When it rains it pours – or at least that seems to be the typical modus operandi when it comes to outbreaks or new bugs popping up. Last week was the announcement of E. coli with the mcr-1 gene in a human patient in the US. This week it’s a notice sent out by APIC and the CDC about clusters of Burkholderia cepacia in PICUs asking for healthcare professionals to report any clusters of B. cepacia directly to the CDC.
According the email I received from APIC, the CDC has received several reports about clusters of B. cepacia infections seen in patients not associated with cystic fibrosis, which is more common. The isolates from at least 2 states have matching strain types suggesting there is a common source. Burkholderia is a gram-negative bacterium that is commonly found in soil and water, and while it is not a pathogen that is typically a medical risk to healthy people, it is often resistant to antibiotics. The type of infection can range from no symptoms to serious respiratory infections, especially with cystic fibrosis patients.
The fact that several states have found the same strain is concerning as there have been past outbreaks associated with transmission as a result of contaminated medicines and devices including a 2004 voluntary recall of an over-the-counter nasal spray due to contamination, a 2004 outbreak lined to exposure to sublingual probes and a 2005 outbreak with clusters of pneumonia and other infections associated with a contaminated mouthwash.
Due to the ubiquitous nature of Burkholderia, it can be spread to susceptible persons via direct person-to-person contact and contact with contaminated environmental surfaces and fomites. The fact that these bacteria can readily be found in the environment makes cleaning and disinfection important, particularly in manufacturing facilities where as noted above, clusters of infections have been associated with contaminated mouthwash, nasal spray and medical devices. Once in a healthcare facility cleaning and disinfection and strict adherence to hand hygiene needs to be considered to avoid indirect transmission to patients through contact with contaminated surfaces or contaminated hands of healthcare workers.
It will be interesting to follow this investigation as the CDC works to determine what the common source for these clusters are. You can be sure that I’ll be keeping my fingers crossed that it is found quickly and the number of PICU patients infected can be minimized!
Bugging Off - with the hopes that next week I’ll continue on the journey of our Disinfection Dysfunction story!