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

  • Lucila Marquez (a1) (a2) (a3), Katie N. Jones (a3), Elaine M. Whaley (a3), Tjin H. Koy (a3), Paula A. Revell (a1) (a4), Ruston S. Taylor (a5), M. Brooke Bernhardt (a5), Jeffrey L. Wagner (a5), James J. Dunn (a4), John J. LiPuma (a6) and Judith R. Campbell (a1) (a2) (a3)...



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


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


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


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.


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.


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


Corresponding author

Address correspondence to Lucila Marquez, MD, MPH, 1102 Bates Avenue, Suite 1150, Houston, TX 77030 (


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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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