Real-time investigation of a Burkholderia cenocepacia bacteremia outbreak in a Vietnamese Intensive Care Unit
Burkholderia cepacia complex (Bcc) is a group of Gram-negative, non-fermenting bacilli encompassing more than 20 species. Although Burkholderia cepacia complex bacteria are typically found in natural environment, they have recently been identified as an important opportunistic pathogen. Bcc bacteria can cause severe infections in critically ill and immunocompromised individuals. Among Bcc species, B. cenocepacia is the most virulent species, accounting for the large number of Bcc infections worldwide.    Bcc are inherently resistant to antiseptics, disinfectants, and a variety of antibiotics, including carboxypenicillins, first-second-generation cephalosporins, polymyxins and all aminoglycosides, making them a major contaminant in medical products. Of concern, Bcc has been attributed to many nosocomial outbreaks globally. According to a systematic review, a total of 111 nosocomial outbreaks have been reported across hospitals in Europe, North America and Asia between 1971 and 2019, of which 35.1% occurred in the ICUs. In the documented Bcc outbreaks, the major infectious syndromes include bloodstream infection and pneumonia. The source of the outbreak was known in 73.9% of the cases and 53.2% of outbreak sources were due to the contamination of medical solutions, medications and disinfectants. Otherwise, Bcc outbreaks can be directly linked to contaminated medical devices such as the Extracorporeal Membrane Oxygenation (ECMO) water heater device, or the hemodialysis system.    In June 2023, a potential outbreak of Burkholderia spp bacteremia in an Intensive Care Unit (ICU) at a 500-bed tertiary general hospital in Ho Chi Minh City, Vietnam was reported, prompting rapid responses. We conducted a molecular outbreak investigation and outlined hospital infection control measures to confirm and contain the outbreak.