Infection Control & Hospital Epidemiology

Original Article

Outbreak of Tsukamurella Species Bloodstream Infection among Patients at an Oncology Clinic, West Virginia, 2011–2012

Isaac Seea1a2 c1, Duc B. Nguyena1a2, Somu Chatterjeea3, Thein Shwea3, Melissa Scotta3, Sherif Ibrahima3, Heather Moulton-Meissnera2, Steven McNultya4, Judith Noble-Wanga2, Cindy Pricea5, Kim Schramma6, Danae Bixlera3 and Alice Y. Guha2

a1 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia

a2 Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia

a3 Division of Infectious Disease Epidemiology, West Virginia Bureau for Public Health, Charleston, West Virginia

a4 Department of Microbiology, University of Texas Health Science Center, Tyler, Texas

a5 Department of Infection Control, Ohio Valley Medical Center, Wheeling, West Virginia

a6 Department of Microbiology, Ohio Valley Medical Center, Wheeling, West Virginia


Objective. To determine the source and identify control measures of an outbreak of Tsukamurella species bloodstream infections at an outpatient oncology facility.

Design. Epidemiologic investigation of the outbreak with a case-control study.

Methods. A case was an infection in which Tsukamurella species was isolated from a blood or catheter tip culture during the period January 2011 through June 2012 from a patient of the oncology clinic. Laboratory records of area hospitals and patient charts were reviewed. A case-control study was conducted among clinic patients to identify risk factors for Tsukamurella species bloodstream infection. Clinic staff were interviewed, and infection control practices were assessed.

Results. Fifteen cases of Tsukamurella (Tsukamurella pulmonis or Tsukamurella tyrosinosolvens) bloodstream infection were identified, all in patients with underlying malignancy and indwelling central lines. The median age of case patients was 68 years; 47% were male. The only significant risk factor for infection was receipt of saline flush from the clinic during the period September–October 2011 (P = .03), when the clinic had been preparing saline flush from a common-source bag of saline. Other infection control deficiencies that were identified at the clinic included suboptimal procedures for central line access and preparation of chemotherapy.

Conclusion. Although multiple infection control lapses were identified, the outbreak was likely caused by improper preparation of saline flush syringes by the clinic. The outbreak demonstrates that bloodstream infections among oncology patients can result from improper infection control practices and highlights the critical need for increased attention to and oversight of infection control in outpatient oncology settings.

(Received September 30 2013)

(Accepted November 17 2013)


c1 Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop A-24, Atlanta, GA 30333 (