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An Outbreak of Burkholderia cepacia Complex Infections Associated with Contaminated Liquid Docusate

Published online by Cambridge University Press:  07 February 2017

Lucila Marquez
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Infection Control and Prevention, Texas Children’s Hospital, Houston, Texas
Katie N. Jones
Affiliation:
Infection Control and Prevention, Texas Children’s Hospital, Houston, Texas
Elaine M. Whaley
Affiliation:
Infection Control and Prevention, Texas Children’s Hospital, Houston, Texas
Tjin H. Koy
Affiliation:
Infection Control and Prevention, Texas Children’s Hospital, Houston, Texas
Paula A. Revell
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas Department of Pathology, Texas Children’s Hospital, Houston, Texas
Ruston S. Taylor
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas
M. Brooke Bernhardt
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas
Jeffrey L. Wagner
Affiliation:
Department of Pharmacy, Texas Children’s Hospital, Houston, Texas
James J. Dunn
Affiliation:
Department of Pathology, Texas Children’s Hospital, Houston, Texas
John J. LiPuma
Affiliation:
Department of Pediatrics and Communicable Diseases, University of Michigan, Ann Arbor, Michigan
Judith R. Campbell
Affiliation:
Department of Pediatrics, Baylor College of Medicine, Houston, Texas Section of Infectious Diseases, Baylor College of Medicine, Houston, Texas Infection Control and Prevention, Texas Children’s Hospital, Houston, Texas
Corresponding
E-mail address:

Abstract

OBJECTIVE

To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source.

SETTING

A 629-bed, tertiary-care, pediatric hospital in Houston, Texas.

PATIENTS

Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units.

METHODS

We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory.

RESULTS

Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation.

CONCLUSIONS

Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer.

Infect Control Hosp Epidemiol 2017;38:567–573

Type
Original Articles
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

PREVIOUS PRESENTATION. An abstract outlining the investigation was presented as a poster at IDWeek2016 in New Orleans, Louisiana, on October 28, 2016.

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