Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-09T13:34:29.521Z Has data issue: false hasContentIssue false

Burkholderia cepacia Infections Associated With Intrinsically Contaminated Ultrasound Gel: The Role of Microbial Degradation of Parabens

Published online by Cambridge University Press:  02 January 2015

Jim Hutchinson*
Affiliation:
Healthcare Corporation of St. John's, Newfoundland, Canada Memorial University of Newfoundland, St. John's, Newfoundland, Canada
Wendy Runge
Affiliation:
Calgary Regional Health Authority, Calgary, Alberta, Canada
Mike Mulvey
Affiliation:
National Microbiology Laboratory, Health Canada, Winnipeg, Manitoba, Canada
Gail Norris
Affiliation:
Healthcare Corporation of St. John's, Newfoundland, Canada
Marion Yetman
Affiliation:
Healthcare Corporation of St. John's, Newfoundland, Canada
Nelly Valkova
Affiliation:
Institut National de la Recherche Scientifique (INRS)-Institut Armand-Frappier, Laval, Quebec, Canada
Richard Villemur
Affiliation:
Institut National de la Recherche Scientifique (INRS)-Institut Armand-Frappier, Laval, Quebec, Canada
Francois Lepine
Affiliation:
Institut National de la Recherche Scientifique (INRS)-Institut Armand-Frappier, Laval, Quebec, Canada
*
Department of Microbiology, Health Sciences Center, 300 Prince Philip Drive, St. John's, Newfoundland, CanadaA1B 3V6

Abstract

Objective:

To describe an outbreak of serious nosocomial Burkholderia cepacia infections occurring after transrectal prostate biopsy associated with ultrasound gel intrinsically contaminated with paraben-degrading microorganisms.

Methods:

A retrospective chart review prompted by a blood culture isolate of B, cepacia. Identification of microorganisms in ultrasound gel in two Canadian centers and characterization by pulsed-field gel electrophoresis and assays for paraben degradation.

Setting:

Two Canadian university-affiliated, tertiary-care centers in Newfoundland and Alberta.

Results:

Six serious B. cepacia infections were identified at the two centers. Isolates of B. cepacia recovered from the blood of patients from both centers and the ultrasound gel used during the procedures were identical, confirming intrinsic contamination. Strains of Enterobacter cloacae isolated from ultrasound gel at the two centers were also identical. The ability to degrade parabens was proven for both B. cepacia and E. cloacae strains recovered from the ultrasound gel.

Conclusions:

Ultrasound gel is a potential source of infection. Contamination occurs at the time of manufacture, with organisms that degrade parabens, which are commonly used as stabilizing agents. There are far-reaching implications for the infection control community.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Burkholder, W. Sour skin, a bacterial rot of onion bulbs. Phytopathology 1950;40:115118.Google Scholar
2.Govan, JR, Hughes, JE, Vandamme, P. Burkholderia cepacia: medical, taxonomic and ecological issues. J Med Microbiol 1996;45:395407.CrossRefGoogle ScholarPubMed
3.Glass, S, Govan, JR. Pseudomonas cepacia: fatal pulmonary infection in a patient with cystic fibrosis. J Infect 1986;13:157158.Google Scholar
4.Govan, JR, Brown, PH, Maddison, J, et al.Evidence for transmission of Pseudomonas cepacia by social contact in cystic fibrosis. Lancet 1993;342:1519.Google Scholar
5.Poe, RH, Marcus, HR, Emerson, GL. Lung abscess due to Pseudomonas cepacia. Am Rev Respir Dis 1977;115:861865.Google ScholarPubMed
6.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;122:762766.Google Scholar
7.Sobel, JD, Hashman, N, Reinherz, G, Merzbach, D. Nosocomial Pseudomonas cepacia infection associated with chlorhexidine contamination. Am J Med 1982;73:183186.Google Scholar
8.Henderson, DK, Baptiste, R, Parrillo, J, Gill, VJ. Indolent epidemic of Pseudomonas cepacia bacteremia and pseudobacteremia in an intensive care unit traced to a contaminated blood gas analyzer. Am J Med 1988;84:7581.CrossRefGoogle Scholar
9.Conly, JM, Mass, L, Larson, L, Kennedy, J, Low, DE, Harding, GK. Pseudomonas cepacia colonization and infection in intensive care units. CMAJ 1986;134:363366.Google Scholar
10.Borghans, JG, Hosli, MT, Olsen, H, Ravn, EM, Siboni, K, Sogaard, P. Pseudomonas cepacia bacteraemia due to intrinsic contamination of an anaesthetic: bacteriological and serological observations. Acta Pathologica Microbiologica Scandinavica 1979;87:1520.Google Scholar
11.Matrician, L, Ange, G, Burns, S, et al.Outbreak of nosocomial Burkholderia cepacia infection and colonization associated with intrinsically contaminated mouthwash. Infect Control Hosp Epidemiol 2000;21:739741.CrossRefGoogle ScholarPubMed
12.Muradali, D, Gold, WL, Phillips, A, Wilson, S. Can ultrasound probes and coupling gel be a source of nosocomial infection in patients undergoing sonography? An in vivo and in vitro study. AJR Am J Roentgenol 1995;164:15211524.CrossRefGoogle ScholarPubMed
13.Ohara, T, Itoh, Y, Itoh, K. Ultrasound instruments as possible vectors of staphylococcal infection. J Hosp Infect 1998;40:7377.Google Scholar
14.Spencer, P, Spencer, RC. Ultrasound scanning of post-operative wounds: the risks of cross-infection. Clin Radiol 1988;39:245246.Google Scholar
15.Abdullah, BJ, Mohd Yusof, MY, Khoo, BH. Physical methods of reducing the transmission of nosocomial infections via ultrasound and probe. Clin Radiol 1998;53:212214.CrossRefGoogle ScholarPubMed
16.O'Doherty, AJ, Murphy, PG, Curran, RA. Risk of Staphylococcus aureus transmission during ultrasound investigation. J Ultrasound Med 1989;8:619620.Google Scholar
17.Keizur, JJ, Lavin, B, Leidich, RB. Iatrogenic urinary tract infection with Pseudomonas cepacia after transrectal ultrasound guided needle biopsy of the prostate. J Urol 1993;149:523526.CrossRefGoogle ScholarPubMed
18.Zani, F, Minutello, A, Maggi, L, Santi, P, Mazza, P. Evaluation of preservative effectiveness in pharmaceutical products: the use of a wild strain of Pseudomonas cepacia. J Appl Microbiol 1997;83:322326.Google Scholar
19.Warth, AD. Relationships between the resistance of yeasts to acetic, propanoic and benzoic acids and to methyl paraben and pH. Int J Food Microbiol 1989;8:343349.Google Scholar
20.Close, JA, Neilsen, PA. Resistance of a strain of Pseudomonas cepacia to esters of p-hydroxybenzoic acid. Appl Environ Microbiol 1976;31:718722.CrossRefGoogle ScholarPubMed
21.Valkova, N, Lepine, F, Valeanu, L, et al.Hydrolysis of 4-hydroxybenzoic acid esters (parabens) and their aerobic transformation into phenol by the resistant Enterobacter cloacae strain EM. Appl Environ Microbiol 2001;67:24042409.CrossRefGoogle ScholarPubMed
22.Hosokawa, K, Park, NH, Inaoka, T, Itoh, Y, Ochi, K. Streptomycin-resistant (rpsL) or rifampicin-resistant (rpoB) mutation in Pseudomonas putida KH146-2 confers enhanced tolerance to organic chemicals. Environ Microbiol 2002;4:703712.Google Scholar
23.Suemitsu, R, Horiuchi, K, Yanagawase, S, Okamatsu, T. Biotransformation activity of Pseudomonas cepacia on p-hydroxybenzoates and benzalkonium chloride. Journal of Antibacterial and Antifungal Agents 1990;18:579582.Google Scholar
24.Swaminathan, B, Barrett, TJ, Hunter, SB, Tauxe, RV. PulseNet: the molecular subtyping network for foodborne bacterial disease surveillance, United States. Emerg Infect Dis 2001;7:382389.Google Scholar
25.Goldstein, R, Sun, L, Jiang, RZ, Sajjan, U, Forstner, JF, Campanelli, C. Structurally variant classes of pilus appendage fibers coexpressed from Burkholderia (Pseudomonas) cepacia. J Bacteriol 1995;177:10391052.CrossRefGoogle ScholarPubMed
26.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Infect Control Hosp Epidemiol 1997;18:426439.Google Scholar
27.Valkova, N, Lepine, F, Bollet, C, Dupont, M, Villemur, R. PrbA, a gene coding for an esterase hydrolyzing parabens in Enterobacter cloacae and Enterobacter gergoviae strains. J Bacteriol 2002;184:50115017.CrossRefGoogle ScholarPubMed
28.Pyke, M, Hirji, Z, Havill, D, et al.Ultrasound (U/S) Gel: A Potential Source of Microbiologic Contamination. Victoria, British Columbia, Canada: Canadian Association for Clinical Microbiology and Infectious Diseases; 2001.Google Scholar
29.Valkova, N, Lepine, F, Labrie, L, Dupont, M, Beaudet, R. Purification and characterization of PrbA, a new esterase from Enterobacter cloacae hydrolyzing the esters of 4-hydroxybenzoic acid (parabens). J Biol Chem 2003;278:1277912785.CrossRefGoogle Scholar
30.Weist, K, Wendt, C, Petersen, LR, Versmold, H, Ruden, H. An outbreak of pyodermas among neonates caused by ultrasound gel contaminated with methicillin-susceptible Staphylococcus aureus. Infect Control Hosp Epidemiol 2000;21:761764.Google Scholar
31.Gaillot, O, Maruejouls, C, Abachin, E, et al.Nosocomial outbreak of Klebsiella pneumoniae producing SHV-5 extended-spectrum beta-lacta-mase, originating from a contaminated ultrasonography coupling gel. J Clin Microbiol 1998;36:13571360.Google Scholar
32.Howe, RS, Wheeler, C, Mastroianni, L Jr, Blasco, L, Tureck, R. Pelvic infection after transvaginal ultrasound-guided ovum retrieval. Fertil Steril 1988;49:726728.CrossRefGoogle ScholarPubMed