Suspicious outbreak of ventilator-associated pneumonia caused by Burkholderia cepacia in a surgical intensive care unit.
BACKGROUND
We reviewed Burkholderia cepacia infections in a hospital from 2013-2016 to report a suspicious outbreak that occurred in a surgical intensive care unit in 2015, and to outline the infection control measures adopted thereafter.


METHODS
Review of the health care-associated infection data regarding B cepacia via the surveillance system, hospital information system, electronic medical records, and laboratory information system together with the outbreak investigation was managed by the health care-associated infection control team.


RESULTS
During June 1-14, 2015, 4 cases of ventilator-associated pneumonia (VAP) were identified; B cepacia was isolated from endotracheal aspirate samples. On June 16, 120 environmental samples were collected and analyzed for microbiologic differentiation. Thirteen strains of B cepacia were prominently found in the expiratory blocks of ventilators, revealing the biocontamination source. After chemical disinfection without damaging ventilator components, repeat microbiologic testing of random ventilator samples yielded negative results until July 30, 2015. Retrospective data showed that isolation rates of B cepacia strains had increased since 2014. Although the resistance phenotype of these strains varied slightly, they exhibited similar patterns of antibiotic susceptibility.


CONCLUSIONS
Routine cleaning and disinfection of ventilators, in addition to an intervention bundle, should form part of an integrated VAP prevention and management approach.
Nosocomial Infection Control Office, China-Japan Friendship Hospital, Beijing, China.
LiPing
L
Guo
Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University; National Clinical Research Center of Respiratory Diseases, Beijing, China.
Gang
G
Li
Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University; National Clinical Research Center of Respiratory Diseases, Beijing, China.
Jian
J
Wang
Nosocomial Infection Control Office, China-Japan Friendship Hospital, Beijing, China.
Xia
X
Zhao
Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University; National Clinical Research Center of Respiratory Diseases, Beijing, China.
Shupeng
S
Wang
Center for Respiratory Diseases, Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Capital Medical University; National Clinical Research Center of Respiratory Diseases, Beijing, China.
Li
L
Zhai
Surgical Intensive Care Unit, China-Japan Friendship Hospital, Beijing, China.
Hongbin
H
Jia
Nosocomial Infection Control Office, China-Japan Friendship Hospital, Beijing, China; Department of Clinical Laboratory, China-Japan Friendship Hospital, Beijing, China. Electronic address: caobin1999@gmail.com.
Bin
B
Cao
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019121:Burkholderia Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D016956:Burkholderia cepacia; D003422:Critical Care / Q000706:statistics & numerical data; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D008875:Middle Aged; D053717:Pneumonia, Ventilator-Associated / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D012189:Retrospective Studies; D012122:Ventilators, Mechanical / Q000382:microbiology
Burkholderia cepacia (B cepacia); Health care–associated infection; Infection control; Ventilator-associated pneumonia (VAP)