Real-time investigation of a Burkholderia cenocepacia bacteraemia outbreak in a Vietnamese intensive care unit

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection Pub Date : 2025-04-18 DOI:10.1016/j.jhin.2025.04.003

A.T.K. Nguyen , V.K. Phuong Linh , D.T. Huong , P.T. Kieu , V.V. Phat , H.T. Tuyen , Q. Nguyen , N.H. Hien , N.T. Diem Trinh , H.N. Hon , N.T. Binh , P.T. Phuong Thao , T. Quang , N.T. Thu Van , P.T. Ngoc Lan , Y. Mo , D.L. Paterson , G. Thwaites , L. Thwaites , P.T. Duy

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引用次数: 0

Abstract

Background

The Burkholderia cepacia complex (Bcc), a group of environmentally ubiquitous bacteria, are inherently resistant to antiseptics and antibiotics. Bcc can proliferate in pharmaceutical products, resulting in nosocomial outbreaks. However, Bcc is often dismissed as blood culture contaminants, and precise identification of Bcc species remains challenging in resource-limited settings, leading to under-treatment and delay in outbreak detection. This paper reports the first identified Bcc bacteraemia outbreak in a Vietnamese intensive care unit (ICU).

Methods

In June 2023, a Bcc bacteraemia outbreak was acknowledged by the hospital authorities after examination of clinical and microbiological evidence. A comprehensive investigation was performed, encompassing epidemiological and clinical review, environmental sampling, whole-genome sequencing (WGS), and implementation of enhanced infection prevention and control (IPC) measures.

Results

The bacteraemia outbreak involved 19 ICU patients between May and August 2023. The causative bacteria were identified as B. cenocepacia belonging to a novel sequence type, and did not carry any acquired antimicrobial resistance genes. Although these organisms were susceptible to the commonly used antibiotics, the outbreak was associated with a high case fatality rate. Three B. cenocepacia isolates were also found in used syringes for drug infusion in three cases, exhibiting a genomic link to the outbreak cluster. Enhanced IPC measures targeting aseptic techniques in handling intravenous medications resulted in termination of the outbreak.

Conclusions

WGS plays a crucial role in outbreak control, particularly for under-studied opportunistic pathogens. This work also highlights key gaps in IPC measures, species identification, and treatment of Bcc infections, warranting further research to improve hospital prevention and treatment strategies.

查看原文本刊更多论文

在越南重症监护室发生的一次新结核杆菌菌血症暴发的实时调查。

背景：洋葱伯克霍尔德菌复合体（Bcc）是一组普遍存在于环境中的细菌，对防腐剂和抗生素具有固有的耐药性。Bcc可在药品中扩散，导致院内暴发。然而，Bcc通常被认为是血液培养污染物，在资源有限的情况下，准确识别Bcc种类仍然具有挑战性，导致治疗不足和疫情发现延迟。在这里，我们报告在越南ICU首次确定的Bcc菌血症暴发。方法：2023年6月，医院当局在检查临床和微生物学证据后，承认了一次Bcc菌血症暴发。开展了全面调查，包括流行病学和临床审查、环境采样、全基因组测序（WGS）以及实施加强感染预防和控制（IPC）措施。结果：2023年5月至8月共发生19例ICU患者菌血症暴发。病原菌鉴定为新序列型的新绿囊性伯克霍尔德菌，不携带任何获得性耐药基因。虽然这些微生物对常用的抗生素敏感，但这次暴发与高病死率有关。在三个病例的药物输注用过的注射器中也发现了三株结核杆菌分离株，显示出与暴发聚集群的基因组联系。针对处理静脉注射药物的无菌技术加强IPC措施导致疫情终止。结论：WGS在疫情控制中起着至关重要的作用，特别是对于研究不足的条件致病菌。我们的工作还突出了IPC措施、物种鉴定和Bcc感染治疗方面的主要差距，需要进一步研究以改进医院的预防和治疗策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Hospital Infection 医学-传染病学

CiteScore

12.70

自引率

5.80%

发文量

271

审稿时长

19 days

期刊介绍： The Journal of Hospital Infection is the editorially independent scientific publication of the Healthcare Infection Society. The aim of the Journal is to publish high quality research and information relating to infection prevention and control that is relevant to an international audience. The Journal welcomes submissions that relate to all aspects of infection prevention and control in healthcare settings. This includes submissions that: provide new insight into the epidemiology, surveillance, or prevention and control of healthcare-associated infections and antimicrobial resistance in healthcare settings; provide new insight into cleaning, disinfection and decontamination; provide new insight into the design of healthcare premises; describe novel aspects of outbreaks of infection; throw light on techniques for effective antimicrobial stewardship; describe novel techniques (laboratory-based or point of care) for the detection of infection or antimicrobial resistance in the healthcare setting, particularly if these can be used to facilitate infection prevention and control; improve understanding of the motivations of safe healthcare behaviour, or describe techniques for achieving behavioural and cultural change; improve understanding of the use of IT systems in infection surveillance and prevention and control.