Pseudo-outbreak of Burkholderia cepacia blood stream infections in intensive care units of a super-speciality hospital: A cross-sectional study

Abstract

Background: Multiple nosocomial outbreaks caused by Burkholderia cepacia involving contaminated water, contaminated medication, nebulization solution, etc., have been reported. Objectives: This study was conducted with the aim of tracing the most likely causes of sudden increase in isolation rates of B. cepacia from blood samples of patients admitted in different intensive care units (ICUs) of a superspecialty hospital. Materials and Methods: A cross-sectional study was conducted in a super-speciality hospital located in New Delhi, India, from August 2015 to July 2016. Blood samples from 600 non-consecutive patients admitted in various ICUs were received for culture and sensitivity testing during the study period. Blood samples of 147 of these non-consecutive inpatients yielded B. cepacia in culture. Relevant details of all patients were obtained as per the pro forma formulated. Environmental sampling was also performed at regular intervals to trace the possible sources of infection. Chi-square test was used to calculate P value. Results: The study period was divided into three-quarters and the difference in the proportion of cases isolated from the ICUs under study during each of these quarters was not found to be statistically significant (0.05 < P < 0.1). A statistically significant association (P < 0.001 using Chi-square test) was found between afebrile status and simultaneous isolation of B. cepacia from blood samples of patients. B. cepacia could not be consistently isolated from any source during the study period. Conclusions: Nursing staff and doctors working in wards and ICUs should work in liaison with a diagnostic laboratory to assure swift communication of healthcare-associated infection alerts. Isolation of B. cepacia from clinical samples should always be correlated clinically to avoid inadvertent use of antimicrobials.