A Burkholderia contaminans outbreak in an Intensive Care Unit associated with contaminated bath solution: control and microbiological findings

Background: The Burkholderia cepacia complex (BCC) comprises a group of bacteria with a growing threat as a contaminant of non-sterile solutions. We describe an outbreak of a BCC involving patients at intensive care unit related to a no-rinse bathing solution (NRBS).

Methods: We carried out patients, environmental and laboratory investigation performing analyses of cases, pulsed-field-gel electrophoresis and whole genome sequence (WGS) of isolates.

Results: We investigated 32 cases and 16 isolates that were identified as Burkholderia contaminans, belonging to two different clones. One clone (new ST2175) was identified in 6 sequences (4 from patients; 2 from bath cart samples) and for the remaining 10 isolates (7 isolates from patients; 3 from NRBS) we identified the ST762. The investigation demonstrated that NRBS was the source of the outbreak caused by ST762 clone of B. contaminans.

Discussion: Early suspicion of a common source, rapid implementation of control measures and laboratory support are vital in an outbreak investigation. We also highlight the role of WGS which was very important to conclude our investigation regarding environmental samples and bacterial typing.

Conclusion: We highlight the need to regulation water-based products and the role of WGS for investigate environmental samples.