An outbreak of Burkholderia cepacia bloodstream infections in a tertiary-care facility in northern India detected by a healthcare-associated infection surveillance network

Abstract

Objective: The burden of healthcare-associated infections (HAIs) is higher in low- and middle-income countries, but HAIs are often missed because surveillance is not conducted. Here, we describe the identification of and response to a cluster of Burkholderia cepacia complex (BCC) bloodstream infections (BSIs) associated with high mortality in a surgical ICU (SICU) that joined an HAI surveillance network. Setting: A 780-bed, tertiary-level, public teaching hospital in northern India. Methods: After detecting a cluster of BCC in the SICU, cases were identified by reviewing laboratory registers and automated identification and susceptibility testing outputs. Sociodemographic details, clinical records, and potential exposure histories were collected, and a self-appraisal of infection prevention and control (IPC) practices using assessment tools from the World Health Organization and the US Centers for Disease Control and Prevention was conducted. Training and feedback were provided to hospital staff. Environmental samples were collected from high-touch surfaces, intravenous medications, saline, and mouthwash. Results: Between October 2017 and October 2018, 183 BCC BSI cases were identified. Case records were available for 121 case patients. Of these 121 cases, 91 (75%) were male, the median age was 35 years, and 57 (47%) died. IPC scores were low in the areas of technical guidelines, human resources, and monitoring and evaluation. Of the 30 environmental samples, 4 grew BCC. A single source of the outbreak was not identified. Conclusions: Implementing standardized HAI surveillance in a low-resource setting detected an ongoing Burkholderia cepacia outbreak. The outbreak investigation and use of a multimodal approach reduced incident cases and informed changes in IPC practices.

Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

“…To date, several outbreaks have been identified and contained through use of data from the surveillance network, including an outbreak of colistinresistant Klebsiella pneumoniae in network hospitals 29 and a large outbreak of bloodstream infections caused by Burkholderia cepacia. 30 There are at least seven limitations to the data generated by the surveillance network. First, hospitals participating in this network are not representative of all hospitals in India; our results might not be generalisable.…”

Successful Treatment of Subarachnoid Hemorrhage Complicated by Mixed Intracranial Infection of Burkholderia cepacia and Propionibacterium acnes Postoperatively: A Case Report

“…Although most Burkholderia cepacia strains are harmless to humans, certain strains may cause infections in individuals with weakened immune systems or chronic diseases such as cystic brosis. These infections are typically associated with transmission from healthcare workers, shared respiratory therapy equipment among patients, contact with Burkholderia cepacia-contaminated items, and implants in the body [3,4,5] .…”

Single-Center Experience of Control of Ventilator-Circuit-Transmitted Burkholderia cepacia Outbreak in an Intensive Care Unit

“…Common sources related to B. cepacia outbreak include contaminated chlorhexidine [ 15 ], albuterol [ 3 , 16 ], intravenous bromopride [ 17 ], multi-dosed medications [ 18 , 19 ], alcohol-free mouth wash [ 20 ], table cloth [ 21 ], and respiratory therapy device [ 22 ]. However, it is not uncommon for the transmission route to be elusive [ 7 , 8 , 9 , 23 , 24 ]. In the early phase of this outbreak, we attempted to identify a single cause to explain the outbreak.…”