Outbreak of Extended-Spectrum β-Lactamase–producing<i>Klebsiella oxytoca</i>Infections Associated with Contaminated Handwashing Sinks1

Klebsiella oxytoca is primarily a health care-associated pathogen acquired from environmental sources.During October 2006-March 2011, a total of 66 patients in a hospital in Toronto, Ontario, Canada, acquired class A extendedspectrum β-lactamase-producing K. oxytoca with 1 of 2 related pulsed-fi eld gel electrophoresis patterns.New cases continued to occur despite reinforcement of infection control practices, prevalence screening, and contact precautions for colonized/infected patients.Cultures from handwashing sinks in the intensive care unit yielded K. oxytoca with identical pulsed-fi eld gel electrophoresis patterns to cultures from the clinical cases.No infections occurred after implementation of sink cleaning 3×/day, sink drain modifi cations, and an antimicrobial stewardship program.In contrast, a cluster of 4 patients infected with K. oxytoca in a geographically distant medical ward without contaminated sinks was contained with implementation of active screening and contact precautions.Sinks should be considered potential reservoirs for clusters of infection caused by K. oxytoca.K lebsiella oxytoca is an opportunistic pathogen that causes primarily hospital-acquired infections, most often involving immunocompromised patients or those requiring intensive care.Reported outbreaks have most frequently involved environmental sources (1-4).K. oxytoca, like other Enterobacteriaceae, may acquire extended-spectrum β-lactamases (ESBL) and carbapenemases (1,5); outbreaks of multidrug-resistant K. oxytoca infection pose an increasing risk to hospitalized patients.We report an outbreak of infections caused by ESBLproducing K. oxytoca in the intensive care unit (ICU), stepdown unit, and medical care unit at a hospital in Toronto, Ontario, Canada, during a 4-year period.Contributing to the ongoing diffi culties in the containment of this outbreak has been the contamination of handwashing sinks in the ICU.We describe a retrospective review of all K. oxytoca isolates intermediate or resistant to third-generation cephalosporins identifi ed from inpatients from April 1997 through December 2011, the investigation of the source of the K. oxytoca outbreak, and the interventions implemented to contain the outbreak. MethodsThe outbreak occurred at an acute tertiary-care facility in Toronto with 472 beds, including a 16 single-bed medical-surgical ICU, a 6-bed cardiac care unit , and two 4-bed step-down units.Outbreak cases of K. oxytoca were defi ned as hospital-acquired isolates with pulsed-fi eld gel electrophoresis (PFGE) patterns belonging to 2 related clonal groups; all such isolates produced an Ambler class A ESBL. Isolates were considered hospital acquired if the fi rst specimen (clinical culture or rectal swab) yielding resistant K. oxytoca was obtained >3 days after the admission date or if the specimen was obtained <3 days after admis- Outbreak of Extended-Spectrum β-Lactamase-producing Klebsiella oxytoca Infections Associated with Contaminated Handwashing Sinks

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