RESUMO
Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through polymerase chain reaction-random amplified polymorphic DNA (PCR-RAPD) and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.
Assuntos
Infecções por Burkholderia/epidemiologia , Burkholderia cepacia/isolamento & purificação , Surtos de Doenças , Infecções por Bactérias Gram-Negativas/epidemiologia , Diálise Renal/efeitos adversos , Stenotrophomonas maltophilia/isolamento & purificação , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Infecções por Burkholderia/etiologia , Infecções por Burkholderia/prevenção & controle , Burkholderia cepacia/classificação , Burkholderia cepacia/genética , Desinfecção/métodos , Feminino , Infecções por Bactérias Gram-Negativas/etiologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Diálise Renal/normas , Sepse/epidemiologia , Sepse/etiologia , Sepse/prevenção & controle , Stenotrophomonas maltophilia/classificação , Stenotrophomonas maltophilia/genéticaRESUMO
OBJECTIVES: To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS: We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS: From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION: The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.
Assuntos
Infecções por Burkholderia/etiologia , Burkholderia cepacia/isolamento & purificação , Fibrose Cística/microbiologia , Transplante de Pulmão/efeitos adversos , Adolescente , Adulto , Brasil/epidemiologia , Infecções por Burkholderia/mortalidade , Contraindicações de Procedimentos , Fibrose Cística/complicações , Fibrose Cística/mortalidade , Fibrose Cística/cirurgia , DNA Bacteriano , Feminino , Humanos , Unidades de Terapia Intensiva , Estimativa de Kaplan-Meier , Tempo de Internação , Transplante de Pulmão/mortalidade , Masculino , Filogenia , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVES: To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation. METHODS: We prospectively analyzed clinical data and respiratory tract samples (sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013. RESULTS: From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection. CONCLUSION: The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto , Adulto Jovem , Transplante de Pulmão/efeitos adversos , Burkholderia cepacia/isolamento & purificação , Infecções por Burkholderia/etiologia , Fibrose Cística/microbiologia , Filogenia , Fatores de Tempo , Brasil/epidemiologia , DNA Bacteriano , Estudos Prospectivos , Análise de Regressão , Fatores de Risco , Transplante de Pulmão/mortalidade , Resultado do Tratamento , Infecções por Burkholderia/mortalidade , Fibrose Cística/cirurgia , Fibrose Cística/complicações , Fibrose Cística/mortalidade , Estimativa de Kaplan-Meier , Contraindicações de Procedimentos , Unidades de Terapia Intensiva , Tempo de InternaçãoRESUMO
Las especies del complejo Burkholderia cepacia (CBC) son capaces de causar infecciones crónicas del tracto respiratorio en pacientes con fibrosis quística y en otros individuos inmunocomprometidos. La mayoría de estas especies exhiben alta resistencia a la terapia antibiótica, lo que genera la necesidad de una detección rápida y precisa para poder implementar estrategias de control adecuadas. En este trabajo se utilizó la técnica de reacción en cadena de la polimerasa (PCR) para amplificar el gen recA (PCR-recA), con el fin de identificar microorganismos pertenecientes al CBC. Con este método molecular como referencia, se evaluó la sensibilidad (S) y la especificidad (E) de dos sistemas de identificación comerciales automatizados, VITEK 2 y API 20NE (bioMérieux®), así como también el valor de las pruebas bioquímicas manuales más representativas para la identificación de estos microorganismos. El método VITEK 2 presentó una S del 71,1 % y una E del 100 %; para el método API 20NE, estos valores fueron 69,7 % y 90,2 %, respectivamente. En cuanto a las pruebas fenotípicas manuales, los resultados obtenidos fueron más heterogéneos, lo que posiblemente se deba a que estas bacterias podrían sufrir presión selectiva para sobrevivir en pacientes crónicos y perder factores fenotípicos característicos. La técnica de PCR-recA resultó de fácil implementación, por lo que cabe considerar a esta técnica de identificación como una opción viable, aun en laboratorios de diagnóstico clínico de mediana complejidad.
Species belonging to the Burkholderia cepacia complex (BCC) are capable of causing chronic respiratory tract infections in patients suffering from cystic fibrosis as wel as in immunocompromised individuals. Most of these species are highly resistant to antibiotic therapy, generating the need for their rapid and accurate detection for the proper treatment and clinical management of these patients. In this wok, the polymerase chain reaction (PCR) technique based on the amplification of the recA gene (PCR-recA) was applied for an accurate identification of bacteria belonging to the BCC. Sensitivity (S) and specificity (E) of two biochemically-based commercial automated systems, API 20NE and VITEK 2 (bioMérieux®), and of the most representative biochemical manual tests for the identification of the Burkholderia cepacia complex were herein evaluated. The commercial systems VITEK 2 and API 20NE showed the following sensitivity and specificity vaues for identification to the species level, S: 71.1 %, E: 100 %, S: 69.7 %, E: 90.2 %, respectively. More complex results were observed for phenotypic manual tests, since BCC bacteria can undergo selective pressure to survive in chronic patients causing the loss of their typical phenotypic characteristics. The PCR-recA technique was easy to implement even in medium-complexity clinical diagnostic laboratories.
Assuntos
Humanos , Técnicas de Tipagem Bacteriana/métodos , Infecções por Burkholderia/microbiologia , Complexo Burkholderia cepacia/isolamento & purificação , Kit de Reagentes para Diagnóstico , Infecções Respiratórias/microbiologia , Automação , Proteínas de Bactérias/genética , Infecções por Burkholderia/diagnóstico , Infecções por Burkholderia/etiologia , Colorimetria/métodos , Fibrose Cística/complicações , Suscetibilidade a Doenças , DNA Bacteriano/genética , Genes Bacterianos , Genótipo , Reação em Cadeia da Polimerase/métodos , Padrões de Referência , Reprodutibilidade dos Testes , Recombinases Rec A/genética , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/etiologia , Sensibilidade e Especificidade , SoftwareRESUMO
Species belonging to the Burkholderia cepacia complex (BCC) are capable of causing chronic respiratory tract infections in patients suffering from cystic fibrosis as well as in immunocompromised individuals. Most of these species are highly resistant to antibiotic therapy, generating the need for their rapid and accurate detection for the proper treatment and clinical management of these patients. In this work, the polymerase chain reaction (PCR) technique based on the amplification of the recA gene (PCR-recA) was applied for an accurate identification of bacteria belonging to the BCC. Sensitivity (S) and specificity (E) of two biochemically-based commercial automated systems, API 20NE and VITEK 2 (bioMérieux®), and of the most representative biochemical manual tests for the identification of the Burkholderia cepacia complex were herein evaluated. The commercial systems VITEK 2 and API 20NE showed the following sensitivity and specificity vaues for identification to the species level, S: 71.1 %, E: 100 %, S: 69.7 %, E: 90.2 %, respectively. More complex results were observed for phenotypic manual tests, since BCC bacteria can undergo selective pressure to survive in chronic patients causing the loss of their typical phenotypic characteristics. The PCR-recA technique was easy to implement even in medium-complexity clinical diagnostic laboratories.
Assuntos
Técnicas de Tipagem Bacteriana/métodos , Infecções por Burkholderia/microbiologia , Complexo Burkholderia cepacia/isolamento & purificação , Kit de Reagentes para Diagnóstico , Infecções Respiratórias/microbiologia , Automação , Proteínas de Bactérias/genética , Infecções por Burkholderia/diagnóstico , Infecções por Burkholderia/etiologia , Colorimetria/métodos , Fibrose Cística/complicações , DNA Bacteriano/genética , Suscetibilidade a Doenças , Genes Bacterianos , Genótipo , Humanos , Reação em Cadeia da Polimerase/métodos , Recombinases Rec A/genética , Padrões de Referência , Reprodutibilidade dos Testes , Infecções Respiratórias/diagnóstico , Infecções Respiratórias/etiologia , Sensibilidade e Especificidade , SoftwareRESUMO
An outbreak of central venous catheter-associated bloodstream infections was reported in a hospital in Ecuador. Commercially produced ampoules of water for injection were found to be contaminated with Burkholderia cepacia and Myroides odoratus. Removal of these ampoules yielded a 10-fold reduction in the incidence of catheter-associated infection.
Assuntos
Bacteriemia/etiologia , Infecções por Burkholderia/etiologia , Burkholderia cepacia/isolamento & purificação , Cateterismo Venoso Central/efeitos adversos , Cateteres de Demora/microbiologia , Microbiologia da Água , Bacteriemia/epidemiologia , Infecções por Burkholderia/epidemiologia , Infecções por Burkholderia/transmissão , Surtos de Doenças , Equador/epidemiologia , Contaminação de Equipamentos , Flavobacteriaceae/isolamento & purificação , Infecções por Flavobacteriaceae/epidemiologia , Infecções por Flavobacteriaceae/microbiologia , Hospitais de Ensino , Humanos , Incidência , Estudos RetrospectivosAssuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Infecções por Burkholderia/diagnóstico por imagem , Burkholderia cepacia/isolamento & purificação , Fluordesoxiglucose F18 , Oclusão de Enxerto Vascular/diagnóstico por imagem , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos , Diálise Renal , Adulto , Infecções por Burkholderia/etiologia , Infecções por Burkholderia/microbiologia , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/microbiologia , Humanos , Masculino , RadiografiaRESUMO
BACKGROUND: Burkholderia cepacia has been described as a cause of opportunist infections in patients with immune deficiency because of the high transmission rates. Actually the B. cepacia is subdivided in nine different genomic species that show morphological similarity, called genomovars. High mortality rates have been associated with infections caused by genomovars in susceptible patients; antibiotics are not efficient because of the high resistance level and genomic mutability. Little is known about the epidemiological traits of this bacterium; therefore, their isolation remains a relevant technical problem. AIMS: The objective of this review is to describe Burkholderia cepacia as a bacterial complex with high pathogenicity and variability of habitats. MATERIALS AND METHODS: A systematic search was realized using the international bibliographic databanks SCIELO, HIGHWIRE, PUBMED, SCIRUS and LILACS to provide a useful and practical review for the health workers that do not know this microorganism. CONCLUSIONS: Today, B. cepacia complex is a very important problem for the acquired immunodeficiency syndrome and cystic fibrosis patients. The immunodeficiency caused by these diseases is a positive factor for this microorganism to infect and kill these patients. Therefore, this opportunistic pathogen should be pointed out as a risk to these patients and hospitals all over the world must be prepared to detect and combat this bacterium.
Assuntos
Infecções por Burkholderia/etiologia , Burkholderia cepacia , Fibrose Cística/fisiopatologia , Infecções Oportunistas/etiologia , Infecções por Burkholderia/fisiopatologia , Comorbidade , Fibrose Cística/complicações , Fibrose Cística/imunologia , Humanos , Infecções Oportunistas/fisiopatologia , Prognóstico , Fatores de RiscoRESUMO
Ralstonia pickettii and Burkholderia cepacia complex isolates are causes of healthcare-associated infection related to contamination of intravenously administered products. Based on microbiological and epidemiological data and molecular typing by pulsed-field gel electrophoresis, we report the occurrence of two outbreaks of R. pickettii and B. cepacia complex bloodstream infections. The first outbreak occurred from August 1995 to September 1996, and the second outbreak occurred from 28 March to 8 April 1998, affecting adults and neonates, respectively. Infusion of contaminated water for injection was the source of infection.