Methods: Procedure review, environmental sampling for bacterial culture, rep-PCR
Results: Patient A had multiple myeloma; she developed fatigue and a temperature of 102.2 degrees F three days following her transplant. Three of 3 blood culture sets that day grew B. cepacia, and 1 of 2 was positive 48 hours later. Stem cell cultures before transplant were sterile. Patient B also had myeloma; three days post-transplant she developed a temperature of 100.9 degrees F; in the next 48 hours, 6/6 blood cultures grew B. cepacia. Catheters were removed from both patients; one of two catheter tips grew B cepacia. Both patients received IV ceftazidime followed by oral ciprofloxacin and recovered. Burkholderia spp. was recovered from de-ionized water from a water bath used to defrost stored, frozen stem cells and from 5 swab cultures from water bath surfaces. Cultures from containers and surfaces used in stem cell storage and transport, but not thawing, had no growth or grew another organism (Stenotrophomonas). De-ionized water prepared in a dedicated sink was sterile, but surfaces of a plastic jug used to transport water from this sink to the water bath grew B. cepacia. This jug was not routinely cleaned between uses. B cepacia strains were molecularly typed using rep-PCR. One viable patient strain and two environmental samples had identical molecular fingerprints. Sterile water replaced de-ionized water and no further cases occurred.
Conclusion: Sterility is crucial for all products in contact with IV infused materials. To our knowledge, this is the first reported case of infection by Burkholderia spp. present in ambient deionized water in immunocompromised individuals undergoing autologous stem cell transplantation. Enhanced awareness needs to be exercised for opportunistic water borne pathogens in these settings.
K. M. Papp-Wallace, None
S. Rudin, None
R. A. Bonomo, Merck: Grant Investigator , Grant recipient
Allergan: Grant Investigator , Grant recipient
Wockhardt: Grant Investigator , Grant recipient
H. Fung, None
M. Doherty, None
P. Axelrod, None
S. Becka, None