scholarly journals Outbreak of Burkholderia cepacia Complex Due to Multiple Brands of Contaminated Aqueous Chlorhexidine in Hong Kong

2020 ◽  
Vol 41 (S1) ◽  
pp. s337-s337
Author(s):  
Shuk-Ching WONG ◽  
Vincent Chi-Chung CHENG
Keyword(s):  
Hong Kong ◽  
Peritoneal Dialysis ◽  
Burkholderia Cepacia ◽  
Environmental Samples ◽  
Community Pharmacies ◽  
Site Visit ◽  
Newly Diagnosed ◽  
Environmental Isolates ◽  
Exit Site ◽  
Culture Positive

Background: Contaminated chlorhexidine produced by a single company has been implicated in the outbreak or pseudo-outbreak of Burkholderia cepacia complex (BCC). However, simultaneous occurrence of multiple brands of contaminated chlorhexidine supplied by different manufacturers resulting in a persistent outbreak for >1 year has not been well described. Objective: We report an outbreak of BCC with epidemiological investigation and using whole-genome sequencing (WGS) analysis of patient and environmental isolates in Hong Kong. Methods: Upon the investigation of a cohort of renal patients undergoing peritoneal dialysis colonized or infected with BCC in their exit sites, different brands of 0.05% aqueous chlorhexidine (aqCHX) used for exit site dressing, supplied from hospital or purchased from community pharmacies by patients, were cultured. A risk factor analysis for exit-site acquisition of BCC was performed. A site visit to a local manufacturer was conducted to investigate the process of production and to collect environmental samples for culture, which were further analyzed by WGS along with the BCC isolates cultured from patients and aqCHX purchased from community pharmacies. Results: Four patients undergoing peritoneal dialysis had cultures positive for BCC in the exit site swab in September 2019. A snapshot screening revealed 88 (32.0%) of 275 renal dialysis patients colonized with BCC. Of these patients, 47 (17.1%) were newly diagnosed and 41 (14.9%) were known to be colonized or infected with BCC according to retrospective data retrieval from January 1, 2018. A significantly greater proportion of patients with newly diagnosed BCC (cases) had used contaminated aqCHX for exit-site dressing than those with culture negative for BCC (controls): 38 of 47 (80.9%) versus 54 of 187 (28.9%) (P < .001). Of 161 aqCHX samples, 10 brands from 4 manufacturers (purchased from community pharmacies), 125 (77.6%) were culture positive for BCC, whereas all 77 aqCHX samples supplied by the hospital, which are different brands and are produced by different manufacturers, were proven to be sterile. Of the 28 environmental samples taken from a local manufacturer during the site visit, 19 samples (67.9%, 3 collected from the instrument for production of aqCHX and all 16 newly produced aqCHX samples) were culture positive for BCC. WGS revealed 3 major clusters characterized by B. cenocepacia genomovar IIIA ST1547 and 2 novel MLST clusters from 52 patients and 26 environmental isolates selected. Conclusions: This outbreak was terminated by product recall, and the government has decided to take regulatory actions to ensure the sterility of antiseptics, including aqCHX.Funding: NoneDisclosures: None

scholarly journals Burkholderia cepacia—An Uncommon Cause of Exit-Site Infection in a Peritoneal Dialysis Patient

2014 ◽  
Vol 34 (4) ◽  
pp. 471-472 ◽  
Author(s):  
Desmond Y. H. Yap ◽  
Cindy B. Y. Choy ◽  
Maggie M. Y. Mok ◽  
Tin Kan Wong ◽  
Tak Mao Chan
Keyword(s):  
Peritoneal Dialysis ◽  
Burkholderia Cepacia ◽  
Dialysis Patient ◽  
Peritoneal Dialysis Patient ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection

scholarly journals Burkholderia cepacia: An Outbreak in the Peritoneal Dialysis Unit

2019 ◽  
Vol 39 (1) ◽  
pp. 92-95 ◽  
Author(s):  
Sarah Gleeson ◽  
Eoin Mulroy ◽  
Elizabeth Bryce ◽  
Sally Fox ◽  
Susan L. Taylor ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Burkholderia Cepacia ◽  
Clinical Course ◽  
Treatment Options ◽  
Catheter Removal ◽  
Exit Site ◽  
Exit Site Infection ◽  
Dialysis Unit ◽  
Recent Outbreak ◽  
Healthcare Associated

Burkholderia cepacia is a ubiquitous, opportunistic, environmental gram-negative bacillus which most commonly affects cystic fibrosis and immunocompromised patients. Rarely, it can cause peritoneal dialysis (PD) exit-site infection (ESI). Information relating to predisposing factors, clinical course, and treatment options for B. cepacia ESIs is limited. Although reports of B. cepacia healthcare-associated infections exist, outbreaks in PD units have not previously been reported. A recent outbreak of B. cepacia ESI in our PD unit provided a unique opportunity to study B. cepacia ESIs and to outline an approach to investigating such an outbreak. After unexpectedly identifying B. cepacia as the cause of PD catheter ESIs in 3 patients over an 11-week period, we began systematically screening our PD population for B. cepacia exit-site colonization. A further 6 patients were found to be affected, 3 with asymptomatic colonization and 3 with symptomatic B. cepacia ESI. Four of the 6 developed tunnel infections requiring multiple courses of antibiotic treatment, and 3 patients required catheter removal; 2 patients with symptomatic ESIs without tunnel involvement responded to oral and topical antibiotics. Further investigation implicated 4% chlorhexidine aqueous bodywash used by all patients as the probable source of the outbreak. This is the first reported outbreak of B. cepacia ESIs. We noted an association between diabetes mellitus and refractory/more extensive infection. Our experience suggests that isolated ESIs can be treated successfully with oral antibiotics whereas tunnel infections generally require catheter removal.

scholarly journals Extrusion of both Superficial and Deep Cuffs of a Functional Double-Cuff Peritoneal Dialysis Catheter after Significant Weight Loss

2021 ◽  
pp. 190-194
Author(s):  
Aravindh S. Ganapathy ◽  
Myron S. Powell ◽  
James L. Pirkle
Keyword(s):  
Weight Loss ◽  
Peritoneal Dialysis ◽  
Subcutaneous Tissue ◽  
Peritoneal Dialysis Catheter ◽  
Dialysis Catheter ◽  
Review Of The Literature ◽  
Significant Weight Loss ◽  
Exit Site ◽  
Special Circumstances ◽  
Uncommon Complication

Extrusion of the superficial cuff of a peritoneal dialysis (PD) catheter is an uncommon complication that may be associated with infection or malfunction. However, extrusion of both the superficial and deep cuffs of a double-cuff catheter is rare and uniformly associated with failure and peritonitis. We report a case of a presternal-type PD double-cuff catheter with extrusion of both cuffs through an abdominal exit site after 6 years of use that has remained functional, which has not been previously reported. In this case, the patient had achieved a 60-kg weight loss resulting in retraction of the subcutaneous tissue around both cuffs, while the catheter was held in place by the titanium connector between the presternal extension tubing and the inner, coiled catheter. In such special circumstances, extrusion of both cuffs may not necessitate urgent catheter removal. A review of the literature revealed previous cases of superficial cuff extrusions with catheters remaining functional but not with deep cuff extrusion.

scholarly journals Repeat exit site infection in peritoneal dialysis patient with polycythemia vera – a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Edyta Gołembiewska ◽  
Kazimierz Ciechanowski
Keyword(s):  
Pseudomonas Aeruginosa ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Polycythemia Vera ◽  
Significant Risk ◽  
Renal Amyloidosis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
First Case

Abstract Background Infectious complications of peritoneal dialysis (PD) remain a common cause of catheter loss and discontinuation of PD. Exit site infection (ESI) constitutes a significant risk factor for PD-related peritonitis and determination of predisposing states is relevant. We here present a case of repeat ESI due to Pseudomonas aeruginosa in a PD patient with skin changes in the course of polycythemia vera (PV). Case presentation A 73-year-old PD patient with chronic kidney disease secondary to renal amyloidosis and ankylosing spondylitis, presented to the nephrology unit with signs of ESI. In 2006 he was diagnosed with PV and since then has was successfully treated with hydroxyurea; however, he reported recurrent episodes of developing skin nodules in the course of the disease. Exit site swab yielded Pseudomonas aeruginosa and the infection developed in the ulcerated PV nodule that appeared in exit site 2 weeks earlier. Patient was treated with intraperitoneal amikacin and oral ciprofloxacin, however, due to neurological complications, the treatment had to be interrupted and finally catheter was removed. Similar episode of ESI with Pseudomonas aeruginosa developed in the patient two years earlier and also required catheter removal. Conclusion This is the first case report demonstrating the development of ESI on the polycythemia vera skin lesion in this area. Skin manifestations of PV might be a predisposing factor to ESI in PD patients.

Exit-Site Infection during Continuous and Cycling Peritoneal Dialysis in Children

1990 ◽  
Vol 10 (1) ◽  
pp. 31-35 ◽  
Author(s):  
Maurice Levy ◽  
J. Williamson Balfe ◽  
Dennis Geary ◽  
Sue Fryer-Keene ◽  
Robert Bannatyne
Keyword(s):  
Peritoneal Dialysis ◽  
Site Infection ◽  
Exit Site ◽  
Exit Site Infection ◽  
Daily Dialysis ◽  
Pseudomonas Species ◽  
Before And After ◽  
Species Being ◽  
Catheter Replacement

A 10-year retrospective review of pediatric patients on peritoneal dialysis showed that 50 of 83 had 132 episodes of exit-site infection (ESI). Thirty-nine episodes were purulent. The most prevalent organism was Staphylococcus aureus. Staphylococcus epidermidis was also common, usually occurring in purulent infections. Gramnegative organisms were responsible for 23 ESls, with Pseudomonas species being the most common. Age, sex, concomitant primary disease type, length of training, dressing techniques, quality of daily dialysis technique, use of diapers, and pyelostomies did not affect the incidence of ESI. However, 40% of children with a skin infection from other sites had associated peritoneal catheter ESI. Thirty-eight episodes of ESI in 28 patients resulted in peritonitis; the main organisms involved were Staphylococcus and Pseudomonas species. Catheters were replaced in 13 patients with peritonitis, but there was no difference in the incidence of ESI before and after catheter replacement.

P1198CATHETER-RELATED INFECTIONS DUE TO SERRATIA SPECIES IN PATIENTS RECEIVING PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Christy Au ◽  
Jasper Chan ◽  
Terence Yip ◽  
Desmond Yap ◽  
Daniel Tak Mao Chan
Keyword(s):  
Peritoneal Dialysis ◽  
Medical Therapy ◽  
Chronic Haemodialysis ◽  
Exit Site ◽  
Exit Site Infection ◽  
2Nd Generation ◽  
Queen Mary Hospital ◽  
Skin Abnormalities ◽  
Tract Involvement ◽  
Antibiotics Susceptibility

Abstract Background and Aims Serratia species can cause catheter-related infections in peritoneal dialysis (PD) patients but data on this clinical entity remains limited. This study aims to investigate the clinical characteristics, antibiotics susceptibility/resistance profiles and treatment outcomes of Serratia catheter-related infections in PD patients. Method We retrospectively reviewed all PD patients who were followed up at Queen Mary Hospital and Tung Wah Hospital, Hong Kong between 2004 to 2017. Patients with Serratia exit site infection (ESI) or peritonitis were included for analysis. Results One hundred and seventy-three patients with Serratia catheter-related infections were included. 161 patients had ESI, of which 10 (6.2%) progressed to tunnel tract involvement and 11 (6.8%) developed PD peritonitis. Skin abnormalities surrounding the exit site were present in 58 patients (36%), and 40 patients (24.8%) were hospitalized within 1 month prior to Serratia ESI. 142 patients (88.2%) with ESI responded to medical therapy alone, and repeat ESI occurred in 56 patients (34.7%) at a median of 12 months. Twenty-two patients had Serratia peritonitis, which accounted for 1% of peritonitis during the study period. Concomitant intra-abdominal pathologies were detected in 12 patients (54.5%). Ten patients (45.5%) responded to medical treatment while the remaining 12 (54.5%) required catheter removal. Nine patients (36.4%) failed PD resumption and switched to chronic haemodialysis. Repeat peritonitis occurred in two patients at 2 months and 3 years after the initial episode respectively. While Serratia species in PD patients are generally susceptible to aminoglycosides, carboxy-/ureido-penicillins and carbapenems, they exhibit substantial rates of resistance to ampicillin, and 1st- and 2nd-generation cephalosporins. Conclusion Serratia ESI responds favourably to medical therapy and seldom progresses to tunnel tract infection or peritonitis. Serratia peritonitis is associated with considerable risk of catheter loss and peritoneal failure.

Mycobacterium chimaera infections among cardiothoracic surgery patients associated with heater-cooler devices—Kansas and California, 2019

2021 ◽  
pp. 1-6
Author(s):  
Kerui Xu ◽  
Lauren E. Finn ◽  
Robert L. Geist ◽  
Christopher Prestel ◽  
Heather Moulton-Meissner ◽  
...  
Keyword(s):  
Operating Room ◽  
Environmental Samples ◽  
Chart Review ◽  
Whole Genome ◽  
Environmental Isolates ◽  
Outbreak Strain ◽  
Medical Chart Review ◽  
The Us ◽  
Control And Prevention ◽  
Cleaning And Disinfection

Abstract Background: In 2015, an international outbreak of Mycobacterium chimaera infections among patients undergoing cardiothoracic surgeries was associated with exposure to contaminated LivaNova 3T heater-cooler devices (HCDs). From June 2017 to October 2020, the Centers for Disease Control and Prevention was notified of 18 patients with M. chimaera infections who had undergone cardiothoracic surgeries at 2 hospitals in Kansas (14 patients) and California (4 patients); 17 had exposure to 3T HCDs. Whole-genome sequencing of the clinical and environmental isolates matched the global outbreak strain identified in 2015. Methods: Investigations were conducted at each hospital to determine the cause of ongoing infections. Investigative methods included query of microbiologic records to identify additional cases, medical chart review, observations of operating room setup, HCD use and maintenance practices, and collection of HCD and environmental samples. Results: Onsite observations identified deviations in the positioning and maintenance of the 3T HCDs from the US Food and Drug Administration (FDA) recommendations and the manufacturer’s updated cleaning and disinfection protocols. Additionally, most 3T HCDs had not undergone the recommended vacuum and sealing upgrades by the manufacturer to decrease the dispersal of M. chimaera–containing aerosols into the operating room, despite hospital requests to the manufacturer. Conclusions: These findings highlight the need for continued awareness of the risk of M. chimaera infections associated with 3T HCDs, even if the devices are newly manufactured. Hospitals should maintain vigilance in adhering to FDA recommendations and the manufacturer’s protocols and in identifying patients with potential M. chimaera infections with exposure to these devices.

Modification of the percutaneous approach to peritoneal dialysis catheter placement under peritoneoscopic visualization: clinical results in 78 patients.

1992 ◽  
Vol 3 (1) ◽  
pp. 103-107
Author(s):  
N S Nahman ◽  
D F Middendorf ◽  
W H Bay ◽  
R McElligott ◽  
S Powell ◽  
...  
Keyword(s):  
Peritoneal Dialysis ◽  
Catheter Placement ◽  
Seldinger Technique ◽  
First Episode ◽  
Dialysis Access ◽  
Peritoneal Dialysis Catheter ◽  
Exit Site ◽  
Exit Site Infection ◽  
Percutaneous Approach ◽  
Tunnel Infection

The placement of percutaneous peritoneal dialysis catheters under direct peritoneoscopic visualization is a relatively new technique for establishing peritoneal dialysis access. In this study, in which a modification of the Seldinger technique was used to facilitate the placement of the peritoneoscope, the experience with 82 consecutive catheterization procedures in 78 patients is reported. In 2 (2.4%) of 82 catheterization procedures, we were unable to enter the peritoneal cavity but experienced no other complications unique to the percutaneous approach. Of the 80 successful catheterization procedures, 76 represented first-time catheter placement and constituted a population subjected to life-table analysis examining catheter survival rates, the time to first cutaneous exit site or s.c. tunnel infection, and the time to first episode of peritonitis. After a follow-up period of 50.1 patient yr, 11 catheters were lost because of catheter dysfunction. Other clinical complications included peritoneal fluid leaks at the cutaneous exit site in 11 instances (0.22/patient yr), cutaneous exit site infection in 7 instances (0.14/patient yr), s.c. tunnel infection in 2 instances (0.04/patient yr), and 34 episodes of peritonitis (0.68/patient yr). The results of this study demonstrate that the suggested modification of the percutaneous placement of peritoneal dialysis catheters, under peritoneoscopic visualization, is a viable method for establishing peritoneal access.

CAPD Catheter Exit-Site and Tunnel Infection with Fungal Etiology—Treatment and Catheter Reinsertion for an Extremely Rare Complication

2017 ◽  
Vol 37 (2) ◽  
pp. 237-239
Author(s):  
Manmeet Singh Jhawar ◽  
Jasmin Das ◽  
Pratish George ◽  
Anil Luther
Keyword(s):  
Candida Albicans ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Fungal Infection ◽  
Continuous Ambulatory Peritoneal Dialysis ◽  
Rare Complication ◽  
Exit Site ◽  
Duration Of Therapy ◽  
Tunnel Infection ◽  
Few Data

Fungal infection is an extremely rare etiology of exit-site and tunnel infection in patients on continuous ambulatory peritoneal dialysis (CAPD). There are few data available regarding its management—especially choice of antifungals, duration of therapy, and removal of catheter. There are no guidelines pertaining to reinsertion of the CAPD catheter following fungal exit-site and tunnel infection. This case report highlights Candida albicans as a rare cause of exit-site and tunnel infection of the CAPD catheter. The catheter was removed and the patient received appropriate antifungal therapy followed by reinsertion of the CAPD catheter and re-initiation on CAPD.

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