Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine

Abstract

Whether Burkholderia cepacia complex should be an objectionable organism in antiseptic solutions with acceptable total bacterial counts is controversial. By using next-generation sequencing, we documented a polyclonal B. cepacia complex outbreak affecting peritoneal dialysis patients in Hong Kong that was caused by contaminated chlorhexidine solutions. Epidemiologic investigations at a manufacturing site identified a semiautomated packaging machine as the probable source of contamination in some of the brands. Use of whole-genome sequencing differentiated the isolates into 3 brand-specific clonal types. Changes in exit site care recommendations, rapid recall of affected products, and tightening of regulatory control for chlorhexidine-containing skin antiseptics could prevent future similar outbreaks. Environmental opportunistic pathogens, including B. cepacia complex, might be included in regular surveillance as indicator organisms for monitoring environmental contamination.

Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016–2019

“…Needle sharing could increase transmission of an epidemic strain. A recent polyclonal BCC outbreak in peritoneal dialysis patients in Hong Kong was caused by contaminated aqueous chlorhexidine ( 30 ); however, PFGE typing of the strains from the patients in our study and the strains isolated in the aqueous chlorhexidine suggested that they were unrelated (K.S. Luk, unpub.…”

Burkholderia cepacia—A rare but important cause of refractory peritonitis in patients with continuous ambulatory peritoneal dialysis: A case report and literature review

“…B. cepacia-related nosocomial outbreaks may be correlated with exposure to environmental factors, including intrinsically or extrinsically contaminated chlorhexidine, povidoneiodine, benzalkonium chloride, intravenous fluids, or drugs, sodium docusate, eye drops, alcohol-free mouthwash, and nebulized salbutamol and albuterol. 16 Notably, the patient in the current study developed peritonitis before being admitted to the hospital and was…”

“…However, the efficacy of the treatment should be further explored. B. cepacia 4,[9][10][11][12][13][14][15][16] (Table 1). These studies did not provide treatment options used for the cases.…”

Burkholderia cepacia complex outbreak linked to a no-rinse cleansing foam product, United States – 2017–2018

“…FDA, CDC and state and local partners issued notifications and health advisories throughout the duration of the outbreak response to inform the public and healthcare professionals of the outcomes of the investigation, including recall information, and provided specific advice to protect public health ( Fig. 3 ) [ 11 , 13 – 15 ]. FDA and CDC shared specific guidance advising patients, pharmacies, ACHs and other healthcare facilities and companies that purchased the recalled product to: (1) immediately quarantine material under their control and contact the manufacturer; (2) immediately stop using and dispensing the recalled product; and (3) follow the recall instructions for the recalled lots and avoid the use of all other lots of the product while further investigation was being conducted.…”

“…https://doi.org/10.1017/S0950268822000668 Published online by Cambridge University Press Bcc are considered environmental, opportunistic pathogens that frequently contaminate pharmaceuticals and cosmetics and researchers have suggested that they be considered for inclusion in regular surveillance to monitor environmental contamination at production facilities [15,16]. The ubiquitous occurrence of Bcc in water, which is a primary component in the manufacture of many medical devices, drugs, and cosmetic products, and the resistance of Bcc to many disinfectants and preservatives, has led to multiple outbreaks of Bcc involving intrinsic contamination of these non-sterile products [4,5].…”