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During May 2018‒December 2022, we reviewed transfusion-transmitted sepsis cases in the United States attributable to polymicrobial contaminated apheresis platelet components, including Acinetobacter calcoaceticus‒baumannii complex or Staphylococcus saprophyticus isolated from patients and components. Transfused platelet components underwent bacterial risk control strategies (primary culture, pathogen reduction or primary culture, and secondary rapid test) before transfusion. Environmental samples were collected from a platelet collection set manufacturing facility. Seven sepsis cases from 6 platelet donations from 6 different donors were identified in patients from 6 states; 3 patients died. Cultures identified Acinetobacter calcoaceticus‒baumannii complex in 6 patients and 6 transfused platelets, S. saprophyticus in 4 patients and 4 transfused platelets. Whole-genome sequencing showed environmental isolates from the manufacturer were closely related genetically to patient and platelet isolates, indicating the manufacturer was the most probable source of recurrent polymicrobial contamination. Clinicians should maintain awareness of possible transfusion-transmitted sepsis even when using bacterial risk control strategies.

Stenotrophomonas maltophilia is an opportunistic bacterial pathogen found in healthcare settings. During May 2022–September 2023, an acute care hospital in northern California, USA, identified 13 S. maltophilia bloodstream infections among intensive care unit patients. Whole-genome sequencing showed the isolates were highly related. We identified risk factors for infection by conducting a matched case–control study, targeted assessment of infection prevention and control practices, and laboratory testing of suspected environmental reservoirs. Among 13 case-patients and 39 control-patients, patients exposed to iodinated contrast (odds ratio [OR] 12.0; 95% CI 2.1–∞), injectable propofol (OR 12.2; 95% CI 1.5–101.4), or fentanyl (OR 9.2; 95% CI 1.8–∞) had increased odds of S. maltophilia bloodstream infection. Although we did not have culture confirmation of a source, we suspect S. maltophilia was transmitted by exposure to nonsterile water from a common source. We recommended infection prevention and control practices to reduce risk for contamination from nonsterile water.

SARS-CoV-2 infections among vaccinated nursing home residents increased after the Omicron variant emerged. Data on booster dose effectiveness in this population are limited. During July 2021-March 2022, nursing home outbreaks in 11 US jurisdictions involving >3 infections within 14 days among residents who had received at least the primary COVID-19 vaccine(s) were monitored. Among 2,188 nursing homes, 1,247 outbreaks were reported in the periods of Delta (n = 356, 29%), mixed Delta/Omicron (n = 354, 28%), and Omicron (n = 536, 43%) predominance. During the Omicron-predominant period, the risk for infection within 14 days of an outbreak start was lower among boosted residents than among residents who had received the primary vaccine series alone (risk ratio [RR] 0.25, 95% CI 0.19-0.33). Once infected, boosted residents were at lower risk for all-cause hospitalization (RR 0.48, 95% CI 0.40-0.49) and death (RR 0.45, 95% CI 0.34-0.59) than primary vaccine-only residents.

During June 2017–November 2019, a total 36 patients with carbapenem-resistant Pseudomonas aeruginosa harboring Verona-integron–encoded metallo-β-lactamase were identified in a city in western Texas, USA. A faucet contaminated with the organism, identified through environmental sampling, in a specialty care room was the likely source for infection in a subset of patients.

Background: Stenotrophomonas maltophilia is an opportunistic pathogen found in healthcare settings. During April–September 2022, nine S. maltophilia bloodstream infections (BSIs) were identified among intensive care unit (ICU) patients at a hospital in Alameda County, California. Whole genome sequencing found isolates to be highly related. Despite implementation of infection prevention and control (IPC) interventions, four additional S. maltophilia BSIs were identified during June–September 2023. We investigated to identify risk factors for infection and stop transmission. Methods: We conducted a matched case-control study. A case was defined as S. maltophilia isolated from a blood culture from an ICU patient with a fever during April 2022–September 2023; control-patient subjects were patients admitted to the ICU during the same period with hospital stay greater than or equal to their matched case. Three control subjects were matched to each case. We extracted information on risk factors for infection from medical charts and observed IPC practices in hospital locations of interest. We collected environmental samples from the ICU, radiology unit, and emergency department. Results: Among 13 cases and 39 control subjects, patients exposed to iodinated contrast Omnipaque-300 (odds ratio [OR]: 5.7; 95% CI: 1.2–28.0), injectable propofol (OR: 12.2; 95% CI: 1.5–101.4), or fentanyl (OR: 9.2; 95% CI: 1.8–Inf.) were more likely to have a S. maltophilia BSI, compared with control-subjects. IPC deficiencies included improper cleaning and storage of medical equipment, including the contrast injection system, and patient care supplies. The outbreak strain of S. maltophilia was not isolated from environmental samples. Conclusions: Although a point-source was not identified, S. maltophilia was likely transmitted through improper IPC practices involving injectable contrast or anesthesia. Recommendations on proper cleaning and disinfection of the contrast injection system and proper storage, preparation, and administration of medications were made to reduce risk for contamination.

Background: Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans . Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia , posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients. Disclosures: None

Background: Candida auris is a frequently drug-resistant yeast that can cause invasive disease and is easily transmitted in healthcare settings. Pediatric cases are rare in the United States, with <10 reported before 2022. In August 2021, the first C. auris case in Las Vegas was identified in an adult. By May 2022, 117 cases were identified across 16 healthcare facilities, including 3 pediatric cases at an acute-care hospital (ACH) with adult cases, representing the first pediatric cluster in the United States. The CDC and Nevada Division of Public and Behavioral Health (NVDPBH) sought to describe these cases and risk factors for C. auris acquisition. Methods: We defined a case as a patient’s first positive C. auris specimen. We reviewed medical records and infection prevention and control (IPC) practices. Environmental sampling was conducted on high-touch surfaces throughout affected adult and pediatric units. Isolate relatedness was assessed using whole-genome sequencing (WGS). Results: All 3 pediatric patients were born at the facility and had congenital heart defects. All were aged <6 months when they developed C. auris bloodstream infections; 2 developed C. auris endocarditis. One patient died. Patients overlapped in the pediatric cardiac intensive care unit; 2 did not leave between birth and C. auris infection. Mobile medical equipment was shared between adult and pediatric patients; lapses in cleaning and disinfection of shared mobile medical equipment and environmental surfaces were observed, presenting opportunities for transmission. Overall, 32 environmental samples were collected, and C. auris was isolated from 2 specimens from an adult unit without current cases. One was a composite sample from an adult patient’s bed handles, railings, tray table and call buttons, and the second was from an adult lift-assistance device. WGS of specimens from adult and pediatric cases and environmental isolates were in the same genetic cluster, with 2–10 single-nucleotide polymorphisms (SNPs) different, supporting within-hospital transmission. The pediatric cases varied by 0–3 SNPs; at least 2 were highly related. Conclusions: C. auris was likely introduced to the pediatric population from adults via inadequately cleaned and disinfected mobile medical equipment. We made recommendations to ensure adequate cleaning and disinfection and implement monitoring and audits. No pediatric cases have been identified since. This investigation demonstrates transmission can occur between unrelated units and populations and that robust infection prevention and control practices throughout the facility are critical for reducing C. auris environmental burden and limiting transmission, including to previously unaffected vulnerable populations, like children. Disclosures: None

Background: Stenotrophomonas maltophilia is a gram-negative, biofilm-producing bacterium that is ubiquitous in water environments and often associated with healthcare-associated infections (HAIs). Outbreaks of S. maltophilia bloodstream infections are a rare event and raise the suspicion of a common source. We used whole-genome sequencing (WGS) for an investigation of a cluster of S. maltophilia HAIs at a single hospital. Methods: A patient was defined as an intensive care unit (ICU) patient with fever and S. maltophilia isolated from a culture and who was treated for an HAI from May to October 2022. The response to the cluster included an epidemiologic investigation, water infection control risk assessments (WICRA), and environmental sampling. We also conducted WGS to characterize and assess relatedness between clinical and environmental S. maltophilia isolates. Results: From May 5 to October 1, 2022, we identified 11 HAIs due to S. maltophilia : 9 bloodstream infections and 2 ventilator-associated pneumonia cases. The initial epidemiological investigation did not identify common medical products, procedures, or personnel as an exposure source. The WICRA identified several breaches that may have exposed patients to contaminated water from sink backsplashes in the ICU, computerized tomography (CT) rooms, and the emergency department. In the CT rooms, saline bags were sometimes used for multiple patients, as were single-use intravenous contrast solution bottles. No additional cases were identified once infection control breaches were mitigated by installing sink splashguards, disinfecting drains, dedicating sink use for handwashing, and adhering to single-patient use of pharmaceutical products in the CT rooms. Of 46 environmental water samples, 19 were culture-positive for S. maltophilia . Isolates available for WGS included 7 clinical isolates (6 blood and 1 respiratory) and 17 environmental isolates. Among the 24 isolates sequenced, 16 unique multilocus sequence types (MLSTs) were identified. The 6 blood isolates sequenced were highly related (ST239, 0–4 high-quality, single-nucleotide variants [hqSNV] over 98.99% core genome), suggesting a common source. Two clusters of related environmental isolates were identified; however, overall MLST and hqSNV analyses suggested no relatedness between clinical and environmental isolates. Conclusions: An ICU cluster of S. maltophilia bloodstream infections was likely associated with water contamination of room surfaces and use of single-use intravenous products for multiple patients in the setting of a national pharmaceutical product shortage. This investigation highlights the importance of strong surveillance and water infection control, including routine assessment of ancillary areas in which intravenous products are administered and interdisciplinary collaboration to properly mitigate nosocomial transmission. Disclosures: None

We investigated concurrent outbreaks of carrying (VIM-CRPA) and Enterobacterales carrying (KPC-CRE) at a long-term acute-care hospital (LTACH A). We defined an incident case as the first detection of or from a patient's clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had 11 had and 7 had and . Also, were identified from 7 Enterobacterales, and all were . We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.

Stenotrophomonas maltophilia is an opportunistic bacterial pathogen found in healthcare settings. During May 2022-September 2023, an acute care hospital in northern California, USA, identified 13 S. maltophilia bloodstream infections among intensive care unit patients. Whole-genome sequencing showed the isolates were highly related. We identified risk factors for infection by conducting a matched case-control study, targeted assessment of infection prevention and control practices, and laboratory testing of suspected environmental reservoirs. Among 13 case-patients and 39 control-patients, patients exposed to iodinated contrast (odds ratio [OR] 12.0; 95% CI 2.1-∞), injectable propofol (OR 12.2; 95% CI 1.5-101.4), or fentanyl (OR 9.2; 95% CI 1.8-∞) had increased odds of S. maltophilia bloodstream infection. Although we did not have culture confirmation of a source, we suspect S. maltophilia was transmitted by exposure to nonsterile water from a common source. We recommended infection prevention and control practices to reduce risk for contamination from nonsterile water.Stenotrophomonas maltophilia is an opportunistic bacterial pathogen found in healthcare settings. During May 2022-September 2023, an acute care hospital in northern California, USA, identified 13 S. maltophilia bloodstream infections among intensive care unit patients. Whole-genome sequencing showed the isolates were highly related. We identified risk factors for infection by conducting a matched case-control study, targeted assessment of infection prevention and control practices, and laboratory testing of suspected environmental reservoirs. Among 13 case-patients and 39 control-patients, patients exposed to iodinated contrast (odds ratio [OR] 12.0; 95% CI 2.1-∞), injectable propofol (OR 12.2; 95% CI 1.5-101.4), or fentanyl (OR 9.2; 95% CI 1.8-∞) had increased odds of S. maltophilia bloodstream infection. Although we did not have culture confirmation of a source, we suspect S. maltophilia was transmitted by exposure to nonsterile water from a common source. We recommended infection prevention and control practices to reduce risk for contamination from nonsterile water.