Outbreak of Burkholderia cepacia complex bacteremia in a chemotherapy day care unit due to intrinsic contamination of an antiemetic drug

Background: In the end of 2009, a large number of patients with cancer undergoing chemotherapy at the day care unit of a private hospital in Mumbai, India developed Burkholderia cepacia complex (BCC) blood stream infection (BSI). Objective: The objectives were to identify the source of the outbreak and terminate the outbreak as rapidly as possible. Materials and Methods: All infection control protocols and processes were reviewed. Intensive training was started for all nursing staff involved in patient care. Cultures were sent from the environment (surfaces, water, air), intravenous fluids, disinfectants and antiseptics and opened/unopened medication. Results: A total of 13 patients with cancer with tunneled catheters were affected with BCC BSI. The isolates were of similar antimicrobial sensitivity. No significant breach of infection control protocols could be identified. Cultures from the prepared intravenous medication bags grew BCC. Subsequently, culture from unused vials of the antiemetic granisetron grew BCC, whereas those from the unopened IV fluid bag and chemotherapy medication were negative. On review, it was discovered that the outbreak started when a new brand of granisetron was introduced. The result was communicated to the manufacturer and the brand was withdrawn. There were no further cases. Conclusions: This outbreak was thus linked to intrinsic contamination of medication vials. We acknowledge a delay in identifying the source as we were concentrating more on human errors in medication preparation and less on intrinsic contamination. We recommend that in an event of an outbreak, unopened vials be cultured at the outset.     

湖北地区伯克霍尔德氏菌医院感染流行特点分析

目的 回顾性调查2000～2003年湖北地区伯克霍尔德氏菌感染的流行特点。指导临床科学地预防和控制伯克霍尔德氏菌引起的感染。方法用WHONET 5软件分析湖北地区细菌耐药监测网上15所大型综合医院内有关伯克霍尔德氏菌感染的资料。结果分别有134、14、11、4和50名患者相应感染洋葱、类鼻疽、皮氏、鼻疽和仅鉴定到属的伯克霍尔德氏菌。共有4次伯克霍尔德氏菌感染的局部流行。患者所在主要医院的构成比、不同伯克霍尔德氏菌种的构成比和许多患者基本情况的构成比均因年份而异。大部分差异具显著性。结论伯克霍尔德氏菌感染具有区域性，而且，各伯克霍尔德氏菌种都有其各自的流行特点。及时、定期地监测伯克霍尔德氏菌医院感染的流行状况。是预防和控制其感染扩散的重要手段。     

Clinically lesser known entity in India: A Report of two cases of Melioidosis

Melioidosis is endemic in the South Asian regions, like Thailand, Singapore Malaysia and Australia. The disease is more pronounced in the southern part of the country. It is caused by Burkholderia pseudomallei which causes systemic involvement, morbidity and mortality associated with the disease is high. Due to highly varied clinical presentation, and low general awareness this infection is largely underdiagnosed and under reported in our country. Most laboratories in the country still rely on conventional culturing methods with their low sensitivity, adding to the under reporting. To enhance physician awareness we describe here two cases who presented to our institute after months of misdiagnosis.     

Retrospective Study on Fatal Melioidosis in Captive Zoo Animals in Thailand

Melioidosis is caused by Burkholderia pseudomallei and is an important zoonotic infectious disease causing high mortality from fulminant septicaemia in humans and a wide variety of animal species. The incidence of fatal melioidosis in zoo animals has been significant in many Thai zoos. A total number of 32 cases were evaluated throughout the Thai zoo animal populations. The highest prevalence of disease has been reported from the north‐eastern region followed by the zoos in the southern part of the country, approximately 47% and 38%, respectively, while the other zoos reported sporadic infections. Herbivores and non‐human primates were the most commonly affected animals with incidences of 59% and 28%, respectively. This appears to be a seasonal correlation with the highest incidence of melioidosis in zoo animals reported in the rainy season (44%) or subdivided monthly in June (19%) followed by September and November (16% and 12%, respectively). The route of infection and the incubation period still remain unclear. This retrospective study examined the clinical presentation in various zoo species, pathological findings and epidemiological data as well as conducting an in depth literature review.     

Cranial melioidosis with extradural extension after a fall in the bathroom

A 32-year-old diabetic male, with a past history of head injury and seizures, presented with a painful swelling over his forehead present for the past three months. Cranial MRI demonstrated the presence of a scalp collection with extradural extension through a bony defect. Biopsy from the area showed caseating necrosis suggestive of tuberculosis. Although the patient failed to return for initiation of anti-tubercular therapy for the next 11 months, the swelling did not progress, and there were no constitutional symptoms. The indolent nature of the swelling prompted re-evaluation and delayed cultures of pus from the collection grew Burkholderia pseudomallei.     

Imported Melioidosis in South Korea: A Case Series with a Literature Review

Objectives

Melioidosis is a potentially fatal infectious disease caused by the environmental anaerobic Gram-negative bacillus Burkholderia pseudomallei. Melioidosis is endemic to areas of northern Australia and Southeast Asia. With increasing international travel and migration, imported cases of melioidosis are being reported regularly. Here, we summarize the 11 cases of melioidosis reported in South Korea from 2003 to 2014.

Methods

Tracing epidemiological investigations were performed on every patient reported to the National Surveillance System since 2011. A systematic literature search was performed to identify melioidosis cases that occurred prior to 2011.

Results

The overall fatality rate was 36.4%. All the patients had visited Southeast Asia where melioidosis is endemic. The stay in the endemic region ranged from 4 days to 20 years. Of the seven patients who developed initial symptoms after returning to South Korea, the time interval between returning to South Korea and symptom onset ranged from 1 day to 3 years. The remaining four patients developed symptoms during their stay in the endemic region and were diagnosed with melioidosis in South Korea. Seven (63.6%) patients possessed at least one risk factor, all of whom were diabetic. Pneumonia was the most frequent clinical manifestation, but the patients showed a wide spectrum of clinical features, including internal organ abscesses, a mycotic aneurysm of the aorta, and coinfection with tuberculosis.

Conclusion

An early diagnosis and initiation of the appropriate antibiotics can reduce the mortality of melioidosis. Consequently, increased awareness of the risk factors and clinical features of melioidosis is required.     

左氧氟沙星治疗新生儿洋葱伯克霍尔德菌感染的病例分析及文献回顾

目的：探讨临床药师在新生儿洋葱伯克霍尔德菌感染治疗中的作用。方法：回顾性分析临床药师参与1例左氧氟沙星治疗新生儿洋葱伯克霍尔德菌感染的病例。结果：临床药师通过对左氧氟沙星用于新生儿感染的风险和益处进行评估,参与抗感染方案的调整,经过综合治疗患儿呼吸较前好转,体温恢复正常,病情改善。结论：在充分评估风险获益后,氟喹诺酮类药物可用于治疗危及生命或难以治疗的感染儿童,有利于降低儿科患者洋葱伯克霍尔德菌重症感染的致死率。