Outbreak of Stenotrophomonas maltophilia and Burkholderia cepacia Bloodstream Infections at a Hemodialysis Center

Abstract

Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through PCR-RAPD and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.

Massive sequencing of the V3–V4 hypervariable region of bronchoalveolar lavage from patients with COVID-19 and VAP reveals the collapse of the pulmonary microbiota

“…The second group of non-ESKAPE bacteria involved in VAP cases was the genus Stenotrophomas ( n =8). This pathogen has been described as the causative agent of hospital outbreaks in our country [47] and in other parts of the world [48]. Previously, the inclusion of this pathogen among the members of the ESKAPE group has been envisaged, since there are more and more reports of this bacterium associated with HAIs.…”

Emerging infections in vulnerable hosts: Stenotrophomonas maltophilia and Elizabethkingia anophelis

“…A report in Spain in 2016 revealed that contaminated bronchoscopes due to inadequate installation of automated endoscope reprocessors resulted in S. maltophilia isolates grown from bronchial washing specimens in a bronchoscopy unit [71]. We summarize S. maltophilia outbreaks during 2020-2022 in Table 1 [51,[62][63][64]66,[72][73][74]. The four outbreaks occurred in Mexico, Brazil, India, and Turkey [60,62,64,66].…”

“…Although S. maltophilia and E. anophelis are considered opportunistic pathogens, several outbreaks have been reported in various populations. S. maltophilia outbreaks often involve ICU patients, individuals with haematologic malignancies who receive bone marrow transplantation, haemodialysis patients, and burn patients [46,[60][61][62][63][64][65][66]. In many of these cases, the suspected cause of the outbreaks has been patient exposure to contaminated tap water, medical devices, ice machines, or soap [66,67,68,69,70].…”

“…We summarize S. maltophilia outbreaks during 2020-2022 in Table 1 [51,[62][63][64]66,[72][73][74]. The four outbreaks occurred in Mexico, Brazil, India, and Turkey [60,62,64,66]. The sources of the outbreaks included faucets in the emergency department, dialysis water, high-touch environmental surfaces and fluids from normal saline used for suction and in the inspiratory circuit, ECMO water heater devices, and commercial needleless blood gas injectors [60,62,64,66].…”

Waterborne Outbreaks in Hemodialysis Patients and Infection Prevention

“…Incoming water supply (potable water) was associated with Mycobacterium mucogenicum bacteremia in a patient receiving home hemodialysis [ 12 ]. Contamination of dialysis water, including postosmosis points, reuse rooms, looping pipe, and dialysis machines, led to an outbreak of S maltophilia and B cepacia bacteremia in a hemodialysis clinic, possibly due to lack of proper disinfection of water system and maintenance [ 13 ].…”