Case-crossover study of Burkholderia cepacia complex bloodstream infection associated with contaminated intravenous bromopride.
OBJECTIVE
To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI).


METHODS
Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006.


METHODS
Twenty-five patients with BCC-BSI.


METHODS
After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar chi(2) adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using SpeI.


RESULTS
The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals.


CONCLUSIONS
Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.
Martins
Ianick Souto
IS
Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. ianicksm@.yahoo.com.br
Pellegrino
Flávia Lúcia Piffano Costa
FL
Freitas
Andrea d'Avila
Ad
Santos
Marisa da Silva
Mda S
Ferraiuoli
Giovanna Ianini d'Alemeida
GI
Vasques
Márcia Regina Guimarães
MR
Amorim
Efigenia Lourdes Teixeira
EL
Oliveira
Sandra
S
Nouér
Simone Aranha
SA
Cardoso
Fernando Luiz Lopes
FL
Mascarenhas
Luiz Affonso
LA
Magalhães
Ana Cristina Gouveia
AC
Cleinman
Isabella Barbosa
IB
Figueiredo
Agnes Marie Sá
AM
Moreira
Beatriz Meurer
BM
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D001938:Brazil / Q000453:epidemiology; D019121:Burkholderia Infections / Q000453:epidemiology / Q000382:microbiology; D042602:Burkholderia cepacia complex / Q000145:classification / Q000235:genetics / Q000302:isolation & purification; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D018592:Cross-Over Studies; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004866:Equipment Contamination; D005260:Female; D016304:Hospitals, Private / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007275:Injections, Intravenous / Q000009:adverse effects*; D008297:Male; D008787:Metoclopramide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D008875:Middle Aged
C013855:bromopride; D008787:Metoclopramide