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BACKGROUND: Burkholderia cepacia complex is a group of Gram-negative bacilli found naturally in soil and water that are important pathogens in community and hospital settings for immunocompromised people and those with chronic lung diseases, particularly cystic fibrosis (CF). Healthcare-associated outbreaks of B. cepacia involving patients without CF have also been associated with contaminated medical solutions and equipment. In October 2013, the Kentucky Department for Public Health (KDPH) received reports of B. cepacia-positive cultures from five non-CF ICU patients in Hospital A, a large academic medical center, occurring over a 19-day period. KDPH and the Infection Prevention and Control team of Hospital A conducted an investigation to identify the source of the infections.
METHODS: Active surveillance was conducted to identify additional hospital-acquired cases. A case-control study was conducted with 15 case-patients and 33 control-patients selected randomly from among all non-CF Hospital A patients who spent ≥72 hours in one of the affected ICUs during the period September 1, 2013 to March 1, 2014. Cases and controls were compared on a number of putative demographic and clinical risk factors in bivariable analyses using Fisher’s exact test and Student’s T test for categorical and numeric variables respectively. Logistic regression was used to calculate multivariable-adjusted odds ratios and 95% confidence intervals. Environmental cultures were collected from products used on case-patients, sinks, wash basins, dialysis hook-ups and ventilator tubing and from medical equipment reprocessing areas.
RESULTS: A total of 15 hospital-acquired, non-CF B. cepacia cases were identified during the study period. In bivariable analyses, the only risk factors that were significantly associated with case status were tracheotomy (OR 14.0, 95% CI 2.4-97.6) and bronchoscopy (OR 24.1, 95% CI 3.8-246.6). In a logistic regression model including tracheotomy, bronchoscopy, sex (which had an elevated but non-significant OR) and mechanical ventilation (which was marginally significant with a p value < 0.10), only bronchoscopy remained significantly associated with case status (aOR 10.0, 95% CI 1.4-70.8). A dose-response analysis showed the odds of being infected with B. cepacia increased with the number of bronchoscopies a patient had (Chi-square for trend 15.68, p-value <0.01). Cultures of environmental samples were all negative for B. cepacia.
CONCLUSIONS: Although environmental samples were all negative, we identified contamination of bronchoscopes from a common source as a possible cause of the outbreak. After the supply-water filter for the bronchoscope reprocessing equipment was replaced, no further cases were identified.