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An outbreak of Burkholderia cepacia complex exit site infection among peritoneal dialysis patients caused by
Lily Shui-Kuen Cheng1, Sandy Ka-Yee Chau1, Wai-Shan Chan2
1Department of Pathology, United Christian Hospital, Hong Kong Special Administrative Region.
Background:
Wound dressing is intended to provide a physical barrier from microorganisms. Spray dressing is convenient and can be applied to wounds of various contours. In July 2020, a cluster of four Burkholderia cepacia complex (BCC) exit site infections was identified among peritoneal dialysis patients in a regional hospital in Hong Kong. In response, our hospital infection control team conducted an epidemiologic investigation.
Methods:
We conducted a retrospective cohort study of peritoneal dialysis patients with culture-confirmed BCC exit site infections from January 2011 to July 2020. Outbreak investigations, including case finding, molecular typing and post-outbreak surveillance, were performed.
Discussion:
A substantial increase in BCC exit site infections has been observed since 2013, rising from 0.23 in 2012 to 1.09 episodes per 100 patient-year in 2015, with the number of cases in the first half of 2020 already surpassing the total from 2019. The potential source had been traced to a spray dressing introduced to exit site care in December 2012. Burkholderia cepacia complex was isolated from both the unopened and in-use sprays from the same lot. Multilocus sequence typing analysis confirmed their genetic relatedness. The spray dressing was subsequently removed from exit site care. Post-outbreak surveillance over two years showed a marked and sustained decrease in BCC exit site infection.
Conclusion:
Water-based spray dressing can be a source of BCC causing wound infections. The use of contaminated spray dressing, especially in chronic wounds with proximity to indwelling catheters, may pose an inherent risk to patients.
Insights
Contaminated spray dressings caused Burkholderia cepacia complex (BCC) infections in peritoneal dialysis patients. Removing the implicated spray dressing led to a significant decrease in BCC exit site infections, highlighting a critical risk in wound care.
Area of Science:
- Infectious Diseases
- Medical Microbiology
- Public Health
Background:
- A cluster of four Burkholderia cepacia complex (BCC) exit site infections occurred in peritoneal dialysis (PD) patients in Hong Kong in July 2020.
- The infections prompted an epidemiologic investigation by the hospital infection control team.
Purpose of the Study:
- To investigate the cause of a cluster of BCC exit site infections in PD patients.
- To identify the source of infection and implement control measures.
Main Methods:
- A retrospective cohort study was conducted on PD patients with culture-confirmed BCC exit site infections from January 2011 to July 2020.
- Epidemiologic investigations included case finding, molecular typing (multilocus sequence typing), and post-outbreak surveillance.
Main Results:
- A significant increase in BCC exit site infections was observed starting in 2013, with a peak in 2015 and a continued rise in 2020.
- The potential source was traced to a specific lot of spray dressing introduced in December 2012.
- BCC was isolated from both unopened and in-use spray dressing containers, and molecular typing confirmed the genetic relatedness of isolates from patients and the dressing.
Conclusions:
- Water-based spray dressings can serve as a reservoir for BCC, leading to wound infections.
- Contaminated spray dressings pose an inherent risk to patients, particularly those with chronic wounds near indwelling catheters.
- Removal of the contaminated spray dressing resulted in a sustained decrease in BCC exit site infections.
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