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Int J Infect Dis. 2018 Oct 17. pii: S1201-9712(18)34554-5. doi: 10.1016/j.ijid.2018.10.008. [Epub ahead of print]

Epidemiological Investigation and Successful Management of Burkholderia cepacia Outbreak in Neuro-Trauma Intensive Care Unit.

Author information

1
Department of Microbiology and Medicne, All India Institute of Medical Sciences, New Delhi, India-110029. Electronic address: neha.rstg@gmail.com.
2
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029.. Electronic address: surbhikhurana.11@gmail.com.
3
Department of Clinical Microbiology, CMC, Vellore, India. Electronic address: vbalaji@cmcvellore.ac.in.
4
Department of Clinical Microbiology, CMC, Vellore, India. Electronic address: francisyesurajansci@gmail.com.
5
Department of Clinical Microbiology, CMC, Vellore, India. Electronic address: suresh874u@gmail.com.
6
Department of Neurosurgery, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029. Electronic address: drdeepakgupta@gmail.com.
7
Department of Neuroanaesthesiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029. Electronic address: keshavgoyal@yahoo.co.in.
8
Department of Neuroanaesthesiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029. Electronic address: dr_ashi2208@yahoo.com.
9
Department of Neuroanaesthesiology, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029. Electronic address: drnavdeep_kumar@yahoo.com.
10
Department of Microbiology, All India Institute of Medical Sciences, New Delhi, India-110029. Electronic address: ashutoshpanda2086@gmail.com.
11
Department of Orthopaedics, Chief, Jai Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029.. Electronic address: rmalhotra62@hotmail.com.
12
Department of Laboratory Medicine, Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India-110029.. Electronic address: purvamathur@yahoo.co.in.

Abstract

OBJECTIVE:

This study describes a detailed epidemiological and molecular characterization of an outbreak of Burkholderia cepacia at a neuro-trauma intensive care unit of a level-1 trauma centre. It emphasizes stringent infection control interventions taken to successfully curb this outbreak.

METHODS:

Clinical and microbiological data was reviewed for the patients, who had more than one blood culture that grew B. cepacia. Bacterial identification and antimicrobial susceptibility was done using automated VITEK II systems. Prospective surveillance, environmental sampling and Multi Locus Sequence Typing (MLST) were done for extensive source tracking. Intensive infection control measures were taken to further control its hospital spread.

RESULTS:

Out of total 48 patients having B. cepacia bacteraemia, 31% (15) had Central line associated blood stream infection. Of the 231 environmental samples collected and screened, only 2 water samples grew B. cepacia with similar phenotypic characteristics. The clinical strains characterised by MLST typing were clonal. Isolates from the water, however represented a novel strain type (ST 1289). Intensive terminal cleaning, disinfection of water supply and augmentation of infection control activities were done to curb the outbreak. Subsequent reductions in bacteraemia cases were observed.

CONCLUSION:

Early diagnosis, appropriate therapy along with rigorous implementation of essential hospital infection control practices is required for successful containment of this pathogen and curbing outbreak.

KEYWORDS:

Burkholderia cepacia; MLST typing; Neuro-trauma unit; Novel ST type; outbreak

PMID:
30342249
DOI:
10.1016/j.ijid.2018.10.008
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