Boszczowski Icaro, do Prado Gladys Villas Boas, Dalben Mirian F, Telles Roberto C P, Freire Maristela Pinheiro, Guimarães Thaís, Oliveira Maura S, Rosa Juliana F, Soares Robson E, Llacer Pedro Enrique Dorlhiac, Dulley Frederico Luiz, Costa Silvia F, Levin Anna S
Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil, Infection Control Department, Hospital das Clinicas, Universidade de São Paulo, SP, Brazil.
Department of Infectious Diseases and LIM-54, University of São Paulo, São PauloSP, Brazil, Department of Infectious Diseases and LIM-54, University of São Paulo, São Paulo, SP, Brazil.
Rev Inst Med Trop Sao Paulo. 2014 Jan-Feb;56(1):71-6. doi: 10.1590/S0036-46652014000100011.
The objective was to describe an outbreak of bloodstream infections by Burkholderia cepacia complex (Bcc) in bone marrow transplant and hematology outpatients.
On February 15, 2008 a Bcc outbreak was suspected. 24 cases were identified. Demographic and clinical data were evaluated. Environment and healthcare workers' (HCW) hands were cultured. Species were determined and typed. Reinforcement of hand hygiene, central venous catheter (CVC) care, infusion therapy, and maintenance of laminar flow cabinet were undertaken. 16 different HCWs had cared for the CVCs. Multi-dose heparin and saline were prepared on counter common to both units.
14 patients had B. multivorans (one patient had also B. cenopacia), six non-multivorans Bcc and one did not belong to Bcc. Clone A B. multivorans occurred in 12 patients (from Hematology); in 10 their CVC had been used on February 11/12. Environmental and HCW cultures were negative. All patients were treated with meropenem, and ceftazidime lock-therapy. Eight patients (30%) were hospitalized. No deaths occurred. After control measures (multidose vial for single patient; CVC lock with ceftazidime; cleaning of laminar flow cabinet; hand hygiene improvement; use of cabinet to store prepared medication), no new cases occurred.
This polyclonal outbreak may be explained by a common source containing multiple species of Bcc, maybe the laminar flow cabinet common to both units. There may have been contamination by B. multivorans (clone A) of multi-dose vials.
描述骨髓移植和血液科门诊中由洋葱伯克霍尔德菌复合体（Bcc）引起的血流感染暴发情况。
2008年2月15日怀疑发生了Bcc暴发。共识别出24例病例。对人口统计学和临床数据进行了评估。对环境和医护人员的手部进行了培养。确定了菌种并进行了分型。加强了手部卫生、中心静脉导管（CVC）护理、输液治疗以及层流柜的维护。16名不同的医护人员护理过CVC。多剂量肝素和生理盐水在两个科室共用的柜台上配制。
14例患者感染了多食伯克霍尔德菌（1例患者还感染了洋葱伯克霍尔德菌），6例感染了非多食Bcc，1例不属于Bcc。克隆A多食伯克霍尔德菌在12例患者中出现（来自血液科）；其中10例患者的CVC在2月11日/12日使用过。环境和医护人员培养结果均为阴性。所有患者均接受了美罗培南治疗以及头孢他啶封管治疗。8例患者（30%）住院治疗。无死亡病例发生。采取控制措施（为单患者使用多剂量小瓶；用头孢他啶封管CVC；清洁层流柜；改善手部卫生；使用柜子储存配制好的药物）后，未出现新病例。
此次多克隆暴发可能是由含有多种Bcc菌种的共同来源引起的，可能是两个科室共用的层流柜。多剂量小瓶可能被多食伯克霍尔德菌（克隆A）污染。
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