title: Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit.
abstract: BACKGROUND
  An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described.
  
  
  METHODS
  Over 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.
  
  
  RESULTS
  B. 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 The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed.
  
  
  CONCLUSIONS
  Moisturizing 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.
authors.affiliation: Service of Intensive Care Medicine, Hospital Universitari del Mar, Universitat Autònoma de Barcelona, Passeig Marítim 25-29, E-08003 Barcelona, Spain. Falvarez@imas.imim.es
authors.forename: Francisco
authors.initials: F
authors.lastname: Alvarez-Lerma
authors.forename: Elena
authors.initials: E
authors.lastname: Maull
authors.forename: Roser
authors.initials: R
authors.lastname: Terradas
authors.forename: Concepción
authors.initials: C
authors.lastname: Segura
authors.forename: Irene
authors.initials: I
authors.lastname: Planells
authors.forename: Pere
authors.initials: P
authors.lastname: Coll
authors.forename: Hernando
authors.initials: H
authors.lastname: Knobel
authors.forename: Antonia
authors.initials: A
authors.lastname: Vázquez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019121:Burkholderia Infections / Q000453:epidemiology* / Q000635:transmission; D016956:Burkholderia cepacia / Q000302:isolation & purification* / Q000472:pathogenicity; D003428:Cross Infection / Q000453:epidemiology* / Q000635:transmission; D004196:Disease Outbreaks; D004197:Disease Reservoirs / Q000382:microbiology*; D016521:Electrophoresis, Gel, Pulsed-Field; D004643:Emollients / Q000009:adverse effects*; D006801:Humans; D007362:Intensive Care Units; D013030:Spain / Q000453:epidemiology
chemical_list: D004643:Emollients