title: Healthcare-associated respiratory tract infection and colonization in an intensive care unit caused by Burkholderia cepacia isolated in mouthwash.
abstract: OBJECTIVE
  Burkholderia cepacia has been linked to healthcare-associated infections and colonization caused by contamination of alcohol-free mouthwash used in patients undergoing mechanical ventilation. The purpose of our study was to establish the source of a clustering of healthcare-associated B. cepacia isolates in patients on mechanical ventilation in the intensive care unit (ICU).
  
  
  METHODS
  During April 2012 the Infection Control Committee became concerned when B. cepacia was isolated from tracheal aspirate cultures of three ICU patients. The medical records for the years 2011 and 2012 were reviewed to identify further cases. Cultures of potential reservoirs were done. Isolates from patients and an alcohol-free mouthwash were submitted to multilocus sequence typing (MLST) analysis and antimicrobial resistance testing.
  
  
  RESULTS
  Four patients with positive cultures for B. cepacia were identified before the review of the medical records for the years 2011 and 2012. Nine further cases were identified in the review, defined as a patient with pneumonia who had a culture of respiratory secretions that was positive for B. cepacia. Three were cases of infection and 10 were colonizations. All of the isolates from patients (J, K, L, and M) and mouthwash samples (B19, B20, and B21) were genetically identical by MLST analysis.
  
  
  CONCLUSIONS
  Our findings strongly suggest that alcohol-free mouthwash solution intrinsically contaminated with B. cepacia was the source of these colonizations and infections involving adults in the ICU.
authors.affiliation: Servicio de Microbiología y Tuberculosis, Hospital Vozandes, Villalengua Oe2-37, Quito, Ecuador; Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador; Unidad de Investigaciones en Biomedicina, Zurita & Zurita Laboratorios, Quito, Ecuador. Electronic address: jzurita@hcjb.org.
authors.forename: Jeannete
authors.initials: J
authors.lastname: Zurita
authors.affiliation: Instituto de Microbiología, Universidad San Francisco de Quito, Cumbayá, Quito, Ecuador.
authors.forename: Lorena
authors.initials: L
authors.lastname: Mejia
authors.affiliation: Instituto de Microbiología, Universidad San Francisco de Quito, Cumbayá, Quito, Ecuador.
authors.forename: Sonia
authors.initials: S
authors.lastname: Zapata
authors.affiliation: Instituto de Microbiología, Universidad San Francisco de Quito, Cumbayá, Quito, Ecuador.
authors.forename: Gabriel
authors.initials: G
authors.lastname: Trueba
authors.affiliation: Servicio de Microbiología y Tuberculosis, Hospital Vozandes, Villalengua Oe2-37, Quito, Ecuador.
authors.forename: Ana Cecilia
authors.initials: AC
authors.lastname: Vargas
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Vozandes, Quito, Ecuador.
authors.forename: Samanta
authors.initials: S
authors.lastname: Aguirre
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Vozandes, Quito, Ecuador.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Falconi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019121:Burkholderia Infections / Q000453:epidemiology / Q000382:microbiology*; D016956:Burkholderia cepacia / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009067:Mouthwashes; D058885:Multilocus Sequence Typing; D012121:Respiration, Artificial; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000382:microbiology*
chemical_list: D009067:Mouthwashes
keywords: Burkholderia cepacia; Healthcare-associated infections; ICU; Mouthwash; Outbreak