2103. Clinical Profile of Patients with Burkholderia cepacia complex Bacteremia and Contaminated Ultrasound Gel as Possible Source of Infection

Abstract

Background Burkholderia cepacia complex (Bcc) is Gram-negative bacteria commonly affecting those with cystic fibrosis, causing pneumonia and also a nosocomial pathogen. We looked at the clinical profile and possible source of Bcc bacteremia in patients without cystic fibrosis, admitted to a tertiary care hospital in South India.MethodsRetrospective chart review was done of patients with Bcc bacteremia over the period 2012–2017. Patient risk factors, outcome, sensitivity profile were looked into. Possible sources for Bcc were analysed.ResultsTwenty-two patients with Bcc bacteremia were identified during this period. Age of patients ranged from 16 months to 83 years, averaging 47 years. 89.5% were nosocomial; 77.3% had indwelling vascular catheter, either CVC, dialysis catheter or permacath. When 30 days mortality was looked at, 17 patients survived and five patients expired. Those who expired had high Pitt’s bacteremic score (scoring done either prior to or within 48 hours of positive culture). Four patients had underlying pneumonia, among whom two patient’s respiratory sample grew Bcc, three also had underling vascular catheters. Sensitivity pattern of Bcc was noted as follows- trimethoprim sulfamethoxazole was uniformly sensitive (100%), ceftazidime was sensitive in 86.5%, minocycline in 73% of isolates. Meropenem was tested in 19 and was found sensitive in 15 isolates (79%), fluoroquinolone was tested only in eight isolates and was sensitive in 7.As majority was CLABSI, the bundle compliance and common products used for cvc were audited. Feedback and training for bundle compliance were given. The ultrasound gel, even the unopened bottle used for cvc insertion grew Bcc. Despite sterile cover around the probe after the application of contaminated gel, an associated risk was considered and was replaced with sterile gel sachet. At 3 months follow-up there is no further incidence of Bcc bacteremia, though longer follow-up is needed.Conclusion Bcc bacteremia is found to be an important nosocomial pathogen, commonly associated with intravascular catheters with 22.7% mortality in this study. Cotrimoxazole was 100% sensitive. Good infection control practices, including early removal of unnecessary catheters are important to prevent Bcc CLABSI. Ultra sound gels can harbour Bcc and poses a serious risk of infection.Disclosures All authors: No reported disclosures.