Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit

Francisco Álvarez-Lerma,Irene Planells,Concepción Segura,Elena Maull,Roser Terradas,Antonia Vázquez,Pere Coll,Hernando Knobel

doi:10.1186/cc6778

Francisco Álvarez-Lerma, Irene Planells + Show 6 more

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https://doi.org/10.1186/cc6778

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Abstract

BackgroundAn outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described.MethodsOver a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured.ResultsB. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed.ConclusionMoisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections.

Highlights

Burkholderia cepacia is a nonfermenting Gram-negative aerobic bacillus that was until recently considered an opportunistic pathogen in oncological patients or in those with cystic fibrosis
During a period of 18 days in August 2006, five patients admitted to a multidisciplinary intensive care unit (ICU) were identified in whom one or more strains of B. cepacia, with identical pattern of antibiotic susceptibility
In four patients specimens were obtained in the ICU, whereas in the remaining patient the pathogen was isolated in a urine sample collected before ICU admission

Summary

Introduction

Burkholderia cepacia is a nonfermenting Gram-negative aerobic bacillus that was until recently considered an opportunistic pathogen in oncological patients or in those with cystic fibrosis. This pathogen is associated with low morbidity and mortality despite high intrinsic resistance to numerous antimicrobial and antiseptic agents [1]. Simultaneous detection of several isolations of this pathogen in the same service heralds the occurrence of an epidemic outbreak associated with a reservoir. Under such these circumstances it is advisable that an epidemiological study be conducted to identify the origin of the infection and the ICU = intensive care unit; PFGE = ulsed field gel electrophoresis. Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described

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