Burkholderia cepaciaInfections Associated With Intrinsically Contaminated Ultrasound Gel: The Role of Microbial Degradation of Parabens

Abstract

AbstractObjective:To describe an outbreak of serious nosocomialBurkholderia cepaciainfections occurring after transrectal prostate biopsy associated with ultrasound gel intrinsically contaminated with paraben-degrading microorganisms.Methods:A retrospective chart review prompted by a blood culture isolate ofB, cepacia.Identification of microorganisms in ultrasound gel in two Canadian centers and characterization by pulsed-field gel electrophoresis and assays for paraben degradation.Setting:Two Canadian university-affiliated, tertiary-care centers in Newfoundland and Alberta.Results:Six seriousB. cepaciainfections were identified at the two centers. Isolates ofB. cepaciarecovered from the blood of patients from both centers and the ultrasound gel used during the procedures were identical, confirming intrinsic contamination. Strains ofEnterobacter cloacaeisolated from ultrasound gel at the two centers were also identical. The ability to degrade parabens was proven for bothB. cepaciaandE. cloacaestrains recovered from the ultrasound gel.Conclusions:Ultrasound gel is a potential source of infection. Contamination occurs at the time of manufacture, with organisms that degrade parabens, which are commonly used as stabilizing agents. There are far-reaching implications for the infection control community.