Volume 26, Number 9—September 2020
Synopsis
Polyclonal Burkholderia cepacia Complex Outbreak in Peritoneal Dialysis Patients Caused by Contaminated Aqueous Chlorhexidine
Sally C.Y. Wong1, Shuk-Ching Wong, Jonathan H.K. Chen, Rosana W.S. Poon, Derek L.L. Hung, Kelvin H.Y. Chiu, Simon Y.C. So, Wing Shan Leung, Tak Mao Chan, Desmond Y.H. Yap, Vivien W.M. Chuang, Kwok-Yung Yuen2, and Vincent C.C. Cheng2
Table 2
Environmental specimens collected and tested for investigation of Burkholderia cepacia complex outbreak in peritoneal dialysis unit, Hong Kong, China, March 13, 2018–September 6, 2019*
| Characteristic | No. specimens | Culture result (mean, median, range), CFU/mL |
|---|---|---|
| Peritoneal dialysis unit | ||
| Environment | ||
| Air samples | 2 | Negative for BCC |
| Swab specimens from sink and faucet | 12 | |
| Water samples from sink in ward | 10 | |
| Soaps from dispensers next to patient sinks | 4 | |
| Swab specimens from wound dressing trolleys | 3 | |
| Blood pressure cuffs, gloves, and tissue paper | 6 (2 each) | |
| Connection shield SysIIK with povidone–iodine solution† | 3 | |
| Exit site care agents | ||
| In-use povidone–iodine | 10 | Negative for BCC |
| Single-use prepackaged saline and sterile water | 10 (5 each) | |
| White wine vinegar |
3 |
|
| Aqueous chlorhexidine | ||
| Brand A (outside hospital) | 51 | 43 with BCC only (3.6 × 103, 1.9 × 102, 2.7–7.6 × 104); 4 with Ralstonia species only (77, 85, 46–93); 4 with BCC and Ralstonia species (120, 120, 94–130) |
| Brand B (outside hospital) | 45 | 45 with BCC (5.9 × 104, 4.6 × 104, 2.9 × 104–1.2 × 105) |
| Brand C (outside hospital) | 4 | 4 with BCC (8.3 × 103, 6.8 × 103, 8 × 102–1.9 × 104) |
| Brand D (outside hospital) | 2 | 2 with BCC (2.8 × 105, 2.8 × 105, 2.4–3.2 × 105) |
| Brand E (outside hospital) | 1 | 1 with BCC (1.5 × 105) |
| Brand F (outside hospital) | 1 | Negative for BCC |
| Brand G (from hospital) | 47 | Negative for BCC |
| Brand H (from hospital) |
30 |
Negative for BCC |
| Brand B manufacturing site | ||
| Environment | ||
| Air samples | 2 | Negative for BCC |
| Plastic packaging | 1 | Negative for BCC |
| Plastic container in preparation room | 1 | Negative for BCC |
| Surface of fan in preparation room | 1 | Negative for BCC |
| Surface of air conditioner in preparation room | 1 | Negative for BCC |
| Specimens collected during dilution and packaging process | ||
| 5% chlorhexidine from original bottle | 1 | Negative for BCC |
| Chlorhexidine in measuring beaker | 1 | Negative for BCC |
| Distilled water | 1 | Negative for BCC |
| Diluted chlorhexidine in mixing compartment of semiautomated packaging machine ([I] in Figure 2), before mixing with stirring rod | 1 | BCC from enriched culture method with overnight incubation in neutralization broth |
| Stirring rod surface swab specimen, before mixing diluted chlorhexidine solution | 1 | Negative for BCC |
| Stirring rod surface swab specimen, after mixing diluted chlorhexidine solution | 1 | BCC from enriched culture method with overnight incubation in neutralization broth |
| Diluted chlorhexidine in mixing bowl of packaging machine, after mixing with stirring rod | 1 | BCC from enriched culture method with overnight incubation in neutralization broth |
| Newly packed 25 mL 0.05% aqueous chlorhexidine | 16 | 16‡ with BCC 1.2 × 105, 1.2 × 105, 3.6 × 104–2.4 × 105); 3 with concurrent Achromobacter species |
*BCC, Burkholderia cepacia complex.
†Baxter Healthcare SA, https://www.baxter.com.
‡Three specimens had concurrent Achromobacter species found in culture.
1Current affiliation: Queen Elizabeth Hospital, Hong Kong, China.
2These senior authors contributed equally to this article.
Page created: May 12, 2020
Page updated: August 18, 2020
Page reviewed: August 18, 2020
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.