Abstract
A recent hospital outbreak related to premoistened gloves used to wash patients exposed the difficulties of defining Burkholderia species in clinical settings. The outbreak strain displayed key B. stabilis phenotypes, including the inability to grow at 42°C; we used whole-genome sequencing to confirm the pathogen was B. stabilis. The outbreak strain genome comprises 3 chromosomes and a plasmid, sharing an average nucleotide identity of 98.4% with B. stabilis ATCC27515 BAA-67, but with 13% novel coding sequences. The genome lacks identifiable virulence factors and has no apparent increase in encoded antimicrobial drug resistance, few insertion sequences, and few pseudogenes, suggesting this outbreak was an opportunistic infection by an environmental strain not adapted to human pathogenicity. The diversity among outbreak isolates (22 from patients and 16 from washing gloves) is only 6 single-nucleotide polymorphisms, although the genome remains plastic, with large elements stochastically lost from outbreak isolates.
Highlights
A recent hospital outbreak related to premoistened gloves used to wash patients exposed the difficulties of defining Burkholderia species in clinical settings
Our outbreak isolates and control strain shared a defining characteristic of B. stabilis, the inability to grow at 42°C [26]
We provide a thorough and detailed description of a Burkholderia sp. outbreak resolved by whole-genome sequencing (WGS) [4] and illustrate various associated challenges, including morphotype differences, species designation, and a large genome with associated assembly, annotation, and interpretation issues
Summary
A recent hospital outbreak related to premoistened gloves used to wash patients exposed the difficulties of defining Burkholderia species in clinical settings. The outbreak strain displayed key B. stabilis phenotypes, including the inability to grow at 42°C; we used whole-genome sequencing to confirm the pathogen was B. stabilis. The genome lacks identifiable virulence factors and has no apparent increase in encoded antimicrobial drug resistance, few insertion sequences, and few pseudogenes, suggesting this outbreak was an opportunistic infection by an environmental strain not adapted to human pathogenicity. An outbreak of B. stabilis was identified among hospitalized patients across several cantons in Switzerland during 2015–2016 [4]. The source of the infection was traced to contaminated commercially available, premoistened washing gloves used for bedridden patients. We conducted in-depth characterization of the B. stabilis strain from the Switzerland outbreak by using clinical methods and whole-genome sequencing (WGS). We provide a thorough comparative genomic analysis of this outbreak strain
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