Burkholderia contaminans Colonization from Contaminated Liquid Docusate (Colace) in a Immunocompetent Adult with Legionnaire’s Disease: Infection Control Implications and the Potential Role of Candida pellucosa

Abstract

Objective: B. contaminans was cultured from respiratory secretions and liquid docusate (Colace) in a Neurosurgical Intensive Care Unit (NICU) patient with community-acquired Legionnaire’s disease but not from another bottle given to the patient. Unexpectedly, C. pelliculosa was cultured from two bottles, but not the B. contaminans bottle or respiratory secretions. Methods: B. cepacia, later identified as B. contaminans, was cultured from a bottle of liquid docusate (Colace) dispensed to a non-cystic fibrosis patient. His respiratory secretions were colonized with B. contaminans. Results: Eradication of B. contaminans colonization in the patient’s respiratory secretions was attempted. With levofloxacin, B. contaminans developed multidrug resistance (MDR). Subsequent TMP-SMX therapy did not result in further MDR. Nine other ICU patients were given docusate from the same lot, but there were no other B. contaminans isolates. Conclusion: B. contaminans colonization of respiratory secretion may be difficult to eliminate. The significance of C. pelliculosa cultured from liquid docusate (Colace) remains to be elucidated. In this case, it appeared that B. contaminans may have inhibited the growth of C. pelliculosa in the same bottle. Others should be alerted to the possibility that C. pelliculosa may be present in B. contaminans–contaminated lots of liquid docusate (Colace).

A multistate investigation of health care–associated Burkholderia cepacia complex infections related to liquid docusate sodium contamination, January-October 2016

“…This and other recent outbreaks highlight Bcc as a frequent and problematic pathogen in healthcare due to its environmental persistence and tendency to contaminate many types of aqueous solutions. 17,18 Water is the most common raw material used in the manufacture of non-sterile liquid drugs which may pose an underappreciated risk for exposure to pathogens resulting in healthcare associated infections 19…”

Small-molecule activators of a bacterial signaling pathway inhibit virulence

“…The BCC is composed of approximately 20 species, many of which are significant pathogens for people with cystic fibrosis (CF) and chronic granulomatous disease (CGD)(1-3) and to an ever-growing group of hospitalized patients exposed to contaminated medications or medical devices. (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17) B. pseudomallei causes melioidosis, a serious systemic infection that can include sepsis, of B. dolosa (33) and is required for virulence. Our recent work showed that otherwise isogenic BCC constructs carrying evolved (late) fixL sequence variants are more virulent than constructs carrying ancestral (early) fixL sequence variants.…”