Burkholderia cepacia complex nosocomial outbreaks in India: A scoping review

Burkholderia cepacia complex (Bcc) is an opportunistic pathogen that causes severe infections in immunocompromised individuals. It is a common contaminant of medical drugs, solutions and devices used in healthcare setups. This scoping review aimed to assess Bcc outbreaks in Indian hospital settings and address a wide range of sources to improve outbreak management. As per PRISMA-ScR guidelines, electronic databases 'Embase', 'PubMed' and 'Web of Science' were searched from 1993 to September 2024 to identify studies reporting Burkholderia cepacia complex outbreaks across India. The search identified 22 outbreak reports meeting the inclusion criteria. Bacteremia was the most common presentation in twenty studies, followed by acute-onset post-operative endophthalmitis in two studies. In 14 outbreak studies, B. cepacia was the identified species, whereas five studies had Bcc; one study each had B. cenocepacia, B. multivorans and B. contaminans isolated. Most outbreaks were associated with contaminated pharmaceuticals (45.4%) and medical (18.1%) products in contrast to the environment as a source (13.6%). Multi-locus sequence typing (MLST) was employed to study clonality among isolates in six outbreaks. This review highlights that varied medical products and environmental surfaces/objects can harbour Bcc and act as potential sources of Bcc outbreaks in hospitals. Ensuring immediate identification of Bcc from clinical samples, regular sterility checks, thorough epidemiological investigations, and timely infection control and prevention measures are critical to help manage and prevent these outbreaks and the subsequent mortality.