The Children's Hospital, Denver, Colorado 80045, USA.
Infect Control Hosp Epidemiol. 2011 Aug;32(8):804-10. doi: 10.1086/660876.
To determine the source of Burkholderia cepacia complex associated with a hospital outbreak and describe the measures taken to identify and confirm the source.
A 250-bed, tertiary care pediatric hospital in Denver, Colorado.
An epidemiologic investigation was used to identify possible causes for an apparent outbreak of B. cepacia complex in pediatric patients who had new positive cultures with this organism from December 2003 to February 2004. Chart review, microbiology reports, surgical records, site visits, literature review, staff interviews, and cultures of common products and equipment were performed to determine a source of contamination. Random amplified polymorphic DNA and pulsed-field gel electrophoresis typing, performed by 2 independent laboratories, were used for molecular typing of patient and source isolates.
Five pediatric patients had new positive B. cepacia complex cultures from either the sinus or the respiratory tract, and all 5 patients had prior exposure to 0.05% oxymetazoline hydrochloride Major Twice-A-Day 12-hour nasal spray (Proforma, Miami, FL). Four of the 5 patients had isolates that were identical to the B. cepacia complex isolates recovered from the unopened Twice-A-Day 12-hour nasal spray.
Intrinsic contamination of Major Twice-A-Day 12-hour nasal spray with B. cepacia complex resulted in nosocomial transmission to 4 patients at our facility and resulted in a voluntary product recall by the manufacturer. B. cepacia complex species are common contaminants of an increasing variety of nonsterile medical products. Enhanced culture techniques may be useful in evaluating possible product contamination, suggesting additional measures that should be considered to assure the safety of products that may be used in high-risk patients.
确定与医院暴发相关的洋葱伯克霍尔德菌复合体的来源，并描述确定和确认来源所采取的措施。
科罗拉多州丹佛市一家拥有 250 张床位的三级儿科医院。
采用流行病学调查方法，对 2003 年 12 月至 2004 年 2 月期间患有新的洋葱伯克霍尔德菌复合体阳性培养物的儿科患者进行调查，以确定这一明显暴发的可能原因。对图表审查、微生物学报告、手术记录、现场访问、文献复习、工作人员访谈以及常见产品和设备的培养物进行了评估，以确定污染来源。随机扩增多态性 DNA 和脉冲场凝胶电泳分型，由 2 个独立的实验室进行，用于对患者和来源分离物进行分子分型。
5 名儿科患者的鼻窦或呼吸道有新的洋葱伯克霍尔德菌复合体阳性培养物，所有 5 名患者均有使用 0.05%羟甲唑啉盐酸 major twice-a-day 12 小时鼻喷剂（Proforma，迈阿密，佛罗里达州）的既往暴露史。5 名患者中有 4 名患者的分离物与从未开封的 major twice-a-day 12 小时鼻喷剂中回收的洋葱伯克霍尔德菌复合体分离物完全相同。
major twice-a-day 12 小时鼻喷剂固有污染与洋葱伯克霍尔德菌复合体一起导致我们医院的 4 名患者发生医院内传播，并导致制造商自愿召回该产品。伯克霍尔德菌复合体种是越来越多种非无菌医疗产品的常见污染物。增强的培养技术可能有助于评估可能的产品污染，提示应考虑采取其他措施，以确保可能用于高危患者的产品的安全性。
