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. 2024 Mar 16;6(2):100359.
doi: 10.1016/j.infpip.2024.100359. eCollection 2024 Jun.

An outbreak of Burkholderia cepacia complex exit site infection among peritoneal dialysis patients caused by contaminated spray dressing

Lily Shui-Kuen Cheng  1 , Sandy Ka-Yee Chau  1 , Wai-Shan Chan  2 , Jonathan Hon-Kwan Chen  3 , Barry Kin-Chung Wong  1 , Kitty Sau-Chun Fung  1
Affiliations

An outbreak of Burkholderia cepacia complex exit site infection among peritoneal dialysis patients caused by contaminated spray dressing

Lily Shui-Kuen Cheng et al. Infect Prev Pract. .

Abstract

Background: Wound dressing is intended to provide a physical barrier from microorganisms. Spray dressing is convenient and can be applied to wounds of various contours. In July 2020, a cluster of four Burkholderia cepacia complex (BCC) exit site infections was identified among peritoneal dialysis patients in a regional hospital in Hong Kong. In response, our hospital infection control team conducted an epidemiologic investigation.

Methods: We conducted a retrospective cohort study of peritoneal dialysis patients with culture-confirmed BCC exit site infections from January 2011 to July 2020. Outbreak investigations, including case finding, molecular typing and post-outbreak surveillance, were performed.

Discussion: A substantial increase in BCC exit site infections has been observed since 2013, rising from 0.23 in 2012 to 1.09 episodes per 100 patient-year in 2015, with the number of cases in the first half of 2020 already surpassing the total from 2019. The potential source had been traced to a spray dressing introduced to exit site care in December 2012. Burkholderia cepacia complex was isolated from both the unopened and in-use sprays from the same lot. Multilocus sequence typing analysis confirmed their genetic relatedness. The spray dressing was subsequently removed from exit site care. Post-outbreak surveillance over two years showed a marked and sustained decrease in BCC exit site infection.

Conclusion: Water-based spray dressing can be a source of BCC causing wound infections. The use of contaminated spray dressing, especially in chronic wounds with proximity to indwelling catheters, may pose an inherent risk to patients.

Keywords: Burkholderia cepacia complex; Exit site infection; Hong Kong; Outbreak; Peritoneal dialysis; Spray dressing.

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Figures

Figure 1
Figure 1
Number of patients who had bcc peritoneal catheter exit site infections in a Regional Hospital in Hong Kong from 2011 to 2022.
Figure 2
Figure 2
Incidence of BCC peritoneal catheter exit site infections in a Regional Hospital in Hong Kong from 2011 to 2022.
See this image and copyright information in PMC

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