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Burkholderia cepacia respiratory tract acquisition: epidemiology and molecular characterization of a large nosocomial outbreak

Published online by Cambridge University Press:  15 May 2009

C. F. Pegues ,
D. A. Pegues ,
D. S. Ford ,
P. L. Hibberd ,
L. A. Carson ,
C. M. Raine  and
D. C. Hooper
C. F. Pegues
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, MA
D. A. Pegues
Affiliation:
Infectious Disease Unit, Massachusetts General Hospital, Boston, MA
D. S. Ford
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, MA
P. L. Hibberd
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, MA Infectious Disease Unit, Massachusetts General Hospital, Boston, MA
L. A. Carson
Affiliation:
Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA
C. M. Raine
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, MA
D. C. Hooper*
Affiliation:
Infection Control Unit, Massachusetts General Hospital, Boston, MA Infectious Disease Unit, Massachusetts General Hospital, Boston, MA
*
* Address for correspondence: David C. Hooper, MD, Infectious Disease Unit, Gray 5, 32 Fruit St., Massachusetts General Hospital, Boston, MA 02114USA.
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Summary

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In 1994 we investigated a large outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract acquisition. A case patient was defined as any patient with at least one sputum culture from which B. cepacia was isolated from 1 January to 31 December 1994. Seventy cases were identified. Most (40 [61 %]) occurred between 1 February and 31 March 1994; of these, 35 (86%) were mechanically ventilated patients, 30 of whom were in an intensive-care unit (ICU) when B. cepacia was first isolated. Compared with control patients who were mechanically ventilated in an ICU, these 30 case-patients were significantly more likely to have been ventilated for 2 or more days (30/30 v. 15/30; P < 0·001) or to have been intubated more than once (12/30 v. 2/30; OR = 9·3, 95% CI 1·6–68·8; P = 0·002) before the first isolation of B. cepacia. By multivariate analysis, the 35 mechanically ventilated case-patients were significantly more likely to have received a nebulized medication (OR = 11·9, 95% CI = 1·6–553·1; P < 0·001) and a cephalosporin antimicrobial (OR = 11·9, 95% CI = 1·6–553·1) in the 10 days before the first isolation of B. cepacia, compared with B. cepacia-negative control-patients matched by date and duration of most recent mechanical ventilation. Although B. cepacia was not cultured from medications or the hospital environment, all outbreak strains tested had an identical DNA restriction endonuclease digestion pattern by pulsed-field gel electrophoresis. Review of respiratory therapy procedures revealed opportunities for contamination of nebulizer reservoirs. This investigation suggests that careful adherence to standard procedures for administration of nebulized medications is essential to prevent nosocomial respiratory infections.

Type
Special Article
Information
Epidemiology & Infection , Volume 116 , Issue 3 , June 1996 , pp. 309 - 317
Copyright
Copyright © Cambridge University Press 1996

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