title: [Outbreak of Burkholderia cepacia complex caused by contaminated alcohol-free mouthwash].
abstract: BACKGROUND
  A total of three intensive care units (ICU) at a German university hospital were involved in an outbreak of Burkholderia cepacia complex (Bcc).
  
  
  METHODS
  Patients with microbiological detection of Bcc were evaluated. Products used for mouth hygiene were microbiologically tested. The clonal identity of Bcc was proven by pulse-field gel electrophoresis (PFGE).
  
  
  RESULTS
  On 3 ICUs 12 cases were identified whereby the first detection of Bcc was in respiratory specimens of 11 patients and 1 in a wound swab from the oral cavity. Of these patients six developed ventilator-associated pneumonia (VAP). Investigations revealed that five different batches of an alcohol-free mouthwash containing hexetidine were highly contaminated. Isolates of Bcc from patients and mouthwashes were genetically indistinguishable. A recall of the product was initiated. After elimination of the product from the ICUs no more cases were identified.
  
  
  CONCLUSIONS
  The source of the outbreak was an intrinsically contaminated alcohol-free mouthwash. Detection of Bcc in specimens from ICU patients should lead to further investigations. Antiseptic oral care products are recommended for reducing the risk of VAP but they may be microbiologically contaminated and, in consequence, increase the risk. The safety of patient care products should be increased by stricter regulations.
authors.affiliation: Institut für Umweltmedizin und Krankenhaushygiene, Universitätsklinikum Freiburg, Breisacher Str. 115b, 79106, Freiburg, Deutschland. maria.martin@uniklinik-freiburg.de
authors.forename: M
authors.initials: M
authors.lastname: Martin
authors.forename: I
authors.initials: I
authors.lastname: Winterfeld
authors.forename: E
authors.initials: E
authors.lastname: Kramme
authors.forename: I
authors.initials: I
authors.lastname: Ewert
authors.forename: B
authors.initials: B
authors.lastname: Sedemund-Adib
authors.forename: F
authors.initials: F
authors.lastname: Mattner
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000891:Anti-Infective Agents, Local; D001992:Bronchoalveolar Lavage Fluid / Q000382:microbiology; D019121:Burkholderia Infections / Q000209:etiology* / Q000382:microbiology; D042602:Burkholderia cepacia complex; D003428:Cross Infection / Q000209:etiology* / Q000382:microbiology; D016208:Databases, Factual; D004196:Disease Outbreaks; D004340:Drug Contamination; D056736:Drug Recalls; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D006590:Hexetidine; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009055:Mouth / Q000382:microbiology; D009067:Mouthwashes; D009910:Oral Hygiene; D053717:Pneumonia, Ventilator-Associated / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies
chemical_list: D000891:Anti-Infective Agents, Local; D009067:Mouthwashes; D006590:Hexetidine