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Multi-institutional outbreak of Burkholderia cepacia complex associated with contaminated mannitol solution prepared

Maria Beatriz Souza Dias1, Larissa G T Cavassin, Valeska Stempliuk

  • 1Infection Control Department, Hospital Sírio Libanês, São Paulo, Brazil.

American Journal of Infection Control
|May 14, 2013
PubMed
Abstract

Insights

A Burkholderia cepacia complex (BCC) outbreak was linked to contaminated 3% mannitol solution used in urologic surgery. Larger volumes of the contaminated solution increased infection risk, highlighting manufacturing contamination as a key issue.

Area of Science:

  • Infectious Diseases
  • Hospital Epidemiology
  • Microbiology

Background:

  • Nosocomial outbreaks caused by Burkholderia cepacia complex (BCC) are a significant concern in healthcare settings.
  • This study investigates a specific outbreak of BCC infections linked to a contaminated medical product.

Purpose of the Study:

  • To describe an outbreak of Burkholderia cepacia complex (BCC) infections.
  • To identify risk factors associated with these nosocomial infections.
  • To determine the source of contamination, specifically a 3% mannitol solution.

Main Methods:

  • Retrospective chart review and case-control study design.
  • Inclusion of hospitalized patients undergoing urologic surgery who received intraoperative irrigation with 3% mannitol solution.
  • Procedural review and culture of the mannitol solution to identify the causative agent.

Main Results:

  • Seven cases of BCC infections were identified in patients.
  • BCC isolates were recovered from patient samples (blood/urine) and from the mannitol solution lots.
  • Increased volume of contaminated mannitol solution was a significant risk factor for infection (OR, 1.5; P < .05).
  • The contaminating organism was also found in mannitol lots used at other hospitals.

Conclusions:

  • Manipulated mannitol solution can serve as a source of nosocomial infections.
  • Contamination likely occurred during the manufacturing process at a compounding pharmacy.
  • Effective infection control measures and inter-hospital communication were crucial in preventing further spread.
Keywords:
Endoscopic urological surgeryExtrinisic contaminationHealth care-associated infectionOutbreak investigation

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