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Risk Factors for Burkholderia cepacia Complex Bacteremia Among Intensive Care Unit Patients Without Cystic Fibrosis: A Case-Control Study

Published online by Cambridge University Press:  02 January 2015

Adam M. Bressler ,
Keith S. Kaye ,
John J. LiPuma ,
Barbara D. Alexander ,
Christopher M. Moore ,
L. Barth Reller  and
Christopher W. Woods
Adam M. Bressler
Affiliation:
Infectious Disease Specialists of Atlanta and the Clinical Microbiology Laboratory, Dekalb Medical Center, Atlanta, Georgia
Keith S. Kaye
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham
John J. LiPuma
Affiliation:
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor
Barbara D. Alexander
Affiliation:
Clinical Microbiology Laboratory, Duke University School of Medicine, Durham
Christopher M. Moore
Affiliation:
University of Virginia School of Medicine, Charlottesville
L. Barth Reller
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham Clinical Microbiology Laboratory, Duke University School of Medicine, Durham
Christopher W. Woods*
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham Clinical Microbiology Laboratory, Duke University School of Medicine, Durham Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
*
Clinical Microbiology Laboratory, 113 Durham Veterans Affairs Medical Center, Durham, NC 27705 (woods004@mc.duke.edu)
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Abstract

Background.

The Burkholderia cepacia complex is associated with colonization or disease in patients with cystic fibrosis (CF). For patients without CF, this complex is poorly understood apart from its presence in occasional point source outbreaks.

Objective.

To investigate risk factors for B. cepacia bacteremia in hospitalized, intensive care unit patients without CF.

Methods.

We identified patients with 1 or more blood cultures positive for B. cepacia between May 1, 1996, and March 31, 2002, excluding those with CF. Control patients were matched to case patients by ward, duration of hospitalization, and onset date of bacteremia. Matched analyses were used to identify risk factors for B. cepacia bacteremia.

Results.

We enrolled 40 patients with B. cepacia bacteremia into the study. No environmental or other point source for B. cepacia complex was identified, although horizontal spread was suspected. Implementation of contact precautions was effective in decreasing the incidence of B. cepacia bacteremia. We selected 119 matched controls. Age, sex, and race were similar between cases and controls. In multivariable analysis, renal failure that required dialysis, recent abdominal surgery, 2 or more bronchoscopic procedures before detection of B. cepacia bacteremia, tracheostomy, and presence of a central line before detection of B. cepacia bacteremia were independently associated with development of B. cepacia bacteremia, whereas presence of a percutaneous feeding tube was associated with a lower risk of disease.

Conclusions.

B. cepacia complex is an important emerging group of nosocomial pathogens in patients with and patients without CF. Nosocomial spread is likely facilitated by cross-transmission, frequent pulmonary procedures, and central venous access. Infection control measures appear useful for limiting the spread of virulent, transmissible clones of B. cepacia complex.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 951 - 958
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1. Coenye, T, Vandamme, P, Govan, JR, LiPuma, JJ. Taxonomy and identification of the Burkholderia cepacia complex. J Clin Microbiol 2001;39:3427–3436.Google Scholar
2. Isles, A, Maclusky, I, Corey, M, et al. Pseudomonas cepacia infection in cystic fibrosis: an emerging problem. J Pediatr 1984;104:206–210.Google Scholar
3. Tablan, OC, Martone, WJ, Doershuk, CF, et al. Colonization of the respiratory tract with Pseudomonas cepacia in cystic fibrosis: risk factors and outcomes. Chest 1987;91:527–532.Google Scholar
4. Chaparro, C, Maurer, J, Gutierrez, C, et al. Infection with Burkholderia cepacia in cystic fibrosis: outcome following lung transplantation. Am J Respir Crit Care Med 2001;163:43–48.Google Scholar
5. Ramirez, JC, Patterson, GA, Winton, TL, de Hoyos, AL, Miller, JD, Maurer, JR. Bilateral lung transplantation for cystic fibrosis. The Toronto Lung Transplant Group. J Thorac Cardiovasc Surg 1992;103:287–293.Google Scholar
6. Snell, GI, de Hoyos, A, Krajden, M, Winton, T, Maurer, JR. Pseudomonas cepacia in lung transplant recipients with cystic fibrosis. Chest 1993;103:466–471.Google Scholar
7. Aris, RM, Routh, JC, LiPuma, JJ, Heath, DG, Gilligan, PH. Lung transplantation for cystic fibrosis patients with Burkholderia cepacia complex: survival linked to genomovar type. Am J Respir Crit Care Med 2001;164:2102–2106.Google Scholar
8. Chen, JS, Witzmann, KA, Spilker, T, Fink, RJ, LiPuma, JJ. Endemicity and inter-city spread of Burkholderia cepacia genomovar III in cystic fibrosis. J Pediatr 2001;139:643–649.CrossRefGoogle ScholarPubMed
9. De Soyza, A, McDowell, A, Archer, L, et al. Burkholderia cepacia complex genomovars and pulmonary transplantation outcomes in patients with cystic fibrosis. Lancet 2001;358:1780–1781.Google Scholar
10. Heath, DG, Hohneker, K, Carriker, C, et al. Six-year molecular analysis of Burkholderia cepacia complex isolates among cystic fibrosis patients at a referral center for lung transplantation. J Clin Microbiol 2002;40:1188–1193.Google Scholar
11. LiPuma, JJ, Spilker, T, Gill, LH, Campbell, PW III, Liu, L, Mahenthiralingam, E. Disproportionate distribution of Burkholderia cepacia complex species and transmissibility markers in cystic fibrosis. Am J Respir Crit Care Med 2001;164:92–96.CrossRefGoogle ScholarPubMed
12. Mahenthiralingam, E, Vandamme, P, Campbell, ME, et al. Infection with Burkholderia cepacia complex genomovars in patients with cystic fibrosis: virulent transmissible strains of genomovar III can replace Burkholderia multivorans . Clin Infect Dis 2001;33:1469–1475.Google Scholar
13. Manno, G, Dalmastri, C, Tabacchioni, S, et al. Epidemiology and clinical course of Burkholderia cepacia complex infections, particularly those caused by different Burkholderia cenocepacia strains, among patients attending an Italian cystic fibrosis center. J Clin Microbiol 2004;42:1491–1497.Google Scholar
14. Agodi, A, Barchitta, M, Giannino, V, et al. Burkholderia cepacia complex in cystic fibrosis and non-cystic fibrosis patients: identification of a cluster of epidemic lineages. J Hosp Infect 2002;50:188–195.CrossRefGoogle ScholarPubMed
15. Holmes, A, Nolan, R, Taylor, R, et al. An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis. J Infect Dis 1999;179:1197–1205.CrossRefGoogle ScholarPubMed
16. Ramsey, AH, Skonieczny, P, Coolidge, DT, Kurzynski, TA, Proctor, ME, Davis, IP. Burkholderia cepacia lower respiratory tract infection associated with exposure to a respiratory therapist. Infect Control Hosp Epidemiol 2001;22:423–426.CrossRefGoogle ScholarPubMed
17. Siddiqui, AH, Mulligan, ME, Mahenthiralingam, E, et al. An episodic outbreak of genetically related Burkholderia cepacia among non-cystic fibrosis patients at a university hospital. Infect Control Hosp Epidemiol 2001;22:419–422.CrossRefGoogle ScholarPubMed
18. Woods, CW, Bressler, AM, LiPuma, IJ, et al. Virulence associated with outbreak-related strains of Burkholderia cepacia complex among a cohort of patients with bacteremia. Clin Infect Dis 2004;38:1243–1250.Google Scholar
19. LiPuma, JJ, Dasen, SE, Nielson, DW, Stern, RC, Stull, TL. Person-to-person transmission of Pseudomonas cepacia between patients with cystic fibrosis. Lancet 1990;336:1094–1096.CrossRefGoogle ScholarPubMed
20. Steinbach, S, Sun, L, Jiang, RZ, et al. Transmissibility of Pseudomonas cepacia infection in clinic patients and lung-transplant recipients with cystic fibrosis. N Engl J Med 1994;331:981–987.Google Scholar
21. LiPuma, JJ, Dulaney, BJ, McMenamin, JC, et al. Development of rRNA-based PCR assays for identification of Burkholderia cepacia complex isolates recovered from cystic fibrosis patients. J Clin Microbiol 1999;37:3167–3170.Google Scholar
22. Mahenthiralingam, E, Bischof, J, Byrne, SK, et al. DNA-based diagnostic approaches for identification of Burkholderia cepacia complex, Burkholderia vietnamiensis, Burkholderia multivorans, Burkholderia stabilis, and Burkholderia cepacia genomovars I and III. J Clin Microbiol 2000;38:3165–3173.Google Scholar
23. Coenye, T, LiPuma, JJ. Multilocus restriction typing: a novel tool for studying global epidemiology of Burkholderia cepacia complex infection in cystic fibrosis. J Infect Dis 2002;185:1454–1462.Google Scholar
24. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. I Clin Microbiol 1995;33:2233–2239.Google Scholar
25. Agerton, T, Valway, S, Gore, B, et al. Transmission of a highly drug-resistant strain (strain W1) of Mycobacterium tuberculosis: community outbreak and nosocomial transmission via a contaminated bronchoscope. JAMA 1997;278:1073–1077.Google Scholar
26. Kirschke, DL, Jones, TK, Craig, AS, et al. Pseudomonas aeruginosa and Serratia marcescens contamination associated with a manufacturing defect in bronchoscopes. N Engl J Med 2003;348:214–220.Google Scholar
27. Michele, TM, Cronin, WA, Graham, NM, et al. Transmission of Mycobacterium tuberculosis by a fiberoptic bronchoscope: identification by DNA fingerprinting. JAMA 1997;278:1093–1095.CrossRefGoogle ScholarPubMed
28. Ramsey, AH, Oemig, TV, Davis, JP, Massey, JP, Torok, TJ. An outbreak of bronchoscopy-related Mycobacterium tuberculosis infections due to lack of bronchoscope leak testing. Chest 2002;121:976–981.CrossRefGoogle ScholarPubMed
29. Srinivasan, A, Wolfenden, LL, Song, X, et al. An outbreak of Pseudomonas aeruginosa infections associated with flexible bronchoscopes. N Engl J Med 2003;348:221–227.Google Scholar
30. Cisneros, JM, Reyes, MJ, Pachon, J, et al. Bacteremia due to Acinetobacter baumannii: epidemiology, clinical findings, and prognostic features. Clin Infect Dis 1996;22:1026–1032.Google Scholar
31. Maki, DG. Nosocomial bacteremia: an epidemiologic overview. Am J Med 1981;70:719–732.Google Scholar
32. O'Grady, NP, Alexander, M, Dellinger, EP, et al. Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2002;35:1281–1307.Google Scholar
33. Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality. JAMA 1994;271:1598–1601.Google Scholar
34. Pittet, D, Wenzel, RP. Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths. Arch Intern Med 1995;155:1177–1184.Google Scholar
35. Shehabi, AA, Abu-Al-Soud, W, Mahafzah, A, et al. Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis. Scand J Infect Dis 2004;36:174–178.Google Scholar
36. Vallés, J, Léon, C, Alvarez-Lerma, F. Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Spanish Collaborative Group for Infections in Intensive Care Units of Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMIUC). Clin Infect Dis 1997;24:387–395.CrossRefGoogle Scholar
37. Jang, TN, Kuo, BI, Shen, SH, et al. Nosocomial gram-negative bacteremia in critically ill patients: epidemiologic characteristics and prognostic factors in 147 episodes. J Formosan Med Assoc 1999;98:465–473.Google Scholar
38. Agodi, A, Mahenthiralingam, E, Barchitta, M, Giannino, V, Sciacca, A, Stefani, S. Burkholderia cepacia complex infection in Italian patients with cystic fibrosis: prevalence, epidemiology, and genomovar status. J Clin Microbiol 2001;39:2891–2896.CrossRefGoogle ScholarPubMed