title: An outbreak of Burkholderia cepacia bacteremia in hospitalized hematology patients selectively affecting those with acute myeloid leukemia.
abstract: BACKGROUND
  Burkholderia cepacia complex (Bcc) is a group of common environmental bacteria that preferentially colonize and infect patients with cystic fibrosis but are also emerging as nosocomial pathogens, possibly due to their resistance to disinfectants and antimicrobials.
  
  
  METHODS
  We investigated a 3-month outbreak of Bcc bacteremia among hospitalized hematology patients. Environmental investigation and infection control measures were implemented. A retrospective, cross-sectional study was conducted to identify risk factors.
  
  
  RESULTS
  Bcc was repeatedly isolated from the blood of 9 patients without central venous catheter who did not easily respond to targeted antibiotic treatment and 3 died of the infection. A point source was not identified and horizontal spread was suspected. Strict infection control measures terminated the outbreak. Interestingly, diagnosis of acute myeloid leukemia but not neutropenia or prior chemotherapy was a risk factor for infection acquisition. Neutropenia was positively correlated with infection duration.
  
  
  CONCLUSIONS
  Bcc is not only a serious threat among immunocompromized hematology patients, but is also transmissible in clinical settings. Acute myeloid leukemia appears to confer additional risk for infection acquisition.
authors.affiliation: Hematology Department and Hematopoietic Cell Transplantation Unit, G. Papanikolaou Hospital, Thessaloniki, Greece. anna_vardi@yahoo.com
authors.forename: Anna
authors.initials: A
authors.lastname: Vardi
authors.forename: Antonia
authors.initials: A
authors.lastname: Sirigou
authors.forename: Chrysavgi
authors.initials: C
authors.lastname: Lalayanni
authors.forename: Melina
authors.initials: M
authors.lastname: Kachrimanidou
authors.forename: Panayiotis
authors.initials: P
authors.lastname: Kaloyannidis
authors.forename: Riad
authors.initials: R
authors.lastname: Saloum
authors.forename: Achilles
authors.initials: A
authors.lastname: Anagnostopoulos
authors.forename: Damianos
authors.initials: D
authors.lastname: Sotiropoulos
mesh_terms: D000328:Adult; D000368:Aged; D016470:Bacteremia / Q000453:epidemiology* / Q000382:microbiology; D019121:Burkholderia Infections / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D042602:Burkholderia cepacia complex / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D004783:Environmental Microbiology; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D015470:Leukemia, Myeloid, Acute / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis