Investigation and control of an outbreak of urinary tract infections caused by Burkholderia cepacian-contaminated anesthetic gel

Abstract

Background: This report describes an outbreak of 71 patients developed B. cepacia urinary tract infection (UTI) by contaminated single-use anesthetic gel.

Methods: Epidemiological investigation of patients with B. cepacia-positive urine or blood samples between March 19, 2018 and Novemeber 15, 2018 was conducted to identify the source of infection. Microbiological samples from hospital surfaces, endoscopes, disposable items, and the hands of staff were tested for B. cepacia contamination. Pulsed-field gel electrophoresis (PFGE) was used to compare homology in B. cepacia isolates.

Results: During the outbreak, nosocomial B. cepacia UTI was confirmed in 71 patients. Epidemiological investigation showed that 66 patients underwent invasive urological diagnosis and treatment, while the remaining five patients underwent bedside indwelling catheterization, with all patients exposed to single-use anesthetic gel. All batches of anesthetic gel were recalled and the outbreak abated. Overall, 155 samples were collected from environmental surfaces and disposable items, and B. cepacia contamination was confirmed in samples from one used cystoscope and three anesthetic gels from the same batch. PFGE showed homology between 17 out of 20 B. cepacia isolates from patients and three isolates from the contaminated anesthetic gel. All patients achieved cure.

Conclusion: Contaminated single-use anesthetic gel was confirmed as the source of the B. cepacia outbreak, with infection occurring during invasive urological diagnostic and treatments. Thus, investigations of nosocomial outbreaks of B. cepacia infection should consider contamination of diagnostic and treatment items used in infected patients.

Keywords: B. cepacia; Outbreak; Urinary tract infection.

Fig. 1

Epidemiological curve of the B. cepacia UTI outbreak. Even after implementing infection control measures, cases of infection continued to occur until the contaminated anesthetic gel was recalled and the outbreak terminated. a A report on August 21, 2018 showed that most B. cepacia infections originated prior to hospital admission, indicating that the cases did not constitute an outbreak. b On September 13, 2018, case findings were expanded to include the entire hospital and the epidemiological investigation was repeated, confirming the outbreak. B. cepacia was only detected from a cystoscope used by one patient. c Terminal disinfection was performed on October 26, 2018. d The cystoscope sampling method was replaced on November 11, 2018. B. cepacia was detected from one batch of anesthesia gel, then all anesthesia gels were recalled and the outbreak was terminated

Fig. 2

PFGE homology analysis of selected B. cepacia isolates. Isolates B1, B2, and B3 were recovered from anesthetic gel (20180701). Isolate B12 was recovered from a patient that acquired infection outside the hospital. The remaining 20 B. cepacia isolates were recovered from blood or urine samples from nosocomial UTI inpatients. Isolates B10 and B18 were both recovered from patients with bladder tumors accepted cystoscopy in the outpatient cystoscope room, and were detected by urine culture within 24 h of admission, corresponding to 15 and 65 days after cystoscopy, respectively. B17 was recovered from a patient with a ureter tumor who was diagnosed with B. cepacia infection 1 day after cystoscopy