Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.
Clin Microbiol Infect. 2013 Sep;19(9):832-7. doi: 10.1111/1469-0691.12047. Epub 2012 Nov 23.
The Burkholderia cepacia complex is a group of Gram-negative bacteria known as respiratory pathogens in cystic fibrosis patients, but also increasingly reported as a cause of healthcare associated infections. We describe an outbreak of B. cepacia bloodstream infections in a referral hospital in Phnom Penh, Cambodia. Over a 1.5-month period, blood cultures from eight adult patients grew B. cepacia. Bloodstream infection occurred after a median of 2.5 days of hospitalisation. Three patients died: 7, 10 and 17 days after blood cultures were sampled. As part of the outbreak investigation, patient files were reviewed and environmental sampling was performed. All patients had peripheral venous catheters that were flushed with Ringer lactate drawn from a 1 L bag, used as multiple-dose vial at the ward. Cultures of unopened Ringer lactate and disinfectants remained sterile but an in-use bag of Ringer lactate solution and the dispensing pin grew B. cepacia. The isolates from patients and flushing solution were identified as B. cepacia by recA gene sequence analysis, and random amplified polymorphic DNA typing confirmed clonal relatedness. The onset of the outbreak had coincided with the introduction of a dispensing pin with a screw fit that did not allow proper disinfection. Re-enforcement of aseptic procedures with sterile syringe and needle has ended the outbreak. Growth of B. cepacia should alert the possibility of healthcare associated infection also in tropical resource-limited settings. The use of multiple-dose vials should be avoided and newly introduced procedures should be assessed for infection control risks.
洋葱伯克霍尔德菌复合体是一组革兰氏阴性细菌,被认为是囊性纤维化患者的呼吸道病原体,但也越来越多地被报道为医疗保健相关感染的原因。我们描述了柬埔寨金边一家转诊医院洋葱伯克霍尔德菌血流感染的暴发。在 1.5 个月的时间里,8 名成年患者的血液培养物中生长出洋葱伯克霍尔德菌。血流感染发生在住院治疗后中位数为 2.5 天。3 名患者死亡:在血液培养物取样后 7、10 和 17 天。作为暴发调查的一部分,对患者病历进行了审查,并进行了环境采样。所有患者均使用外周静脉导管,这些导管用取自 1 升袋的林格乳酸冲洗,在病房中用作多剂量小瓶。未开封的林格乳酸和消毒剂的培养物保持无菌,但在使用中的林格乳酸溶液袋和分配针上生长出洋葱伯克霍尔德菌。患者和冲洗液中的分离株通过 recA 基因序列分析鉴定为洋葱伯克霍尔德菌,随机扩增多态性 DNA 分型证实了克隆相关性。暴发的发生恰逢引入了一种带有螺丝固定的分配针,无法进行适当的消毒。加强无菌注射器和无菌针的无菌程序已结束暴发。在热带资源有限的环境中,也应警惕洋葱伯克霍尔德菌生长引起的医疗保健相关感染的可能性。应避免使用多剂量小瓶,并且应评估新引入的程序以控制感染的风险。