Investigation of an Outbreak of Gram-Negative Bacteremia Among Hematology-Oncology Outpatients

Abstract

AbstractObjective:To identify risk factors associated with an outbreak of gram-negative bacteremia (GNB).Setting:A university hospital.Patients:Hematology-oncology outpatients.Design:Retrospective case-control study.Results:Thirty-eight patients developed GNB; 13 patients experienced more than one episode, and eight blood cultures grew more than one gram-negative organism. The most frequently isolated organisms were Stenotrophomonas maltophilia, Klebsiella pneumoniae, Acinetobacter baumannii, and Acinetobacter johnsonii. When the GNB patients (cases) were compared with randomly selected hematology-oncology patients (controls), central venous catheter (CVC) self-care (71% vs 39%; P=.02), and duration of recent hospital stay (median, 15 vs 4 days; P=.01) were identified as risk factors. In a logistic regression model, duration of recent hospital stay was the only risk factor significantly associated with GNB (odds ratio, 1.05; 95% confidence interval, 1.01-1.08; P<.02).Conclusions:Hematology-oncology patients providing their own CVC care who have recently been hospitalized for more than 2 weeks may be at increased risk of GNB. CVCs should be protected from possible environmental contamination in hematology-oncology patients. Patients providing their own CVC care should undergo continued rigorous education regarding proper CVC care.