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Risk Factors for Burkholderia cepacia Complex Bacteremia Among Intensive Care Unit Patients Without Cystic Fibrosis: A Case-Control Study

Published online by Cambridge University Press:  02 January 2015

Adam M. Bressler ,
Keith S. Kaye ,
John J. LiPuma ,
Barbara D. Alexander ,
Christopher M. Moore ,
L. Barth Reller  and
Christopher W. Woods
Adam M. Bressler
Affiliation:
Infectious Disease Specialists of Atlanta and the Clinical Microbiology Laboratory, Dekalb Medical Center, Atlanta, Georgia
Keith S. Kaye
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham
John J. LiPuma
Affiliation:
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, Ann Arbor
Barbara D. Alexander
Affiliation:
Clinical Microbiology Laboratory, Duke University School of Medicine, Durham
Christopher M. Moore
Affiliation:
University of Virginia School of Medicine, Charlottesville
L. Barth Reller
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham Clinical Microbiology Laboratory, Duke University School of Medicine, Durham
Christopher W. Woods*
Affiliation:
Department of Medicine, Duke University School of Medicine, Durham Clinical Microbiology Laboratory, Duke University School of Medicine, Durham Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina
*
Clinical Microbiology Laboratory, 113 Durham Veterans Affairs Medical Center, Durham, NC 27705 ([email protected])
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Abstract

Background.

The Burkholderia cepacia complex is associated with colonization or disease in patients with cystic fibrosis (CF). For patients without CF, this complex is poorly understood apart from its presence in occasional point source outbreaks.

Objective.

To investigate risk factors for B. cepacia bacteremia in hospitalized, intensive care unit patients without CF.

Methods.

We identified patients with 1 or more blood cultures positive for B. cepacia between May 1, 1996, and March 31, 2002, excluding those with CF. Control patients were matched to case patients by ward, duration of hospitalization, and onset date of bacteremia. Matched analyses were used to identify risk factors for B. cepacia bacteremia.

Results.

We enrolled 40 patients with B. cepacia bacteremia into the study. No environmental or other point source for B. cepacia complex was identified, although horizontal spread was suspected. Implementation of contact precautions was effective in decreasing the incidence of B. cepacia bacteremia. We selected 119 matched controls. Age, sex, and race were similar between cases and controls. In multivariable analysis, renal failure that required dialysis, recent abdominal surgery, 2 or more bronchoscopic procedures before detection of B. cepacia bacteremia, tracheostomy, and presence of a central line before detection of B. cepacia bacteremia were independently associated with development of B. cepacia bacteremia, whereas presence of a percutaneous feeding tube was associated with a lower risk of disease.

Conclusions.

B. cepacia complex is an important emerging group of nosocomial pathogens in patients with and patients without CF. Nosocomial spread is likely facilitated by cross-transmission, frequent pulmonary procedures, and central venous access. Infection control measures appear useful for limiting the spread of virulent, transmissible clones of B. cepacia complex.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 8 , August 2007 , pp. 951 - 958
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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