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Case-Crossover Study of Burkholderia cepacia Complex Bloodstream Infection Associated with Contaminated Intravenous Bromopride

Published online by Cambridge University Press:  02 January 2015

Ianick Souto Martins ,
Flávia Lúcia Piffano Costa Pellegrino ,
Andrea d'Avila Freitas ,
Marisa da Silva Santos ,
Giovanna lanini d'Alemeida Ferraiuoli ,
Màrcia Regina Guimarães Vasques ,
Efigenia Lourdes Teixeira Amorim ,
Sandra Oliveira ,
Simone Aranha Nouér  and
Fernando Luiz Lopes Cardoso
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Ianick Souto Martins*
Affiliation:
Faculdade de Medicina, Rio de Janeiro, Rio de Janeiro
Flávia Lúcia Piffano Costa Pellegrino
Affiliation:
Instituto de Microbiologia, Rio de Janeiro, Rio de Janeiro
Andrea d'Avila Freitas
Affiliation:
Universidade Federal do Rio de Janeiro, Faculdade de Medicina, Rio de Janeiro, Rio de Janeiro
Marisa da Silva Santos
Affiliation:
Universidade Estadual do Rio de Janeiro; Intituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro
Giovanna lanini d'Alemeida Ferraiuoli
Affiliation:
Universidade Estadual do Rio de Janeiro; Intituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro
Màrcia Regina Guimarães Vasques
Affiliation:
Universidade Estadual do Rio de Janeiro; Intituto Nacional de Cardiologia, Rio de Janeiro, Rio de Janeiro
Efigenia Lourdes Teixeira Amorim
Affiliation:
Laboratório Dr. Sérgio Franco, Rio de Janeiro, Rio de Janeiro
Sandra Oliveira
Affiliation:
Hospital da Clínicas de Niterói, Niterói, Rio de Janeiro, Brazil
Simone Aranha Nouér
Affiliation:
Faculdade de Medicina, Rio de Janeiro, Rio de Janeiro
Fernando Luiz Lopes Cardoso
Affiliation:
Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Rio de Janeiro
Luiz Affonso Mascarenhas
Affiliation:
Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Rio de Janeiro
Ana Cristina Gouveia Magalhães
Affiliation:
Hospital Universitário Clementino Fraga Filho, Rio de Janeiro, Rio de Janeiro
Isabella Barbosa Cleinman
Affiliation:
Faculdade de Medicina, Rio de Janeiro, Rio de Janeiro
Agnes Marie Sá Figueiredo
Affiliation:
Instituto de Microbiologia, Rio de Janeiro, Rio de Janeiro
Beatriz Meurer Moreira
Affiliation:
Instituto de Microbiologia, Rio de Janeiro, Rio de Janeiro
*
Pós-Graduação em Doenças Infecciosas e Parasitárias, Hospital Universitário Clementino Fraga Filho, Av. Rodolpho Paulo Rocco 255, 5° andar, Cidade Universitária, CEP 21941-902, Rio de Janeiro, Brazil (ianicksm@.yahoo.com.br)
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Abstract

Objective.

To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI).

Design and Setting.

Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006.

Patients.

Twenty-five patients with BCC-BSI.

Design.

After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using Spel.

Results.

The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals.

Conclusion.

Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 5 , May 2010 , pp. 516 - 521
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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