{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T22:14:49Z","timestamp":1790806489338,"version":"4.1.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"11","license":[{"start":{"date-parts":[[2019,7,16]],"date-time":"2019-07-16T00:00:00Z","timestamp":1563235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R21Al109459"],"award-info":[{"award-number":["R21Al109459"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R01AI127472"],"award-info":[{"award-number":["R01AI127472"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000060","name":"National Institute of Allergy and Infectious Diseases","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000060","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,5,23]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Vancomycin-resistant enterococci (VRE) are a major cause of hospital-acquired infections. The risk of infection from interventional radiology (IR) procedures is not well documented. Whole-genome sequencing (WGS) surveillance of clinical bacterial isolates among hospitalized patients can identify previously unrecognized outbreaks.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed WGS surveillance data from November 2016 to November 2017 for evidence of VRE transmission. A previously unrecognized cluster of 10 genetically related VRE (Enterococcus faecium) infections was discovered. Electronic health record review identified IR procedures as a potential source. An outbreak investigation was conducted.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of the 10 outbreak patients, 9 had undergone an IR procedure with intravenous (IV) contrast \u226422 days before infection. In a matched case-control study, preceding IR procedure and IR procedure with contrast were associated with VRE infection (matched odds ratio [MOR], 16.72; 95% confidence interval [CI], 2.01 to 138.73; P = .009 and MOR, 39.35; 95% CI, 7.85 to infinity; P &amp;lt; .001, respectively). Investigation of IR practices and review of the manufacturer\u2019s training video revealed sterility breaches in contrast preparation. Our investigation also supported possible transmission from an IR technician. Infection prevention interventions were implemented, and no further IR-associated VRE transmissions have been observed.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>A prolonged outbreak of VRE infections related to IR procedures with IV contrast resulted from nonsterile preparation of injectable contrast. The fact that our VRE outbreak was discovered through WGS surveillance and the manufacturer\u2019s training video that demonstrated nonsterile technique raise the possibility that infections following invasive IR procedures may be more common than previously recognized.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/cid\/ciz666","type":"journal-article","created":{"date-parts":[[2019,7,15]],"date-time":"2019-07-15T19:10:23Z","timestamp":1563217823000},"page":"2336-2343","source":"Crossref","is-referenced-by-count":66,"title":["Outbreak of Vancomycin-resistant Enterococcus faecium in Interventional Radiology: Detection Through Whole-genome Sequencing-based Surveillance"],"prefix":"10.1093","volume":"70","author":[{"given":"Alexander J","family":"Sundermann","sequence":"first","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Department of Infection Control and Hospital Epidemiology, University of Pittsburgh Medical Center, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmed","family":"Babiker","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane W","family":"Marsh","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen A","family":"Shutt","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mustapha M","family":"Mustapha","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony W","family":"Pasculle","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chinelo","family":"Ezeonwuka","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa I","family":"Saul","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa P","family":"Pacey","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daria","family":"Van 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Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee H","family":"Harrison","sequence":"additional","affiliation":[{"name":"Microbial Genomic Epidemiology Laboratory, University of Pittsburgh School of Medicine and Graduate School of Public Health, Pennsylvania"},{"name":"Division of Infectious Diseases, University of Pittsburgh School of Medicine, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2019,7,16]]},"reference":[{"key":"2020082914220749300_CIT0001","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1017\/ice.2016.174","article-title":"Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011\u20132014","volume":"37","author":"Weiner","year":"2016","journal-title":"Infect Control Hosp 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