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Shan J, Wang Y, Huai W, Bao X, Jin M, Jin Y, Jin Y, Zhang Z, Li H, Chen H, Cao Y. Development of an investigation form for hemodialysis infection outbreak: Identifying sources in the early stage. Am J Infect Control 2024:S0196-6553(24)00658-8. [PMID: 39153515 DOI: 10.1016/j.ajic.2024.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 08/13/2024] [Accepted: 08/13/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND There are many infectious factors causing the outbreak of hemodialysis infection, which may easily lead to the delay of investigation and treatment. This study aimed to develop an investigation form for hemodialysis infection outbreak (HIO), and to identify sources of outbreak in early stage. METHODS After an exhaustive literature review, we used the Delphi method to determine the indicators and relative risk scores of the assessment tools through 2 rounds of specialist consultation and overall consideration of the opinions and suggestions of 18 specialists. RESULTS A total of 87 studies of HIOs were eligible for inclusion. The mean authority coefficient (Cr) was 0.89. Kendall's W coefficient of the specialist consultation was 0.359 after 2 rounds of consultation (P < .005), suggesting that the specialists had similar opinions. Based on 4 primary items and 13 secondary items of the source of HIO, and tripartite distribution characteristics of infected patients, we constructed the investigation form. CONCLUSIONS The investigation form may be implemented during the initial phase of an outbreak investigation, it is a prerequisite for taking effective control measures, avoiding HIO occurrence. However, the efficacy of the investigation form needs to be further evaluated.
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Affiliation(s)
- Jiao Shan
- Department of Hospital-Acquired Infection Control, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yan Wang
- Department of Nephrology, Peking University People's Hospital, Beijing, China
| | - Wei Huai
- Department of Emergency, Peking University Third Hospital, Beijing, China
| | - Xiaoyuan Bao
- Medical Information Center, Peking University Health Science Center, Beijing, China
| | - Meng Jin
- Medical Information Center, Peking University Health Science Center, Beijing, China
| | - Yicheng Jin
- School of General Studies, Columbia University, New York, NY, USA
| | - Yixi Jin
- Khoury College of Computer Sciences, Northeastern University, Seattle, WA, USA
| | - Zexin Zhang
- Graduate School of Medicine Faculty of Medicine, Kyoto University, Kyoto, Kyoto Prefecture, Japan
| | - Hong Li
- Department of Hospital-Acquired Infection Control, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Hui Chen
- Department of Hospital-Acquired Infection Control, Beijing Jishuitan Hospital, Capital Medical University, Beijing, China
| | - Yulong Cao
- Department of Hospital-Acquired Infection Control, Peking University People's Hospital, Beijing, China.
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Craven H, Erlandsson H, McGuinness D, McGuinness D, Mafra D, Ijaz U, Bergman P, Shiels P, Stenvinkel P. A normative microbiome is not restored following kidney transplantation. Clin Sci (Lond) 2023; 137:1563-1575. [PMID: 37756543 PMCID: PMC10582644 DOI: 10.1042/cs20230779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/22/2023] [Accepted: 09/26/2023] [Indexed: 09/29/2023]
Abstract
Dialysis and kidney transplantation (Ktx) mitigate some of the physiological deficits in chronic kidney disease (CKD), but it remains to be determined if these mitigate microbial dysbiosis and the production of inflammatory microbial metabolites, which contribute significantly to the uraemic phenotype. We have investigated bacterial DNA signatures present in the circulation of CKD patients and those receiving a KTx. Our data are consistent with increasing dysbiosis as CKD progresses, with an accompanying increase in trimethylamine (TMA) producing pathobionts Pseudomonas and Bacillus. Notably, KTx patients displayed a significantly different microbiota compared with CKD5 patients, which surprisingly included further increase in TMA producing Bacillus and loss of salutogenic Lactobacilli. Only two genera (Viellonella and Saccharimonidales) showed significant differences in abundance following KTx that may reflect a reciprocal relationship between TMA producers and utilisers, which supersedes restoration of a normative microbiome. Our metadata analysis confirmed that TMA N-oxide (TMAO) along with one carbon metabolism had significant impact upon both inflammatory burden and the composition of the microbiome. This indicates that these metabolites are key to shaping the uraemic microbiome and might be exploited in the development of dietary intervention strategies to both mitigate the physiological deficits in CKD and enable the restoration of a more salutogenic microbiome.
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Affiliation(s)
- Hannah Craven
- University of Glasgow, College of Medical, Veterinary and Life Sciences, School of Molecular Biosciences, Davidson Bld, Glasgow, U.K
| | - Helen Erlandsson
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Dagmara McGuinness
- University of Glasgow, College of Medical, Veterinary and Life Sciences, School of Molecular Biosciences, Davidson Bld, Glasgow, U.K
| | | | - Denise Mafra
- Fluminense Federal University (UFF), Niterói, RJ, Brazil
| | | | - Peter Bergman
- Department of Laboratory Medicine, Division of Clinical Immunology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical immunology and Transfusion Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Paul G. Shiels
- University of Glasgow, College of Medical, Veterinary and Life Sciences, School of Molecular Biosciences, Davidson Bld, Glasgow, U.K
| | - Peter Stenvinkel
- Department of Clinical Science, Intervention and Technology, Division of Renal Medicine, Karolinska Institutet, Stockholm, Sweden
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Kanamori H, Weber DJ, Flythe JE, Rutala WA. Waterborne Outbreaks in Hemodialysis Patients and Infection Prevention. Open Forum Infect Dis 2022; 9:ofac058. [PMID: 35233434 PMCID: PMC8879210 DOI: 10.1093/ofid/ofac058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Accepted: 01/27/2022] [Indexed: 11/20/2022] Open
Abstract
Individuals treated with dialysis are at high risk for healthcare-associated infections. We conducted a literature review of outbreaks associated with water in hemodialysis during years 2011–2021 to understand the role of water as a source of infections for patients receiving hemodialysis with a focus on the risks associated with dialysis water and dialysate. For dialysis patients, water and dialysate have been a source of healthcare-associated pathogens, including nontuberculous mycobacteria and gram-negative bacilli as well as systemic reactions due to gram-negative bacilli–associated endotoxin. Lapses in infection prevention practices and dialysis water management were primarily involved in waterborne outbreaks. Dialysis clinics should adhere to recommendations regarding monitoring and levels of bacteria and endotoxin in hemodialysis water and dialysate. Since hemodialysis patients are at increased risk of healthcare-associated infections, it is important for healthcare personnel to adhere to infection prevention guidelines in hemodialysis patient care, especially hand hygiene, aseptic technique, cleaning/disinfection, and water management.
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Affiliation(s)
- Hajime Kanamori
- Department of Infectious Diseases, Internal Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - David J Weber
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Jennifer E Flythe
- Division of Nephrology and Hypertension and Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Anversa L, Romani CD, Caria ES, Saeki EK, Nascentes GAN, Garbelotti M, Stancari RCA, Dantas STA, Rall VLM, Ruiz LS, Camargo CH, Richini-Pereira VB. Quality of dialysis water and dialysate in hemodialysis centers: highlight for occurrence of non-fermenting gram-negative bacilli. J Appl Microbiol 2022; 132:3416-3429. [PMID: 35108426 DOI: 10.1111/jam.15470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from hemodialysis centers. METHODS AND RESULTS Samples were fortnightly collected from three hemodialysis centers in Bauru City, Brazil, between July/2017 and June/2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulfate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity, and genetic similarity among some isolated NFGNB. Of the analyzed samples, only 4/72 (5.6%) had conductivity values ≥ 10 mS/cm, 4/216 (1.9%) presented total coliforms, and 1/216 (0.5%) had heterotrophic bacteria count > 100 CFU/mL. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified microorganisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating persistence of bacterial clones in the systems over time. CONCLUSIONS NFGNB were observed in several dialysis water and dialysate samples from all investigated centers, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY Regular inclusion of actions for NFGNB control and monitoring in hemodialysis fluids are suggested for greater safety of the dialytic process.
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Affiliation(s)
- L Anversa
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C D Romani
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E S Caria
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - E K Saeki
- Adolfo Lutz Institute, Regional Laboratories Center Presidente Prudente, Presidente Prudente, Brazil
| | - G A N Nascentes
- Federal Institute of Education, Science and Technology of Triângulo Mineiro, Uberaba, Brazil
| | - M Garbelotti
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - R C A Stancari
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - S T A Dantas
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - V L M Rall
- Institute of Biosciences, Department of Microbiology and Immunology, São Paulo State University (Unesp), Botucatu, Brazil
| | - L S Ruiz
- Adolfo Lutz Institute, Regional Laboratories Center Bauru, Bauru, Brazil
| | - C H Camargo
- Adolfo Lutz Institute, Central Laboratory, São Paulo, Brazil
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Carvalho GC, Dua K, Gupta G, Bugno A, Pinto TDJA. Reflection about the hemodialysis water microbiological quality in Brazil. BRAZ J PHARM SCI 2022. [DOI: 10.1590/s2175-97902022e19235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
| | - Kamal Dua
- The University of Newcastle, Australia; Hunter Medical Research Institute, Australia; University of Technology Sydney, Australia
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Luk KS, Tsang YM, Ho AYM, To WK, Wong BKH, Wong MML, Wong YC. Invasive Burkholderia cepacia Complex Infections among Persons Who Inject Drugs, Hong Kong, China, 2016-2019. Emerg Infect Dis 2021; 28:323-330. [PMID: 34906288 PMCID: PMC8798689 DOI: 10.3201/eid2802.210945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
During March 2016–January 2019, Burkholderia cepacia complex (BCC) infection developed in 13 persons who inject drugs (PWID) in Kowloon West Region, Hong Kong, China. Seven cases were infective spondylitis, 2 endocarditis, 2 septic arthritis, 1 intramuscular abscess and bacteremia, and 1 necrotizing fasciitis. Pulsed-field gel electrophoresis revealed that the isolates from 9 patients were clonally related. This clone caused major illness, and 11 of the 13 patients required surgical treatment. Clinicians should be aware of this pathogen and the appropriate broad-spectrum antimicrobial drugs to empirically prescribe for PWID with this life-threatening infection. Close collaboration among public health authorities, outreach social workers, and methadone clinics is essential for timely prevention and control of outbreaks in the PWID population.
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Global burden, point sources, and outbreak management of healthcare-associated Burkholderia cepacia infections: An integrative review. Infect Control Hosp Epidemiol 2021; 41:777-783. [PMID: 32441235 DOI: 10.1017/ice.2020.184] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). DESIGN Integrative review. METHODS A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). RESULTS In total, we reviewed 125 documented outbreaks of Burkholderia cepacia-related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. CONCLUSIONS Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.
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8
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Yiek WK, Coenen O, Nillesen M, van Ingen J, Bowles E, Tostmann A. Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review. Antimicrob Resist Infect Control 2021; 10:77. [PMID: 33971944 PMCID: PMC8108015 DOI: 10.1186/s13756-021-00935-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 04/09/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Healthcare-associated infections (HAIs) are a significant cause of morbidity and mortality in hospitalized patients. Water in the environment can be a source of infection linked to outbreaks and environmental transmission in hospitals. Water safety in hospitals remains a challenge. This article has summarized available scientific literature to obtain an overview of outbreaks linked to water-containing hospital equipment and strategies to prevent such outbreaks. METHODS We made a list of water-containing hospital equipment and devices in which water is being used in a semi-closed circuit. A literature search was performed in PubMed with a search strategy containing the names of these medical devices and one or more of the following words: outbreak, environmental contamination, transmission, infection. For each medical device, we summarized the following information: the function of the medical device, causes of contamination, the described outbreaks and possible prevention strategies. RESULTS The following water-containing medical equipment or devices were identified: heater-cooler units, hemodialysis equipment, neonatal incubators, dental unit waterlines, fluid warmers, nebulizers, water traps, water baths, blanketrol, scalp cooling, and thermic stimulators. Of the latter three, no literature could be found. Of all other devices, one or more outbreaks associated with these devices were reported in the literature. CONCLUSIONS The water reservoirs in water-containing medical devices can be a source of microbial growth and transmissions to patients, despite the semi-closed water circuit. Proper handling and proper cleaning and disinfection can help to reduce the microbial burden and, consequently, transmission to patients. However, these devices are often difficult to clean and disinfect because they cannot be adequately opened or disassembled, and the manufacturer's cleaning guidelines are often not feasible to execute. The development of equipment without water or fluid containers should be stimulated. Precise cleaning and disinfection guidelines and instructions are essential for instructing healthcare workers and hospital cleaning staff to prevent potential transmission to patients.
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Affiliation(s)
- Wing-Kee Yiek
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Olga Coenen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Mayke Nillesen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jakko van Ingen
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Edmée Bowles
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Alma Tostmann
- Department of Medical Microbiology, Radboud Centre for Infectious Diseases, Radboud University Medical Centre, Nijmegen, The Netherlands.
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Weinbren M, Inkster T. The hospital-built environment: biofilm, biodiversity and bias. J Hosp Infect 2021; 111:50-52. [PMID: 33631235 DOI: 10.1016/j.jhin.2021.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Affiliation(s)
- M Weinbren
- Department of Microbiology, King's Mill Hospital, Sutton-in-Ashfield, UK.
| | - T Inkster
- Department of Microbiology, Queen Elizabeth University Hospital, Glasgow, UK
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Wong MY, Tseng YH, Huang TY, Lin BS, Tung CW, Chu C, Huang YK. Comparison of Microbiological Characteristics and Genetic Diversity between Burkholderia cepacia Complex Isolates from Vascular Access and Other Clinical Infections. Microorganisms 2020; 9:microorganisms9010051. [PMID: 33375496 PMCID: PMC7824166 DOI: 10.3390/microorganisms9010051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/19/2020] [Accepted: 12/23/2020] [Indexed: 11/24/2022] Open
Abstract
Burkholderia cepacia complex (BCC) is a group of closely related bacteria with widespread environmental distribution. BCC bacteria are opportunistic pathogens that cause nosocomial infections in patients, especially cystic fibrosis (CF). Multilocus sequence typing (MLST) is used nowadays to differentiate species within the BCC complex. This study collected 41 BCC isolates from vascular access infections (VAIs) and other clinical infections between 2014 and 2020. We preliminarily identified bacterial isolates using standard biochemical procedures and further conducted recA gene sequencing and MLST for species identification. We determined genetic diversity indices using bioinformatics software. We studied 14 isolates retrieved from patients with VAIs and observed that Burkholderia cepacia was the predominant bacterial species, and B. contaminans followed by B. cenocepacia were mainly retrieved from patients with other infections. According to MLST data, we identified that all B. contaminans isolates belonged to ST102, while a wide variety of sequence types (STs) were found in B. cenocepacia isolates. In summary, the high diversity and easy transmission of BCC increase BCC infections, which provides insights into their potential clinical effects in non-CF infections.
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Affiliation(s)
- Min Yi Wong
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan; (M.Y.W.); (Y.-H.T.)
- Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan;
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan;
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan; (M.Y.W.); (Y.-H.T.)
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan;
| | - Tsung-Yu Huang
- Microbiology Research and Treatment Center, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan;
- Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan 71150, Taiwan;
| | - Chun-Wu Tung
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan;
- Department of Nephrology, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
| | - Chishih Chu
- Department of Microbiology, Immunology and Biopharmaceuticals, National Chiayi University, Chiayi City 60004, Taiwan;
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan; (M.Y.W.); (Y.-H.T.)
- College of Medicine, Chang Gung University, Taoyuan City 33302, Taiwan;
- Division of Infectious Diseases, Department of Internal Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi County 61363, Taiwan
- Correspondence: ; Tel.: +886-975368209
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Chopyk J, Akrami K, Bavly T, Shin JH, Schwanemann LK, Ly M, Kalia R, Xu Y, Kelley ST, Malhotra A, Torriani FJ, Sweeney DA, Pride DT. Temporal variations in bacterial community diversity and composition throughout intensive care unit renovations. MICROBIOME 2020; 8:86. [PMID: 32513256 PMCID: PMC7278141 DOI: 10.1186/s40168-020-00852-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 05/01/2020] [Indexed: 05/10/2023]
Abstract
BACKGROUND Inanimate surfaces within a hospital serve as a reservoir of microbial life that may colonize patients and ultimately result in healthcare associated infections (HAIs). Critically ill patients in intensive care units (ICUs) are particularly vulnerable to HAIs. Little is known about how the microbiome of the ICU is established or what factors influence its evolution over time. A unique opportunity to bridge the knowledge gap into how the ICU microbiome evolves emerged in our health system, where we were able to characterize microbial communities in an established hospital ICU prior to closing for renovations, during renovations, and then after re-opening. RESULTS We collected swab specimens from ICU bedrails, computer keyboards, and sinks longitudinally at each renovation stage, and analyzed the bacterial compositions on these surfaces by 16S rRNA gene sequencing. Specimens collected before ICU closure had the greatest alpha diversity, while specimens collected after the ICU had been closed for over 300 days had the least. We sampled the ICU during the 45 days after re-opening; however, within that time frame, the alpha diversity never reached pre-closure levels. There were clear and significant differences in microbiota compositions at each renovation stage, which was driven by environmental bacteria after closure and human-associated bacteria after re-opening and before closure. CONCLUSIONS Overall, we identified significant differences in microbiota diversity and community composition at each renovation stage. These data help to decipher the evolution of the microbiome in the most critical part of the hospital and demonstrate the significant impacts that microbiota from patients and staff have on the evolution of ICU surfaces. Video Abstract.
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Affiliation(s)
- Jessica Chopyk
- Department of Pathology, University of California, San Diego, USA
| | - Kevan Akrami
- Department of Medicine, University of California, San Diego, USA
| | - Tovia Bavly
- Department of Pathology, University of California, San Diego, USA
| | - Ji H Shin
- Department of Pathology, University of California, San Diego, USA
| | | | - Melissa Ly
- Department of Pathology, University of California, San Diego, USA
| | - Richa Kalia
- Department of Biology, San Diego State University, San Diego, USA
| | - Ying Xu
- Department of Biology, San Diego State University, San Diego, USA
| | - Scott T Kelley
- Department of Biology, San Diego State University, San Diego, USA
| | - Atul Malhotra
- Department of Medicine, University of California, San Diego, USA
| | | | - Daniel A Sweeney
- Department of Medicine, University of California, San Diego, USA
| | - David T Pride
- Department of Pathology, University of California, San Diego, USA.
- Department of Medicine, University of California, San Diego, USA.
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12
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Comparative Genomics and Evolutionary Analysis of RNA-Binding Proteins of Burkholderia cenocepacia J2315 and Other Members of the B. cepacia Complex. Genes (Basel) 2020; 11:genes11020231. [PMID: 32098200 PMCID: PMC7074383 DOI: 10.3390/genes11020231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 02/17/2020] [Accepted: 02/19/2020] [Indexed: 12/15/2022] Open
Abstract
RNA-binding proteins (RBPs) are important regulators of cellular functions, playing critical roles on the survival of bacteria and in the case of pathogens, on their interaction with the host. RBPs are involved in transcriptional, post-transcriptional, and translational processes. However, except for model organisms like Escherichia coli, there is little information about the identification or characterization of RBPs in other bacteria, namely in members of the Burkholderia cepacia complex (Bcc). Bcc is a group of bacterial species associated with a poor clinical prognosis in cystic fibrosis patients. These species have some of the largest bacterial genomes, and except for the presence of two-distinct Hfq-like proteins, their RBP repertoire has not been analyzed so far. Using in silico approaches, we identified 186 conventional putative RBPs in Burkholderia cenocepacia J2315, an epidemic and multidrug resistant pathogen of cystic fibrosis patients. Here we describe the comparative genomics and phylogenetic analysis of RBPs present in multiple copies and predicted to play a role in transcription, protein synthesis, and RNA decay in Bcc bacteria. In addition to the two different Hfq chaperones, five cold shock proteins phylogenetically close to E. coli CspD protein and three distinct RhlE-like helicases could be found in the B. cenocepacia J2315 genome. No RhlB, SrmB, or DeaD helicases could be found in the genomes of these bacteria. These results, together with the multiple copies of other proteins generally involved in RNA degradation, suggest the existence, in B. cenocepacia and in other Bcc bacteria, of some extra and unexplored functions for the mentioned RBPs, as well as of alternative mechanisms involved in RNA regulation and metabolism in these bacteria.
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13
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Ferro P, Vaz-Moreira I, Manaia CM. Betaproteobacteria are predominant in drinking water: are there reasons for concern? Crit Rev Microbiol 2019; 45:649-667. [PMID: 31686572 DOI: 10.1080/1040841x.2019.1680602] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Betaproteobacteria include some of the most abundant and ubiquitous bacterial genera that can be found in drinking water, including mineral water. The combination of physiology and ecology traits place some Betaproteobacteria in the list of potential, yet sometimes neglected, opportunistic pathogens that can be transmitted by water or aqueous solutions. Indeed, some drinking water Betaproteobacteria with intrinsic and sometimes acquired antibiotic resistance, harbouring virulence factors and often found in biofilm structures, can persist after water disinfection and reach the consumer. This literature review summarises and discusses the current knowledge about the occurrence and implications of Betaproteobacteria in drinking water. Although the sparse knowledge on the ecology and physiology of Betaproteobacteria thriving in tap or bottled natural mineral/spring drinking water (DW) is an evidence of this review, it is demonstrated that DW holds a high diversity of Betaproteobacteria, whose presence may not be innocuous. Frequently belonging to genera also found in humans, DW Betaproteobacteria are ubiquitous in different habitats, have the potential to resist antibiotics either due to intrinsic or acquired mechanisms, and hold different virulence factors. The combination of these factors places DW Betaproteobacteria in the list of candidates of emerging opportunistic pathogens. Improved bacterial identification of clinical isolates associated with opportunistic infections and additional genomic and physiological studies may contribute to elucidate the potential impact of these bacteria.
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Affiliation(s)
- Pompeyo Ferro
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Ivone Vaz-Moreira
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
| | - Célia M Manaia
- Universidade Católica Portuguesa, CBQF - Centro de Biotecnologia e Química Fina - Laboratório Associado, Escola Superior de Biotecnologia, Porto, Portugal
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14
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Huai W, Ma QB, Zheng JJ, Zhao Y, Zhai QR. Distribution and drug resistance of pathogenic bacteria in emergency patients. World J Clin Cases 2019; 7:3175-3184. [PMID: 31667167 PMCID: PMC6819302 DOI: 10.12998/wjcc.v7.i20.3175] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/23/2019] [Accepted: 09/11/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Antibiotic resistance has become a global threat for human health, calling for rational use of antibiotics.
AIM To analyze the distribution and drug resistance of the bacteria, providing the prerequisite for use of antibiotics in emergency patients.
METHODS A total of 2048 emergency patients from 2013 to 2017 were enrolled. Their clinical examination specimens were collected, followed by isolation of bacteria. The bacterial identification and drug susceptibility testing were carried out.
RESULTS A total of 3387 pathogens were isolated. The top six pathogens were Acinetobacter baumannii (660 strains), Staphylococcus aureus (436 strains), Klebsiella pneumoniae (347 strains), Pseudomonas aeruginosa (338 strains), Escherichia coli (237 strains), and Candida albicans (207 strains). The isolation rates of these pathogens decreased year by year except Klebsiella pneumoniae, which increased from 7.1% to 12.1%. Acinetobacter baumannii is a widely-resistant strain, with multiple resistances to imipenem, ciprofloxacin, minocycline and tigecycline. The Staphylococcus aureus had high resistance rates to levofloxacin, penicillin G, and tetracycline. But the susceptibility of it to vancomycin and tigecycline were 100%. Klebsiella pneumoniae had high resistance rates to imipenem, cefoperazone/sulbactam, amikacin, and ciprofloxacin, with the lowest resistance rate to tigecycline. The resistance rates of Pseudomonas aeruginosa to cefoperazone/sulbactam and imipenem were higher, with the resistance rate to amikacin below 10%. Besides, Escherichia coli had high resistance rates to ciprofloxacin and cefoperazone/sulbactam and low resistance rates to imipenem, amikacin, and tigecycline.
CONCLUSION The pathogenic bacteria isolated from the emergency patients were mainly Acinetobacter baumannii, Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and Candida albicans. The detection rates of drug-resistant bacteria were high, with different bacteria having multiple drug resistances to commonly used antimicrobial agents, guiding the rational use of drugs and reducing the production of multidrug-resistant bacteria.
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Affiliation(s)
- Wei Huai
- Emergency Department, Third Clinical Medical College, Peking University, Beijing 100191, China
| | - Qing-Bian Ma
- Emergency Department, Third Clinical Medical College, Peking University, Beijing 100191, China
| | - Jia-Jia Zheng
- Laboratory Department, Third Clinical Medical College, Peking University, Beijing 100191, China
| | - Yang Zhao
- Laboratory Department, Third Clinical Medical College, Peking University, Beijing 100191, China
| | - Qiang-Rong Zhai
- Emergency Department, Third Clinical Medical College, Peking University, Beijing 100191, China
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15
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Sommerstein R, Führer U, Lo Priore E, Casanova C, Meinel DM, Seth-Smith HM, Kronenberg A, On Behalf Of Anresis, Koch D, Senn L, Widmer AF, Egli A, Marschall J, On Behalf Of Swissnoso. Burkholderia stabilis outbreak associated with contaminated commercially-available washing gloves, Switzerland, May 2015 to August 2016. ACTA ACUST UNITED AC 2018; 22. [PMID: 29233255 PMCID: PMC5727593 DOI: 10.2807/1560-7917.es.2017.22.49.17-00213] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
We describe an outbreak of Burkholderia stabilis associated with contaminated washing gloves, a commercially available Class I medical device. Triggered by an increase in Burkholderia cepacia complex (BCC) bacteremias and the detection of BCC in unopened packages of washing gloves, an ad hoc national outbreak committee comprising representatives of a public health organisation, a regulatory agency, and an expert association convened and commissioned an outbreak investigation. The investigation included retrospective case finding across Switzerland and whole genome sequencing (WGS) of isolates from cases and gloves. The investigation revealed that BCC were detected in clinical samples of 46 cases aged 17 to 91 years (33% females) from nine institutions between May 2015 and August 2016. Twenty-two isolates from case patients and 16 from washing gloves underwent WGS. All available outbreak isolates clustered within a span of < 19 differing alleles, while 13 unrelated clinical isolates differed by > 1,500 alleles. This BCC outbreak was rapidly identified, communicated, investigated and halted by an ad hoc collaboration of multiple stakeholders. WGS served as useful tool for confirming the source of the outbreak. This outbreak also highlights current regulatory limitations regarding Class I medical devices and the usefulness of a nationally coordinated outbreak response.
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Affiliation(s)
- Rami Sommerstein
- These authors contributed equally to the manuscript.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Urs Führer
- Infectious Diseases Department, Biel Hospital, Biel, Switzerland.,These authors contributed equally to the manuscript
| | - Elia Lo Priore
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Carlo Casanova
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Dominik M Meinel
- Applied Microbiology Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Helena Mb Seth-Smith
- Applied Microbiology Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | - Daniel Koch
- Federal Office of Public Health, Bern, Switzerland
| | - Laurence Senn
- Service of Hospital Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Andreas F Widmer
- Department of Infectious Diseases, University Hospital Basel, Basel, Switzerland
| | - Adrian Egli
- Applied Microbiology Research Unit, Department of Biomedicine, University of Basel, Basel, Switzerland.,Division of Clinical Microbiology, University Hospital Basel, Basel, Switzerland.,These authors contributed equally to the manuscript
| | - Jonas Marschall
- These authors contributed equally to the manuscript.,Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
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16
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Vieira RGL, Moraes TDS, Silva LDO, Bianchi TC, Veneziani RCS, Ambrósio SR, Bastos JK, Pires RH, Martins CHG. In vitro studies of the antibacterial activity of Copaifera spp. oleoresins, sodium hypochlorite, and peracetic acid against clinical and environmental isolates recovered from a hemodialysis unit. Antimicrob Resist Infect Control 2018; 7:14. [PMID: 29410782 PMCID: PMC5782372 DOI: 10.1186/s13756-018-0307-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Accepted: 01/15/2018] [Indexed: 02/06/2023] Open
Abstract
Background Patients submitted to hemodialysis therapy are more susceptible to infection, especially to infection by Gram-positive bacteria. Various research works have attempted to discover new antimicrobial agents from plant extracts and other natural products. Methods The present study aimed to assess the antibacterial activities of Copaifera duckei, C. reticulata, and C. oblongifolia oleoresins; sodium hypochlorite; and peracetic acid against clinical and environmental isolates recovered from a Hemodialysis Unit. The Minimum Inhibitory Concentration and the Fractionated Inhibitory Concentration Index were determined; the ability of the tested compounds/extracts to inhibit biofilm formation was evaluated by calculating the MICB50 and IC50. Results C. duckei was the most efficient among the assayed Copaifera species, and its oleoresin was more effective than peracetic acid and sodium hypochlorite. Copaifera oleoresins and disinfectants did not act synergistically at any of the tested combinations. Certain of C. duckei oleoresin, peracetic acid, and sodium hypochlorite concentrations inhibited biofilm formation and eradicated 50% of the biofilm population. Conclusion C. duckei oleoresin is a potential candidate for disinfectant formulations. Based on these results and given the high incidence of multi-resistant bacteria in hemodialysis patients, it is imperative that new potential antibacterial agents like C. duckei oleoresin, which is active against Staphylococcus, be included in disinfectant formulations.
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Affiliation(s)
- Rosimara Gonçalves Leite Vieira
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Thaís da Silva Moraes
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Larissa de Oliveira Silva
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Thamires Chiquini Bianchi
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Rodrigo Cassio Sola Veneziani
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Sérgio Ricardo Ambrósio
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Jairo Kenupp Bastos
- School of Pharmaceutical Sciences of Ribeirão Preto, University of São Paulo, Avenida do Café, s/n, Ribeirão Preto - São Paulo, 14040-903 Brazil
| | - Regina Helena Pires
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
| | - Carlos Henrique Gomes Martins
- Nucleus of Research in Sciences and Technology, Laboratory of Research in Applied Microbiology, University of Franca, Avenida Armando Salles de Oliveira, 201, Franca - São Paulo, 14404-600 Brazil
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Mali S, Dash L, Gautam V, Shastri J, Kumar S. An Outbreak of Burkholderia cepacia Complex in the Paediatric Unit of a Tertiary Care Hospital. Indian J Med Microbiol 2017; 35:216-220. [DOI: 10.4103/ijmm.ijmm_16_258] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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18
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Nannini EC, Ponessa A, Muratori R, Marchiaro P, Ballerini V, Flynn L, Limansky AS. Polyclonal outbreak of bacteremia caused by Burkholderia cepacia complex and the presumptive role of ultrasound gel. Braz J Infect Dis 2015; 19:543-5. [PMID: 26322722 PMCID: PMC9427536 DOI: 10.1016/j.bjid.2015.06.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Revised: 06/27/2015] [Accepted: 06/30/2015] [Indexed: 12/01/2022] Open
Abstract
A nosocomial polyclonal outbreak associated to bacteremia caused by different Burkholderia cepacia complex (BCC) species and clones is reported. Molecular characterization identified Burkholderia stabilis, Burkholderia contaminans, and Burkholderia ambifaria among BCC isolates obtained from patients in neonatal and adult intensive care units. BCC was also isolated from an intrinsically contaminated ultrasound gel, which constituted the presumptive BCC source. Prior BCC outbreak related to contaminated ultrasound gels have been described in the setting of transrectal prostate biopsy. Outbreak caused strains and/or clones of BCC have been reported, probably because BCC are commonly found in the natural environment; most BCC species are biofilm producers, and different species may contaminate an environmental source. The finding of multiple species or clones during the analysis of nosocomial BCC cases might not be enough to reject an outbreak from a common source.
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Affiliation(s)
- Esteban C Nannini
- Division of Infectious Diseases, Sanatorio Británico, Rosario, Argentina; Division of Infectious Diseases, School of Medicine, Universidad Nacional de Rosario, Rosario, Argentina.
| | - Adriana Ponessa
- Department of Microbiology, Sanatorio Británico, Rosario, Argentina
| | - Rosa Muratori
- Division of Infectious Diseases, Sanatorio Británico, Rosario, Argentina
| | - Patricia Marchiaro
- Instituto de Biología Molecular y Celular de Rosario - CONICET, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Viviana Ballerini
- Instituto de Biología Molecular y Celular de Rosario - CONICET, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
| | - Luis Flynn
- Division of Infectious Diseases, Sanatorio Británico, Rosario, Argentina
| | - Adriana S Limansky
- Instituto de Biología Molecular y Celular de Rosario - CONICET, Facultad de Ciencias Bioquímicas y Farmacéuticas, Universidad Nacional de Rosario, Rosario, Argentina
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19
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Coutinho CP, Barreto C, Pereira L, Lito L, Melo Cristino J, Sá-Correia I. Incidence of Burkholderia contaminans at a cystic fibrosis centre with an unusually high representation of Burkholderia cepacia during 15 years of epidemiological surveillance. J Med Microbiol 2015; 64:927-935. [DOI: 10.1099/jmm.0.000094] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Carla P. Coutinho
- iBB-Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
| | - Celeste Barreto
- Cystic Fibrosis Center, Department of Paediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Luísa Pereira
- Cystic Fibrosis Center, Department of Paediatrics, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Luís Lito
- Laboratório de Patologia Clínica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - José Melo Cristino
- Laboratório de Patologia Clínica, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisbon, Portugal
| | - Isabel Sá-Correia
- iBB-Institute for Bioengineering and Biosciences, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Av. Rovisco Pais, 1049-001 Lisbon, Portugal
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20
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Montaño-Remacha C, Márquez-Cruz MD, Hidalgo-Guzmán P, Sánchez-Porto A, Téllez-Pérez FDP. [An outbreak of Burkholderia cepacia bacteremia in a hemodialysis unit, Cadiz, 2014]. Enferm Infecc Microbiol Clin 2015; 33:646-50. [PMID: 25824991 DOI: 10.1016/j.eimc.2015.02.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Revised: 02/10/2015] [Accepted: 02/11/2015] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In January 2014 a possible outbreak of Burkholderia cepacia bacteremia occurred in a hemodialysis center situated in La Linea de la Concepción (Cadiz). An investigation was begun to confirm the outbreak, identify the source, and implement control measures. METHODS A descriptive analysis was performed to describe the characteristics of the patients affected with Burkholderia cepacia bacteremia from November 2013 to February 2014. Environmental samples were taken. A molecular typing study was performed using pulsed field gel electrophoresis (SpeI PFGE) and MLST analysis in order to determine the genetic similarity between the isolates. RESULTS The bacterium was isolated from blood cultures of 7 patients during the study period. Three of the samples (2 of which were also cases) were endoluminal fluid from catheter locks, and 4 chlorhexidine bottle samples. The patients were coincident in 2 of the 6 work shifts. The mean age of the cases was 67 years of whom 57% were women. Human samples and an environmental sample was analyzed and found to be genetically identical (ST653 clone). CONCLUSIONS The analysis confirmed the outbreak of Burkholderia cepacia, with 7 cases among the patients of the hemodialysis center. The outbreak was due to the same strain, probably a common source and secondary transmission from person to person.
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Affiliation(s)
- Carmen Montaño-Remacha
- Servicio de Epidemiología, Área de Gestión Sanitaria Campo de Gibraltar, Sistema Andaluz de Salud, Algeciras, España.
| | - María Dolores Márquez-Cruz
- Servicio de Medicina Preventiva, Área de Gestión Sanitaria Campo de Gibraltar, Sistema Andaluz de Salud, La Línea de la Concepción, España
| | - Pilar Hidalgo-Guzmán
- Servicio de Nefrología, Área de Gestión Sanitaria Campo de Gibraltar, Sistema Andaluz de Salud, Algeciras, España
| | - Antonio Sánchez-Porto
- Servicio de Microbiología, Área de Gestión Sanitaria Campo de Gibraltar, Sistema Andaluz de Salud, La Línea de la Concepción, España
| | - Francisco de Paula Téllez-Pérez
- Servicio de Enfermedades Infecciosas, Área de Gestión Sanitaria Campo de Gibraltar, Sistema Andaluz de Salud, La Línea de la Concepción, España
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21
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Outbreak ofBurkholderia cepaciaBacteremia Caused by Contaminated Chlorhexidine in a Hemodialysis Unit. Infect Control Hosp Epidemiol 2015. [DOI: 10.1017/s0195941700026709] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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22
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Ferranti G, Marchesi I, Favale M, Borella P, Bargellini A. Aetiology, source and prevention of waterborne healthcare-associated infections: a review. J Med Microbiol 2014; 63:1247-1259. [DOI: 10.1099/jmm.0.075713-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The purpose of this review is to discuss the scientific literature on waterborne healthcare-associated infections (HCAIs) published from 1990 to 2012. The review focuses on aquatic bacteria and describes both outbreaks and single cases in relation to patient characteristics, the settings and contaminated sources. An overview of diagnostic methods and environmental investigations is summarized in order to provide guidance for future case investigations. Lastly, on the basis of the prevention and control measures adopted, information and recommendations are given. A total of 125 reports were included, 41 describing hospitalized children. All cases were sustained by opportunistic pathogens, mainly Legionellaceae, Pseudomonadaceae and Burkholderiaceae. Hot-water distribution systems were the primary source of legionnaires’ disease, bottled water was mainly colonized by Pseudomonaceae, and Burkholderiaceae were the leading cause of distilled and sterile water contamination. The intensive care unit was the most frequently involved setting, but patient characteristics were the main risk factor, independent of the ward. As it is difficult to avoid water contamination by microbes and disinfection treatments may be insufficient to control the risk of infection, a proactive preventive plan should be put in place. Nursing staff should pay special attention to children and immunosuppressed patients in terms of tap-water exposure and also their personal hygiene, and should regularly use sterile water for rinsing/cleaning devices.
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Affiliation(s)
- Greta Ferranti
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Isabella Marchesi
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Marcella Favale
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Paola Borella
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Annalisa Bargellini
- Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Modena, Italy
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Vardi A, Sirigou A, Lalayanni C, Kachrimanidou M, Kaloyannidis P, Saloum R, Anagnostopoulos A, Sotiropoulos D. An outbreak of Burkholderia cepacia bacteremia in hospitalized hematology patients selectively affecting those with acute myeloid leukemia. Am J Infect Control 2013; 41:312-6. [PMID: 23040605 DOI: 10.1016/j.ajic.2012.04.325] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2012] [Revised: 04/18/2012] [Accepted: 04/18/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Burkholderia cepacia complex (Bcc) is a group of common environmental bacteria that preferentially colonize and infect patients with cystic fibrosis but are also emerging as nosocomial pathogens, possibly due to their resistance to disinfectants and antimicrobials. METHODS We investigated a 3-month outbreak of Bcc bacteremia among hospitalized hematology patients. Environmental investigation and infection control measures were implemented. A retrospective, cross-sectional study was conducted to identify risk factors. RESULTS Bcc was repeatedly isolated from the blood of 9 patients without central venous catheter who did not easily respond to targeted antibiotic treatment and 3 died of the infection. A point source was not identified and horizontal spread was suspected. Strict infection control measures terminated the outbreak. Interestingly, diagnosis of acute myeloid leukemia but not neutropenia or prior chemotherapy was a risk factor for infection acquisition. Neutropenia was positively correlated with infection duration. CONCLUSIONS Bcc is not only a serious threat among immunocompromized hematology patients, but is also transmissible in clinical settings. Acute myeloid leukemia appears to confer additional risk for infection acquisition.
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O'Grady EP, Viteri DF, Sokol PA. A unique regulator contributes to quorum sensing and virulence in Burkholderia cenocepacia. PLoS One 2012; 7:e37611. [PMID: 22624054 PMCID: PMC3356288 DOI: 10.1371/journal.pone.0037611] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 04/23/2012] [Indexed: 01/08/2023] Open
Abstract
Burkholderia cenocepacia causes chronic and life-threatening respiratory infections in immunocompromized people. The B. cenocepacia N-acyl-homoserine lactone (AHL)-dependent quorum sensing system relies on the production of AHLs by the synthases CepI and CciI while CepR, CciR and CepR2 control expression of many genes important for pathogenesis. Downstream from, and co-transcribed with cepI, lies BCAM1871 encoding a hypothetical protein that was uncharacterized prior to this study. Orthologs of B. cenocepacia BCAM1871 are uniquely found in Burkholderia spp and are conserved in their genomic locations in pathogenic Burkholderia. We observed significant effects on AHL activity upon mutation or overexpression of BCAM1871, although these effects were more subtle than those observed for CepI indicating BCAM1871 acts as an enhancer of AHL activity. Transcription of cepI, cepR and cciIR was significantly reduced in the BCAM1871 mutant. Swimming and swarming motilities as well as transcription of fliC, encoding flagellin, were significantly reduced in the BCAM1871 mutant. Protease activity and transcription of zmpA and zmpB, encoding extracellular zinc metalloproteases, were undetectable in the BCAM1871 mutant indicating a more significant effect of mutating BCAM1871 than cepI. Exogenous addition of OHL restored cepI, cepR and fliC transcription but had no effect on motility, protease activity or zmpA or zmpB transcription suggesting AHL-independent effects. The BCAM1871 mutant exhibited significantly reduced virulence in rat chronic respiratory and nematode infection models. Gene expression and phenotypic assays as well as vertebrate and invertebrate infection models showed that BCAM1871 significantly contributes to pathogenesis in B. cenocepacia.
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Affiliation(s)
| | | | - Pamela A. Sokol
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- * E-mail:
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25
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Epidemiology and molecular characterization of a clone of Burkholderia cenocepacia responsible for nosocomial pulmonary tract infections in a French intensive care unit. Diagn Microbiol Infect Dis 2010; 66:29-40. [DOI: 10.1016/j.diagmicrobio.2009.06.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 06/04/2009] [Accepted: 06/08/2009] [Indexed: 11/17/2022]
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Naturally occurring Class A ss-lactamases from the Burkholderia cepacia complex. Antimicrob Agents Chemother 2008; 53:876-82. [PMID: 19075063 DOI: 10.1128/aac.00946-08] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Chromosomally encoded ss-lactamases from the Burkholderia cepacia complex species (formerly Pseudomonas cepacia) were characterized. Cloning and sequencing identified an Ambler class A ss-lactamase (PenB) from B. cenocepacia. It shares 82% amino acid identity with the PenA ss-lactamases previously identified from B. multivorans 249. Its expression was dependent upon a LysR-type regulatory protein. Its narrow-spectrum hydrolysis activity mostly included penicillins but also included expanded-spectrum cephalosporins and aztreonam at lower levels. In that study, Pen-like ss-lactamases (PenC, PenD, PenE, PenF) that shared 63 to 92% identity with PenB from B. cenocepacia were identified from other Burkholderia species. The corresponding ss-lactamase genes might be used as genetic tools for accurate Burkholderia species identification.
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Romero-Gómez MP, Quiles-Melero MI, Peña García P, Gutiérrez Altes A, García de Miguel MA, Jiménez C, Valdezate S, Sáez Nieto JA. Outbreak of Burkholderia cepacia bacteremia caused by contaminated chlorhexidine in a hemodialysis unit. Infect Control Hosp Epidemiol 2008; 29:377-8. [PMID: 18462153 DOI: 10.1086/529032] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Yang CJ, Chen TC, Liao LF, Ma L, Wang CS, Lu PL, Chen YH, Hwan JJ, Siu LK, Huang MS. Nosocomial outbreak of two strains of Burkholderia cepacia caused by contaminated heparin. J Hosp Infect 2008; 69:398-400. [PMID: 18511156 DOI: 10.1016/j.jhin.2008.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Accepted: 03/25/2008] [Indexed: 11/26/2022]
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Yan H, Shi L, Alam M, Li L, Yang L, Yamasaki S. Usefulness of Sau-PCR for molecular epidemiology of nosocomial outbreaks due to Burkholderia cepacia which occurred in a local hospital in Guangzhou, China. Microbiol Immunol 2008; 52:283-6. [DOI: 10.1111/j.1348-0421.2008.00035.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Borges CRM, Lascowski KMS, Filho NR, Pelayo JS. Microbiological quality of water and dialysate in a haemodialysis unit in Ponta Grossa-PR, Brazil. J Appl Microbiol 2008; 103:1791-7. [PMID: 17953589 DOI: 10.1111/j.1365-2672.2007.03431.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS The objective of the study was to determine the microbiological quality of samples of water and dialysate in a haemodialysis unit. METHODS AND RESULTS Seventy-two samples each of water and dialysate were collected during November 2003 to April 2004. The following microbiological analyses were performed: test for total and faecal coliforms, which produced negative results for all the samples; counts of total heterotrophic bacteria, where three samples of water and two of dialysate showed levels higher than those permitted by national standards; and endotoxin assay, which revealed high quantities only in samples of water that preceded reverse osmosis. Nonfermenting Gram-negative bacteria were identified in 54 samples of dialysate and in 26 samples of water. The test for adhesion to an inert surface showed that various bacteria were capable of forming biofilms. Twenty-seven per cent of the bacteria were resistant to sodium hypochlorite at 500 ppm for 10-min contact time. Sixty per cent of the isolates were resistant to three or more antibiotics. CONCLUSIONS Water and dialysate can be a source of infection for patients who need haemodialysis. SIGNIFICANCE AND IMPACT OF THE STUDY An adequate system for water treatment, disinfection of the haemodialysis system and microbiological monitoring of the water and dialysate are necessary to reduce bacteraemia and pyrogenia outbreaks.
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Affiliation(s)
- C R M Borges
- Department of Microbiology, State University of Londrina, Londrina, PR, Brazil
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Menard A, Monnez C, Estrada de Los Santos P, Segonds C, Caballero-Mellado J, Lipuma JJ, Chabanon G, Cournoyer B. Selection of nitrogen-fixing deficient Burkholderia vietnamiensis strains by cystic fibrosis patients: involvement of nif gene deletions and auxotrophic mutations. Environ Microbiol 2007; 9:1176-85. [PMID: 17472633 DOI: 10.1111/j.1462-2920.2007.01240.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Burkholderia vietnamiensis is the third most prevalent species of the Burkholderia cepacia complex (Bcc) found in cystic fibrosis (CF) patients. Its ability at fixing nitrogen makes it one of the main Bcc species showing strong filiations with environmental reservoirs. In this study, 83% (29 over 35) of the B. vietnamiensis CF isolates and 100% of the environmental ones (over 29) were found expressing the dinitrogenase complex (encoded by the nif cluster) which is essential in N(2) fixation. Among the deficient strains, two were found growing with ammonium chloride suggesting that they were defective in N(2) fixation, and four with amino acids supplements suggesting that they were harbouring auxotrophic mutations. To get insights about the genetic events that led to the emergence of the N(2)-fixing defective strains, a genetic analysis of B. vietnamiensis nitrogen-fixing property was undertaken. A 40-kb-long nif cluster and nif regulatory genes were identified within the B. vietnamiensis strain G4 genome sequence, and analysed. Transposon mutagenesis and nifH genetic marker exchanges showed the nif cluster and several other genes like gltB (encoding a subunit of the glutamate synthase) to play a key role in B. vietnamiensis ability at growing in nitrogen-free media. nif cluster DNA probings of restricted genomic DNA blots showed a full deletion of the nif cluster for one of the N(2)-fixing defective strain while the other one showed a genetic organization similar to the one of the G4 strain. For 17% of B. vietnamiensis clinical strains, CF lungs appeared to have favoured the selection of mutations or deletions leading to N(2)-fixing deficiencies.
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Affiliation(s)
- Aymeric Menard
- Research Group on "Bacterial Opportunistic Pathogens and Environment", Université de Lyon, Lyon, F-69003, France
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Estivariz CF, Bhatti LI, Pati R, Jensen B, Arduino MJ, Jernigan D, Lipuma JJ, Srinivasan A. An Outbreak of Burkholderia cepacia Associated With Contamination of Albuterol and Nasal Spray. Chest 2006; 130:1346-53. [PMID: 17099009 DOI: 10.1378/chest.130.5.1346] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Species within the Burkholderia cepacia complex (Bcc) can contaminate medications and disinfectants and cause severe pneumonia in critically ill patients or persons with cystic fibrosis. In March 2004, we investigated a hospital outbreak of Bcc possibly associated with a contaminated nasal spray. METHODS We conducted a matched case-control study, environmental sampling, and observations of infection control practices. Case patients had infection or colonization with Bcc, and control patients had sputum culture not yielding Bcc. Isolates from patients and environmental samples were compared by pulsed-field gel electrophoresis (PFGE). RESULTS Bcc was recovered from sputum in 18 patients. Compared with matched control patients (n = 18), case patients were more likely to be receiving mechanical ventilation (p = 0.01), to have been hospitalized > 6 days (p = 0.01), and to have received antimicrobial treatment within 7 days before sputum collection (p = 0.03). Bcc was cultured from opened, but not unopened, multidose albuterol bottles, a nebulizer attached to a ventilator, and opened and unopened nasal spray bottles from contaminated lots. PFGE showed that isolates from albuterol samples and from patients were indistinguishable but unrelated to the nasal spray strain. Observations revealed improper aseptic techniques during respiratory therapy procedures and inadequate nebulizer cleaning. CONCLUSIONS Despite a temporal association with use of a contaminated nasal spray, this outbreak was caused by extrinsic contamination of multidose albuterol used for nebulization treatments and lack of adherence to infection control precautions. Implementation and re-enforcement of infection control measures successfully terminated the outbreak.
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Affiliation(s)
- Concepcion F Estivariz
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Lo Cascio G, Bonora MG, Zorzi A, Mortani E, Tessitore N, Loschiavo C, Lupo A, Solbiati M, Fontana R. A napkin-associated outbreak of Burkholderia cenocepacia bacteraemia in haemodialysis patients. J Hosp Infect 2006; 64:56-62. [PMID: 16859809 DOI: 10.1016/j.jhin.2006.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2005] [Accepted: 04/13/2006] [Indexed: 11/20/2022]
Abstract
This article reports a catheter-related outbreak of bacteraemia involving 38 patients in two haemodialysis units in Verona. Burkholderia cepacia complex strains were isolated from human blood and from an individually wrapped disinfection napkin that was contained in a commercially available, sterile dressing kit used to handle central venous catheters. Micro-organisms isolated from blood cultures and from the napkin were identified by standard procedures and confirmed as B. cenocepacia (genomovar III) by molecular analysis. Using pulsed-field gel electrophoresis analysis, the clinical isolates were indistinguishable or closely related to the B. cenocepacia isolated from the napkin. In conclusion, this study found that a contaminated commercial napkin soaked in quaternary ammonium, even when quality certified, was the source of infection.
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Affiliation(s)
- G Lo Cascio
- Dipartimento di Patologia, Sezione di Microbiologia, Università di Verona, Verona, Italy.
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Held MR, Begier EM, Beardsley DS, Browne FA, Martinello RA, Baltimore RS, McDonald LC, Jensen B, Hadler JL, Dembry LM. Life-threatening sepsis caused by Burkholderia cepacia from contaminated intravenous flush solutions prepared by a compounding pharmacy in another state. Pediatrics 2006; 118:e212-5. [PMID: 16785290 DOI: 10.1542/peds.2005-2617] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We report 2 life-threatening cases of Burkholderia cepacia sepsis caused by infusate contamination during compounding. Bacterial isolates from the patients' blood cultures and the infusate were indistinguishable by pulsed-field gel electrophoresis. Proper quality controls at a local and national level are important for ensuring safe delivery of compounded medications to patients in all settings, including those outside health care facilities.
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Affiliation(s)
- Melissa R Held
- Department of Pediatrics, Division of Infectious Diseases, Yale University School of Medicine, New Haven, Connecticut, USA.
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Assaad W, Magalhães M, Plesa M, Hart CA, Cornelis P, Winstanley C. Identical Burkholderia cepacia complex strain types isolated from multiple patients attending a hospital in Brazil. J Med Microbiol 2006; 55:247-249. [PMID: 16434721 DOI: 10.1099/jmm.0.46321-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Wail Assaad
- Division of Medical Microbiology and Genitourinary Medicine, University of Liverpool, Daulby Street, Liverpool L69 3GA, United Kingdom
| | - Marcelo Magalhães
- Department of Tropical Medicine, Federal University of Pernambuco, Recife, Brazil
| | - Maria Plesa
- Laboratory of Microbial Interactions, Department of Molecular and Cellular Interactions, Flanders Interuniversity Institute of Biotechnology, Vrije Universiteit Brussel, Brussels, Belgium
| | - C Anthony Hart
- Division of Medical Microbiology and Genitourinary Medicine, University of Liverpool, Daulby Street, Liverpool L69 3GA, United Kingdom
| | - Pierre Cornelis
- Laboratory of Microbial Interactions, Department of Molecular and Cellular Interactions, Flanders Interuniversity Institute of Biotechnology, Vrije Universiteit Brussel, Brussels, Belgium
| | - Craig Winstanley
- Division of Medical Microbiology and Genitourinary Medicine, University of Liverpool, Daulby Street, Liverpool L69 3GA, United Kingdom
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Campana S, Taccetti G, Ravenni N, Favari F, Cariani L, Sciacca A, Savoia D, Collura A, Fiscarelli E, De Intinis G, Busetti M, Cipolloni A, d'Aprile A, Provenzano E, Collebrusco I, Frontini P, Stassi G, Trancassini M, Tovagliari D, Lavitola A, Doherty CJ, Coenye T, Govan JRW, Vandamme P. Transmission of Burkholderia cepacia complex: evidence for new epidemic clones infecting cystic fibrosis patients in Italy. J Clin Microbiol 2005; 43:5136-42. [PMID: 16207975 PMCID: PMC1248445 DOI: 10.1128/jcm.43.10.5136-5142.2005] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To analyze national prevalence, genomovar distribution, and epidemiology of the Burkholderia cepacia complex in Italy, 225 putative B. cepacia complex isolates were obtained from 225 cystic fibrosis (CF) patients attending 18 CF centers. The genomovar status of these isolates was determined by a polyphasic approach, which included whole-cell protein electrophoresis and recA restriction fragment length polymorphism (RFLP) analysis. Two approaches were used to genotype B. cepacia complex isolates: BOX-PCR fingerprinting and pulsed-field gel electrophoresis (PFGE) of genomic macrorestriction fragments. A total of 208 (92%) of 225 isolates belonged to the B. cepacia complex, with Burkholderia cenocepacia as the most prevalent species (61.1%). Clones delineated by PFGE were predominantly linked to a single center; in contrast, BOX-PCR clones were composed of isolates collected either from the same center or from different CF centers and comprised multiple PFGE clusters. Three BOX-PCR clones appeared of special interest. One clone was composed of 17 B. cenocepacia isolates belonging to recA RFLP type H. These isolates were collected from six centers and represented three PFGE clusters. The presence of insertion sequence IS 1363 in all isolates and the comparison with PHDC reference isolates identified this clone as PHDC, an epidemic clone prominent in North American CF patients. The second clone included 22 isolates from eight centers and belonged to recA RFLP type AT. The genomovar status of strains with the latter RFLP type is not known. Most of these isolates belonged to four different PFGE clusters. Finally, a third clone comprised nine B. pyrrocinia isolates belonging to recA RFLP type Se 13. They represented three PFGE clusters and were collected in three CF centers.
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Affiliation(s)
- S Campana
- Department of Pediatrics, Cystic Fibrosis Center, University of Florence, 50132 Florence, Italy.
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Moreira BM, Leobons MBGP, Pellegrino FLPC, Santos M, Teixeira LM, de Andrade Marques E, Sampaio JLM, Pessoa-Silva CL. Ralstonia pickettii and Burkholderia cepacia complex bloodstream infections related to infusion of contaminated water for injection. J Hosp Infect 2005; 60:51-5. [PMID: 15823657 DOI: 10.1016/j.jhin.2004.09.036] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2003] [Accepted: 09/23/2004] [Indexed: 11/29/2022]
Abstract
Ralstonia pickettii and Burkholderia cepacia complex isolates are causes of healthcare-associated infection related to contamination of intravenously administered products. Based on microbiological and epidemiological data and molecular typing by pulsed-field gel electrophoresis, we report the occurrence of two outbreaks of R. pickettii and B. cepacia complex bloodstream infections. The first outbreak occurred from August 1995 to September 1996, and the second outbreak occurred from 28 March to 8 April 1998, affecting adults and neonates, respectively. Infusion of contaminated water for injection was the source of infection.
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Affiliation(s)
- B M Moreira
- Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, CCS, Bloco I, Sala 28, Cidade Universitária, 21941-590 Rio de Janeiro, RJ, Brazil.
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Otağ F, Ersöz G, Salcioğlu M, Bal C, Schneider I, Bauernfeind A. Nosocomial bloodstream infections with Burkholderia stabilis. J Hosp Infect 2005; 59:46-52. [PMID: 15571853 DOI: 10.1016/j.jhin.2004.06.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 06/11/2004] [Indexed: 10/26/2022]
Abstract
Burkholderia stabilis was grown from blood cultures of seven patients presenting with signs and symptoms of septicaemia in the intensive care unit at Mersin University Hospital, Mersin, Turkey between July and October 2002. Four patients had one B. stabilis-positive blood culture, two patients had two, and one patient had four. Isolates from six of seven patients had the same resistotype and random amplified polymorphic DNA analysis type. Despite treatment with ciprofloxacin and imipenem, to which the strains were susceptible, all patients died one to eight days after isolation of B. stabilis from their blood. B. stabilis should be regarded as an opportunistic pathogen that may cause nosocomial bloodstream infections.
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Affiliation(s)
- F Otağ
- Faculty of Medicine, Mersin University, Mersin, Tip Fakultesi, Mikrobiyoloji ve Klinik Mikrobiyoloji AD, 33079 Mersin, Turkey.
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Souza AV, Moreira CR, Pasternak J, Hirata MDL, Saltini DA, Caetano VC, Ciosak S, Azevedo FM, Severino P, Vandamme P, Magalhães VD. Characterizing uncommon Burkholderia cepacia complex isolates from an outbreak in a haemodialysis unit. J Med Microbiol 2004; 53:999-1005. [PMID: 15358822 DOI: 10.1099/jmm.0.45702-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
An outbreak of bacteraemia in a haemodialysis unit where 65 episodes of infection involved 35 outpatients is reported. Burkholderia cepacia complex was the agent most frequently recovered from blood. Thirty-three environmental and clinical isolates of B. cepacia complex were characterized by whole-cell protein electrophoresis and recA-RFLP profile. Fourteen isolates were genomovar I and 16 isolates were not classifiable by their recA-RFLP pattern. Ribotyping, random amplification of polymorphic DNA (RAPD) and integron profile were used to explore the clonality of the isolates, and revealed multiple strain genotypes. Four ribotypes and RAPD types and three integron patterns were identified. The water supply was identified as the source of the outbreak, and inappropriate cleaning and a leak in the reverse osmosis tubing connection were the probable causes of contamination. B. cepacia complex was still recovered from blood of patients even after apparently adequate measures were taken and water quality standards were met, suggesting that higher standards for water quality should be adopted in haemodialysis units. The genomovars recovered here were distinct from those commonly reported for cystic fibrosis isolates.
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Affiliation(s)
- Andrea V Souza
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Cláudia R Moreira
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Jacyr Pasternak
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Maria de Lurdes Hirata
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Denise Alves Saltini
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Viviane Cristina Caetano
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Suely Ciosak
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Fátima M Azevedo
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Patricia Severino
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Peter Vandamme
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
| | - Vanda D Magalhães
- Centro de Pesquisa Experimental, Instituto de Ensino e Pesquisa Albert Einstein - Av. Albert Einstein 627, 05651-901, São Paulo, SP, Brazil 2Infection Control Service, Hospital da Beneficência Portuguesa de São Paulo, São Paulo, Brazil 3Infection Control Service, Hospital Israelita Albert Einstein, São Paulo, Brazil 4Laboratorium voor Microbiologie, Faculteit Wetenschappen, Universiteit Gent, Gent, Belgium
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Manzar S, Nair AK, Pai MG, Al-Khusaiby SM. Pseudo-outbreak of Burkholderia cepacia in a neonatal intensive care unit. J Hosp Infect 2004; 58:159. [PMID: 15474189 DOI: 10.1016/j.jhin.2004.05.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2004] [Indexed: 11/18/2022]
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