Down the sink: the local experience of a Burkholderia cenocepacia outbreak at the Canberra Hospital

Dr Heather Wilson1, Dr Karina Kennedy1, Ms Shannon Broadrick1, Ms Fiona Kimber1, Ms Wendy Beckingham1, Prof Peter Collignon1

1Canberra Hospital And Health Services, Canberra, Australia

Introduction:

Burkholderia cenocepacia is an environmental organism and an unusual isolate from blood, although is a recognised cause of nosocomial outbreaks due to contamination of various fluids. B. cenocepacia bacteraemia in two patients in the Canberra Hospital ICU prompted an investigation into a common source.

Methods:

Clinical and epidemiological data were obtained from the patients’ medical records. Clinical and environmental specimens were cultured and identified by MALDI-TOF (Bruker). Further characterisation, using recA gene sequencing and whole genome sequencing, was performed at Queensland Pathology.

Results:

The finding that our two patients occupied the same bed within hours of having the blood cultures collected directed environmental testing of the area. B. cepacia complex was grown from a hand wash basin next to the bed, however recA sequencing subsequently identified this as B. multivorans. Central line insertion using ultrasound guidance was also identified as a common exposure, and in collaboration with colleagues in Queensland, B. cenocepacia was cultured from one brand of ‘sterile’ ultrasound gel. The concentration of organisms in the gel was 100 CFU/µl. A coordinated hospital response led by infection prevention and control resulted in a rapid withdrawal of the contaminated product from the hospital. There have been no further clinical isolates.

Conclusion:

Heavily contaminated ‘sterile’ ultrasound gel was identified as the source of a B. cenocepacia outbreak. Molecular techniques are essential to identify members of the B. cepacia complex to the species level in order to direct the appropriate infection control response. Collaborative action allowed early containment of the outbreak.


Conclusion:

Heavily contaminated ‘sterile’ ultrasound gel was identified as the source of a B. cenocepacia outbreak. Molecular techniques are essential to identify members of the B. cepacia complex to the species level in order to direct the appropriate infection control response. Collaborative action allowed early containment of the outbreak.