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    Stenotrophomonas maltophilia outbreak with a commercial blood gas injector as the culprit and interventions for source and prevention: A possible passage between patient and ECMO water heater device
    (Mosby-Elsevier, 2023) Menekse, Sirin; Tanriverdi, Elif Seren; Ogus, Halide; Altinay, Ece; Kaya, Cigdem; Caglayan, Elif; Aydogan, Arzu Atesoglu
    Background: Despite low virulence of Stenotrophomonas maltophilia, it represents one of the leading drug -resistant bacteria. We report a large outbreak of S. maltophilia infection associated with an unexpected source, which turned out to be a commercial needleless blood gas injector. Methods: Over a period from January 1 to December10, 2021, 113 patients were identified to have S. malto-philia infection as documented by positive cultures from the clinical samples, extracorporeal membrane oxy-genation (ECMO) water heater devices and commercial needleless blood gas injectors. Results: Sixty-seven isolates (59 clinical, 4 ECMO, 4 blood gas injectors) were sent for molecular analysis. Both arbitrarily primed polymerase chain reaction and pulsed -field gel electrophoresis analyses showed 12 distinct genotypes. Of 67 isolates, 58 were clonally related (86.6%), with 52 indistinguishable strains from 4 blood gas needleless injectors, 46 patients' samples (78%), and 2 ECMO samples (50%). Two ECMO samples and 1 clinical sample were clonally identical. Conclusions: In the event that eradication of infections would not be possible despite taking all environmen-tal disinfection measures including the ECMO devices, unexpected sources, such as a commercial needleless blood gas injector, should not be omitted from the list for surveillance. In addition, obtaining surveillance cul-tures of ECMO water reservoirs should be placed in the routine clinical practice. & COPY; 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.