Hostname: page-component-cb9f654ff-lqqdg Total loading time: 0 Render date: 2025-08-08T01:34:27.666Z Has data issue: false hasContentIssue false
  • English
  • Français

An outbreak of Burkholderia contaminans at a quaternary children’s hospital linked to equipment reprocessing

Published online by Cambridge University Press:  14 September 2022

Zheyi Teoh Open the ORCID record for Zheyi Teoh [Opens in a new window] ,
Andrea L. Ankrum ,
Jareen Meinzen-Derr ,
MaryAnn Weingartner ,
Mary Jo Goebel ,
Felicia Scaggs Huang Open the ORCID record for Felicia Scaggs Huang [Opens in a new window]  and
Joshua K. Schaffzin Open the ORCID record for Joshua K. Schaffzin [Opens in a new window]
Zheyi Teoh*
Affiliation:
Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Andrea L. Ankrum
Affiliation:
Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Jareen Meinzen-Derr
Affiliation:
Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio Division of Biostatistics and Epidemiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio University of Cincinnati College of Medicine, Cincinnati, Ohio
MaryAnn Weingartner
Affiliation:
Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Mary Jo Goebel
Affiliation:
James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
Felicia Scaggs Huang
Affiliation:
Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
Joshua K. Schaffzin
Affiliation:
Division of Infectious Diseases, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Department of Infection Prevention & Control, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
*
Author for correspondence: Zheyi Teoh, E-mail: zheyi.teoh@cchmc.org
Get access Rights & Permissions [Opens in a new window]

Abstract

Burkholderia cepacia complex (BCC) has been increasingly implicated in local and multistate outbreaks in both adult and pediatric healthcare settings. However, a lack of source identification may be common for BCC outbreak investigations. We describe, in detail, the investigation of an outbreak of BCC (B. contaminans) among pediatric patients at a large quaternary-care children’s hospital and our system-level changes and outcomes.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 8 , August 2023 , pp. 1267 - 1273
Check for updates
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

Compant, S, Nowak, J, Coenye, T, Clement, C, Ait Barka, E. Diversity and occurrence of Burkholderia spp in the natural environment. FEMS Microbiol Rev 2008;32:607–626.10.1111/j.1574-6976.2008.00113.xCrossRefGoogle ScholarPubMed
Shaban, RZ, Sotomayor-Castillo, C, Nahidi, S, et al. Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: an integrative review. Infect Control Hosp Epidemiol 2020;41:777–783.CrossRefGoogle ScholarPubMed
Kim, JM, Ahn, Y, LiPuma JJ, Hussong D, Cerniglia CE. Survival and susceptibility of Burkholderia cepacia complex in chlorhexidine gluconate and benzalkonium chloride. J Ind Microbiol Biotechnol 2015;42:905–913.10.1007/s10295-015-1605-xCrossRefGoogle ScholarPubMed
Rose, H, Baldwin, A, Dowson, CG, Mahenthiralingam, E. Biocide susceptibility of the Burkholderia cepacia complex. J Antimicrob Chemother 2009;63:502–510.10.1093/jac/dkn540CrossRefGoogle ScholarPubMed
Alvarez-Lerma, F, Maull, E, Terradas, R, et al. Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit. Crit Care 2008;12:R10.10.1186/cc6778CrossRefGoogle Scholar
Brooks, RB, Mitchell, PK, Miller, JR, et al. Multistate outbreak of Burkholderia cepacia complex bloodstream infections after exposure to contaminated saline flush syringes: United States, 2016–2017. Clin Infect Dis 2019;69:445–449.10.1093/cid/ciy910CrossRefGoogle ScholarPubMed
Douce, RW, Zurita, J, Sanchez, O, Cardenas Aldaz, P. Investigation of an outbreak of central venous catheter-associated bloodstream infection due to contaminated water. Infect Control Hosp Epidemiol 2008;29:364–366.10.1086/533543CrossRefGoogle ScholarPubMed
Mali, S, Dash, L, Gautam, V, Shastri, J, Kumar, S. An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital. Indian J Med Microbiol 2017;35:216–220.CrossRefGoogle ScholarPubMed
Marquez, L, Jones, KN, Whaley, EM, et al. An outbreak of Burkholderia cepacia complex infections associated with contaminated liquid docusate. Infect Control Hosp Epidemiol 2017;38:567–573.10.1017/ice.2017.11CrossRefGoogle ScholarPubMed
Saalfeld, S, Shinohara, DR, Silva, JA, et al. Inter-hospital outbreak of Burkholderia cepacia complex VAP caused by contaminated mouthwash in coronavirus disease 2019 (COVID-19) patients. Infect Control Hosp Epidemiol 2022;43:1081–1083.CrossRefGoogle Scholar
Hafliger, E, Atkinson, A, Marschall, J. Systematic review of healthcare-associated Burkholderia cepacia complex outbreaks: presentation, causes and outbreak control. Infect Prev Pract 2020;2:100082.10.1016/j.infpip.2020.100082CrossRefGoogle ScholarPubMed
Rhee, C, Baker, MA, Tucker, R, et al. Cluster of Burkholderia cepacia complex infections associated with extracorporeal membrane oxygenation water heater devices. Clin Infect Dis 2022.10.1093/cid/ciac200CrossRefGoogle Scholar
Joshi, NA, Fass, JN. Sickle: a sliding-window, adaptive, quality-based trimming tool for FastQ files (Version 1.33) [computer program]. 2011.Google Scholar
Prjibelski, A, Antipov, D, Meleshko, D, Lapidus, A, Korobeynikov, A. Using SPAdes de novo assembler. Curr Protocols Bioinformat 2020;70:e102.Google ScholarPubMed
Gardner, SN, Slezak, T, Hall, BG. kSNP3.0: SNP detection and phylogenetic analysis of genomes without genome alignment or reference genome. Bioinformatics 2015;31:2877–2878.10.1093/bioinformatics/btv271CrossRefGoogle ScholarPubMed
Coenye, T, Spilker, T, Martin, A, LiPuma, JJ. Comparative assessment of genotyping methods for epidemiologic study of Burkholderia cepacia genomovar III. J Clin Microbiol 2002;40:3300–3307.10.1128/JCM.40.9.3300-3307.2002CrossRefGoogle ScholarPubMed
US Pharmacopeia <USP 60>. Microbiological Examination of Nonsterile Products—Tests for Burkholderia cepacia Complex. Rockville, MD: 2019..+Microbiological+Examination+of+Nonsterile+Products—Tests+for+Burkholderia+cepacia+Complex.+Rockville,+MD:+2019.>Google Scholar
Harris, PA, Taylor, R, Thielke, R, Payne, J, Gonzalez, N, Conde, JG. Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 2009;42:377–381.CrossRefGoogle ScholarPubMed
Harris, PA, Taylor, R, Minor, BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform 2019;95:103208.CrossRefGoogle ScholarPubMed
Jolley, KA, Bray, JE, Maiden, MCJ. Open-access bacterial population genomics: BIGSdb software, the PubMLST.org website and their applications. Wellcome Open Res 2018;3:124.CrossRefGoogle ScholarPubMed
Glowicz, J, Crist, M, Gould, C, et al. A multistate investigation of healthcare-associated Burkholderia cepacia complex infections related to liquid docusate sodium contamination, January–October 2016. Am J Infect Control 2018;46:649–655.10.1016/j.ajic.2017.11.018CrossRefGoogle Scholar
Akinboyo, IC, Sick-Samuels, AC, Singeltary, E, et al. Multistate outbreak of an emerging Burkholderia cepacia complex strain associated with contaminated oral liquid docusate sodium. Infect Control Hosp Epidemiol 2018;39:237–239.10.1017/ice.2017.265CrossRefGoogle ScholarPubMed
Recall expansion of Durisan nonalcohol hand sanitizer. US Food and Drug Administration website. https://www.fda.gov/safety/recalls-market-withdrawals-safety-alerts/recall-expansion-durisan-non-alcohol-hand-sanitizer. Published 2021. Accessed September 7, 2022.Google Scholar
Vonberg, RP, Weitzel-Kage, D, Behnke, M, Gastmeier, P. Worldwide Outbreak Database: the largest collection of nosocomial outbreaks. Infection 2011;39:29–34.CrossRefGoogle ScholarPubMed
FDA advises drug manufacturers that Burkholderia cepacia complex poses a contamination risk in non-sterile, water-based drug products. US Food and Drug Administration website. https://www.fda.gov/drugs/drug-safety-and-availability/fda-advises-drug-manufacturers-burkholderia-cepacia-complex-poses-contamination-risk-non-sterile. Published 2021. Accessed September 7, 2022.Google Scholar
Torbeck, L, Raccasi, D, Guilfoyle, DE, Friedman, RL, Hussong, D. Burkholderia cepacia: this decision is overdue. PDA J Pharm Sci Technol 2011;65:535–543.CrossRefGoogle ScholarPubMed
Rutala, WA, Weber, DJ. Guideline for disinfection and sterilization in healthcare facilities, 2008. Centers for Disease Control and Prevention website. https://www.cdc.gov/infectioncontrol/pdf/guidelines/disinfection-guidelines-H.pdf. Published 2008. Accessed September 7, 2022.Google Scholar
ANSI/ASHRAE standard 188–2018. Legionellosis: risk management for building water systems. ASHRAE website. https://www.ashrae.org/technical-resources/bookstore/ansi-ashrae-standard-188-2018-legionellosis-risk-management-for-building-water-systems. Published 2018. Accessed September 7, 2022.Google Scholar
Health Technical Memorandum 04-01: Safe water in healthcare premises. Part B: Operational management. UK National Health Service website. https://www.england.nhs.uk/publication/safe-water-in-healthcare-premises-htm-04-01/. Published 2016. Accessed September 7, 2022.Google Scholar
Gamage, SD, Ambrose, M, Kralovic, SM, Roselle, GA. Water safety and health care: preventing infections caused by opportunistic premise plumbing pathogens. Infect Dis Clin 2021;35:667–695.CrossRefGoogle ScholarPubMed
Lucero, CA, Cohen, AL, Trevino, I, et al. Outbreak of Burkholderia cepacia complex among ventilated pediatric patients linked to hospital sinks. Am J Infect Control 2011;39:775–778.CrossRefGoogle ScholarPubMed
Essential elements of a reprocessing program for flexible endoscopes—recommendations of the Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention website. https://www.cdc.gov/hicpac/pdf/flexible-endoscope-reprocessing.pdf. Updated 2017. Accessed September 7, 2022.Google Scholar
Supplementary material: Image

Teoh et al. supplementary material

Figure S1

Download Teoh et al. supplementary material(Image)
Image 135.3 KB