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Systematic review of healthcare-associated Burkholderia cepacia complex outbreaks: presentation, causes and outbreak
Emmanuel Häfliger1, Andrew Atkinson1, Jonas Marschall1
1Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland.
Insights
Healthcare-associated outbreaks of Burkholderia cepacia complex (BCC) are often linked to contaminated medical products. This review highlights the need for stricter regulations and standardized reporting of BCC outbreaks in hospitals.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Microbiology
Background:
- The Burkholderia cepacia complex (BCC) is a known cause of healthcare-associated outbreaks.
- Previous systematic analyses of nosocomial BCC outbreaks are lacking.
Purpose of the Study:
- To systematically review and analyze reported nosocomial outbreaks caused by the Burkholderia cepacia complex (BCC).
Main Methods:
- A systematic literature search was conducted using Embase, Pubmed, and conference abstracts.
- Studies published from 1971 to September 2019 reporting nosocomial BCC outbreaks were included.
Main Results:
- 111 outbreak reports were identified, primarily in academic and community hospitals.
- Contaminated medical solutions/medications (53.2%) and disinfectants (12%) were the most common sources.
- Multidrug resistance was observed in 26.1% of BCC strains, and PFGE was the most common typing method.
Conclusions:
- Medical products are the leading cause of BCC outbreaks, emphasizing the need for improved product safety and regulation.
- While BCC-related mortality was low, significant variability in outbreak investigation and reporting was noted.
Background:
Over the past decades, the Burkholderia cepacia complex (BCC) has been linked to multiple healthcare-associated outbreaks. No systematic analysis of these outbreaks has been carried out to date. The aim of this study was to conduct a systematic review of reports on nosocomial BCC outbreaks.
Methods:
Published studies from 1971 until 9/12/2019 presenting nosocomial BCC outbreaks were identified using Embase, Pubmed and abstracts from professional meetings.
Results:
We identified a total of 111 outbreak reports. Thirty-two percent of the affected institutions were academic hospitals and 43.8% community hospitals. The average outbreak duration was 198.6 ± 604.4 days. A total of 240 deaths (10% of the 2390 case patients) were reported but only 28 (1.2% of the 2390 case patients and 11.7% of the 240 deaths) were directly attributable to BCC. The source could be identified in 73.9% of the outbreaks; 53.2% were caused by contaminated medical solutions and medications, 12% were due to a contaminated disinfectant. In 28.2% of the outbreaks intrinsic product contamination was reported. Multidrug resistance was noted in 26.1% of the BCC strains. PFGE was the most frequently used typing method (43.2%) in the context of outbreak work-up.
Conclusion:
Medical products are the most frequent source of BCC outbreaks, representing over half of the identified sources, with 12% of the outbreaks caused by disinfectant products. Intrinsic product contamination was detected frequently, suggesting a need for stricter regulation. While BCC-related mortality was low, our systematic review revealed significant heterogeneity in both investigations and reporting of BCC outbreaks.
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