Hospital-Acquired Listeriosis Outbreak Caused by Contaminated Diced Celery-Texas, 2010

Background. Listeria monocytogenes causes often-fatal infections affecting mainly immunocompromised persons. Sources of hospital-acquired listeriosis outbreaks can be difficult to identify. We investigated a listeriosis outbreak spanning 7 months and involving 5 hospitals. Methods. Outbreak-related cases were identified by pulsed-field gel electrophoresis (PFGE) and confirmed by multiple-locus variable-number tandem-repeat analysis (MLVA). We conducted patient interviews, medical records reviews, and hospital food source evaluations. Food and environmental specimens were collected at a hospital (hospital A) where 6 patients had been admitted before listeriosis onset; these specimens were tested by culture, polymerase chain reaction (PCR), and PFGE. We collected and tested food and environmental samples at the implicated processing facility. Results. Ten outbreak-related patients were immunocompromised by >= 1 underlying conditions or treatments; 5 died. All patients had been admitted to or visited an acute-care hospital during their possible incubation periods. The outbreak strain of L. monocytogenes was isolated from chicken salad and its diced celery ingredient at hospital A, and in 19 of >200 swabs of multiple surfaces and in 8 of 11 diced celery products at the processing plant. PCR testing detected Listeria in only 3 of 10 environmental and food samples from which it was isolated by culturing. The facility was closed, products were recalled, and the outbreak ended. Conclusions. Contaminated diced celery caused a baffling, lengthy outbreak of hospital-acquired listeriosis. PCR testing often failed to detect the pathogen, suggesting its reliability should be further evaluated. Listeriosis risk should be considered in fresh produce selections for immunocompromised patients.