Objective: Neonates usually acquire Group B streptococcal infection vertically from the maternal birth canal during delivery. In January 2010, a Group B streptococcal outbreak investigation was conducted in response to an increased number of clinical specimens from our neonatal intensive care unit. Methods: Microbiology laboratory records were reviewed to identify Group B streptococcal from specimens originating from the neonatal intensive care unit during December 2009 and January 2010. Patients from whom these specimens were collected were identified and their charts reviewed. Environmental samples to screen for Group B streptococcal were collected from the unit, clinical and environmental isolates were compared by pulsed field gel electrophoresis. Point prevalence screening was conducted twice before declaring the outbreak over. Results: Pulsed field gel electrophoresis patterns of three clinical strains from six patients were indistinguishable. One environmental strain was isolated from one of the patients monitor, and had identical pulsed field gel electrophoresis pattern to that of the three clinical strains. Infection control measures were implemented in the neonatal intensive care unit and follow-up point prevalence screening identified no new cases. Conclusions: Although poor infection control practice has been implicated in previous reports of nosocomial outbreaks of Group B streptococcal infection in neonatal intensive care units, our finding provides unique evidence that the environment can act as a reservoir of Group B streptococcal and play a key role in nosocomial transmission.

BACKGROUND The present study describes a vancomycin-resistant enterococci (VRE) outbreak investigation and a case-control study to identify risk factors for VRE acquisition in a tertiary care pediatric hospital. OBJECTIVE To report an outbreak investigation and a case-control study to identify risk factors for VRE colonization or infection in hospitalized children. METHODS Screening for VRE cases was performed by culture or polymerase chain reaction. A case-control study of VRE-colonized patients was undertaken. Environmental screening was performed using standard culture and susceptibility methods, with pulsed-field gel electrophoresis to determine relationships between VRE isolates. Statistical analysis was performed using SAS version 9.0 (SAS Institute Inc, USA). RESULTS Thirty-four VRE-positive cases were identified on 10 wards between February 28, 2005, and May 27, 2005. Pulsed-field gel electrophoresis analysis confirmed a single outbreak strain that was also isolated from a video game found on one affected ward. Multivariate analysis identified cephalosporin use as the major risk factor for VRE colonization. CONCLUSIONS In the present study outbreak, VRE colonization was significantly associated with cephalosporin use. Because shared recreational items and environmental surfaces may be colonized by VRE, they warrant particular attention in housekeeping protocols, particularly in pediatric institutions.

OBJECTIVE:To determine whether contaminated ultrasound gel is the source of intermittent outbreaks of nosocomial infection due to Burkholderia cepacia complex in patients without cystic fibrosis since 1992.DESIGN:A prospective clinical and in vitro study of all in-use bottles of ultrasound gel, as well as a retrospective analysis of archived bacterial strains, were performed. Handling of gel for clinical purposes throughout the hospital was evaluated. Gel and archived clinical isolates of B. cepacia complex were speciated to genomovar level and characterized by pulsed-field gel electrophoresis, and the pulsed-field gel electrophoresis patterns were compared.SETTING:The Hospital for Sick Children, a 300-bed, tertiary care, pediatric academic health sciences center in Toronto, Canada.PATIENTS:All patients without cystic fibrosis from whom B. cepacia complex was recovered at the Hospital for Sick Children since 1992.RESULTS:No standardized protocol for storage or handling of ultrasound gel was found. Gel from 39% of bottles grew either B. cepacia (genomovar I) or Burkholderia stabilis (genomovar IV). These isolates had pulsed-field gel electrophoresis patterns identical to 2 of the 7 clinical pulsed-field gel electrophoresis types that are responsible for 88% of clinical isolates.CONCLUSIONS:Contaminated ultrasound gel contributed to nosocomial infection due to B. cepacia complex in this institution over the course of 10 years. Suggested guidelines for the handling of ultrasound gel are provided.

TransfusionVolume 46, Issue 4 p. 679-681 Fatal septic shock associated with transfusion-transmitted Serratia marcescens Sandra Ramírez-Arcos MSc, PhD, Sandra Ramírez-Arcos MSc, PhD Research and Development Canadian Blood Services Ottawa, Ontario K1G 4J5, Canada e-mail: [email protected]Search for more papers by this authorIan Chin-Yee MD, FRCP(C), Ian Chin-Yee MD, FRCP(C) Department of Hematology London Health Sciences Center London, Ontario N6A 4G5, CanadaSearch for more papers by this authorHeather Hume MD, FRCP(C), Heather Hume MD, FRCP(C) Transfusion MedicineSearch for more papers by this authorMargaret Fearon MD, FRCP(C), Margaret Fearon MD, FRCP(C) Medical MicrobiologySearch for more papers by this authorMindy Goldman MD, FRCP(C), Mindy Goldman MD, FRCP(C) Donor and Transplantation Canadian Blood Services Ottawa, Ontario K1G 4J5, CanadaSearch for more papers by this authorKathleen Eckert ART, Kathleen Eckert ART Department of Hematology London Health Sciences Center London, Ontario N6A 4G5, CanadaSearch for more papers by this authorIrene Martincic BSc, MLT, Irene Martincic BSc, MLT Research and Development Canadian Blood Services Ottawa, Ontario K1G 4J5, CanadaSearch for more papers by this authorGary Peters MLT, CIC, Gary Peters MLT, CIC Department of Microbiology London Health Sciences Center London, Ontario N6A 4G5, CanadaSearch for more papers by this authorDanuta Kovach RT, Danuta Kovach RT Division of Microbiology The Hospital for Sick Children Toronto, Ontario M5G 1X8, CanadaSearch for more papers by this authorSusan E. Richardson MD, FRCP(C), Susan E. Richardson MD, FRCP(C) Division of Microbiology The Hospital for Sick Children Toronto, Ontario M5G 1X8, CanadaSearch for more papers by this author Sandra Ramírez-Arcos MSc, PhD, Sandra Ramírez-Arcos MSc, PhD Research and Development Canadian Blood Services Ottawa, Ontario K1G 4J5, Canada e-mail: [email protected]Search for more papers by this authorIan Chin-Yee MD, FRCP(C), Ian Chin-Yee MD, FRCP(C) Department of Hematology London Health Sciences Center London, Ontario N6A 4G5, CanadaSearch for more papers by this authorHeather Hume MD, FRCP(C), Heather Hume MD, FRCP(C) Transfusion MedicineSearch for more papers by this authorMargaret Fearon MD, FRCP(C), Margaret Fearon MD, FRCP(C) Medical MicrobiologySearch for more papers by this authorMindy Goldman MD, FRCP(C), Mindy Goldman MD, FRCP(C) Donor and Transplantation Canadian Blood Services Ottawa, Ontario K1G 4J5, CanadaSearch for more papers by this authorKathleen Eckert ART, Kathleen Eckert ART Department of Hematology London Health Sciences Center London, Ontario N6A 4G5, CanadaSearch for more papers by this authorIrene Martincic BSc, MLT, Irene Martincic BSc, MLT Research and Development Canadian Blood Services Ottawa, Ontario K1G 4J5, CanadaSearch for more papers by this authorGary Peters MLT, CIC, Gary Peters MLT, CIC Department of Microbiology London Health Sciences Center London, Ontario N6A 4G5, CanadaSearch for more papers by this authorDanuta Kovach RT, Danuta Kovach RT Division of Microbiology The Hospital for Sick Children Toronto, Ontario M5G 1X8, CanadaSearch for more papers by this authorSusan E. Richardson MD, FRCP(C), Susan E. Richardson MD, FRCP(C) Division of Microbiology The Hospital for Sick Children Toronto, Ontario M5G 1X8, CanadaSearch for more papers by this author First published: 30 March 2006 https://doi.org/10.1111/j.1537-2995.2006.00783.xCitations: 23Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinkedInRedditWechat REFERENCES 1 Goldman M, Blajchman MA. Blood product-associated bacterial sepsis. Transfus Med Rev 1991; 5: 73-83. 2 Heltberg O, Skov F, Gerner-Smidt P, et al. Nosocomial epidemic of Serratia marcescens septicemia ascribed to contaminated blood transfusion bags. Transfusion 1993; 33: 221-7. 3 Blajchman MA, Thornley JH, Richardson H, et al. Platelet transfusion-induced Serratia marcescens sepsis due to vacuum tube contamination. Transfusion 1979; 19: 39-44. 4 Arendt A, Carmean J, Koch E, et al. Fatal bacteria infections associated with platelet transfusions-United States, 2004. MMWR Morb Mortal Wkly Rep 2005; 54: 168-70. 5 Te Boekhorst PA, Beckers EA, Vos MC, et al. Clinical significance of bacteriologic screening in platelet concentrates. Transfusion 2005; 45: 514-9. 6 Wendel S, Morato LE, Fontao-Wendel R, et al. Double, double, toil and trouble. Transfusion 2005; 45: 1241. Citing Literature Volume46, Issue4April 2006Pages 679-681 ReferencesRelatedInformation

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