An outbreak of Burkholderia cepacia complex infections in pediatric, non-cystic fibrosis, patients

Background: The Burkholderia cepacia complex includes several related, yet distinct species of gram-negative bacteria typically seen in patients with cystic fibrosis (CF). B. cepacia has also been implicated in healthcare-associated outbreaks that have resulted in recalls of contaminated products and devices.

Methods: We investigated a cluster of children in our pediatric and cardiovascular intensive care units with clinical specimens positive for B. cepacia. Cases were defined as non-CF patients with admissions to the units between February 1 and May 13, 2016 with any clinical specimen positive for B. cepacia. All isolates were evaluated for molecular relatedness with repetitive extragenic palindromic polymerase chain reaction (rep-PCR) in the molecular microbiology laboratory at Texas ChildrenÕs Hospital and sent to the Burkholderia cepacia Research Laboratory and Repository at University of Michigan for species identification and confirmatory genotyping. The investigation included detailed review of all cases, direct observation of clinical practices, respiratory surveillance cultures, and environmental and product cultures. Local and State health departments, as well as the CDC and FDA were notified.

Results: A total of 18 cases were identified. The range in ages for cases was 2 months to 12 years. Underlying conditions included pulmonary hypertension and congenital heart disease. Cultures were positive in the following specimens: 14 respiratory, 4 urine, and 3 blood. Rep-PCR typing showed that 15 of the 18 isolates represented the same strain, which was identified as a novel species within the B. cepacia complex.  No surveillance cultures were positive. Environmental and product cultures did not reveal a source.  Modified infection control practices included increased environment of care rounds, placing cases on special contact isolation, removal of multi-dose bottles of ultrasound gel, and cleaning of feeding supplies with sterile or distilled water only.

Conclusion: Our investigation revealed an outbreak with a unique strain of B. cepacia complex in non-CF pediatric patients. To date, direct observation of clinical practices, environmental and product cultures were unable to identify a source.

Figure 1: Epidemic curve