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Objective: This study describes a detailed epidemiological and molecular characterization of an outbreak of Burkholderia cepacia at a neuro-trauma intensive care unit of a level-1 trauma centre. It emphasizes stringent infection control interventions taken to successfully curb this outbreak.
Methods: Clinical and microbiological data was reviewed...
Contexts in source publication
Context 1
... unusually high incidence of BCC in blood cultures from the neurotrauma ICU was observed, which prompted a detailed epidemiological and microbiological investigation (Mathur et al., 2015). The strains had similar colony morphology and unique pigmentation on culture plates (Figure 2). The relevant demographic characteristics and risk factors were assessed and analysed: age, sex, type and mode of trauma, duration of hospitalization, presence of prior antibiotic treatment, clinical co-morbidities, exposure and duration of exposure to central venous access, device days and history of indwelling devices, and clinical outcome. ...
Context 2
... mean time from admission to culture positivity was 8.1 days. Microbial culture demonstrated growth of unusually highly pigmented violet-coloured colonies of 0.5-1 mm, with an entire edge and regular margins, in contrast to typical non-lactose- fermenting colonies of BCC (Figure 2). All clinical isolates obtained had a similar morphological appearance and growth character- istics on microbial culture. ...
Citations
... of B. cepacia in different aspects of healthcare settings [57][58][59][60][61][62][63][64][65][66][67][68]. Burkholderia cepacia is a major concern due to its multi-drug resistant (MDR) nature. ...
... Prevalence in hospitals Documented in burn and ICU units worldwide [57][58][59] Transmission Occurs through contaminated equipment, solutions, and healthcare personnel contact [60][61][62] Common sites of infection CLAB (38.6%), SSTIs (36.4%), vertebral osteomyelitis (18.2%); also reported in urinary tract, prosthetic joints, and central nervous system (lower frequencies) [63][64][65] Antibiotic resistance MDR nature; variable resistance to different antibiotics; lowest resistance observed to imipenem and meropenem in some studies (around 50%); resistance reported to fluoroquinolones, aminoglycosides, and beta-lactams [66][67][68] * The battle against B. cepacia requires a multi-pronged approach. ...
This review explores the paradox of Burkholderia species, a bacterium capable of both beneficial and harmful actions. Genus Burkholderia is a Gram-negative, rod-shaped, motile bacterium with remarkable genetic diversity. It can thrive in diverse environments and exchange genes with other bacteria through horizontal gene transfer. The ambivalence of Burkholderia lies in its potential to act as both a plant pathogen and an opportunistic human pathogen. Early isolations linked it to urinary tract infections and meningitis. However, its true threat emerged for individuals with cystic fibrosis and chronic granulomatous disease, who are susceptible to severe Burkholderia infections like pneumonia and septicemia. Beyond healthcare, Burkholderia exhibits useful applications in agriculture and biotechnology. Certain strains promote plant growth by fixing nitrogen, solubilizing phosphorus, and producing growth hormones. Burkholderia offers promise in bioremediation, degrading pollutants like hydrocarbons, pesticides and heavy metals. However, responsible application is crucial. Environmental contamination, biofilm formation, and potential plant diseases raise concerns. Careful consideration and ongoing research are necessary to mitigate these risks. Biotechnology leverages Burkholderia's diverse functionalities. It produces bioplastics, enzymes, and rhamnolipids with potential applications in various industries. Despite its benefits, it poses a healthcare risk to immunocompromised individuals, causing respiratory infections and hospital outbreaks. Its multi-drug resistance necessitates strict infection control protocols and development of novel treatment strategies. In conclusion, Burkholderia presents a complex picture. While its potential benefits in agriculture and biotechnology are promising, responsible use and continuous research are paramount to exploit its advantages and mitigate potential hazards.
... The role of the host response to infection by SARS-CoV-2 in coronavirus disease 2019 (COVID- 19) disease has been used as a potential target for therapy, and several immunomodulatory treatments have been proposed throughout the outbreak. 2 Steroid therapy use, with varying doses and regimens, and the use of specific biologic drugs such as tocilizumab may lead to profound immune suppression, 3 and use of broad-spectrum antibiotics and multiple antibiotics, sometimes for a prolonged period, may lead to the emergence of drug-resistant pathogens. ...
... This was a prospective, cross-sectional study conducted in the Department of Microbiology, Peerless Hospitex Hospital and Research Center Ltd. for a period of 6 months, spanning from September 2020 to February 2021. A total of 150 patients admitted in both COVID-19 and non-COVID- 19 Intensive therapy units, ICU, and non-ICU wards were enrolled in the study. The study obtained permission from the institutional ethical committee, vide letter number-PHH and RCL/CREC/FM02 dated 9th September 2021. ...
... 18 Both hand hygiene compliance (from 79.8 to 87.8 %) and CVC bundle care compliance (from 75.6 to 89.8 %) had improved significantly after thorough training (►Fig. 1), which is similar to the study conducted by Rastogi et al 19 and these were probably reflected in curbing the rate of BSI following IPC training. In agreement with other studies, coordinated infection control activities such as implementing standard hand hygiene, barrier and contact precautions, cohorting of patients having the same opportunistic infections, environmental surveillance and source tracking, water disinfection, and enhanced and terminal cleaning of the ICUs helped us to decrease BSI rates significantly over next couple of months (March and April 2021) in our hospital (►Fig. ...
Background: Bloodstream infections (BSI) due to opportunistic microbes in the
coronavirus disease 2019 (COVID-19) pandemic lead to high morbidity and mortality
among hospitalized patients. Thus, it is vital to find out the risk factors of BSI and to
learn the ways to mitigate it.
Aim: The aim of this study was to evaluate important risk factors of BSI due to
opportunistic pathogens and to assess the role of the rigid infection control program to
deal with this issue.
Methods: A prospective, cross-sectional study was performed for 6 months on 150
patients admitted in both COVID-19 and non-COVID-19 intensive care units of our
hospital. BSI was confirmed by the BACTEC and Vitek 2 compact system. Prospective
surveillance and environmental sampling were carried out for source tracking along
with rigorous infection control measures and the outcome was analyzed.
Findings: Burkholderia cepacia, Elizabethkingia meningoseptica, Candida auris, vancomycin-resistant Enterococcus, and Achromobacter xylosoxidans were the common
opportunistic pathogens isolated from a single or paired blood sample(s) in our study.
Key risk factors were prolonged intensive care unit stay, central venous access,
mechanical ventilation, immune-compromised condition, and use of biologics. Reverse
osmosis water and used normal saline bottles were the common environmental source
of infection. Following the implementation of precise infection control measures, there
was a sharp decline in BSI cases, which was not attributed to the downfall of COVID-19
cases.
Conclusion: Combined prospective surveillance and environmental sampling helped
to find out the sources and implementation of an intensive and insistent infection
control program that are needed to control opportunistic pathogens mediated BSI.
... In all the five cases, the isolated colonies showed violet pigment production which was a unique feature shown by members of Burkholderia cepacia complex. This is supported in a study by Rastogi et al [15] and Ranjan et al [16] which also highlights the violet pigment producing BCC from blood cultures. ...
Burkholderia cepacia complex (BCC) represent a group of opportunistic organisms that cause a wide variety of infections including the nosocomial. The organism is found to cause sepsis and is also reported to cause blood stream infections in malignancy. Here, we present a case series of five patients with sepsis in which an unsual violet pigment producing BCC was isolated. Keywords: Violet pigment, Burkholderia, Sepsis, Malignancy
... Burkholderia is a diverse genus of gram-negative and obligate aerobic bacteria that are ubiquitously found in the environment and have beneficial biotechnological properties, but at the same time represent well-known pathogens of plants, animals, and humans [1][2][3][4]. Members of the Burkholderia cepacia complex (BCC) have frequently been reported to cause health care-associated infections in critically ill patients and colonizations and infections in patients suffering from cystic fibrosis (CF) [5][6][7][8]. ...
Background
In September 2018, Burkholderia cepacia complex (BCC) infections of three patients associated with exposure to a mouthwash solution (MWS) were notified to the Robert Koch Institute (RKI). As the product was still in the market and scale of the outbreak unclear a nation-wide investigation was initiated.
Methods
We aimed to investigate BCC infections/colonizations associated with MWS. Hospitals, laboratories and public health services were informed that BCC isolates should be sent to the RKI. These isolates were typed by pulsed-field gel electrophoresis (PFGE) and whole genome sequencing (WGS) including development of an ad hoc core genome MLST (cgMLST) scheme.
Results
In total, 36 patients from six hospitals met the case definition, the last patient in November 2018. Twenty-nine isolates from 26 of these patients were available for typing. WGS analysis revealed two distinct cgMLST clusters. Cluster 1 (Burkholderia arboris) contained isolates from patients and MWS obtained from four hospitals and isolates provided by the manufacturer. Patient and MWS isolates from another hospital were assigned to cluster 2 (B. cepacia).
Conclusion
The combined clinical, epidemiological and microbiological investigation, including whole genome analysis, allowed for uncovering a supraregional BCC outbreak in healthcare settings. Strains of B. arboris and B. cepacia were identified as contaminating species of MWS bottles and subsequent colonization and putative infection of patients in several hospitals. Despite a recall of the product by the manufacturer in August 2018 the outbreak lasted until December 2018. Reporting of contaminated medical products and recalls should be optimized to protect patients.
... Regarding Burkholdria cepacia, it is resistant to penicillin (Amoxicillne + Clavulanic Acid, amoxicilline), cephalosporin (Ceftazidime, Cefalotine), β-lactamine (Ceftriaxone, Cefotaxime, Cefoxitine, Oxacilline), Fusidamine, Macrolide, lincosamide TEC. These results are similar with another study concerning resistance to Ceftriaxone but contradictory for sensitivity to Ciprofloxacin [Rastogi et al., 2019]. ...
... In recent years, the Burkholderia cepacia complex has been shown to cause frequent infections and pose medical risks to healthy humans [4e6]. Case reports indicate that this species causes hospital-acquired infections, especially in patients with immunocompromised and chronic lung diseases, such as cystic fibrosis [7,8]. Outbreaks of B. cepacia infections are often associated with contaminated intravenous drugs, medical devices, or skin disinfectants [9]. ...
Penile prolapse is a disease manifested by an inability to retract the penis into the preputial sheath. It is reported in a variety of animal species, especially in young and intact males. However, penile prolapse in horses is commonly caused by trauma, sexual activity, pseudohermaphroditism, or neurological deficits, and less often by an infectious background. The present case report aimed to determine the etiological factor of penis infection associated with penile prolapse in a stallion in Poland. Our report indicates that the infectious background of penile prolapse was related to the Burkholderia cepacia complex. Based on antibiotic susceptibility results, the stallion was administered effective streptomycin and enrofloxacin treatment and recovered without complications. The following options are likely to be the infection source: contamination of hay or animal hygiene products. Finally, given its ability to grow in antiseptic solutions, difficulties in culturing, and innate multidrug resistance, this microorganism is currently a challenge to both detection and treatment in veterinary medicine cases.
... Indeed, the sampling of multiple environmental sources (e.g. bed rails, linen, stethoscopes, carts, ICU furniture, mechanical ventilators and its contours, walls) has been included among the strategies for the successful management of a hospital outbreak of B. cepacia infections in a neurotrauma ICU [22]. Furthermore, detergent and disinfectants were analyzed. ...
... Importantly, only two months after the terminal cleaning of the ICU and the implementation of all BEHA procedures, no further cases of B. cepacia infection were recorded. Moreover, the environmental sampling should include also the healthcare workers, which could be done at regular intervals [22]. Unfortunately, BEHA requires a significant effort in terms of organization and costs and, thus, could not be implemented -or not completely -in hospital settings with restricted resources. ...
This article reports the largest nosocomial outbreak of B. cepacia-related Hospital Acquired Infectios (HAIs) and the epidemiological investigations leading to identification of ultrasound gel as a direct means of infection transmission. Multiple environmental sampling was conducted to identify the source and route of infection. The samples were collected from all sources considered to be potential reservoirs of B. cepacia. Standard methods for pathogen isolation and antibiotic sensitivity testing were used. In all, 61 patients developed B. cepacia-related sepsis and this agent was isolated only from ultrasonography gel. All patients required the placement of a central venous line to receive the chemotherapy for the underlying hematologic disease. The hospital outbreak persisted after identification of the source of infection and it took more than four months to be completely eradicated after the first cases. B. cepacia is a serious threat for hospitalized patients needing invasive procedures, including the central line placement for chemotherapy, regardless of the need of any intensive care. Implementation of protocols for active surveillance of HAIs should also target this opportunistic agent and include periodic sterility control of commonly used medical materials, including ultrasonography gel and equipment.
... It has been recognized as an opportunistic human pathogen since the early 1980s [1]. BCC has been isolated from numerous water sources and wet surfaces, including disinfectants and intravenous fluids [2]. Hospital outbreaks have been reported due to anesthetics, disinfectants, intravenous solutions, nebulizer solutions, mouthwash, and medical devices, including respiratory therapy equipment (Table 1). ...
... Summary of various outbreaks of Burkholderia cepacia complex in hospital setup in India over the last 5 years[2][3][4][5][6][7][8] PICU Pediatric intensive care unit, CCU Cardiac care unit, NICU Neonatal intensive care unit ...
Introduction:
Burkholderia cepacia complex is a ubiquitous organism with a high virulence potential. It is found most commonly in moist environments. Hospital outbreaks have been reported from diverse sources such as contaminated faucets, nebulizers, disinfectant solutions, multidose antibiotic vials, tap water, bottled water, nasal sprays, and ultrasound gels. In this article, we present our experience in investigating and successfully managing an outbreak of nosocomial transmission of Burkholderia cepacia sepsis in the neonatal intensive care unit at SGT Hospital, Haryana, India.
Case presentation:
During the month of March, multiple Burkholderia cepacia complex isolates were recovered from blood cultures of Caucasian babies admitted to the neonatal intensive care unit of our hospital. The organisms were multidrug-resistant, with in vitro sensitivity to meropenem alone (minimum inhibitory concentration = 4 μg/ml). An outbreak was suspected, and the neonatal intensive care unit in-charge and hospital infection control teams were alerted. Outbreak investigation was initiated, and surveillance samples were collected. Burkholderia cepacia complex was successfully isolated from suction apparatus. The isolates were phenotypically typed (biotyping and antimicrobial susceptibility testing) and found to be identical.
Conclusions:
In our study, the index case might have been exposed to infection due to a physiological state of low immunity (preterm, low birth weight, and mechanical ventilation). The rest of the cases might have been exposed to this organism due to inadequate hand hygiene/improper cleaning and disinfection practices. Timely reporting and implementation of infection control measures played a significant role in curtailing this outbreak.
... These results were in agreement with 26 about the causes of contamination with B.cepacia in pharmaceutical companies, insufficient cleaning procedures emphasizing the contamination of the preparation tanks and machines filling in addition the use of one type of disinfectant for long period of time was also a cause of contamination because unfortunately B.cepacia able to survive and multiply in the presence of disinfectants. 9 Many pharmaceutical manufactures will routinely use two "in-use" disinfectants in a specified rotational sequence for the site disinfection program. 11 The authors performed a disinfectant efficacy test of other non-oxidizing disinfectants as Tego (alkyl diazeptane) and Viragri (quaternary ammonium compounds) against the contaminant organism B.cepacia on different surfaces and different contact time as showed in Stage II. ...
Burkholderia cepacia complex (BCC) have recently received a reasonable attention as one of the major risks in susceptible pharmaceutical products. This microorganism can easily spread and cause severe contamination especially to the water stations for pharmaceutical companies. It rapidly grow within the product and cause cystic fibrosis and septicemia in humans.
The traceability of the sources of contamination of pharmaceutical non-sterile aqueous preserved products and how to control it during the manufacturing operations as it is concern with the public health.
: The samples collected for the analysis were taken from different sources provided from the pharmaceutical company such as: aqueous finished products, filling machines, preparation tanks and water stations, identified by API 20NE, Vitek 2 compact system and 16S rRNA.
: From 213 different samples of finished product, 22 bacterial isolates had been identified as Burkholderia cepacia group. Raw materials and primary packaging materials did not result in any bacterial isolates while the machine surfaces and preparation tanks were contaminated. From 384 pharmaceutical water samples, 35 isolates were identified as B.cepacia.
Our study suggests that the chlorine treatment and hydrogen peroxide have a significant effect on B.cepacia in water disinfection.
... Bcc species have been responsible for many outbreaks in different sectors of intensive care units (Abe et al., 2007;Baul et al., 2018;Katsiari et al., 2012;Liao et al., 2011;Rastogi et al., 2019;Srinivasan, Arora, & Sahai, 2016;Vardi et al., 2013). Infections acquired in hospital settings are usually due to contamination of medical devices or ! ...
Bacteria belonging to the Burkholderia cepacia complex (Bcc) are life threatening opportunistic pathogens of cystic fibrosis patients and an emerging cause of serious infections in immune-compromised individuals. These bacteria are intrinsically resistant to clinically used antibiotics, which complicates disease management and treatment. Therefore, it is important to identify and develop new antimicrobial strategies to counteract Bcc infections.It has recently been shown that macrophages are essential for replication of Burkholderia cenocepacia and for triggering acute pro-inflammatory and fatal infection in zebrafish larvae. A major objective of this thesis was to apply Transposon-Directed Insertion Sequencing (TraDIS) to detect mutants with reduced intracellular survival and virulence in zebrafish embryos. Massive parallel sequencing of insertion sequences followed by bioinformatics analysis showed that the use of Himar1 transposon resulted in a large bias for insertion in rRNA and tRNA genes, with over 70% of reads mapped to these genes for yet unknown reasons. Although based on one biological experiment, analysis of the remaining insertion sequences identified several mutants that were absent or underrepresented at 8 and 18 hours post infection, including mutants of the afc cluster, a gene cluster that specifies the production of a compound with antifungal activity. This finding is in agreement with recent studies in the laboratory, showing that the LysR-type transcriptional regulator ShvR and its regulatory target afc are essential for the switch from persistent to acute infection by B. cenocepacia K56-2 in zebrafish embryos. This proof of principle shows the feasibility of identifying bacterial factors important for virulence of intracellular bacteria in zebrafish larvae using transposon-based high throughput screens.B. cenocepacia H111 is closely related to strain K56-2, yet is less virulent in different animal models. We found that constitutive expression of shvR in B. cenocepacia H111 increased virulence in zebrafish larvae to almost K56-2 levels in an afc dependent manner, which strengthens the finding that AFC is a key factor in acute virulence of B. cenocepacia K56-2, and strengthens our hypothesis that differences in regulatory signals between strains may be a major reason for differences in pathogenicity.In a second objective, I further analysed the role of several established bacterial factors in virulence of B. cenocepacia K56-2 in zebrafish embryos. While MgtC slightly contributed to virulence only in older larvae, we found that the zinc metalloprotease zmpA mutant was significantly attenuated in virulence, as found in a rat model of chronic infection. Previous unpublished results obtained in the laboratory have shown that B. cenocepacia K56-2 triggers autophagy in macrophages of infected zebrafish larvae, visualized as labeling of bacteria containing vacuoles with Lc3-GFP. Although no significant differences in the increase of pro-inflammatory gene expression was found, I observed that fewer zmpA containing vacuoles in infected macrophages in vivo recruited Lc3 compared to phagosomes containing wildtype bacteria. Together the data suggest that ZmpA contributes to induction of autophagy and inflammation in infected macrophages in zebrafish. Further research is needed to determine the correlation between bacterial factors, the engagement of the autophagy machinery and the extent of pro-inflammatory responses, which may lead to the discovery of new therapeutic targets against these important opportunistic pathogens.
