An Outbreak ofBurkholderia cepaciaComplex Infections Associated with Contaminated Liquid Docusate

Abstract

OBJECTIVETo investigate an outbreak ofBurkholderia cepaciacomplex and describe the measures that revealed the source.SETTINGA 629-bed, tertiary-care, pediatric hospital in Houston, Texas.PATIENTSPediatric patients without cystic fibrosis (CF) hospitalized in the pediatric and cardiovascular intensive care units.METHODSWe investigated an outbreak ofB. cepaciacomplex from February through July 2016. Isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR); specific species identification and genotyping were performed at an independent laboratory. The investigation included a detailed review of all cases, direct observation of clinical practices, and respiratory surveillance cultures. Environmental and product cultures were performed at an accredited reference environmental microbiology laboratory.RESULTSOverall, 18 respiratory tract cultures, 5 blood cultures, 4 urine cultures, and 3 stool cultures were positive in 24 patients. Among the 24 patients, 17 had symptomatic infections and 7 were colonized. The median age of the patients was 22.5 months (range, 2–148 months). Rep-PCR typing showed that 21 of 24 cases represented the same strain, which was identified as a novel species within theB. cepaciacomplex. Product cultures of liquid docusate were positive with an identical strain ofB. cepaciacomplex. Local and state health departments, as well as the CDC and FDA, were notified, prompting a multistate investigation.CONCLUSIONSOur investigation revealed an outbreak of a unique strain ofB. cepaciacomplex isolated in clinical specimens from non-CF pediatric patients and from liquid docusate. This resulted in a national alert and voluntary recall by the manufacturer.Infect Control Hosp Epidemiol2017;38:567–573