Burkholderia cepacia ST 767 causing a three-year nosocomial outbreak in a hemodialysis unit

IF 4.7 3区医学 Q1 INFECTIOUS DISEASES

Journal of Infection and Public Health Pub Date : 2025-05-30 DOI:10.1016/j.jiph.2025.102843

Stéfani T.A. Dantas , Gousilin R. Silva , Iranildo A. Fernandes , Ary Fernandes Júnior , José C.F. Pantoja , Carlos H. Camargo , Juliano L. Gonçalves , Ivana G. Castilho , Nathália C.C. Silva , Vera L.M. Rall

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引用次数: 0

Abstract

Background

The risk of bloodstream infections increases in patients undergoing chronic hemodialysis, primarily due to water contamination or improper handling during dialyzer reprocessing. This study aimed to identify virulence factors and gather epidemiological data on the Burkholderia cepacia complex (Bcc), isolated from water and blood cultures during an outbreak in a hemodialysis unit.

Methods

We analyzed 33 Bcc isolates from blood cultures of patients with bacteremia undergoing hemodialysis and 24 isolates from water samples collected between 2019 and 2022. All isolates were tested for virulence factor-encoding genes, including cblA, esmR, zmpA, and zmpB, using polymerase chain reaction (PCR) assays. The isolates were further characterized using Multi-Locus Sequence Typing (MLST) and Pulsed-Field Gel Electrophoresis (PFGE). Biofilm production was assessed on polystyrene microplates at 20°C and 35°C.

Results

The genes zmpB and zmpA were present in 100 % and 96.5 % of the isolates, respectively. However, none of the isolates carried the cblA or esmR genes. Within the Bcc, the species B. cepacia (genomovar I) was identified through recA gene sequencing. PFGE analysis revealed that all human- and water-derived isolates shared the same pulsotype, classified as ST-767.

Conclusions

Despite routine water disinfection with peracetic acid, the detection of a single pulsotype of this species over three years indicates the persistent of Burkholderia cepacia ST 767 in the plumbing system, leading to the contamination of patients undergoing hemodialysis. This persistence is likely facilitated by biofilm formation, as all water-derived isolates demonstrated biofilm production at 20°C. To exacerbate the situation, all isolates exhibited multidrug resistance, further complicating patient treatment and management.

查看原文本刊更多论文

洋葱伯克氏菌ST 767在血液透析单位引起三年的医院爆发

背景：慢性血液透析患者血液感染的风险增加，主要是由于水污染或透析器再加工过程中的不当处理。本研究旨在确定毒力因素并收集有关洋葱伯克霍尔德菌复群（Bcc）的流行病学数据，该复群是在血液透析单位爆发期间从水和血液培养物中分离出来的。方法对2019年至2022年采集的血液透析菌血症患者血培养物中的33株Bcc和水样中的24株Bcc进行分析。采用聚合酶链反应（PCR）检测所有分离株的毒力因子编码基因，包括cblA、esmR、zmpA和zmpB。采用多位点序列分型（MLST）和脉冲场凝胶电泳（PFGE）对分离菌株进行了进一步的鉴定。在20°C和35°C条件下，在聚苯乙烯微孔板上评估生物膜的生成情况。结果zmpB和zmpA基因分别在100 %和96.5 %的分离株中存在。然而，没有分离物携带cblA或esmR基因。在Bcc中，通过recA基因测序鉴定出了B. cepacia （genomic ovar I）。PFGE分析显示，所有人源和水源分离株具有相同的脉冲型，分类为ST-767。结论尽管用过氧乙酸对水进行常规消毒，但在三年内检测到单一脉冲型的该物种表明，洋葱伯克氏菌ST 767在管道系统中持续存在，导致血液透析患者受到污染。生物膜的形成可能促进了这种持久性，因为所有水源分离物在20°C下都显示出生物膜的产生。更严重的是，所有分离株都表现出多药耐药，进一步复杂化了患者的治疗和管理。

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 Infection and Public Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH -INFECTIOUS DISEASES

CiteScore

13.10

自引率

1.50%

发文量

203

审稿时长

96 days

期刊介绍： The Journal of Infection and Public Health, first official journal of the Saudi Arabian Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences and the Saudi Association for Public Health, aims to be the foremost scientific, peer-reviewed journal encompassing infection prevention and control, microbiology, infectious diseases, public health and the application of healthcare epidemiology to the evaluation of health outcomes. The point of view of the journal is that infection and public health are closely intertwined and that advances in one area will have positive consequences on the other. The journal will be useful to all health professionals who are partners in the management of patients with communicable diseases, keeping them up to date. The journal is proud to have an international and diverse editorial board that will assist and facilitate the publication of articles that reflect a global view on infection control and public health, as well as emphasizing our focus on supporting the needs of public health practitioners. It is our aim to improve healthcare by reducing risk of infection and related adverse outcomes by critical review, selection, and dissemination of new and relevant information in the field of infection control, public health and infectious diseases in all healthcare settings and the community.