ABSTRACT
OBJECTIVE To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source. SETTING A 629-bed, tertiary-care, pediatric hospital in Houston, Texas. PATIENTS Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units. METHODS We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory. RESULTS Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2-148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation. CONCLUSIONS Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer. Infect Control Hosp Epidemiol 2017;38:567-573.
Subject(s)
Burkholderia Infections/transmission , Burkholderia cepacia complex/isolation & purification , Cross Infection/microbiology , Cross Infection/transmission , Dioctyl Sulfosuccinic Acid/adverse effects , Drug Contamination , Burkholderia Infections/diagnosis , Burkholderia cepacia complex/genetics , Child , Child, Preschool , Cross Infection/diagnosis , Cystic Fibrosis , Disease Outbreaks , Female , Genotype , Hospitals, Pediatric , Humans , Infant , Male , Polymerase Chain Reaction , Texas/epidemiologyABSTRACT
Multiyear molecular epidemiological surveillance of multidrug-resistant Pseudomonas aeruginosa (MRPA) in a pediatric cystic fibrosis care center identified an endemic MRPA strain (Houston-1). Recent hospitalization was found to be a statistically significant risk factor for acquisition of the endemic strain. Multiple infection control improvements led to the reduced incidence of the Houston-1 strain in the CF population.
Subject(s)
Cystic Fibrosis/complications , Drug Resistance, Multiple, Bacterial , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/genetics , Cluster Analysis , Genotype , Hospitals, Pediatric , Humans , Incidence , Infection Control/methods , Molecular Epidemiology , Molecular Typing , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/classification , Pseudomonas aeruginosa/isolation & purification , Risk FactorsABSTRACT
Children with tuberculosis are rarely contagious, but their caregivers may be. Only 7 (12%) of 59 children were potentially contagious, and 10 (17%) were accompanied by contagious adults. Screening caregivers was more cost-effective than performing employee contact investigations, with one-sixteenth the cost ($5,470 vs $88,323) and requiring screening of 35 times fewer persons.
