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Outbreak of Burkholderia cepacia bacteremia in immunocompetent children caused by contaminated nebulized sulbutamol in Saudi Arabia

      To the Editor:
      From early spring 2003 through May 2004, hospitals across Saudi Arabia and the Gulf Cooperation Council States experienced outbreaks of Burkholderia cepacia nosocomial infections secondary to the use of contaminated multidose albuterol nebulization solutions that were manufactured and distributed in the Gulf Region. After an exhaustive investigation, the National Guard's Department of Infection Prevention and Control identified the cause of the outbreak, and triggered a regional recall of the contaminated product in April 2004 after which there were no further cases. The National Guard Hospital outbreak investigation, case descriptions and definitions, supporting laboratory data, and infection control recommendations were the subject of a detailed paper that was authored by the National Guard Infection Prevention and Control group. The paper was published in the pages of this journal in April 2005.
      • Balkhy H.B.
      • Cunningham G.
      • Francis C.
      • Almuneef M.A.
      • Stevens G.
      • Akkad N.
      • et al.
      A National Guard outbreak of Burkholderia cepacia infection and colonization secondary to intrinsic contamination of albuterol nebulization solution.
      Last month, another iteration of this outbreak appeared, also in the pages of this journal.
      • Ghazal S.S.
      • Al-Mudaimeegh K.
      • Al Fakihi E.M.
      • Asery A.T.
      Outbreak of Burkholderia cepacia bacteremia in immunocompetent children caused by contaminated nebulized sulbutamol in Saudi Arabia.
      Although the authors chose a title that focuses on B cepacia bacteremia in immunocompetent children, the content is largely reflective of our paper. The authors also claim to be the first to diagnose the national outbreak. Nowhere is our original article referenced or highlighted. This was unlikely to have been an inadvertent oversight; American Journal of Infection Control (AJIC) enjoys wide readership among infection control professionals, and the outbreak was publicized widely. Although it is possible that the authors did not inform AJIC of, nor made any reference to, the original article with the eventual duplication in the journal, it indicates an oversight on the part of article reviewers.
      Priority claims are discouraged according to consensus standards that govern editorial policy for biomedical journals.
      • International Committee of Medical Editors
      Uniform requirements for manuscripts submitted to biomedical journals.
      • Summers J.B.
      • Kaminski J.M.
      Citation etiquette in biomedical publications.
      • Summers J.B.
      False firstedness: the dilemma of priority claims in biomedical publications.
      • Bernstein J.E.
      Opiate-mediated pruritis and citation etiquette.
      One of the basic principles in medical writing is to acknowledge and recognize the work of others, especially when the work addresses the same subject matter, was published well in advance in the same journal, and is indexed in Pubmed. The readers of AJIC reasonably expect to see only high-quality original articles by authors who observe consensus guidelines that, at a minimum, acknowledge other investigators' work. The efforts of our group should have been acknowledged.

      References

        • Balkhy H.B.
        • Cunningham G.
        • Francis C.
        • Almuneef M.A.
        • Stevens G.
        • Akkad N.
        • et al.
        A National Guard outbreak of Burkholderia cepacia infection and colonization secondary to intrinsic contamination of albuterol nebulization solution.
        Am J Infect Control. 2005; 33: 182-188
        • Ghazal S.S.
        • Al-Mudaimeegh K.
        • Al Fakihi E.M.
        • Asery A.T.
        Outbreak of Burkholderia cepacia bacteremia in immunocompetent children caused by contaminated nebulized sulbutamol in Saudi Arabia.
        Am J Infect Control. 2006; 6: 394-398
        • International Committee of Medical Editors
        Uniform requirements for manuscripts submitted to biomedical journals.
        Ann Intern Med. 1997; 126: 36-47
        • Summers J.B.
        • Kaminski J.M.
        Citation etiquette in biomedical publications.
        Comp Med. 2002; 52: 396
        • Summers J.B.
        False firstedness: the dilemma of priority claims in biomedical publications.
        J Am Acad Dermatol. 2005; 52: 735-736
        • Bernstein J.E.
        Opiate-mediated pruritis and citation etiquette.
        J Am Acad Dermatol. 2000; 43: 324-325