophoresis.

Results: Case 1 and 2 appeared to have the same susceptibility patterns; case 3 had an unrelated pattern.   The isolate from case 3 was examined with pulse field gel electrophoresis was found to be unrelated to multiple environmental isolates.  The first two cases may have been related, but the third was clearly differentiated by antimicrobial susceptibility patterns.  The source of the bloodstream infections appeared to be from contaminated medical equipment.

Conclusions: Sphingomonas paucimobilis has been isolated from 3 NICU patients while on ECMO.  We could not confirm the organisms were identical or identical to isolates obtained from ECMO equipment.   Due to this outbreak, we have developed new procedures for maintaining EMCO equipment, particularly using refined sterile techniques for assembly and priming of circuits.