A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India

Abstract

Burkholderia cepacia complex (BCC) is a significant opportunistic pathogen in hospitalized and immunocompromised patients, particularly in cystic fibrosis. It is widely distributed in natural habitats such as soil and water and frequently encountered in nosocomial outbreaks due to contaminated disinfectants and medical devices. However reports on outbreaks due to this organism are lacking from the Indian subcontinent. We report here a sporadic outbreak due to BCC which occurred in the pediatric Intensive Care Unit of our institute, the probable source being contaminated distilled water. The isolate from three babies and environmental sources including distilled water were identical and confirmed as BCC. Strict infection control measures were instituted to prevent the spread of infection. This report highlights the potential role of B.cepacia in causing sporadic outbreaks especially in ICUs, associated with water.

An outbreak investigation of bacteraemia due to Burkholderia cepacia complex at the National Hospital of Sri Lanka

“…1 A study carried out in Saudi Arabia in 2006 found that the outbreak of BCC bacteraemia was due to contaminated salbutamol nebulizer solution 3 . Studies done elsewhere have implicated contaminated nasal spray 4 , contaminated rubber stopper of sealed multidose amikacin vials 5 , contamination of the gel applied to the ultrasound probe used to guide the insertion of a central venous catheter 6 and intravenous fentanyl.…”

“…1 It plays a role in the commercial industry related to biocontrol, bioremediation and plant growth promotion which can also create an environment to be a reservoir of this bacterium. 1 There are 17 closely related species found to be in the complex.…”

“…1 It plays a role in the commercial industry related to biocontrol, bioremediation and plant growth promotion which can also create an environment to be a reservoir of this bacterium. 1 There are 17 closely related species found to be in the complex. B. cepacia complex can cause blood stream infection, pneumonia, surgical wound infection and genitourinary tract infection especially in immunocompromised hosts such as patients with chronic granulomatous disease (CGD) and cystic fibrosis.…”

“…B. cepacia complex can cause blood stream infection, pneumonia, surgical wound infection and genitourinary tract infection especially in immunocompromised hosts such as patients with chronic granulomatous disease (CGD) and cystic fibrosis. 1 A high level of intrinsic resistance in this organism to different groups of antibiotics makes treatment options very difficult.…”

“…1 It can be also due to contaminated fresh frozen plasma (FFP) and cryoprecipitate due to thawing in water baths. 2 Three outbreaks in other government hospitals had occured in July and August 2017 without identification of the source (Personal communication).…”