Ramon Z Shaban1, Samuel Maloney2, John Gerrard3, Peter Collignon4, Deborough Macbeth5, Marilyn Cruickshank6, Anna Hume7, Amy V Jennison8, Rikki M A Graham8, Haakon Bergh9, Heather L Wilson10, Petra Derrington11. 1. Infection Control Department, Division of Infectious Diseases and Immunology, Gold Coast Hospital and Health Service and Griffith University, Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia. Electronic address: r.shaban@griffith.edu.au. 2. Infectious Diseases and Immunology, Gold Coast Hospital and Health Service, Pathology Queensland, Health Support Queensland, Department of Health, Queensland Government, Gold Coast University Hospital, Southport, Queensland, Australia. 3. Infectious Diseases and Immunology, Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Queensland, Australia. 4. ACT Pathology, The Canberra Hospital, Australian National University School of Medicine, Canberra, Australia. 5. Infection Control Department, Infectious Diseases and Immunology, Gold Coast Hospital and Health Service, Southport, Queensland, Australia. 6. Australasian College for Infection Prevention and Control, School of Nursing and Midwifery, Griffith University, Southport, Queensland, Australia. 7. Medical Microbiology, Gold Coast Hospital and Health Service, Pathology Queensland, Health Support Queensland, Department of Health , Queensland Government, Southport, Queensland, Australia. 8. Molecular Epidemiology, Public Health Microbiology, Forensic and Scientific Services, Health Support Queensland, Department of Health, Queensland Government, Southport, Queensland, Australia. 9. Central Microbiology, Molecular Bacteriology/Quality, Pathology Queensland, Health Support Queensland, Department of Health, Queensland Government, Southport, Queensland, Australia. 10. Microbiology and Antimicrobial Stewardship, Department of Infectious Diseases and Microbiology, Canberra Hospital and Health Services, Garran, Australian Capital Territory, Australia. 11. Pathology Queensland, Health Support Queensland, Department of Health, Queensland Government, Southport, Queensland, Australia.
Abstract
BACKGROUND: We report an outbreak of Burkholderia cenocepacia bacteremia and infection in 11 patients predominately in intensive care units caused by contaminated ultrasound gel used in central line insertion and sterile procedures within 4 hospitals across Australia. METHODS: Burkholderia cenocepacia was first identified in the blood culture of a patient from the intensive care unit at the Gold Coast University Hospital on March 26, 2017, with 3 subsequent cases identified by April 7, 2017. The outbreak response team commenced investigative measures. RESULTS: The outbreak investigation identified the point source as contaminated gel packaged in sachets for use within the sterile ultrasound probe cover. In total, 11 patient isolates of B cenocepacia with the same multilocus sequence type were identified within 4 hospitals across Australia. This typing was the same as identified in the contaminated gel isolate with single nucleotide polymorphism-based typing, demonstrating that all linked isolates clustered together. CONCLUSION: Arresting the national point-source outbreak within multiple jurisdictions was critically reliant on a rapid, integrated, and coordinated response and the use of informal professional networks to first identify it. All institutions where the product is used should look back at Burkholderia sp blood culture isolates for speciation to ensure this outbreak is no larger than currently recognized given likely global distribution.
BACKGROUND: We report an outbreak of Burkholderia cenocepacia bacteremia and infection in 11 patients predominately in intensive care units caused by contaminated ultrasound gel used in central line insertion and sterile procedures within 4 hospitals across Australia. METHODS:Burkholderia cenocepacia was first identified in the blood culture of a patient from the intensive care unit at the Gold Coast University Hospital on March 26, 2017, with 3 subsequent cases identified by April 7, 2017. The outbreak response team commenced investigative measures. RESULTS: The outbreak investigation identified the point source as contaminated gel packaged in sachets for use within the sterile ultrasound probe cover. In total, 11 patient isolates of B cenocepacia with the same multilocus sequence type were identified within 4 hospitals across Australia. This typing was the same as identified in the contaminated gel isolate with single nucleotide polymorphism-based typing, demonstrating that all linked isolates clustered together. CONCLUSION: Arresting the national point-source outbreak within multiple jurisdictions was critically reliant on a rapid, integrated, and coordinated response and the use of informal professional networks to first identify it. All institutions where the product is used should look back at Burkholderia sp blood culture isolates for speciation to ensure this outbreak is no larger than currently recognized given likely global distribution.