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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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References

1.Mangram, A, Jarvis, WR. Nosocomial Burkholderia cepacia outbreaks and pseudo-outbreaks. Infect Control Hosp Epidemiol 1996;17:718–720.CrossRefGoogle ScholarPubMed
2.Govan, JR, Hughes, JE, Vandamme, P. Burkholderia cepacia: medical, taxonomic and ecological issues. J Med Microbiol 1996;45:395–407.Google Scholar
3.LiPuma, JJ. Burkholderia cepacia. Management issues and new insights. Clin Chest Med 1998;19:473–486.Google Scholar
4.Tablan, OC. Nosocomially acquired Pseudomonas cepacia infection in patients with cystic fibrosis. Infect Control Hosp Epidemiol 1993;14:124–126.CrossRefGoogle ScholarPubMed
5.Pegues, DA, Carson, LA, Anderson, RL, Norgard, MJ, Argent, TA, Jarvis, WR, et al.Outbreak of Pseudomonas cepacia bacteremia in oncology patients. Clin Infect Dis 1993;16:407–411.Google Scholar
6.Martone, WJ, Tablan, OC, Jarvis, WR. The epidemiology of nosocomial epidemic Pseudomonas cepacia infections. Eur J Epidemiol 1987;3:222–232.CrossRefGoogle ScholarPubMed
7.Jarvis, WR, Olson, D, Tablan, O, Martone, WJ. The epidemiology of nosocomial Pseudomonas cepacia infections: endemic infections. Eur J Epidemiol 1987;3:233–236.CrossRefGoogle ScholarPubMed
8.Holmes, A, Nolan, R, Taylor, R, Finley, R, Riley, M, Jiang, RZ, et al.An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis. J Infect Dis 1999;179:1197–1205.CrossRefGoogle ScholarPubMed
9.Sellick, JA Jr. The use of statistical process control charts in hospital epidemiology. Infect Control Hosp Epidemiol 1993;14:649–656.CrossRefGoogle ScholarPubMed
10.Henry, DA, Campbell, ME, LiPuma, JJ, Speert, DP. Identification of Burkholderia cepacia isolates from patients with cystic fibrosis and use of a simple new selective medium. J Clin Microbiol 1997;35:614–619.CrossRefGoogle ScholarPubMed
11.LiPuma, JJ, Dulaney, BJ, McMenamin, JD, Whitby, PW, Stull, TL, Coenye, T, 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
12.Mahenthiralingam, E, Bischof, J, Byrne, SK, Radomski, C, Davies, JE, Av-Gay, Y, et al.DNA-based diagnostic approaches for the 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.CrossRefGoogle ScholarPubMed
13.Anderson, DJ, Kuhns, JS, Vasil, ML, Gerding, DN, Janoff, EN. DNA fingerprinting by pulsed field gel electrophoresis and ribotyping to distinguish Pseudomonas cepacia isolates from a nosocomial outbreak. J Clin Microbiol 1991;29:648–649.CrossRefGoogle ScholarPubMed
14.Tenover, FC, Arbeit, RD, Goering, RV, Mickelsen, PA, Murray, BE, Persing, DH, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
15.Mahenthiralingam, E, Simpson, DA, Speert, DP. Identification and characterization of a novel DNA marker associated with epidemic Burkholderia cepacia strains recovered from patients with cystic fibrosis. J Clin Microbiol 1997;35:808–816.Google Scholar
16.Sajjan, US, Sun, L, Goldstein, R, Forstner, JF. Cable (cbl) type II pili of cystic fibrosis-associated Burkholderia cepacia: nucleotide sequence of the cblA major subunit pilin gene and novel morphology of the assembled appendage fibers. J Bacteriol 1995;177:1030–1038.CrossRefGoogle ScholarPubMed
17.LiPuma, JJ. Burkholderia cepacia epidemiology and pathogenesis: implications for infection control. Curr Opin Pulm Med 1998;4:337–341.Google Scholar
18.Garner, JS. Guideline for isolation precautions in hospitals. The Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
19.CDC Nosocomial Burkholderia cepacia infection and colonization associated with intrinsically contaminated mouthwash—Arizona, 1998. MMWR 1998;47:926–928.Google Scholar
20.van Laer, F, Raes, D, Vandamme, P, Lammens, C, Sion, JP, Vrints, C, et al.An outbreak of Burkholderia cepacia with septicemia on a cardiology ward. Infect Control Hosp Epidemiol 1998;19:112–113.Google Scholar
21.Okazaki, M, Watanabe, T, Morita, K, Higurashi, Y, Araki, K, Shukuya, N, et al.Molecular epidemiological investigation using a randomly amplified polymorphic DNA assay of Burkholderia cepacia isolates from nosocomial outbreaks. J Clin Microbiol 1999;37:3809–3814.Google Scholar
22.Gravel-Tropper, D, Sample, ML, Oxley, C, Toye, B, Woods, DE, Garber, GE. Three-year outbreak of pseudobacteremia with Burkholderia cepacia traced to a contaminated blood gas analyzer. Infect Control Hosp Epidemiol 1996;17:737–740.CrossRefGoogle ScholarPubMed
23.Steere, AC, Tenney, JH, Mackel, DC, Snyder, MJ, Polakavetz, S, Dunne, ME, et al.Pseudomonas species bacteremia caused by contaminated normal human serum albumin. J Infect Dis 1977;135:729–735.Google Scholar
24.LiPuma, JJ, Mahenthiralingam, E. Commercial use of Burkholderia cepacia. Emerg Infect Dis 1999;5:305–306.Google Scholar
25.LiPuma, JJ, Spilker, T, Gill, L, Campbell, PW, 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
26.Balandreau, J, Viallard, V, Cournoyer, B, Coenye, T, Laevens, S, Vandamme, P. Burkholderia cepacia genomovar III is a common plant-associated bacterium. Appl Environ Microbiol 2001;67:982–985.CrossRefGoogle ScholarPubMed
27.Gonzalez, CF, Mark, GL, Mahenthiralingam, E, LiPuma, JJ. Isolation of soilborne genomovar III Burkholderia cepacia and lytic phages with inter-genomovar host range. Pediatr Pulmonol 2000;20(suppl):288–289.Google Scholar
28.Miller, SM, Parke, JL, Bies, S, LiPuma, JJ. Detection, recovery and identification of Burkholderia cepacia from the natural environment. Pediatr Pulmonol 2000;20(suppl):288.Google Scholar