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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. Cheng2Comments to Author 
Author affiliations: Queen Mary Hospital, Hong Kong, China (S.C.Y. Wong, S.-C. Wong, J.H.K. Chen, R.W.S. Poon, D.L.L. Hung, K.H.Y. Chiu, S.Y.C. So, W.S. Leung, Vincent C.C. Cheng); The University of Hong Kong, Hong Kong (T.M. Chan, D.Y.H. Yap, K.Y. Yuen); Hospital Authority, Hong Kong (V.W.M. Chuang)

Main Article

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.

Main Article

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
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