Background. Burkholderia cepacia complex (Bcc) comprises multi-drug resistant, Gram-negative, motile, and aerobic bacteria. Bcc causes severe nosocomial infections particularly in patients with intravascular catheters and in those with cystic fibrosis. We studied a Bcc outbreak in non-cystic fibrosis patients. Methods. We analyzed data from six patients hospitalized at our center. Blood cultures identified as infectious were incubated onto 5% blood sheep agar, chocolate agar, and eosin methylene blue (EMB) agar. We examined possible sites that could be sources of infection at the clinic. We confirmed isolations with pulsed-field gel electrophoresis (PFGE) tests. Results. The first patient was hospitalized due to left renal agenesis, urinary tract infection, and renal failure. Bcc was isolated in blood cultures obtained due to high fever on the third day of hospitalization. We stopped new patient hospitalizations after detecting Bcc in blood cultures of other five patients. We did not detect further positive specimens obtained from other clinic and the patient rooms. PFGE patterns were similar in all clinical isolates of Bcc indicating that the outbreak had originated from the source. Conclusions. Bcc infection should be considered in cases of nosocomial outbreaks of multi-drug resistant organisms that require hospitalization at intensive care units. Control measures should be taken for prevention of nosocomial infections and required investigations should be done to detect the source of infection
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1. Abdallah M, Abdallah HA, Memish ZA. Burkholderia cepacia complex outbreaks among non-cystic fibrosis patients in the intensive care units: a review of adult and pediatric literature. Infez Med 2018; 26: 299-307.
2. Mali S, Dash L, Gautam V, Shastri J, Kumar S. An outbreak of Burkholderia cepacia complex in the paediatric unit of a tertiary care hospital. Indian J Med Microbiol 2017; 35: 216-220.
3. Dizbay M, Tunccan OG, Sezer BE, Aktas F, Arman D. Nosocomial Burkholderia cepacia infections in a Turkish university hospital: a five-year surveillance. J Infect Dev Ctries 2009; 3: 273-277.
4. Srinivasan S, Arora NC, Sahai K. Report on the newly emerging nosocomial Burkholderia cepacia in a tertiary hospital. Med J Armed Forces India 2016; 72 (Suppl 1): S50-S53.
5. Mahenthiralingam E, Baldwin A, Dowson CG. Burkholderia cepacia complex bacteria: opportunistic pathogens with important natural biology. J Appl Microbiol 2008; 104: 1539-1551.
6. Leitao JH, Sousa SA, Ferreira AS, Ramos CG, Silva IN, Moreira LM. Pathogenicity, virulence factors, and strategies to fight against Burkholderia cepacia complex pathogens and related species. Appl Microbiol Biotechnol 2010; 87: 31-40.
7. Antony B, Cherian EV, Boloor R, Shenoy KV. A sporadic outbreak of Burkholderia cepacia complex bacteremia in pediatric intensive care unit of a tertiary care hospital in coastal Karnataka, South India. Indian J Pathol Microbiol 2016; 59: 197-199.
8. Ko S, An HS, Bang JH, Park SW. An outbreak of Burkholderia cepacia complex pesudobacteremia associated with intrinsically contaminated commercial 0.5% chlorhexidine solution. Am J Infect Control 2015; 43: 266-268.
9. Song JE, Kwak YG, Um TH, et al. Outbreak of Burkholderia cepacia pseudobacteraemia caused by intrinsically contaminated commercial 0.5% chlorhexidine solution in neonatal intensive care units. J Hosp Infect 2018; 98: 295-298.
10. Heo ST, Kim SJ, Jeong YG, Bae IG, Jin JS, Lee JC. Hospital outbreak of Burkholderia stabilis bacteraemia related to contaminated chlorhexidine in haematological malignancy patients with indwelling catheters. J Hosp Infect 2008; 70: 241-245.
11. Hamill RJ, Houston ED, Georghiou PR, et al. An outbreak of Burkholderia (formerly Pseudomonas) cepacia respiratory tract colonization and infection associated with nebulized albuterol therapy. Ann Intern Med 1995; 122: 762-766.
12. Righi E, Girardis M, Marchegiano P, et al. Characteristics and outcome predictors of patients involved in an outbreak of Burkholderia cepacia complex. J Hosp Infect 2013; 85: 73-75.
13. Bressler AM, Kaye KS, LiPuma JJ, et al. 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.
14. Martin M, Christiansen B, Caspari G, et al. Hospital- wide outbreak of Burkholderia contaminans caused by prefabricated moist washcloths. J Hosp Infect 2011; 77: 267-270.
15. Shrivastava B, Sriram A, Shetty S, Doshi R, Varior R. An unusual source of Burkholderia cepacia outbreak in a neonatal intensive care unit. J Hosp Infect 2016; 94: 358-360.
16. LiPuma JJ, Currie BJ, Lum GD, Vandamme PAR. Burkholderia, stenotrophomonas, ralstonia, cupriavidus, pandoraea, brevundimonas, comamonas, delftia, and acidovorax. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA (eds). Manual of Clinical Microbiology.Washington DC: ASM Press, 2007: 749-769.