Investigating an Increased Incidence of Burkholderia Cepacia Among Non-Cystic Fibrosis Pediatric Patients

Abstract

<h3>Background</h3> Burkholderia cepacia Complex (BCC), commonly identified in patients with Cystic Fibrosis (CF), has been associated with outbreaks from contaminated medications (Abdelfattah 2018) and devices (Lucero, 2011). An increase of BCC in cultures of non-CF patients prompted an investigation including an assessment of commonalities such as medications, procedures, staffing, equipment, and treatment locations. Our journey to identify a source and implement control measures led to a yearlong, multi-facility outbreak investigation with support and involvement of the Massachusetts Department of Public Health and the Centers for Disease Control. <h3>Methods</h3> Literature review of past outbreaks aided in narrowing our scope of potential sources. Chart reviews helped identify commonalities across patients, however, these commonalities did not elucidate a root cause. Through the Burkholderia cepacia Research Laboratory & Repository at the University of Michigan, whole-genome sequencing identified matching isolates. Over 20 patients and 50 environmental isolates from our facility were evaluated. <h3>Results</h3> Three distinct BCC clusters were identified: a larger cluster of 10 patients with Burkholderia cenocepacia recA subgroup and two smaller clusters of 2 patients each with a matching Burkholderia cepacia indeterminate species. Despite environmental sampling not identifying a source, our Respiratory program re-educated staff on not storing respiratory equipment within the splash zone of a sink and use of sterile water for all respiratory care items. Additionally, a policy was formalized for reprocessing of custom tracheostomies, and we transitioned to single-use temperature probes for one of our ventilators. Ultimately, new information suggested the primary source was external to our facility. <h3>Conclusions</h3> Early identification of outbreaks in healthcare facilities and evaluation of all possible causes is central to Infection Prevention. Ongoing surveillance and analysis utilizing established epidemiologic methods are essential to successfully minimizing the adverse effects to patients.