Seasonal Outbreak of Bacillus Bacteremia Associated With Contaminated Linen in Hong Kong

<span class="paragraphSection"><div class="boxTitle">Abstract</div><div class="boxTitle">Background.</div>A high seasonal incidence of <span style="font-style:italic;">Bacillus</span> bacteremia was associated with the use of contaminated hospital linens.<div class="boxTitle">Methods.</div>An outbreak investigation was conducted to study the incidence and source of <span style="font-style:italic;">Bacillus</span> bacteremia during the baseline, outbreak, and postoutbreak period from 1 January 2012 through 31 July 2016 at a university-affiliated teaching hospital in Hong Kong. Replicate organism detection and counting plates were used for microbial screening of linen samples. The <span style="font-style:italic;">Bacillus</span> species isolated from patient and linen samples were identified by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and were phylogenetically analyzed.<div class="boxTitle">Results.</div>During the study period, a total of 113 207 blood cultures were collected from 43 271 patients, of which 978 (0.86%) specimens from 744 (1.72%) patients were identified as <span style="font-style:italic;">Bacillus</span> species. The incidence of <span style="font-style:italic;">Bacillus</span> bacteremia per 10 000 patient admissions and per 10 000 patient-days was significantly higher during the summer outbreak as compared with baseline and 1 year postoutbreak after cessation of the linen supply from the designated laundry and change of laundry protocol (39.97 vs 18.21 vs 2.27; 13.36 vs 5.61 vs 0.73; <span style="font-style:italic;">P</span> < .001). The mean total aerobic bacterial count per 100 cm² was significantly higher among the 99 linen samples screened during the outbreak period compared to the 100 screened in the postoutbreak period (916.0 ± 641.6 vs 0.6 ± 1.6; <span style="font-style:italic;">P</span> < .001). Blood culture isolates of <span style="font-style:italic;">Bacillus cereus</span> group in 14 of 87 (16.1%) patients were phylogenetically associated with 9 linen sample isolates.<div class="boxTitle">Conclusions.</div>Suboptimal conditions of hospital laundry contributed to the seasonal outbreak of <span style="font-style:italic;">Bacillus</span> bacteremia.</span>

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