Hostname: page-component-8448b6f56d-cfpbc Total loading time: 0 Render date: 2024-04-24T12:39:32.867Z Has data issue: false hasContentIssue false
  • English
  • Français

Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: An integrative review

Published online by Cambridge University Press:  22 May 2020

Ramon Z. Shaban Open the ORCID record for Ramon Z. Shaban [Opens in a new window] ,
Cristina Sotomayor-Castillo Open the ORCID record for Cristina Sotomayor-Castillo [Opens in a new window] ,
Shizar Nahidi Open the ORCID record for Shizar Nahidi [Opens in a new window] ,
Cecilia Li Open the ORCID record for Cecilia Li [Opens in a new window] ,
Deborough Macbeth Open the ORCID record for Deborough Macbeth [Opens in a new window] ,
Brett G. Mitchell Open the ORCID record for Brett G. Mitchell [Opens in a new window]  and
Philip L. Russo Open the ORCID record for Philip L. Russo [Opens in a new window]
Ramon Z. Shaban*
Affiliation:
Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, New South Wales, Australia Department of Infectious Diseases and Sexual Health, Westmead Hospital and the Directorate of Nursing, Midwifery and Clinical Governance, Western Sydney Local Health District, Westmead, New South Wales, Australia
Cristina Sotomayor-Castillo
Affiliation:
Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, New South Wales, Australia
Shizar Nahidi
Affiliation:
Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, New South Wales, Australia
Cecilia Li
Affiliation:
Susan Wakil School of Nursing and Midwifery, University of Sydney, Camperdown, New South Wales, Australia Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Camperdown, New South Wales, Australia
Deborough Macbeth
Affiliation:
Infection Control Department, Infectious Diseases and Immunology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia
Brett G. Mitchell
Affiliation:
School of Nursing and Midwifery, Newcastle University, Callaghan, New South Wales, Australia School of Nursing, Avondale University College, Wahroonga, New South Wales, Australia
Philip L. Russo
Affiliation:
Department of Nursing Research, Cabrini Institute, Malvern, Victoria, Australia Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
*
Author for correspondence: Ramon Z. Shaban, E-mail: ramon.shaban@sydney.edu.au
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs).

Design:

Integrative review.

Methods:

A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION).

Results:

In total, we reviewed 125 documented outbreaks of Burkholderia cepacia–related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines.

Conclusions:

Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 7 , July 2020 , pp. 777 - 783
Check for updates
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Martin, M, Winterfeld, I, Kramme, E, et al. Outbreak of Burkholderia cepacia complex caused by contaminated alcohol-free mouthwash. Anaesthesist 2012;61:25–29.CrossRefGoogle ScholarPubMed
Burkholder, WH. Sour skin, a bacterial rot of onion bulbs. Phytopathology 1950;40:115–117.Google Scholar
France, MW, Dodd, M, Govan, J, et al. The changing epidemiology of Burkholderia species infection at an adult cystic fibrosis centre. J Cyst Fibros 2008;7:368–372.CrossRefGoogle ScholarPubMed
Vardi, A, Sirigou, A, Lalayanni, C, et al. An outbreak of Burkholderia cepacia bacteremia in hospitalized hematology patients selectively affecting those with acute myeloid leukemia. Am J Infect Control 2013;41:312–316.CrossRefGoogle ScholarPubMed
LiPuma, JJ. Burkholderia cepacia epidemiology and pathogenesis: implications for infection control. Curr Opin Pulm Med 1998;4:337–341.10.1097/00063198-199811000-00005CrossRefGoogle ScholarPubMed
Huang, CH, Jang, TN, Liu, CY, et al. Characteristics of patients with Burkholderia cepacia bacteremia. J Microbiol Immunol Infect 2001;34:215–219.Google ScholarPubMed
Chien, YC, Liao, CH, Sheng, WH, et al. Clinical characteristics of bacteraemia caused by Burkholderia cepacia complex species and antimicrobial susceptibility of the isolates in a medical centre in Taiwan. Int J Antimicrob Agents 2018;51:357–364.CrossRefGoogle Scholar
Boszczowski, I, do Prado, GV, Dalben, MF, et al. Polyclonal outbreak of bloodstream infections caused by Burkholderia cepacia complex in hematology and bone marrow transplant outpatient units. Rev Inst Med Trop Sao Paulo 2014;56:71–76.CrossRefGoogle Scholar
Hanulik, V, Webber, MA, Holy, O, et al. Epidemiology of Burkholderia multivorans strains obtained from non-cystic fibrosis patients isolated in large hospitals across the Czech Republic. J Hosp Infect 2014;86:74–75.CrossRefGoogle ScholarPubMed
Dedeckova, K, Fila, L, Skalicka, V, et al. PCR detection of Burkholderia cepacia complex as one of key factors to handle a long-term outbreak. J Cyst Fibros 2012;11:440–445.CrossRefGoogle ScholarPubMed
Anderson, DJ, Kuhns, JS, Vasil, ML, et al. DNA fingerprinting by pulsed field gel electrophoresis and ribotyping to distinguish Pseudomonas cepacia isolates from a nosocomial outbreak. J Clin Microbiol 1991;29:648–649.CrossRefGoogle ScholarPubMed
Zurita, J, Mejia, L, Zapata, S, et al. Healthcare-associated respiratory tract infection and colonization in an intensive care unit caused by Burkholderia cepacia isolated in mouthwash. Int J Infect Dis 2014;29:96–99.CrossRefGoogle Scholar
Lucero, CA, Cohen, AL, Trevino, I, et al. Outbreak of Burkholderia cepacia complex among ventilated pediatric patients linked to hospital sinks. Am J Infect Control 2011;39:775–778.CrossRefGoogle ScholarPubMed
Berkelman, RL, Lewin, S, Allen, JR, et al. Pseudobacteremia attributed to contamination of povidone-iodine with Pseudomonas cepacia. Ann Intern Med 1981;95:32–36.CrossRefGoogle ScholarPubMed
Magalhaes, M, Doherty, C, Govan, JR, et al. Polyclonal outbreak of Burkholderia cepacia complex bacteraemia in haemodialysis patients. J Hosp Infect 2003;54:120–123.CrossRefGoogle ScholarPubMed
Meyer, GW. Pseudomonas cepacia septicemia associated with intravenous therapy. Calif Med 1973;119:15–18.Google ScholarPubMed
Zou, Q, Li, N, Liu, J, et al. Investigation of an outbreak of Burkholderia cepacia infection caused by drug contamination in a tertiary hospital in China. Am J Infect Control 2019.Google Scholar
Shaban, RZ, Maloney, S, Gerrard, J, et al. Outbreak of health care-associated Burkholderia cenocepacia bacteremia and infection attributed to contaminated sterile gel used for central line insertion under ultrasound guidance and other procedures. Am J Infect Control 2017;45:954–958.CrossRefGoogle ScholarPubMed
Whittemore, R, Knafl, K. The integrative review: updated methodology. J Adv Nurs 2005;52:546–553.CrossRefGoogle ScholarPubMed
Coenye, T, Vandamme, P, Govan, J, et al. Taxonomy and identification of Bukholderia cepacia complex. J Clin Microbiol 2001;39:3427–3436.CrossRefGoogle Scholar
Stone, SP, Cooper, BS, Kibbler, CC, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. J Antimicrob Chemother 2007;59:833–840.CrossRefGoogle ScholarPubMed
Stone, SP, Cooper, BS, Kibbler, CC, et al. The ORION statement: guidelines for transparent reporting of outbreak reports and intervention studies of nosocomial infection. Lancet Infect Dis 2007;7:282–288.CrossRefGoogle ScholarPubMed
Kotsanas, D, Brett, J, Kidd, TJ, et al. Disinfection of Burkholderia cepacia complex from non-touch taps in a neonatal nursery. J Perinat Med 2008;36:235–239.CrossRefGoogle Scholar
Kuzumoto, K, Kubota, N, Ishii, K, et al. Successful cessation of transmitting healthcare-associated infections due to Burkholderia cepacia complex in a neonatal intensive care unit in a Japanese children’s hospital. Eur J Med Res 2011;16:537–542.CrossRefGoogle Scholar
Lee, JK. Two outbreaks of Burkholderia cepacia nosocomial infection in a neonatal intensive care unit. J Paediatr Child Health 2008;44:62–66.Google Scholar
Patra, S, Bhat, YR, Lewis, LE, et al. Burkholderia cepacia sepsis among neonates. Indian J Pediatr 2014;81:1233–1236.CrossRefGoogle ScholarPubMed
Jacobson, M, Wray, R, Kovach, D, et al. Sustained endemicity of Burkholderia cepacia complex in a pediatric institution, associated with contaminated ultrasound gel. Infect Control Hosp Epidemiol 2006;27:362–366.CrossRefGoogle Scholar
Mali, S, Dash, L, Gautam, V, et al. An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital. Indian J Med Microbiol 2017;35:216–220.Google ScholarPubMed
Antony, B, Cherian, EV, Boloor, R, et al. A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India. Indian J Pathol Microbiol 2016;59:197–199.CrossRefGoogle Scholar
Doit, C, Loukil, C, Simon, AM, et al. Outbreak of Burkholderia cepacia bacteremia in a pediatric hospital due to contamination of lipid emulsion stoppers. J Clin Microbiol 2004;42:2227–2230.CrossRefGoogle Scholar
Whiteford, ML, Wilkinson, JD, McColl, JH, et al. Outcome of Burkholderia (Pseudomonas) cepacia colonisation in children with cystic fibrosis following a hospital outbreak. Thorax 1995;50:1194–1198.CrossRefGoogle ScholarPubMed
Loukil, C, Saizou, C, Doit, C, et al. Epidemiologic investigation of Burkholderia cepacia acquisition in two pediatric intensive care units. Infect Control Hosp Epidemiol 2003;24:707–710.CrossRefGoogle ScholarPubMed
Centers for Disease Control and Prevention. Nosocomial Burkholderia cepacia infection and colonization associated with intrinsically contaminated mouthwash—Arizona, 1998. Morb Mortal Wkly Rep 1998;47:926–928.Google Scholar
Lo Cascio, G, Bonora, MG, Zorzi, A, et al. A napkin-associated outbreak of Burkholderia cenocepacia bacteraemia in haemodialysis patients. J Hosp Infect 2006;64:56–62.CrossRefGoogle ScholarPubMed
Matrician, L, Ange, G, Burns, S, et al. Outbreak of nosocomial Burkholderia cepacia infection and colonization associated with intrinsically contaminated mouthwash. Infect Control Hosp Epidemiol 2000;21:739–741.CrossRefGoogle ScholarPubMed
Sunenshine, R, Schultz, M, Lawrence, MG, et al. An outbreak of postoperative gram-negative bacterial endophthalmitis associated with contaminated trypan blue ophthalmic solution. Clin Infect Dis 2009;48:1580–1583.CrossRefGoogle ScholarPubMed
Liao, CH, Chang, HT, Lai, CC, et al. Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit. Diagn Microbiol Infect Dis 2011;70:260–266.CrossRefGoogle Scholar
Maningo, E, Watanakunakorn, C. Xanthomonas maltophilia and Pseudomonas cepacia in lower respiratory tracts of patients in critical care units. J Infect 1995;31:89–92.CrossRefGoogle ScholarPubMed
Abdelfattah, R, Al-Jumaah, S, Al-Qahtani, A, et al. Outbreak of Burkholderia cepacia bacteraemia in a tertiary care centre due to contaminated ultrasound probe gel. J Hosp Infect 2018;98:289–294.CrossRefGoogle Scholar
Keizur, JJ, Lavin, B, Leidich, RB. Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate. J Urol 1993;149:523–526.10.1016/S0022-5347(17)36135-9CrossRefGoogle Scholar
Hua, CN, Tokeshi, J. Emergence of Burkholderia cepacia in Honolulu: a case of nursing home-acquired B. cepacia sepsis. Hawaii J Med Public Health 2013;72:308–309.Google ScholarPubMed
Dallal, MM, Telefian, CF, Hajia, M, et al. Identification and molecular epidemiology of nosocomial outbreaks due to Burkholderia cepacia in cystic fibrosis patients of Masih Daneshvary Hospital, Iran. J Prev Med Hyg 2014;55:27–30.Google Scholar
Hanulik, V, Webber, MA, Chroma, M, et al. An outbreak of Burkholderia multivorans beyond cystic fibrosis patients. J Hosp Infect 2013;84:248–251.CrossRefGoogle ScholarPubMed
Holmes, A, Nolan, R, Taylor, R, et al. An epidemic of Burkholderia cepacia transmitted between patients with and without cystic fibrosis. J Infect Dis 1999;179:1197–1205.CrossRefGoogle ScholarPubMed
Ledson, MJ, Gallagher, MJ, Corkill, JE, et al. Cross infection between cystic fibrosis patients colonised with Burkholderia cepacia. Thorax 1998;53:432–436.CrossRefGoogle ScholarPubMed
Smith, DL, Gumery, LB, Smith, EG, et al. Epidemic of Pseudomonas cepacia in an adult cystic fibrosis unit: evidence of person-to-person transmission. J Clin Microbiol 1993;31:3017–3022.CrossRefGoogle Scholar
Heo, ST, Kim, SJ, Jeong, YG, et al. Hospital outbreak of Burkholderia stabilis bacteraemia related to contaminated chlorhexidine in haematological malignancy patients with indwelling catheters. J Hosp Infect 2008;70:241–245.CrossRefGoogle ScholarPubMed
Abe, K, D’Angelo, MT, Sunenshine, R, et al. Outbreak of Burkholderia cepacia bloodstream infection at an outpatient hematology and oncology practice. Infect Control Hosp Epidemiol 2007;28:1311–1313.CrossRefGoogle ScholarPubMed
Baul, SN, De, R, Mandal, PK, et al. Outbreak of Burkholderia cepacia infection: a systematic study in a hematolooncology unit of a tertiary care hospital from eastern India. Mediterr J Hematol Infect Dis 2018;10(1):e2018051.CrossRefGoogle Scholar
Siboni, K, Olsen, H, Ravn, E, et al. Pseudomonas cepacia in 16 nonfatal cases of postoperative bacteremia derived from intrinsic contamination of the anaesthetic fentanyl. Clinical and epidemiological observations in Denmark and Holland. Scand J Infect Dis 1979;11:39–45.CrossRefGoogle Scholar
Lalitha, P, Das, M, Purva, PS, et al. Postoperative endophthalmitis due to Burkholderia cepacia complex from contaminated anaesthetic eye drops. Br J Ophthalmol 2014;98:1498–1502.CrossRefGoogle ScholarPubMed
Berkelman, RL, Godley, J, Weber, JA, et al. Pseudomonas cepacia peritonitis associated with contamination of automatic peritoneal dialysis machines. Ann Intern Med 1982;96:456–458.Google ScholarPubMed
Gleeson, S, Mulroy, E, Bryce, E, et al. Burkholderia cepacia: an outbreak in the peritoneal dialysis unit. Perit Dial Int 2019;39:92–95.CrossRefGoogle ScholarPubMed
Kaitwatcharachai, C, Silpapojakul, K, Jitsurong, S, et al. An outbreak of Burkholderia cepacia bacteremia in hemodialysis patients: an epidemiologic and molecular study. Am J Kidney Dis 2000;36:199–204.CrossRefGoogle ScholarPubMed
Souza, AV, Moreira, CR, Pasternak, J, et al. Characterizing uncommon Burkholderia cepacia complex isolates from an outbreak in a haemodialysis unit. J Med Microbiol 2004;53:999–1005.CrossRefGoogle Scholar
Kutty, PK, Moody, B, Gullion, JS, et al. Multistate outbreak of Burkholderia cenocepacia colonization and infection associated with the use of intrinsically contaminated alcohol-free mouthwash. Chest 2007;132:1825–1831.CrossRefGoogle ScholarPubMed
Alvarez-Lerma, F, Maull, E, Terradas, R, et al. Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit. Crit Care 2008;12(1):R10.CrossRefGoogle Scholar
Bassett, DC, Stokes, KJ, Thomas, WR. Wound infection with Pseudomonas multivorans. A water-borne contaminant of disinfectant solutions. Lancet 1970;1:1188–1191.CrossRefGoogle ScholarPubMed
Berthelot, P, Grattard, F, Mahul, P, et al. Ventilator temperature sensors: an unusual source of Pseudomonas cepacia in nosocomial infection. J Hosp Infect 1993;25:33–43.CrossRefGoogle ScholarPubMed
Martin, M, Christiansen, B, Caspari, G, et al. Hospital-wide outbreak of Burkholderia contaminans caused by prefabricated moist washcloths. J Hosp Infect 2011;77:267–270.CrossRefGoogle ScholarPubMed
Nannini, EC, Ponessa, A, Muratori, R, et al. Polyclonal outbreak of bacteremia caused by Burkholderia cepacia complex and the presumptive role of ultrasound gel. Braz J Infect Dis 2015;19:543–545.CrossRefGoogle ScholarPubMed
Panlilio, AL, Beck-Sague, CM, Siegel, JD, et al. Infections and pseudoinfections due to povidone-iodine solution contaminated with Pseudomonas cepacia. Clin Infect Dis 1992;14:1078–1083.CrossRefGoogle ScholarPubMed
Ghazal, SS, Al-Mudaimeegh, K, Al Fakihi, EM, et al. Outbreak of Burkholderia cepacia bacteremia in immunocompetent children caused by contaminated nebulized sulbutamol in Saudi Arabia. Am J Infect Control 2006;34:394–398.CrossRefGoogle ScholarPubMed
Manzar, S, Nair, AK, Pai, MG, et al. Pseudo-outbreak of Burkholderia cepacia in a neonatal intensive care unit. J Hosp Infect 2004;58:159.CrossRefGoogle Scholar
Brooks, RB, Mitchell, PK, Miller, JR, et al. Multistate outbreak of Burkholderia cepacia complex bloodstream infections after exposure to contaminated saline flush syringes—United States, 2016–2017. Clin Infect Dis 2019;69:445–449.CrossRefGoogle ScholarPubMed
Becker, SL, Berger, FK, Feldner, SK, et al. Outbreak of Burkholderia cepacia complex infections associated with contaminated octenidine mouthwash solution, Germany, August to September 2018. Euro Surveill 2018;23(42). doi: 10.2807/1560-7917.ES.2018.23.42.CrossRefGoogle ScholarPubMed
Yamunadevi, VR, Ramasubramanian, V, Senthur Nambi, P, et al. Outbreak of Burkholderia cepacia bacteraemia in a tertiary care centre due to contaminated ultrasound probe gel. J Hosp Infect 2018;100:e257–e258.CrossRefGoogle Scholar
Sommerstein, R, Fuhrer, U, Lo Priore, E, et al. Burkholderia stabilis outbreak associated with contaminated commercially available washing gloves, Switzerland, May 2015 to August 2016. Euro Surveill 2017;22(49). doi: 10.2807/1560-7917.CrossRefGoogle ScholarPubMed
Lee, S, Han, SW, Kim, G, et al. An outbreak of Burkholderia cenocepacia associated with contaminated chlorhexidine solutions prepared in the hospital. Am J Infect Control 2013;41:e93–e96.CrossRefGoogle ScholarPubMed
Lee, CS, Lee, HB, Cho, YG, et al. Hospital-acquired Burkholderia cepacia infection related to contaminated benzalkonium chloride. J Hosp Infect 2008;68:280–282.CrossRefGoogle ScholarPubMed
Romero-Gomez, MP, Quiles-Melero, MI, Pena Garcia, P, et al. Outbreak of Burkholderia cepacia bacteremia caused by contaminated chlorhexidine in a hemodialysis unit. Infect Control Hosp Epidemiol 2008;29:377–378.CrossRefGoogle Scholar
Supplementary material: File

Shaban et al. Supplementary Materials

Shaban et al. Supplementary Materials

Download Shaban et al. Supplementary Materials(File)
File 72.9 KB