Case-Crossover Study of Burkholderia cepacia Complex Bloodstream Infection Associated with Contaminated Intravenous Bromopride

Authors:
  • FPFlávia Lúcia Piffano Costa Pellegrino
    Flávia Lúcia Piffano Costa Pellegrino
  • AFAndrea D'Avila Freitas
    Andrea D'Avila Freitas
  • MSMarisa da Silva Santos
    Marisa da Silva Santos
  • GFGiovanna Lanini D'Alemeida Ferraiuoli
    Giovanna Lanini D'Alemeida Ferraiuoli
  • MVMàrcia Regina Guimarães Vasques
    Màrcia Regina Guimarães Vasques
  • EAEfigenia Lourdes Teixeira Amorim
    Efigenia Lourdes Teixeira Amorim
  • SOSandra Oliveira
    Sandra Oliveira
  • SNSimone Aranha Nouér
    Simone Aranha Nouér
  • FCFernando Luiz Lopes Cardoso
    Fernando Luiz Lopes Cardoso
  • LMLuiz Affonso Mascarenhas
    Luiz Affonso Mascarenhas
  • AMAna Cristina Gouveia Magalhães
    Ana Cristina Gouveia Magalhães
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Abstract
Objective.: To investigate an outbreak of healthcare-associated Burkholderia cepacia complex (BCC) primary bloodstream infections (BCC-BSI). Design and Setting.: Case-crossover study in a public hospital, a university hospital and a private hospital in Rio de Janeiro, Brazil, from March 2006 to May 2006. Patients.: Twenty-five patients with BCC-BSI. Design.: After determining the date BCC-BSI symptoms started for each patient, 3 time intervals of data collection were defined, each one with a duration of 3 days: the case period, starting just before BCC-BSI symptoms onset; the control period, starting 6 days before BCC-BSI symptoms onset; and the washout period, comprising the 3 days between the case period and the control period. Exposures evaluated were intravascular solutions and invasive devices and procedures. Potential risk factors were identified by using the McNemar χ2 adjusted test. Cultures of samples of potentially contaminated solutions were performed. BCC strain typing was performed by pulsed-field gel electrophoresis using Spel. Results.: The statistical analysis revealed that the use of bromopride and dipyrone was associated with BCC-BSI. A total of 21 clinical isolates from 17 (68%) of the 25 patients and an isolate obtained from the bromopride vial were available for strain typing. Six pulsotypes were detected. A predominant pulsotype (A) accounted for 11 isolates obtained from 11 patients (65%) in the 3 study hospitals. Conclusion.: Our investigation, using a case-crossover design, of an outbreak of BCC-BSI infections concluded it was polyclonal but likely caused by infusion of contaminated bromopride. The epidemiological finding was validated by microbiological analysis. After recall of contaminated bromopride vials by the manufacturer, the outbreak was controlled.