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Burkholderia cepacia Lower Respiratory Tract Infection Associated With Exposure to a Respiratory Therapist

  • Alan H. Ramsey (a1), Patrice Skonieczny (a2), Diane T. Coolidge (a2), Terry A. Kurzynski (a3), Mary E. Proctor (a4) and Jeffrey P. Davis (a4)...



To investigate and control a nosocomial outbreak of Burkholderia cepacia lower respiratory tract infection.


Outbreak investigation and case-control study.


A 260-bed community hospital.


Participants were mechanically ventilated intensive care patients without cystic fibrosis. A case was defined as a hospitalized patient with a sputum culture positive for B cepacia between January 1 and November 6, 1998.


Respiratory therapy infection control policies and practices were reviewed; laboratory and environmental studies and a retrospective case-control study were conducted. Case-patients were matched with control-patients on age, gender, diagnosis, and type of intensive care unit.


Nine case-patients were identified; B cepacia likely caused pneumonia in seven and colonization in two. Two respiratory therapy practices probably contributed to the transmission of B cepacia: multidose albuterol vials were used among several patients, and nebulizer assemblies often were not dried between uses. B cepacia was grown from cultures of three previously opened multidose vials; pulsed-field gel electrophoresis patterns of B cepacia from seven case-patients and two multidose vials were indistinguishable. Case-patients had longer durations of heated humidified mechanical ventilation (mean, 9.8 days vs 4.4 days; P=.03) and were more likely to have exposure to one particular respiratory therapist than controls (odds ratio, undefined; 95% confidence interval, 4.7-∞ P=.001). The association with the respiratory therapist, a temporary employee, persisted after controlling for duration of heated humidified ventilation. No new B cepacia infections were identified after control measures were implemented.


B cepacia probably was transmitted among patients through use of extrinsically contaminated multidose albuterol vials. Respiratory therapy departments must pay close attention to infection control practices, particularly among new or temporary staff.


Corresponding author

University of Wisconsin, Department of Family Medicine, 777 S Mills St, Madison, WI53715-1896


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1.Isles, A, Maclusky, I, Corey, M, Gold, R, Prober, C, Fleming, P, et al.Pseudomonas cepacia infection in cystic fibrosis patients: an emerging problem. J Padiatr 1984;104:206210.
2.Mangram, A, Jarvis, WR. Nosocomial Burkholderia cepacia outbreaks and pseudo-outbreaks. Infect Control Hosp Epidemiol 1996;17:718720.
3.Centers for Disease Control and Prevention. Nosocomial Burkholderia cepacia infection and colonization associated with intrinsically contaminated mouthwash—Arizona, 1998. MMWR 1998;47:926928.
4.Vartivarian, S, Anaissie, E. Stenotrophomonas maltophila and Burkholderia cepacia. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. 5th ed. Philadelphia, PA: Churchill Livingstone; 2000:23352339.
5.Drabick, JA, Gracely, EJ, Heidecker, GJ, LiPuma, JJ. Survival of Burkholderia cepacia on environmental surfaces. J Hosp Infect 1996;32:267276.
6.Pegues, CF, Pegues, DA, Ford, DS, Hibbard, PL, Carson, LA, Raine, CM, et al.Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak. Epidemiol Infect 1996;116:309317.
7.Reboli, AC, Koshinski, R, Arias, K, Marks-Austin, K, Stieritz, D, Stull, TL. An outbreak of Burkholderia cepacia lower respiratory tract infection associated with contaminated albuterol nebulization solution. Infect Control Hosp Epidemiol 1996;17:741743.
8.Hamill, RJ, Houston, ED, Georghiou, PR, Wright, CE, Koza, MA, Cadle, RM, et al.An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med 1995;122:762766.
9.Takigawa, K, Fujita, J, Negayama, K, Yamigashi, Y, Yamaji, Y, Ouchi, K, et al.Nosocomial outbreak of Pseudomonas cepacia respiratory infection in immunocompromised patients associated with contaminated nebulizer devices. Kansenshogaku Zasshi 1993;67:11151125.
10.Weems, JJ Jr. Nosocomial outbreak of Pseudomonas cepacia associated with contamination of reusable electronic ventilator temperature probes. Infect Control Hosp Epidemiol 1993;14:583586.
11.Berthelot, P, Grattard, F, Mahul, P, Jospe, R, Pozzetto, B, Ros, A, et al.Ventilator temperature sensors: an unusual source of Pseudomonas cepacia in a nosocomial infection. J Hosp Infect 1993;25:3343.
12.Gautom, RK. Rapid pulsed-field gel electrophoresis protocol for typing of Escherichia coli 0157:H7 and other gram-negative organisms in 1 day. J Clin Microbiol 1997;35:29772980.
13.Govan, JR, Hughes, JE, Vandamme, P. Burkholderia cepacia: medical, taxonomic and ecological issues. J Med Microbiol 1996;45:395407.
14.Goldmann, DA, Klinger, JD. Pseudomonas cepacia: biology, mechanisms of virulence, epidemiology. J Pediatr 1986;108:806812.
15.LiPuma, JL, Mahenthiralingam, E. Commercial use of Burkholderia cepacia. Emerg Infect Dis 1999;5:305306.
16.Hammill, RJ, Cadle, R, Koza, M. Burkholderia cepacia and nebulized albuterol. Ann Intern Med 1996;124:274.

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Burkholderia cepacia Lower Respiratory Tract Infection Associated With Exposure to a Respiratory Therapist

  • Alan H. Ramsey (a1), Patrice Skonieczny (a2), Diane T. Coolidge (a2), Terry A. Kurzynski (a3), Mary E. Proctor (a4) and Jeffrey P. Davis (a4)...


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