title: Burkholderia contaminans Colonization from Contaminated Liquid Docusate (Colace) in a Immunocompetent Adult with Legionnaire's Disease: Infection Control Implications and the Potential Role of Candida pellucosa.
abstract: Objective:B. contaminanswas cultured from respiratory secretions and liquid docusate (Colace) in a Neurosurgical Intensive Care Unit (NICU) patient with community-acquired Legionnaire's disease but not from another bottle given to the patient. Unexpectedly,C. pelliculosawas cultured from two bottles, but not theB. contaminansbottle or respiratory secretions.Methods:B. cepacia, later identified asB. contaminans, was cultured from a bottle of liquid docusate (Colace) dispensed to a non-cystic fibrosis patient. His respiratory secretions were colonized withB. contaminans.Results:Eradication ofB. contaminanscolonization in the patient's respiratory secretions was attempted. With levofloxacin,B. contaminansdeveloped multidrug resistance (MDR). Subsequent TMP-SMX therapy did not result in further MDR. Nine other ICU patients were given docusate from the same lot, but there were no otherB. contaminansisolates.Conclusion:B. contaminanscolonization of respiratory secretion may be difficult to eliminate. The significance ofC. pelliculosacultured from liquid docusate (Colace) remains to be elucidated. In this case, it appeared thatB. contaminansmay have inhibited the growth ofC. pelliculosain the same bottle. Others should be alerted to the possibility thatC. pelliculosamay be present inB. contaminans-contaminated lots of liquid docusate (Colace).
authors.affiliation: Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. bacunha@winthrop.org.|State University of New York, School of Medicine, Stony Brook, New York, NY 11501, USA. bacunha@winthrop.org.
authors.forename: Burke A
authors.initials: BA
authors.lastname: Cunha
authors.affiliation: Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. jgian@winthrop.org.
authors.forename: John
authors.initials: J
authors.lastname: Gian
authors.affiliation: Infectious Disease Division, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. bDieguez@winthrop.org.
authors.forename: Bertamaria
authors.initials: B
authors.lastname: Dieguez
authors.affiliation: Infection Control Department, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. ESantos-Cruz@winthrop.org.
authors.forename: Elsa
authors.initials: E
authors.lastname: Santos-Cruz
authors.affiliation: Infection Control Department, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. RPSilletti@winthrop.org.
authors.forename: Daniela
authors.initials: D
authors.lastname: Matassa
authors.affiliation: Pharmacy Department, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. sgerson@winthrop.org.
authors.forename: Steve
authors.initials: S
authors.lastname: Gerson
authors.affiliation: Pharmacy Department, Winthrop-University Hospital, Mineola, New York, NY 11501, USA. pdaniels@winthrop.org.
authors.forename: Pat
authors.initials: P
authors.lastname: Daniels
authors.affiliation: Medical Microbiology Laboratory, Winthrop-University Hospital, 222 Station Plaza North, Mineola, New York, NY 11501, USA. crosales@winthrop.org.
authors.forename: Carlos
authors.initials: C
authors.lastname: Rosales
authors.affiliation: Medical Microbiology Laboratory, Winthrop-University Hospital, 222 Station Plaza North, Mineola, New York, NY 11501, USA. rsilletti@winthrop.org.
authors.forename: Rodger P
authors.initials: RP
authors.lastname: Silletti
keywords: B. contaminans outbreaks; Burkholderia cepacia; Burkholderia cepacia outbreaks; Candida pullucosa; Gram negative bacilli (GNB); Legionnaire’s disease; TMP-SMX; antibiotic resistance; colonization of respiratory secretions; complex (BCC) colonization; contaminated medications; doxycycline; levofloxacin; multidrug resistant (MDR); occidiofungin Hansenula anomala