title: Case-crossover study of Burkholderia cepacia complex bloodstream infection associated with contaminated intravenous bromopride.
abstract: 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.
authors.affiliation: Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. ianicksm@.yahoo.com.br
authors.forename: Ianick Souto
authors.initials: IS
authors.lastname: Martins
authors.forename: Flávia Lúcia Piffano Costa
authors.initials: FL
authors.lastname: Pellegrino
authors.forename: Andrea d'Avila
authors.initials: Ad
authors.lastname: Freitas
authors.forename: Marisa da Silva
authors.initials: Mda S
authors.lastname: Santos
authors.forename: Giovanna Ianini d'Alemeida
authors.initials: GI
authors.lastname: Ferraiuoli
authors.forename: Márcia Regina Guimarães
authors.initials: MR
authors.lastname: Vasques
authors.forename: Efigenia Lourdes Teixeira
authors.initials: EL
authors.lastname: Amorim
authors.forename: Sandra
authors.initials: S
authors.lastname: Oliveira
authors.forename: Simone Aranha
authors.initials: SA
authors.lastname: Nouér
authors.forename: Fernando Luiz Lopes
authors.initials: FL
authors.lastname: Cardoso
authors.forename: Luiz Affonso
authors.initials: LA
authors.lastname: Mascarenhas
authors.forename: Ana Cristina Gouveia
authors.initials: AC
authors.lastname: Magalhães
authors.forename: Isabella Barbosa
authors.initials: IB
authors.lastname: Cleinman
authors.forename: Agnes Marie Sá
authors.initials: AM
authors.lastname: Figueiredo
authors.forename: Beatriz Meurer
authors.initials: BM
authors.lastname: Moreira
mesh_terms: 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
chemical_list: C013855:bromopride; D008787:Metoclopramide