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An Episodic Outbreak of Genetically Related Burkholdebja cepacia Among Non-Cystic Fibrosis Patients at a University Hospital

Published online by Cambridge University Press:  02 January 2015

Anwer H. Siddiqui ,
Maury E. Mulligan ,
Eshwar Mahenthiralingam ,
Joan Hebden ,
Jeanine Brewrink ,
Sadaf Qaiyumi ,
Judith A. Johnson  and
John J. LiPuma
Anwer H. Siddiqui*
Affiliation:
Division of Hospital Epidemiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland VA Maryland Health Care System, Baltimore, Maryland
Maury E. Mulligan
Affiliation:
Division of Hospital Epidemiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland University of Maryland Medical System, Baltimore, Maryland
Eshwar Mahenthiralingam
Affiliation:
Cardiff School of Biosciences, Cardiff University, Cardiff, Wales, United Kingdom
Joan Hebden
Affiliation:
VA Maryland Health Care System, Baltimore, Maryland University of Maryland Medical System, Baltimore, Maryland
Jeanine Brewrink
Affiliation:
University of Maryland Medical System, Baltimore, Maryland
Sadaf Qaiyumi
Affiliation:
Division of Hospital Epidemiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland VA Maryland Health Care System, Baltimore, Maryland
Judith A. Johnson
Affiliation:
Department of Pathology, University of Maryland, Baltimore, Maryland
John J. LiPuma
Affiliation:
Department of Pediatrics and Communicable Disease, University of Michigan Medical School Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
*
Medical Director Infectious Diseases, Middletown Regional Hospital, Box 105, 105 McKnightDr, Middletown, OH 45044-4898
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Abstract

Objective:

To investigate an outbreak of Burkholderia cepacia.

Design:

Observational study and chart review.

Patients:

Adult non-cystic fibrosis (CF) patients.

Setting:

Intensive care units (ICUs) at a university-affiliated teaching hospital.

Methods:

As part of the epidemiological investigation, we conducted a chart review and collected environmental samples. A review of work schedules of healthcare workers also was performed. We used B cepacia selective agar for preliminary screening for all isolates, which subsequently were confirmed as members of the B cepacia complex by polyphasic analysis employing conventional biochemical reactions and genus- and species-specific polymerase chain reaction assays. Pulsed-field gel electrophoresis, randomly amplified polymorphic DNA typing, and automated ribotyping were used to genotype the isolates. As part of the intervention, contact isolation precautions were initiated for all patients identified as having had a culture positive for B cepacia.

Results:

Between September 1997 and September 1999, B cepacia was isolated from 31 adult patients without CF in ICUs at a university-affiliated teaching hospital. Based on geographic clustering and genotypic analysis, three distinct clusters were observed involving 20 patients. Isolates from 17 of these patients were available for testing and were found to be of the same strain (outbreak strain). Further taxonomic analysis indicated that the outbreak strain was B cepacia complex genomovar III. Twelve (71%) of the 17 patients were judged to be infected, and 5 (29%) were colonized with this strain. Six of 200 environmental cultures from multiple sources in the hospital's ICUs yielded B cepacia. Two of these isolates, both recovered from rooms of colonized patients, were the same genotype as the outbreak strain recovered from patients.

Conclusion:

Despite an extensive investigation, the source of the B cepacia clone involved in this outbreak remains unknown. The spatial and temporal pattern of cases suggests that cross-transmission of a genetically related strain contributed to clustering among patients. The initiation of contact isolation may have limited the extent of this transmission. Additional studies are needed to elucidate better the epidemiology of nosocomial B cepacia infection among non-CF adult patients.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 22 , Issue 7 , July 2001 , pp. 419 - 422
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2001

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