Systematic review of healthcare-associated Burkholderia cepacia complex outbreaks: presentation, causes and outbreak control

Abstract

Summary Background Over the past decades, the Burkholderia cepacia complex (BCC) has been linked to multiple healthcare-associated outbreaks. No systematic analysis of these outbreaks has been carried out to date. The aim of this study was to conduct a systematic review of reports on nosocomial BCC outbreaks. Methods Published studies from 1971 until 9/12/2019 presenting nosocomial BCC outbreaks were identified using Embase, Pubmed and abstracts from professional meetings. Results We identified a total of 111 outbreak reports. Thirty-two percent of the affected institutions were academic hospitals and 43.8% community hospitals. The average outbreak duration was 198.6 ± 604.4 days. A total of 240 deaths (10% of the 2390 case patients) were reported but only 28 (1.2% of the 2390 case patients and 11.7% of the 240 deaths) were directly attributable to BCC. The source could be identified in 73.9% of the outbreaks; 53.2% were caused by contaminated medical solutions and medications, 12% were due to a contaminated disinfectant. In 28.2% of the outbreaks intrinsic product contamination was reported. Multidrug resistance was noted in 26.1% of the BCC strains. PFGE was the most frequently used typing method (43.2%) in the context of outbreak work-up. Conclusion Medical products are the most frequent source of BCC outbreaks, representing over half of the identified sources, with 12% of the outbreaks caused by disinfectant products. Intrinsic product contamination was detected frequently, suggesting a need for stricter regulation. While BCC-related mortality was low, our systematic review revealed significant heterogeneity in both investigations and reporting of BCC outbreaks.

Characterization of respiratory microbial dysbiosis in hospitalized COVID-19 patients

“…In addition to our study, two recent studies also reported nosocomial BCC-associated deaths of COVID-19 patients 41 , 42 . However, all three studies are single case reports and could hardly be used to draw inferences about an undetected BCC-associated nosocomial outbreak whose primary sources have been identified to be contaminated medical products/devices (mainly the disinfectant products) 43 . BCC bacteria, a major threat to hospitalized CF patients, are predominantly localized in the phagocytes and mucus in the CF lung 44 and might accelerate the decline in pulmonary function of COVID-19 patients.…”

Combined Clinical, Epidemiological, and Genome-Based Analysis Identified a Nationwide Outbreak of Burkholderia cepacia Complex Infections Caused by Contaminated Mouthwash Solutions

“…The outbreaks in German hospitals described herein correspond to the existing evidence on similar outbreaks in high-, low-, and middle-income countries. A first systematic review of BCC outbreak reports published between 1971 and 2019 reported that BCC was associated with 111 nosocomial outbreaks worldwide (20 in Europe), with 2390 affected patients and 240 fatalities (28 directly attributed to BCC) [ 22 ]. Most outbreaks occurred either exclusively in ICUs or with the involvement of the ICU, which is in line with our results.…”

“…A recall of involved medical products is one of the most common reported interventions in outbreaks caused by BCC. Notably, in about one-fourth of the reviewed BCC outbreaks, no source of the outbreak could be detected, making it difficult to introduce targeted infection prevention and control measures and other interventions [ 22 ]. Investigations of the patients’ records and the environment were conducted only in 59.5% of the reviewed outbreaks.…”

“…Investigations of the patients’ records and the environment were conducted only in 59.5% of the reviewed outbreaks. Overall, the quality of outbreak reporting in the literature varied largely [ 21 , 22 ]. Standardization of outbreak reporting in the future would significantly contribute to better understanding of dynamics of such infections and appropriate IPC measures.…”

“…Therefore, these medical products should be considered as a potential source when BCC species are detected in patients without typical risk factors. Given difficulties in timely detection and identification of BCC bacteria, prevention of BCC contamination on-site by pharmaceutical manufacturers and further development of detection methods of species in case of suspected contamination are urgently needed [ 9 , 15 , 21 , 22 ]. In Germany, reporting of such incidents does not necessarily include the involvement of epidemic intelligence services.…”