title: Characterizing uncommon Burkholderia cepacia complex isolates from an outbreak in a haemodialysis unit.
abstract: An outbreak of bacteraemia in a haemodialysis unit where 65 episodes of infection involved 35 outpatients is reported. Burkholderia cepacia complex was the agent most frequently recovered from blood. Thirty-three environmental and clinical isolates of B. cepacia complex were characterized by whole-cell protein electrophoresis and recA-RFLP profile. Fourteen isolates were genomovar I and 16 isolates were not classifiable by their recA-RFLP pattern. Ribotyping, random amplification of polymorphic DNA (RAPD) and integron profile were used to explore the clonality of the isolates, and revealed multiple strain genotypes. Four ribotypes and RAPD types and three integron patterns were identified. The water supply was identified as the source of the outbreak, and inappropriate cleaning and a leak in the reverse osmosis tubing connection were the probable causes of contamination. B. cepacia complex was still recovered from blood of patients even after apparently adequate measures were taken and water quality standards were met, suggesting that higher standards for water quality should be adopted in haemodialysis units. The genomovars recovered here were distinct from those commonly reported for cystic fibrosis isolates.
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Souza
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Cláudia R
authors.initials: CR
authors.lastname: Moreira
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Jacyr
authors.initials: J
authors.lastname: Pasternak
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Maria de Lurdes
authors.initials: ML
authors.lastname: Hirata
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Denise Alves
authors.initials: DA
authors.lastname: Saltini
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Viviane Cristina
authors.initials: VC
authors.lastname: Caetano
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Suely
authors.initials: S
authors.lastname: Ciosak
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Fátima M
authors.initials: FM
authors.lastname: Azevedo
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Patricia
authors.initials: P
authors.lastname: Severino
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Peter
authors.initials: P
authors.lastname: Vandamme
authors.affiliation: Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium.
authors.forename: Vanda D
authors.initials: VD
authors.lastname: Magalhães
mesh_terms: D019121:Burkholderia Infections / Q000453:epidemiology*; D016956:Burkholderia cepacia / Q000145:classification / Q000235:genetics*; D003428:Cross Infection / Q000453:epidemiology*; D004196:Disease Outbreaks; D006436:Hemodialysis Units, Hospital; D006801:Humans; D032023:Integrons; D019105:Random Amplified Polymorphic DNA Technique; D021521:Ribotyping; D014871:Water Microbiology