CME ACTIVITY: Alcaligenes xylosoxidans Bloodstream Infections in Outpatient Oncology Office

caligenes xylosoxidans bloodstream infections by conducting a matched case–control study and a prospective study. Pulsed-fi eld gel electrophoresis (PFGE) was performed on blood culture isolates, and 1 explanted central venous catheter (CVC) was tested for biofi lm. We identifi ed 12 cases of A. xylosoxidans bloodstream infection. Case-patients were more likely than controls to have had a CVC (7/7 [100%] vs 4/47 [8.7%], respectively; p<0.0001). Ten case isolates were indistinguishable by PFGE analysis, and A. xylosoxidans biofi lm from the CVC matched the outbreak strain. We observed multiple breaches in infection control, which may have caused contamination of multidose vials used to fl ush the CVCs. Our study links A. xylosoxidans with CVC biofi lm and highlights areas for regulation and oversight in outpatient settings. A xylosoxidans, also known as Achromobacter xylosoxidans, is a gram-negative, water-borne organism that causes healthcare-associated infections (1–7) and bacteremia in immunocompromised patients with indwelling catheters (6–11); it can also contaminate liquids (2,5,12–14). A. xylosoxidans is found in soil and water and grows in saline (15,16). On January 16, 2002, the Acute Communicable Disease Control (ACDC) program of the Los Angeles County Department of Public Health was noti? ed by a local hospital epidemiologist about a cluster of patients with A. xylosoxidans bloodstream infections (17). The patients had been admitted to Hospital A over a period of 2 months. To con? rm the presence of an outbreak, ACDC conducted a telephone survey, which asked the microbiology laboratories of Hospital A and 4 surrounding hospitals for a list of all patients who had had positive blood cultures for A. xylosoxidans in the past 3 months. One laboratory identi? ed 3 such patients, and Hospital A laboratory identi? ed 7; all 9 patients (1 case-patient had positive blood Alcaligenes xylosoxidans Bloodstream Infections in Outpatient Oncology Offi ce