An Outbreak of Burkholderia cepacia Complex Infections Associated with Contaminated Liquid Docusate.
OBJECTIVE To investigate an outbreak of Burkholderia cepacia complex and describe the measures that revealed the source. SETTING A 629-bed, tertiary-care, pediatric hospital in Houston, Texas. PATIENTS Pediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units. METHODS We investigated an outbreak of B. cepacia complex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory. RESULTS Overall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2-148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within the B. cepacia complex. Product cultures of liquid docusate were positive with an identical strain of B. cepacia complex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation. CONCLUSIONS Our investigation revealed an outbreak of a unique strain of B. cepacia complex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer. Infect Control Hosp Epidemiol 2017;38:567-573.
1Department of Pediatrics,Baylor College of Medicine,Houston,Texas.
Lucila
L
Marquez
3Infection Control and Prevention,Texas Children's Hospital,Houston,Texas.
Katie N
KN
Jones
3Infection Control and Prevention,Texas Children's Hospital,Houston,Texas.
Elaine M
EM
Whaley
3Infection Control and Prevention,Texas Children's Hospital,Houston,Texas.
Tjin H
TH
Koy
1Department of Pediatrics,Baylor College of Medicine,Houston,Texas.
Paula A
PA
Revell
5Department of Pharmacy,Texas Children's Hospital,Houston,Texas.
Ruston S
RS
Taylor
5Department of Pharmacy,Texas Children's Hospital,Houston,Texas.
M Brooke
MB
Bernhardt
5Department of Pharmacy,Texas Children's Hospital,Houston,Texas.
Jeffrey L
JL
Wagner
4Department of Pathology,Texas Children's Hospital,Houston,Texas.
James J
JJ
Dunn
6Department of Pediatrics and Communicable Diseases,University of Michigan,Ann Arbor,Michigan.
John J
JJ
LiPuma
1Department of Pediatrics,Baylor College of Medicine,Houston,Texas.
Judith R
JR
Campbell
D019121:Burkholderia Infections / Q000175:diagnosis / Q000635:transmission*; D042602:Burkholderia cepacia complex / Q000235:genetics / Q000302:isolation & purification*; D002648:Child; D002675:Child, Preschool; D003428:Cross Infection / Q000175:diagnosis / Q000382:microbiology* / Q000635:transmission*; D003550:Cystic Fibrosis; D004143:Dioctyl Sulfosuccinic Acid / Q000009:adverse effects*; D004196:Disease Outbreaks; D004340:Drug Contamination; D005260:Female; D005838:Genotype; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D008297:Male; D016133:Polymerase Chain Reaction; D013781:Texas / Q000453:epidemiology
D004143:Dioctyl Sulfosuccinic Acid