Ralstonia pickettii and Burkholderia cepacia complex bloodstream infections related to infusion of contaminated water for injection

Objective. To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI). Design and Setting. Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006. Patients. Twenty-five patients with BCC-BSI. Design. After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using Spel. Results. The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals. Conclusion. Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.

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Investigation of an Outbreak of Central Venous Catheter–Associated Bloodstream Infection Due to Contaminated Water

Infection Control and Hospital Epidemiology ◽

10.1086/533543 ◽

2008 ◽

Vol 29 (4) ◽

pp. 364-366 ◽

Cited By ~ 21

Author(s):

Richard W. Douce ◽

Jeannete Zurita ◽

Olga Sanchez ◽

Paul Cardenas Aldaz

Keyword(s):

Central Venous Catheter ◽

Bloodstream Infection ◽

Burkholderia Cepacia ◽

Bloodstream Infections ◽

Venous Catheter ◽

Contaminated Water ◽

Central Venous ◽

Fold Reduction

An outbreak of central venous catheter-associated bloodstream infections was reported in a hospital in Ecuador. Commercially produced ampoules of water for injection were found to be contaminated withBurkholderia cepaciaandMyroides odoratus.Removal of these ampoules yielded a 10-fold reduction in the incidence of catheter-associated infection.

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A 17-Year Nationwide Study of Burkholderia cepacia Complex Bloodstream Infections Among Patients in the United States Veterans Health Administration

Clinical Infectious Diseases ◽

10.1093/cid/cix559 ◽

2017 ◽

Vol 65 (8) ◽

pp. 1327-1334 ◽

Cited By ~ 10

Author(s):

Nadim G El Chakhtoura ◽

Elie Saade ◽

Brigid M Wilson ◽

Federico Perez ◽

Krisztina M Papp-Wallace ◽

...

Keyword(s):

United States ◽

Burkholderia Cepacia ◽

Bloodstream Infections ◽

Veterans Health Administration ◽

The United States ◽

Burkholderia Cepacia Complex ◽

Veterans Health ◽

Health Administration ◽

Nationwide Study

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Multistate Outbreak of Burkholderia cepacia Complex Bloodstream Infections After Exposure to Contaminated Saline Flush Syringes: United States, 2016–2017

Clinical Infectious Diseases ◽

10.1093/cid/ciy910 ◽

2018 ◽

Vol 69 (3) ◽

pp. 445-449 ◽

Cited By ~ 7

Author(s):

Richard B Brooks ◽

Patrick K Mitchell ◽

Jeffrey R Miller ◽

Amber M Vasquez ◽

Jessica Havlicek ◽

...

Keyword(s):

Public Health ◽

Burkholderia Cepacia ◽

Skilled Nursing Facility ◽

Bloodstream Infections ◽

Rapid Identification ◽

Burkholderia Cepacia Complex ◽

Nursing Facilities ◽

Healthcare Facilities ◽

Health Authorities ◽

Public Health Authorities

Abstract Background Burkholderia cepacia complex (Bcc) has caused healthcare-associated outbreaks, often in association with contaminated products. The identification of 4 Bcc bloodstream infections in patients residing at a single skilled nursing facility (SNF) within 1 week led to an epidemiological investigation to identify additional cases and the outbreak source. Methods A case was initially defined via a blood culture yielding Bcc in a SNF resident receiving intravenous therapy after 1 August 2016. Multistate notifications were issued to identify additional cases. Public health authorities performed site visits at facilities with cases to conduct chart reviews and identify possible sources. Pulsed-field gel electrophoresis (PFGE) was performed on isolates from cases and suspect products. Facilities involved in manufacturing suspect products were inspected to assess possible root causes. Results An outbreak of 162 Bcc bloodstream infections across 59 nursing facilities in 5 states occurred during September 2016–January 2017. Isolates from patients and pre-filled saline flush syringes were closely related by PFGE, identifying contaminated flushes as the outbreak source and prompting a nationwide recall. Inspections of facilities at the saline flush manufacturer identified deficiencies that might have led to the failure to sterilize a specific case containing a partial lot of the product. Conclusions Communication and coordination among key stakeholders, including healthcare facilities, public health authorities, and state and federal agencies, led to the rapid identification of an outbreak source and likely prevented many additional infections. Effective processes to ensure the sterilization of injectable products are essential to prevent similar outbreaks in the future.

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

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46652014000100011 ◽

2014 ◽

Vol 56 (1) ◽

pp. 71-76 ◽

Cited By ~ 5

Author(s):

Icaro Boszczowski ◽

Gladys Villas Boas do Prado ◽

Mirian F. Dalben ◽

Roberto C. P. Telles ◽

Maristela Pinheiro Freire ◽

...

Keyword(s):

Bone Marrow ◽

Laminar Flow ◽

Hand Hygiene ◽

Bone Marrow Transplant ◽

Burkholderia Cepacia ◽

Bloodstream Infections ◽

Marrow Transplant ◽

Burkholderia Cepacia Complex ◽

Hand Hygiene Improvement ◽

Laminar Flow Cabinet

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.

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Antimicrobial activity of essential oils toward clinical and environmental strains of the opportunistic pathogen of Cystic Fibrosis patients Burkholderia cepacia complex

Planta Medica ◽

10.1055/s-0033-1352360 ◽

2013 ◽

Vol 79 (13) ◽

Author(s):

A Lo Nostro ◽

M Barnabei ◽

E Perrin ◽

A Bilia ◽

G Pesavento ◽

...

Keyword(s):

Cystic Fibrosis ◽

Antimicrobial Activity ◽

Essential Oils ◽

Burkholderia Cepacia ◽

Opportunistic Pathogen ◽

Burkholderia Cepacia Complex

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Comparison of Microbiological Characteristics and Genetic Diversity between Burkholderia cepacia Complex Isolates from Vascular Access and Other Clinical Infections

Microorganisms ◽

10.3390/microorganisms9010051 ◽

2020 ◽

Vol 9 (1) ◽

pp. 51

Author(s):

Min Yi Wong ◽

Yuan-Hsi Tseng ◽

Tsung-Yu Huang ◽

Bor-Shyh Lin ◽

Chun-Wu Tung ◽

...

Keyword(s):

Genetic Diversity ◽

Vascular Access ◽

Burkholderia Cepacia ◽

Bacterial Species ◽

Diversity Indices ◽

Burkholderia Cepacia Complex ◽

Reca Gene ◽

Clinical Effects ◽

Environmental Distribution ◽

Microbiological Characteristics

Burkholderia cepacia complex (BCC) is a group of closely related bacteria with widespread environmental distribution. BCC bacteria are opportunistic pathogens that cause nosocomial infections in patients, especially cystic fibrosis (CF). Multilocus sequence typing (MLST) is used nowadays to differentiate species within the BCC complex. This study collected 41 BCC isolates from vascular access infections (VAIs) and other clinical infections between 2014 and 2020. We preliminarily identified bacterial isolates using standard biochemical procedures and further conducted recA gene sequencing and MLST for species identification. We determined genetic diversity indices using bioinformatics software. We studied 14 isolates retrieved from patients with VAIs and observed that Burkholderia cepacia was the predominant bacterial species, and B. contaminans followed by B. cenocepacia were mainly retrieved from patients with other infections. According to MLST data, we identified that all B. contaminans isolates belonged to ST102, while a wide variety of sequence types (STs) were found in B. cenocepacia isolates. In summary, the high diversity and easy transmission of BCC increase BCC infections, which provides insights into their potential clinical effects in non-CF infections.

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The epidemiology of central venous catheter-related bloodstream infection in our renal units is changing

The Journal of Vascular Access ◽

10.1177/1129729821990222 ◽

2021 ◽

pp. 112972982199022

Author(s):

Salvatore Mandolfo ◽

Adriano Anesi ◽

Vanina Rognoni

Keyword(s):

Burkholderia Cepacia ◽

Present Report ◽

Statistical Significance ◽

Bloodstream Infections ◽

Venous Catheter ◽

Renal Unit ◽

Gram Positive ◽

Gram Negative ◽

Gram Positive Bacteria ◽

Over Time

Recent reports have shown an increase in the rate of Gram-negative bacteremia in several settings, including catheter-related bloodstream infections (CRBSI). To analyze if the epidemiology of CRBSI is also changing in hemodialysis patients, we revisited the etiology of CRBSIs in our renal unit over 8 years. During the observed periods, 149 episodes of CRBSIs were reported and the CRBSI incidence rate, ranged between 0.67 and 0.82 episodes/1000 tCVC days. Of these 149 episodes, 84 (56.3%) were due to Gram-positive bacteria, 62 (41.6%) to Gram-negative bacteria, and 3 (2.1%) to polymicrobial flora, no episodes of fungi were found. There was a trend, but not statistically significative, increase over time in the number of Gram-negative CRBSIs among the total CRBSIs, rising from 37.8% in the first period to 41.2% in the second period and to 44.3% in the last period, with a parallel decrease in the percentage of Gram-positive CRBSIs (from 59.5% to 56.9% and subsequently to 54.1%). Between Gram-negative, we reported an intensification of CRBSI due to Enterobacterales, particularly Escherichia coli. Among the Gram-negative, we have isolated germs rarely reported in the literature, such as Burkholderia cepacia, Pantoea agglomerans, and Rhizobium radiobacter. Regarding Gram-positive bacteria, a triplicate incidence of Staphylococcus aureus was reported with MRSA accounting for 42% in the third period. Among the Gram-positive bacteria, we reported two episodes of Kocuria kristinae and two of Bacillus spp. Our data demonstrated that the epidemiology of CRBSI in the same center, will change over time and Gram-negative strains are an increasing cause of CRBSI. The limitation of the present report is that statistical significance has not been reached, probably due to the limited number of CRBSI. New bacteria, both Gram-negative and Gram-positive, are emerging. Collaboration with the Microbiology Department appears essential to an appropriate diagnosis.

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