kjcm Korean Journal of Clinical Microbiology Korean J Clin Microbiol 1229-0025 Korean Journal of Clinical Microbiology 10.5145/kjcm.2008.11.1.5 kjcm-11-5 Original Article Pseudo-outbreak of Klebsiella oxytoca from Bronchial Washing Specimens LeeJa Young 1 ShinJeong Hwan 1 2 LeeHyun-Kyung 3 YuSeong-Mi 5 ParkEun Hee 6 LeeHee Ryune 1 KimJae Hyen 1 KimHye Ran 1 MoonChi Sook 3 KimYoung Jae 4 LeeJeong Nyeo 1 2 Department of Laboratory Medicine, College of Medicine, Inje University, Busan, Korea Paik Institute for Clinical Research, College of Medicine, Inje University, Busan, Korea Department of Internal Medicine, College of Medicine, Inje University, Busan, Korea Department of Anesthesiology, College of Medicine, Inje University, Busan, Korea Department of Nursing, Gwangju Health College, Gwangju, Korea Busan Metropolitan City Institute of Health and Environment, Busan, Korea Department of Laboratory Medicine, Busan Paik Hospital, College of Medicine, Inje University, 633-165, Gaegeum-dong, Busanjin-gu, Busan 614-735, Korea. (Tel) 82-51-890-6475, (Fax) 82-51-893-1562, (E-mail) jhsmile@inje.ac.kr 042008 20042008 111 510 19112007 16012008 Copyright © 2008 Korean Journal of Clinical Microbiology 2008 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background

We noticed a sudden increase in the isolation of Klebsiella oxytoca from bronchial washing specimens during May to June 2006. An epidemiological investigation was conducted to identify the cause of the outbreak and to implement appropriate infection control measures.

 Methods

A total of 18 isolates of K. oxytoca were found. The 14 bronchial washing specimens that yielded K. oxytoca were taken in the outpatient bronchoscopy suite, and the other 4 specimens were obtained by a portable bronchoscopy. The medical records and microbiologic findings of these patients were reviewed. Environmental samples from two bron-choscopes and the bronchoscopy suite were cultured. The relations between the available 10 isolates from bronchial washing fluid were investigated by pulsed-field gel electrophoresis (PFGE).

 Results

No patients were judged to have had true infections attributable to K. oxytoca either before or after bronchoscopy. Cultures of samples from two bronchoscopes and related environment did not grow K. oxytoca. The PFGE analysis showed that 8 of 10 isolates had a similar pattern of DNA fragments. An infection control strategy was implemented, including adequately cleaning and disinfecting the broncho-scopes, and a sharp reduction in the incidence of K. oxytoca from bronchial washing samples followed.

 Conclusion

The sudden increase of K. oxytoca from bronchial washing specimens was a pseudo-outbreak. We presumed that the bronchoscopes became contaminated during a procedure in a patient colonized with K. oxytoca in the upper-respiratory tract.

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Pulsed-field gel electrophoresis patterns of K. oxytoca isolates from bronchial washings.

Epidemic curve of K. oxytoca isolates from bronchial washing samples collected during May and June. Solid bars, number of isolates related to the outbreak determined by PFGE analysis; striped bars, number of isolates unrelated to the outbreak determined by PFGE; open bars, number of isolates unavailable for PFGE.

Patient characteristics and the dates of the bronchial washing cultures that grew K. oxytoca

No. Case Sex Age Ward Date Clinical diagnosis Antimicrobial therapy
1∗ M 50 MICU 05/11/06 Tb Anti-Tb medication
2 F 77 Respiratory 05/22/06 Tb pleurisy Anti-Tb medication
3 F 59 Outpatient 05/22/06 Bronchitis −
4 F 59 Outpatient 05/26/06 R/O Endobronchial Tb −
5 M 41 Respiratory 05/26/06 Tb Anti-Tb medication
6 M 59 Respiratory 05/29/06 Pneumonia +
7 F 30 MICU 05/29/06 R/O Tb, sarcoidosis Anti-Tb medication
8∗ M 50 Outpatient 05/29/06 Tb Anti-Tb medication
9 M 39 Outpatient 05/30/06 Pneumonia +
10 M 60 Respiratory 06/01/06 COPD +
11 F 64 Outpatient 06/01/06 Bronchiectasis −
12 F 54 Outpatient 06/02/06 Bronchiectasis −
13 F 35 Respiratory 06/02/06 Bronchitis −
14 M 73 Respiratory 06/02/06 Pneumonia +
15 F 50 Outpatient 06/02/06 Bronchitis −
16 F 61 Respiratory 06/02/06 Tb Anti-Tb medication
17 M 67 MICU 06/05/06 Pneumonia +
18 F 66 MICU 06/20/06 Pneumonia +

Cases 1 and 8 are the same patient. Abbreviations: MICU, medical intensive care unit; Tb, tuberculosis; COPD, chronic obstructive pulmonary disease.