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Vazquez Deida AA, Spicer KB, McNamara KX, Arduino MJ, Gable P, Halpin AL, Caverly LJ, LiPuma JJ, Bardach B, Mayle C, Baird SN, Czaja CA, Chinn R, Siegel JD, Perkins KM. Burkholderia multivorans Infections Associated with Use of Ice and Water from Ice Machines for Patient Care Activities - Four Hospitals, California and Colorado, 2020-2024. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:883-887. [PMID: 39361547 DOI: 10.15585/mmwr.mm7339a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/05/2024]
Abstract
Ice machines can harbor water-related organisms, and the use of ice or tap water for clinical care activities has been associated with infections in health care settings. During 2021-2022, a total of 23 cases of infection by Burkholderia multivorans (sequence type ST659) were reported at two southern California hospitals and linked to contaminated ice and water from ice machines. In addition to these 23 cases, this report also includes 23 previously unreported cases of B. multivorans ST659 infections that occurred during 2020-2024: 13 at a northern California hospital, eight at a hospital in Colorado, and two additional cases at one of the southern California hospitals. The same brand of ice machine and brands of filters, descaling, and sanitizing products were used by all four hospitals; B. multivorans was isolated from samples collected from ice machines in two of the hospitals. Whole genome sequencing indicated that all clinical and ice machine isolates were highly genetically similar (0-14 single nucleotide variant differences across 81% of the selected reference genome). Recommendations from public health officials to halt the outbreak included avoiding ice and tap water during clinical care activities. An investigation is ongoing to determine possible sources of ice machine contamination. During outbreaks of water-related organisms in health care facilities, health care personnel should consider avoiding the use of tap water, including ice and water from ice machines, for patient care.
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Casale R, Boattini M, Comini S, Bastos P, Corcione S, De Rosa FG, Bianco G, Costa C. Clinical and microbiological features of positive blood culture episodes caused by non-fermenting gram-negative bacilli other than Pseudomonas and Acinetobacter species (2020-2023). Infection 2024:10.1007/s15010-024-02342-6. [PMID: 38990473 DOI: 10.1007/s15010-024-02342-6] [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: 06/10/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION Non-fermenting Gram-negative bacilli (NFGNB) other than Pseudomonas aeruginosa and Acinetobacter baumannii complex are pathogens of interest due to their ability to cause health-care associated infections and display complex drug resistance phenotypes. However, their clinical and microbiological landscape is still poorly characterized. METHODS Observational retrospective study including all hospitalized patients presenting with a positive positive blood culture (BC) episode caused by less common NFGNB over a four-year period (January 2020-December 2023). Clinical-microbiological features and factors associated with mortality were investigated. RESULTS Sixty-six less common NFGNB isolates other than Pseudomonas and Acinetobacter species causing 63 positive BC episodes were recovered from 60 patients. Positive BC episodes were predominantly sustained by Stenotrophomonas maltophilia (49.2%) followed by Achromobacter species (15.9%) that exhibited the most complex resistance phenotype. Positive BC episodes had bloodstream infection criteria in 95.2% of cases (60 out 63), being intravascular device (30.2%) and respiratory tract (19.1%) the main sources of infection. Fourteen-day, 30-day, and in-hospital mortality rates were 6.4%, 9.5%, and 15.9%, respectively. The longer time from admission to the positive BC episode, older age, diabetes, admission due to sepsis, and higher Charlson Comorbidity Index were identified as the main predictors of in-hospital mortality. CONCLUSIONS Positive BC episodes sustained by NFGNB other than Pseudomonas and Acinetobacter species were predominantly sustained by Stenotrophomonas maltophilia and Achromobacter species, having bloodstream infection criteria in the vast majority of cases. Factors that have emerged to be associated with mortality highlighted how these species may have more room in prolonged hospitalisation and at the end of life for patients with chronic organ diseases.
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Affiliation(s)
- Roberto Casale
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, Turin, 10126, Italy
| | - Matteo Boattini
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy.
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, Turin, 10126, Italy.
- Lisbon Academic Medical Centre, Lisbon, Portugal.
| | - Sara Comini
- Operative Unit of Clinical Pathology, Carlo Urbani Hospital, Jesi, 60035, Italy
| | - Paulo Bastos
- Department of Medical and Clinical Pharmacology, Toulouse University Hospital, Toulouse, France
| | - Silvia Corcione
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, 10124, Italy
| | - Francesco Giuseppe De Rosa
- Department of Medical Sciences, Infectious Diseases, University of Turin, Turin, 10124, Italy
- Unit of Infectious Diseases, Cardinal Massaia Hospital, Asti, 14100, Italy
| | - Gabriele Bianco
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Department of Experimental Medicine, University of Salento, Via Provinciale Monteroni n. 165, Lecce, 73100, Italy
| | - Cristina Costa
- Department of Public Health and Paediatrics, University of Turin, Turin, Italy
- Microbiology and Virology Unit, University Hospital Città della Salute e della Scienza di Torino, Corso Bramante 88/90, Turin, 10126, Italy
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Ibrahim T, Abdallah TA, Abdallah A, Qazi R, Alimam A, Mohammad H, Eltayeb F, Daghfal J, Ali M, Hadi HA. Epidemiology, microbiological, clinical characteristics, and outcome of Burkholderia cepacia complex infections in non-cystic fibrosis adult patients from Qatar. IJID REGIONS 2024; 11:100355. [PMID: 38617502 PMCID: PMC11015122 DOI: 10.1016/j.ijregi.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 04/16/2024]
Abstract
Objectives Burkholderia species infections are associated with diverse and challenging clinical presentations because of distinct virulence and antimicrobial resistance factors. The study aims to evaluate the epidemiology, microbiological, and clinical outcomes of Burkholderia cepacia complex (Bcc) infections in non-cystic fibrosis (CF) patients from Qatar. Methods A retrospective study was conducted on adult patients across all hospitals at Hamad Medical Corporation between January 2012 and December 2018 to evaluate clinically relevant Bcc in non-CF adult patients. Results Over 7 years, 72 episodes of Burkholderia species infections were recorded, 64 were secondary to Bcc primarily affecting males (78.12%) with a mean age of 53 years, from the Middle and Southeastern region (92.2%) affected predominantly by diabetes mellitus (34.4%), chronic kidney (23.4%), coronary heart (20.3%), and hypertensive diseases (17.2%) while recent hospitalization and admission to critical care were evident in 45.3% and 93.8% of cases, respectively. Main infection sites were urinary (43.8%) and respiratory (29.7%) with associated bacteremia recorded in 26.6% of cases. Microbiological characteristics demonstrated high-level resistance profiles leading to delayed microbiological clearance in case of bacteremia (61%) and management with multiple therapeutic agents (range 4-6) resulting in disease resolution in 90.6% of cases with observed 30-day mortality of 7.8%. Conclusions B. cepacia infections are infrequent, recorded mainly in middle-aged males with chronic comorbidities presenting as urinary, respiratory, and bacteremia associated with hospitalization, admission to critical care, and invasive procedures. High-level antimicrobial resistance is observed necessitating multiple therapeutic agents and suboptimal bacteriological clearance.
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Affiliation(s)
- Tawheeda Ibrahim
- Department of Bariatric Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Ahmed Abdallah
- Departmnet of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Rabia Qazi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Abeir Alimam
- Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hashim Mohammad
- Departmnet of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Faiha Eltayeb
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Joanne Daghfal
- Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Maisa Ali
- Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Abdel Hadi
- Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
- College of Medicine, Qatar University, Doha, Qatar
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Yu P, Yang R, Cen C. Evaluation of the prevention effect of high-quality nursing quality control in disinfection supply center on nosocomial infection. Medicine (Baltimore) 2024; 103:e35459. [PMID: 38215132 PMCID: PMC10783402 DOI: 10.1097/md.0000000000035459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 01/14/2024] Open
Abstract
To explore the application effect of high-quality nursing quality control in disinfection supply center. The control group consisted of 1850 medical devices managed using the conventional quality control mode from January 2021 to December 2021, while the observation group consisted of 1900 medical devices managed using the high-quality nursing quality control mode from January 2022 to December 2022. The qualified rates of equipment cleaning, sterilization, and packaging were analyzed in both the observation and control groups. The occurrence of nosocomial infections in 2021 and 2022 were compared, and the changes in the Beck-Srivaatava stress scale index (BSSI) and Symptom Checklist-90 scores of the staff before and after implementing the high-quality nursing quality control mode were analyzed. The qualified rate of equipment cleaning, sterilization, and packaging in the observation group were 99.08%, 99.73%, and 99.78%, respectively, which were significantly higher than those in the control group (P < .05). The incidence of nosocomial infections in interventional and surgical cases in 2022 was 0.79%, which was significantly lower than that in 2021 (P < .05). The BSSI score of female staff was (68.76 ± 7.81) points, which was higher than that of male staff (P < .05). After the implementation of the high-quality nursing quality control mode, the BSSI score of the staff was (47.76 ± 9.12) points, which was significantly lower than that before implementation (P < .05). After the implementation of the high-quality nursing quality control mode, the staff's Symptom Checklist-90 scores for somatization, compulsion, interpersonal sensitivity, depression, hostility, and paranoia were (1.28 ± 0.29), (1.53 ± 0.24), (1.50 ± 0.21), (1.46 ± 0.32), (1.44 ± 0.26), and (1.38 ± 0.30) points, respectively, showing a decrease compared to before implementation (P < .05). The high-quality nursing quality control mode has great application value in the disinfection supply center. It can effectively improve the qualified rates of equipment cleaning, sterilization, and packaging, prevent nosocomial infections and improve the working pressure and psychological health of staff.
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Affiliation(s)
- Ping Yu
- Central Sterile Supply Department, Renhe Hospital Affiliated to China Three Gorges University, Yichang, Hubei, China
| | - Rong Yang
- Department of Nursing, Renhe Hospital Affiliated to China Three Gorges University, Yichang, Hubei, China
| | - Changfei Cen
- Department of Critical Care Medicine, Renhe Hospital Affiliated to China Three Gorges University, Yichang, Hubei, China
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Al Zunitan M, Aldawood F, El-Saed A, Azzam M, Abou Yassine K, Alshammari L, Alshamrani MM. Two consecutive outbreaks caused by chlorhexidine mouthwash contaminated with Burkholderia contaminans in a two-hospital tertiary care system. J Hosp Infect 2023; 142:96-104. [PMID: 37852538 DOI: 10.1016/j.jhin.2023.10.005] [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: 07/13/2023] [Revised: 10/06/2023] [Accepted: 10/06/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Hospital outbreaks caused by Burkholderia spp. have been linked to contamination of several medical solutions and products and are frequently associated with delayed detection and high mortality. AIM To describe the management of two consecutive Burkholderia contaminans outbreaks caused by contaminated mouthwash of different brands during the COVID-19 pandemic. METHODS This was a retrospective cohort study of all patients involved in two outbreaks caused by B. contaminans detected in 2021 and 2022. The investigation was initiated after a cluster of positive respiratory specimens, followed by retrospective and prospective case-finding. FINDINGS A total of 69 patients were affected, 47 in 2021 and 22 in 2022. The majority of affected patients had positive respiratory specimens (85.5%); 55.1% of cases had COVID-19, and 72.5% had multidrug-resistant organisms. Almost all (97.1%) patients required ventilation and 42.0% died. Seventeen percent of cases in the first outbreak were deemed to have been acquired by patient-to-patient transmission, whereas all of the cases in the second outbreak were infected directly from using mouthwash. The experience gained from the first outbreak and the formation of a multidisciplinary Infection Control Rapid Response Team resulted in more rapid recognition and control of the second outbreak. Multivariate analysis showed that older age, intensive care unit admission, and COVID-19 infection were independent predictors of mortality. CONCLUSION Burkholderia outbreaks at the time of COVID-19 were associated with high mortality. Rapid detection and response by a dedicated experienced team (as in the second outbreak) can reduce mortality and prevent superimposed cross-transmission between patients.
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Affiliation(s)
- M Al Zunitan
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - F Aldawood
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - A El-Saed
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Community Medicine Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - M Azzam
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - K Abou Yassine
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - L Alshammari
- Infection Prevention and Control Department, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia
| | - M M Alshamrani
- Infection Prevention and Control Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia; King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Singhal T, Wani S, Shah S, Thakkar P, Vidisha Daiya, Veeraraghavan B. Burkholderia cepacia complex as a cause of community acquired bacteremia in a young immuncompetent male. Indian J Med Microbiol 2023; 46:100422. [PMID: 37945116 DOI: 10.1016/j.ijmmb.2023.100422] [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: 12/21/2022] [Revised: 06/18/2023] [Accepted: 06/26/2023] [Indexed: 11/12/2023]
Abstract
Burkholderia cepacia complex (BCC) is a well-recognized cause of nosocomial infections. We describe here a young healthy male who presented with fever and chest pain with ECG changes of acute pericarditis. Two sets of blood cultures at separate timings grew gram negative bacilli identified as BCC by molecular methods. The patient responded to intravenous ceftazidime despite high ceftazidime MIC's. The source of infection was probably contaminated nasal spray/nasal saline wash which he used after a balloon sinoplasty procedure one month ago. Issues related to accurate identification and susceptibility testing of BCC are also discussed.
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Affiliation(s)
- Tanu Singhal
- Department of Infectious Disease, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Sunil Wani
- Department of Cardiology, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Sweta Shah
- Department of Microbiology and Infection Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Pooja Thakkar
- Department of Microbiology and Infection Control, Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Vidisha Daiya
- Department of Infectious Disease. Kokilaben Dhirubhai Ambani Hospital and Medical Research Institute, Mumbai, India.
| | - Balaji Veeraraghavan
- The Hilda Lazarus Core Research Chair, Christian Medical College & Hospital, Vellore, India.
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Batool A, Yaqoob A, Anwar Z, Joshi LT, Batool R, Lone D, Saleem Z, Ahmed Q, Bin Jardan YA, Bourhia M, Qamar MU. Outbreak investigation of NDM-producing Burkholderia cepacia causing neonatal sepsis in Pakistan. Future Microbiol 2023; 18:1159-1169. [PMID: 37850347 DOI: 10.2217/fmb-2023-0063] [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: 03/16/2023] [Accepted: 08/03/2023] [Indexed: 10/19/2023] Open
Abstract
Aim: To investigate the outbreak of Burkholderia cepacia complex (BCC), mortality, antimicrobial resistance and associated risk factors in the neonatal intensive care unit. Method: Eighteen blood culture samples from neonates and twenty swab samples from different neonatal intensive care unit surfaces were collected. The VITEK 2 was used to confirm the isolates and generate the antibiogram. PCR was used to identify blaNDM. Results: Eighteen samples tested positive for BCC, and 10/18 (55.5%) of the neonates died. 13/18 (72%) of the neonates had late-onset neonatal sepsis, and 10/18 (55%) had low birth weight. Resistance to minocycline and chloramphenicol was 100%, 72.2% to meropenem; 72.2% NDM gene was found in neonates and was 20% from the environment. Conclusion: Outbreak of NDM-producing BCC resulting in high neonatal mortality in NICU.
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Affiliation(s)
- Alia Batool
- Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Asma Yaqoob
- Department of Pathology, Aziz Fatima Medical & Dental College, Faisalabad, Pakistan
| | - Zahid Anwar
- Department of Paediatrics, Department of Paediatrics, Fatima Memorial Hospital College of Medicine & Dentistry, Lahore, Pakistan
| | - Lovleen Tina Joshi
- Peninsula School of Dentistry, Faculty of Health, University of Plymouth, Plymouth, PL4 8AA, UK
| | - Ramsha Batool
- Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Durreshahwar Lone
- Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, Bahauddin Zakariya University, Multan, Pakistan
| | - Qasim Ahmed
- Department of Pathology, Fatima Memorial Hospital College of Medicine and Dentistry, Lahore, Pakistan
| | - Yousef A Bin Jardan
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 11451, Riyadh, Saudi Arabia
| | - Mohammed Bourhia
- Department of Chemistry & Biochemistry, Faculty of Medicine & Pharmacy, Ibn Zohr University, Laayoune 70000, Morocco
| | - Muhammad Usman Qamar
- Intitute of Microbiology, Faculty of Life Sciences, Government College University, Faisalabad, 38000, Pakistan
- Division of Infectious Diseases, Department of Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
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Teoh Z, Ankrum AL, Meinzen-Derr J, Weingartner M, Goebel MJ, Scaggs Huang F, Schaffzin JK. An outbreak of Burkholderia contaminans at a quaternary children's hospital linked to equipment reprocessing. Infect Control Hosp Epidemiol 2023; 44:1267-1273. [PMID: 36102334 PMCID: PMC11151214 DOI: 10.1017/ice.2022.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Burkholderia cepacia complex (BCC) has been increasingly implicated in local and multistate outbreaks in both adult and pediatric healthcare settings. However, a lack of source identification may be common for BCC outbreak investigations. We describe, in detail, the investigation of an outbreak of BCC (B. contaminans) among pediatric patients at a large quaternary-care children's hospital and our system-level changes and outcomes.
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Affiliation(s)
- Zheyi Teoh
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Andrea L Ankrum
- Department of Infection Prevention & Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jareen Meinzen-Derr
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - MaryAnn Weingartner
- Department of Infection Prevention & Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Mary Jo Goebel
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Felicia Scaggs Huang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Infection Prevention & Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
| | - Joshua K Schaffzin
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Infection Prevention & Control, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati Medical Center, Cincinnati, Ohio
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Shen BJ, Wang JT, Chang HT, Chang SC, Liao CH. Single-Center Experience of Control of Ventilator-Circuit-Transmitted Burkholderia cepacia Outbreak in an Intensive Care Unit. Trop Med Infect Dis 2023; 8:335. [PMID: 37505631 PMCID: PMC10384831 DOI: 10.3390/tropicalmed8070335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/29/2023] Open
Abstract
Burkholderia cepacia is an emerging nosocomial pathogen frequently associated with outbreaks, but the exact transmission route of this pathogen can at times be elusive in spite of extensive environmental investigative cultures. Active surveillance for sputum cultures was performed for all patients from September 2008 to September 2009 in an intensive care unit (ICU) with B. cepacia outbreak. With evidence of persistent positive conversion of sputum cultures (colonization) and infections among patients, discontinuing re-usable ventilator circuits was introduced. A total of 689 patients were admitted to this unit for a mean duration of 8.7 ± 7.5 days. There were 489 patients (71.0%) with a stay for one to ten days; 161 (23.4%) patients for 11 to 20 days; and 39 (5.7%) with over 20 days. In the first group, 13.5% of patients had cultures converting from negative to positive, in contrast to 66.7% in the last group (p < 0.01). With intervention of using disposable ventilator circuits since June 2009, the incidence of isolated B. cepacia decreased gradually. The estimated 30-day isolation-free probabilities of the groups before, during, one month (August 2009) after, and two months (September 2009) after this intervention were 38.5%, 47.3%, 66.5%, and 96.0%, respectively (p < 0.01). Furthermore, the effect of discontinuing reusable ventilator circuit persisted in the following 6 years; both total isolates of B. cepacia and the infection caused by it were much lower compared to the outbreak period. In summary, this six-year outbreak in a medical ICU persisted until reusable ventilator circuits were discontinued in 2009. The effect of disposable circuits on the decreased incidence of B. cepacia infection maintained in the following years.
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Affiliation(s)
- Bing-Jie Shen
- Department of Radiation Oncology, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City 24352, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
| | - Jann-Tay Wang
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Hou-Tai Chang
- Department of Critical Care Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
| | - Shan-Chwen Chang
- Division of Infectious Disease, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100225, Taiwan
| | - Chun-Hsing Liao
- Division of Infectious Disease, Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City 22060, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei 100147, Taiwan
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10
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Jia Y, Liu Y, Liu Y, Yang K, Liu Y. Clinical characteristics, drug resistance and death risk factors of Burkholderia cepacia infection in hematopoietic stem cell transplant patients. BMC Infect Dis 2022; 22:777. [PMID: 36203152 PMCID: PMC9535976 DOI: 10.1186/s12879-022-07754-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 09/20/2022] [Indexed: 11/17/2022] Open
Abstract
Background Burkholderia cepacia (BC) has been detected more and more in infected patients in recent years. However, as a high-risk population, the clinical characteristics and prognosis of BC infection in hematopoietic stem cell transplantation (HSCT) patients have not been reported. The purpose of this study is to obtain data that will help fill in the gaps in this field, provide evidence for reducing the mortality rate of BC infection in HSCT patients, and guide the use of antibiotics in the future. Methods Electronic medical records of patients with BC infection who underwent HSCT in Xiangya Hospital of Central South University from September 1, 2015 to August 31, 2021 were collected. At the same time, 1:1 case–control matching was conducted according to gender, age and disease type. Comparisons between patients with/without BC infection and respiratory failure were made respectively, and the sensitivity of BC to five clinically commonly used antibiotics was also evaluated. Univariate and multivariate analyses were performed to identify independent risk factors for death. Results The most common site of BC infection in HSCT patients was the lung (75%). Although BC infection rate (3.74%) and antibiotic resistance were not significant, it was closely associated with a higher risk of death (P = 0.022), which even further increased to 90.9% when combined with respiratory failure (P = 0.008). Procalcitonin > 10 µg/L (HR = 40.88, 95% CI 6.51–256.63, P = 0.000) and septic shock (HR = 4.08, 95% CI 1.02–16.33, P = 0.047) were two independent risk factors for death. Conclusion HSCT patients with BC infection are in critical condition, and the management of respiratory infection should be especially strengthened to improve the prognosis of these patients.
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Affiliation(s)
- Yan Jia
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Ya Liu
- Department of Gastroenterologyy, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, China
| | - Yi Liu
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Kaitai Yang
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China
| | - Yanfeng Liu
- Department of Hematology, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China.
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11
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Rhee C, Baker MA, Tucker R, Vaidya V, Holtzman M, Seethala RR, Bentain-Melanson M, Lenox J, Smith AR, Boyer JC, Gassett A, Brigl M, Sater M, Huntley M, Woolley AE, Goldberg HJ, Reilly K, Resnick A, Pearson M, Klompas M. Cluster of Burkholderia cepacia Complex Infections Associated with Extracorporeal Membrane Oxygenation Water Heater Devices. Clin Infect Dis 2022; 75:1610-1617. [PMID: 35271726 DOI: 10.1093/cid/ciac200] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Burkholderia cepacia complex is a group of potential nosocomial pathogens often linked to contaminated water. We report on a cluster of 8 B.cepacia complex infections in cardiothoracic ICU patients attributed to contaminated ECMO water heaters. METHODS In December 2020, we identified an increase in B.cepacia complex infections in the cardiothoracic ICU at Brigham and Women's Hospital. We sought commonalities, sequenced isolates, obtained environmental specimens, and enacted mitigation measures. RESULTS Whole genome sequencing of 13 B.cepacia complex clinical specimens between November 2020-February 2021 identified 6 clonally related isolates, speciated as Burkholderia contaminans. All 6 occurred in patients on ECMO. Microbiology review identified two additional B.contaminans cases from June 2020, including one ECMO patient, that may have been cluster-related as well. All 8 definite/probable cluster cases required treatment; 3 died and 3 developed recurrent infections. After ECMO was identified as the major commonality, all 9 of the hospital's ECMO water heaters were cultured; all grew B.contaminans. Air sampling adjacent to the water heaters was culture-negative. Water heater touch screens were culture-positive for B.contaminans. The sink drain in the ECMO heater reprocessing room also grew clonal B.contaminans. Observations of reprocessing revealed opportunities for cross-contamination between devices via splash from the contaminated sink. The cluster was aborted by removing all water heaters from clinical service. CONCLUSIONS We identified a cluster of 8 B.cepacia complex infections associated with contaminated ECMO water heaters. This cluster underscores the potential risks associated with water-based ECMO heaters and, more broadly, water-based care for vulnerable patients.
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Affiliation(s)
- Chanu Rhee
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Meghan A Baker
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | | | | | | | | | | | | | | | - Jon C Boyer
- Brigham and Women's Hospital, Boston, MA, USA
| | | | | | | | | | | | | | | | | | | | - Michael Klompas
- Brigham and Women's Hospital, Boston, MA, USA.,Department of Population Medicine, Harvard Medical School / Harvard Pilgrim Health Care Institute, Boston, MA, USA
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12
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Frensch M, Jäger C, Müller PF, Tadić A, Wilhelm I, Wehrum S, Diedrich B, Fischer B, Meléndez AV, Dengjel J, Eibel H, Römer W. Bacterial lectin BambL acts as a B cell superantigen. Cell Mol Life Sci 2021; 78:8165-8186. [PMID: 34731252 PMCID: PMC8629787 DOI: 10.1007/s00018-021-04009-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
B cell superantigens crosslink conserved domains of B cell receptors (BCRs) and cause dysregulated, polyclonal B cell activation irrespective of normal BCR-antigen complementarity. The cells typically succumb to activation-induced cell death, which can impede the adaptive immune response and favor infection. In the present study, we demonstrate that the fucose-binding lectin of Burkholderia ambifaria, BambL, bears functional resemblance to B cell superantigens. By engaging surface glycans, the bacterial lectin activated human peripheral blood B cells, which manifested in the surface expression of CD69, CD54 and CD86 but became increasingly cytotoxic at higher concentrations. The effects were sensitive to BCR pathway inhibitors and excess fucose, which corroborates a glycan-driven mode of action. Interactome analyses in a model cell line suggest BambL binds directly to glycans of the BCR and regulatory coreceptors. In vitro, BambL triggered BCR signaling and induced CD19 internalization and degradation. Owing to the lectin's six binding sites, we propose a BCR activation model in which BambL functions as a clustering hub for receptor glycans, modulates normal BCR regulation, and induces cell death through exhaustive activation.
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Affiliation(s)
- Marco Frensch
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- International Max Planck Research School for Molecular and Cellular Biology (IMPRS-MCB), Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany
| | - Christina Jäger
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Peter F Müller
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Annamaria Tadić
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Isabel Wilhelm
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany
| | - Sarah Wehrum
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
| | - Britta Diedrich
- Department of Biology, University of Fribourg, Fribourg, Switzerland
- Department of Dermatology, University Medical Center and University of Freiburg, Freiburg, Germany
| | - Beate Fischer
- Center for Chronic Immunodeficiency, CCI and University Medical Center Freiburg, Freiburg, Germany
| | - Ana Valeria Meléndez
- Faculty of Biology, University of Freiburg, Freiburg, Germany
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany
| | - Joern Dengjel
- Department of Biology, University of Fribourg, Fribourg, Switzerland
- Department of Dermatology, University Medical Center and University of Freiburg, Freiburg, Germany
| | - Hermann Eibel
- Center for Chronic Immunodeficiency, CCI and University Medical Center Freiburg, Freiburg, Germany.
| | - Winfried Römer
- Faculty of Biology, University of Freiburg, Freiburg, Germany.
- Signaling Research Centers BIOSS and CIBSS, University of Freiburg, Freiburg, Germany.
- International Max Planck Research School for Molecular and Cellular Biology (IMPRS-MCB), Max Planck Institute of Immunobiology and Epigenetics, Freiburg, Germany.
- Spemann Graduate School of Biology and Medicine (SGBM), University of Freiburg, Freiburg, Germany.
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany.
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Schulz-Stübner S. [Infection Prevention in the Intensive Care Unit (ICU)]. Anasthesiol Intensivmed Notfallmed Schmerzther 2021; 56:485-501. [PMID: 34298569 DOI: 10.1055/a-1249-5156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Secondary to the underlying disease, the need for invasive devices and frequent drug-induced changes in immunocompetence and microbiota, critically ill patients have a high risk of suffering nosocomial infections. According to data from the European Centre for Disease Prevention and Control (ECDC) this affects 8,4% of patients treated in an ICU for more than 48 hours. Key points of infection prevention are maintenance of the patients' microbiota and sometimes individually chosen interventions to its restoration or focused manipulation; development and implementation of care bundles for frequently used medical devices and invasive treatments (esp. intravenous catheters and invasive ventilation); adequate staffing not only for physicians, nurses and other medical staff but also for housekeeping staff, infection surveillance and motivational feedback, patient empowerment and visitor involvement. Functional building design and well organized logistics assist in achieving infection prevention goals by fostering adherence to basic hygiene procedure, esp. hand hygiene and risk-adjusted use of personal protective equipment. Daily interdisciplinary rounds following the principles of crew resource management strategies allow the structured check for unnecessary devices and inadequate use of antiinfective agents in particular and the discussion of all aspects of the patients' situation in general.
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Inter-hospital outbreak of Burkholderia cepacia complex VAP caused by contaminated mouthwash in coronavirus disease 2019 (COVID-19) patients. Infect Control Hosp Epidemiol 2021; 43:1081-1083. [PMID: 33866991 PMCID: PMC8485014 DOI: 10.1017/ice.2021.183] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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