Consecutive outbreaks of Burkholderia cepacia complex caused by intrinsically contaminated chlorhexidine mouthwashes

Saalfeld, Silvia Maria dos Santos; Shinohara, Danielle Rosani; Anjos, Márcia Maria dos; Martinez, Hilton Vizi; Campos, E.; Mitsugui, Cecília Saori; Oliveira, Anderson Rodrigo; Granzotto, Daniele Cristina Tita; Nishiyama, Sheila Alexandra Belini; Tognim, Maria Cristina Bronharo

doi:10.1016/j.ajic.2020.04.025

Cited by 6 publications

(8 citation statements)

References 21 publications

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“…B. cepacia prefers a wet environment, such as contaminated mouthwashes [ 13 ]. Unlike most bacteria, it shows high viability and develops resistance to solutions for sterilization and disinfection [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses

Miura¹,

Toshida²

2022

Cureus

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In this report, we present a case of Burkholderia cepacia (B. cepacia)-induced bilateral microbial keratitis in a patient who wore colored contact lenses (CLs) on both eyes. The patient was a 19-year-old woman who presented to our hospital with pain, discharge, and photophobia affecting both eyes while she was wearing colored cosmetic CLs. There were corneal ulcers in both of her eyes without refractive correction. Although impairment of vision was not detected at the first visit, both eyes showed neovascularization of the upper part of the cornea and had relatively well-demarcated corneal ulcers associated with corneal stromal opacity. Cultures of cornea grew B. cepacia in both eyes. She received antimicrobial agents to which this organism was sensitive, resulting in the healing of the corneal ulcers with scarring after approximately one month. Improper fitting of colored cosmetic CLs, contamination of lenses or solutions, and inadequate lens care can be risk factors for developing this condition.

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Section: Discussionmentioning

confidence: 99%

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses

Miura¹,

Toshida²

2022

Cureus

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“…Some, but not all, members of BCC are pathogenic to humans, and their natural habitat in the plant environment is believed to be the reservoir for human infection. BCC is uniquely capable of surviving in nutrient-poor liquid media, colonization of which in hospital settings has resulted in outbreaks due to contaminated mouthwash [4], albuterol nebulization solution [5], injection fluids [6], liquid and intravenous medications [7,8] and chemical detergents [9]. BCC is associated with three main categories of human infection of importance to the pulmonary and critical care community.…”

Section: Discussionmentioning

confidence: 99%

Of onions and men: Report of cavitary community acquired pneumonia due to <em>Burkholderia cepacia</em> complex in an immunocompetent patient and review of the literature

Manglani

Sherman

Shengelia

et al. 2020

Monaldi Arch Chest Dis

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Burkholderia cepacia complex consists of highly antibiotic resistant gram negative bacilli that are plant symbionts and also potential agents of human infection. This bacterial family’s claim to fame in clinical medicine is as the scourge of cystic fibrosis patients, in whom it is a notorious respiratory pathogen. Outside of cystic fibrosis, it rarely comes to mind as an etiology of community acquired pneumonia with or without lung cavitation in immunocompetent hosts. We describe a case of an otherwise healthy, community-dwelling man who presented with subacute cavitary lung disease, the causative organism of which turned out to be Burkholderia cepacia complex. Our report is accompanied by a review of the literature, which identified an additional eleven cases in the same category. We analyze all of the available cases for the emergence of any identifiable patterns or peculiarities.

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“…Therefore, the inadvertent use of Bcc contaminated FPPs constitutes a public health hazard with potential serious health implications for susceptible individuals and vulnerable populations [ 4 ]. In fact, various Bcc contaminated FPPs have been reported as the cause of several serious healthcare associated infection outbreaks across multiple healthcare settings [ 6 , 16 ]. Moreover, the consequences of Bcc contamination in FPPs can result in company associated financial loss and reputational damage [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

“…In fact, members of the Bcc have been reported to utilise pharmaceutical APs as energy sources, allowing them to remain viable within an otherwise unfavourable environment [ 21 ]. The ability of Bcc to persist in the presence of APs is evidenced by numerous FPP contamination events in which Bcc have been isolated from opened and unopened containers of antimicrobial solutions, preserved pharmaceuticals, preserved cosmetics, and toiletries, at relatively high Colony Forming Units (CFU) (up to 10 5 −10 6 CFU/mL) [ 6 , 15 ]. Additionally, undetected Bcc in FPPs, largely reflects upon the limitations of current conventional microbiological quality control testing methods used within the pharmaceutical sector.…”

Section: Introductionmentioning

confidence: 99%

A culture-independent nucleic acid diagnostics method for use in the detection and quantification of Burkholderia cepacia complex contamination in aqueous finished pharmaceutical products

Duong,

Minogue,

Fullbrook

et al. 2024

PLoS ONE

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The Burkholderia cepacia complex (Bcc) is the number one bacterial complex associated with contaminated Finished Pharmaceutical Products (FPPs). This has resulted in multiple healthcare related infection morbidity and mortality events in conjunction with significant FPP recalls globally. Current microbiological quality control of FPPs before release for distribution depends on lengthy, laborious, non-specific, traditional culture-dependent methods which lack sensitivity. Here, we present the development of a culture-independent Bcc Nucleic Acid Diagnostic (NAD) method for detecting Bcc contaminants associated with Over-The-Counter aqueous FPPs. The culture-independent Bcc NAD method was validated to be specific for detecting Bcc at different contamination levels from spiked aqueous FPPs. The accuracy in Bcc quantitative measurements was achieved by the high degree of Bcc recovery from aqueous FPPs. The low variation observed between several repeated Bcc quantitative measurements further demonstrated the precision of Bcc quantification in FPPs. The robustness of the culture-independent Bcc NAD method was determined when its accuracy and precision were not significantly affected during testing of numerous aqueous FPP types with different ingredient matrices, antimicrobial preservative components and routes of administration. The culture-independent Bcc NAD method showed an ability to detect Bcc in spiked aqueous FPPs at a concentration of 20 Bcc CFU/mL. The rapid (≤ 4 hours from sample in to result out), robust, culture-independent Bcc NAD method presented provides rigorous test specificity, accuracy, precision, and sensitivity. This method, validated with equivalence to ISO standard ISO/TS 12869:2019, can be a valuable diagnostic tool in supporting microbiological quality control procedures to aid the pharmaceutical industry in preventing Bcc contamination of aqueous FPPs for consumer safety.

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Consecutive outbreaks of Burkholderia cepacia complex caused by intrinsically contaminated chlorhexidine mouthwashes

Cited by 6 publications

References 21 publications

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses

Burkholderia Cepacia-Induced Bilateral Microbial Keratitis in a Wearer of Colored Cosmetic Contact Lenses

Of onions and men: Report of cavitary community acquired pneumonia due to <em>Burkholderia cepacia</em> complex in an immunocompetent patient and review of the literature

A culture-independent nucleic acid diagnostics method for use in the detection and quantification of Burkholderia cepacia complex contamination in aqueous finished pharmaceutical products

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