Major article| Volume 41, ISSUE 4, P312-316, April 2013

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An outbreak of Burkholderia cepacia bacteremia in hospitalized hematology patients selectively affecting those with acute myeloid leukemia

Published:October 08, 2012DOI:


      Burkholderia cepacia complex (Bcc) is a group of common environmental bacteria that preferentially colonize and infect patients with cystic fibrosis but are also emerging as nosocomial pathogens, possibly due to their resistance to disinfectants and antimicrobials.


      We investigated a 3-month outbreak of Bcc bacteremia among hospitalized hematology patients. Environmental investigation and infection control measures were implemented. A retrospective, cross-sectional study was conducted to identify risk factors.


      Bcc was repeatedly isolated from the blood of 9 patients without central venous catheter who did not easily respond to targeted antibiotic treatment and 3 died of the infection. A point source was not identified and horizontal spread was suspected. Strict infection control measures terminated the outbreak. Interestingly, diagnosis of acute myeloid leukemia but not neutropenia or prior chemotherapy was a risk factor for infection acquisition. Neutropenia was positively correlated with infection duration.


      Bcc is not only a serious threat among immunocompromized hematology patients, but is also transmissible in clinical settings. Acute myeloid leukemia appears to confer additional risk for infection acquisition.

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        • Lipuma J.J.
        Burkholderia cepacia complex as human pathogens.
        J Nematol. 2003; 35: 212-217
        • Gautam V.
        • Singhal L.
        • Ray P.
        Burkholderia cepacia complex: beyond pseudomonas and acinetobacter.
        Indian J Med Microbiol. 2011; 29: 4-12
        • Alvarez-Lerma F.
        • Maull E.
        • Terradas R.
        • Sequra C.
        • Planells I.
        • Coll P.
        • et al.
        Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of a nosocomial infection in a multidisciplinary intensive care unit.
        Crit Care. 2008; 12: R10
        • Liao C.H.
        • Chang H.T.
        • Lai C.C.
        • Huang Y.T.
        • Hsu M.S.
        • Liu C.Y.
        • et al.
        Clinical characteristics and outcomes of patients with Burkholderia cepacia bacteremia in an intensive care unit.
        Diagn Microbiol Infect Dis. 2011; 70: 260-266
        • Loukil C.
        • Saizou C.
        • Doit C.
        • Bidet P.
        • Mariani-Kurkdjian P.
        • Aujard Y.
        • et al.
        Epidemiologic investigation of Burkholderia cepacia acquisition in two pediatric intensive care units.
        Infect Control Hosp Epidemiol. 2003; 24: 707-710
        • Romero-Gómez M.P.
        • Quiles Melero M.I.
        • Peña García P.
        • Gutiérrez Altes A.
        • García de Miquel M.A.
        • Jiménez C.
        • et al.
        Outbreak of Burkholderia cepacia bacteremia caused by contaminated chlorhexidine in a hemodialysis unit.
        Infect Control Hosp Epidemiol. 2008; 29: 377-378
        • Magalhães M.
        • Doherty C.
        • Govan J.R.
        • Vandamme P.
        Polyclonal outbreak of Burkholderia cepacia complex bacteraemia in haemodialysis patients.
        J Hosp Infect. 2003; 54: 120-123
        • Doit C.
        • Loukil C.
        • Simon A.M.
        • Ferroni A.
        • Fontan J.E.
        • Bonacorsi S.
        • et al.
        Outbreak of Burkholderia cepacia bacteremia in a pediatric hospital due to contamination of lipid emulsion stoppers.
        J Clin Microbiol. 2004; 42: 2227-2230
        • Memish Z.A.
        • Stephens G.
        • Balkhy H.H.
        • Cunningham G.
        • Francis C.
        • Poff G.
        Outbreak of Burkholderia cepacia bacteremia in immunocompetent children caused by contaminated nebulized sulbutamol in Saudi Arabia.
        Am J Infect Control. 2009; 37: 431-432
        • Mann T.
        • Ben-David D.
        • Zlotkin A.
        • Shachar D.
        • Keller N.
        • Toren A.
        • et al.
        An outbreak of Burkholderia cenocepacia bacteremia in immunocompromised oncology patients.
        Infection. 2010; 38: 187-194
        • Abe K.
        • D’Angelo M.T.
        • Sunenshine R.
        • Noble-Wang J.
        • Cope J.
        • Jensen B.
        • et al.
        Outbreak of Burkholderia cepacia bloodstream infection at an outpatient hematology and oncology practice.
        Infect Control Hosp Epidemiol. 2007; 28: 1311-1313
        • Heo S.T.
        • Kim S.J.
        • Jeong Y.G.
        • Bae I.G.
        • Jin J.S.
        • Lee J.C.
        Hospital outbreak of Burkholderia stabilis bacteraemia related to contaminated chlorhexidine in haematological malignancy patients with indwelling catheters.
        J Hosp Infect. 2008; 70: 241-245
        • Garner J.S.
        • Jarvis W.R.
        • Emori T.G.
        • Horan T.C.
        • Hughes J.M.
        CDC definitions for nosocomial infections.
        Am J Infect Control. 1988; 16: 128-140
        • Coenye T.
        • Spilker T.
        • Martin A.
        • LiPuma J.J.
        Comparative assessment of genotyping methods for epidemiologic study of Burkholderia cepacia genomovar III.
        J Clin Microbiol. 2002; 40: 3300-3307
      1. NCI Common Toxicity Criteria. Version 2.0, 1999. Available from: Accessed May 21, 2012.

        • Bressler A.M.
        • Kaye K.S.
        • LiPuma J.J.
        Risk Factors for Burkholderia cepacia complex bacteremia among intensive care unit patients without cystic fibrosis: a case-control study.
        Infect Control Hosp Epidemiol. 2007; 28: 951-958
        • Woods C.W.
        • Bressler A.M.
        • LiPuma J.J.
        • Alexander B.D.
        • Clements D.A.
        • Weber D.J.
        • et al.
        Virulence associated with outbreak-related strains of Burkholderia cepacia complex among a cohort of patients with bacteremia.
        Clin Infect Dis. 2004; 38: 1243-1250
        • Siddiqui A.H.
        • Mulligan M.E.
        • Mahenthiralingam E.
        • Hebden J.
        • Brewrink J.
        • Qaiyumi S.
        • et al.
        An episodic outbreak of genetically related Burkholderia cepacia among non–cystic fibrosis patients at a university hospital.
        Infect Control Hosp Epidemiol. 2001; 22: 419-422
        • Martins I.S.
        • Pellegrino F.L.
        • Freitas A.
        • Santos Mda S.
        • Ferraiuoli G.I.
        • Vasques M.R.
        • et al.
        Case-crossover study of Burkholderia cepacia complex bloodstream infection associated with contaminated intravenous bromopride.
        Infect Control Hosp Epidemiol. 2010; 31: 516-521
        • Yang J.C.
        • Chen T.C.
        • Liao L.F.
        • Ma L.
        • Wang C.S.
        • Lu P.L.
        • et al.
        Nosocomial outbreak of two strains of Burkholderia cepacia caused by contaminated heparin.
        J Hosp Infect. 2008; 69: 398-400
        • Lee C.S.
        • Lee H.B.
        • Cho Y.G.
        • Park J.H.
        • Lee H.S.
        Hospital-acquired Burkholderia cepacia infection related to contaminated benzalkonium chloride.
        J Hosp Infect. 2008; 68: 280-282
        • Nasser R.M.
        • Rahi A.C.
        • Haddad M.F.
        • Daoud Z.
        • Irani-Hakime N.
        • Almawi W.Y.
        Outbreak of Burkholderia cepacia bacteremia traced to contaminated hospital water used for dilution of an alcohol skin antiseptic.
        Infect Control Hosp Epidemiol. 2004; 25: 231-239
        • Molina-Cabrillana J.
        • Bolaños-Rivero M.
        • Alvarez-León E.E.
        • Martín Sánchez A.M.
        • Sánchez-Palacios M.
        • Alvarez D.
        • et al.
        Intrinsically contaminated alcohol-free mouthwash implicated in a nosocomial outbreak of Burkholderia cepacia colonization and infection.
        Infect Control Hosp Epidemiol. 2006; 27: 1281-1282
        • Balkhy H.H.
        • 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
        • Vonberg R.P.
        • Gastmeier P.
        Hospital-acquired infections related to contaminated substances.
        J Hosp Infect. 2007; 65: 15-23
        • Alberich Jordà M.
        • Rayman N.
        • Tas M.
        • Verbakel S.E.
        • Battista N.
        • van Lom K.
        • et al.
        The peripheral cannabinoid receptor Cb2, frequently expressed on AML blasts, either induces a neutrophilic differentiation block or confers abnormal migration properties in a ligand-dependent manner.
        Blood. 2004; 104: 1252
        • Tirouvanziam R.
        • Gernez Y.
        • Conrad C.K.
        • Moss R.B.
        • Schrijver I.
        • Dunn C.E.
        • et al.
        Profound functional and signaling changes in viable inflammatory neutrophils homing to cystic fibrosis airways.
        Proc Natl Acad Sci. 2008; 105: 4335-4339
        • Morris M.R.
        • Doull I.J.
        • Dewitt S.
        • Hallett M.B.
        Reduced iC3b-mediated phagocytic capacity of pulmonary neutrophils in cystic fibrosis.
        Clin Exp Immunol. 2005; 142: 68-75
        • Le Dieu R.
        • Taussig D.C.
        • Ramsay A.G.
        • Mitter R.
        • Miraki-Moud F.
        • Fatah R.
        • et al.
        Peripheral blood T cells in acute myeloid leukemia (AML) patients at diagnosis have abnormal phenotype and genotype and form defective immune synapses with AML blasts.
        Blood. 2009; 114: 3909-3916
        • Ramsey A.H.
        • Skonieczny P.
        • Coolidge D.T.
        • Kurzynski T.A.
        • Proctor M.E.
        • Davis J.P.
        Burkholderia cepacia lower respiratory tract infection associated with exposure to a respiratory therapist.
        Infect Control Hosp Epidemiol. 2001; 22: 423-426
        • Shehabi A.A.
        • Abu-Al-Soud W.
        • Mahafzah A.
        • Khuri-Bulos N.
        • Abu Khader I.
        • Quis I.S.
        • et al.
        Investigation of Burkholderia cepacia nosocomial outbreak with high fatality in patients suffering from diseases other than cystic fibrosis.
        Scand J Infect Dis. 2004; 36: 174-178
        • Govan J.R.
        • Brown P.H.
        • Maddison J.
        • Doherty C.J.
        • Nelson J.W.
        • Dodd M.
        • et al.
        Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis.
        Lancet. 1993; 342: 15-19