Ultrasound Gel as a Source of Burkholderia cepacia Sepsis Outbreak in Preterm Neonates

Abstract

Background: In the middle of 2018, we noticed an outbreak of sepsis due to Burkholderia cepacia complex among inborn babies, and this continued till December 2020. These babies were not responding to conventional antibiotic therapy. Aim: To study the clinical profile of neonates with Burkholderia septicemia, to determine its antimicrobial susceptibility patterns, and to identify the source of infection. Materials and methods: This was a retrospective descriptive study conducted in the inborn nursery of the Government Medical College, Thiruvananthapuram for a period of 30 months, from June 2018 to December 2020. All babies whose blood culture was positive for Burkholderia were identified from the records. Microbiological surveillance was done for source identification. Results: Out of the total 2264 neonates admitted during the study period, 84 (3.7%) had Burkholderia cepacia sepsis. The mean gestational age was 31(2) weeks. The most common clinical presentation was feed intolerance (64%) and 12% had a liver abscess. The highest antimicrobial sensitivity was observed for ceftazidime and cotrimoxazole (100%) followed by cefoperazone-sulbactam (98%) and meropenem (94%). The outbreak was controlled by the withdrawal of contaminated muti-use USG gel and the implementation of the practice of single-use sterile USG gel. Conclusions: Gastrointestinal manifestations are predominantly a manifestation in Burkholderia cepacia sepsis and a strong suspicion of liver abscess should be kept in mind. cotrimoxazole and ceftazidime are the best choice of antibiotics. Unsterile ultrasound gel use in the labor room and NICU can be a source of infection