POLYCLONAL OUTBREAK OF BLOODSTREAM INFECTIONS CAUSED BY Burkholderia cepacia COMPLEX IN HEMATOLOGY AND BONE MARROW TRANSPLANT OUTPATIENT UNITS

Abstract

Aim: The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients. Methods: On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units. Findings: 14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred. Conclusions: This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.

Epidemiological investigation and successful management of a Burkholderia cepacia outbreak in a neurotrauma intensive care unit

“…BCC are opportunistic Gram-negative nosocomial pathogens that can cause life-threatening disease in patients and have the propensity to produce serious outbreaks within the clinical setting (Sousa et al, 2011). BCC are emerging and challenging pathogens in trauma victims in whom several injuries and various medical and surgical interventions lead to a prolonged hospital stay, along with exposure and dependence on various invasive medical devices and the use of multiple broad-spectrum antibiotics as prophylaxis or therapeutic regimen (Bressler et al, 2007;Boszczowski et al, 2014). Furthermore, the bacteria have innate potential to survive and proliferate in the hospital environment, growing on moist surfaces such as water tanks and others, making these very successful nosocomial pathogens causing serious life-threatening infections in young adult trauma patients.…”

Genomics Reveals a Unique Clone of Burkholderia cenocepacia Harboring an Actively Excising Novel Genomic Island

“…Members of the Bcc have emerged as important nosocomial pathogens worldwide due to their high intrinsic resistance to most of the antibiotics and antiseptics as well as their survival ability in the limited nutrition environment for a prolonged period (Gautam et al, 2011; Sousa et al, 2011). The outbreaks by members of Bcc have been reported in the intensive care units (Lee, 2008), dialysis patients (Romero-Gomez et al, 2008), and transplant patients (Boszczowski et al, 2014) worldwide. Members of the Bcc are most common contaminants of many pharmaceutical end products and pharmaceutical manufacturing environments (Torbeck et al, 2011).…”

Pseudo-outbreak of Burkholderia cepacia blood stream infections in intensive care units of a super-speciality hospital: A cross-sectional study

“…[3] Multiple healthcare-associated outbreaks have been described involving contaminated water, prefabricated moist washcloths, contaminated medication, nebulization solution, antiseptic solution, heparin, moisturizing body milk, and mouthwash solution. [4] In a systematic review of nosocomial infections related to contaminated substances, BCC along with Enterobacter spp. ranked first as contaminating pathogen in substances other than blood.…”