347. Non-Clonal Outbreak of Burkholderia cepacia Complex in the Intensive Care Unit Confirmed by Genomic Analysis and Eradicated after Terminal Cleaning of the Unit
Session: Poster Abstract Session: HAI: Outbreaks
Thursday, October 8, 2015
Room: Poster Hall
Posters
  • B cepacia poster final.pdf (753.8 kB)
  • Background:  Burkholderia cepacia complex (BCC) has been implicated in nosocomial outbreaks of respiratory infections and in critically ill patients. Patient-to-patient cross-transmission has also been described. The aim of this study was to investigate a suspected outbreak of BCC carriage among non-cystic fibrosis (CF) patients in an intensive care unit (ICU).

    Methods:  In May 2014 a suspected outbreak of BCC prompted closure and terminal cleaning of an ICU. Environmental and surveillance cultures were obtained before and after terminal cleaning. Education of nurses and respiratory therapists was provided. Contact precautions were implemented for all patients colonized or infected with BCC and other significant epidemiologic organisms. Patients in the ICU ≥48 hours with a positive BCC culture were identified.  Whole genome sequencing (WGS) was performed on a subset of isolates that best fit the criteria of a clonal outbreak.

    Results: Positive cultures for BCC were recovered in 28 patients from 9/17/13 to 6/30/14. There were no further positive BCC cultures after this time. The median age was 65 years, 65% were male, and 61% white. The median length of stay (LOS) was 65 days; the median ICU LOS was 33 days. Median LOS prior to a positive BCC culture was 25 days; the median ICU LOS prior to a positive BCC culture was 19 days. The mean total duration of mechanical ventilation was 44 days (28 days prior to BCC infection). All patients had >1 central venous catheter with 54% on total parenteral nutrition within 7 days of BCC infection. The cohort was also notable for 28% requiring renal replacement therapy; 32% solid organ transplant recipients within 6 months of BCC infection. Culture sources included 50% respiratory tract and 25% blood. Only 18% met criteria for ventilator associated pneumonia. 71.4% were on systemic antibiotics in the 7 days prior to the first positive BCC culture. WGS of positive cultures obtained from clinical, surveillance and environmental cultures showed that the outbreak was polyclonal and heterogeneous; no point source for the BCC outbreak was identified.

    Conclusion:  Genomic analysis demonstrated a non-clonal outbreak of BCC in an intensive care unit. Terminal cleaning of the entire unit eradicated the outbreak.

    Rabea Khedimi, MD1, Gopi Patel, MD1, Roopa Kohli-Seth, MD2, Camille Hamula, PhD3, Theodore Pak, AB4, Deena Altman, MD1,4, Martha Lewis, BS4, Elizabeth Somers, BS4, Robert Sebra, Ph.D.4, Harm Van Bakel, PhD4, Ali Bashir, PhD4, Andrew Kasarskis, Ph.D4, Fran Wallach, MD5 and Shirish Huprikar, MD1, (1)Infectious Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, (2)Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, (3)Microbiology, Icahn School of Medicine at Mount Sinai, New York, NY, (4)Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, (5)Infectious Disease, Icahn School of Medicine at Mount Sinai, New York, NY

    Disclosures:

    R. Khedimi, None

    G. Patel, None

    R. Kohli-Seth, None

    C. Hamula, None

    T. Pak, None

    D. Altman, None

    M. Lewis, None

    E. Somers, None

    R. Sebra, None

    H. Van Bakel, None

    A. Bashir, None

    A. Kasarskis, None

    F. Wallach, None

    S. Huprikar, None

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