title: Polyclonal outbreak of bloodstream infections caused by Burkholderia cepacia complex in hematology and bone marrow transplant outpatient units.
abstract: OBJECTIVE
  The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients.
  
  
  METHODS
  On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units.
  
  
  RESULTS
  14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred.
  
  
  CONCLUSIONS
  This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Icaro
authors.initials: I
authors.lastname: Boszczowski
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Gladys Villas Boas
authors.initials: GV
authors.lastname: do Prado
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Mirian F
authors.initials: MF
authors.lastname: Dalben
authors.affiliation: Department of Infectious Diseases and LIM-54, University of São Paulo, São PauloSP, Brazil, Department of Infectious Diseases and LIM-54, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Roberto C P
authors.initials: RC
authors.lastname: Telles
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Maristela Pinheiro
authors.initials: MP
authors.lastname: Freire
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Thaís
authors.initials: T
authors.lastname: Guimarães
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Maura S
authors.initials: MS
authors.lastname: Oliveira
authors.affiliation: Department of Infectious Diseases and LIM-54, University of São Paulo, São PauloSP, Brazil, Department of Infectious Diseases and LIM-54, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Juliana F
authors.initials: JF
authors.lastname: Rosa
authors.affiliation: Department of Infectious Diseases and LIM-54, University of São Paulo, São PauloSP, Brazil, Department of Infectious Diseases and LIM-54, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Robson E
authors.initials: RE
authors.lastname: Soares
authors.affiliation: Hematology Unit, Hospital das Clínicas, University of São Paulo, São PauloSP, Brazil, Hematology Unit, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Pedro Enrique Dorlhiac
authors.initials: PE
authors.lastname: Llacer
authors.affiliation: Chief of Bone Marrow Transplant Unit, Hospital das Clínicas, University of São Paulo, São PauloSP, Brazil, Chief of Bone Marrow Transplant Unit, Hospital das Clínicas, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Frederico Luiz
authors.initials: FL
authors.lastname: Dulley
authors.affiliation: Department of Infectious Diseases and LIM-54, University of São Paulo, São PauloSP, Brazil, Department of Infectious Diseases and LIM-54, University of São Paulo, São Paulo, SP, Brazil.
authors.forename: Silvia F
authors.initials: SF
authors.lastname: Costa
authors.affiliation: Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
authors.forename: Anna S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D016026:Bone Marrow Transplantation; D019121:Burkholderia Infections / Q000453:epidemiology / Q000382:microbiology*; D042602:Burkholderia cepacia complex / Q000302:isolation & purification*; D055499:Catheter-Related Infections / Q000453:epidemiology / Q000382:microbiology*; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D005260:Female; D006402:Hematologic Diseases; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult