A report on healthcare-associated Myroides odoratimimus outbreak. Is the urine bottle guilty?

Abstract

Introduction: The aim of this study was to report a 9-case Myroides odoratimimus outbreak in the intensive care units (ICUs) of a secondary care hospital.

Methodology: The hospital laboratory recorded several consecutive detections of Myroides spp. in urine samples in March 2023. Consequently, an outbreak investigation was initiated. Epidemiological data of each patient was collected to identify the cause of the outbreak.

Results: All patients were followed up in the ICU and all growths were found to be in urinary catheters. None of the patients had clinical symptoms of urinary tract infection. Outbreak investigation revealed that urine bottles, which should be separate for each ICU patient, were in fact used for all patients. Environmental sampling of surfaces was not performed. No clustering was observed in terms of patients regarding follow-up doctors and staff. There was no mortality among these patients during the outbreak. All strains identified as Myroides spp. in the hospital laboratory were identified as Myroides odoratimimus with matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF-MS). Pulsed-field gel electrophoresis (PFGE) revealed that there were 3 PFGE groups. The clustering rate was 88.8%. When the similarity ratio between PFGE profiles was > 85, one of the 9 strains showed a unique profile; while the remaining 8 strains were classified into 2 epidemiologically related groups.

Conclusions: Myroides spp. represents a new threat with a broad antimicrobial resistance profile, and the potential to cause epidemics across a wide clinical spectrum from colonization to lethal infection, particularly in ICU patients.