Outbreak of Extended-Spectrum β-Lactamase–producing<i>Klebsiella oxytoca</i>Infections Associated with Contaminated Handwashing Sinks1
Bibliographic record
Abstract
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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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.001 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".