An outbreak investigation of bacteraemia due to Burkholderia cepacia complex at the National Hospital of Sri Lanka

S Vathshalan,W P H Abeydeera,C G U A Patabendige,T S K R D Caldera,N Liyanage,W P D P Perera

doi:10.4038/sljid.v7i2.8153

Abstract

Burkholderia cepacia complex (BCC) is an opportunistic pathogen in immunocompromised patients and well distributed in the natural environment. Nosocomial outbreaks of BCC are due to contaminated solutions and medical devices. However, in Sri Lanka, there have been no nosocomial outbreaks of BCC reported in the past. We report here an outbreak investigation of bacteraemia due to BCC in the wards and ICUs of the National Hospital of Sri Lanka (NHSL) during the period of August 14th 2017 to September 13th 2017 which an extensive investigation traced to a contaminated nebulizer solution of a particular brand of ipratropium bromide. The blood culture isolates from the patients with bacteraemia and from the particular nebulizer solution were found to be identical and confirmed as BCC. There had been outbreaks in other hospitals with the same organism in the recent past but they were not able to find the common source for the outbreak. The incident was reported officially to the relevant authorities and other hospitals, and an alternative agent for the use of nebulization was strongly recommended to prevent further cases immediately.

Highlights

Burkholderia cepacia complex (BCC) is a Gram negative aerobic bacillus distributed in the soil and various aquatic environments.[1]
The observation of a rise in isolation of B. cepacia complex with the same antibiotic susceptibility testing (AST) pattern from blood cultures during the period of 14th August to 13th September 2017 necessitated the search for a possible common source of the outbreak
The outbreak investigation was started immediately to find the possible source to control the outbreak and it was initiated in the intensive care units (ICU) as there were several blood cultures positive for BCC from the ICUs

Summary

Introduction

Burkholderia cepacia complex (BCC) is a Gram negative aerobic bacillus distributed in the soil and various aquatic environments.[1] It plays a role in the commercial industry related to biocontrol, bioremediation and plant growth promotion which can create an environment to be a reservoir of this bacterium.[1]. There are 17 closely related species found to be in the complex. B. cepacia complex can cause blood stream infection, pneumonia, surgical wound infection and genitourinary tract infection especially in immunocompromised hosts such as patients with chronic granulomatous disease (CGD) and cystic fibrosis.[1] A high level of intrinsic resistance in this organism to different groups of antibiotics makes treatment options very difficult. Received 20 September 2017 and accepted 01 October 2017

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Conclusion