Outbreak of Pseudomonas cepacia Bacteremia in Oncology Patients

Abstract

In 1991, an outbreak of Pseudomonas cepacia bacteremia (PCB) occurred among patients at an oncology clinic in Alabama. A case-patient was defined as any patient at Alabama Oncology Hematology Associates (AOHA) who had at least one blood culture positive for P. cepacia from 7 August through 31 October. Fourteen case-patients were identified; all required hospitalization (median duration, 17 days), but none died of PCB. A cohort study assessing risk factors for PCB focused on all patients who had been treated on the 8 days when case-patients had last visited AOHA during the period 7-21 August. Only patients with central venous catheters developed PCB (P < .001). Among patients with central venous catheters, PCB occurred only after visits to AOHA at which the catheters were flushed with heparin solution in the AOHA laboratory rather than in the treatment area (P < .001). P. cepacia was cultured from the only intravenous fluid bag used to prepare heparin flush solution in the laboratory during the interval 7-21 August. All outbreak-associated isolates of P. cepacia had an identical DNA ribotype pattern. These findings emphasize the importance of avoiding multiple use of single-use solutions, especially for high-risk patients with long-term indwelling central venous catheters.

Use of ribotyping in epidemiological surveillance of nosocomial outbreaks

“…P. cepacia isolates from the blood cultures and from the povidone-iodine had similar antibiograms and identical plasmid profiles and ribotypes. Pegues et al also used ribotyping to study an outbreak of P. cepacia bacteremia among patients with longterm indwelling central venous catheters (112).…”

Antimicrobial resistance and DNA-fingerprinting pattern of Burkholderia cepacia blood isolates

“…2 Molecular and classic epidemiological studies provided considerable evidence that B. cepacia can spread from patient to patient with cystic fibrosis within and outside hospitals. [4][5][6] Pegues et al 5 reported an outbreak of B. cepacia bacteremia in 1991 among patients at an oncology clinic. In Japan, Okazaki et al 10 analyzed the DNA profiles of 28 intrahospital strains of B. cepacia isolated from sputum specimens and found that 20 clinical isolates from 8 patients hospitalized in a critical care center and 2 isolates from environmental specimens had identical DNA profiles.…”

“…In the United States, B. cepacia causes severe pulmonary infection in patients with cystic fibrosis, 3 and can spread from patient to patient. [4][5][6] Our attention was directed to the fact that B. cepacia was isolated from blood specimens of patients with sepsis or bacteremia. In the present study, the antimicrobial susceptibility of B. cepacia isolates from blood specimens of patients suspected of having sepsis to several antibiotics was determined, and the genetic relatedness of B. cepacia isolates was analyzed by pulsedfield gel electrophoresis (PFGE).…”

Comparison of Rapid, Automated Ribotyping and DNA Macrorestriction Analysis ofBurkholderia pseudomallei

“…Ribotyping has been used extensively to analyze B. pseudomallei and other clinically important Burkholderia species (3,8,11,12,15,16). The technical demands and time required to complete a single analysis restrict ribotyping to centers with a Burkholderia research interest.…”

“…Both methods have been used to investigate suspected Burkholderia sp. outbreaks (3,6,11), but the time and expertise needed have prevented more widespread adoption of either method.…”